Protocopedia - User contributions [en]

IMS

2026-04-03T15:39:28Z

Jonesk:

[[Main Page|Protocols]]

== Section 1 - Command Operations ==
{| class="wikitable"
|+
!Section
!Description
!Issue Date
!Revision Date
!Effective Date
|-
|1.1
|[[Incident Management System Organization]]
|January 1, 2017
|January 1, 2026
|January 1, 2026
|-
|1.2
|[[1.2 Organization / Command Structure|Organization / Command Structure]]
|January 1, 2017
|
|January 1, 2026
|-
|1.3
|[[1.3 Area Command|Area Command]]
|January 1, 2017
|
|January 1, 2026
|-
|1.4
|[[1.4 Unified Command|Unified Command]]
|January 1, 2017
|
|January 1, 2026
|-
|1.5
|[[1.5 Incident Commander|Incident Commander]]
|January 1, 2017
|
|January 1, 2026
|}

== Section 2 - Operations ==

== Section 3 - Special Hazards Operations ==

== Section 4 - Safety ==

== Section 5 - Fire Cause Investigation ==

== Forms / Checklists ==

IMS

2026-04-03T15:38:00Z

Jonesk:

1.3 Area Command

2026-04-03T12:13:26Z

Jonesk:

==== Purpose ====
Oversee the management of incident(s), focusing on strategic assistance, direction, and resolving competition for resources. This position does not supersede any Incident Commanders or Unified Commands but supports and provides strategic direction.

==== Responsibilities ====
The overall direction and setting of priorities for Incident Management Teams (IMTs) assigned to incidents in close proximity or large complex incidents. This includes ensuring that conflicts are resolved, that incident objectives are established, and that strategies are selected for the use of critical resources. The Area Commander has the responsibility to coordinate with local, state, federal, and volunteer assisting and/or cooperating organizations.

==== Activation ====
Multiple simultaneous alarms with implementation of the Incident Management System in the same geographical area. The complexity and span or control of an incident warrants. Critical lifesaving or property values are at risk, and incidents are utilizing limited resources. The incidents will continue into the next operational period.

<div style="margin-left: 2em;">'''Location:''' Area Command Post
</div>

<div style="margin-left: 2em;">'''Recommended Staffing:''' Most qualified in management of large complex incidents with respect to their functional areas
</div>

<div style="margin-left: 2em;">'''Reports To:''' Agency Administrations
</div>

==== Procedure ====

* Arrive in area and establish Area Command.

* Establish appropriate location for the Area Command facilities, consider Mobile Command Center Vehicle.
* Notify the Incident Commanders covered by the Area Command.
* Activate the elements of the area command needed to manage the incident(s) via Branch Commanders. (Planning, Logistics, Aviation, Tech Specialists, etc.)
* Review objectives and strategies for each incident, including expectations of Agency Administrators, concerns, or restraints.
* Assess the incident situation; establish priorities and objectives for the overall command.
* If operating as a Unified Area Command, develop working agreement for how Area Commanders will function together.
* Determine and assign an appropriate Area Command team. A small team is more manageable.
* Identify and allocate critical resources to best meet the needs of Area Command.
* Consider establishing an Area Command Staging Area / Mobilization Center to pool resources prior to allocation to area incidents or individual staging areas.
* Obtain incident briefing and IAP’s from Incident Commanders (as appropriate).
* Assess incident situations prior to strategy meeting.
* Brief the Area Command Staff and IMT, if established.
* Determine need for an assigned Technical Specialists to support Area Command.
* Participate in the preparation and authorize the implementation of the Incident Action Plan (IAP).
* Develop an operating guide for the Area Command staff.
* Prepare for additional operational cycles.
* Establish PIO or, if needed, Joint Information Center (JIC).
* Review the progress of the incident and channel organizational efforts towards highest priority tasks.
* Approve overall plan for demobilization and return to normal operating status.
* Maintain log of major actions/decisions.
* Prepare a final incident summary.
[[IMS|back to IMS]]

1.3 Area Command

2026-04-03T12:08:43Z

Jonesk:

==== Purpose ====
Oversee the management of incident(s), focusing on strategic assistance, direction, and resolving competition for resources. This position does not supersede any Incident Commanders or Unified Commands but supports and provides strategic direction.

==== Responsibilities ====
The overall direction and setting of priorities for Incident Management Teams (IMTs) assigned to incidents in close proximity or large complex incidents. This includes ensuring that conflicts are resolved, that incident objectives are established, and that strategies are selected for the use of critical resources. The Area Commander has the responsibility to coordinate with local, state, federal, and volunteer assisting and/or cooperating organizations.

==== Activation ====
Multiple simultaneous alarms with implementation of the Incident Management System in the same geographical area. The complexity and span or control of an incident warrants. Critical lifesaving or property values are at risk, and incidents are utilizing limited resources. The incidents will continue into the next operational period.

<div style="margin-left: 2em;">'''Location:''' Area Command Post
</div>
<br>
<div style="margin-left: 2em;">'''Recommended Staffing:''' Most qualified in management of large complex incidents with respect to their functional areas
</div>
<br>
<div style="margin-left: 2em;">'''Reports To:''' Agency Administrations
</div>
<br>
==== Procedure ====

* Arrive in area and establish Area Command.

* Establish appropriate location for the Area Command facilities, consider Mobile Command Center Vehicle.
* Notify the Incident Commanders covered by the Area Command.
* Activate the elements of the area command needed to manage the incident(s) via Branch Commanders. (Planning, Logistics, Aviation, Tech Specialists, etc.)
* Review objectives and strategies for each incident, including expectations of Agency Administrators, concerns, or restraints.
* Assess the incident situation; establish priorities and objectives for the overall command.
* If operating as a Unified Area Command, develop working agreement for how Area Commanders will function together.
* Determine and assign an appropriate Area Command team. A small team is more manageable.
* Identify and allocate critical resources to best meet the needs of Area Command.
* Consider establishing an Area Command Staging Area / Mobilization Center to pool resources prior to allocation to area incidents or individual staging areas.
* Obtain incident briefing and IAP’s from Incident Commanders (as appropriate).
* Assess incident situations prior to strategy meeting.
* Brief the Area Command Staff and IMT, if established.
* Determine need for an assigned Technical Specialists to support Area Command.
* Participate in the preparation and authorize the implementation of the Incident Action Plan (IAP).
* Develop an operating guide for the Area Command staff.
* Prepare for additional operational cycles.
* Establish PIO or, if needed, Joint Information Center (JIC).
* Review the progress of the incident and channel organizational efforts towards highest priority tasks.
* Approve overall plan for demobilization and return to normal operating status.
* Maintain log of major actions/decisions.
* Prepare a final incident summary.
[[IMS|back to IMS]]

1.3 Area Command

2026-04-03T12:07:44Z

Jonesk: /* Activation */

IMS

2026-04-03T12:07:11Z

Jonesk:

1.5 Incident Commander

2026-04-03T12:06:53Z

Jonesk: Created page with "==== Purpose ==== The Incident Commander (IC) provides comprehensive leadership and management to the response effort. The position is the focal point of all facets of the operation consistent with the Incident Management System. ==== Responsibilities ==== The IC is ultimately responsible for all incident response activities including development and implementation of an Incident Action Plan (IAP) plan to stabilize the incident, make decisions and issue orders for effi..."

==== Purpose ====
The Incident Commander (IC) provides comprehensive leadership and management to the response effort. The position is the focal point of all facets of the operation consistent with the Incident Management System.

==== Responsibilities ====
The IC is ultimately responsible for all incident response activities including development and implementation of an Incident Action Plan (IAP) plan to stabilize the incident, make decisions and issue orders for efficient and effective utilization of resources. The IC must process information and cues obtained through radio transmissions, face to face reports, and observations from a variety of sources and relay and receive same from Section Chiefs and Command Staff operating within their span of control. '''It is recognized that the IC may not have knowledge of unique or specialized operations (i.e. confined space, hazmat, etc.) and thus may utilize group or division leaders who are technical specialists to aid in command and control of the incident.''' '''It is therefore imperative that their role be confined to managing the alarm and resources required.'''

==== Activation ====
Any situation requiring four or more units where, in the judgment of the on-scene ranking officer, the Incident Management System (IMS) should be implemented for concerns of safety for personnel, management of resources, and scene control.

<div style="margin-left: 2em;">'''Location:''' On Scene at Command Post</div>

<div style="margin-left: 2em;">'''Recommended Staffing:''' First arriving Fire Department officer until relieved by higher authority</div>

<div style="margin-left: 2em;">'''Reports To:''' Final Authority</div>

==== Procedure ====

* Arrive on the scene and establish or assume command; obtain incident briefing previous IC.
* If not previously established, identify command name (“4th Avenue Command”), report command post location and establish A (Alpha) side.
* Assess the incident situation and conduct an initial strategy briefing with the current operation command personnel.
* Activate the elements of the IMS appropriate for management of the incident.
* Brief Command Staff and primary Section Chiefs.
* Participate in the preparation and authorize the implementation of an (the) Incident Action Plan (IAP).
* Determine conditions and needs to make informed command decisions and transmit incident objectives to command staff.
* Coordinate primary IC Staff activities.
* Manage overall incident operations and resource utilization.
* Approve requests for and utilization of additional resources.
* Authorize release of information to the media.
* Ensure the incident status form (worksheet) or command board is utilized and completed. Ensure that proper forms are available and utilized by section and group leaders.
* Obtain briefings from Section Chiefs, Command Staff, and agency representatives on incident management issues and/or concerns.
* Obtain information on environmental issues and/or concerns.
* Review the progress of the incident and direct organizational efforts towards higher priority tasks.
* Ensure that safety procedures are utilized and followed by all personnel.
* Approve plan for demobilization of resources and return to normal operating status.
* Prepare a final incident summary for media briefing, reports, etc.
[[IMS|back to IMS]]

Incident Management System Organization

2026-04-03T11:52:58Z

Jonesk:

== 1.1 Incident Management System Organization ==

=== Purpose ===
The organizational structure outline in this plan has been derived from the '''National Interagency Incident Management System (NIMS)'''. '''NIMS''' is utilized by the Federal Government and is recognized and recommended by the Florida Fire Chiefs’ Association as the standard Incident Command System. In addition, certain portions of this manual have been adapted from Firescope, Phoenix Fireground Command System, Florida Incident Field Operations Guide, and the National Fire Service Incident Management System Consortium.

=== General ===
Under the Incident Management System, (IMS), the ultimate control and direction of all emergency response falls under a single individual, the Incident Commander, except where a Unified Command or Area Command is established. Incident Command is responsible for the overall incident response effort and the implementation of the appropriate portions of this plan. This command system is quite flexible in that the incident commander can activate, consolidate, or delete various positions depending on the needs of the incident. Although this structure is designed for full or partial implementation, it is important that all position roles are reviewed to ensure vital functions are not overlooked.

=== NIMS ===

* It is recommended that the person ultimately taking command at an incident be a chief officer or other qualified individual, highly trained and skilled in the Incident Management System. The Incident Management System is not rank structured but can be filled from whatever positions are best suited for the needs of the individual department.
* The degree of plan implementation will again depend upon the nature and magnitude of the incident. The following pages outline the roles and responsibilities of the various areas of the command structure.
* The IMS organizational structure develops in a modular fashion based on the kind and size of an incident. The organization’s staff builds from the top down with the responsibility and performance placed initially with the Incident Commander. As the need exists, four separate sections can be deployed, each with several units that may be established. The General Staff positions are:
** Operations
** Planning
** Logistics
** Administration (Finance)
* In addition to these four sections, Command Staff may include the following:
** Safety Officer
** Public Information Officer (PIO)
** Liaison Officer
** Incident Command Aide
[[IMS|back to IMS]]

Incident Management System Organization

2026-04-03T11:52:29Z

Jonesk:

IMS

2026-04-03T11:50:27Z

Jonesk:

1.4 Unified Command

2026-04-03T11:50:11Z

Jonesk: Created page with "==== Purpose ==== A Unified Command links the responding organizations to the incident and provides a forum for these agencies to make consensus decisions. The Unified Command establishes a common set of incident objectives and strategies while Incident Commanders continue to carry out their respective agency’s jurisdictional responsibilities. ==== Responsibilities ==== The overall management of an incident. The Unified Command will develop overall objectives and stra..."

==== Purpose ====
A Unified Command links the responding organizations to the incident and provides a forum for these agencies to make consensus decisions. The Unified Command establishes a common set of incident objectives and strategies while Incident Commanders continue to carry out their respective agency’s jurisdictional responsibilities.

==== Responsibilities ====
The overall management of an incident. The Unified Command will develop overall objectives and strategies. The Unified Command will have ultimate approval of all resources. Unified Command is intended to be a ‘decision by committee’. If a decision cannot be agreed on by the Unified Command, the Unified Command member with the most jurisdictional responsibility will be deferred to for the final decision.

Unified commands with routine agencies such as law enforcement, other fire departments, and management teams from private entities shall be established using a streamline process to prevent delays in operations activities with the goal of hazard mitigation.

==== Activation ====
When an incident affects the jurisdictional or statutory responsibility of more than one agency. The incident is multijurisdictional and without a common system or organizational framework.

<div style="margin-left: 2em;">'''Location:''' Incident Command Post</div>

<div style="margin-left: 2em;">'''Recommended Staffing:''' Top management personnel from Agencies having Jurisdiction (AHJ). Non-government responders and private industries when an incident affects their facilities.</div>

<div style="margin-left: 2em;">'''Reports To:''' Authority having Jurisdiction (AHJ)</div>

==== Procedure ====

* Agreement by Authority having Jurisdiction for a Unified Command to be established.
* Selection of members to the command determined by specifics of the incident.
* Establish a Unified Command and obtain an incident briefing from the previous Incident Commander.
* Establish a Unified Command Post that is Co-Located with all Unified Command Personnel; consider use of Mobile Command Vehicles.
* If needed, fill the Command staff positions. There should be only one Operations Section Chief to oversee Branch directors from each discipline.
* Assess the incident situation and conduct a strategy meeting with members of the Unified Command.
* Prepare one set of Incident Objectives based off of all unified discipline strategies.
* Brief the Command Staff and primary Section Chiefs.
* Prepare and approve an Incident Action Plan.
* Determine needs to make informed command decisions and relate these needs to the command staff.
* Manage overall incident operations.
* Consider a joint staging area for incident resources.
* Coordinate primary staff activities.
* Approve requests for and utilization of extended resources.
* Authorize release of information to the media. Establish a Joint Information Center (JIC) for PIOs and Media if size of incident warrants.
* Ensure the incident status form (worksheet) or command board is utilized and completed. Ensure that proper forms are available and utilized by section group leaders.
* Obtain briefing from Section Chiefs, Command Staff and agency representatives on management concerns.
* Obtain information on environmental concerns.
* Review the progress of the incident and channel organizational efforts towards highest priority tasks.
* Ensure that safety procedures and disciplines are practiced and maintained by all personnel.
* Approve plan for demobilization and return to normal operating status.
* Prepare final incident summary for media briefing, reports, etc.
[[IMS|back to IMS]]

1.3 Area Command

2026-04-03T11:36:35Z

Jonesk:

==== Purpose ====
Oversee the management of incident(s), focusing on strategic assistance, direction, and resolving competition for resources. This position does not supersede any Incident Commanders or Unified Commands but supports and provides strategic direction.

==== Responsibilities ====
The overall direction and setting of priorities for Incident Management Teams (IMTs) assigned to incidents in close proximity or large complex incidents. This includes ensuring that conflicts are resolved, that incident objectives are established, and that strategies are selected for the use of critical resources. The Area Commander has the responsibility to coordinate with local, state, federal, and volunteer assisting and/or cooperating organizations.

==== Activation ====
Multiple simultaneous alarms with implementation of the Incident Management System in the same geographical area. The complexity and span or control of an incident warrants. Critical lifesaving or property values are at risk, and incidents are utilizing limited resources. The incidents will continue into the next operational period.

<div style="margin-left: 2em;">'''Location:''' Area Command Post</div>

<div style="margin-left: 2em;">'''Recommended Staffing:''' Most qualified in management of large complex incidents with respect to their functional areas</div>

<div style="margin-left: 2em;">'''Reports To:''' Agency Administrations</div>

==== Procedure ====

* Arrive in area and establish Area Command.

* Establish appropriate location for the Area Command facilities, consider Mobile Command Center Vehicle.
* Notify the Incident Commanders covered by the Area Command.
* Activate the elements of the area command needed to manage the incident(s) via Branch Commanders. (Planning, Logistics, Aviation, Tech Specialists, etc.)
* Review objectives and strategies for each incident, including expectations of Agency Administrators, concerns, or restraints.
* Assess the incident situation; establish priorities and objectives for the overall command.
* If operating as a Unified Area Command, develop working agreement for how Area Commanders will function together.
* Determine and assign an appropriate Area Command team. A small team is more manageable.
* Identify and allocate critical resources to best meet the needs of Area Command.
* Consider establishing an Area Command Staging Area / Mobilization Center to pool resources prior to allocation to area incidents or individual staging areas.
* Obtain incident briefing and IAP’s from Incident Commanders (as appropriate).
* Assess incident situations prior to strategy meeting.
* Brief the Area Command Staff and IMT, if established.
* Determine need for an assigned Technical Specialists to support Area Command.
* Participate in the preparation and authorize the implementation of the Incident Action Plan (IAP).
* Develop an operating guide for the Area Command staff.
* Prepare for additional operational cycles.
* Establish PIO or, if needed, Joint Information Center (JIC).
* Review the progress of the incident and channel organizational efforts towards highest priority tasks.
* Approve overall plan for demobilization and return to normal operating status.
* Maintain log of major actions/decisions.
* Prepare a final incident summary.
[[IMS|back to IMS]]

IMS

2026-04-03T11:35:24Z

Jonesk: /* Section 1 - Command Operations */

1.3 Area Command

2026-04-03T11:35:13Z

Jonesk: Created page with "==== Purpose ==== Oversee the management of incident(s), focusing on strategic assistance, direction, and resolving competition for resources. This position does not supersede any Incident Commanders or Unified Commands but supports and provides strategic direction. ==== Responsibilities ==== The overall direction and setting of priorities for Incident Management Teams (IMTs) assigned to incidents in close proximity or large complex incidents. This includes ensuring tha..."

==== Purpose ====
Oversee the management of incident(s), focusing on strategic assistance, direction, and resolving competition for resources. This position does not supersede any Incident Commanders or Unified Commands but supports and provides strategic direction.

==== Responsibilities ====
The overall direction and setting of priorities for Incident Management Teams (IMTs) assigned to incidents in close proximity or large complex incidents. This includes ensuring that conflicts are resolved, that incident objectives are established, and that strategies are selected for the use of critical resources. The Area Commander has the responsibility to coordinate with local, state, federal, and volunteer assisting and/or cooperating organizations.

==== Activation ====
Multiple simultaneous alarms with implementation of the Incident Management System in the same geographical area. The complexity and span or control of an incident warrants. Critical lifesaving or property values are at risk, and incidents are utilizing limited resources. The incidents will continue into the next operational period.

<div style="margin-left: 2em;">'''Location:''' Area Command Post</div>

<div style="margin-left: 2em;">'''Recommended Staffing:''' Most qualified in management of large complex incidents with respect to their functional areas</div>

<div style="margin-left: 2em;">'''Reports To:''' Agency Administrations</div>

==== Procedure ====

* Arrive in area and establish Area Command.

* Establish appropriate location for the Area Command facilities, consider Mobile Command Center Vehicle.
* Notify the Incident Commanders covered by the Area Command.
* Activate the elements of the area command needed to manage the incident(s) via Branch Commanders. (Planning, Logistics, Aviation, Tech Specialists, etc.)
* Review objectives and strategies for each incident, including expectations of Agency Administrators, concerns, or restraints.
* Assess the incident situation; establish priorities and objectives for the overall command.
* If operating as a Unified Area Command, develop working agreement for how Area Commanders will function together.
* Determine and assign an appropriate Area Command team. A small team is more manageable.
* Identify and allocate critical resources to best meet the needs of Area Command.
* Consider establishing an Area Command Staging Area / Mobilization Center to pool resources prior to allocation to area incidents or individual staging areas.
* Obtain incident briefing and IAP’s from Incident Commanders (as appropriate).
* Assess incident situations prior to strategy meeting.
* Brief the Area Command Staff and IMT, if established.
* Determine need for an assigned Technical Specialists to support Area Command.
* Participate in the preparation and authorize the implementation of the Incident Action Plan (IAP).
* Develop an operating guide for the Area Command staff.
* Prepare for additional operational cycles.
* Establish PIO or, if needed, Joint Information Center (JIC).
* Review the progress of the incident and channel organizational efforts towards highest priority tasks.
* Approve overall plan for demobilization and return to normal operating status.
* Maintain log of major actions/decisions.
* Prepare a final incident summary.

1.2 Organization / Command Structure

2026-04-03T11:13:39Z

Jonesk:

[[File:1.2 Regular Response.png|center|640x640px]]

=== <div style="text-align: center;">Expanding or Moderate Structure Fire, HazMat Incident, or EMS Response</div> <div style="text-align: center;">(to include multiple alarm responses)</div> ===
[[File:1 2 Exanding Struture Fire.png|center]]

=== <div style="text-align: center;">Major Inciddent</div> ===
[[File:Major Incident.png|center]][[IMS|back to IMS]]

1.2 Organization / Command Structure

2026-04-03T11:11:44Z

Jonesk:

File:Major Incident.png

2026-04-03T11:01:03Z

Jonesk:

Major Incident

IMS

2026-04-01T20:46:03Z

Jonesk:

1.2 Organization / Command Structure

2026-04-01T20:34:42Z

Jonesk: Created page with "640x640px center"

[[File:1.2 Regular Response.png|center|640x640px]]

[[File:1 2 Exanding Struture Fire.png|center]]

File:1 2 Exanding Struture Fire.png

2026-04-01T20:33:40Z

Jonesk:

Expanded

File:1.2 Regular Response.png

2026-04-01T20:31:08Z

Jonesk:

Small Structure Fire, HazMat Incident, or EMS Response. First Alarm Units

Incident Management System Organization

2026-04-01T20:28:10Z

Jonesk:

Incident Management System Organization

2026-04-01T20:27:49Z

Jonesk:

1.1 Incident Management System Organization

== 1.1 Incident Management System Organization ==

=== Purpose ===
The organizational structure outline in this plan has been derived from the '''National Interagency Incident Management System (NIMS)'''. '''NIMS''' is utilized by the Federal Government and is recognized and recommended by the Florida Fire Chiefs’ Association as the standard Incident Command System. In addition, certain portions of this manual have been adapted from Firescope, Phoenix Fireground Command System, Florida Incident Field Operations Guide, and the National Fire Service Incident Management System Consortium.

=== General ===
Under the Incident Management System, (IMS), the ultimate control and direction of all emergency response falls under a single individual, the Incident Commander, except where a Unified Command or Area Command is established. Incident Command is responsible for the overall incident response effort and the implementation of the appropriate portions of this plan. This command system is quite flexible in that the incident commander can activate, consolidate, or delete various positions depending on the needs of the incident. Although this structure is designed for full or partial implementation, it is important that all position roles are reviewed to ensure vital functions are not overlooked.

=== NIMS ===

* It is recommended that the person ultimately taking command at an incident be a chief officer or other qualified individual, highly trained and skilled in the Incident Management System. The Incident Management System is not rank structured but can be filled from whatever positions are best suited for the needs of the individual department.
* The degree of plan implementation will again depend upon the nature and magnitude of the incident. The following pages outline the roles and responsibilities of the various areas of the command structure.
* The IMS organizational structure develops in a modular fashion based on the kind and size of an incident. The organization’s staff builds from the top down with the responsibility and performance placed initially with the Incident Commander. As the need exists, four separate sections can be deployed, each with several units that may be established. The General Staff positions are:
** Operations
** Planning
** Logistics
** Administration (Finance)
* In addition to these four sections, Command Staff may include the following:
** Safety Officer
** Public Information Officer (PIO)
** Liaison Officer
** Incident Command Aide

Incident Management System Organization

2026-04-01T20:26:35Z

Jonesk:

DISPLAYTITLE

== 1.1 Incident Management System Organization ==

=== Purpose ===
The organizational structure outline in this plan has been derived from the '''National Interagency Incident Management System (NIMS)'''. '''NIMS''' is utilized by the Federal Government and is recognized and recommended by the Florida Fire Chiefs’ Association as the standard Incident Command System. In addition, certain portions of this manual have been adapted from Firescope, Phoenix Fireground Command System, Florida Incident Field Operations Guide, and the National Fire Service Incident Management System Consortium.

=== General ===
Under the Incident Management System, (IMS), the ultimate control and direction of all emergency response falls under a single individual, the Incident Commander, except where a Unified Command or Area Command is established. Incident Command is responsible for the overall incident response effort and the implementation of the appropriate portions of this plan. This command system is quite flexible in that the incident commander can activate, consolidate, or delete various positions depending on the needs of the incident. Although this structure is designed for full or partial implementation, it is important that all position roles are reviewed to ensure vital functions are not overlooked.

=== NIMS ===

* It is recommended that the person ultimately taking command at an incident be a chief officer or other qualified individual, highly trained and skilled in the Incident Management System. The Incident Management System is not rank structured but can be filled from whatever positions are best suited for the needs of the individual department.
* The degree of plan implementation will again depend upon the nature and magnitude of the incident. The following pages outline the roles and responsibilities of the various areas of the command structure.
* The IMS organizational structure develops in a modular fashion based on the kind and size of an incident. The organization’s staff builds from the top down with the responsibility and performance placed initially with the Incident Commander. As the need exists, four separate sections can be deployed, each with several units that may be established. The General Staff positions are:
** Operations
** Planning
** Logistics
** Administration (Finance)
* In addition to these four sections, Command Staff may include the following:
** Safety Officer
** Public Information Officer (PIO)
** Liaison Officer
** Incident Command Aide

IMS

2026-04-01T20:25:42Z

Jonesk:

IMS

2026-04-01T20:23:22Z

Jonesk:

IMS

2026-04-01T20:22:23Z

Jonesk:

[[IMS|IMS Main Page]]

== Section 1 - Command Operations ==
{| class="wikitable"
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!Section
!Description
!Issue Date
!Revision Date
!Effective Date
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|1.1
|[[Incident Management System Organization]]
|January 1, 2017
|January 1, 2026
|January 1, 2026
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IMS

2026-04-01T20:21:44Z

Jonesk:

== Section 1 - Command Operations ==
{| class="wikitable"
|+
!Section
!Description
!Issue Date
!Revision Date
!Effective Date
|-
|1.1
|[[Incident Management System Organization]]
|January 1, 2017
|January 1, 2026
|January 1, 2026
|-
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Main Page

2026-04-01T20:20:47Z

Jonesk:

==TABLE OF CONTENTS==

[[Medical Director Authorization]]

[[IMS]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===
{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

[[IMS]]

Main Page

2026-04-01T20:20:04Z

Jonesk: /* Section 1 - Command Operations */

==TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===
{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

[[IMS]]

IMS

2026-04-01T20:18:22Z

Jonesk:

{| class="wikitable"
|+
!Section
!Description
!Issue Date
!Revision Date
!Effective Date
|-
|1.1
|[[Incident Management System Organization]]
|January 1, 2017
|January 1, 2026
|January 1, 2026
|-
|
|
|
|
|
|-
|
|
|
|
|
|}

Main Page

2026-04-01T20:17:53Z

Jonesk:

==EMS TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

[[IMS]]

==IMS TABLE OF CONTENTS==
===Section 1 - Command Operations===
{| class="wikitable"
|+
!Section
!Description
!Revision Date
|-
|1.1
|[[Incident Management System Organization]]
|
|-
|1.2
|[[Organization / Command Structure]]
|
|-
|1.3
|Area Command
|
|-
|1.4
|Unified Command
|
|-
|1.5
|Incident Commander
|
|-
|1.6
|Safety Officer
|
|-
|1.7
|Incident Commander Aide
|
|-
|1.8
|Public Information Officer (PIO)
|
|-
|1.9
|Liaison Officer
|
|-
|1.10
|Operations Section Chief
|
|-
|1.10.1
|Branch Director
|
|-
|1.10.2
|Division/Group Supervisor
|
|-
|1.10.3
|Special Operations Group (SOG)
|
|-
|1.10.4
|Rehabilitation Officer
|
|-
|1.10.5
|Staging Officer
|
|-
|1.10.6
|Water Supply Group Supervisor
|
|-
|1.11
|Planning Section Chief
|
|-
|1.11.1
|Planning and Operational Cycle - The Planning “P” and Operational “O”
|
|-
|1.12
|Logistics Section Chief
|
|-
|1.13
|Finance/Administrative Section Chief
|
|-
|1.14
|Critical Incident Stress Management
|
|-
|1.15
|Post Incident Analysis / “Hot Wash”
|
|}

===Section 2 - Operations===

===Section3 - Special Hazards Operations===

===Section 4 - Safety===

===Section 5 - Fire/Cause Investigation===

===Forms / Checklists===

IMS

2026-04-01T20:17:43Z

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{| class="wikitable"
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!Section
!Description
!Issue Date
!Revision Date
!Effective Date
|-
|1.1
|Incident Management System Organization
|January 1, 2017
|January 1, 2026
|January 1, 2026
|-
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|
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|}

Main Page

2026-03-31T15:01:00Z

Jonesk: /* Section 1 - Command Operations */

==EMS TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

==IMS TABLE OF CONTENTS==
===Section 1 - Command Operations===
{| class="wikitable"
|+
!Section
!Description
!Revision Date
|-
|1.1
|[[Incident Management System Organization]]
|
|-
|1.2
|Organization / Command Structure
|
|-
|1.3
|Area Command
|
|-
|1.4
|Unified Command
|
|-
|1.5
|Incident Commander
|
|-
|1.6
|Safety Officer
|
|-
|1.7
|Incident Commander Aide
|
|-
|1.8
|Public Information Officer (PIO)
|
|-
|1.9
|Liaison Officer
|
|-
|1.10
|Operations Section Chief
|
|-
|1.10.1
|Branch Director
|
|-
|1.10.2
|Division/Group Supervisor
|
|-
|1.10.3
|Special Operations Group (SOG)
|
|-
|1.10.4
|Rehabilitation Officer
|
|-
|1.10.5
|Staging Officer
|
|-
|1.10.6
|Water Supply Group Supervisor
|
|-
|1.11
|Planning Section Chief
|
|-
|1.11.1
|Planning and Operational Cycle - The Planning “P” and Operational “O”
|
|-
|1.12
|Logistics Section Chief
|
|-
|1.13
|Finance/Administrative Section Chief
|
|-
|1.14
|Critical Incident Stress Management
|
|-
|1.15
|Post Incident Analysis / “Hot Wash”
|
|}

===Section 2 - Operations===

===Section3 - Special Hazards Operations===

===Section 4 - Safety===

===Section 5 - Fire/Cause Investigation===

===Forms / Checklists===

Incident Management System Organization

2026-03-31T14:59:34Z

Jonesk: Created page with "== 1.1 Incident Management System Organization == === Purpose === The organizational structure outline in this plan has been derived from the '''National Interagency Incident Management System (NIMS)'''. '''NIMS''' is utilized by the Federal Government and is recognized and recommended by the Florida Fire Chiefs’ Association as the standard Incident Command System. In addition, certain portions of this manual have been adapted from Firescope, Phoenix Fireground Comman..."

Main Page

2026-03-31T14:52:21Z

Jonesk: /* Section 1 - Command Operations */

==EMS TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

==IMS TABLE OF CONTENTS==
===Section 1 - Command Operations===
{| class="wikitable"
|+
!Section
!Description
!Revision Date
|-
|1.1
|Incident Management System Organization
|
|-
|1.2
|Organization / Command Structure
|
|-
|1.3
|Area Command
|
|-
|1.4
|Unified Command
|
|-
|1.5
|Incident Commander
|
|-
|1.6
|Safety Officer
|
|-
|1.7
|Incident Commander Aide
|
|-
|1.8
|Public Information Officer (PIO)
|
|-
|1.9
|Liaison Officer
|
|-
|1.10
|Operations Section Chief
|
|-
|1.10.1
|Branch Director
|
|-
|1.10.2
|Division/Group Supervisor
|
|-
|1.10.3
|Special Operations Group (SOG)
|
|-
|1.10.4
|Rehabilitation Officer
|
|-
|1.10.5
|Staging Officer
|
|-
|1.10.6
|Water Supply Group Supervisor
|
|-
|1.11
|Planning Section Chief
|
|-
|1.11.1
|Planning and Operational Cycle - The Planning “P” and Operational “O”
|
|-
|1.12
|Logistics Section Chief
|
|-
|1.13
|Finance/Administrative Section Chief
|
|-
|1.14
|Critical Incident Stress Management
|
|-
|1.15
|Post Incident Analysis / “Hot Wash”
|
|}

===Section 2 - Operations===

===Section3 - Special Hazards Operations===

===Section 4 - Safety===

===Section 5 - Fire/Cause Investigation===

===Forms / Checklists===

Main Page

2026-03-31T14:45:42Z

Jonesk: /* TABLE OF CONTENTS */

==EMS TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

==IMS TABLE OF CONTENTS==

===Section 1 - Command Operations===

===Section 2 - Operations===

===Section3 - Special Hazards Operations===

===Section 4 - Safety===

===Section 5 - Fire/Cause Investigation===

===Forms / Checklists===

Analgesia and Sedation

2026-03-30T17:45:01Z

Jonesk: /* 2.04 ANALGESIA/SEDATION */

==Section 2 - PRIMARY CARE==
===2.04 ANALGESIA/SEDATION===
''"THE BELOW MEDICATIONS MAY ALL CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR EACH DOSE TO TAKE EFFECT PRIOR TO ANY ADDITIONAL DOSES BEING ADMINISTERED."''

'''PAIN MANAGEMENT:'''
Moderate to severe pain is an “Emergency Medical Condition”, which historically has been undertreated in EMS. Moderate to severe pain can be described as pain greater than or equal to 6 on the 0-10 pain scale. Pain management should target the two components of pain: physiologic pain, pain receptors and psychologic, anxiety, fear, etc. The treatment of pain and anxiety can be accomplished with narcotic analgesics and benzodiazepines in a safe and reversible manner. The maximal effects of a IV or IO dose of a analgesic or anxiolytic occurs within seconds, not minutes.

Considering the above, a logical approach to pain management in an average-sized adult would be to titrate IV Morphine up to 10 mg then titrate Valium or Versed up to 10 mg. Complications can be reversed by administering Narcan or Romazicon.

'''PROCEDURE:'''
* The numeric rating scale will be used to measure pain on all patients. The numeric rating scale ranges from 0 (no pain) to 10 (unbearable pain).
* Non-pharmaceutical (BLS) interventions such as: immobilization of fractures; elevation of extremities; ice packs and padding of spine boards and splints should be attempted first, then re-assess the patient.
* If the pain is still significant (6 or greater) and the patient does not have a contraindication then follow the guidelines below.
* Vital signs are to be taken before and after the administration of the medication. Appropriate documentation is expected.
* Patient's will be continuously monitored while they are under the influence of one of these medications. This will include at a minimum vital signs every 5 minutes and pulse oximetry.
'''[[Chest Pain Acute Coronary Syndrome|ANGINA / MYOCARDIAL INFARCTION]]:'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect.
* NOTE: [[Morphine_Sulfate|MORPHINE SULFATE]] is the preferred treatment of choice, if allergic to MS continue to the following:
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered as needed for pain.
'''[[Acute Abdominal Pain|ACUTE ABDOMINAL PAIN]]:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered.
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect.
'''ANXIETY:'''
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP or IM to desired effect.
'''[[Burns - Thermal, Electrical, Chemical|BURNS]]: (with moderate to severe pain)'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect.
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV, IO or IN, titrated to effect.
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered
'''COMBATIVE POST RESUSCITATION / [[Head Injuries|HEAD INJURY]]:'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect
Note: Morphine should be considered first for combative head injury and suspected MI.
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV or IN, titrated to effect
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP titrated to effect
* [[Ketamine|KETAMINE (KETALAR)]] 0.5 mg/kg IVP or IN, titrated to effect OR 1-2 mg/kg IM x 1 dose - Remember that Ketamine is not reversible and may mask changes in patient condition.
'''[[Cold Emergencies|FROST BITE]]:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
'''MUSCULOSKELETAL PAIN / [[Extremity Injuries|EXTREMITY PAIN]]:'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV, IO or IN, titrated to effect
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP titrated to effect
* [[Ketamine|KETAMINE (KETALAR)]] 0.5 mg/kg IVP or IN, titrated to effect OR 1-2 mg/kg IM x 1 dose - Remember that Ketamine is not reversible and may mask changes in patient condition.
'''FLANK PAIN/[[Suspected Kidney Stone|SUSPECTED KIDNEY STONES]]:'''
* TORADOL (KETOROLAC) 15mg – 30mg IV depending on hydration status
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2-20mg IV, IO or IN titrated to effect
'''[[Sickle Cell Anemia Crisis|SICKLE CELL ANEMIA CRISIS]]:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
'''PEDIATRIC PATIENTS:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Morphine_Sulfate|MORPHINE SULFATE]], 0.1 mg/kg titrate small increments every 20-30 seconds for effect
* [[Versed|MIDAZOLAM (VERSED)]], 0.1 mg/kg refer to Handtevy System for dosage
'''PROCEDURAL SEDATION: Cardioversion, Pacing, Intubation'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV, IO or IN, titrated to effect
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 5 mg SLOW IVP to desired effect

'''THE ABOVE MEDICATIONS MAY ALL CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR EACH DOSE TO TAKE EFFECT PRIOR TO ANY ADDITIONAL DOSES BEING ADMINISTERED.'''

* These drugs may be given in combination for maximum effectiveness.
* Ensure that Pulse Oximeter is in place.
* Ensure that BVM, [[Flumazenil|FLUMAZENIL (ROMAZICON)]] and/or [[Naloxone|NALOXONE (NARCAN)]] are readily available.

[[Category:Primary Care|0204]]

Drug Assisted Intubation

2026-03-27T12:49:40Z

Jonesk: /* Paralytics if needed: */

====Patients who require intubation have at least one of the following 5 indications:====
*1. Failure to ventilate
*2. Inability to maintain airway patency
*3. Inability to protect the airway against aspiration
*4. Failure to adequately oxygenate
*5. Anticipation of an injuries or illness that will eventually lead to the inability to maintain airway patency i.e. Angio Edema, Bad Strep Infection, Ludwig’s Angioedema etc.

====The (7) Seven P’s of DAI====
*1. Prepare
*2. Pre-oxygenate
*3. Pretreatment / Treatment
*4. Paralysis if needed
*5. Protection and positioning
*6. Placement and proof
*7. Post-intubation management

====Prepare:====
*Have all emergency airway supplies prepared and ready, (i.e. Bougie Tube, King Vision, King Airway, Cric-kit) Pre-oxygenate:
* If time permits, pre-oxygenate all patients via NRBM or BVM. 2 Person BVM is recommended once medications are administered. Pretreatment / Treatment:
*Consider [[Lidocaine|LIDOCAINE]] 1.5mg/kg for patients with increased Intracranial pressure. (i.e. head trauma, brain tumor, stroke.) *Administer as early as possible prior to intubation.
*Administer [[Morphine_Sulfate|MORPHINE]]: Adult 2-20mg

==== Paralytics if needed: ====
*<s>If intubation is unsuccessful due to the patient being clinched, strong gag reflex, or seizure, consider Succinylcholine: Adult 1.5mg/kg. Pediatric 2mg/kg.</s>
*<s>Do not administer to patients with Hx of HYPERKALEMIA, RHABDOMYOLYSIS, Severe Burns and Malignant hyperthermia. (i.e. peaked T waves, kidney insufficiency, renal failure, acidosis, crush injuries.)</s>
*<s>If ventricular dysrhythmias are present after medication administration, consider Calcium Chloride.</s>

====Placement and proof:====
*Allow medications to work.
*Maintain Sellick’s maneuver until cuff inflated.
*Ventilate with bag-valve mask if unsuccessful.
*Confirm tube placement EtCO2 and lung sounds.
*Visualize the ET tube passing through the vocal cords.
*st-intubation management:
*Secure endotracheal tube with commercially available device
*Continued sedation (i.e. Versed) (watch for hypotension) consider Fentanyl for pain and sedation
*Continuous SaO2 and EtCO2 monitoring
*Reassess vital signs frequently
*Restrain patient to prevent accidental extubation

====Remember to titrate to effect all medications administered====
====ONCE THE DECISION IS MADE TO PERFORM (DAI), THE LEAD PARAMEDIC MUST CONSIDER THE FOLLOWING:====
*2 PERSON BVM.
*ESTABLISH THE AIRWAY - IF INTUBATION ATTEMPTS FAIL, RETURN TO BVM USE AND TRY TO KEEP SaO2 ABOVE 92% DURING ADDITONAL ATTEMPTS.
*AN ATTEMPT TO PLACE THE KING AIRWAY SHALL BE MADE.
*IF THE KING AIRWAY FAILS, RETURN TO BVM.
*IF UNABLE TO VENTLATE VIA BLS BVM PERFORM SURGICAL CRICOTHYROTOMY

[[Category:Primary Care|0205]]

Drug Assisted Intubation

2026-03-27T11:26:32Z

Jonesk:

====Patients who require intubation have at least one of the following 5 indications:====
*1. Failure to ventilate
*2. Inability to maintain airway patency
*3. Inability to protect the airway against aspiration
*4. Failure to adequately oxygenate
*5. Anticipation of an injuries or illness that will eventually lead to the inability to maintain airway patency i.e. Angio Edema, Bad Strep Infection, Ludwig’s Angioedema etc.

====The (7) Seven P’s of DAI====
*1. Prepare
*2. Pre-oxygenate
*3. Pretreatment / Treatment
*4. Paralysis if needed
*5. Protection and positioning
*6. Placement and proof
*7. Post-intubation management

====Prepare:====
*Have all emergency airway supplies prepared and ready, (i.e. Bougie Tube, King Vision, King Airway, Cric-kit) Pre-oxygenate:
* If time permits, pre-oxygenate all patients via NRBM or BVM. 2 Person BVM is recommended once medications are administered. Pretreatment / Treatment:
*Consider [[Lidocaine|LIDOCAINE]] 1.5mg/kg for patients with increased Intracranial pressure. (i.e. head trauma, brain tumor, stroke.) *Administer as early as possible prior to intubation.
*Administer [[Morphine_Sulfate|MORPHINE]]: Adult 2-20mg

==== Paralytics if needed: ====
*If intubation is unsuccessful due to the patient being clinched, strong gag reflex, or seizure, consider Succinylcholine: Adult 1.5mg/kg. Pediatric 2mg/kg.
*Do not administer to patients with Hx of HYPERKALEMIA, RHABDOMYOLYSIS, Severe Burns and Malignant hyperthermia. (i.e. peaked T waves, kidney insufficiency, renal failure, acidosis, crush injuries.)
*If ventricular dysrhythmias are present after medication administration, consider Calcium Chloride.

====Placement and proof:====
*Allow medications to work.
*Maintain Sellick’s maneuver until cuff inflated.
*Ventilate with bag-valve mask if unsuccessful.
*Confirm tube placement EtCO2 and lung sounds.
*Visualize the ET tube passing through the vocal cords.
*st-intubation management:
*Secure endotracheal tube with commercially available device
*Continued sedation (i.e. Versed) (watch for hypotension) consider Fentanyl for pain and sedation
*Continuous SaO2 and EtCO2 monitoring
*Reassess vital signs frequently
*Restrain patient to prevent accidental extubation

====Remember to titrate to effect all medications administered====
====ONCE THE DECISION IS MADE TO PERFORM (DAI), THE LEAD PARAMEDIC MUST CONSIDER THE FOLLOWING:====
*2 PERSON BVM.
*ESTABLISH THE AIRWAY - IF INTUBATION ATTEMPTS FAIL, RETURN TO BVM USE AND TRY TO KEEP SaO2 ABOVE 92% DURING ADDITONAL ATTEMPTS.
*AN ATTEMPT TO PLACE THE KING AIRWAY SHALL BE MADE.
*IF THE KING AIRWAY FAILS, RETURN TO BVM.
*IF UNABLE TO VENTLATE VIA BLS BVM PERFORM SURGICAL CRICOTHYROTOMY

[[Category:Primary Care|0205]]

Main Page

2026-03-27T11:19:08Z

Jonesk: Removed Link to Code Cool Protocol

==TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||<s>Code Cool Post ROSC Induced Hypothermia</s> REMOVED||March-26
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

Main Page

2026-03-26T19:53:22Z

Jonesk: /* Section 2 - Primary Care */

==TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||March-26
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

Analgesia and Sedation

2026-03-26T19:52:18Z

Jonesk: /* 2.04 ANALGESIA/SEDATION */

==Section 2 - PRIMARY CARE==
===2.04 ANALGESIA/SEDATION===
''"THE BELOW MEDICATIONS MAY ALL CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR EACH DOSE TO TAKE EFFECT PRIOR TO ANY ADDITIONAL DOSES BEING ADMINISTERED."''

'''PAIN MANAGEMENT:'''
Moderate to severe pain is an “Emergency Medical Condition”, which historically has been undertreated in EMS. Moderate to severe pain can be described as pain greater than or equal to 6 on the 0-10 pain scale. Pain management should target the two components of pain: physiologic pain, pain receptors and psychologic, anxiety, fear, etc. The treatment of pain and anxiety can be accomplished with narcotic analgesics and benzodiazepines in a safe and reversible manner. The maximal effects of a IV or IO dose of a analgesic or anxiolytic occurs within seconds, not minutes.

Considering the above, a logical approach to pain management in an average-sized adult would be to titrate IV Morphine up to 10 mg then titrate Valium or Versed up to 10 mg. Complications can be reversed by administering Narcan or Romazicon.

'''PROCEDURE:'''
* The numeric rating scale will be used to measure pain on all patients. The numeric rating scale ranges from 0 (no pain) to 10 (unbearable pain).
* Non-pharmaceutical (BLS) interventions such as: immobilization of fractures; elevation of extremities; ice packs and padding of spine boards and splints should be attempted first, then re-assess the patient.
* If the pain is still significant (6 or greater) and the patient does not have a contraindication then follow the guidelines below.
* Vital signs are to be taken before and after the administration of the medication. Appropriate documentation is expected.
* Patient's will be continuously monitored while they are under the influence of one of these medications. This will include at a minimum vital signs every 5 minutes and pulse oximetry.
'''[[Chest Pain Acute Coronary Syndrome|ANGINA / MYOCARDIAL INFARCTION]]:'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect.
* NOTE: [[Morphine_Sulfate|MORPHINE SULFATE]] is the preferred treatment of choice, if allergic to MS continue to the following:
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered as needed for pain.
'''[[Acute Abdominal Pain|ACUTE ABDOMINAL PAIN]]:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered.
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect.
'''ANXIETY:'''
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP or IM to desired effect.
'''[[Burns - Thermal, Electrical, Chemical|BURNS]]: (with moderate to severe pain)'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect.
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV, IO or IN, titrated to effect.
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered
'''COMBATIVE POST RESUSCITATION / [[Head Injuries|HEAD INJURY]]:'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect
Note: Morphine should be considered first for combative head injury and suspected MI.
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV or IN, titrated to effect
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP titrated to effect
* [[Ketamine|KETAMINE (KETALAR)]] 0.5 mg/kg IVP or IN titrated to effect OR 1-2 mg/kg IM x 1 dose - Remember that Ketamine is not reversible and may mask changes in patient condition.
'''[[Cold Emergencies|FROST BITE]]:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
'''MUSCULOSKELETAL PAIN / [[Extremity Injuries|EXTREMITY PAIN]]:'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV, IO or IN, titrated to effect
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP titrated to effect
* [[Ketamine|KETAMINE (KETALAR)]] 0.5 mg/kg IVP or IN every 20 seconds titrated to effect OR 1-2 mg/kg IM x 1 dose - Remember that Ketamine is not reversible and may mask changes in patient condition.
'''FLANK PAIN/[[Suspected Kidney Stone|SUSPECTED KIDNEY STONES]]:'''
* TORADOL (KETOROLAC) 15mg – 30mg IV depending on hydration status
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2-20mg IV, IO or IN titrated to effect
'''[[Sickle Cell Anemia Crisis|SICKLE CELL ANEMIA CRISIS]]:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
'''PEDIATRIC PATIENTS:'''
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
* [[Morphine_Sulfate|MORPHINE SULFATE]], 0.1 mg/kg titrate small increments every 20-30 seconds for effect
* [[Versed|MIDAZOLAM (VERSED)]], 0.1 mg/kg refer to Handtevy System for dosage
'''PROCEDURAL SEDATION: Cardioversion, Pacing, Intubation'''
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IO or IN, titrated to effect
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV, IO or IN, titrated to effect
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 5 mg SLOW IVP to desired effect

'''THE ABOVE MEDICATIONS MAY ALL CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR EACH DOSE TO TAKE EFFECT PRIOR TO ANY ADDITIONAL DOSES BEING ADMINISTERED.'''

* These drugs may be given in combination for maximum effectiveness.
* Ensure that Pulse Oximeter is in place.
* Ensure that BVM, [[Flumazenil|FLUMAZENIL (ROMAZICON)]] and/or [[Naloxone|NALOXONE (NARCAN)]] are readily available.

[[Category:Primary Care|0204]]

Pulseless Electrical Activity (PEA)

2026-03-25T16:19:40Z

Jonesk: /* Pharmacologic Therapy: */

== Section 4 - CARDIAC ==
=== 4.04 PULSELESS ELECTRICAL ACTIVITY (PEA) ===

Pulseless Electrical Activity is a condition associated with poor outcomes. It is identified by the presence of cardiac electrical activity with no corresponding mechanical pulse or signs of perfusion. It is important to CONFIRM true PEA early in the management of the case. Consider all possible reversible causes for PEA utilizing a national recommended mnemonic of “H’s and T’s”:

{| class="wikitable"
|-
! H’s !! T’s
|-
| Hypovolemia|| Tension Pneumothorax
|-
| Hypoxia|| Tamponade, cardiac
|-
| Hydrogen Ion (acidosis)|| Toxins or Tablets (overdose)
|-
| Hypo/hyperkalemia|| Thrombosis, pulmonary
|-
| Hypothermia|| Thrombosis, cardiac
|}

In addition, also consider the following:
{| class="wikitable"
|-
| Hypoglycemia|| Trauma
|}
'''
BASED ON THE MEDICAL ETIOLOGY OF PEA REFER TO APPROPRIATE PRACTICE PARAMETER:'''
* Hypovolemia, [[Shock|SHOCK (5.13)]].
* Tension Pneumothorax, [[Chest Injuries|CHEST INJURIES (6.04)]].
* Hypoxia / Acidosis, [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]].
* Hypothermia, [[Cold Emergencies|COLD EMERGENCIES (5.06)]].
* Hypoglycemia, [[Hypo or Hyperglycemia|HYPO/HYPERGLYCEMIA (5.10)]]
* Toxins, [[Drug Overdose Poisoning|DRUG OVERDOSE/POISONING (5.05)]]

'''''When the Patient found in True PEA:'''''
* Initiate 5 cycles of high quality CPR (push hard/push fast)
** Minimum of 100 compressions per minute, minimize interruptions
** Compression rate of 30:2 for approximately 2 minutes
** Depth of compression of at least 2 inches
** Initiate the use of a mechanical compression device if available
* Assist ventilations with OXYGEN @ 100% via BVM - DO NOT HYPERVENTILATE
* Establish intravenous access via IV or IO
* Reassess for circulation every two minutes
** If a shockable rhythm is identified proceed to [[Ventricular Fibrillation Pulseless Ventricular Tachycardia|VF/VT PARAMETER (4.08)]]
* Consider advanced airway procedure using supraglottic airway (king tube) or endotracheal intubation
** Do not interrupt compressions to place an advanced airway
** Confirm tube placement with capnography (a range 5-20 mmHg is indicative of low cardiac output)
* If hypovolemia suspected, administer IV fluid bolus 200 - 300 ml and reassess
* If HYPOTHERMIC, also follow [[Cold Emergencies|HYPOTHERMIC PARAMETER (5.06)]]

====Pharmacologic Therapy:====
* [[Epinephrine|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest

{| class="wikitable"
|-
! The current national guidelines do not include ATROPINE from treatment of TRUE PEA as there is no proof it has a therapeutic benefit. <br />
Under the Seminole County Practice Parameters the use of ATROPINE SULFATE is indicated in cardiac arrest that may be caused by extreme bradycardia/hypotension.
|}

'''''Check for pulse and rhythm change after all interventions.'''''

====Cases of suspected bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.====
* First, [[Atropine|ATROPINE]] 0.5 -1.0 mg rapid IV / IO. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg
* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above
* [[Epinephrine|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest

'''''If patient combative post resuscitation, refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PARAMETER (2.04)]].'''''

====Termination of Resuscitation:====
In Medical Related Cardiac Arrests, the paramedic may terminate resuscitative efforts in Non-Hypothermic Adults provided all of the following criteria have been provided and established:
* Patient initially presents and maintains PEA
* Airway has been successfully controlled (not necessarily intubated)
* If clinically indicated - ATROPINE SULFATE 1.0 mg rapid IVP/ IO has been administered and allowed time to circulate x1.
* EPINEPHRINE 1:10,000 1 mg IVP or IO has been administered & allowed time to circulate x1, or
* VASOPRESSIN 40 units IVP has been administered and allowed time to circulate. x1
* EtCO2 is (less than) < 20 mm Hg
* Efforts to verify akinetic heart have been taken
** Lack of Heart sounds
** Rule out of H's and T's
'''OR'''
* After 15 minutes of ALS procedures without any response or return of spontaneous circulation
'''OR'''
* After the patient’s personal medical doctor agrees to sign the death certificate
'''''Contact will be made in conjunction and compliance with Federal, State, Local, and Agency Laws and Policies regarding patient body care and removal.'''''
<br />

'''''A paramedic may decide to continue resuscitation efforts as outlined in these Practice Parameters. Reasons to continue may include scene safety, location, and input from present family members.'''''

[[Category:Cardiac|0404]]

Allergic Reaction Anaphylactic Shock

2026-02-20T17:50:07Z

Jonesk:

==Section 5 -MEDICAL==
===5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK===

*For pediatric patients, refer to Handtevy
*Reactions tend to be more severe if they occur immediately after contact or ingestion
*Exam airway for edema

===[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)===
* Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition.
* Establish IV or administer medications into extremity without bite or injection of allergen.
* Administer medications into areas without hives (urticaria)

=== <span style="color: green;">MILD (urticaria, no respiratory involvement)</span> ===
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
*Consider [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP if the speed of reaction appears rapid.
=== <span style="color: gold;">MODERATE (mild respiratory involvement)</span> ===
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IVP/IM
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml or 20mg/100ml IV/IVPB
*[[Epinephrine|EPINEPHRINE]] UPDRAFT (1mg/1ml + 2ml NS)

*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*IPRATROPIUM (ATROVENT) 0.5mg via updraft
=== <span style="color: red;">SEVERE (stridor / airway involvement) </span> ===
*[[Epinephrine|EPINEPHRINE]] 1mg/1ml 0.3-0.5mg IM (may repeat q 10min)
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml or 20mg/100ml IVPB
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*[[Atrovent|IPRATROPIUM BROMIDE [ATROVENT]]] 0.5mg via updraft

=== <span style="color: red;">ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT</span> ===
*[[Epinephrine|EPINEPHRINE]] 0.1mg/1ml 0.5-1mg IVP (may repeat q 10 min)
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)

[[Category:Medical|0502]]

Allergic Reaction Anaphylactic Shock

2026-02-20T17:48:43Z

Jonesk: /* MODERATE (mild respiratory involvement) */

==Section 5 -MEDICAL==
===5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK===

*For pediatric patients, refer to Handtevy
*Reactions tend to be more severe if they occur immediately after contact or ingestion
*Exam airway for edema

===[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)===
* Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition.
* Establish IV or administer medications into extremity without bite or injection of allergen.
* Administer medications into areas without hives (urticaria)

=== <span style="color: green;">MILD (urticaria, no respiratory involvement)</span> ===
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
*Consider [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP if the speed of reaction appears rapid.

=== <span style="color: gold;">MODERATE (mild respiratory involvement)</span> ===
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IVP/IM
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml or 20mg/100ml IV/IVPB
*[[Epinephrine|EPINEPHRINE]] UPDRAFT (1mg/1ml + 2ml NS)

*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*IPRATROPIUM (ATROVENT) 0.5mg via updraft

=== <span style="color: red;">SEVERE (stridor / airway involvement) </span> ===
*[[Epinephrine|EPINEPHRINE]] 1mg/1ml 0.3-0.5mg IM (may repeat q 10min)
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml or 20mg/100ml IVPB
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*[[Atrovent|IPRATROPIUM BROMIDE [ATROVENT]]] 0.5mg via updraft

=== <span style="color: red;">ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT</span> ===
*[[Epinephrine|EPINEPHRINE]] 0.1mg/1ml 0.5-1mg IVP (may repeat q 10 min)
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)

[[Category:Medical|0502]]

Main Page

2026-02-20T17:43:05Z

Jonesk: /* Section 8 - Medication Guidelines */ updated the date of last change

==TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||December-20
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||February-26
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

Main Page

2026-02-20T17:42:21Z

Jonesk: /* Section 5 - Medical */ updated the date of last change

==TABLE OF CONTENTS==

[[Medical Director Authorization]]

[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date !! Reviewed Date
|-
| 1.01 || [[General Measures]] || March-24 ||March-24
|-
| 1.02 || [[Radio Report Format]] || July-21 ||
|-
| 1.03 || [[Refusal of Service]] || October-17 ||
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09 ||
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09 ||
|-
| 1.09|| [[Trauma Transport Protocol]]|| February-19 ||
|-
| 1.10|| [[Emergency Transport]]|| March-09 ||
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09 ||
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
|-
| 1.15|| [[EMS Saturation Disaster Response Levels]]|| April-16 ||
|-
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
|-
| 1.19|| [[Post Exposure Prophylaxis (PEP)]]|| November-21 ||
|-
| 1.20|| [[Scope of Practice]]|| July-23 ||
|-
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
|-
| 1.24|| [[School Medication Authorization Forms]]|| June-18 ||

|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||December-20
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety or Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Mar-22
|-
|4.02 || [[Asystole]]||December-22
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||April-24
|-
|4.07||[[Supraventricular Tachycardia]]||January-20
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||January-20
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||March-22
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||February-26
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||July-22
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Non-Hemorrhagic Shock]]||October-18
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||Jan-24
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}

===Section 6 - Trauma===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||August-18
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||November-25
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||February-26
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||April-20
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===

INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Amiodarone]]||July-17
|-
|[[Ancef]]||January-24
|-
|[[Aspirin]]||March-09
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-20
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]/Tetracaine||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||August-24
|-
|[[TXA]]||July-25
|-
|[[Xopenex]]||April-16
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||March-09
|}

===Section 9 - Procedure Guidelines===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[Lucas Device]]||November-21
|-
|9.01||[[Autovent]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-18
|-
|9.03||[[Blood Draw using Vacutainer|Blood Draw using Vacutainer Tubes]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring and Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[IVAC Medsystem III MultiChannel Infusion Pump]]||March-09
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[ResQPOD Impedance Threshold Device]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Venous Lactate Monitoring Procedure]]||May-12
|-
|9.34||[[Central Venous Access Devices]]||June-12
|-
|9.35||[[Medication Administration Cross Check]]||Jun-12
|-
|9.36||[[Combat Application Tourniquet]]||Jan-14
|-
|9.37||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.38||[[iTClamp Hemorrhage Control System]]||Feb-15
|-
|9.39||[[I-gel Supraglottic Airway]]||February-24
|-
|9.40||[[T-POD Pelvic Stabilization Device]]||Sept-23
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[https://www.health.state.mn.us/communities/ep/surge/burn/tbsa.html Rule of Nines]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|-
|10.14||[[Celox Gauze Powerpoint]]||April-12
|-
|10.15||[[Sepsis and Venous Lactate Powerpoint]]||April-12
|-
|10.16||[[Media:MCSO EMS LVAD Guide.pdf| LVAD EMS Guide]]||Sept-18
|-
|10.16.1||[[Media:LVAD HeartmateIII Green.pdf| HeartMate III LVAD - Green]]||Sept-18
|-
|10.16.2||[[Media:LVAD HeartmateII Red.pdf| HeartMate II LVAD - Red]]||Sept-18
|-
|10.16.3||[[Media:LVAD HeartWare DarkBlue.pdf| HeartWare LVAD - Dark Blue]]||Sept-18
|-
|10.16.4||[[Media:LVAD Jarvik Lavender.pdf| Jarvik 2000 LVAD - Lavendar]]||Sept-18
|-
|10.16.5||[[Media:LVAD Thoratec LightBlue.pdf| Thoratec LVAD - Light Blue]]||Sept-18
|-
|10.16.6||[[Media:LVAD DuraHeart Purple.pdf| DuraHeart LVAD - Purple]]||Sept-18
|-
|10.16.7||[[Media:LVAD TotalArtificialHeart Pink.pdf| Total Artificial Heart LVAD - Pink]]||Sept-18
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
|-
| [[Memo - Masks Required in ED's]]|| 2022-08-22
|-
| [[Memo - QA/QI Program]]|| 2022-03-21
|-
| [[Memo - Additional EMS Skills]]|| 2020-09-01
|-
| [[Memo - Transport of SEPSIS Patients to Freestanding ED's]]|| 2020-07-15
|-
| [[Memo - Clarification on Destination Choices|Clarification on Destination Choices]]|| 2019-11-14
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte Clarification|Transport to the OD Hospital – Advent Health Altamonte Clarification]]|| 2019-11-07
|-
| [[Memo - Transport to the OD Hospital – Advent Health Altamonte|Transport to the OD Hospital – Advent Health Altamonte]]|| 2019-11-04
|-
| [[Memo - Further clarification on Advent Health OD Facility|Further clarification on Advent Health OD Facility]]|| 2019-08-26
|-
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
|-
| [[Memo - Clarification of Baker Act patients transported by EMS|Clarification of Baker Act patients transported by EMS]] || 2018-04-11
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Florida Hospital East Pediatric ED|Florida Hospital East Pediatric ED]] || 2015-11-23
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Transport of Psychiatric Patients|Transport of Psychiatric Patients]] || 2010-05-17
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|-
| [[Memo - Transport of STEMI Patients - Revised 20100219|Transport of STEMI Patients ]] || 2010-03-19
|-
| [[Memo - Aircare Update 20100319|Aircare Update ]] || 2010-03-19
|-
| [[Memo - Delayed Offloads with Critical or Unstable Patients|Delayed Offloads with Critical or Unstable Patients]] || 2010-02-25
|-
| [[Memo - Transport of STEMI Patients|Transport of STEMI Patients]] || 2010-02-19
|-
| [[Memo - Response to Physician's Offices|Response to Physicians Offices]] || 2009-10-14
|-
| [[Memo - Patient Reports Being Given to Hospitals|Patient Reports Being Given to Hospitals]] || 2009-09-23
|-
| [[Memo - Patient Medications - Revised 20090720|Patient Medications ]]|| 2009-07-20
|-
| [[Memo - H1N1 Update 20090624|H1N1 Update ]]|| 2009-06-24
|-
| [[Memo - Multiple Patient Refusal - Wording|Multiple Patient Refusal - Wording]] || 2009-06-04
|-
| [[Memo - Request for Call Reviews|Request for Call Reviews]]|| 2009-05-14
|-
| [[Memo - H1N1 Update 20090505|H1N1 Update ]] || 2009-05-05
|-
| [[Memo - Clarification on Selection for Spinal Immobilization|Clarification on Selection for Spinal Immobilization]] || 2009-04-30
|-
| [[Memo - EKG Strips|EKG Strips]]|| 2009-04-23
|-
| [[Memo - Patient Medications|Patient Medications]]|| 2009-04-23
|-
| [[Memo - Leaving run reports at the E.R.|Leaving run reports at the E.R.]] || 2009-02-03
|-
| [[Memo - Hyperbaric Chamber at CFRH|Hyperbaric Chamber at CFRH]] || 2008-10-16
|-
| [[Memo - Stemi Transport Destinations|Stemi Transport Destinations]] || 2008-07-22
|-
| [[Memo - STEMI Alerts to Winter Park Hospital|STEMI Alerts to Winter Park Hospital]] || 2008-02-04
|-
| [[Memo - Documentation of Medications|Documentation of Medications]]|| 2005-01-27
|}

===Section 12 - Paramedic Clinical Assessment Program===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|12.01||[[Media:PCAP Guidelines Document Jan 2019.pdf|PCAP Guidelines]]||Jan-19
|-
|12.02||[[Media:ALS Contact Form Rev 2010.pdf|ALS Contact Form]]||June-10
|-
|12.03||[[Media:Evaluation Form Equip.pdf|Evaluation Form - Equip]]||Jan-13
|-
|12.04||[[Media:Evaluation Form Protocols.pdf|Evaluation Form - Protocols]]||Jan-13
|-
|12.05||[[Media:Definition of an ALS contact.pdf|ALS Contact Definition]]||June-10
|-
|12.06||[[Media:Daily Performance Evaluation Report Form.pdf|Daily Performance Eval]]||Sept-17
|-
|12.07||[[Media:Medical director meetings roster.pdf|MD Meetings Roster]]||May-13
|-
|12.08||[[Media:Mentor evaluation.pdf|Mentor Evaluation]]||May-13
|-
|12.09||[[Media:Verification of EMT Skills edited final.pdf|Verification of EMT Skills]]||May-13
|-
|12.10||[[Media:PCAP Completion Checklist.pdf|PCAP Completion Checklist]]||Sept-17
|-
|12.11||[[Media:Verification of PM Skills.pdf|Verification of Paramedic Skills]]||May-13
|-
|12.12||[[Media:ALS Contact Form Example 1.pdf|ALS Contact Form Example 1]]||Dec-14
|-
|12.13||[[Media:ALS Contact Form Example 2.pdf|ALS Contact Form Example 2]]||Dec-14
|-
|12.14||[[Media:Incapacitated Patient Management.pdf|Incapacitated Patient Management]]||Dec-14
|}

===Section 13 - COVID-19===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 13.01|| [[MD Memo - Please use Common Sense]]|| 2020-03-13
|-
| 13.02|| [[Hospital Screening and Procedures]]|| 2020-03-26
|-
| 13.03|| [[Dispatch Screening and Procedures]]|| 2020-04-01
|-
| 13.04|| [[Media:SRP Question Card.pdf| Strict Respiratory Precautions Question Card]]|| 2020-04-01
|-
| 13.05|| [[American Red Cross Changed Response Procedures]]|| 2020-03-31
|-
| 13.06|| [[Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice]] || 2020-07-15
|-
| 13.07|| [[Updated COVID Transport to FSED]]|| 2020-07-20
|}

[https://forms.gle/XA7uhzLGYbwqBHTZ9 Link to MD Meeting Sign In]

Allergic Reaction Anaphylactic Shock

2026-02-20T17:41:26Z

Jonesk: Updated Moderate and Severe with new Famotidine dosages

==Section 5 -MEDICAL==
===5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK===

*For pediatric patients, refer to Handtevy
*Reactions tend to be more severe if they occur immediately after contact or ingestion
*Exam airway for edema

===[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)===
* Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition.
* Establish IV or administer medications into extremity without bite or injection of allergen.
* Administer medications into areas without hives (urticaria)

=== <span style="color: green;">MILD (urticaria, no respiratory involvement)</span> ===
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
*Consider [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP if the speed of reaction appears rapid.

=== <span style="color: gold;">MODERATE (mild respiratory involvement)</span> ===
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IVP/IM
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml or 20mg/100ml IVPB
*[[Epinephrine|EPINEPHRINE]] UPDRAFT (1mg/1ml + 2ml NS)

*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*IPRATROPIUM (ATROVENT) 0.5mg via updraft

=== <span style="color: red;">SEVERE (stridor / airway involvement) </span> ===
*[[Epinephrine|EPINEPHRINE]] 1mg/1ml 0.3-0.5mg IM (may repeat q 10min)
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml or 20mg/100ml IVPB
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*[[Atrovent|IPRATROPIUM BROMIDE [ATROVENT]]] 0.5mg via updraft

=== <span style="color: red;">ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT</span> ===
*[[Epinephrine|EPINEPHRINE]] 0.1mg/1ml 0.5-1mg IVP (may repeat q 10 min)
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)

[[Category:Medical|0502]]

Pepcid

2026-02-20T17:37:36Z

Jonesk: Added 20mg vials and changed adult dosage to include 20mg/100mL bags

==Section 8 - MEDICATION GUIDELINES==
===ANTIHISTAMINES===

====Famotidine (PEPCID) / H2 Histamine blocker====
'''DESCRIPTION'''
* Famotidine inhibits histamine at H2 receptor site in the gastric parietal cell, which inhibits gastric acid secretion.
'''INDICATIONS'''
* [[Allergic Reaction Anaphylactic Shock|Hives; Allergic reaction]]; Short term treatment of duodenal and gastric ulcers, management of GERD and erosive esophagitis.
'''CONTRAINDICATIONS'''
* Hypersensitivity to the medication
* Renal impairment
'''PRECAUTIONS'''
* Hepatic disease, renal disease, elderly
'''DOSAGE'''
* Currently supplied in 20mg/50 mL Premixed bags or 20mg Vials
* Adults: 20mg/50mL or 20mg mixed into a 100mL bag, given at a wide open rate.
* Pediatrics - refer to the Handtevy System.

[[Category:Medication Guidelines|Pepcid]]