Section 515.APPENDIX D  Standing Medical Orders

 

1.         STANDING MEDICAL ORDERS/CARDIAC PROTOCOLS shall include at a minimum:

 

            Routine Cardiac Care

            Cardiac Arrest

            Cardiogenic Shock

            Ventricular Fibrillation

            Ventricular Tachycardia

            Ventricular Ectopy

            EMD/PEA

            PVST

            Bradycardia

            Asystole

 

 

 

 

2.         STANDING MEDICAL ORDERS/TRAUMA PROTOCOLS shall include at a minimum:

 

            Field Triage Protocols

            Shock (Hypovolemia)

            Spinal Cord

            Head Trauma

            Load and Go Situations

            Traumatic Arrest

            Amputated Parts

            Burns

 

 

 

 

3.         STANDING MEDICAL ORDERS/PROTOCOLS FOR MEDICAL EMERGENCIES shall include at a minimum:

 

            Asthma

            Anaphylactic Shock

            Diabetic Emergencies

            Drug Overdose

            Coma, Origin Unknown

            Status Epilepticus

            Seizures

            Heat Emergencies

            Cold Emergencies

            Poisoning

            Radiation Injuries

            Renal Protocols (care of patients with shunts and fistulas)

            Near Drowning

 

 

 

 

4.         STANDARD MEDICAL ORDERS/OBSTETRIC/GYNECOLOGICAL PROTOCOLS shall include at a minimum:

 

            Normal Deliveries

            Hemorrhage, including third trimester bleeding

            Abnormal Deliveries (i.e., cord or breech presentation)

            Resuscitation of the Newborn

            Rape/Sexual Assault

 

 

 

 

5.         STANDING MEDICAL ORDERS/PEDIATRIC PROTOCOLS shall include at a minimum:

 

            PEDIATRIC PRIMARY ASSESSMENT - A foundation for all pediatric patient interactions, this protocol should reinforce the need for consistent, methodical patient assessment.  Commonly referred to as "routine medical care" in adult protocols, the protocol should reinforce the following:

 

-           Importance of rapid BLS interventions (i.e., CPR) specifically airway support

-           Age appropriate signs and symptoms of pediatric respiratory distress

-           Age appropriate airway interventions including the use of "blow-by" oxygen administration

-           Indicators of adequate ventilation and perfusion

-           Age appropriate immobilization of the pediatric trauma patient

-           Recognition of and monitoring for imminent life threats

-           Unique assessment considerations and emergent care requirements of children with special health care needs (CSHN), including those who are technologically dependent.  Emphasize the appropriate inclusion of parents/primary caregivers

 

 

            TREATMENT AND RECOGNITION OF THE FOLLOWING DYSRHYTHMIA:

 

-           Asystole

-           Pulseless Electrical Activity

-           Ventricular Fibrillation or Pulseless Ventricular Tachycardia

-           Ventricular Tachycardia

 

            Treatment modalities/algorithms should be consistent with the guidelines set forth by the American Heart Association's "Pediatric Advanced Life Support" algorithms.  The use of intraosseous access should be taught to all ALS providers.

 

            NEONATAL RESUSCITATION - Must incorporate the specific heart rate parameters and requisite interventions according to the American Heart Association recommendations.

 

            PEDIATRIC RESPIRATORY ARREST - Treatment must be in accordance with the American Heart Association "Pediatric Advanced Life Support" guidelines.

 

            PEDIATRIC RESPIRATORY DISTRESS - Differentiation should be made between "upper airway obstruction" (i.e., croup, epiglottitis and foreign body) and other "non-obstructive" causes of respiratory insufficiency (i.e., asthma, bronthiolitis, pneumonia).  The potential for invasive airway interventions must also be identified.

 

            PEDIATRIC BRADYCARDIA - Treatment in accordance with the American Heart Association recommendations.

 

            PEDIATRIC TACHYCARDIA - Interventions for both wide and narrow complex tachycardias in accordance with the American Heart Association recommendations.

 

            PEDIATRIC SHOCK - Differentiation should be made between "hypovolemic" (dehydration, hemorrhagic) and "distributive" (sepsis).

 

            PEDIATRIC ALLERGIC REACTION/ANAPHYLAXIS - Special attention to the differentiation between symptomatic (hives), mild respiratory distress and severe respiratory distress.

 

            PEDIATRIC SEIZURE - Must include the identification of rapid blood glucose monitoring in the field, considerations for febrile seizures and administration of rectal benzodiazepines (specifically in children less than 3 years old).

 

            PEDIATRIC ALTERED LEVEL OF CONSCIOUSNESS - Emphasize the importance of recognizing etiology, aggressive airway maintenance, glucose monitoring and naloxone administration.

 

            PEDIATRIC TOXIC EXPOSURES/INGESTIONS - Incorporate accidental/ environmental events commonly encountered in the pediatric population.  Special consideration should be made to the susceptibility of children to environmental events such as hyperthermia.

 

            PEDIATRIC HYPOTHERMIA - Emphasize the pediatric population at high risk for hypothermia:  neonates and infants.  Address aggressive airway management, warming techniques and recognition of frostbite injury.  Interventions for arrhythmias in accordance with the American Heart Association recommendations.

 

            PEDIATRIC NEAR DROWNING - Emphasize aggressive airway management and the potential for associated cervical spine injury and hypothermia.

 

            PEDIATRIC BURNS - Special emphasis on the pediatric "rule of nines" for burn size estimation, aggressive airway management and triage to the appropriate facility.  Differentiation should be made between thermal injuries, chemical injuries and electrical injuries.

 

            PEDIATRIC TRAUMA - Emphasis should be made on mechanism of injury, limited on-scene time, aggressive airway maintenance and field triage to the appropriate facility and addressing the unique needs of the head-injured child.

 

            SUSPECTED CHILD ABUSE/NEGLECT - Special emphasis should be made on careful documentation of physical findings, discrepancy between history of injury and physical findings, interaction between child and parent/caregiver, and characteristics of the environment.  Discuss the pre-hospital provider's responsibility as a mandated reporter, and to report suspicions to the emergency room staff.  Include directions for responding to parent/caregiver refusal to allow transport.

 

 

 

 

6.         STANDING MEDICAL ORDERS/PROTOCOLS FOR SPECIAL SITUATIONS shall include at a minimum:

 

            Psychological Emergencies

            Spousal Abuse

            Geriatric Abuse

            Child Abuse

 

 

 

 

7.         STANDING MEDICAL ORDERS/PROTOCOLS FOR THE PROCEDURES LISTED as well as any others which may be System specific:

 

            Adult Intubation Procedure

            Pediatric Intubation Procedure

            Defibrillation

            Transtracheal Ventilation-Cricothyrotomy

            Chest Decompression

            Cardioversion

            Medication Administration-IV/ett

 

 

 

 

8.         Standing medical orders may be organized as assessment based versus diagnostic, such as, altered mental status, abnormal vital signs, dysrhythmias and/or blocks, respiratory distress, chest pain.

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)