Protocopedia - User contributions [en]

Scope of Practice

2026-03-12T16:04:04Z

Treloars: /* 1.20 SCOPE OF PRACTICE */

== Section 1 - ADMINISTRATIVE POLICIES ==
===1.20 SCOPE OF PRACTICE===

{| class="wikitable"
|-
! !! Preparation Routine Management Skills !! EMT !! Paramedic
|-
| 1 || Body Substance Isolation Precautions/Application || X || X
|-
| 2 || Initial/Primary and Secondary Assessments || X || X
|-
| 3 || Obtaining and Recording of Vital Signs || X || X
|-
| 4 || Patient Care Report (PCR) Documentation || X || X
|-
| 5 || Obtaining and Documenting Informed Refusals || X || X
|-
| 6 || Initiation of CPR/Determination of Death || X || X
|-
| 7 || Initiation of Trauma Triage Evaluation || X || X
|-
| 8 || IV lifeline and Fluid Administration || || X
|-
| 9 || Intranasal Mucosal Atomization Device (MAD) Administration || || X
|-
| 10 || Intraosseous Infusion and Medication Administration || || X
|-
| 11 || Intramuscular Medication Administration || || X
|-
| 12 || Subcutaneous Medication Administration || || X
|-
| 13 || Saline Lock Initiation || X || X
|-
| 14 || Discontinuing/Removing an Intravenous Line || X || X
|-
| 15 || Reconstitution of Medications for Administration || || X
|-
| 16 || IV Infusion Pump Initiation/Management || || X
|-
| 17 || Monitor Medicated IV Drips || || X
|-
| 18 || Buretrol Application and Management || || X
|-
| 19 || Blood Alcohol Draw (for LEA) on Scene || || X
|-
| 20 || Peripheral Venipuncture, Vacutainer Blood Sample Draw || X || X
|}

{| class="wikitable"
|-
! !! Airway Management Skills !! EMT !! Paramedic
|-
| 1 || Open and Maintain the Airway || X || X
|-
| 1a || Head Tilt-Chin Lift || X || X
|-
| 1b || Jaw Thrust || X || X
|-
| 2 || Obstructed Airway Management || X || X
|-
| 3 || Oropharyngeal Airway Adjunct Placement and Management || X || X
|-
| 4 || Nasopharyngeal Airway Adjunct Placement and Management || X || X
|-
| 5 || Oral Suctioning || X || X
|-
| 6 || Endotracheal Suctioning || || X
|-
| 6a || Tracheostomy Tube Suctioning || || X
|-
| 6b || Tracheostomy Tube Replacement || || X
|-
| 7 || Pulse Oximetry Equipment Application/Reading || X || X
|-
| 8 || Oxygen Administration || X || X
|-
| 8a || Nasal Cannula || X || X
|-
| 8b || Simple Face Mask || X || X
|-
| 8c || Non-Rebreather Mask || X || X
|-
| 9 || Mouth-to-Barrier Devices || X || X
|-
| 10 || Bag Valve Mask Device Application and Management || X || X
|-
| 11 || Ventilation Management || X || X
|-
| 12 || Ventilation with a Flow-Restricted O2 Powered Device (Auto- || || X
|-
| 13 || Orotracheal Intubation || || X
|-
| 14 || Nasotracheal Intubation || || X
|-
| 15 || Cricothyrotomy (Needle or Surgical) || || X
|-
| 16 || Supraglottic Airway || X|| X
|-
| 17 || Ventilator Management - 16 y/o or older || || X
|-
| 18 || CPAP Administration and Management || || X
|-
| 19 || End Tidal CO2 Monitoring & Detection || || X
|-
| 20 || Dynamic Carbon Monoxide Level Monitoring and Management || || X
|-
| 21 || Nasogastric (NG) Tube Placement || || X
|}

{| class="wikitable"
|-
! !! Cardiac Management Skills !! EMT !! Paramedic
|-
| 1 || Automated External Defibrillator (AED) || X || X
|-
| 2 || Cardiac Monitor Setup || X || X
|-
| 3 || Cardiac Monitor Rhythm Interpretation || || X
|-
| 4 || Cardiopulmonary Resuscitation (CPR) || X || X
|-
| 5 || Impedance Threshold Device ResQ-Pod Initiation/Management || X || X
|-
| 6 || Transcutaneous Cardiac pacing || || X
|-
| 7 || Aspirin Administration || X || X
|-
| 8 || Cardiac Medication Administration || || X
|-
| 9 || Cardioversion || || X
|-
| 10 || 12-lead EKG Setup || X || X
|-
| 11 || 12-Lead Interpretation || || X
|-
| 12 || Chest compression Assist Devices (Auto-Pulse) || X || X
|-
| 13 || Dynamic Capnography Monitoring || || X
|}

{| class="wikitable"
|-
! !! Medical Management Skills !! EMT !! Paramedic
|-
| 1 || Glucose Monitoring System Use || X || X
|-
| 2 || Peripheral IV Blood Specimens || || X
|-
| 3 || Oral Glucose Administration || X || X
|-
| 4 || Auto-Injector Epinephrine (Pt. Assisted) || X || X
|-
| 5 || Epinephrine Administration (Subcutaneous) || || X
|-
| 6 || Nitroglycerine Administration (Pt. Assisted) || X || X
|-
| 7 || Nitroglycerine Administration (Non pt. Assist) || || X
|-
| 8 || Metered dose Inhaler (Pt. Assisted) || X || X
|-
| 9 || Nebulized Medications || || X
|-
| 10 || Set up of IV Administration Kit || X || X
|-
| 11 || Automated Non-invasive Blood Pressure Monitoring || X || X
|}

====Patient Assisted Definition:====
*May assist with patient's prescription upon patient request and with written protocol.
*May assist from EMS provided medications with verbal medical direction

{| class="wikitable"
|-
! !! Trauma Management Skills !! EMT !!Paramedic
|-
| 1 || Selective Spinal Immobilization || X || X
|-
| 2 || Spinal Cervical Immobilization || X || X
|-
| 3 || Application of Cervical Collar || X || X
|-
| 4 || Cervical Immobilization Device (CID) Application || X || X
|-
| 5 || Long Spine Board || X || X
|-
| 6 || Short Device Board (KED) || X || X
|-
| 7 || Splinting Devices || X || X
|-
| 8 || Traction Splint || X || X
|-
| 9 || Reeves Stretcher || X || X
|-
| 10 || Pediatric Immobilizer || X || X
|-
| 11 || Helmet Removal || X || X
|-
| 12 || Rapid Extrication Procedures || X || X
|-
| 13 || Needle Decompression of the Chest (Pleural Decompression) || || X
|-
| 14 || Burn Wounds Management || X || X
|-
| 15 || Soft Tissue Injury Management || X || X
|-
| 16 || Bleeding Control Including Tourniquets || X || X
|-
| 17 || Management of Suspected Fractures || X || X
|-
| 18 || Emergency Childbirth Management || X || X
|-
| 19 || Removal of TASER Probes || X || X
|-
| 20 || Emergency C-Section || || X
|}

{| class="wikitable"
|-
! !! Approved Medications !! EMT !! Paramedic
|-
| 1 || Adenosine (Adenocard) || || X
|-
| 2 || Albuterol (Proventil) || || X
|-
| 3 || Aspirin (Chewable) || X || X
|-
| 4 || Atropine Sulfate || || X
|-
| 5 || Calcium Chloride || || X
|-
| 6 || Cimetidine (Tagamet) || || X
|-
| 7 || Dextrose 50% || || X
|-
| 8 || Diazepam (Valium) || || X
|-
| 9 || Diltiazem (Cardizem) || || X
|-
| 10 || Diphenhydramine (Benadryl) || || X
|-
| 11 || Dopamine (Intropin) || || X
|-
| 12 || Epinephrine || || X
|-
| 13 || Epinephrine (Patient’s own Auto injector) || X || X
|-
| 14 || Flumazenil (Romazicon) || || X
|-
| 15 || Furosemide (Lasix) || || X
|-
| 16 || Glucagon || || X
|-
| 17 || Glucose (Oral) || X || X
|-
| 18 || Ketolorac (Toradol) || || X
|-
| 19 || Levalbuterol HCL (Xopenex) || || X
|-
| 20 || Lidocaine HCL || || X
|-
| 21 || Magnesium Sulfate || || X
|-
| 22 || Methylprednisolone (Solu-medrol) || || X
|-
| 23 || Midazolam (Versed) || || X
|-
| 24 || Morphine Sulfate || || X
|-
| 25 || Naloxone (Narcan) || || X
|-
| 26 || Nitroglycerin Sublingual || X || X
|-
| 27 || Nitroglycerine Drip || || X
|-
| 28 || Nitrous Oxide || || X
|-
| 29 || Ondansetron Hydrochloride (Zofran) || || X
|-
| 30 || Oxygen || X || X
|-
| 31 || Pontocaine Ophthalmic || || X
|-
| 32 || Promethazine (Phenergan) || || X
|-
| 33 || Sodium Bicarbonate || || X
|-
| 34 || Vaponefrine (Racemic Epinephrine) || || X
|}

==== Additional Skills/Procedures as Authorized by the Medical Director ====
* The Medical Director reserves the right to authorize personnel to use additional skills and abilities outside of this Scope of Practice for which they have been trained for during special events, local or regional disasters or other situations where it is in the best interest of the welfare of the public and/or the need to mitigate a natural or man-made disaster.
* The Medical Director also authorizes the EMT to administer oral or sublingual medications to patients under the direct supervision of a Seminole County Paramedic.

====Additional services====
* In the event of an emergency declared by the governor that affects the public's health, EMT-basic, or EMT-paramedic may perform immunizations and administer drugs or dangerous drugs, in relation to the emergency, provided the first responder or EMT is under physician medical direction and has received appropriate training regarding the administration of such immunizations and/or drugs.

====Nerve Agent or Organophosphate Release====
* A first responder, EMT-basic, or EMT-paramedic, may administer drugs or dangerous drugs contained within a nerve agent antidote auto-injector kit, including a MARK I kit, in response to suspected or known exposure to a nerve or organophosphate agent provided the first responder or EMT is under physician medical direction and has received appropriate training regarding the administration of such drugs within the nerve agent antidote auto-injector kit.

[[Category:Administrative Policies|0120]]

Ceftriaxone

2025-12-02T12:39:59Z

Treloars: /* CEFTRIAXONE / ROCEPHIN */

==Section 8 - MEDICATION GUIDELINES==
===ANTIBIOTIC===

====CEFTRIAXONE / ROCEPHIN====
'''DESCRIPTION / ACTION:'''
* Ceftriaxone is a third generation cephalosporin antibiotic that is used to treat bacterial infections
* Ceftriaxone is used as the treatment for bacterial infections and is often used pre-operatively to reduce the risk of surgical infections
'''INDICATIONS:'''
* [[Extremity Injuries|Open extremity fracture]]
* [[Trunk Penetrating Injuries|Penetrating trauma to the torso]]
'''CONTRAINDICATIONS:'''
* Allergy to penicillin or cephalosporins
* Administration of calcium containing medications
'''POSSIBLE ADVERSE REACTIONS'''
* Diarrhea
* Skin reactions (rash)
* Allergic reaction
'''DOSAGE AND ADMINISTRATION'''
* IM - Using a standard 10 ml normal saline flush, waste 8 ml of flush. Attach needle to flush and inject into bottle of Ceftriaxone. Swirl bottle to mix and draw back into flush syringe. Inject IM.
** Adult - 1g IM x1 dose.
** Pediatric - 50mg/kg IM up to 1g

Ceftriaxone

2025-12-02T12:39:09Z

Treloars: /* CEFTRIAXONE / ROCEPHIN */

==Section 8 - MEDICATION GUIDELINES==
===ANTIBIOTIC===

====CEFTRIAXONE / ROCEPHIN====
'''DESCRIPTION / ACTION:'''
* Ceftriaxone is a third generation cephalosporin antibiotic that is used to treat bacterial infections
* Ceftriaxone is used as the treatment for bacterial infections and is often used pre-operatively to reduce the risk of surgical infections
'''INDICATIONS:'''
* Open extremity fracture
* Penetrating trauma to the torso
'''CONTRAINDICATIONS:'''
* Allergy to penicillin or cephalosporins
* Administration of calcium containing medications
'''POSSIBLE ADVERSE REACTIONS'''
* Diarrhea
* Skin reactions (rash)
* Allergic reaction
'''DOSAGE AND ADMINISTRATION'''
* IM - Using a standard 10 ml normal saline flush, waste 8 ml of flush. Attach needle to flush and inject into bottle of Ceftriaxone. Swirl bottle to mix and draw back into flush syringe. Inject IM.
** Adult - 1g IM x1 dose.
** Pediatric - 50mg/kg IM up to 1g

Trunk Penetrating Injuries

2025-12-01T21:22:55Z

Treloars: /* INITIAL TRAUMA CARE (2.02) */

==Section 6 - TRAUMA==
===6.12 TRUNK PENETRATING INJURIES===

====[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE (2.02)]]====
* Administer Oxygen via NRBM to maintain SaO2 at >95%
* Support the airway with the most appropriate adjunct.
* Prepare for immediate transport to the closest trauma facility.
* Administer [[Ancef|ANCEF]] 1 gm IV/IO for adults or 50 mg/kg IV/IO up to 1 gm for pediatrics OR
* Administer [[Ceftriaxone|CEFTRIAXONE]] 1 gm IM for adults or 50 mg/kg IM up to 1 gm for pediatrics

====EXTERNAL BLEEDING====
* If chest wound present refer to Parameter 6.04 Chest Injuries.
* Apply a hemostatic (chitosan based) dressing to help stop bleeding if available. **Pack the wound with the hemostatic dressing to assist in bleeding control.
* Look for exit wounds and or additional wounds if gunshot or stab wounds are present.
* Refer to [[Analgesia and Sedation|ANALGESIA / SEDATION PRACTICE PARAMETERS (2.04)]].

====EVISCERATION====
* If evisceration present, apply a moist sterile dressing using normal saline over the exposed contents apply a large over dressing over the moist, sterile dressing protecting the abdominal contents to conserve heat.
* Look for exit wound in the flanks and back areas – dress/cover all wounds.

====IMPALED OBJECT====
* If an impaled object is present, stabilize the impaled object in place by any means possible to reduce movement or inadvertent removal of the impaled item.
* Examine the posterior (back areas) for exit wounds or protruding impaled objects.
[[Category:Trauma|0612]]

Extremity Injuries

2025-12-01T21:22:02Z

Treloars:

==Section 6 - TRAUMA==
===6.06 EXTREMITY INJURIES===

'''[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02)'''

====SUSPECTED FRACTURE:====
* Splint suspected fracture sites in most appropriate fashion:
** Fractures may be immobilized with padded board splints, ladder splints or air splints.
** Femur fractures may be immobilized with a traction splint or inflated MAST.
* Place cold pack on suspected fracture sites.
* If distal pulses are present and neurological function intact, immobilize apparent fractures in present position, (when possible).
* If distal pulses are diminished or absent, immobilize apparent closed fracture(s) in neutral anatomic position. Attempt to reduce severely angulated fractures with inline traction, except when a joint is involved. Note pulses distal to fracture site. Apply appropriate splinting and dressings.
* If open, (compound), fracture:
**cover with sterile dressings and immobilize in present position. Apply appropriate splinting and dressings.
**[[Ancef|ANCEF]] 1 gm IV/IO for adults or 50 mg/kg IV/IO up to 1 gm for pediatrics OR
**[[Ceftriaxone|CEFTRIAXONE]] 1 gm IM for adults or 50 mg/kg IM up to 1 gm for pediatrics

'''DO NOT MANIPULATE OR REDUCE OPEN FRACTURES.'''
* Always assess distal neurovascular status before and after application of splint.
* Refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PRACTICE PARAMETERS]] (2.04).

====DIFFICULT TO CONTROL BLEED OR TRAUMATIC AMPUTATION:====
*If unable to easily control bleeding, consider the following procedures:
**Hemostatic dressing
**[[Combat Application Tourniquet|Combat Action Tourniquet]] if extremity
**[[ITClamp Hemorrhage Control System|iTClamp]] – not usable on trunk of body
*For amputations:
**Splint in line with associated extremity.
**If amputation incomplete, attempt to stabilize with bulky pressure dressing.
**Cleanse amputated part with sterile saline. Wrap in a sterile saline soaked dressing. Place in plastic bag. Attempt to cool with cold pack during transport.
**DO NOT APPLY DIRECTLY TO ICE
*Refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PRACTICE PARAMETERS]] (2.04).

[[Category:Trauma|0606]]

Ceftriaxone

2025-12-01T21:20:28Z

Treloars: /* CEFTRIAXONE / ROCEPHIN */

==Section 8 - MEDICATION GUIDELINES==
===ANTIBIOTIC===

====CEFTRIAXONE / ROCEPHIN====
'''DESCRIPTION / ACTION:'''
* Ceftriaxone is a third generation cephalosporin antibiotic that is used to treat bacterial infections
* Ceftriaxone is used as the treatment for bacterial infections and is often used pre-operatively to reduce the risk of surgical infections
'''INDICATIONS:'''
* Open extremity fracture
* Penetrating trauma to the torso
'''CONTRAINDICATIONS:'''
* Allergy to penicillin or cephalosporins
* Administration of calcium containing medications
'''POSSIBLE ADVERSE REACTIONS'''
* Diarrhea
* Skin reactions (rash)
* Allergic reaction
'''DOSAGE AND ADMINISTRATION'''
* IM - Using a standard 10 ml normal saline flush, waste 8 ml of flush. Attach needle to flush and inject into bottle of Ceftriaxone. Swirl bottle to mix and draw back into flush syringe. Inject IM.
** Adult - 1g IV x1 dose.
** Pediatric - 50mg/kg IV/IO up to 1g

Main Page

2025-11-26T23:53:51Z

Treloars: /* Section 8 - Medication Guidelines */

==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]]||March-19
|-
|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]]||March-09
|-
|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]

Main Page

2025-11-26T23:53:20Z

Treloars: /* Section 8 - Medication Guidelines */

==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]]||March-19
|-
|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]]||March-09
|-
|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/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]

Main Page

2025-11-26T23:51:04Z

Treloars: /* Section 8 - Medication Guidelines */

==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]]||March-19
|-
|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]]||March-09
|-
|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]]/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]

Main Page

2025-11-26T23:50:13Z

Treloars: /* Section 6 - Trauma */

==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]]||March-19
|-
|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]]||March-09
|-
|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]]
|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]

Trunk Penetrating Injuries

2025-11-26T23:46:30Z

Treloars: /* INITIAL TRAUMA CARE (2.02) */

==Section 6 - TRAUMA==
===6.12 TRUNK PENETRATING INJURIES===

====[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE (2.02)]]====
* Administer Oxygen via NRBM to maintain SaO2 at >95%
* Support the airway with the most appropriate adjunct.
* Prepare for immediate transport to the closest trauma facility.
* Administer [[Ancef|ANCEF]] or [[Ceftriaxone|CEFTRIAXONE]] 1 gm IV/IO for adults or 50 mg/kg IV/IO up to 1 gm for pediatrics

====EXTERNAL BLEEDING====
* If chest wound present refer to Parameter 6.04 Chest Injuries.
* Apply a hemostatic (chitosan based) dressing to help stop bleeding if available. **Pack the wound with the hemostatic dressing to assist in bleeding control.
* Look for exit wounds and or additional wounds if gunshot or stab wounds are present.
* Refer to [[Analgesia and Sedation|ANALGESIA / SEDATION PRACTICE PARAMETERS (2.04)]].

====EVISCERATION====
* If evisceration present, apply a moist sterile dressing using normal saline over the exposed contents apply a large over dressing over the moist, sterile dressing protecting the abdominal contents to conserve heat.
* Look for exit wound in the flanks and back areas – dress/cover all wounds.

====IMPALED OBJECT====
* If an impaled object is present, stabilize the impaled object in place by any means possible to reduce movement or inadvertent removal of the impaled item.
* Examine the posterior (back areas) for exit wounds or protruding impaled objects.
[[Category:Trauma|0612]]

Main Page

2025-11-26T23:45:38Z

Treloars: /* Section 6 - Trauma */

==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]]||March-19
|-
|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]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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]]
|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]

Extremity Injuries

2025-11-26T23:45:08Z

Treloars: /* SUSPECTED FRACTURE: */

==Section 6 - TRAUMA==
===6.06 EXTREMITY INJURIES===

'''[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02)'''

====SUSPECTED FRACTURE:====
* Splint suspected fracture sites in most appropriate fashion:
** Fractures may be immobilized with padded board splints, ladder splints or air splints.
** Femur fractures may be immobilized with a traction splint or inflated MAST.
* Place cold pack on suspected fracture sites.
* If distal pulses are present and neurological function intact, immobilize apparent fractures in present position, (when possible).
* If distal pulses are diminished or absent, immobilize apparent closed fracture(s) in neutral anatomic position. Attempt to reduce severely angulated fractures with inline traction, except when a joint is involved. Note pulses distal to fracture site. Apply appropriate splinting and dressings.
* If open, (compound), fracture:
**cover with sterile dressings and immobilize in present position. Apply appropriate splinting and dressings.
**[[Ancef|ANCEF]] or [[Ceftriaxone|CEFTRIAXONE]] 1 gm IV/IO for adults or 50 mg/kg IV/IO up to 1 gm for pediatrics

'''DO NOT MANIPULATE OR REDUCE OPEN FRACTURES.'''
* Always assess distal neurovascular status before and after application of splint.
* Refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PRACTICE PARAMETERS]] (2.04).

====DIFFICULT TO CONTROL BLEED OR TRAUMATIC AMPUTATION:====
*If unable to easily control bleeding, consider the following procedures:
**Hemostatic dressing
**[[Combat Application Tourniquet|Combat Action Tourniquet]] if extremity
**[[ITClamp Hemorrhage Control System|iTClamp]] – not usable on trunk of body
*For amputations:
**Splint in line with associated extremity.
**If amputation incomplete, attempt to stabilize with bulky pressure dressing.
**Cleanse amputated part with sterile saline. Wrap in a sterile saline soaked dressing. Place in plastic bag. Attempt to cool with cold pack during transport.
**DO NOT APPLY DIRECTLY TO ICE
*Refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PRACTICE PARAMETERS]] (2.04).

[[Category:Trauma|0606]]

Extremity Injuries

2025-11-26T23:44:43Z

Treloars: /* SUSPECTED FRACTURE: */

==Section 6 - TRAUMA==
===6.06 EXTREMITY INJURIES===

'''[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02)'''

====SUSPECTED FRACTURE:====
* Splint suspected fracture sites in most appropriate fashion:
** Fractures may be immobilized with padded board splints, ladder splints or air splints.
** Femur fractures may be immobilized with a traction splint or inflated MAST.
* Place cold pack on suspected fracture sites.
* If distal pulses are present and neurological function intact, immobilize apparent fractures in present position, (when possible).
* If distal pulses are diminished or absent, immobilize apparent closed fracture(s) in neutral anatomic position. Attempt to reduce severely angulated fractures with inline traction, except when a joint is involved. Note pulses distal to fracture site. Apply appropriate splinting and dressings.
* If open, (compound), fracture:
**cover with sterile dressings and immobilize in present position. Apply appropriate splinting and dressings.
**[[Ancef|ANCEF]] or [[Ceftriaxone]] gm IV/IO for adults or 50 mg/kg IV/IO up to 1 gm for pediatrics

'''DO NOT MANIPULATE OR REDUCE OPEN FRACTURES.'''
* Always assess distal neurovascular status before and after application of splint.
* Refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PRACTICE PARAMETERS]] (2.04).

====DIFFICULT TO CONTROL BLEED OR TRAUMATIC AMPUTATION:====
*If unable to easily control bleeding, consider the following procedures:
**Hemostatic dressing
**[[Combat Application Tourniquet|Combat Action Tourniquet]] if extremity
**[[ITClamp Hemorrhage Control System|iTClamp]] – not usable on trunk of body
*For amputations:
**Splint in line with associated extremity.
**If amputation incomplete, attempt to stabilize with bulky pressure dressing.
**Cleanse amputated part with sterile saline. Wrap in a sterile saline soaked dressing. Place in plastic bag. Attempt to cool with cold pack during transport.
**DO NOT APPLY DIRECTLY TO ICE
*Refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PRACTICE PARAMETERS]] (2.04).

[[Category:Trauma|0606]]

Ceftriaxone

2025-11-26T18:49:00Z

Treloars:

==Section 8 - MEDICATION GUIDELINES==
===ANTIBIOTIC===

====CEFTRIAXONE / ROCEPHIN====
'''DESCRIPTION / ACTION:'''
* Ceftriaxone is a third generation cephalosporin antibiotic that is used to treat bacterial infections
* Ceftriaxone is used as the treatment for bacterial infections and is often used pre-operatively to reduce the risk of surgical infections
'''INDICATIONS:'''
* Open extremity fracture
* Penetrating trauma to the torso
'''CONTRAINDICATIONS:'''
* Allergy to penicillin or cephalosporins
* Administration of calcium containing medications
'''POSSIBLE ADVERSE REACTIONS'''
* Diarrhea
* Skin reactions (rash)
* Allergic reaction
'''DOSAGE AND ADMINISTRATION'''
* Using a standard 10 ml normal saline flush, waste approximately 0.5 ml of flush. Attach needle to flush and inject into bottle of Ceftriaxone. Swirl bottle to mix and draw back into flush syringe. Inject IV or IM.
** Adult - 1g IV x1 dose.
** Pediatric - 50mg/kg IV/IO up to 1g

Ceftriaxone

2025-11-26T18:35:59Z

Treloars: Created page with "==Section 8 - MEDICATION GUIDELINES== ===ANTIBIOTIC=== ====CEFTRIAXONE / ROCEPHIN==== '''DESCRIPTION / ACTION:''' * Ceftriaxone is a third generation cephalosporin antibiotic that is used to treat bacterial infections * Ceftriaxone is used as the treatment for bacterial infections and is often used pre-operatively to reduce the risk of surgical infections '''INDICATIONS:''' * Open extremity fracture * Penetrating trauma to the torso '''CONTRAINDICATIONS:''' * Allergy to..."

==Section 8 - MEDICATION GUIDELINES==
===ANTIBIOTIC===

====CEFTRIAXONE / ROCEPHIN====
'''DESCRIPTION / ACTION:'''
* Ceftriaxone is a third generation cephalosporin antibiotic that is used to treat bacterial infections
* Ceftriaxone is used as the treatment for bacterial infections and is often used pre-operatively to reduce the risk of surgical infections
'''INDICATIONS:'''
* Open extremity fracture
* Penetrating trauma to the torso
'''CONTRAINDICATIONS:'''
* Allergy to penicillin or cephalosporins
* Administration of calcium containing medications
'''POSSIBLE ADVERSE REACTIONS'''
* Diarrhea
* Skin reactions (rash)
* Allergic reaction
'''DOSAGE AND ADMINISTRATION'''
* Reconstitute with 9.6 ml of normal saline and administer IV or IM.
** Adult - 1g IV x1 dose.
** Pediatric - 50mg/kg IV/IO up to 1g

Main Page

2025-11-26T18:21:52Z

Treloars: /* Section 8 - Medication Guidelines */

==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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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]]
|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]

Magnesium Sulfate

2025-10-27T13:21:56Z

Treloars: /* Magnesium Sulfate */ Remove consider calling for medical direction

==Section 8 - MEDICATION GUIDELINES==
===ELECTROLYTES===

====Magnesium Sulfate====
'''DESCRIPTION'''
* It is an anticonvulsant, especially effective in the control of seizures associated with eclampsia.
'''INDICATIONS'''
* Seizures due to [[Pregnancy Induced Hypertension (PIH)|eclampsia]] (toxemia of pregnancy), Torsades de pointes.
'''CONTRAINDICATIONS'''
* Patients with heart block or recent myocardial infarction.
'''PRECAUTIONS'''
* May cause hypotension, circulatory collapse, or cardiac and respiratory depression. Calcium Chloride should be available to counteract the untoward effects of Magnesium.
'''DOSAGE'''
* Refer to appropriate PRACTICE PARAMETER for specific dosages.
* Refer to Handtevy System infusion instructions for dosage.

[[Category:Medication Guidelines|Magnesium Sulfate]]

Hospital Capability Chart

2025-10-03T15:43:59Z

Treloars:

{| class="wikitable sortable"
|-
! FACILITY !! TRAUMA CENTER !! BURN UNIT !! OBSTETRICS !! STROKES !! STEMI CENTER !! ORTHO SURGERY!! PEDIATRICS
Higher Number - More Services
! BARIATRIC
|-
| HCA Florida Lake Monroe ||Yes || || || Comprehensive||Yes || Yes || ||600 lb limit
|-
| Heathrow ER (FSED)|| || || || || || || || Yes
|-
| AdventHealth Altamonte || || ||Yes ||Primary ||Yes || || NICU Level II|| Yes
|-
| AdventHealth Lake Mary (FSED)|| || || || || || || ||
|-
|AdventHealth Sanford (FSED)
|
|
|
|
|
|
|
|
|-
| HCA Oviedo Medical Center || || || Yes || Primary || || Yes || || Yes
|-
| South Seminole (FSED)|| || || || || || || ||
|-
| Orlando Health - Lake Mary|| || || Yes|| Primary|| Yes||Yes|| Yes || 600 lb limit
|-
| AdventHealth Orlando|| || ||Yes ||Comprehensive ||Yes ||Yes ||Yes, NICU Level IV || Yes
|-
| Orlando Regional Medical Center||Yes ||Yes || || Comprehensive ||Yes ||Yes || || 600 lb limit
|-
| Arnold Palmer||Yes - Pediatric || || || || ||Yes ||Yes ||
|-
| Winnie Palmer|| || || Yes || || || || NICU Level III||
|-
| Orlando VA|| || || || || || || ||
|-
| AdventHealth East|| || || || Primary || || ||Yes ||
|-
| AdventHealth Apopka|| || || || Primary||Yes || ||||
|-
| Nemours|| || || || || || || Yes||
|-
| Advent Health Winter Park|| || ||Yes ||Primary || || || NICU Level II||
|-
| AdventHealth Oviedo (FSED)|| || || || || || || ||
|-
| HCA Florida Casselberry (FSED)|| || || || || || || ||
|-
| HCA Florida Maitland (FSED)|| || || || || || || ||
|}

{| class="wikitable sortable"
|-
! FACILITY !! ADDRESS
|-
| HCA Florida Lake Monroe ||[https://www.google.com/maps/dir//1401+Medical+Plaza+Dr,+Sanford,+FL+32771 1401 Medical Plaza Dr, Sanford, FL 32771]
|-
| HCA Heathrow ER ||[https://www.google.com/maps/dir//4525+International+Pkwy,+Sanford,+FL+32771 4525 International Parkway, FL 32771]
|-
| AdventHealth Altamonte || [https://www.google.com/maps/dir//Florida+Hospital+Altamonte,+East+Altamonte+Drive,+Altamonte+Springs,+FL 601 E Altamonte Dr, Altamonte Springs, FL 32701]
|-
| AdventHealth Lake Mary || [https://www.google.com/maps/dir//Florida+Hospital+Lake+Mary+Emergency+Department,+950+Rinehart+Rd,+Lake+Mary,+FL+32746 950 Rinehart Rd, Lake Mary, FL 32746]
|-
|AdventHealth Sanford
|[https://www.google.com/maps/place/7450+N+Ronald+Reagan+Blvd,+Sanford,+FL+32773 7450 N Ronald Reagan Blvd, Sanford, FL 32773]
|-
| HCA Oviedo Medical Center || [https://www.google.com/maps/dir//Oviedo+Medical+Center,+8300+Red+Bug+Lake+Rd,+Oviedo,+FL+32765 8300 Red Bug Lake Rd, Oviedo, FL 32765]
|-
| ORHS South Seminole FSED|| [https://www.google.com/maps/dir//455+W+Warren+Ave,+Longwood,+FL+32750 455 W Warren Ave, Longwood, FL 32750]
|-
| ORHS - Lake Mary|| [https://www.google.com/maps/dir//380+Rinehart+Rd,+Lake+Mary,+FL+32746 380 Rinehard Rd, Lake Mary, FL 32746]
|-
| AdventHealth Orlando|| [https://www.google.com/maps/dir//Florida+Hospital+Orlando:+Emergency+Room,+East+Rollins+Street,+Orlando,+FL 601 E Rollins St Orlando, FL 32803]
|-
| Orlando Regional Medical Center|| [https://www.google.com/maps/dir//Orlando+Regional+Medical+Center+Emergency+Room,+29+W+Sturtevant+St,+Orlando,+FL+32806 29 W Sturtevant St, Orlando, FL 32806]
|-
| ORHS Arnold Palmer|| [https://www.google.com/maps/dir//Arnold+Palmer+Hospital+for+Children,+West+Miller+Street,+Orlando,+FL 92 West Miller Street, Orlando, FL]
|-
| ORHS Winnie Palmer|| [https://www.google.com/maps/dir/28.524444,-81.3789772/Winnie+Palmer+Hospital+for+Women+and+Babies,+West+Miller+Street,+Orlando,+FL 83 W Miller St, Orlando, FL 32806]
|-
| Orlando VA|| [https://www.google.com/maps/dir//Orlando+VA+Medical+Center,+13800+Veterans+Way,+Orlando,+FL+32827 13800 Veterans Way, Orlando, FL 32827]
|-
| AdventHealth East|| [https://www.google.com/maps/dir//7727+Lake+Underhill+Rd,+Orlando,+FL+32822 7727 Lake Underhill Rd, Orlando, FL 32822]
|-
| Nemours|| [https://www.google.com/maps/dir//13535+Nemours+Pkwy,+Orlando,+FL+32827 13535 Nemours Pkwy, Orlando, FL 32827]
|-
| AdventHealth Winter Park Hospital|| [https://www.google.com/maps/dir//200+N+Lakemont+Ave,+Winter+Park,+FL+32792 200 N Lakemont Ave, Winter Park, FL 32792]
|-
| AdventHealth Apopka|| [https://www.google.com/maps/dir//Florida+Hospital+Apopka,+Ocoee+Apopka+Road,+Apopka,+FL 2100 Ocoee Apopka Rd, Apopka, FL 32703]
|-|}
|Advent Health - Oviedo
| [https://www.google.com/maps/place/8100+Red+Bug+Lake+Rd,+Oviedo,+FL+32765 8100 Red Bug Lake Rd, Oviedo, FL 32765]
|-
|HCA Florida Casselberry
| [https://www.google.com/maps/place/2560+S+US+Hwy+17+92,+Casselberry,+FL+32707 2560 S US Hwy 17-92, Casselberry, Florida, 32707]
|-
|HCA Florida Maitland
| [https://www.google.com/maps/place/9401+Summit+Centre+Way,+Lockhart,+FL+32810 9401 Summit Centre Way, Orlando, FL 32810]
|-
|ORHS Waterford Lakes
|[https://www.google.com/maps/place/11898+Lake+Underhill+Rd,+Orlando,+FL+32825 11898 Lake Underhill Road, Orlando, FL 32825]
|}

Pleural Decompression

2025-08-25T13:06:00Z

Treloars: /* 9.26 PLEURAL DECOMPRESSION */

==Section 9 - Procedure Guidelines==
===9.26 PLEURAL DECOMPRESSION===

'''INDICATIONS:'''
* Chest decompression for relief of tension pneumothorax.

'''EQUIPMENT:'''
* Appropriate sized needle.
* Sterile glove finger.
* Thread the #14 gauge catheter through the end of the glove finger from the inside.
* Tape.
* Sterile gauze pads.
* Antiseptic swabs.
* Occlusive dressing.

'''PROCEDURE:'''
* Locate decompression site.
** Identify the 2nd intercostal space in the mid-clavicular line on the same side as the pneumothorax. '''''OR'''''
** Identify the 5th intercostal space in the mid-axillary line on the same side as the pneumothorax.
* Prepare the site with an antiseptic swab:
* Firmly introduce catheter immediately above the distal rib of the site selected with a glove finger placed over the needle and catheter to serve as a flutter valve.
* Insert the catheter through the parietal pleura until air exits. It should exit under pressure.
* Advance catheter and remove needle.
* Secure the catheter taking care not to allow it to kink.
* Reassess lung sounds and patient condition.
* Dress area with Occlusive dressing then cover with sterile gauze pad.
* Flutter valve must be outside dressing and unobstructed.
* Assess breath sounds and respiratory status.

[[Category:Procedure Guidelines|0926]]

TXA

2025-07-28T16:33:45Z

Treloars: /* Section 8 - MEDICATION GUIDELINES */

==Section 8 - MEDICATION GUIDELINES==
===ANTI-FIBRINOLYTICS===

====Tranexamic Acid (TXA)====

'''DESCRIPTION'''
* Inhibits both plasminogen activation and plasmin activity, thus preventing clot break-down rather than promoting new clot formation. With massive bleeding this may help stabilize clot formation and decrease extravascular bleeding.
'''INDICATIONS'''
* [[Hemorrhagic Shock|Severe Hemorrhagic Shock]] or imminent shock.
*Strongly consider in non-traumatic major bleeding (post-partum, gastrointestinal, postoperative, nasal) with signs of shock or imminent shock.

'''PREGNANCY CATEGORY'''
* B - Safe in Pregnancy
* Safe in breastfeeding

'''CONTRAINDICATION'''
* Hypersensitivity to TXA
* Should not be given more than 3 hours from when severe bleeding event started.

'''RELATIVE CONTRAINDICATIONS'''
* Colorblindness
* History of Seizures
* Ischemic event: Myocardial Infarction, stroke, pulmonary embolism (PE), deep venous thrombosis (DVT)
* Isolated head injury / subarachnoid hemorrhage

'''PRECAUTIONS'''
* Rapid injection can cause hypotension
'''DOSAGE'''
* 1000 mg of TXA mixed in 100 ml or 250 ml of normal saline infused via IO or IV over 10 minutes.
* 20mg/kg (1000mg maximum) TXA mixed in 100 ml of Normal Saline infused via IO or IV over 10 minutes.

[[Category:Medication Guidelines|TXA]]

Main Page

2025-07-28T16:32:40Z

Treloars: /* Section 8 - Medication Guidelines */

==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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[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]

TXA

2025-07-28T16:31:59Z

Treloars:

==Section 8 - MEDICATION GUIDELINES==
===ANTI-FIBRINOLYTICS===

====Tranexamic Acid (TXA)====

'''DESCRIPTION'''
* Inhibits both plasminogen activation and plasmin activity, thus preventing clot break-down rather than promoting new clot formation. With massive bleeding this may help stabilize clot formation and decrease extravascular bleeding.
'''INDICATIONS'''
* [[Hemorrhagic Shock|Severe Hemorrhagic Shock]] or imminent shock.
*Strongly consider in non-traumatic major bleeding (post-partum, gastrointestinal, postoperative, nasal) with signs of shock or imminent shock.

'''PREGNANCY CATEGORY'''
* B - Safe in Pregnancy
* Safe in breastfeeding

'''CONTRAINDICATION'''
* Hypersensitivity to TXA
* Should not be given more then 3 hours from when severe bleeding event started.

'''RELATIVE CONTRAINDICATIONS'''
* Colorblindness
* History of Seizures
* Ischemic event: Myocardial Infarction, stroke, pulmonary embolism (PE), deep venous thrombosis (DVT)
* Isolated head injury / subarachnoid hemorrhage

'''PRECAUTIONS'''
* Rapid injection can cause hypotension
'''DOSAGE'''
* 1000 mg of TXA mixed in 100 ml or 250 ml of normal saline infused via IO or IV over 10 minutes.
* 20mg/kg (1000mg maximum) TXA mixed in 100 ml of Normal Saline infused via IO or IV over 10 minutes.

[[Category:Medication Guidelines|TXA]]

EMS Quality Improvement Program

2025-07-28T16:30:45Z

Treloars: /* Documentation */

==Section 1 - ADMINISTRATIVE POLICIES==
===1.18 EMS QUALITY IMPROVEMENT PROGRAM===

====PURPOSE:====
To establish a system-wide Quality Improvement (QI) program for evaluating the Seminole County Emergency Medical Services (SCEMS) system in order to foster continuous improvement in performance and quality patient care. To identify positive and negative trends in the system, and develop educational programs that will improve or enhance the level of care provided by the system’s EMTs and Paramedics. To assist EMS Providers and Receiving Hospitals in defining standards, evaluating methodologies and utilizing outcome data results for continued system improvement

====AUTHORITY:====
Florida Administrative Code, Department of Health Rules, 64-J-2.004, Section 4(c)

====SCOPE:====
The Seminole County EMS (SCEMS) system is comprised of the following agencies under the Medical Direction of the SCEMS Medical Director:
{| class="wikitable"
|-
| Lake Mary Fire Department|| Longwood Fire Department
|-
|Orlando-Sanford Airport Fire Department || Oviedo Fire Department
|-
|Sanford Fire Department || Seminole County Fire Department

|}

The Seminole County EMS Performance Management Bureau adheres to the philosophy of Continuous Quality Improvement (CQI). CQI is a team-based process that conducts a clinical review of selected cases each month. Based on strict confidentiality and a shared commitment to excellent prehospital care, CQI reveals potential areas for improvement of the EMS System, recommends and oversees training, highlights outstanding clinical performance, audits compliance with treatment protocols, and reviews specific illnesses or injuries along with their associated treatments. These efforts contribute to the continued success of our emergency medical services through a systematic process of review, analysis and improvement. Evaluation will be facilitated by use of data derived from the following sources:
{| class="wikitable"
|-
| EMS reports|| Medical Director Meetings
|-
| Computer-assisted Dispatch (CAD)|| Quality Committees
|-
| Hospital Outcome Data|| Biomedical devices (i.e. cardiac monitors)
|-
| Direct Field Observation|| EMSystem™
|}

====PROGRAM OBJECTIVES:====
* Establish a mechanism for monitoring EMS Performance.
* Establish performance indicators and benchmarks to identify expected levels of pre-hospital care.
* Establish a mechanism to systematically review data derived from EMS reporting systems.
* Assure all Seminole County EMS providers possess a clear understanding of the EMS Protocols.
* Provide quarterly reports to the EMS Group, Medical Director and Fire Chiefs of Seminole County.
* Establish a method to utilize information received from the program to assist the EMS and Training Group in developing educational programs.
* Establish a Benchmarking relationship with other EMS systems for comparison and competition.

====STRUCTURE AND RESPONSIBILITIES:====
=====Medical Director=====
Responsible for implementation and audit of the CQI Program. Provide medical guidance and leadership to ensure that the techniques and practice parameters meet or exceed local/national standards of care for pre-hospital care. The Medical Director shall perform his/her functions in accordance with the Medical Director Contract and Florida Administrative Code Chapter 64J-2. He shall respond to the direction of and be under the direct authority of the Director of Public Safety.
=====Senior Coordinator=====
Responsible for development and implementation of an effective system for continuous monitoring and evaluation of all aspects of patient care. Develop and distribute, as a minimum, quarterly and annual reports of EMS system activities to the EMS Group, Medical Director and Fire Chiefs of Seminole County. Develop and distribute other EMS data/statistics as directed by Director of Public Safety.
=====Peer Review Committee=====
Each agency is encouraged to develop an internal review committee for the confidential review of run reports and evaluating the reports and medical care based on the established thresholds for evaluation.
=====EMS Quality Council:=====
Composed of the EMS Group, local Hospitals, non-emergency ambulance providers and air medical providers. The Council is chaired by the SCEMS Medical Director and works closely together to identify problems, problem resolution, and to develop standards of care for the EMS system.

====ASPECTS OF CARE====
Procedures and services delivered by the providers in the Seminole County EMS System may be categorized as high, potential risk, and/or high volume activities for the purposes of measuring performance and benchmarking within the system. Each agency is responsible for the evaluation of these various aspects of care and submitting data monthly as predicated by the Medical Director.

=====High-Risk=====
Procedures or interventions in which there is an increased chance of a catastrophic event occurring if the procedure or intervention is performed incorrectly. All high-risk procedures will be monitored on a monthly basis to evaluate the associated risk and benefit of the procedure or intervention. The evaluation includes but is not limited to the review of run reports and data generated by run reporting systems. The following is a dynamic listing of the high-risk procedures that are performed by SCEMS Paramedics:
{| class="wikitable"
|-
| Endotracheal Intubation|| Synchronized Cardioversion
|-
| Nasotracheal Intubation|| Defibrillation
|-
| Surgical Cricothyrotomy|| Post-Mortem C-section
|-
| Pleural Decompression|| Escharotomy
|}

=====Potential Risk=====
Procedures, interventions or situations that have a significantly higher than average chance of failure or have been proven to be problematic to the SCEMS system and are not listed as high-risk. Strategic services or procedures shall be reviewed quarterly. The following is a dynamic listing of the strategic procedures that are performed by the agencies of the SCEMS system:
{| class="wikitable"
|-
| Administration of Controlled Substances|| Medical evaluation of tasered patients
|-
| Delayed Offload at Emergency Dept.|| Wave-form Capnography Compliance
|-
| Response time to cardiac arrests > 6 minutes|| 12-lead EKG for all cardiac & SOB pts.
|-
| Questionable transport destination || Absence of IV/IO during cardiac arrest
|-
| Appropriate use of Air Medical Resources|| Use of Continuous Positive Airway Pressure (CPAP) Device
|-
| AMA refusal of incapacitated patient||
|}

=====High-Volume=====
Procedures or interventions that are performed routinely on a daily basis. These skills will be evaluated monthly with a bi-annual report to be produced to determine the status of the individual procedure. The evaluation of the skill or procedure will include but not limited to the tracking of successes vs. failure of a procedure, the number performed in a specific time period and the benefit to the system in continuing the use of the procedure or service.
*Appropriate use of C-Spine Clearance Protocol
*PCR Documentation
*IV/IO
*Airway Management

====CLINICAL INDICATORS====
Clinical indicators are tools for measuring compliance with an expected standard. The program shall use clinical indicators to monitor practice parameter compliance. Clinical indicators should be met or the reason it was not met should be documented. On an semi-annual basis, the Program Coordinator, in association with the EMS Group and the Medical Director, will review and revise as necessary clinical indicators.

====THRESHOLDS FOR EVALUATION====
Thresholds are established for each clinical indicator. They define the acceptable level of performance and may be determined by relevant findings in current literature, National and State standards or past data results. The following is the recommended threshold values for various procedures: (The threshold sets may vary according to call load and other circumstances.)

=====Airway Management=====
*Proper airway documentation complete - 100%
*Managed unstable airway with ET tube, King Tube, or BVM – 100%
*ETCO2 utilized on all unstable airway patients being managed with an ET/King Tube – 100%

=====Trauma Management=====
*Over-triage of Trauma patients <30%
*On-scene time 10 minutes or less unless extenuating circumstances exist (e.g. entrapment, MCI event, etc.) and are documented - 90%
*Appropriate use of air-medical resources – 95%

=====Acute Coronary Syndromes (ACS) and Stroke=====
*Recognition of STEMI – 95%
*ACS patients receive Morphine, Oxygen, Nitro & Aspirin (MONA) or document contraindication - 95%
*12-Leads performed on all chest pain; congestive heart failure; cardiovascular; pre and post cardioversion; & stroke patients (>35 years of age) – 100%
*3-Lead ECG performed on all altered mental status; syncope/fainting; respiratory distress; drug/toxic ingestions and abdominal pain patients (>35 years of age) – 100%
*Stroke recognition and transport to an appropriate primary or comprehensive stroke receiving facility -100%

=====Cardiac Arrest Management=====
*Total response time (from “dispatch complete” to “with patient”) to Cardiac Arrests <6 minutes – 90% fractile
*IV/IO Access – 90%
*Attain return of spontaneous circulation (ROSC) – 10%
*Survival rate of cardiac arrest patients – 10%
*Code Cool implemented on all patients meeting criteria – 100%

=====Documentation=====
*Complete stroke forms for all Stroke/CVA/TIA patients – 100%

====Data Sources:====
Through the use of a variety of data sources, problems or potential problems in patient care can be identified. A yearly evaluation will be performed to determine any outstanding problems with the system and ways to improve. The following are data sources to be used to evaluate the system:
{| class="wikitable"
|-
| Patient Run Reports|| EMSystem data
|-
| Computer-assisted Dispatch (CAD)Reports|| EMS/Hospital Outcome Data
|-
| Random Patient Surveys|| Peer Review Committee Feedback
|-
| ED staff/Physician feedback|| EMS Group Feedback
|}

====Field Observations/MD Ride Time====
Medical Director shall periodically ride with various units to evaluate crew performance in the pre-hospital setting and interactions with hospital personnel.

====Medical Director Review====
The Medical Director shall review, on a monthly basis, EMS reports to assure compliance with Seminole County Practice Parameters and Florida Statures. Review may include cardiac arrest, trauma alerts, deviation from protocol and other reports that he may choose. Selected reports shall be forwarded to the Medical Director prior to the 7th of each month for his/her review and comment. Deviations from Practice Parameters shall be forwarded to the Seminole County Medical Director immediately after such a report is completed or upon its discovery during the Q.I. review process.

The Medical Director shall be contacted immediately in the event an alarm occurs which involves questionable medical treatment or if clarification is required regarding patient care.

====Specific Incident Resolution and Improvement====
=====Notification of an Incident=====
An inquiry can be initiated by the Medical Director, Public Safety Director, hospital representative and/or the affected EMS agency representative to determine the severity of the incident and what action may be necessary. If it is determined that further review and/or action may be needed the Medical Director and the EMS Coordinator of the affected agency shall be notified of the alleged incident and related circumstances.

=====Root Cause Analysis=====
A root cause analysis (RCA) is a process designed for use in investigating and categorizing the root causes of events with safety, system-design, environmental, quality, reliability and parameter impact. The term “event” is used to generically identify occurrences that produce or have the potential to produce these types of consequences. RCA is a tool designed to help identify not only what and how an event occurred, but also why it happened. Only when investigators are able to determine why an event or failure occurred will they be able to specify workable corrective measures that prevent future events of the type observed. During this phase all information regarding the alleged incident will be obtained to include dispatch records, patient care reports, and hospital records. It may be necessary to interview the individuals involved and document their information. A determination will be made by the Medical Director in cooperation with the affected EMS agency representative to ascertain if the care provided during an incident compromised patient outcome. The Public Safety Director shall be notified in writing of all events falling within the Root Cause Analysis category.

=====Sentinel Events=====
A sentinel event is described as an event that has resulted in an unanticipated death or major permanent loss of function, not related to the natural course of the patient’s illness or underlying condition.

=====Development of an Improvement Plan=====
Once the RCA has been completed, if the investigation reveals a deviation from procedure or protocol, an Improvement Plan will be developed. The Medical Director in cooperation with the affected agency representative will develop a plan for the involved individuals to follow to alleviate the potential for similar episodes occurring in the future. If the investigation determines that the problem is a system-wide problem, the area of deficiency will be turned over to the Seminole County EMS System Training Group to develop, in conjunction with the Program Manager; a system-wide educational program. The Medical Director shall communicate any recommendations for corrective action to the Fire Chief of the affected agency with a copy to the Public Safety Director for their ultimate determination.

=====Documentation=====
The Public Safety Director will maintain, in a secure environment, all reports and information gathered during the investigation. At the conclusion of an investigation the Medical Director will prepare a summary report for the Fire Chief and the EMS representative of the affected agency. The report will provide an overview of the incident and a summary of actions to improve the system.

=====Confidentiality=====
All patient care records and reports generated for CQI review purposes are confidential and non-discoverable as outlined in F.S. 401.425.

====Medication Errors====
There are 5 levels of medication errors based on the type of error and the reaction that the patient has, if any. They are:
*Correct medication / Wrong time of administration
**No signs or symptoms or physical indicators.
**No short- or long-term sequelae.
*Correct medication, wrong dose.
**No signs or symptoms or physical indicators
**No short- or long-term sequelae.
*Wrong medication or wrong dose, no or limited signs and symptoms or physical indicators
**No short-term or long-term sequelae.
*Wrong medication or wrong dose.
**Moderate or severe signs or symptoms or physical indicators.
**Short-term sequelae, no long-term sequelae.
**May require monitoring or close observation.
*Wrong medication or wrong dose.
**Moderate or severe signs or symptoms or physical indicators.
**Short and long-term sequelae or death.
**Required intensive monitoring and/or interventions.

In the QI process, levels 1 through 3 do not require intense review. All levels do require some review. All levels require a determination of why the mistake occurred and a determination if there is a way to assure that this does not happen in the future.

Levels 4 and 5 require a detailed review process. These levels will require medical director involvement, including medical director interviews and discussion with the persons involved.

====Trend Analysis====
The Medical Director shall analyze the data for positive or negative trends with appropriate actions taken to rectify or prevent negative trends in patient care.

====Annual Review of the CQI Program====
The CQI Program will be evaluated annually by the Seminole County Medical Director and Public Safety Director. The measurable objectives of the program will be compared to the performance in order to determine the effectiveness of the program. The Program will be enhanced as appropriate. The annual report will be presented to the EMS Group, the Medical Director and the Fire Chiefs of Seminole County.

[[Category:Administrative Policies|0118]]

EMT and Paramedic County Certification Procedure

2025-06-26T15:58:05Z

Treloars:

==Section 1 - ADMINISTRATIVE POLICIES==
===1.17 EMT / PARAMEDIC COUNTY CERTIFICATION PROCEDURE===

This certification procedure is to be followed by all Emergency Medical Technicians (EMTs) and Paramedics employed by the Seminole County EMS (SCEMS) system to function under the license and direction of the Seminole County Medical Director. The following agencies compose the SCEMS: Lake Mary FD, Longwood FD, Oviedo FD, Sanford FD and Seminole County FD. Seminole County certification is required in order to function as an EMT or Paramedic within the geographical confines of Seminole County.

====EMT/PARAMEDIC PROVISIONAL CERTIFICATION (INTERNSHIP)====
To obtain Seminole County EMT certification or Paramedic provisional Certification, candidates must successfully complete the written protocol examination and clinical skills assessment.
* A timed written examination shall consist of one hundred (100) questions for Paramedics and fifty (50) for EMT’s derived from and cross referenced to the most current Seminole County EMS System Practice Parameters.
** The passing score for Paramedics is 92% and the test is open resource.
** The passing score for the EMT test is 80% and the test is closed resource.
** Newly hired Paramedics will be required to pass the EMT test before they can take the Paramedic test.
* Paramedics will be required to pass a timed EKG static dysrhythmia recognition evaluation containing a minimum of twenty (20) static EKG rhythms (including 12-lead) with a score of 90%.
* Practical Skills assessment for EMT shall consist of the following skills:
** Patient assessment -Medical & Trauma
** Airway, Oxygenation and Ventilation Skills.
** Trauma Management.
** Cardiac Arrest Management/AED operation.
** ALS assistance
* Practical Skills assessment for PARAMEDIC shall consist of the EMT skills as well as the following skills:
**Successful demonstration of assessment for and treatment of the following skills:
***Needle chest decompression of a tension pneumothorax
***Surgical and needle cricothyroidotomy
***Insertion of an intraosseous infusion
***Insertion of peripheral intravenous access point
***Oral tracheal intubation, adult and infant
***Insertion of Supraglottic advanced airway device

====SEMINOLE COUNTY PROTOCOL WRITTEN AND CLINICAL SKILL TESTING WILL BE ADMINISTERED UTILIZING THE FOLLOWING PROCEDURE:====
* Written and EKG examinations will be scheduled with the agency EMS Officer.
**If each test is not passed on the first attempt, the employee will have wait at least 1 day to retake the test.
**If the test is not passed on the second or subsequent attempt, the employee will have to wait at least 6 days to retake the test.
**The Medical Director reserves the right to waive or modify the examination retake requirements for just cause. The Medical Director also retains final authority and decision making in all provisional certification requirements, retake procedures and reserves the right to modify, adjust, or mandate further requirements to be met by the provisional paramedic to insure competency prior to being released. In addition, the Medical Director reserves the right to grant or revoke full or provisional certification to any and all EMT’s and Paramedics providing services under his license at any given time.
*Practical Skills assessments will be handled as follows:
**The EMT skills will be assessed during new hire orientation or in their first few weeks of being on shift. The skills will be assessed by a Paramedic
**The Paramedic skills will be assessed by their preceptor as part of the precepting procedure.
**In the event the candidate is unsuccessful in completing the Paramedic certification process, the sponsoring agency may permit the candidate to function as an EMT.

====COUNTY EMT/PARAMEDIC CERTIFICATION====
County EMT/Paramedic Certification authorizes the individual to practice solo and is achieved after the following requirements are met:
* All provisional certification requirements and testing have been successfully satisfied.
* Internship - Complete the agency’s internship in accordance with the Paramedic Clinical Assessment Program (PCAP) under the observation of a paramedic/mentor/field officer.
* Medical Director Face-to-Face Meetings – EMTs are required to attend one (1) meeting within 90 days of being County certified and Paramedics are required to attend one (1) meeting as part of their precepting process.
* EMT's must submit an EMS report to their EMS Officer for review and evaluation.
* As Paramedics are getting close to the end of their precepting, the Agency EMS Officer shall notify the Medical Director's Quality Assurance Manager to have their reports reviewed. The Quality Assurance Manager will review random reports from the preceptee and will provide feedback on writing better reports.
* Critical Thinking Skills – It is expected that during the course of the paramedic’s internship and face-to-face meetings with the Medical Director that their critical thinking skills will be evaluated. In the event, that the paramedic is not performing up to expectation, OR is a new employee with no prior EMS experience, OR has a lack of challenging calls; the Medical Director may request that they submit to mega-code testing on the human patient simulator (SIM Man).
* Completion of Provisional Certification Form – is signed off by all of the following:
**Provisional paramedic
**Candidate’s preceptor/mentor/field officer
**Agency of record EMS officer

===BIENNIAL RECERTIFICATION REQUIREMENTS===
Recertification requirements coincide within the same time frame as State certification.

====EMERGENCY MEDICAL TECHNICIAN (EMT)====
* Maintain current Florida State EMT certification
* Maintain current CPR Healthcare Provider certification (AHA, ARC or equivalent) as approved by Seminole County Medical Director/EMS Office.
* Demonstrate proficiency and recurring education in Pre-Hospital Trauma Life Support (PHTLS) or International Trauma Life Support (ITLS) provider or instructor certification.
* Successful completion of thirty (30) continuing education units (CEUs) as required in F.A.C. 64J-1.008 2(a) and approved through the Seminole County Medical Director/EMS Office.
* Attend a minimum of five (5) Medical Directors meetings and an optional virtual meeting per two-year period or attend four (4) Medical Director meetings and virtually attend the two missed meetings. Each meeting has been approved for two (2) CEUs.

'''''FAILURE TO COMPLY WITH THE RECERTIFICATION REQUIREMENTS SHALL RESULT IN IMMEDIATE SUSPENSION OF SEMINOLE COUNTY CERTIFICATION AND THE INABILITY TO FUNCTION AS AN EMT.'''''

To have their County Certification reinstated the EMT must successfully complete an individualized remediation program as established by the Seminole County Medical Director/EMS Office within fourteen (14) days of the suspension notice.

Should the EMT be unsuccessful in completing the individualized remediation program Seminole County Certification will be revoked for one (1) year. After completion of the one (1) year the EMT may request to have their County Certification reinstated after successfully completing the Primary Seminole County Certification Process. Should the EMT fail to successfully complete the Primary County Certification Process they may not function as an EMT in the Seminole County EMS System.

====PARAMEDIC====
* Maintain current Florida State Paramedic certification.
* Maintain current CPR Healthcare Provider certification (AHA, ARC or equivalent) as approved by Seminole County Medical Director/EMS Office.
* Maintain current Advanced Cardiac Life Support (ACLS) certification (AHA or equivalent) as approved by Seminole County Medical Director/EMS Office.
* Demonstrate proficiency and recurring education in PHTLS or ITLS provider or instructor certification and Pediatric Education for Pre-Hospital Provider (PEPP) or Pediatric Advanced Life Support (PALS) provider or instructor certification.
* Successful completion of thirty (30) continuing education units (CEUs) as required by F.A.C. 64J-1.009 2(a) and approved through the Seminole County Medical Director / EMS Office.
* Attend a minimum of five (5) Medical Directors meetings and an optional virtual meeting per two-year period or attend four (4) Medical Director meetings and virtually attend the two missed meetings. Each meeting has been approved for two (2) CEUs.

'''''FAILURE TO COMPLY WITH THE RECERTIFICATION REQUIREMENTS SHALL RESULT IN IMMEDIATE SUSPENSION OF SEMINOLE COUNTY CERTIFICATION AND THE INABILITY TO FUNCTION AS A PARAMEDIC.'''''

During this time they may function as an EMT, provided they maintain State EMT certification or can obtain EMT certification. To have their County Certification reinstated the Paramedic must successfully complete an individualized remediation program as established by Seminole County Medical Director/EMS Office within fourteen (14) days of the suspension notice. Should the Paramedic be unsuccessful in completing the individualized remediation program Seminole County Certification will be revoked for one (1) year.

After completion of the one (1) year the Paramedic may request to have their County Certification reinstated after successfully completing the Primary Seminole County Certification Process.

In order for the Paramedic to function as an EMT during the one (1) year period their Paramedic County Certification is revoked they must successfully complete the Primary County Certification Process for EMT and successfully complete that year’s recertification process.

Should the Paramedic fail to successfully complete the Primary County Certification Process they may not function as an EMT or a Paramedic in the Seminole County EMS System.

====CONTINUING EDUCATION UNITS (CEU) APPROVAL PROCESS====
Continuing education units (CEUs) are required for National, State and County Certification processes. A CEU is defined as fifty (50) minutes of education coupled with a ten (10) minute break to complete one (1) hour of education/training. In order for these CEUs to be utilized for these certifications they must be approved by the Seminole County EMS System Medical Director. The following information must be submitted:

====CONTINUING EDUCATION APPROVAL====
*Course name
*Course date
*Institution
*Instructor’s Name
*Course Objectives
*Attachments (Please attach one of the following: Lesson Outline, Conference Brochure, or Copy of PowerPoint Presentation)
*Submitted By
*Submitted Date
*Number of CEU's requested

[[Category:Administrative Policies|0117]]

Hospital Capability Chart

2025-06-25T21:01:38Z

Treloars:

{| class="wikitable sortable"
|-
! FACILITY !! TRAUMA CENTER !! BURN UNIT !! OBSTETRICS !! STROKES !! STEMI CENTER !! ORTHO SURGERY!! PEDIATRICS
Higher Number - More Services
! BARIATRIC
|-
| HCA Florida Lake Monroe ||Yes || || || Comprehensive||Yes || Yes || ||600 lb limit
|-
| Heathrow ER (FSED)|| || || || || || || || Yes
|-
| AdventHealth Altamonte || || ||Yes ||Primary ||Yes || || NICU Level II|| Yes
|-
| AdventHealth Lake Mary (FSED)|| || || || || || || ||
|-
| HCA Oviedo Medical Center || || || Yes || Primary || || Yes || || Yes
|-
| South Seminole (FSED)|| || || || || || || ||
|-
| Orlando Health - Lake Mary|| || || Yes|| Primary|| Yes||Yes|| Yes || 600 lb limit
|-
| AdventHealth Orlando|| || ||Yes ||Comprehensive ||Yes ||Yes ||Yes, NICU Level IV || Yes
|-
| Orlando Regional Medical Center||Yes ||Yes || || Comprehensive ||Yes ||Yes || || 600 lb limit
|-
| Arnold Palmer||Yes - Pediatric || || || || ||Yes ||Yes ||
|-
| Winnie Palmer|| || || Yes || || || || NICU Level III||
|-
| Orlando VA|| || || || || || || ||
|-
| AdventHealth East|| || || || Primary || || ||Yes ||
|-
| AdventHealth Apopka|| || || || Primary||Yes || ||||
|-
| Nemours|| || || || || || || Yes||
|-
| Advent Health Winter Park|| || ||Yes ||Primary || || || NICU Level II||
|-
| AdventHealth Oviedo (FSED)|| || || || || || || ||
|-
| HCA Florida Casselberry (FSED)|| || || || || || || ||
|-
| HCA Florida Maitland (FSED)|| || || || || || || ||
|}

{| class="wikitable sortable"
|-
! FACILITY !! ADDRESS
|-
| HCA Florida Lake Monroe ||[https://www.google.com/maps/dir//1401+Medical+Plaza+Dr,+Sanford,+FL+32771 1401 Medical Plaza Dr, Sanford, FL 32771]
|-
| HCA Heathrow ER ||[https://www.google.com/maps/dir//4525+International+Pkwy,+Sanford,+FL+32771 4525 International Parkway, FL 32771]
|-
| AdventHealth Altamonte || [https://www.google.com/maps/dir//Florida+Hospital+Altamonte,+East+Altamonte+Drive,+Altamonte+Springs,+FL 601 E Altamonte Dr, Altamonte Springs, FL 32701]
|-
| AdventHealth Lake Mary || [https://www.google.com/maps/dir//Florida+Hospital+Lake+Mary+Emergency+Department,+950+Rinehart+Rd,+Lake+Mary,+FL+32746 950 Rinehart Rd, Lake Mary, FL 32746]
|-
| HCA Oviedo Medical Center || [https://www.google.com/maps/dir//Oviedo+Medical+Center,+8300+Red+Bug+Lake+Rd,+Oviedo,+FL+32765 8300 Red Bug Lake Rd, Oviedo, FL 32765]
|-
| ORHS South Seminole FSED|| [https://www.google.com/maps/dir//455+W+Warren+Ave,+Longwood,+FL+32750 455 W Warren Ave, Longwood, FL 32750]
|-
| ORHS - Lake Mary|| [https://www.google.com/maps/dir//380+Rinehart+Rd,+Lake+Mary,+FL+32746 380 Rinehard Rd, Lake Mary, FL 32746]
|-
| AdventHealth Orlando|| [https://www.google.com/maps/dir//Florida+Hospital+Orlando:+Emergency+Room,+East+Rollins+Street,+Orlando,+FL 601 E Rollins St Orlando, FL 32803]
|-
| Orlando Regional Medical Center|| [https://www.google.com/maps/dir//Orlando+Regional+Medical+Center+Emergency+Room,+29+W+Sturtevant+St,+Orlando,+FL+32806 29 W Sturtevant St, Orlando, FL 32806]
|-
| ORHS Arnold Palmer|| [https://www.google.com/maps/dir//Arnold+Palmer+Hospital+for+Children,+West+Miller+Street,+Orlando,+FL 92 West Miller Street, Orlando, FL]
|-
| ORHS Winnie Palmer|| [https://www.google.com/maps/dir/28.524444,-81.3789772/Winnie+Palmer+Hospital+for+Women+and+Babies,+West+Miller+Street,+Orlando,+FL 83 W Miller St, Orlando, FL 32806]
|-
| Orlando VA|| [https://www.google.com/maps/dir//Orlando+VA+Medical+Center,+13800+Veterans+Way,+Orlando,+FL+32827 13800 Veterans Way, Orlando, FL 32827]
|-
| AdventHealth East|| [https://www.google.com/maps/dir//7727+Lake+Underhill+Rd,+Orlando,+FL+32822 7727 Lake Underhill Rd, Orlando, FL 32822]
|-
| Nemours|| [https://www.google.com/maps/dir//13535+Nemours+Pkwy,+Orlando,+FL+32827 13535 Nemours Pkwy, Orlando, FL 32827]
|-
| AdventHealth Winter Park Hospital|| [https://www.google.com/maps/dir//200+N+Lakemont+Ave,+Winter+Park,+FL+32792 200 N Lakemont Ave, Winter Park, FL 32792]
|-
| AdventHealth Apopka|| [https://www.google.com/maps/dir//Florida+Hospital+Apopka,+Ocoee+Apopka+Road,+Apopka,+FL 2100 Ocoee Apopka Rd, Apopka, FL 32703]
|-|}
|Advent Health - Oviedo
| [https://www.google.com/maps/place/8100+Red+Bug+Lake+Rd,+Oviedo,+FL+32765 8100 Red Bug Lake Rd, Oviedo, FL 32765]
|-
|HCA Florida Casselberry
| [https://www.google.com/maps/place/2560+S+US+Hwy+17+92,+Casselberry,+FL+32707 2560 S US Hwy 17-92, Casselberry, Florida, 32707]
|-
|HCA Florida Maitland
| [https://www.google.com/maps/place/9401+Summit+Centre+Way,+Lockhart,+FL+32810 9401 Summit Centre Way, Orlando, FL 32810]
|-
|ORHS Waterford Lakes
|[https://www.google.com/maps/place/11898+Lake+Underhill+Rd,+Orlando,+FL+32825 11898 Lake Underhill Road, Orlando, FL 32825]
|}

Main Page

2025-06-25T18:20:51Z

Treloars: /* Section 1 - Administrative Policies */

==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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[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]]||October-20
|-
|[[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]

Obstetrical Patient Transport Decision

2025-06-25T18:20:19Z

Treloars: /* Section 1 - ADMINISTRATIVE POLICIES */

==Section 1 - ADMINISTRATIVE POLICIES==
===1.13 OBSTETRICAL PATIENT TRANSPORT DESTINATION===

'''Patient known to be < 20 weeks gestation:'''
* Last menstrual period, < 20 weeks or verifiable ultrasound proven dates or other proof of < 20 weeks gestation.
* Transport to the closest Emergency department (not closest obstetric facility).

'''Patient known gestation or possible gestation > 20 weeks:'''
* If imminent delivery or medically unstable mother, transport to the closest ED, (not closest obstetric facility).
* If patient with non traumatic abdominal, pelvic or back complaints, (including bleeding or vaginal fluid leak).
** Transport to the closest appropriate obstetric facility with a NICU (Winnie Palmer or Advent Health Orlando).
** Contact appropriate obstetric facility ED for radio report and any additional direction/assistance.
** May transport to the patient’s requested obstetric receiving facility, (i.e. high risk pregnancy with pre-selected obstetrical destination); if patient is not having imminent delivery.

'''If patient is a TRAUMA ALERT'''
* Transport to Orlando Regional Medical Center or HCA Lake Monroe (as per protocol)
* Non Trauma Alert patients are to be transported to the ED of the closest OB receiving facility.

'''Appropriate Obstetric Receiving Facilities:'''

Florida Hospital Altamonte (Seminole)

Oviedo Medical Center (Seminole)

Orlando Health Lake Mary (Seminole)

Winnie Palmer Hospital (Orange)

Florida Hospital Orlando (Orange)

Winter Park Memorial (Orange)

[[Category:Administrative Policies|0113]]

Obstetrical Patient Transport Decision

2025-06-25T18:14:58Z

Treloars:

==Section 1 - ADMINISTRATIVE POLICIES==
===1.13 OBSTETRICAL PATIENT TRANSPORT DESTINATION===

'''Patient known to be < 20 weeks gestation:'''
* Last menstrual period, < 20 weeks or verifiable ultrasound proven dates or other proof of < 20 weeks gestation.
* Transport to the closest Emergency department (not closest obstetric facility).

'''Patient known gestation or possible gestation > 20 weeks:'''
* If imminent delivery or medically unstable mother, transport to the closest ED, (not closest obstetric facility).
* If patient with non traumatic abdominal, pelvic or back complaints, (including bleeding or vaginal fluid leak).
** Transport to the closest appropriate obstetric facility with a NICU (Winnie Palmer or Advent Health Orlando).
** Contact appropriate obstetric facility ED for radio report and any additional direction/assistance.
** May transport to the patient’s requested obstetric receiving facility, (i.e. high risk pregnancy with pre-selected obstetrical destination); if patient is not having imminent delivery.

'''If patient is a TRAUMA ALERT'''
* Transport to Orlando Regional Medical Center or Central Florida Regional (as per protocol)
* Non Trauma Alert patients are to be transported to the ED of the closest OB receiving facility.

'''Appropriate Obstetric Receiving Facilities:'''

Florida Hospital Altamonte (Seminole)

Oviedo Medical Center (Seminole)

Orlando Health Lake Mary (Seminole)

Winnie Palmer Hospital (Orange)

Florida Hospital Orlando (Orange)

Winter Park Memorial (Orange)

[[Category:Administrative Policies|0113]]

Main Page

2025-06-23T14:31:52Z

Treloars: /* Section 4 - Cardiac */

==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]]|| October-20 ||
|-
| 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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[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]]||October-20
|-
|[[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]

Atrial Fibrillation Atrial Flutter

2025-06-23T14:31:22Z

Treloars: /* STABLE: */

==Section 4 - CARDIAC==
===4.03 ATRIAL FIBRILLATION / ATRIAL FLUTTER===

'''CONSIDER MEDICAL ETIOLOGY AND REFER TO APPROPRIATE PRACTICE PARAMETER:'''
* [[Chest Pain Acute Coronary Syndrome|CHEST PAIN / ACUTE CORONARY SYNDROME]] (4.01).
* Hypoxia, [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01).
* Toxic effects of medications or alcohol.
* Thyroid Disease.

==== POTENTIALLY UNSTABLE AND TIME TO ED > 15 MINUTES: ====
* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
* If rate is greater than 150 beats/minute and narrow complex. Consider administration of [[Cardizem|DILTIAZEM (CARDIZEM)]] 0.25 mg/kg IV bolus over 2 minutes. If no response in 30 minutes and heart rate greater than 150, [[Cardizem|DILTIAZEM (CARDIZEM)]] 0.25 mg/kg IV bolus over 2 minutes
* If rate greater than 150 beats/minute and wide complex refer to [[Wide Complex Tachycardia Uncertain Origin|WIDE COMPLEX TACHYCARDIA PARAMETER]] (4.10)
* [[Aspirin|ASPIRIN]] 81mg, chewed, if not previously administered or with known hypersensitivity to the drug or active ulcer disease.

'''''BLACK BOX WARNING: [[Cardizem|DILTIAZEM (CARDIZEM)]] IS CONTRAINDICATED IN HYPOVOLEMIA AND CALCIUM CHANNEL BLOCKER USE.'''''
'''''Use in these situations can result in severe bradycardia and refractory hypotension or cardiac arrest.'''''

==== UNSTABLE: ====
* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)- [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
*O2 saturation, monitor in place.
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 50 Joules.
*Consider pre-medication with [[Versed|MIDAZOLAM (VERSED)]]. Start at 2-5 mg then 2 mg every 30 seconds to 1 min IVP or IN if patient is conscious.
*May repeat as necessary to allow for sedation. See [[Analgesia and Sedation|ANALGESIA/SEDATION PARAMETER]] (2.04)
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 200 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 300 Joules.

'''''Physician's Orders: If NO response, contact Medical Control for consult.'''''

This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC SYMPTOMS, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING AND/OR CIRCULATION.'''''

'''''If there is a prolonged delay or difficulty obtaining synchronization, and the patient is extremely UNSTABLE, then [[Defibrillation|DEFIBRILLATION]] should be administered.'''''

[[Category:Cardiac|0403]]

Main Page

2025-06-23T14:18:15Z

Treloars: /* Section 8 - Medication Guidelines */

==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]]|| October-20 ||
|-
| 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]]||April-20
|-
|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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[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]]||October-20
|-
|[[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]

Trauma Transport Protocol

2025-05-16T12:47:02Z

Treloars: /* FREE STANDING EMERGENCY DEPARTMENTS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth Oviedo ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

HCA Florida Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

HCA Florida Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

HCA Florida Maitland

9401 Summit Centre Way

Orlando, FL 32810

HCA Florida Alafaya

1434 N Alafaya Trail

Orlando, FL 32828

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Trauma Transport Protocol

2025-05-16T12:46:48Z

Treloars: /* FREE STANDING EMERGENCY DEPARTMENTS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

HCA Florida Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

HCA Florida Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

HCA Florida Maitland

9401 Summit Centre Way

Orlando, FL 32810

HCA Florida Alafaya

1434 N Alafaya Trail

Orlando, FL 32828

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Trauma Transport Protocol

2025-05-16T12:46:20Z

Treloars: /* FREE STANDING EMERGENCY DEPARTMENTS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

HCA Florida Maitland

9401 Summit Centre Way

Orlando, FL 32810

HCA Florida Alafaya

1434 N Alafaya Trail

Orlando, FL 32828

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Trauma Transport Protocol

2025-05-16T12:45:45Z

Treloars: /* FREE STANDING EMERGENCY DEPARTMENTS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

HCA Maitland

9401 Summit Centre Way

Orlando, FL 32810

HCA Floria Alafaya

1434 N Alafaya Trail

Orlando, FL 32828

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Trauma Transport Protocol

2025-05-16T12:45:23Z

Treloars: /* FREE STANDING EMERGENCY DEPARTMENTS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

HCA Maitland
9401 Summit Centre Way
Orlando, FL 32810

HCA Floria Alafaya
1434 N Alafaya Trail
Orlando, FL 32828

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Main Page

2025-05-16T12:43:22Z

Treloars: /* Section 1 - Administrative Policies */

==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]]|| October-20 ||
|-
| 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]]||April-20
|-
|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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Geodon]]||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]]||October-20
|-
|[[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]

Trauma Transport Protocol

2025-05-16T12:36:06Z

Treloars: /* INITIAL RECEIVING HOSPITALS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Trauma Transport Protocol

2025-05-16T12:34:58Z

Treloars: /* FREE STANDING EMERGENCY DEPARTMENTS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Trauma Transport Protocol

2025-05-16T12:34:36Z

Treloars: /* INITIAL RECEIVING HOSPITALS */

==South Section 1 - ADMINISTRATIVE POLICIES==
===1.09 TRAUMA TRANSPORT PROTOCOLS===

In the Seminole County Emergency Medical Services System, the Trauma Transport Protocols (TTPs) are subject to paramedic discretion. That is to say, if in a paramedic’s judgment he or she believes the patient requires transport to a Trauma Center even though they don’t meet the criteria, the paramedic is empowered to transport that patient to the Trauma Center.

=== Dispatch Procedures ===

====Communications Center====
*Seminole County Public Safety E-911 Communications Center is located at 150 Eslinger Way in the city of Sanford, FL. All EMS calls for Seminole County are received by and dispatched by this center. The entire county has enhanced 911 and a computer aided dispatch system.

==== List of information to be obtained from caller ====
*Location of patient
*Type of trauma (Circumstances)
*Number of trauma victims
*Extent and severity of trauma injury
*Scene security / safety
*Name of caller
*Callback number

====Method used to identify and dispatch the most readily available unit====
*The Seminole County EMS System operates under a sophisticated “First Response” agreement between 8 cities and two counties. In this agreement the parties agree to provide reciprocal assistance on a joint response/automatic aid based on geographical location. Agencies participating in the First Response Agreement are:
{| class="wikitable"
|-
! Seminole County !! Orange County
|-
| Lake Mary FD || Maitland FD
|-
| Longwood FD || Orange County Fire Rescue
|-
| Oviedo FD || Winter Park FD
|-
| Sanford FD ||
|-
| Seminole County FD ||
|}

*The closest available unit(s) will be dispatched by the Emergency Medical Services dispatcher based on CAD recommendations and/or Automatic Vehicle Locator (AVL) data.

Prior to the first unit’s arrival, multiple response units may be dispatched by request of the Communications Supervisor or EMS Commander based on information received from caller(s). Paramedics upon arrival can request multiple response units.

====Process used to request assistance from emergency response agencies====
* Fire department is requested to respond to all vehicle accidents, trauma alerts and unconfirmed trauma alerts.
* Law enforcement is requested to respond to all vehicle accidents, violent or potential violent crimes.
* Public utility agencies are requested when need is identified.
* Aero-Medical support may be requested by an on-scene Paramedic. In addition, the Communications Supervisor or EMS Commander can request air support prior to a unit’s arrival on scene based on information received from caller(s). Aero-medical resources are requested through the communications center. The following air resources are assigned by region based on availability and weather conditions:
{| class="wikitable"
|-
! COUNTY !! PRIMARY !! SECONDARY !! TERTIARY
|-
| SEMINOLE || AIR CARE 3 (SSCH) || AIR CARE 1 || AIR CARE 2
|}

'''All Seminole County EMS System units and EMS Command personnel will be dispatched on recorded channels. All other requests for an emergency response agency will be made on recorded phone lines.'''

====Pre-Hospital Procedures====
Adult Trauma Triage Criteria & Methodology
The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16) years of age or older for the presence of at least one of the following four criteria to determine whether to transport as a trauma alert. These four criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination in accordance to the Adult Trauma Scorecard methodology as set forth in 64J-2.004 FAC.

====Adult Criteria====
* Meets color-coded triage system (see below)
* GCS ≤ 12 Patient must be evaluated via GCS if not identified as a trauma alert after application of criterion 1.
* Meets local criteria (specify): ''Likely to require surgery within one to four (1-4) hours.''
* Paramedic Judgment: Patient does not meet any of the trauma criteria listed above however, in the judgment of the Paramedic, should be transported as a trauma alert (document as required per 64J-1.014, FAC)

{| class="wikitable"
|-
! ADULT COMPONENT !! BLUE !! RED
|-
| AIRWAY1|| RR ≥ 30 || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CIRCULATION || SUSTAINED HR ≥ 120 BPM || LACK OF RADIAL PULSE WITH SUSTAINED RAPID HEART RATE > 120 BPM OR BP < 90 mm hg
|-
| BEST MOTOR RESPONSE || BMR = 5 || BMR OF ≤ 4 PRESENCE OF PARALYSIS OR SUSPECTED SPINAL INJURY LOSS OF SENSATION
|-
| CUTANEOUS || TISSUE LOSS3 OR GSW TO EXTREMITIES || AMPUTATION4 OR 2°/3° BURNS TO ≥ 15% TBSA OR ANY PENETRATING INJURY TO HEAD, NECK OR TORSO5
|-
| LONGBONE FRACTURE || SINGLE LONGBONE FX DUE TO MVA OR FALL > 10’ || SIGNS OR SYMPTOMS OF MULTIPLE LONGBONE FX SITES6
|-
| AGE ||≥ 55 ||
|-
| MECHANISM OF INJURY || EJECTION FROM VEHICLE7 OR DEFORMED STEERING WHEEL8 ||
|}

 RED = any one (1) transport as a trauma alert BLUE= any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Not just Oxygen

3 Degloving injuries, major flap avulsions (> 5 in.)

4 Amputations proximal to the wrist or ankle

5 Excluding superficial wounds in which the depth of the wound can be easily determined

6 Humerus, (radius,ulna), femur, (tibia or fibula)

7 Excluding any motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck

8 Only applies to driver of the vehicle

====Pediatric Trauma Triage Criteria & Methodology====
* The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person (15) years or younger using the scorecard methodology outlined in 64J-2.005 FAC. Seminole County Emergency Medical Services System recognizes that a child is not simply a small adult and that the adult trauma scores cannot be used as a reliable indicator of the degree of injury in the pediatric patient. Therefore, all pediatric patients will be scored using the pediatric trauma score outlined below; the presence of at least one of the following two criteria to determine whether to transport as a trauma alert. These two criteria are to be applied in the order listed, and once any one criterion is met that identifies the patient as trauma alert, no further assessment is required to determine the transport destination.

====Pediatric Criteria====

* Meets color-coded triage system (see below)
* Patient does not meet any of the trauma criteria listed above but, in the judgment of the EMT or paramedic, should be transported as a trauma alert (document a required per 64J-1.014, FAC)

{| class="wikitable"
|-
! COMPONENT !! BLUE !! RED
|-
| AIRWAY1 || || REQUIRES ACTIVE AIRWAY ASSISTANCE2
|-
| CONSCIOUSNESS || SYMPTOMS OF AMNESIA LOSS OF CONSCIOUSNESS|| ALTERED MENTAL STATUS3 PRESENCE OF PARALYSIS OR LOSS OF SENSATION SUSPECTED SPINAL INJURY
|-
| CIRCULATION || LOSS OF RADIAL OR PEDAL PULSES4 OR SYSTOLIC B/P < 90 mm hg || FAINT / NONPALPABLE CAROTID PULSE OR FAINT / NONPALPABLE FEMORAL PULSE OR BP < 50 mm hg
|-
| FRACTURE || SIGNS OR SYMPTOMS OF A CLOSED LONG BONE FRACTURE (DOES NOT INCLUDE ISOLATED WRIST OR ANKLE FXs) || OPEN LONG BONE FX.5 OR MULTIPLE FX SITES OR MULTIPLE DISLOCATIONS (EXCEPT FOR ISOLATED WRIST OR ANKLE FX OR DISLOCATIONS)

|-
| CUTANEOUS || || MAJOR SOFT TISSUE DISRUPTION6 OR 2°/3° BURNS TO ≥ 10% TBSA OR AMPUTATION7, OR PENETRATING INJURIES TO HEAD, NECK OR TORSO8
|-
| SIZE || ≤ 11 KILOGRAMS9 (Kg)||
|}

RED = any one (1) transport as a trauma alert BLUE = any two (2) transport as a trauma alert

1 Airway evaluation is designed to reflect the intervention required for effective care

2 Patient requiring intubation, manual jaw thrust, continuous suctioning or use of airway adjuncts to assist ventilatory efforts

3 Including drowsiness, lethargy, inability to follow commands, unresponsive to voice, totally unresponsive or coma

4 Carotid and femoral pulses are palpable but, radial or pedal pulses are not palpable

5 Humerus, (radius,ulna), femur, (tibia or fibula)

6 Major degloving injuries or major flap avulsions

7 Amputations proximal to the wrist or ankle

8 Excluding superficial wounds in which the depth of the wound can be easily determined

9 Or body length is equivalent to this weight on the Handtevy System

====Issuing a Trauma Alert:====
* A “Trauma Alert” is to be called by the first arriving unit, if and when in the judgment of the Paramedic, EMT in charge, the adult or pediatric trauma patient meets the criteria.
* To initiate a “Trauma Alert”:
**Establish direct communication with the Trauma Center, Pediatric Trauma Center or other receiving facility on the appropriate facility’s radio talkgroup utilizing either an 800 MHz or VHF radio frequency.
**Give agency name, unit number and state “Trauma Alert”. Give brief description of the situation, location, criteria for call the “Trauma Alert” and approximate E.T.A.
**Once transporting unit is enroute to the trauma center or receiving facility, a complete radio report will be given as outlined in Administrative Policy – [[Radio Report Format|RADIO REPORT FORMAT]] (1.02).
* The transporting agency will provide documentation as prescribed in 64J-2.004 FAC for each adult or 64J-2.005 FAC for each pediatric patient or provide documentation on the Seminole County Abbreviated Report to the hospital staff upon delivery of the patient to the Trauma Center or receiving facility.

====Transport Procedures:====
All trauma alert patients will be transported to the State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident; that meets all criteria as required in the Department of Health Pamphlet DHP 150-9 (January 2010 revision) and 64J-2.002.
* Initial efforts are to direct transportation of the trauma alert patient to the closest SATC.
* The EMT, Paramedic that finds any trauma patient that meets the criteria using the appropriate Trauma Scorecard Methodology, as required in sections 64J-2.004 or 64J-2.005 FAC shall immediately notify their Communications Center and issue a “Trauma Alert”.
* The Paramedic will advise the Communications Center of the following information about the trauma alert scene:
**Total number of patients
**Total number of trauma alert patients
**Criteria by which the alert was called
**Mechanism of injury
**Additional resources needed

====Guidelines for transportation are as follows:====
* AIR SUPPORT to a State Approved Trauma Center (SATC):
**Air support response time is less than 30 minutes.
* GROUND TRANSPORT to a State Approved Trauma Center (SATC):
**The ground transport time is less than 30 minutes.
* AIR TRANSPORT TO INITIAL RECEIVING HOSPITAL (IRH)
**The TTP of the Air Transport Agency indicate diversion (e.g. Cardiac Arrest etc.).
**MCI situations*
**GROUND TRANSPORT to an IRH nearest the scene of the incident:
**When air transport is not available or response time is greater than 30 minutes and ground transport to SATC is greater than 30 minutes. **Cardiac arrest secondary to trauma.
**Lack of patent airway.
**MCI situation*.

<nowiki>*</nowiki>For situations with multiple trauma patients, not meeting trauma alert criteria, the critical patients should be transported to the initial receiving hospital nearest the scene of incident. The non-critical patients should be transported to a different initial receiving hospital, if possible. There may be instances in mass casualty situations when the ground units will be overburdened and may need air transport to facilitate movement of multiple patients to initial receiving hospitals. This decision will be made by the Field Supervisor on the scene.
* If a trauma center or an initial receiving hospital nearest the scene of the incident notifies EMS that it is temporarily unable to provide adequate care for the trauma alert patient, EMS personnel under the direction of Medical Control, will determine which hospital is in the patient’s best interest.

====Emergency inter-facility transfers of Trauma Victims:====
* In accordance with 64J-2.002 FAC, inter-facility transfers to the Trauma Center shall be conducted by services licensed by the department in appropriately permitted ambulances when the patient needs, or is likely to need, medical attention during transport. A critical care patient shall be transported in a permitted air ambulance or ground vehicle that is staffed and equipped requisite to the patient’s requirements. Under extreme circumstances, such as: a patient requiring immediate life, limb, or bodily function saving surgery; an inability to provide that surgery in a timely manner at the originating hospital; and a lack of timely response by a permitted inter-facility transport vehicle, EMS may need to provide that transfer. The attending physician and the originating hospital will ensure that the level of patient care established in the originating hospital is appropriately provided during the transport. The originating hospital will provide personnel and equipment as necessary for the safest transfer possible. '''If that level of care is, in the determination of EMS, not being provided for contact the Medical Director on call.'''
*Assess the patient upon arrival.
*Transport to the facility where the patient has been accepted by physician.

====List of Hospitals====

====TRAUMA CENTERS====
* The following is a list of trauma centers to where Seminole County Emergency Medical Services System will routinely transport trauma alert patients. It is preferable that pediatric patients (15 years old and younger) and burn patients be transported to a Level I trauma center.
{| class="wikitable"
|-
| Orlando Regional Medical Center (TL I)

29 W Sturtevant St

Orlando, Florida 32806

Arnold Palmer Hospital for Children (TL I)

92 West Miller Street

Orlando, FL 32806
| HCA Florida Lake Monroe (TL II)

1403 Medical Plaza Dr

Sanford, FL 32771

Halifax Hospital Medical Center (TL II)

303 North Clyde Morris Blvd.

Daytona Beach, Florida 32015
|}

====INITIAL RECEIVING HOSPITALS====
* The following is a list of initial receiving hospitals to where Seminole County Emergency Medical Services System will routinely transport trauma patients that are not trauma alerts. Initial receiving hospitals are indicated by written documentation.
{| class="wikitable"
|-
| '''Seminole County'''
AdventHealth Altamonte Springs

601 E. Altamonte Dr.

Altamonte Springs, Florida 32701

Oviedo Medical Center

8300 Red Bug Lake Road

Oviedo, FL 32765

Orlando Health Lake Mary

380 Rinehart Rd

Lake Mary, FL 32746

'''Volusia County'''

AdventHealth Fish Memorial

1055 Saxon Blvd

Orange City, Florida 32763

| '''Orange County'''

AdventHealth Apopka

2100 Ocoee Apopka Road

Apopka, FL 32703

AdventHealth East Orlando

7727 Lake Underhill Road

Orlando, Florida 32822

AdventHealth Orlando

601 East Rollins Street

Orlando, Florida 32803

AdventHealth Winter Park Memorial Hospital

200 Lakemont Ave

Winter Park, Florida 32792

Nemours Children Hospital

13535 Nemours Parkway

Orlando, FL 32827 (407) 567-4000
|}

====FREE STANDING EMERGENCY DEPARTMENTS====
The following is a list of Free Standing Emergency Departments to where Seminole County Emergency Medical Services system will elect to transport when the injured patient appears to have a minor injury and is unlikely to require hospital admission or emergent or urgent surgical intervention beyond the capabilities of a free standing emergency department.
{| class="wikitable"
|-
|
AdventHealth ER

8100 Red Bug Lake Road

Oviedo, FL 32765

AdventHealth Lake Mary

950 Rinehart Road

Lake Mary, FL 32746

AdventHealth Waterford Lakes ED

13691 E Colonial Drive

Orlando FL 32826

Baldwin Park ER

2361 N Semoran Blvd

Orlando, FL 32807

Heathrow ER

4525 International Parkway

Sanford, FL 32771

Orlando Health Emergency Room – Longwood

555 W SR 434

Longwood, FL 32750

HCA Florida Casselberry

2560 S US Hwy 17-92

Casselberry, FL 32707

|}

====Deviations:====
'''''Any deviation from these protocols will be documented and justified on the Patient Care Report.'''''

[[Category:Administrative Policies|0109]]

Code Cool Post ROSC Induced Hypothermia

2025-05-16T12:29:46Z

Treloars:

==Section 4 - CARDIAC==
===4.12 CODE COOL – POST ROSC INDUCED HYPOTHERMIA===

====Indication====
ROSC (return of spontaneous circulation) post VF/VT resuscitation (non – trauma)

====Utilization:====
* ROSC
* Age ≥ 18
* Temperatures > 34°C (Tympanic measurement) repeat measurement for possible change.
* Unresponsiveness to pain
* Intubated with EtCO2 > 20 mm Hg
* Not obviously pregnant

Preparation for Induction – Hypothermia
* NEURO assessment:
* Pupils (size, reactivity, equality)
* Motor Response to Pain
* Remove clothing, protect modesty
* Apply cold packs to axilla and groin
* Goal EtCO2 = 40; NO Hyperventilation
* Attempt second IV/IO (if not in place)

Transport to the closest hospital with cooling capabilities:
* HCA Lake Monroe
* AdventHealth Hospital facilities
* Orlando Health Lake Mary

Induction of Paralysis: (prevention of shivering)
* Administer [[Versed|VERSED]] or [[Morphine_Sulfate|Morphine]] (IV/IO/IN) or Valium (IV/IO) titrated dose to effect.

Saline infusion and Maintenance of Mean Arterial Pressure (MAP)
* Initiate cold saline bolus through up to two (2) IV or IO access points
* Infuse cold saline at 30mL/kg to max of 2 Liters
{| class="wikitable"
|-
! Weight (lbs) !! Weight (kg) !!
Volume Target (mL)
|-
| 88|| 40|| 1200
|-
| 110|| 50|| 1500
|-
| 132|| 60|| 1800
|-
| ≥143|| ≥65|| 2000
|}

* Target Mean Arterial Pressure (MAP) 90 – 100
* Check MAP on the LP12, but manually monitor
{| class="wikitable"
|-
! Systolic !! Diastolic !! MAP
|-
| 110|| 80|| 90
|-
| 120|| 75-90|| 90-100
|-
| 130|| 70-85|| 90-100
|-
| 140|| 65-80|| 90-100
|}

'''MAP = Diastolic Value + 1/3 Pulse Pressure'''

'''Target Diastolic: 80 – 90'''

'''''If chilled saline does not maintain MAP continue to maintenance of MAP with vasopressors'''''

Maintenance of MAP with vasopressors
* Support B/P with Dopamine as required to Maintain MAP of 90-100

Dopamine 400mg/250mL/NaCl
{| class="wikitable"
|-
! Weight (lbs) !! Weight (kg) !! 5mcg/kg/min !! 10mcg/kg/min !! 20mcg/kg/min
|-
| 88|| 40|| 8|| 15|| 30
|-
| 110|| 50|| 9|| 19|| 38
|-
| 132|| 60|| 11|| 23|| 45
|-
| 154|| 70|| 13|| 26|| 53
|-
| 176|| 80|| 15|| 30|| 60
|-
| 198|| 90|| 17|| 34|| 68
|-
| 220|| 100|| 19|| 38|| 75
|-
| 242|| 110|| 21|| 41|| 83
|}

* Patient assessment is critical for ongoing care, with any new signs of patient movement (i.e., gasping, eye fluttering, shivering, seizure activity, movement) during ICE therapy, administration of 10mg Versed and 10mg Morphine is required. (Additional may be needed)
* Reassess patient’s airway frequently and with every movement
* Cold saline is a strong vasoconstrictor, maintaining cerebral perfusion is essential during the therapeutic hypothermia process. '''''Maintain MAP at 90 – 100 mmHg'''''
* Monitor EtCO2 frequently and target 40 mm Hg, If EtCO2 falls below 20 mm Hg, consider possible loss of pulses.
* If there is a loss of ROSC at any time, discontinue cooling and go to appropriate protocol for treatment. Chilled saline infusion should be slowed to KVO rate during the resuscitative process. Upon ROSC (if attained) return chilled saline to wide open infusion.
* Chilled saline is infused at 30mL/kg to a maximum of 2000 mL.
* Continue to address specific differentials (H’s and T’s) associated with original dysrhythmia or cause of arrest

====Contraindications for “Code Cool”====
* PEA and Asystole
* Active Bleeding
* Hemodynamically unstable arrhythmias
* Sickle Cell Anemia
* End Stage Terminal Disease
* Obviously Pregnant

====Relative contraindications for “Code Cool”====
* Prolonged QT (consider pacing)
* Cryoglobulinemia (single or mixed immunoglobulins that undergo reversible precipitation at low temperatures)
* [http://www.niams.nih.gov/Health_Info/Raynauds_Phenomenon/raynauds_ff.asp/ Raynaud’s Phenomenon]

[[Category:Cardiac|0412]]

Chest Pain Acute Coronary Syndrome

2025-05-16T12:28:36Z

Treloars:

==Section 4 - CARDIAC==
===4.01 CHEST PAIN/ACUTE CORONARY SYNDROME===

'''Perform initial assessment:'''
* Interview and subjective assessment
* Vital signs
* Oxygen saturation and sideline/sidestream capnography if available
* Pre-treatment 12-Lead ECG
* Focused history (SAMPLE, OPQRST)
* Identify '''cardiac risk factors and contraindications''' for Fibrynolytics
* Physical exam
* Inquire if the patient has an old ECG and Cardiologist name

Indications for 12-Lead ECG include but are not limited to:
* Chest pain/discomfort
* Palpitations/dysrhythmias
* Shortness of breath
* Syncope/dizziness
* Feelings of “impending doom”
* Sweating nausea or vomiting
* Beware of atypical presentations (absence of chest pain) in women, diabetics & geriatric patients.

If Symptoms, Chief Complaint and 12-Lead diagnostic pre-treatment ECG evaluation suggests angina/ myocardial infarction, consider one of the following notifications:

'''“STEMI ALERT” (ST ELEVATION MI)''' – If the 12-Lead diagnostic ECG evaluation indicates ONE of the following findings:
* ST elevation > 1.0 mm present in two (2) or more inferior leads
* ST elevation > 2.0 mm in two (2) or more precordial leads
'''When transporting a STEMI to the ED of any hospital, have your EKG strip initialed by the attending physician verifying the STEMI or not. Please ask the physician to initial, date and to indicate “Yes” or “No” to certify the correct diagnosis of STEMI or not. If you are unable to have the physician initial at the time of your transport you may have him do it the next time you are at the ED.'''

'''“CARDIAC ALERT”''' – If 12-Lead diagnostic ECG evaluation indicates ONE of the following findings:
* New bifascicular block (RBBB) with QRS axis deviation of > -50
* Signs of ischemia such as: new inverted T-Waves or ST depression in two (2) or more contiguous leads
* Normal ECG with signs and symptoms of Myocardial infarction
* New Left Bundle Branch Block (LBBB)
* Hyper-acute T waves present in two or more contiguous leads
* Onset of any new arrhythmia

'''TREATMENT:'''
*Consider [[Morphine_Sulfate|MORPHINE]], [[Oxygen|OXYGEN]], [[Nitro_Tablets|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray|NITROGLYCERIN SPRAY]] AND [[Aspirin|ASPIRIN]] (MONA)
* Administer [[Oxygen|OXYGEN]], nasal cannula if saO2 > 92%; non-rebreather if saO2 < 92%.
* If systolic BP > 110 mm Hg: [[Nitro_Spray|NITROGLYCERIN SPRAY]] or [[Nitro_Tablets|NITROGLYCERIN TABLETS]] 0.4 mg SL (Do not withhold if unable to establish IV). Repeat at 5 minute intervals until either systolic BP < 110 mm Hg or [[Nitro_Drip|NITROGLYCERIN]] drip established. (Team member should be assigned as “nitro-time keeper”)

{| class="wikitable"
|-
! Black Box Warning
|-
| '''''The administration of sublingual nitroglycerin is CONTRAINDICATED if the patient taking daily doses of or has a recent history (36-48 hrs) of using any type of erectile dysfunction medications from the phosphodiesterase type 5 (PDE-5) class such as Sildenafil Citrate (Viagra), Vardenafil (Levitra) or Tadalafil (Cialis).'''''

'''''The IV (perenteral) administration of nitroglycerin has a RELATIVE CONTRAINDICATION when the patient has ingested any type of PDE-5 medications in the past 48 hrs. The provider must weigh the risk vs. benefit of nitroglycerin administration based on the patient’s condition.'''''
|}

* If systolic BP > 110 mm Hg, [[Nitro_Drip|NITROGLYCERIN DRIP]], START at 5-15 mcg/minute via Infusion Regulator (Dial-a-Flow device) or Buretrol device. Titrate and increase [[Nitro_Drip|NITROGLYCERIN DRIP]] at 5 mcg/minute increments every 3-5 minutes until relief of discomfort. Establish second IV of NaCl, however keep in mind the patient may be a candidate for Thrombolytics. Monitor and document BP every 5 minutes. If pain is relieved, leave drip at setting when relief occurred.

'''''If pain is not relieved and/ or more severe- follow initial nitro drip infusion with [[Morphine_Sulfate|MORPHINE SULFATE]] administration Refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PARAMETERS]] (2.04)'''''

* BABY ASA 162 – 324 mg, chewed.
* Evaluate and treat the patient’s pain level. Pain level equal to or greater than 4 must be treated with a goal in the reduction of pain severity to a level of 2 or less.
* Obtain additional 12-lead ECG, post-treatment of patient.
* Perform blood draw of all tubes. The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes. Document that blood was drawn.
* If patient has vomiting or severe nausea, obtain detailed history and administer an Antiemetic medication as appropriate.
* If systolic BP < 90 mm Hg, consider fluid boluses in increments of 200 - 300 ml, to titrate systolic BP > 90 mm Hg. Monitor for signs of fluid overload.
* If condition worsens despite fluid therapy, administer [[Dopamine|DOPAMINE]] 5 - 20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.

'''''Remove transdermal patches to avoid excessive dosing. (Transdermal patches may also cause electrical arcing during defib or cardioversion).'''''

'''''Vasovagal reaction may occur. It is usually transient and responds to elevating the patient’s legs. [[Atropine|ATROPINE]] may be used but is rarely necessary.'''''

'''TRANSPORT DESTINATION'''
*Patients with identified STEMI/Cardiac alerts must be transported to a STEMI receiving facility.
*Current STEMI receiving facilities:
**AdventHealth Altamonte
**Orlando Health Lake Mary
**HCA Florida Lake Monroe Hospital
**AdventHealth Orlando
**AdventHealth Apopka
**Orlando Regional Medical Center

[[File:Chest_Pain_Flowchart_2013-06.jpg]]

[[Category:Cardiac|0401]]

Memo - Stroke Alerts

2025-05-14T18:29:51Z

Treloars: Created page with "May 12, 2025 '''Stroke Alerts''' Please be advised of a change in stroke alert policy. All stroke alerts should be taken to the nearest (by time of transport) comprehensive stroke center This new directive took into account multiple considerations. Although we have made great improvement in attempting to determine the severity of patients with stroke by examination in the field, we recognize that such a determination is still not exact. We also recognize that stroke..."

May 12, 2025

'''Stroke Alerts'''

Please be advised of a change in stroke alert policy. All stroke alerts should be taken to the nearest (by time of transport) comprehensive stroke center

This new directive took into account multiple considerations. Although we have made great improvement in attempting to determine the severity of patients with stroke by examination in the field, we recognize that such a determination is still not exact. We also recognize that stroke can be a condition of evolving severity. We have had patients that could have benefited by the advanced interventions at a comprehensive stroke center, but they were instead taken to a primary stroke center. We now have three comprehensive stroke centers that are all within a reasonable transport timeframe. The final determination for this collective decision was the answer to the question “where do you want to go if you are having stroke symptoms of any severity?” The answer was a resounding “to the nearest comprehensive stroke center!”

Main Page

2025-05-14T18:28:49Z

Treloars: /* Section 11 - Medical Director Memos */

==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]]|| October-20 ||
|-
| 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 - DRAFT|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]]||April-20
|-
|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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Geodon]]||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]]||October-20
|-
|[[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

2025-05-13T22:01:55Z

Treloars: /* Section 5 - Medical */

==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]]|| October-20 ||
|-
| 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 - DRAFT|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]]||April-20
|-
|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]]||March-19
|-
|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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Geodon]]||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]]||October-20
|-
|[[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 - 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]

Suspected Stroke Transient Ischemic Attack TIA

2025-05-13T22:00:19Z

Treloars:

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a BE-FAST Pre-Hospital Stroke Exam

==== BE FAST Exam ====

*BE FAST and VAN assessments can be performed simultaneously

{| class="wikitable"
|Balance
|Is the person suddenly having trouble with balance or coordination?
|-
|Eyes
|Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain?
|-
|Face
|Face numbness or weakness, especially one side
“Smile”
|-
|Arm
|Arm numbness or weakness, especially on one side of the body
“Arms out like Superman”
|-
|colspan="2"|(VAN Positive or Negative?)
|-
|Speech 
|Slurred speech or difficulty speaking or understanding
“You can’t teach an old dog new tricks”
|-
|colspan="2"|(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!))
|-
|Time 
|Time since – Last seen normal/Last Known Well (LKW)
|}

*Perform Blood Glucose
*Complete Stroke Checklist
**Identify any t-PA exclusions and document all findings
**Leave copy at hospital
**Forward or Fax the duplicate Stroke Checklist to County EMS QA office
**A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
*Obtain IV Access
**An 18 gauge is preferable.
**Avoid multiple attempts and IO's
**Notify ER staff and document location of any missed IV’s.
**'''Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.'''
*Perform blood draw of all tubes.
**The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.
**Document that blood was drawn.
*HYPERTENSION - Do not treat hypertension.
*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
*Do not allow aspiration
*Maintain head and neck in neutral alignment, without flexing the neck
*Protect paralyzed limbs from injury
*Obtain 12-lead EKG
*Nausea/vomiting - administer an antiemetic
*Have Patient hold both arms up for 10 seconds
**Is arm weakness present?
***YES - continue VAN assessment 
***NO - Patient is VAN negative.

====VAN Assessment====
{| class="wikitable"
|Visual 
|'''IS VISION GAZED IN ONE DIRECTION? NEW ONSET BLINDNESS?'''
Test: Ask the person to look up, then down then left, then right. Or have them follow your finger in those directions.

Normal: No preferred gaze and eyes move past midline upon request.

Abnormal: Gaze is deviated to one side and does not pass the midline upon request or new onset blindness.
|-
|Aphasia 
|'''CAN THE PERSON SPEAK & UNDERSTAND LANGUAGE?'''
Test: Ask them to name an ordinary object such as a pen. Or ask them to make a fist

Normal: The patient can understand language and name ordinary objects.

Abnormal: Inability to understand or express speech or name ordinary objects, does not follow simple commands such as “close your eyes” or make a fist

Slurred speech alone does not indicate a positive VAN test

|-
|Neglect 
|'''IS THE PATIENT IGNORING ONE SIDEOF THE BODY (Usually the left side)?'''
Test: Ask the patient to close their eyes and tell them that you will touch each arm individually and then both at the same time. Ask them to acknowledge each touch.

Normal: Patient acknowledges both individual touches and simultaneous touch.

Abnormal: Patient does not acknowledge simultaneous touch usually ignoring the left side

If the patient does not acknowledge individual touches this does not indicate a positive VAN test.

|}

'''ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE'''

BE-FAST and VAN assessments often are performed simultaneously

====TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)====

If patient exhibits symptoms, regardless of time frame, call in as STROKE ALERT 

Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but a LKW of <24 should receive EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

{| class="wikitable"
|+DESTINATION SELECTION
|-
|colspan="2"|All suspected stroke and TIA patients must be transported to a COMPREHENSIVE stroke-receiving facility..
|}

{| class="wikitable"
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|-
|HCA Lake Monroe
|Comprehensive Stroke Care
|}

Suspected Stroke Transient Ischemic Attack TIA

2025-05-13T21:59:50Z

Treloars: /* PRIMARY STROKE DESTINATIONS */

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a BE-FAST Pre-Hospital Stroke Exam

==== BE FAST Exam ====

*BE FAST and VAN assessments can be performed simultaneously

{| class="wikitable"
|Balance
|Is the person suddenly having trouble with balance or coordination?
|-
|Eyes
|Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain?
|-
|Face
|Face numbness or weakness, especially one side
“Smile”
|-
|Arm
|Arm numbness or weakness, especially on one side of the body
“Arms out like Superman”
|-
|colspan="2"|(VAN Positive or Negative?)
|-
|Speech 
|Slurred speech or difficulty speaking or understanding
“You can’t teach an old dog new tricks”
|-
|colspan="2"|(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!))
|-
|Time 
|Time since – Last seen normal/Last Known Well (LKW)
|}

*Perform Blood Glucose
*Complete Stroke Checklist
**Identify any t-PA exclusions and document all findings
**Leave copy at hospital
**Forward or Fax the duplicate Stroke Checklist to County EMS QA office
**A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
*Obtain IV Access
**An 18 gauge is preferable.
**Avoid multiple attempts and IO's
**Notify ER staff and document location of any missed IV’s.
**'''Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.'''
*Perform blood draw of all tubes.
**The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.
**Document that blood was drawn.
*HYPERTENSION - Do not treat hypertension.
*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
*Do not allow aspiration
*Maintain head and neck in neutral alignment, without flexing the neck
*Protect paralyzed limbs from injury
*Obtain 12-lead EKG
*Nausea/vomiting - administer an antiemetic
*Have Patient hold both arms up for 10 seconds
**Is arm weakness present?
***YES - continue VAN assessment 
***NO - Patient is VAN negative.

====VAN Assessment====
{| class="wikitable"
|Visual 
|'''IS VISION GAZED IN ONE DIRECTION? NEW ONSET BLINDNESS?'''
Test: Ask the person to look up, then down then left, then right. Or have them follow your finger in those directions.

Normal: No preferred gaze and eyes move past midline upon request.

Abnormal: Gaze is deviated to one side and does not pass the midline upon request or new onset blindness.
|-
|Aphasia 
|'''CAN THE PERSON SPEAK & UNDERSTAND LANGUAGE?'''
Test: Ask them to name an ordinary object such as a pen. Or ask them to make a fist

Normal: The patient can understand language and name ordinary objects.

Abnormal: Inability to understand or express speech or name ordinary objects, does not follow simple commands such as “close your eyes” or make a fist

Slurred speech alone does not indicate a positive VAN test

|-
|Neglect 
|'''IS THE PATIENT IGNORING ONE SIDEOF THE BODY (Usually the left side)?'''
Test: Ask the patient to close their eyes and tell them that you will touch each arm individually and then both at the same time. Ask them to acknowledge each touch.

Normal: Patient acknowledges both individual touches and simultaneous touch.

Abnormal: Patient does not acknowledge simultaneous touch usually ignoring the left side

If the patient does not acknowledge individual touches this does not indicate a positive VAN test.

|}

'''ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE'''

BE-FAST and VAN assessments often are performed simultaneously

====TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)====

If patient exhibits symptoms, regardless of time frame, call in as STROKE ALERT 

Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but a LKW of <24 should receive EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

{| class="wikitable"
|+DESTINATION SELECTION
|-
|colspan="2"|All suspected stroke and TIA patients must be transported to a COMPREHENSIVE stroke-receiving facility..
|}

=====COMPREHENSIVE STROKE DESTINATIONS=====
{| class="wikitable"
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|-
|HCA Lake Monroe
|Comprehensive Stroke Care
|}

Main Page

2025-05-13T21:59:18Z

Treloars: /* Section 5 - Medical */

==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]]|| October-20 ||
|-
| 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 - DRAFT|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]]||April-20
|-
|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]]||March-19
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transcient 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]]||January-24
|-
|6.07||[[Head Injuries]]||September-24
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|-
|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
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Flumazenil]]||April-16
|-
|[[Geodon]]||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]]||October-20
|-
|[[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 - 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
|}

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Suspected Stroke Transcient Ischemic Attack TIA

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