EMERGENCY MEDICAL SERVICES

Routine Patient Care 1.1 • If patient is in cardiac arrest refer to Cardiac Arrest - 3.2A, or Cardiac Arrest - 3.2P. • Determine if pediatric protocols apply. “Pediatric Patient” is defined as a child who fits on a length-based resuscitation tape up to 36 kg (79 lbs) or 145 cm (57 in). Vermont EMS strongly encourages the use of a pediatric reference system when treating pediatric patients. Agencies should adopt and train with a system that uses weight, length, or age to identify normal ranges of vital signs and appropriate equipment sizes. The system should also identify pediatric medication doses by volume and minimize the need for medication math. • Establish responsiveness. • General Impression. Comparison of Adult and Pediatric Assessment Triangle Appearance Work of Breathing Circulation to Skin Awake, speaking, eye Adult opening, agitated, limp, slow, equal chest riseLabored, noisy, fast, Pink, flushed, pale, ashen, cyanosis unresponsive Muscle tone, Airway sounds, body Pediatric consolability, gaze/look, interactiveness, position, head bobbing, chest wall retractions, Pallor, mottling, cyanosis speech/cry nasal flaring, grunting • Determine if DNR/COLST protocol applies (Do Not Resuscitate (DNR) & Clinical Orders (COLST) - 8.7). AIRWAY AND BREATHING • Airway • Assess breathing: rate, effort, tidal volume, and breath sounds. o If breathing is inadequate, ventilate with 100% oxygen using bag-valve-mask. o Administer oxygen to address signs of hypoxia. o Assess lung sounds and chest. CIRCULATION ASSESSMENT • Assess patient’s circulation including pulse, skin signs and capillary refill time. • Control serious bleeding using direct pressure, pressure bandages, tourniquets, or hemostatic bandages (Tourniquet & Hemostatic Agent – Adult & Pediatric 6.6). DISABILITY ASSESSMENT • Assess level of consciousness appropriate for age. • Utilize spinal motion restriction if patient has a mechanism of injury that could cause a spinal injury (Spinal Trauma and Assessment - 4.6). SECONDARY/FOCUSED ASSESSMENT AND TREATMENT • Obtain chief complaint, history of present illness, and prior medical history. • Complete a physical assessment as appropriate for the patient’s presentation. • Refer to appropriate protocol(s) for further treatment options. • Determine level of pain. 2023 Vermont EMS has taken extreme caution to ensure all information is accurate and in accordance with professional standards in effect at the time of publication. These protocols, policies, or procedures MAY NOT BE altered or modified. Routine Patient Care 1.1 EMR SECONDARY/FOCUSED ASSESSMENT AND TREATMENT (CONTINUED) • Dress and bandage lacerations and abrasions. • Cover evisceration with a sterile dressing to prevent heat loss. • Maintain normal body temperature. • Stabilize impaled objects. Do not remove an impaled object unless it interferes with CPR or your ability to maintain the patient’s airway. • Monitor vital signs at least every 15 minutes (at least every 5 minutes if the patient is unstable). • Perform basic splinting as indicated. MAJOR MULTIPLE SYSTEM TRAUMA • See Traumatic Emergencies - 4.12. CIRCUMSTANCES NOT COVERED UNDER STATEWIDE EMS PROTOCOLS • It is impossible to write a protocol for every potential situation. In rare instances where the patient’s best interests may not be specifically addressed in a protocol, contact on-line Medical Direction. • Please note that while Medical Direction can have some variation from facility to facility, on-line Medical Direction may not direct providers to practice outside their scope of practice, and likewise, providers should not ask to perform procedures outside their scope of practice as defined within these protocols. EMR SCOPE OF PRACTICE It is understood that emergency medical responders will function up to their scope of practice outlined by the National EMS Scope of Practice Model using the Vermont EMT-level protocols and American Heart Association guidelines for Healthcare Provider CPR. • Airway Management – (Airway Management Protocol - 5.1A or Airway Management Protocol - 5.1P). o BVM o Cleared, Opened o Oral Suctioning o Oropharyngeal Airway o Oxygen Administration o Naloxone Intranasal o Pulse Oximetry • Cardiac Management (Cardiac Arrest – 3.2A, or Cardiac Arrest – 3.2P). o CPR – Cardiopulmonary Resuscitation o Defibrillation – AED • Other Skills o Anaphylaxis: May assist patient with use of patient’s own epinephrine auto injector. o Assist patient with use of patient’s own MDI. o Burn Care (Burns/Electrocution/Lightning – Adult & Pediatric 4.0) o Childbirth (Obstetrical Emergencies - 2.19) o Cold / Hot Pack (Musculoskeletal Injuries – Adult & Pediatric 4.5) o Cervical Spine Stabilization – Manual Stabilization Only o Spinal Motion Restriction – (Spinal Trauma and Assessment - 4.6) o Extremity Hemorrhage (Tourniquet & Hemostatic Agent – Adult & Pediatric 6.6) o Nerve Agent Autoinjectors (Nerve Agent/Organophosphate Poisoning – 2.15A, or Nerve Agent/ Organophosphate Poisoning – 2.15P) o Splinting (Musculoskeletal Injuries – Adult & Pediatric 4.5) o Wound Care (Musculoskeletal Injuries – Adult & Pediatric 4.5.