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:

  1. Anaphylaxis, P 65-66, Moderate 2:  changed SQ to IM, Severe 9:  SL or SQ changed to IM, IO, or SL.

  2. Excited Delirium, P 67B, New 5 and reworded 6.

  3. Toxic Smoke Inhalation, P 71D, added new 10.

  4. Spinal Trauma, P 80, Moved 5 to 4, moved 7 to 5, removed old 4, added new 6 and 7.

  5. Frost Bite, P 113, 6 moved to 4 and new 6, 7, and 8.

  6. Heat Cramps, P114, 5 and 6 reworded.

  7. Heat Stroke, P 115, revised 2 and 4.

  8. Epinephrine-Adult, D 174, added IO to Adult Dosages and changed SL to IM to Adult Dosages.

  9. Hydroxocobalamin, D 177A, expanded the indications.

  10. 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:

  1. Burns, P 73, removed morphine and added fentanyl to 10.

  2. Pediatric Hypoglycemia, P 106, in #4 changed glucose <35 to <60 and in #5 deleted glucose and added dextrose.

  3. Pediatric Anaphylaxis, P 109, in Moderate 2, changed SQ to IM and in Severe 6, changed 1,000 to 10,000.

  4. Frostbite, P 113, changed dose in #8.

  5. Drowning, P117, removed Near from title, deleted all notification information above #1, added CPAP to #1, rewrote #5, #7, and #8.

  6. Drugs Commonly Prescribed, R 122, updated to include more commonly used drugs.  (May not be available online until March 23, 2009)

  7. Use of External Pacemaker, R 142, added 10% to Procedure 6A.

  8. 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.

  9. 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:

  1. Chest Discomfort-Suspected Angina/AMI, C 44, added chewable to 2, added discomfort to 4, revised 5, 7 a-h updated.

  2. Renal Failure and Dialysis Patients, P 71 A, changes shunt to fistula in 2, changed albuterol dosage in 5C and *.

  3. Burns, P 73, changed 2A, added B 1-2-3, added to 9, added IV/IO/IM to 10.

  4. Crush Injury Syndrome, P 74A, added 7C, changed 8a.

  5. 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. 

  6. Calcium Gluconate, D 170A, added Indication 3 and added Adult Dosage/Route 3.

  7. 50% Dextrose, D 171, reviewed and no change.

  8. Fentanyl, D 175B, reviewed and no change.

  9. Ventolin, D 191, added Indications 5-6 and associated Adult and Pediatric Dosage/Routes.

  10. 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: 

  1. 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.

  2. The COP, EMS Scene Management & Inter-agency Relations, G 43-43F, has added 2 new points at the top of p. 43 E.

  3. The Cardiac Protocol, Ventricular Fibrillation/Pulseless Ventricular Tachycardia, C 46-46A,   added to 5 and 11, added * to 9 and ** to 13.

  4. 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.

  5. 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.

  6. 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.

  7. 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

Narcan (D 185).

July 12, 2010:  Added Drug Reference Sheet Drugs/Drug References.pdf in Miscellaneous.

August 12, 2010:

  1. A new COP, Determination of Patient Transport Destination, G 17A, has been added.

  2. The Cardiac Protocol, Acute Stroke, C 44B, has been completely revised.

  3. The Environmental Protocol, Hypothermia, P116, has been completely revised.

  4. 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.

 

Table of Contents August 2010


 

Cardiac Protocols Drug References Environmental Protocols Patient Care Procedures (Guidelines)
MCI Medical Protocols OB-Gyn Protocols Pediatric Protocols
References Respiratory Protocols Special Situations Trauma Protocols

BLS Protocols

Miscellaneous    

Cardiac Protocols Acute Stroke
Asystole
Bradycardia
 
Chest Pain Suspected AMI
General Assessment of Cardiac Patients
LVAD HeartMate (XVE)

LVAD HeartMate II

LVAD VentrAssist

Post-Resuscitation
Pulmonary Edema
Pulseless Electrical Activity PEA
Stable Narrow - Complex Tachycardia
Stable Wide -Complex Tachycardia
Thoratec Venticular Assist Device
Unstable Narrow - Complex Tachycardia
Unstable Wide - Complex Tachycardia
V Fib Pulseless V Tac
 
 

Drug References  50% Dextrose 
Acetylsalicylic
Activated Charcoal
Adenosine
Amiodarone
Ativan
Atropine
Benadryl
Calcium Gluconate
Dopamine
Epinephrine-Adult
Epinephrine-Pediatric
Etomidate

Fentanyl

 
Glucagon
Heparin
Hydroxocobalamin
Ipecac Syrup
Ipratropium
Lasix
Lidocaine
Magnesium Sulfate
Morphine
 
Narcan
Nitroglycerin
Ondansetron
Oxymetazoline
Pralidoxime Chloride (2-PAM)
 
Racemic Epinephrine
Sodium Bicarbonate
Succinylcholine
Valium  
Vecuronium  
Ventolin
Versed

Environmental Protocols
Frostbite
Heat Cramps
Heat Stroke
Hypothermia
Drowning

County Operating Procedures

Abandoned Babies (Full Abandoned Babies Act below in Misc)
Blood Draws
 
Cancellation Slow Down
Code 99
Determination of Patient Transport
Direction-Blood Test
Dispatch of Medical Personnel
Documentation
Emergency Transports
 
Emergency Service Animals
EMS-No CPR
EMS Scene Management & Inter-Agency Relations
Field Resuscitation Guidelines
General Guidelines
Hazardous Materials
Helicopter Triage
Infectious Disease
Inter-Facility Transport
Level of Certification
Medical Control
Medical Professionals at the Scene
Medications and Allergies
 
Moonlighting
No CPR Bracelet-Call EMS Office For Copy
Non-Transport of Patients
On-Scene Med Authority
Patient Refusal of Treatment/Transport
Patient Treatment Rights
(POLST) Physician Orders for Life-Sustaining Treatment 2 pages
Relationship Between Between EMS and Private Physician
Restraints Aggressive Patients Transport
Schedule 2 Medications
Thank You For Your Offer
Trauma Triage Tool  
Trauma Triage Medical Control

MCI
Spokane County MCI-Field Operations Guide (FOG) 2006

Medical Protocols
Acute Epistaxis
Anaphylaxis
Coma of Unknown Origin
Emergency Disconnect of Hemodialysis
Excited Delirium
Grand Mal Seizure
Hypoglycemia
Mental Health Emergencies
 
 
Poisoning Overdose
Renal Failure

Toxic Smoke Inhalation

Treatment of Patients Exposed To Nerve Agents

OB-Gyn Protocols
Complications of Delivery
Emergency Delivery
General Considerations
Medications For Neonatal Resuscitation
Neonatal Resuscitation
Pre-Eclampsia
Spontaneous Abortion

Sexaul Assault


Pediatric Protocols
Airway Obstruction-Pediatric
Child Abuse
General Considerations Pediatrics
 
Pediatric Anaphylaxis
Pediatric Asystole
Pediatric Bradycardia
Pediatric Coma
Pediatric Fever
Pediatric Hypoglycemia
Pediatric Pulseless V-Tach or V-Fib
Pediatric Respiratory Arrest
Pediatric Respiratory Distress
Pediatric Respiratory-Stridor
Pediatric Respiratory-Wheezing
Pediatric Seizures
Pediatric Shock
Pediatric Trauma
Stable Narrow-Complex Ped Tachycardia
Stable Wide-Complex Ped Tachycardia
Sudden Infant Death
Unstable Narrow-Complex Ped Tachycardia
Unstable Wide-Complex Ped Tachycardia

References
AED Defib Protocol
Apgar Scoring
Bag Valve Mask
Blood Tube Information
Burn Chart
Capnometry/Capnography
Carotid Sinus
Community Resources
Conversion Table
Continuous Poitive Airway Pressure (CPAP)
Diabetic Coma and Insulin
Double Lumen Airway
Drugs Commonly Prescribed
Emergency Departments
Endotracheal Drug Admin
Endotracheal Intubation
Estimating Tracheal Tube
Failed Resuscitation
Glossary
Helicopter Safety Reference
Helmet Removal
Intraosseous Infusion In Adults
Intraosseous Infusion In Children Call  office for copy
Intraosseous Needle Placement
 
IV Fluids
King Airway
King Airway Skills Sheet  
Needle Cricothyroitomy
Needle Thoracostomy
Oxygen Administration
Pandemic Index of Severity for Triage  
   
Pediatrics at a Glance
Rapid Sequence Intubation
Revised Trauma Score
Smallpox Vaccination Concerns
Spinal Precautions in Children
SQ & IM Injections
Tiered Response-Patient Care-System Issues
Thermometers
Tourniquet
Helmet Removal From Injured Patients
Use of External Pacemakers

Respiratory Protocols
Asthma
Chronic Obstructive Pulmonaru Disease (COPD)
Airway Obstruction:  Adult
 

Special Situations
Drowning and Near Drowning
Electrocution
Hypothermia
Mental Health Emergencies
Pregnancy and Cardiac Arrest
Traumatic Cardiac Arrest

Trauma Protocols
Abdominal Trauma
Animal Bites
Burns
Chemical Burns to the Eye
Chest Trauma
Crush Injury
Head Trauma
Injuries To Ear and Nose
Penetrating and Blunt Eye
Penetrating and Blunt Neck
Soft Tissue Avulsions
Spinal Trauma
Taser Trauma

BLS/ILS Protocols

and

Supplemental

Protocols

Aspirin
BLS-LVAD
BLS-VAD
BLS-Treatment of Nerve Agent
EMT Glucose Testing
MARK 1 Kit (Atropine & 2-PAM)
BLS Airway Obstruction:  Adult
BLS Airway Obstruction-Pediatric
First Responder Field Protocols http://www.doh.wa.gov/hsqa/emstrauma/download/frprot.pdf
EMT-Basic Field Protocol  http://www.doh.wa.gov/hsqa/emstrauma/download/emtbprot.pdf  
Intravenous Therapy and Airway Technican Field Protocols http://www.doh.wa.gov/hsqa/emstrauma/download/ivawprt.pdf
Intermediate Life Support Technican Field Protocols  http://www.doh.wa.gov/hsqa/emstrauma/download/ilsprt.pdf
Intermediate Life Support and Airway Field Protocols   http://www.doh.wa.gov/hsqa/emstrauma/download/ilsawprt.pdf

Miscellaneous Abandoned Babies Act

Acknowledgments

Affiliate County Operating Procedures

Affiliate Intent to Cover a Special Event

Affiliate Service Update Form

Airway Skills Evaluation Form

BLS-ILS-ALS Education Requirements For Certification

Certification Made Easy

Double Lumen Airway-AED Skills Maintenance

Drug Reference Sheet July 2010

Emergency Support Function #8

EMS Awards Nomination Form

EMS Manual Updates July 2004-June 2008

EMS Manual Updates July 2008-November 2008

Infectious Disease Exposure Form (Legal Size)

 
Interpretation of Step 3 of the State of Washington Prehospital Trauma Triage (Destination) Procedure

Introduction

Manikin Intubation Requirements For Recertification

Medical Abbreviations

On Line Certification Application   http://www.doh.wa.gov/hsqa/emstrauma/download/gettingstarted.pdf

 
PAD AED Training Recommendations    
 
PAD Locations-Spokane County August 2010 (Printable)

PM OTEP Random Review Form

PM Requirements For Spokane County

PM Student Advisory Committee Recommendation Process

Physician Advisor Letter

Pyramid Security Agreement

 

Pyramid Use Instructions
 
Quick Clot Memo
 
Recommendation for Follow-up to a Possible Infectious Disease Exposure*

Step 3 Additional Information Memo October 2009

Suggested QI Review for Physician Advisors