EMS Medical Policies and Protocols

242 Pages·2013·2.61 MB·English

KANSAS CITY MISSOURI
EMS Medical Policies and Protocols

KCMO Office of the EMS Medical Director
5/15/2013

Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108
Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Table of Contents
Page 2 of 242

PREFACE 6
INTRODUCTION 7
POLICIES EFFECTIVE DATE
Ambulance Diversion Guidelines Policy 7/1/2004 52
Central On-Line Medical Control Policy 1/1/2007 43
Determination of Hospital Destination Policy 7/15/2010 8
DOA Policy 10/1/2007 50
Equipment Brought In Policy 10/1/2005 62
Helicopter Utilization Policy 1/1/2006 19
Infection Control Policy 4/28/2003 31
Request of Ambulance Policy 1/1/2006 45
KCFD Rehabilitation Policy 12/23/1994 47
Medical Intervention Policy 1/1/2006 34
Medical Research in KCMO EMS Policy 7/1/2005 60
Medical Standards during Patient Transfer Policy 5/1/2013 17
Medical Values Statement Policy 1/1/2006 41
Multiple Encounter Incident Policy 6/23/1997 33
On-Scene AED Coordination Policy 7/1/2005 32
Patient Contact Policy 7/1/2005 61
Person Exceeding the EMS System’s Capability Policy 5/26/1997 49
Procedures for Do Not Resuscitate Requests Policy 5/1/2013 48
Refusal of Service Policy 9/1/2009 24
Medical Transfer of Care and Report Format Policy 5/1/2013 21
Safe Place for Newborns Act of 2002 Policy 12/1/2002 57
Scope of Practice Policy 10/1/2007 38
Suspected Abuse/Neglect Policy 12/1/2002 58
Vascular Access Policy 10/1/2007 23

DISPATCH RELATED POLICIES EFFECTIVE DATE
911 Dispatch Policy to Hospitals with Emergency Departments Policy 5/26/1997 69
Ambulance Transport Requests From Health Care Facilities Policy 5/1/2004 64
Emergency Medical Dispatch Policy 5/1/2004 63
EMS CAD Data Policy 1/1/2006 68
Notification of OEMSMD Policy 9/1/2003 66
Physician Certification Statements (PCS) Policy 5/1/2001 70
Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108
Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Table of Contents
Page 3 of 242

MEDICAL COMBINED ADULT/PEDIATRIC EFFECTIVE DATE
Allergic Reaction (Anaphylaxis) Protocol 9/1/2009 75
Altered Mental Status Protocol 9/15/2010 82
Behavioral/Psychiatric Disorders Protocol 11/15/2009 79
Cardiac Arrest Protocol 5/1/2010 100
Cardiac Dysrhythmia Protocol 1/1/2005 95
Child birth/Neonatal Resuscitation Protocol 1/1/2005 104
Cyanide Poisoning Protocol 10/1/2008 109
Drowning/Near-Drowning Protocol 9/1/2009 117
General Medical Protocol 10/1/2007 71
Hyperthermia Protocol 1/1/2005 83
Hypothermia Protocol 1/1/2005 85
Management of Patients Exposed to STUN or EMD Weapons Protocol 2/1/2009 111
Ophthalmologic Emergencies Protocol 1/1/2005 108
Poisoning Protocol 1/1/2005 86
Respiratory Distress Protocol 11/15/2009 90
Seizure Protocol 11/15/2009 87
Shock Protocol 10/1/2008 77
Syncope Protocol 1/1/2005 89
Treatment of Nerve Agent and Organophosphate Casualties Protocol 11/15/2009 113
Carbon Monoxide Exposure 2/1/2012 119

TRAUMA COMBINED ADULT/PEDIATRIC EFFECTIVE DATE
Burns Protocol 1/1/2006 128
General Trauma Protocol 7/1/2008 118
Spinal Restriction/Omission of Spinal Restriction Protocol 9/1/2009 130

ADULT PROTOCOLS EFFECTIVE DATE
Chest Pain Protocol 11/15/2009 137
Prehospital Termination of Resuscitation Protocol 2/1/2009 143
Stroke/CVA Protocol 7/1/2005 141
Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108
Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Table of Contents
Page 4 of 242

PROCEDURES EFFECTIVE DATE
12-Lead ECG Monitoring (Zoll E-Series) Procedure 7/1/2007 172
Analgesic Medication Administration Procedure 11/15/2009 203
Antiemetic Medication Procedure 2/1/2009 190
CO2 Detector (EZ CAP II) Procedure 7/1/2005 148
Combat Application Tourniquet (CAT) Procedure 10/1/2008 187
Combat Gauze Procedure 10/1/2008 189
Confirmation of Endotracheal Tube Placement Procedure 7/1/2007 167
Continuous Positive Airway Pressure (CPAP) Procedure 7/1/2008 184
Duodote Administration Procedure 11/15/2009 208
End Tidal CO2 Monitoring (Zoll E-Series - Capnostat) Procedure 7/1/2007 175
Esophageal Detector Device (EDD) Procedure 9/15/2000 170
Intranasal Drug Administration Procedure 11/15/2009 180
Intraosseous (intramedullary) Cannulation Procedure 8/2/1996 158
LMA Supreme Procedure_____________________________________ 5/1/2008_____ 194
Nasogastric/Orogastric Tube Insertion Procedure 8/1/1995 165
Nasotracheal Intubation Procedure 7/1/2005 152
Needle Cricothyroidotomy with TTJI Procedure 2/15/1998 157
Needle Thoracostomy Procedure 8/2/1996 155
Non-Invasive BP Monitoring (Zoll E-Series) Procedure 7/1/2007 182
Oral Endotracheal Intubation Procedure 7/1/2005 146
Patient Restraint Procedure 2/1/2009 191
Prehospital Administration of Acetaminophen (Tylenol) Procedure 2/1/2009 198
Prehospital Administration of Dimenhydrinate (Dramamine) Procedure 2/1/2009 199
Prehospital Administration of Diphenhydramine (Benadryl) Procedure 2/1/2009 200
Prehospital Management of Minor Wounds Procedure 2/1/2009 202
Procedural Sedation Procedure 7/1/2005 206
Pulse Oximetry Procedure 7/1/2007 163
Rapid Glucose Determination Procedure 10/1/2004 179
Transcutaneous Cardiac Pacing Procedure 8/2/1996 160
RAD – 57 Procedure 2/1/2012 211
Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108
Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Table of Contents
Page 5 of 242

DRUGS EFFECTIVE DATE
Adenosine (Adenocard) 8/2/1996 215
Albuterol (Proventil) 8/2/1996 214
Aspirin (acetylsalicylic acid) 12/1/1997 225
Atropine Sulfate 12/1/1997 218
Atrovent (ipratroprium bromide) 9/1/1999 226
Calcium Chloride 8/2/1996 221
Diphenhydramine (Benadryl) 8/2/1996 215
Dopamine Hydrochloride 8/2/1996 222
Epinephrine 9/1/2009 217
Fentanyl Citrate 2/1/2009 231
Glucagon 11/1/2001 230
Glucose (Dextrose) 12/1/1997 212
Lidocaine Hydrochloride 8/2/1996 219
Midazolam Hydrochloride (Versed) 2/1/2009 224
Morphine Sulfate 1/1/2007 228
Naloxone Hydrochloride (Narcan) 12/1/1997 211
Neosynephrine (phenylephrine hydrochloride) 9/1/1999 227
Nitroglycerin 9/1/1998 220
Ondansetron Hydrochloride (Zofran) 2/1/2009 233
Oxygen (O2) 4/1/1999 213
Sodium Bicarbonate 8/2/1996 223

Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108
Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Preface
Page 6 of 242

The policies, protocols, procedures and drugs described in this document are applicable
to the Kansas City, Missouri Emergency Medical Services (EMS) System. The document
represents the hard work of multiple individuals and agencies including: KCFD, KCI EMT
Program, the Emergency Physicians Advisory Board (EPAB), the Medical Equipment and
Protocol Labor-Management Committee, the Office of the EMS Medical Director and
the Emergency Medical Services Coordinating Committee of Kansas City, Missouri.

This is a “living” document” and is frequently updated. We would like to thank the
above agencies for their tireless work on this document and most especially we would
like to thank the individual paramedics, system status controllers, EMTs, emergency
responders and other individuals who continuously provide excellent emergency
medical care under frequently difficult and sometimes dangerous circumstances to the
Citizens of Kansas City, Missouri and it’s visitors.

Joseph Salomone, MD Paul Berardi Theodore M. Barnett, MD
EMS Medical Director Chief, Fire Depertment Chairman
Kansas City, Missouri Kansas City, Missouri EPAB

Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108 Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Introduction
Page 7 of 242

The Scope of Practice Policy delineates the specific skills that each level of City privileged
out-of-hospital practitioner (Emergency Responder, EMT, EMT-I and Paramedic) can
accomplish within the KCMO EMS System.

Furthermore, each protocol specifies what skills are appropriate for each level of
privileged practitioner. Items written in “normal” type are appropriate for all levels or
personnel. Items written in “bold” are to be accomplished only by paramedic level
personnel. Items that are in “bold” and prefaced with “(orders)” are to be
accomplished only by paramedics after approval by on-line medical control.
Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108 Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Determination of Hospital Destination Policy
Page 8 of 242

BACKGROUND: N/A

POLICY:
I. General Routing
A. For all life threatening emergencies, transport the patient to the nearest
appropriate hospital defined as the hospital that requires the least amount of
transport time.
1. When the hospital is “closed to ambulances”, no patient will be taken
to that hospital, except as noted below in A.2. Patients will be
transported to the nearest “open” hospital emergency department or
trauma center as indicated.
2. The following situations are exceptions to “A.1:”
a) Patients who are in cardiac arrest may still be taken to the
closest appropriate hospital, unless it is “out of service.”
b) Medical patients who are “unstable” may still be taken to the
closest appropriate hospital, unless it is “out of service.”
“Unstable” is defined as:
(1) Unable to establish or maintain an airway
(2) Unable to ventilate
(3) Unremitting shock
(4) As determined by medical control
B. For all non-life threatening emergencies, transport the patient to the hospital
of the patient’s choice.
1. When the patient is unable to make such a judgment, the choice of an
appropriate party acting on behalf of the patient will be followed.
2. When no person is available to act for the patient, transport to the
nearest appropriate “open” hospital.
3. When the chosen hospital is “closed to ambulance,” transport the
patient to an appropriate “open” hospital of the patient’s second
choice.
C. Ambulances should not transport more than one patient in the same
ambulance unless the patients have established a previous relationship, such
as family or friends and are being transported to the same destination
hospital.
D. Patients with isolated mental health problems may be taken directly to the
Center for Behavioral Medicine (formerly Western Missouri Mental Health) if
they request.
1. This does not include drug or alcohol intoxicated patients or patients
with any other active medical problem.
Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108 Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Determination of Hospital Destination Policy
Page 9 of 242

E. See attached table for a list of facilities and services provided.

II. Time Critical Diagnosis Routing
A. Trauma Routing
1. Any trauma patient with any of the following criteria should be
routed to a Trauma Center even if it is not the nearest hospital.
2. Physiologic Criteria
a) Shock, as define as BP less than 90mmHg (adults)Respiratory
distress
(1) RR > 29 or < 10 (adults), or <20 (infant less than 1 year)
(2) Decreased or absent breath sounds
b) Altered mental status with Glasgow Coma Scale of less than 14

3. Mechanism of Injury
a) Occupant ejection
b) Fall from height > 20 feet (adults), >10 feet (children)
c) Pedestrian/bicycle/motorcycle hit at speed > 20 mph
d) Death of same car occupant
e) Prolonged extrication > 20 minutes
f) Vehicle telemetry data consistent with high risk of injury

4. Anatomic
a) Penetrating injury to head, neck, torso or extremities proximal
to elbow or knee
b) Airway burns
c) 20% second degree burns and/or 5% third degree burns
d) Flail chest
e) Two or more proximal long bone fractures
f) Pelvic fracture
g) Paralysis
h) Amputation proximal to wrist or ankle
i) Open and/or depressed skull fracture
j) Crushed, degloved or mangled extremity

5. For any trauma patients with the following criteria, contact medical
control and consider transport to a Trauma Center even if it is not the
nearest hospital.
a) Age < 16 or > 55
b) Pregnancy greater than 20 weeks
Version 5.0 effective 5/1/2013
Office of the EMS Medical Director
Emergency Medical Services

2400 Troost Avenue, Suite 4200, Kansas City, Missouri 64108 Joseph Salomone, MD

Voice: [phone] Fax: [phone] EMS Medical Director
Determination of Hospital Destination Policy
Page 10 of 242

c) Patient with bleeding disorder or patient on anticoagulants
d) Patient with any known serious medical disorder i.e. dialysis

6. Patients who are less than 16 years old and who meet the physiologic
(pediatric), mechanism of injury or anatomic criteria should be routed to
a Missouri state designated pediatric trauma center.
7. Traumatic cardiopulmonary arrest patients should be taken to the
nearest Trauma Center, unless it is “out of service.”
8. When there is more than one adult trauma patient, attempt to evenly
distribute patients. If this is not feasible, contact central medical control
at Truman Medical Center – Hospital Hill for routing assistance.
9. When more than one patient less than 16 years old meets physiologic
or anatomic criteria per the trauma routing protocol, contact central
medical control at Children’s Mercy Hospital for routing assistance.
10. Burn patients with suspected more than 20% second degree burns
and/or greater than 5% third degree burns, consider routing directly to
KUMC for adults and CMH for patients under age 16.
B. STEMI Routing
1. Patients with identified ST elevation of 1mm or greater in two or
more contiguous leads or left bundle branch block should be transported
to the closest STEMI center.
C. Stroke Routing
1. Patients identified with acute stroke symptoms should be transported
to the closest Stroke center.

III. Hospital Diversion Routing
A. Definitions
1. Diversion – The rerouting of an ambulance(s) from the intended
receiving facility to an alternate receiving facility due to a temporary
lack of critical resources in the intended receiving facility.
2. Diversion Categories:
a) Open – The hospital ED is open to all ambulance traffic.
b) Trauma Diversion – Trauma centers cannot accept patients
who meet trauma routing criteria.
c) Closed to Ambulances – The ED is functioning but cannot
accept any ambulance patients.
d) Open to Trauma – The ED can only accept ambulance patients
meeting trauma routing criteria.
Version 5.0 effective 5/1/2013