IMPORTANT
Relevance of County Operating Procedures and Protocols to the different levels of certified EMS providers in Spokane County
All FR, EMT-B, and EMT-I responders are obligated to follow the State of Washington mandated Patient Care Protocols for their level of certification. A number of additional protocols have been developed within our EMS system that are also relevant to our EMT-B and EMT-I responders (see BLS/ILS Protocols Section below). They include the following:
1. Patients With a Left Ventricular Assist Device (LVAD)
2. Patients With a Thoratec Ventricular Assist Device (VAD)
3. Treatment of Patients Exposed to Nerve Agents
State Allowed Discretionary Decisions Within BLS Protocols
In addition, the State of Washington allows some local modification of State BLS and EMT I protocols. The following modifications are recommended to be applied to the appropriate State protocol.
1. Cardiovascular Emergencies - Aspirin should be administered without online contact with medical control unless there is a specific reason not to do so such as an allergy to this medicine.*
2. Anaphylaxis - Epinephrine for anaphylaxis should be administered without online contact with medical control unless the EMS provider is seeking confirmation of the indications for administration by BLS personnel in our county. The lower weight limit for the use of a pediatric auto-injector for an infant or child is 15 kg (33 lbs). Medical control should be contacted to consider pediatric auto-injector administration to children <15 kg (33lbs) with appropriate indications.
3. Diabetic Emergencies - EMT-Bs may assess the blood glucose level provided they have successfully completed a Spokane County approved training program.*
4. Nitroglycerin should not be given patients who have used erectile dysfunction drugs within the past 24 hours for Viagra or Levitra or 96 hours for Cialis.
All certified EMS providers in Spokane County are obligated to follow Spokane County Operating Procedures to the extent to which implementation is within the scope of practice of the provider's level of certification. Similarly, Reference material, medications, special situations, and our Mass Casualty Incident Guide represent consensus recommendations within our EMS system that should be applied by all EMS providers within the scope of practice of the providers level of certification.
Click Here For Manual Sections
Bulletin January 20, 2009: See Ipecac Syrup In Drug Section
UPDATES-Scroll Down For Latest Updates
All previous updates from July 2004 through August 2010 are below in Miscellaneous
November 1, 2010:
Added Drug Protocol Rocuronium, D 188C, in case of a possible shortage of Succinylcholine. Succinylcholine remains our preferred agent for these indications providing supplies are available. It is not in the Table of Contents.
December 27, 2010:
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The Pediatric Airway Obstruction ALS, P99, has been changed as follows: Infant 7 and 8 have been removed and a new 7 added. Child has added a new 7 & 8.
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The Reference Needle Cricothyrotomy, R151, added (60 degree for the Quick Trach) at the end of 6).
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The COPS Determination of Patient Transportation, G17A, changed nearer hospital to an alternate on the end of the second line in the * at the bottom of the page.
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The Medical Anaphylaxis, P65, has been changed the title to Allergic Reactions and Anaphylaxis and Benadryl for Mild and Moderate has been changed to 25-50.
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The Medical Toxic Smoke Inhalation, P71D, has inserted a new 10 and added a new 14.
February 11, 2010:
The COPS, POLST form has been updated to the 2011 Washington State version.
April 5, 2011:
The Medical Protocol, Grand Mal Seizure, P68, has changed 5) and changed ativan to Lorazepam and change the wording in the * at the end relating to the availability of Lorazepam.
April 13, 2011:
The new April 2011 POLST Form as been added to the Miscellaneous section. It is front and back and if you print it, use green card stock only.
July 1, 2011:
1. The COPS, Inter-Facility Transfer, G12, has added the ILS level.
2. The COPS, Determination of Patient Transport Destination, G17A, added Step 4 to 1b, revised 2, and added 3.
3. The COPS, Field Resuscitation Guidelines, G30, has changed as follows: WITHHOLDING OF CPR 1,)A, 1) was changed and DISCONTINUING OF CPR 1), B), D) was added.
4. The Cardiac Protocol, Chest Discomfort, C44, has change 2), 5), and 7).
5. The Cardiac Protocol, General Considerations for Patients with Significant Cardiac Arrythmias or Cardiac Arrest, C45, has a name change and totally changed the protocol.
6. The Cardiac Protocol, Ventricular Fibrillation/Pulseless Ventricular Tachycardia, C46, has almost totally changed.
7. The Cardiac Protocol, Asystole*/PEA, C47, is totally changed...C 49 PEA removed.
8. The Cardiac Protocol, Bradycardia, C48, is totally changed.
9. 10. The Cardiac Protocol, Stable Wide-Complex Tachycardia, C50, has changed everything except 2.
11. The Cardiac Protocol, Unstable*Wide-Complex Tachycardia, C51, has removed the original 3 and 4 and the * is changed.
12. The Cardiac Protocol, Unstable Narrow-Complex Tachycardia, C52, reviewed with no changes.
13. The Cardiac Protocol, Stable Narrow-Complex Tachycardia, C53, has changed 4 to indicate the brand name.
14. The Cardiac Protocol, Post-Cardiac Arrest Care, C54, has changed the name to Post-Cardiac Arrest Care and has been totally redone.
15. The Cardiac Protocol, Pulmonary Edema, C55, was reviewed with no changes.
16. The Cardiac Protocol, LVAD-HeartMate II, C57B, was reviewed with no changes.
17. The Cardiac Protocol, Thoratec Venticular Assist Device(s), C57D, was reviewed with no changes.
18. The Cardiac Protocol, LVAD HeartMate (XVE), C57, was reviewed with no changes.
19. The Cardiac Protocol, LVAD-VentrAssist, C57C, was reviewed with no changes.
20. The Drug Protocol, Adenocard (Adenosine), D166, added to Indications and Precautions/Side Effects.
21. The Drug Protocol, Atropine, D168, deleted former indications 2 and 3.
22. The Drug Protocol, Amiodarone, D166A, revised Adult Dosage Indication 1.
23. The Drug Protocol, Benadryl (Diphenhydramine), D169, added to Indication 2.
24. The Drug Protocol, Magnesium Sulfate, D182, was reviewed with no changes.
25. The Drug Protocol, Sodium Bicarbonate, D189, deleted former indications 2 and 3.
26. The Drug Protocol, Fentanyl, D175B, changed the BP <90 in Precautions to <100.
Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org. Please update staff within 30 days.
November 18, 2011
These Pediatric Protocol changes are based upon the State’s Pediatric Technical Advisory Committee as well as new AHA guidelines and the input of the Spokane County EMS Protocol Committee:
1. Pediatric Bradycardia, P101
2. Pediatric/Stable Narrow-Complex Ped Tachycardia November 2011.doc, P 102 C
3. Pediatric Pulseless Ventricular Tachycardia or V-FIB, P 103
4. Pediatric Asystole /Pulseless Electrical Activity, P 104
5. Unstable Narrow-Complex Pediatric Tachycardia, P 102
6. Unstable Wide-Complex Pediatric Tachycardia, P 102 A
7. Stable Wide-Complex Pediatric Tachycardia, P 102 B
Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org. Please update staff within 30 days.
November 21, 2011
A new Pediatric Protocol, Pediatric Resuscitation Care, P106A has been added.
Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org. Please update staff within 30 days.
November 23, 2011
Morphine, D 184, is back in the manual and may be substituted for Fentanyl in the event of a Fentanyl drug shortage.
Continuous Positive Airway Pressure, R 149A, has changed Procedure 2.
January 20, 2012
Morphine, D184 added Indication 2: For the treatment of severe pain when Fentanyl is not available.
Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org. Please update staff within 30 days.
Table of Contents January 2012