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
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 - 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 November 2008 are below in Miscellaneous
January 8, 2009: Several changes/additions have been made:
Anaphylaxis, P 65-66, Moderate 2: changed SQ to IM, Severe 9: SL or SQ changed to IM, IO, or SL.
Excited Delirium, P 67B, New 5 and reworded 6.
Toxic Smoke Inhalation, P 71D, added new 10.
Spinal Trauma, P 80, Moved 5 to 4, moved 7 to 5, removed old 4, added new 6 and 7.
Frost Bite, P 113, 6 moved to 4 and new 6, 7, and 8.
Heat Cramps, P114, 5 and 6 reworded.
Heat Stroke, P 115, revised 2 and 4.
Epinephrine-Adult, D 174, added IO to Adult Dosages and changed SL to IM to Adult Dosages.
Hydroxocobalamin, D 177A, expanded the indications.
Versed, D 192, added Indication 6 and changed Adult Dosages.
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.
March 5, 2009: Fentanyl, D 175B has been revised to add additional Precautions to both Adult and Pediatric Dosage changes.
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.
March 19, 2009: Several changes/additions have been made:
Burns, P 73, removed morphine and added fentanyl to 10.
Pediatric Hypoglycemia, P 106, in #4 changed glucose <35 to <60 and in #5 deleted glucose and added dextrose.
Pediatric Anaphylaxis, P 109, in Moderate 2, changed SQ to IM and in Severe 6, changed 1,000 to 10,000.
Frostbite, P 113, changed dose in #8.
Drowning, P117, removed Near from title, deleted all notification information above #1, added CPAP to #1, rewrote #5, #7, and #8.
Drugs Commonly Prescribed, R 122, updated to include more commonly used drugs. (May not be available online until March 23, 2009)
Use of External Pacemaker, R 142, added 10% to Procedure 6A.
King Airway, R 144, new, however, to avoid wasting current stock of combitubes, the introduction of this airway may be phased-in by each agency but it is mandatory by January 1, 2010.
Tourniquet, R 146A, new.
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.
May 6, 2009: Several changes have been made:
Chest Discomfort-Suspected Angina/AMI, C 44, added chewable to 2, added discomfort to 4, revised 5, 7 a-h updated.
Renal Failure and Dialysis Patients, P 71 A, changes shunt to fistula in 2, changed albuterol dosage in 5C and *.
Burns, P 73, changed 2A, added B 1-2-3, added to 9, added IV/IO/IM to 10.
Crush Injury Syndrome, P 74A, added 7C, changed 8a.
Helicopter Safety Reference, R 157, changed the LZ surface from <10 to <7 and trees, added requested by pilot in Mark the LZ, and under Safety, changed helicopter to aircraft, no smoking within 200 feet, keep personnel back 200 feet, and added 3 o'clock and 9 o'clock for the tail rotor guards.
Calcium Gluconate, D 170A, added Indication 3 and added Adult Dosage/Route 3.
50% Dextrose, D 171, reviewed and no change.
Fentanyl, D 175B, reviewed and no change.
Ventolin, D 191, added Indications 5-6 and associated Adult and Pediatric Dosage/Routes.
General Guidelines, G1, updated Field Treatment 3B.
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.
June 22, 2009: Morphine, D184, has been reintroduced for transports >30 minutes.
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.
August 17, 2009: A new County Operating Procedure (COP), Trauma Triage Medical Control, G 22, has been added. The Table of Contents has been updated, too.
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.
August 26, 2009: Field Resuscitation Guidelines, G 30-32, has been revised by adding a new 8 relating to a death on-scene.
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.
October 2, 2009: Updated the Physician Advisor Letter for PM and Intermediates in the Miscellaneous section . We will email a copy to agencies and physician advisors.
October 16, 2009: A new Reference, Tiered Response to EMS Patient Care Concerns and System Issues, R 162A, has been added and a new Trauma Protocol, Animal Bites, P 72A has been added. The Table of Contents has been updated. Additionally, Interpretation of Step 3 of the State of Washington Prehospital Trauma Triage (Destination) Procedure has been posted in the Miscellaneous section.
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.
February 1, 2010:
The COP, Dispatch of Medical Personnel, G 7, has been revised as follows: Purpose 2 has been revised and Standard 6 and 7 have been revised.
The COP, EMS Scene Management & Inter-agency Relations, G 43-43F, has added 2 new points at the top of p. 43 E.
The Cardiac Protocol, Ventricular Fibrillation/Pulseless Ventricular Tachycardia, C 46-46A, added to 5 and 11, added * to 9 and ** to 13.
A new Reference , Pandemic Index of Severity for Triage (PIST), R 131A. There must be a local or state declaration of an emergency under the provisions of RCW 38.52. A local declaration must be made by the local executive and the EMS providers are registered as emergency workers under state law (RCW 38.52) and under the direction of the Spokane Regional Health District Officer, a physician delegate to the Spokane County MPD.
The Trauma Protocol, Abdominal Trauma, P 72, Changed 1, 5, and 6. Under Evisceration, revised B and removed C. Under Impaled Objects, added B. Under Blunt trauma, added B.
The Trauma Protocol, Penetrating or Blunt injuries of Neck, P 76, was changed be adding a heading Blunt Injury and revised 4 under Blunt and added Penetrating Injury and 1-8 for Penetrating Injury.
The Trauma Protocol, Soft Tissue Avulsions or Amputations, P 79, added 4 under Attached Tissue and revised 3, 4, and 5 under Unattached.
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.
March 23, 2010: Minor updates to Unstable Wide-Complex Tachycardia (HR>150) (C 51), Etomidate (D 175A), Fentanyl (D 175B), and
July 12, 2010: Added Drug Reference Sheet Drugs/Drug References.pdf in Miscellaneous.
August 12, 2010:
-
A new COP, Determination of Patient Transport Destination, G 17A, has been added.
-
The Cardiac Protocol, Acute Stroke, C 44B, has been completely revised.
-
The Environmental Protocol, Hypothermia, P116, has been completely revised.
-
The Reference, Needle Thoracostomy, R150, has been revised to include expanded Indications and Associated Signs as well as removing Procedure 1 (see Indications for Medical Control).
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.