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Suffolk County Protocols
On-Line Medical Control Physician
a. a physician authorized by the Medical Director and the Regional Emergency Medical Advisory Committee (REMAC) to provide advice and direction when such physician is present at the scene of an out-of-hospital medical emergency
b. a physician authorized by the Medical Director to provide advice and direction to ALS Providers providing out-of-hospital medical care
c. a physician receiving additional authority as a Deputy Fire Coordinator-Medical (DFC-Medical) to operate as an agent of the county, when specifically called upon -
b
Disaster Medical Response Team (DMRT) Physician
a. a physician authorized by the Medical Director and the Regional Emergency Medical Advisory Committee (REMAC) to provide advice and direction when such physician is present at the scene of an out-of-hospital medical emergency
b. a physician authorized by the Medical Director to provide advice and direction to ALS Providers providing out-of-hospital medical care
c. a physician receiving additional authority as a Deputy Fire Coordinator-Medical (DFC-Medical) to operate as an agent of the county, when specifically called upon -
c
Designated EMS Field Physician
a. a physician authorized by the Medical Director and the Regional Emergency Medical Advisory Committee (REMAC) to provide advice and direction when such physician is present at the scene of an out-of-hospital medical emergency
b. a physician authorized by the Medical Director to provide advice and direction to ALS Providers providing out-of-hospital medical care
c. a physician receiving additional authority as a Deputy Fire Coordinator-Medical (DFC-Medical) to operate as an agent of the county, when specifically called upon -
a
When required by protocol, voice contact with Medical Control should be established as promptly as possible,
but not more than _____ minutes, after technician-patient contact is established
a. 30
b. 15
c. 20 -
c
Refusal of Medical Assistance (RMA) consults must take place via
a. telephone
b. On-Line
c. Medcom radio -
a
An ALS Provider has the right to question an order that is believed to be contraindicated or for which the ALS
Provider is not certified
a. True
b. False -
a
An ALS Provider believes an order is contraindicated, and clarifies the order and restates the patient's condition. If the order is not altered or retracted, the ALS Provider must carry out the order unless he/she is not credentialed or trained in that intervention, or if that intervention is not listed in the formulary of authorized procedures.
a. True
b. False -
a
Procedure attempts are limited to ____ attempts per patient
a. 3
b. 1
c. 2 -
c
To assume responsibility for the care of a patient, an on-scene physician must agree to assume all responsibility for the patient, document the assumption of responsibility on the Prehospital Care Report (PCR), and agree to accompany the patient to the hospital in the ambulance.
a. True
b. False -
a
The EMS Medical Director, a Medical Control Physician, or a Designated EMS Field Physician may provide on-scene medical control in accordance with System protocols. The primary role of these physicians is to
a. perform hands-on clinical care
b. provide direct on-scene medical control and direction
c. accompany the patient to the hospital -
b
Psychiatric Emergencies should be transported to the closest emergency department for medical evaluation and clearance for secondary transfer, as indicated by additional diagnostic testing.
a. True
b. False -
a
Patients that may require hyperbaric therapy should be transported to the closest emergency department for evaluation and clearance for secondary transfer, as indicated by additional diagnostic testing.
a. True
b. False -
a
Patients that are victims of sexual assault should be transported to a hospital that maintains a Sexual
Assault Nurse Examiner (SANE) Program, unless the assault is compounded by an unstable illness or
injury.
a. True
b. False -
a
Per NY State DOH, if the transport time from the scene to the Trauma Center is _____________, Medical Control must be contacted for transport decision, in accordance with current NYS BLS & ALS guidelines.
a. greater than (>) forty (40) minutes
b. greater than (>) twenty (20) minutes
c. greater than (>) thirty (30) minutes -
c
Nitrous Oxide is ok to use on the medevac aircraft
a. True
b. False -
b
Which of the following is required on all endotracheal intubations performed in the ALS System
a. End-Tidal CO2 waveform capnography, use of an available tube holder, immobilization of the head with cervical collar
b. End-Tidal CO2 waveform capnography, use of a commercially available tube holder, immobilization of the head with cervical collar, head blocks and long
backboard
c. End-Tidal CO2 waveform capnography, use of the RES-Q Pod, use of a commercially available tube holder, immobilization of the head with cervical collar, head blocks and long
backboard -
b
The use of the RES-Q Pod™ is required for all patients in cardiac arrest when
a. Return of Spontaneous Circulation (ROSC) is established
b. resuscitation is being performed and when Return of Spontaneous Circulation (ROSC) is established
c. either an endotracheal tube or supraglottic airway is used -
c
Any patient greater than twelve (>12) years old and weighing greater than (>) thirty six (36) Kg. may be
treated as an adult.
a. True
b. False -
a
Unstable patients include those with:
- Pulse < 50 or > 110
- SBP < 90mmHg or > 180mmHg, DBP > 110mmHg
- Respiratory rate < 10 or >
- Persistent: chest pain or discomfort, respiratory distress; unresolved AMS.
- Status Post Cardiac or Respiratory Arrest.
- Multisystem or penetrating trauma.
a. True
b. False -
a
VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA
a. Defibrillation 360 joules or biphasic equivalent, Epinephrine 1:10,000 1 mg IV/IO/EJ; repeat q 3- min, Amiodarone 300 mg IV/IO/EJ bolus, may repeat Amiodarone 150 mg IV/IO/EJ in 3-5 minutes.
b. Defibrillation 360 joules or biphasic equivalent, Epinephrine 1:1,000 1 mg IV/IO/EJ; repeat q 3- min, Amiodarone 300 mg IV/IO/EJ bolus, may repeat Amiodarone 150 mg IV/IO/EJ in 3-5 minutes.
c. a. Defibrillation 360 joules or biphasic equivalent, Epinephrine 1:10,000 1 mg IV/IO/EJ; repeat q 3- min, Amiodarone 300 mg IV/IO/EJ bolus, to repeat Amiodarone call medical control -
a
If renal failure, TCA OD or hyperkalemia is suspected and the patient is well ventilated during VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR / TACHYCARDIA / ASYSTOLE / PEA what is the correct dosage of Sodium Bicarbonate
a. Call Medical Control
b. 40-80 mEq/kg IV/IO/EJ
c. 1 mEq/kg IV/IO/EJ -
c
If Torsade de Pointes is suspected during VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA what is the correct dosage of Magnesium Sulfate
a. Call Medical Control
b. 2 g IV/IO/EJ
c. 1 mEq/kg IV/IO/EJ -
b
H's & T's of ASYSTOLE / PEA
a. Hyperglycemia, Hypervolemia, Hypoxia, Acidosis, Hyperkalemia, Toxins, Tension Pneumothorax
b. Hypoglycemia, Hypovolemia, Hypoxia, Acidosis, Hyperkalemia, Toxins, Tension Pneumothorax
c. Hyperglycemia, Hypovolemia, Hypoxia, Acidosis, Hypokalemia, Tension Pneumothorax -
b
What is the correct Fluid bolus to administer during ASYSTOLE / PEA
a. Fluid bolus of 40 ml/kg (may be repeated to a total of 80 ml/kg)
b. Fluid bolus of 20 ml/kg (may be repeated to a total of 60 ml/kg)
c. Fluid bolus of 20 ml/kg (may be repeated to a total of 40 ml/kg) -
c
SHOCK / HYPOPERFUSION AFTER ROSC protocol
a. There are no standing orders, call Medical Control
b. Is intended for use in patients that are in shock, secondary to post-cardiac arrest. As evidence by *SBP < 90 with signs and symptoms of Inadequate Tissue Perfusion.
c. Is intended for use in patients that are in shock, with a SBP < 90 with signs and symptoms of Inadequate Tissue Perfusion. -
b
What is the correct dosage of Dopamine in the SHOCK / HYPOPERFUSION AFTER ROSC protocol
a. Bolus of 10 mcg/kg/min-if Systolic B/P < 90 mmHg
Midazolam up to 5mg IV or up to 10 mg IM/IN OR Lorazepam up to 4 mg IV/IM
Agencies without Controlled Substances:
Etomidate 5 mg IV every 5 minutes (SBP > 100) -
b
If SBP drops below 90 mmHg during the THERAPEUTIC HYPOTHERMIA Protocol
a. administer Dopamine 10 mcg/kg/min after fluid bolus
complete
b. administer Dopamine 10 mcg/kg/min before administering fluid bolus
c. administer Dopamine 10 mg/kg/min after fluid bolus
complete -
a
What is the correct amount of Infuse chilled normal saline to administer during the THERAPEUTIC HYPOTHERMIA Protocol
a. There is no limit
b. total of 15 ml/kg or 1 L maximum
c. total of 30 ml/kg or 2 L maximum -
c
VENTRICULAR TACHYCARDIA WITH PULSE
Stable Without Decompensation administer
a. Monitor and transport
b. Amiodarone 300 mg in 100 ml over 10 minutes.
c. Amiodarone 150 mg in 100 ml over 10 minutes. -
c
VENTRICULAR TACHYCARDIA WITH PULSE, QRS is wide and Polymorphic
Stable Without Decompensation administer
a. 2g of Magnesium Sulfate in 100 ml NS over 10
minutes.
b. 1g of Magnesium Sulfate in 100 ml NS over 10
minutes.
c. Contact Medical Control -
b
VENTRICULAR TACHYCARDIA WITH PULSE
Unstable (Decompensated SBP < 90 mmHg), or chest
pain, or pulmonary edema AND PT AWAKE what is the cardioversion setting
a. Premedicate, 100 joules, repeat 200, 300, 360 until rhythm converts, Contact Medical Control if unsuccessful after 4 attempts
b. Cardioversion is contraindicated
c. Premedicate, 100 joules, repeat 200, 300, 360, continue with 360 joules during transport until rhythm converts, Contact Medical Control if unsuccessful after 6 attempts -
a
VENTRICULAR TACHYCARDIA WITH PULSE
Unstable (Decompensated SBP < 90 mmHg), or chest
pain, or pulmonary edema AND PT AWAKE what is the correct dosage for premedication and what are the correct medications
a. Contact Medical Control for approval of Lorazepam up to 4 mg IV/IM OR Diazepam up to 10 mg IV OR Midazolam up to 5 mg IV OR 10 IM/IN OR Fentanyl 100mcg IV/IM/IN. If no controlled substances available, premedicate with Etomidate 0.15 mg/kg IV.
b. Premedicate with Lorazepam up to 4 mg IV/IM OR Diazepam up to 10 mg IV OR Midazolam up to 5 mg IV OR
10 IM/IN OR Fentanyl 100mcg IV/IM/IN. If no controlled substances available, premedicate with Etomidate 0.15 mg/kg IV.
c. Premedicate with Lorazepam up to 8 mg IV/IM OR Diazepam up to 5 mg IV OR Midazolam up to 10 mg IV OR
5 IM/IN OR Fentanyl 100mcg IV/IM/IN. If no controlled substances available, premedicate with Etomidate 0.15 mg/kg IV. -
b
c. Premedicate with Lorazepam up to 8 mg IV/IM OR Diazepam up to 5 mg IV OR Midazolam up to 10 mg IV OR
5 IM/IN OR Fentanyl 100mcg IV/IM/IN. If no controlled substances available, premedicate with Etomidate 0.15 mg/kg IV. Transcutaneous Pacing -
a
SUPRAVENTRICULAR TACHYCARDIA
Stable without decompensated shock
a. Adenosine 12mg IVP, Adenosine 6mg IVP, If resolved, and vital signs are within normal limits, transport to closest Hospital and Signal 34 Medical Control after the alarm. If SVT persists, or SVT returns, CONTACT MEDICAL CONTROL.
b. Adenosine 6mg IVP, Adenosine 12mg IVP, Adenosine 12mg IVP, If resolved, and vital signs are within normal limits, transport to closest Hospital and Signal 34 Medical Control after the alarm. If SVT persists, or SVT returns, CONTACT MEDICAL CONTROL.
c. Adenosine 6mg IVP, Adenosine 12mg IVP, If resolved, and vital signs are within normal limits, transport to closest Hospital and Signal 34 Medical Control after the alarm. If SVT persists, or SVT returns, CONTACT MEDICAL CONTROL. -
c
SUPRAVENTRICULAR TACHYCARDIA
Unstable *(Decompensated SBP <90mmHg) and Pt. is
awake.
a. Premedicate with Lorazepam up to 4 mg IV/IM OR
Diazepam up to 10mg IV OR Midazolam up to 5 mg IV/IM
OR 10 mg IM/IN OR Fentanyl 100mcg IV/IM/IN
If no controlled substances available, premedicate with
Etomidate 0.15 mg/kg IV. Cardioversion at 50 joules or
biphasic equivalent. May repeat at 100 joules or biphasic equivalent. If rhythm does not convert after four (4) successive cardioversion attempts, CONTACT MEDICAL
CONTROL.
b. Premedicate with Lorazepam up to 8 mg IV/IM OR Diazepam up to 5 mg IV OR Midazolam up to 10 mg IV OR
5 IM/IN OR Fentanyl 100mcg IV/IM/IN. If no controlled substances available, premedicate with Etomidate 0.15 mg/kg IV. Cardioversion at 50 joules or
biphasic equivalent. May repeat at 100 joules or biphasic equivalent. If rhythm does not convert after four (4) successive cardioversion attempts, CONTACT MEDICAL -
a
SUPRAVENTRICULAR TACHYCARDIA
Unstable *(Decompensated SBP <90mmHg) and Pt. is
unresponsive.
a. Cardioversion at 100 joules or biphasic equivalent. May repeat at 200 joules or biphasic equivalent, until rhythm
converts. If rhythm does not convert after six (6) successive cardioversion attempts, CONTACT MEDICAL
CONTROL.
b. Cardioversion at 100 joules or biphasic equivalent. May repeat at 200 joules or biphasic equivalent, until rhythm
converts. If rhythm does not convert after four (4) successive cardioversion attempts, CONTACT MEDICAL
CONTROL.
c. Cardioversion at 50 joules or biphasic equivalent. May repeat at 100 joules or biphasic equivalent, until rhythm
converts. If rhythm does not convert after six (6) successive cardioversion attempts, CONTACT MEDICAL
CONTROL. -
b
ATRIAL FIBRILLATION / ATRIAL FLUTTER
is UNSTABLE if
a. rate greater than (>) 150 (Decompensated SBP < 90 mmHg) AND PATIENT RESPONSIVE
c. Patient is symptomatic with a new onset, complex is narrow AND irregular, blood pressure is normal or elevated, administer Diltiazem 0.25 mg/kg to a max dose of 20 mg, IV bolus, slowly, over 2 minutes, monitoring blood pressure continuously. -
c
ATRIAL FIBRILLATION / ATRIAL FLUTTER
UNSTABLE WITHOUT DECOMPENSATION
has a rate
a. less than (<) 150
b. greater than (>) 150
c. less than (<) 180 -
b
ATRIAL FIBRILLATION / ATRIAL FLUTTER
UNSTABLE WITHOUT DECOMPENSATION, rate greater than (>) 150 and a history of WPW, Pre- Excitation Afib/Aflutter, or other accessory pathway dysrhythmias administration of Diltiazem is
a. Standing Orders, 0.25 mg/kg to a max dose of 20 mg, IV bolus, slowly, over 2 minutes, monitoring blood pressure continuously.
b. Never given even if Medical Control advises as it is a contraindication
c. Withheld and Medical Control consulted -
c
ACUTE CORONARY SYNDROME ENTRY PROTOCOL
What is the correct dosage of ASA
a. 2 - 81mg oral/chewable if patient already took aspirin
b. 324mg oral/chewable if patient took aspirin and is still symptomatic
c. 324mg oral/chewable only if patient did not take aspirin for this episode -
c
ACUTE CORONARY SYNDROME ENTRY PROTOCOL
STEMI
a. Administer Nitroglycerin 0.4 mg SL tablet or spray. Repeat every 5 minutes for a total of 3 doses. The SBP must be > 120 prior to each dose.
If SBP drops below (<) 90 administer fluid bolus of 20 ml/kg. This may be repeated to a total of 40ml/kg.
b. Administer Nitroglycerin 0.4 mg SL tablet or spray. Repeat every 10 minutes for a total of 2 doses. The SBP must be > 120 prior to each dose.
If SBP drops below (<) 90 administer fluid bolus of 20 ml/kg. This may be repeated to a total of 40ml/kg.
c. Administer Nitroglycerin 0.4 mg SL tablet or spray. Repeat every 5 minutes for a total of 3 doses. The SBP must be > 120 prior to each dose.
If SBP drops below (<) 90 administer fluid bolus of 40 ml/kg. This may be repeated to a total of 60ml/kg. -
a
ACUTE CORONARY SYNDROME ENTRY PROTOCOL
STEMI
Protocol has been followed but pain is not completely relieved, what medication can be administered
a. SBP is greater than (>) 90: • Morphine Sulfate up to 10 mg IVP
b. SBP is greater than (>) 120: • Morphine Sulfate up to 10 mg IVP
c. SBP is greater than (>) 120: • Morphine Sulfate up to 20 mg IVP -
b
How many attempts are you allowed to gain IV access.
a. 1
b. 2
c. 3 -
b
What must you do if you have failed at the maximum number of attempts to gain IV access
a. Contact Medical Control
KVO or Saline Lock, Cardiac monitor, Transport, Obtain 12 Lead EKG, Morphine Sulfate up to 10 mg IVP
b. Obtain baseline and continuous oxygen saturation readings and cardiac monitoring. Apply CPAP, titrate up to 10 cmH20* via manometer or CPAP valve and monitor with continuous sidestream waveform capnography. IV NS at KVO or Saline Lock, Cardiac monitor, Transport, Obtain 12 Lead EKG, Morphine Sulfate up to 10 mg IVP
c. Obtain baseline and continuous oxygen saturation readings and cardiac monitoring. Nitroglycerin 0.4mg SL. This Initial NTG may be a -
c
ASTHMA without respiratory failure or respiratory failure is not imminent
a. Albuterol AND Ipratropium Bromide unit-combination dose via med nebulizer may be repeated 1 additional time.
IV NS at KVO, Methylprednisolone 125 mg IV, Cardiac Monitor
b. Albuterol AND Ipratropium Bromide unit-combination dose via med nebulizer may be repeated 2 additional times. IV NS at KVO, Methylprednisolone 125 mg IV, Cardiac Monitor
c. Albuterol AND Ipratropium Bromide unit-combination dose via med nebulizer may be repeated 2 additional times. IV NS at KVO, Methylprednisolone 25 mg IV, Cardiac Monitor -
a
ASTHMA
patient in respiratory failure, or respiratory failure imminent what is the correct dosage of Epinephrine
a. Epinephrine 0.3 mg (0.3 ml of a 1:10,000 solution) IV
b. Epinephrine 0.3 mg (0.3 ml of a 1:10,000 solution) IM
c. Epinephrine 0.3 mg (0.3 ml of a 1:1,000 solution) IM -
c
After giving the correct dosage of Epinephrine to a
ASTHMA
patient in respiratory failure, or respiratory failure, what medication and dosage can you give according to standing orders
a. Nothing, the standing orders stop there and you must contact Medical Control
b. Magnesium Sulfate IV infusion, 2 grams in 100 ml over 10 minutes
c. Methylprednisolone 125 mg IM -
b
COPD / EXACERBATION
a. Albuterol AND Ipratropium Bromide combination dose via nebulizer, CPAP titrate up to 10 cmH via manometer or CPAP valve with continuous side stream waveform capnography, if SBP greater than (>) 120 mmHg, IV NS at KVO or Saline Lock, Cardiac Monitor, Obtain 12 Lead EKG, Methylprednisolone 125 mg IV
b. Albuterol via nebulizer, CPAP titrate up to 10 cmH20 via manometer or CPAP valve with continuous side stream waveform capnography, if SBP greater than (>) 120 mmHg, IV NS at KVO or Saline Lock, Cardiac Monitor, Obtain 12 Lead EKG, Methylprednisolone 125 mg IV
c. Albuterol AND Ipratropium Bromide combination dose via med nebulizer, CPAP titrate up to 20 cmH20 via manometer or CPAP valve with continuous side stream waveform capnography, if SBP greater than (>) 90 mmHg, IV NS at KVO or Saline Lock, Cardiac Monitor, Obtain 12 Lead EKG, Methylprednisolone 125 mg IV -
a
ANAPHYLACTIC SHOCK / ALLERGIC REACTION
Anaphylactic Shock is considered when
a. The patient is presenting with respiratory failure and SBP <100mmHg with signs and symptoms of Inadequate Tissue Perfusion that are consistent with anaphylactic shock:
b. The patient is presenting with severe respiratory distress and SBP <90mmHg with signs and symptoms of Inadequate Tissue Perfusion that are consistent with anaphylactic shock:
c. The patient is presenting with respiratory failure and SBP <90mmHg with signs and symptoms of Inadequate Tissue Perfusion that are consistent with a severe allergic reaction: -
b
Anaphylactic Shock
a. Epinephrine 0.3 mg, 1:10,000 solution IM, Diphenhydramine 25 mg IV/IM, Methylprednisolone 125 mg IV, Albuterol AND Atrovent combination via nebulizer, 2 treatments, SBP less than (<) 90, 20 ml/kg NS fluid bolus, repeat total 40 ml/kg or until SBP is
