TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER f: EMERGENCY SERVICES AND HIGHWAY SAFETY
PART 515 EMERGENCY MEDICAL SERVICES, TRAUMA CENTER, COMPREHENSIVE STROKE CENTER, PRIMARY STROKE CENTER AND ACUTE STROKE READY HOSPITAL CODE
SECTION 515.APPENDIX D STANDING MEDICAL ORDERS



 

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

            Electromechanical dissociation/pulseless electrical activity (EMD/PEA)

            Paroxysmal supraventricular tachycardia (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

            Stroke, in accordance with Section 515.220

 

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 INITIAL ASSESSMENT/MEDICAL CARE − A foundation for all pediatric patient interactions, this protocol shall reinforce the need for consistent, methodical patient assessment.  Commonly referred to as "routine medical care" in adult protocols, the protocol shall 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.  The protocol shall emphasize the appropriate inclusion of parents/primary caregivers.

 

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

 

PEDIATRIC AED – Treatment shall be in accordance with the Department approved Pediatric AED protocol and in accordance with American Heart Association guidelines. AEDs can be used in children age one to eight years.  Use of pediatric pads and cables is preferable. 

 

PEDIATRIC ALLERGIC REACTION/ANAPHYLAXIS − Special attention to the differentiation between local reaction (hives), mild respiratory distress and severe cardio-respiratory compromise.

 

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

 

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

 

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

 

PEDIATRIC ENVIRONMENTAL HYPERTHERMIA – Emphasis on appropriate assessment, cooling techniques and fluid replacement considerations of children presenting with environmental hyperthermia.

 

PEDIATRIC HYPOTHERMIA – Emphasis on the pediatric population at high risk for hypothermia:  neonates and infants.  Aggressive airway management, warming techniques and recognition of frostbite injury shall be addressed.  Interventions for associated arrhythmias in accordance with the American Heart Association recommendations.

 

PEDIATRIC NEAR DROWNING – Emphasis on aggressive airway management and the potential for associated cervical spine injury and hypothermia.

 

PEDIATRIC PULSELESS ARREST – Treatment and recognition of the following dysrhythmias:  asystole, pulseless electrical activity, ventricular fibrillation, ventricular fibrillation or pulseless ventricular tachycardia.  Treatment modalities should be consistent with guidelines set forth by the American Heart Association's Pediatric Advanced Life Support.  Appropriateness for intraosseous access should be included.

 

PEDIATRIC RESPIRATORY ARREST − Treatment shall be in accordance with the American Heart Association Pediatric Advanced Life Support guidelines.

 

PEDIATRIC RESPIRATORY DISTRESS − Differentiation shall be made between "upper airway obstruction" (i.e., croup, epiglottitis and foreign body) and  lower airway disease (i.e., asthma, bronchiolitis, pneumonia).  The potential for invasive airway interventions shall also be identified.   Respiratory distress in children with a tracheostomy tube or on a ventilator shall also be addressed.

 

PEDIATRIC SEIZURE − Shall 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 three years old).

 

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

 

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

 

PEDIATRIC TOXIC EXPOSURES/INGESTIONS − Accidental/ environmental toxic exposure or ingestion events commonly encountered in the pediatric population shall be incorporated. 

 

PEDIATRIC TRAUMA – Emphasis 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 shall be 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.  The pre-hospital provider's responsibility as a mandated reporter and reporting suspicions to the emergency room staff shall be discussed.  Directions for responding to parent/caregiver refusal to allow transport shall be included.

 

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 that 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:  Amended at 37 Ill. Reg. 19610, effective November 20, 2013)