EMS Total

1"

less than 100cm H2O

120 per minute

40-60 breaths/min

children older than 3 yrs

birth to 1 month

greater than 1 month to 1 yr of age

greater than 1 yr to 12 yrs of age

greater than 12 yrs to 15 yrs of age

greater than 15 yrs of age

over 1 year of age

Florida Statute 383.50

A+O x4

awake, alert and fully oriented to person, place, time and situation

• follow EMT assessment
• at least 1 set of vital signs
• any improvement from initial complaint

• trauma or medical illness (hypoxia, hypoglycemia, stroke)
• psychiatric illness (suicidal/homicidal, hallucinations, delusions)
• presence of a toxic ingestion or exposure

with an appropriate witness signature

Rescue District/Battalion Chief

supine, Fowler's or semi-Fowler's position

at least every 10 min

as soon as the call is over

by the end of the shift

every 6 months

2nd degree misdemeanor

when the rescue crew is on scene and is not canceled prior to patient contact.

Incident Commander

Orange Park Level II Trauma Center

• when accompanied by an: 
• RN
• PA
• Physician

ED

Rescue District/Battalion Chief

• when accompanied by
• RN
• PA
• Physician

15 min

more than 30 min

64 J-2.004 F.A.C.

64 J-2.005 FAC

The Medical Director of the EMS provider that issues the trauma alert

The Physician at the receiving trauma center/hospital

(64 J-2.005 FAC)

rapid transport

3rd trimester

loss of 2-point discrimination

localized

pulselessness

Because ice increases vasoconstriction

LCsss

• lime
• carbolic acid
• sulfuric acid
• solid potassium
• sodium metals

electrical

(430.3010)

lukewarm NS or sterile water

reverse triage

patients in cardiac arrest

95-100%

40 degrees

if spinal immobilization is indicated

shock position

2-4 lpm

30 degrees

systolic less than 90 mmHG

if time of onset is greater than 2 hours

if time of onset is 2 hours or less

only if time will be saved 

• -distance + travel exceeds 25 min
• -helicopter can be launched prior to rescue arrival

full Fowler's position

220 mmHG

120 mmHG

semi-Fowler's position

100%

• Unwitnessed Arrest
• Perform 2min of CPR prior to any other intervention

Supine, Fowlers or Semi-Fowlers

Shock position (Trendelenburg position)

LSB elevated on right side approx. 15° or (6")

If LSB cannot be elevated, manually displace uterus to the left as much as possible without causing spinal movement and maintain this throughout transport.

Shock position- use caution with trauma PT, potential respiratory compromise.

If blood noted in anterior chamber elevate head or LSB to 40°

Place them in the shock position

Place them in the position of comfort, with head of bed elevated to 30° if tolerated.

Full Fowlers position

Semi-Fowlers or position of comfort

Recovery position

sitting position with head leaning forward

Shock position

Semi-Fowlers with the head elevated 30°

1st or 2nd trimester- position of comfort

3rd trimester- recover position (left side)

Breech Delivery - Knee-Chest position

Limb or Brow presentation- Knee-Chest

Prolapsed Cord- Knee-Chest or supine with hips elevated

Head of the stretcher should be at least at a 45° angle

• Apearance
• Pulse
• Grimmace
• Activity
• Respirations

• Appearance
• 0 Blue all over
• 1 Acrocyanosis
• 2 Pink all over

• Pulse
• 0 Absent
• 1 Less than 100
• 2 Greater or equal to 100

• Grimmace
• 0 No Response
• 1 Grimmace/Weak Cry
• 2 Sneeze/Cough Vigorous Cry

• Activity/Muscle Tone
• 0 Limp/Flacid
• 1 Some Motion/Flexion
• 2 Active Motion

• Respirations
• 0 Absent
• 1 Slow/irregulat
• 2 Vigorous Cry/Normal Respirations

• EYE Opening
• 4 Spontaneous
• 3 To Speach
• 2 To Pain
• 1 None

• Verbal Response
• 5 Oriented
• 4 Confused
• 3 Inappropriate Words
• 2 Incomprehensible sounds
• 1 None

• Best Motor Response
• 6 Obeys
• 5 Localizes
• 4 Withdraws
• 3 Flexion
• 2 Extension
• 1 None

• Statewide #, obtain name and ID from contact person
• Notify Rescue District/Batt Chief
• Notify Division Chief of Rescue in writing within 24hrs that you've reported to Florida Abuse Regisry

Sharps

Active airway assistance beyond beyond administration of oxygen

• Patient lacks a radial pulse with HR >120
• or
• Has systolic <90

• Pt. has 2nd or 3rd degree burns to 15% or more of the total body surface area
• or
• Amputation proximal to wrist/ankle
• or
• Penetrating injury to the head, neck or torso

• The PT exihibits a score or 4 or less on the GCS 
• or
• exhibits the presence of paralysis
• or
• there is suspicion of spinal cord injury
• or
• the loss of sensation

Pt reveals signs or symptoms of two or more long bone fracture sites

The patient as a resp rate of 30 or greater

patient has a sustained HR of 120 or greater

BMR of 5 on GCS

Pt has soft tissue loss from either major degloving or a major flap avulsion 5" or greater.

GSW to extremities

Pt reveals signs or symptoms of a single longbone fracture from a MVC or a fall from 10' or greater

Pt is 55yrs or older

Pt has been ejected from a motor vehicle or driver of vehicle impacted with the steering wheel causing steering wheel deformity

• Medical director of the EMS provider
• or 
• Physician at the the receiving trauma center or hospital

Greater than 104°

89.6°F to 98.6°F

Rectal temp below 95°F

• Oral or rectal temp is greater than 105°F
• (tympanic greater than 104°F)

Pt anxiety

Pt intoxicated or under influence or otherwise incapable of providing informed consent

Pt experiencing an emergency medical condition

The competent pt would normally give consent

Unreasonable force shall not be used

Pt gives verbal permission to treat

Pt gives written permission to treat

Pt does not object as you begin assessment

A&Ox4

No significant mental impairment

Not suicidal or homicidal and does not want to hurt themselves

Pt behavior that necessitated restraints

Type of restraint used

Status of circulation distal to restraints

• 1.Spouses
• 2.Relatives
• 3.Law Enforcement
• 4.Friends
• 5.Other Fire/Rescue Personnel

JFRD officer documenting may not sign as a witness

Wash with soap and water

Cleanse with appropriate disinfecting agent

Dry thoroughly before returning to storage

Trauma pt with the anatomical and physical characteristics of a person 15yrs of age or less.

Airway-

• pt is intubated 
• or 
• pt is assisted through such measures as jaw thrust
• or
• continuous suctioning
• or
• the use of adjuncts to assist vent efforts

Circulation

• Pt has a faint or non palpable 
• carotid or femoral
• or
• systolic <50

Consciousness

• Pt exhibits altered mental status
• or
• there is presence of paralysis, the suspicion of spinal cord injury
• or 
• loss of sensation

Fracture

• Evidence of open long bone fracture
• or
• multiple fracture sites (except isolated wrist/ankle)or 
• multiple dislocations (except isolated wrist/ankle)

Cutaneous

• Pt has a major soft tissue disruption including major flap avulsion
• or
• 2nd or 3rd degree burns to 10% or more of the total body surface area.
• or
• Amputation proximal to wrist or ankle
• or
• Any penetrating injury to head, neck, torso

Consciousness

• Pt has symptoms of amnesia
• or 
• there is a loss of consciousness

Circulation

• Carotid or femoral is palpable but radial or pedal are not.
• or
• systolic blood pressure is >90

Fracture

Pt reveals signs or symptoms of single closed long bone fracture

Size

• PED trauma pt weighing 11kilos or less
• or
• body length is equivalent to this weight on a PED length and weight emergency tape (33" or less)

Rapid transport

Mechanism of Injury

The best treatment is rapid transport

Due to the increased maternal blood volume

Asense of distal pulses

Proper immobilization

Severe metabolic acidosis

the release of myoglobin, uric acid and other toxins into the blood

• Hypvolemia
• Dysrhythmia
• Renal Failure

Loss of two-point discrimination

• Pain
• Paresthesia
• Pressure
• Passive Stretching
• Pulselessness

• Do Not
• Elevate
• Apply cold packs (ice increases vasoconstriction)

Double or blurred Vision

Look elsewhere for the cause

a bruise

An extremity injury

Blood in the anterior chamber of the eye

40 degrees

Cuff #1- 100mL of air

Cuff #2- 15mL of air

Management of the pt's airway

Oxygen Saturation Levels

Calf Pain

Cervical Spine Considerations

• at least 6lpm (typically 8lpm)
• Adjust flow to maintain a mist of the med

Melena- bloody, tarry stools

Abdominal/Flank Pain

Urticaria- hives

Allergic Reaction/Anaphylaxis

Nuchal Rigidity- Stiff neck

Coma/Altered Consciousness

Oliguria- diminished/infrequent urination

Mild Pre-Eclampsia

• Decreased LOC
• Impaired Movement
• Asymmetry of face and extremities
• Seizures
• Unequal pupils

Administer Oxygen as indicated

• Pt in Semi-Fowlers
• or
• Position of comfort

Administer 100% oxygen

Pt in Full-Fowlers position

Pleuritic Chest Pain- chest pain exacerbated by forceful breathing

Drowning/Near-Drowning Submersion

• Dysbarism
• Barotrauma
• Decompression Sickness

• Tenderness
• Mottling
• Rash from bubble emboli
• Subcutaneous Emphysema

Admin. Oxygen as indicated- SAT. below 95% admin 2-4lpm nasal canula

Room air SAT. above 95%, no oxygen administered

Pt in position of comfort with head of bed elevated 30°

Obtain BP in both arms

Florida Bureau of EMS Stroke Alert Checklist

Dont administer any oral meds

Admin. 100% oxygen

Assess for reversible causes

Obtundation

Admin. supplemental oxygen, maintain saturation between 95 and 100%

Aggressive airway procedures and supplemental ventilation should be performed.

Reposition Airway

Before vent and after opening airway, look for obstruction and remove if visible.

Then begin CPR

Pathology of the complaint, differential (field) diagnosis and this protocol

Use the E-C technique

at least 10lpm

adjust liter flow to maintain oxygen in the reservoir bag

Distance from the tip of the nose to the angle of the jaw

Cardia, respiratory or traumatic arrest

• Less than 5' tall, Greater than 7'
• Less than 16yrs old
• Pt has esophageal disease
• Ingested caustic substance
• Foreign Body Airway Obstruction
• Responsive or has gag reflex

The epigastrum in the mid-line slightly inferior to the xiphoid process

Then lungs while ventilating pt

For a BGL less than 70mg/dl

Prevent aspiration of blood by placing the pt in a sitting position with their head leaning forward.

Pinch nostrils and pack gauze between upper lif and gum to provide pressure.

Tell pt not to sniff, blow or manipulate nasal passages

Place pt in the recovery position to maintain aspiration prophylaxis

Diagnosis and immediate treatment of Underlying Cause

Greater than 104°

Moist or dry skin (may be sweating)

Semi-Fowlers with head elevated 30°

Position of comfort

• Shivering
• 89.6° to 98.6°

NIOSH Pocket Guide to Hazardous Chems

ERG

Cherry-red skin

1st or 2nd trimester or unknown preg status- allow pt to assume position of comfort

3rd trimester- pt in recover position

• Systolic Greater than 140
• Diastolic greater than 90

Systolic- greater than 30mmHg increase above baseline

Diastolic-greater than 15mmHg increase above baseline

Greater than 2lb per wk

Systolic greater than 160

Diastolic greater than 110

Greater than 6lb per wk

Seizure activity

Can occur postpartum (up to 6wks)

Pt Hyperventilates after tonic/clonic seizure

Fetal head entering vaginal canal to expulsion of the fetus

Oropharynx first before nostrils

Clamp (2 to 3 inches apart) 7 to 10 inches from abdomen of the neonate

Cut between clamps

Does not deliver within 3min

gloved hand to make an airway for neonate, using fingers to make airspace

• Knee-chest position
• or 
• Supine with hips elevated

Less than 100cmH2O

Hypopharynx and then the nostils

Vent 100% oxygen at 40-60 breaths a min

vent pressure may exceed 30 to 40 cmH2O, occlude the pop-off valve

Admin chest compressions- 120 per min

Re-assess every 30sec

• Asystole
• and 
• BradyCardia