EMS Protocols

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EMS Protocols
2013-03-07 15:13:07
Thurston County

MPD Dr. Larry Fontanilla
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  1. Appendix D is about what?
    • Death in the Field (DIF)
    • EMT's may withhold or terminate resuscitation of patients who show the obvious signs of death. All other cases or in any doubt, EMT should begin resuscitation immediately and follow Thurston County Protocols
  2. Obvious Signs of Death
    • Rigor Mortis
    • Livor Mortis (bluish color)
    • Decapitation
    • Incineration
    • Decomposition
    • Body Position Incompatible with Life
    • Evisceration of Heart or Brain
  3. Appendix D-2
    • EMT's and Paramedics should withhold or terminate resuscitation if End of Life Treatment Documentation is present and valid (signed)
    • Examples of End of Life Treatment Documentation:
    • -POLST form with part A checked DNAR (allow natural death)
    • -Pt is in a licensed nursing home and there is a DNR order signed by physician
    • -Documentation that the patient is enrolled in hospice
  4. EMT's are authorized by the MPD to withhold or terminate resuscitation if... (appendix d-3)
    • the pt has been diagnosed with a terminal illness and there is a reasonable indication that the pt and his/her family did not want to have CPR performed
    • *if family is present and desires CPR, EMS personnel should perform regardless of any documentation
  5. According to Appendix M, a pt can refuse care only if they:
    • have fluency in english
    • are over 18 yrs old
    • be oriented to person, place, time and not show any obvious cognitive deficit
    • be free of the influence of alcohol, drugs, or any mind altering substances
    • not have any injury or medical condition affecting their judgement
    • not have threatened or attempted suicide during this episode
    • demonstrate the ability to explain the decision they are making and the possible negative outcomes including death and devastating disability
  6. Appendix F states that healthcare workers, including EMS providers, subject to provisions of title 18, RCW, are required to report...
    • 1: When there is a reasonable cause to believe that abandonment, abuse, financial exploitations, or neglect of a vulnerable adult has occurred, mandated reporters shall immediately report to DSHS
    • 2: If there is a reason to suspect that sexual or physical assault has occurred, mandated reporters shall immediately report to the appropriate law enforcement agency (city police or county sheriff) AND to the dept.
  7. Define a Vulnerable Adult according to Appendix F
    • someone over the age of 60 who is unable to care for him/herself
    • an adult living in a nursing, board, or adult family home
    • an adult with a developmental disability
    • an adult with a legal guardian
    • an adult receiving personal care services in his or her own or his or her family's home
  8. Signs of physical abuse in adults according to Appendix F
    • unexplained bruises, welts, black eyes, wounds or fractures
    • multiple injuries in various stages of healing
    • sudden changes in behavior (fearful or depressed, engages in self-destructive behavior)
    • caregiver refuses to allow visitors
    • person is in restraints or locked in a room
    • missing patches of hair or hemorrhage below scalp
    • person reports abuse
  9. Signs of mental abuse in adults according to Appendix F
    • person is emotionally upset, agitated, withdrawn, non communicative, depressed or non responsive
    • caregiver refuses to allow visitors or does not let patient participate in family or community activities
    • person reports abuse
  10. Signs of sexual abuse in adults according to Appendix F
    • bruising around breasts and/or genital area
    • an unexplained venereal disease
    • soiled underclothes or bedding
    • sudden changes in behavior
    • person reports sexual abuse
  11. Signs of abuse in young children according to Appendix F
    • clinginess
    • bedwetting
    • inappropriate sexual knowledge
    • aggressive behavior
    • nightmares
  12. Signs of abuse in older children according to Appendix F
    • inability to concentrate in school
    • drop in grades
    • promiscuity
    • self-destructive behaviors
    • comments about suicide
    • poor relations with peers
    • depression
    • eating disorders
  13. According to Appendix F, when responding to sudden unexpected child death or serious injury...
    • Insure safety and provide medical aid as needed to save or assist the child
    • If child is clearly dead, do NOT love the body
    • make sure law enforcement has been notified (give them your contact info)
    • document all adults and children present (include who left, what was said, appearance, reactions to child's death or injury
    • document