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Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.\u003cbr\u003e\n\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tDecontaminate by irrigating with water if safe to use water.\u003cbr\u003e\ni.\tRemove all contaminated clothing.\u003cbr\u003e\nii.\tBrush away dry chemical, prior to irrigating.\u003cbr\u003e\niii.\tIrrigate for minimum of 20 minutes.\u003cbr\u003e\n3.\tRemove jewelry and clothing prior to transport.\u003cbr\u003e\n4.\tTransport to appropriate medical facility.\u003cbr\u003e\n5.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tEstimate percentage of Body Surface Area (BSA).\u003cbr\u003e\nb.\tAssess for additional associated trauma.\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n1.\tIn route, initiate one or two large bore IV or IO (determined by patient condition) of an isotonic solution titrate to maintain adequate end organ perfusion.\u003cbr\u003e\n2.\tFor use of narcotic analgesics, see Pain Management Treatment Guidelines. \u003cbr\u003e\n3.\tMaintain body warmth post irrigation. \u003cbr\u003e\n4.\tDo not apply electrodes to burned skin areas.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049269"},{"listId":10049267,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"BURNS-THERMAL","summary":"","detail":"BURNS\t- THERMAL INJURIES\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any one or all the following: Partial thickness - burns involving the epidermal and dermal layers characterized by reddening or blistering skin. Full thickness - burns involving all skin layers, muscle fascia, and/or charred black or grayish skin, dry in appearance.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nAirway management, fluid replacement, and transport to a burn center after stabilization. Stop the burning process and remove from source.\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tInitiate transport to appropriate medical facility. Consider air evacuation. \u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tFor partial or full thickness Burns, estimate percentage of body surface area (BSA) involved using the Palm Principle (1 palm of patient = 1% BSA) or rule of 9’s\u003cbr\u003e\nb.\tRemove jewelry and clothing unless adhered to skin.\u003cbr\u003e\nc.\tPlace dry sterile dressings over burns, with no two burned surfaces touching.\u003cbr\u003e\nd.\tMaintain body temperature.\u003cbr\u003e\ne.\tFlush eye burns continuously with Normal Saline\u003cbr\u003e\n\u003cbr\u003e\n3.\tFor burns \u003c10% BSA\u003cbr\u003e\na.\tApply sterile dressing, moisten with NS or sterile water, or water gel/aquacool\u003cbr\u003e\n\u003cbr\u003e\n4.\tFor burns \u003e10% BSA\u003cbr\u003e\na.\tApply DRY sterile dressing and DO NOT moisten\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n\u003cbr\u003e\n1.\tIn route, initiate a large bore IV of Lactated Ringers.\u003cbr\u003e\na.\tInitiate a second IV in an unburned area if possible and if patient condition warrants. \u003cbr\u003e\n2.\tIf \u003e 20% BSA affected or patient is hypotensive administer fluids: 5 or younger: 125 ml./hr., 6-13: 250 ml./hr., and 14 or older: 500 ml./hr.\u003cbr\u003e\n3.\tFor use of narcotic analgesics, see Pain Management Treatment Guidelines.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tWith facial or airway involvement (singed nasal hair, soot inside nares, stridor etc.) early invasive airway management should be considered. \u003cbr\u003e\na.\tSee Airway Management Procedure Guidelines and Pain Management Treatment Guidelines.\u003cbr\u003e\n2.\tConsider cyanide poisoning in smoke inhalation given the following signs and symptoms (prevalence):\u003cbr\u003e\na.\tUnresponsiveness (78%); Respiratory failure (73%), Hypotension (54%), Cardiac arrest or seizures (20%), Cyanosis or Almond odor (15%), or Cherry colored skin (11%).\u003cbr\u003e\nb.\tHYDROXOCOBALAMIN IV 5gm. administered IV/IO over 30 minutes.\u003cbr\u003e\nc.\tIntubation and vasopressors often required in cyanide poisoning.\u003cbr\u003e\n3.\tAttempt not to apply electrodes to burned areas.\u003cbr\u003e\n4.\tUnless the method of injury involved traumatic forces, transport should be to the closest facility, where airway and pain management, fluid replacement, and transfer to a burn center can be arranged.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049267"},{"listId":10049281,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"CARDIAC ARREST TRAUMA","summary":"","detail":"TRAUMA CARDIAC ARREST \u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms include an unresponsive apneic patient with absent carotid pulses with a high suspicion of traumatic origin.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n Effective CPR, ALS intervention, possible decision to terminate resuscitation\u003cbr\u003e\nVerify that the mechanism of injury is consistent with the patient presentation and the cause of arrest\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess X-ABC’s (hemorrhage control as priority) and manage as indicated.\u003cbr\u003e\na.\tC- spine precautions\u003cbr\u003e\nb.\tInitiate CPR, ventilate with 100% OXYGEN.\u003cbr\u003e\n\u003cbr\u003e\n2.\tContact medical control if patient meets criteria for Termination of Resuscitative Efforts Guidelines.\u003cbr\u003e\n\u003cbr\u003e\n3.\tTransport the patient as soon as possible to the nearest medical facility, consider ALS intercept if transport time \u003e 10 minutes.\u003cbr\u003e\na.\tInsert airway (follow Airway Management Guidelines).\u003cbr\u003e\nb.\tTurn the defibrillator/monitor on and apply defibrillation electrodes.\u003cbr\u003e\nc.\tAnalyze the ECG rhythm.\u003cbr\u003e\nd.\tIf patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.\u003cbr\u003e\n4.\tFor traumatic arrest deemed appropriate for transport, all interventions beyond CPR, and spinal restrictions should be performed in-route to receiving facility to minimize scene time. Assess risk of CPR in-route before initiating transport.\u003cbr\u003e\n AEMT\u003cbr\u003e\n5.\tIn route, initiate two large bore IV or IO access lines administering an isotonic fluids (LR or NS).\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n6.\tPlace a Supraglottic Airway or ETT in accordance with the corresponding Airway Management Guidelines, allowing no disruption of chest compressions during placement. Managing the airway with BLS techniques is appropriate if good ventilation is achieved.\u003cbr\u003e\n\u003cbr\u003e\n7.\tConsider reasons patient may be in arrest and rule out reversible causes.\u003cbr\u003e\n\u003cbr\u003e\n8.\tIf chest trauma suspected perform bilateral needle chest decompressions in the second intercostal space in the mid-clavicular line early in the resuscitation. \u003cbr\u003e\n\u003cbr\u003e\n9.\tIf patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.\u003cbr\u003e\n\u003cbr\u003e\n10.\tFollow Termination of Resuscitation guidelines with on-line medical direction if needed.\u003cbr\u003e\n\u003cbr\u003e\n11.\tH’s \u0026 T’s\u003cbr\u003e\n\u003cbr\u003e\nHypovolemia\u003cbr\u003e\nHypoxia\u003cbr\u003e\nHydrogen Ion (acidosis)\u003cbr\u003e\nHyper-/hypokalemia\u003cbr\u003e\nHypothermia.\u003cbr\u003e\nToxins\u003cbr\u003e\nTamponade (cardiac)\u003cbr\u003e\nTension pneumothorax","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049281"},{"listId":10049271,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"CRUSH INJURY","summary":"","detail":"CRUSH INJURIES\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nCompression of extremities or other parts of the body for \u003e1 hr that causes muscle swelling and/or neurological disturbances in the affected areas of the body. Crush syndrome is localized crush injury with systemic manifestations.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nCrush injury is very painful, see PAIN MANGEMENT GUIDELINES. EKG changes associated with hyperkalemia: peaked T waves, QRS \u003e 0.12, loss of P wave, “bizarre” wide complex. Patients may easily become hypothermic.\u003cbr\u003e\n\u003cbr\u003e\n1.\tAssess the scene for safety. Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.\u003cbr\u003e\n\u003cbr\u003e\n2.\tControl exsanguinating hemorrhage\u003cbr\u003e\n3.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n4.\tEvaluate for spinal restriction\u003cbr\u003e\n5.\tTreat for shock\u003cbr\u003e\n6.\tCheck distal pulses frequently\u003cbr\u003e\nAEMT:\u003cbr\u003e\n\u003cbr\u003e\n1.\tEstablish IV fluid therapy and provide bolus prior to releasing the crushed body part\u003cbr\u003e\na.\t1-2 L NS/LR bolus then titrate for hypotension.\u003cbr\u003e\n2.\tGoal to maintain SBP greater than 90.\u003cbr\u003e\nPARAMEDIC:\u003cbr\u003e\n\u003cbr\u003e\n1.\tIf patient is entrapped for longer than 60 min infuse NS at 1000ml/hr and give 1 amp of Sodium Bicarbonate\u003cbr\u003e\n2.\tProvide appropriate pain control.\u003cbr\u003e\n3.\tMay give MIDAZOLAM 2.5 mg IV/IO/IM/IN for anxiety. Repeat as needed.\u003cbr\u003e\n4.\tApply EKG and monitory for EKG changes and hyperkalemia. See HYPERKALEMIA in Medical Section.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049271"},{"listId":10049274,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"EYE INJURY","summary":"","detail":"EYE INJURIES\u003cbr\u003e\nALL LEVELS:\u003cbr\u003e\n\u003cbr\u003e\n1.\tLacerations on or near the eyelid or eye:\u003cbr\u003e\na.\tDo not apply pressure to the eyeball.\u003cbr\u003e\nb.\tCover BOTH eyes with a loose dressing.\u003cbr\u003e\nc.\tPreserve avulsed parts in a clean plastic bag. Use moist gauze.\u003cbr\u003e\n2.\tForeign bodies:\u003cbr\u003e\na.\tNon-impaled: Cover BOTH eyes with loose dressing.\u003cbr\u003e\nb.\tImpaled: DO NOT REMOVE - stabilize with a paper cup and bulky dressing (donut) if available. Protect otherwise. Cover unaffected eye.\u003cbr\u003e\n3.\tAvulsed eye: \u003cbr\u003e\na.\tCover with sterile moist dressings; use sterile saline, Ringer’s Lactate, or sterile water. Cover unaffected eye.\u003cbr\u003e\n1.\tChemical burns: \u003cbr\u003e\na.\tIrrigate copiously with tap water, saline, or Ringer’s Lactate as soon as possible, minimum of 2L. \u003cbr\u003e\nPARAMEDIC: \u003cbr\u003e\n\u003cbr\u003e\n1.\tConsider application of cardiac monitor due to potential involvement of cranial nerves with deep penetrating eye trauma. Treat lethal dysrhythmias concurrently.\u003cbr\u003e\n2.\tConsider Pain Management Guidelines","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049274"},{"listId":13608599,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"GERIATRIC PATIENTS (TRAUMA)","summary":"","detail":"GERIATRIC PATIENTS (TRAUMA)\u003cbr\u003e\nTRAUMA PATIENTS\u003cbr\u003e\nGENERAL CONSIDERATIONS\u003cbr\u003e\nThere is no scientific definition of the age at which a patient should be considered “geriatric”. For years it has been 65. Recent data has made some training programs drop the age to 55 where the anatomic and physiologic changes of age become clinically important. Geriatric patients pose new issues and need to be handled differently. Their vital signs, mental status, use of anti-coagulants, and more complicated medical history are just a few considerations.\u003cbr\u003e\n\u003cbr\u003e\n1.\tA thorough history of past and present medical conditions needs to be obtained.\u003cbr\u003e\n2.\tCurrent medications, particularly anti-coagulants (Eliquis, Xarelto, Warfarin) and anti-platelet drugs (Plavix), should be reviewed.\u003cbr\u003e\n3.\tVital signs may be inadequate while appearing within normal limits.\u003cbr\u003e\na.\tGeriatric patients have limited capacity to raise their heart rates when stressed. Tachycardia may be occurring at rates of 90.\u003cbr\u003e\nb.\tGeriatric patients very commonly have uncontrolled high blood pressure. Systolic blood pressures below 120 mmHg may indicate hypotension and commonly accepted levels of 90 mmHg may represent severe hypoperfusion\u003cbr\u003e\n4.\tThermoregulation is reduced due to muscle atrophy, malnutrition, neurological dysfunction and some medications. Provide passive warming measures with blanket and ambulance heaters.\u003cbr\u003e\n5.\tSigns of hypotension and hemorrhagic hypovolemia should be cautiously resuscitated with NS/LR at a rate of 10 cc./kg. as a bolus. This can be repeated as needed. The goal blood pressure is not as clear in geriatric patients, but 90 mmHg is probably a reasonable one.\u003cbr\u003e\n6.\tHead trauma in a patient on anti-coagulants is at higher risk for bleeding.\u003cbr\u003e\n7.\tSpinal trauma is more likely to be complicated due to arthritic and degenerative changes making securing the spine more commonly needed. C-spines should be carefully evaluated.\u003cbr\u003e\n8.\tBones are generally more easily fractured in geriatric patients.\u003cbr\u003e\n9.\tGeriatric patients may have exaggerated responses to medications such an analgesic. Start low and repeat to achieve your goals. Titrate Ketamine, if used, to pain control and discontinue until needed again.\u003cbr\u003e\n10.\tBe prepared to manage confusion or disorientation with calm reassuring care.\u003cbr\u003e\n11.\tBe vigilant for a medical emergency that could have preceded the trauma or be the cause of it.\u003cbr\u003e\n12.\tEvaluate “lift assist” patients thoroughly. Hidden trauma is common. An underlying medical condition is commonly the cause for a “lift assist”.\u003cbr\u003e\n13.\tFalls, even from standing, represent a unique problem with a substantial one-year mortality. Ground level falls should be considered significant in the geriatric patient.\u003cbr\u003e\n14.\tConsider MIH referral for home evaluation for safety and follow-up.\u003cbr\u003e\n15.\tHave a lower threshold for transport to a trauma center in geriatric patients.\u003cbr\u003e\n\u003cbr\u003e\nGERIATRIC TRAUMA ACTIVATION CRITERIA\u003cbr\u003e\n1.\tGround level fall for patients on anti-coagulants\u003cbr\u003e\n2.\tSystolic blood pressure less than 110 mmHg.\u003cbr\u003e\n3.\tHeart rate above 90.\u003cbr\u003e\n4.\tShock Index greater than 1.0.\u003cbr\u003e\n5.\tGround level fall patients not on anticoagulants with Glasgow Coma Scale less than 14 and signs of head trauma.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/13608599"},{"listId":10049276,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"HEAD INJURY/TBI","summary":"","detail":"HEAD INJURIES/TBI\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\n\u003cbr\u003e\nTraumatic brain injury (TBI) is a cerebral insult from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. Concussions are periods of confusion or LOC associated with trauma which may have resolved by the time EMS arrives.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tIncreased ICP may cause HTN, bradycardia, and irregular respirations (Cushing’s Triad).\u003cbr\u003e\n2.\tHypotension usually indicates injury or shock unrelated to the head injury and hemorrhage control should be a priority.\u003cbr\u003e\n3.\tMonitor and document a change in the level of consciousness\u003cbr\u003e\n4.\tUse IV/IO fluids judiciously to avoid hypotension.\u003cbr\u003e\n5.\tA single episode of hypoxia, defined as SpO2 \u003c 90% at any time, has been shown in numerous studies to increase death and disability in moderate to severe TBI.\u003cbr\u003e\n\u003cbr\u003e\nBLS:\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n2.\tEvaluate for Cervical Spine field clearance.\u003cbr\u003e\n3.\tAdminister oxygen; assist ventilations if needed. SpO2 should be at 100%. Avoid hyperventilation: maintain PCO2 at 35-45 range.\u003cbr\u003e\nAEMT:\u003cbr\u003e\n1.\tEstablish an IV of LR or NS.\u003cbr\u003e\n2.\tAvoid hypoxia: administer 02 to maintain oxygen saturation at 100%.\u003cbr\u003e\n3.\tAvoid hypotension: ideal BP unknown but should be above 90 systolic and higher if possible\u003cbr\u003e\n4.\tAvoid hyperventilation: maintain End Tidal CO2 between 35 and 45.\u003cbr\u003e\nPARAMEDIC:\u003cbr\u003e\n1.\tApply cardiac monitor; treat lethal dysrhythmias concurrently to injury treatments.\u003cbr\u003e\n2.\tIntubation should be approached with caution as it has been associated with worse outcomes when performed in the out-of-hospital environment for some patients with traumatic brain injury \u003cbr\u003e\n3.\tTXA is not routinely recommended for TBI which is under study.\u003cbr\u003e\n\u003cbr\u003e\nReminder:\tAvoid the three “H Bombs” of TBI: hypoxia, hypotension, and hyperventilation.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049276"},{"listId":10049272,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"HEMORRHAGE CONTROL","summary":"","detail":"HEMORRHAGE CONTROL \u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nAny wound that creates circulatory shock due to blood loss may need application of tourniquet. Symptoms include pallor, AMS, hypotension, weak pulses, cool clammy skin or physical signs of severe uncontrollable hemorrhage, amputation or near amputation.\u003cbr\u003e\n\u003cbr\u003e\nALL PROVIDERS\u003cbr\u003e\n\u003cbr\u003e\n1.\tApply direct pressure to the injury\u003cbr\u003e\na.\tIf this is effective dress the wound and elevate extremity\u003cbr\u003e\nb.\tIf this is ineffective proceed with protocol\u003cbr\u003e\n\u003cbr\u003e\n2.\tIf wound is amenable to tourniquet placement:\u003cbr\u003e\na.\tApply tourniquet above the wound. Avoid joints.\u003cbr\u003e\nb.\tIf first tourniquet does not control hemorrhage apply second tourniquet above first\u003cbr\u003e\nc.\tDo not release tourniquet until definitive care is at bedside\u003cbr\u003e\n\u003cbr\u003e\n3.\tIf wound is not amenable to tourniquet placement\u003cbr\u003e\na.\tApply hemostatic dressing into wound and apply direct pressure directly to bleeding source\u003cbr\u003e\n\u003cbr\u003e\n4.\tHemodialysis access sites may result in life threatening hemorrhage. Direct digital pressure with hemostatic dressing should be used first followed by tourniquet in the setting of life-threatening hemorrhage when other means of hemorrhage control have been unsuccessful\u003cbr\u003e\n\u003cbr\u003e\n5.\tTreat pain according to pain protocol. Tourniquets are rapidly very painful.\u003cbr\u003e\n\u003cbr\u003e\n6.\tIf significant non-compressible hemorrhage continues consider TXA administration within three hours of start of hemorrhage)\u003cbr\u003e\n\u003cbr\u003e\nAdult Initial Bolus (16 years and older).\u003cbr\u003e\n\u003cbr\u003e\n\tMix 2 grams vial in 250 ml. of fluid.\u003cbr\u003e\nAdminister 2 grams (250 ml.) IV/IO over 10 minutes.\u003cbr\u003e\n\u003cbr\u003e\nTXA is indicated in pregnant patients with clinically significant non-compressible hemorrhage","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049272"},{"listId":10049279,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"MULTISYSTEM TRAUMA","summary":"","detail":"TRAUMA (MULTIPLE SYSTEMS)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all the following: mechanism of injury suggestive of trauma to two or more body systems.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tPrimary Management - Assess X-ABC’s and manage as indicated.\u003cbr\u003e\na.\tX- control hemorrhage as priority. \u003cbr\u003e\nb.\tStabilize airway if necessary: oral / nasal airway; SGA; suction\u003cbr\u003e\n2.\t, Inspection of C-spine, minimize scene time\u003cbr\u003e\na.\tApply pelvic binder if hypotensive and evidence of pelvic injury\u003cbr\u003e\nb.\tConsider use of tourniquet as indicated\u003cbr\u003e\n3.\tInitiate transport to appropriate medical facility. Consider aeromedical evacuation to definitive care. If in doubt, contact medical control.\u003cbr\u003e\n4.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n5.\tConsider traction splint for mid-shaft femur fractures\u003cbr\u003e\n6.\tImmobilize long bone fractures\u003cbr\u003e\n7.\tCover patient to prevent hypothermia\u003cbr\u003e\n8.\tCover suspected open chest wounds with an occlusive dressing. Stabilize fractured and/or flail segments.\u003cbr\u003e\na.\tBe vigilant for developing tension pneumothorax. If a tension pneumothorax is suspected, release the seal over the wound and allow any air under pressure to escape. Then reseal the wound and monitor the patient.\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIn-route, initiate one or two large bore IVs of an isotonic solution and infuse at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n\u003cbr\u003e\n2.\tDon’t overdue crystalloid fluids but use judiciously in all age groups to maintain adequate perfusion. 20 ml./kg. as an initial bolus is usually acceptable. Maintain fluids as indicated.\u003cbr\u003e\n\u003cbr\u003e\n3.\tFor use of analgesics, see Pain Management Guidelines.\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tRefer to Trauma Cardiac Arrest guideline if indicated.\u003cbr\u003e\n2.\tConsider chest decompression for suspected pneumothorax. Consider bilateral in cardiac arrest.\u003cbr\u003e\n3.\tSee Pain Management Guidelines\u003cbr\u003e\n4.\tSee Airway Management Treatment Guidelines.\u003cbr\u003e\n5.\tFor significant suspected or overt non-compressible hemorrhage consider TXA administration within three hours of onset of hemorrhage:\u003cbr\u003e\n\u003cbr\u003e\nAdult Initial Bolus (16 years and older)\u003cbr\u003e\n\u003cbr\u003e\nMix 2 grams vial in 250 ml. bag of fluid.\u003cbr\u003e\nAdminister 2 grams (250 ml.) IV/IO over 10 minutes.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049279"},{"listId":10049277,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"SPINAL IMMOBILIZATION","summary":"","detail":"SPINAL IMMOBILIZATION\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nYou may elect to withhold spinal restriction and discontinue all spinal stabilization efforts if your patient meets ALL of the following criteria. Criteria includes seated patients when considering use of KED. Proceed immediately with spinal stabilization if patient fails to meet ANY of the following:\u003cbr\u003e\n1.\tPatient Reliability:\u003cbr\u003e\na.\tConscious, alert, and well oriented, not under suspicion or the influence of drugs, alcohol, or any other mind-altering substance.\u003cbr\u003e\nb.\tLegal adult or emancipated minor and has no language or communication problems.\u003cbr\u003e\nc.\tNo suspicion of other major distracting injury.\u003cbr\u003e\nd.\tNo suspicion of head/brain injury. \u003cbr\u003e\n2.\tAssess Spinal Column:\u003cbr\u003e\na.\tThe best study on clearing the C-spine and other spinal injuries has the following criteria for clearance in the field:\u003cbr\u003e\na.\tThe patient has no neck pain.\u003cbr\u003e\nb.\tThe patient’s neck is not tender to firm palpation.\u003cbr\u003e\nc.\tThe patient has no numbness, tingling, weakness or other neurologic symptoms in the extremities.\u003cbr\u003e\nd.\tThe patient does not have a painful injury elsewhere that could distract them from recognizing their neck pain.\u003cbr\u003e\ne.\tThe patient is alert and competent and not impaired by alcohol, drugs, head trauma, or other impairing conditions.\u003cbr\u003e\n3.\tAssess Sensory and Motor Function:\u003cbr\u003e\na.\tNo sensory deficit.\u003cbr\u003e\nb.\tNo motor deficit\u003cbr\u003e\nIf the patient fails the above criteria place a C-collar and:\u003cbr\u003e\nIf ambulatory assist to stretcher\u003cbr\u003e\nIf non-ambulatory use rigid extrication device as needed to move patient to stretcher and then remove device if possible.\u003cbr\u003e\nUtilize C-collar if patient is \u003e65 y/o.\u003cbr\u003e\n\u003cbr\u003e\n•\tLong spine boards (LSB) have not been shown to improve patient outcomes. The best use of the LSB is as an extrication device.\u003cbr\u003e\nPatients should not be immobilized on a LSB, however if unconscious and/or unresponsive maintain use of LSB to aid in patient extrication.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049277"},{"listId":13528111,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"TRAUMA ASSESSMENT (GENERAL)","summary":"","detail":"TRAUMA ASSESSMENT (GENERAL)\u003cbr\u003e\n\u003cbr\u003e\nGeneral\u003cbr\u003e\nThe assessment of a trauma patient differs significantly from that of a medical patient. Issues like time management, rapid physical assessment, and timely transport are important. When dispatched to a “trauma patient” little information is made available often to the responding EMT. Trauma can produce isolated injury, generalized injuries, immediate life threats, and even traumatic arrest. \u003cbr\u003e\nAssessment\u003cbr\u003e\nAny level of EMT is capable of a proper trauma assessment. Time is of the essence.\u003cbr\u003e\n1.\tA full history may not be available from the patient or bystanders or family. The mechanism of injury is important to determine with as much detail as possible. Chief complaints, past medical history, and medication may be spotty or unavailable. The primary medication that may be relevant is a blood thinner (Eliquis, Xarelto, Warfarin). If possible, attempt to determine if a medical incident caused the ensuing trauma. These scenes may be chaotic and a team approach with proper delegating of tasks can be helpful.\u003cbr\u003e\n2.\tThe primary survey (X-ABC’s) is easily conducted. “X” for hemorrhage.\u003cbr\u003e\n3.\tA rapid secondary (head-to-toe) examination is indicated.\u003cbr\u003e\na.\tAs much as can be practically done the patient should be exposed.\u003cbr\u003e\nb.\tThe first order of business is to look for potential life threats including hemorrhage, abnormal vital signs (hypotension, tachycardia, tachypnea, low oxygen saturation, and altered mental status).\u003cbr\u003e\nc.\tIdentification of signs of blunt trauma to the head, neck, chest, abdomen, pelvis, and extremities should be sought.\u003cbr\u003e\nd.\tPenetrating trauma may be in multiple locations and a search for all entry and exit wounds needs to be conducted.\u003cbr\u003e\ne.\tAs each life-threat is identified an intervention may be called for before further assessment is conducted.\u003cbr\u003e\nf.\tThe assessment may be more complicated if a medical cause of the incident is found or suspected.\u003cbr\u003e\nTreatment\u003cbr\u003e\nTreatment for trauma patients is detailed in other guidelines. Timely transport is often indicated in trauma patients compared to the traditional medical patient where much can be done on-scene.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/13528111"},{"listId":10049962,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":0,"header":"TRAUMA DESIGNATION","summary":"","detail":"TRAUMA DESIGNATION\u003cbr\u003e\nDetermining how (air or ground) and where (local or El Paso) to transport is an important consideration. It is still the responsibility of the first responding, highest level, EMT to make the determination if it is in the patient’s best interest to have a helicopter launched for scene response or if ground transport to the Level 3 Trauma Center (Mountain View) is the most appropriate. Time is of the essence. Helicopter transport takes considerable time commonly and may be best reserved for patients who have had the opportunity for stabilization at the Level 3 center. Mountain View’s capabilities may change in the future and a call to them for “Trauma Activation” would reveal if the patient in question would be acceptable to them.\u003cbr\u003e\n\u003cbr\u003e\nPHYSIOLOGIC CRITERIA (\"Level 1\")\u003cbr\u003e\nConsider transport to Level 1 or 2 Trauma center if ANY of the following are present:\u003cbr\u003e\n1.\tGlasgow Coma Scale ≤13\u003cbr\u003e\n2.\tSBP \u003c 90mmHg\u003cbr\u003e\n3.\tBreathing \u003c10 or \u003e29 breaths/min (\u003c20 breaths/min if \u003c1 year old)\u003cbr\u003e\n4.\tRequires assisted ventilations\u003cbr\u003e\n5.\tShock index (Heart rate divided by systolic blood pressure) 1.0 or greater.\u003cbr\u003e\n\u003cbr\u003e\nANATOMIC CRITERIA (\"Level 1\")\u003cbr\u003e\nConsider transport to Level 1 or 2 Trauma center if ANY of the following are present:\u003cbr\u003e\n1.\tPenetrating injury to head, neck, torso, or extremity proximal to elbow or knee\u003cbr\u003e\n2.\tChest wall instability or deformity (e.g. flail chest)\u003cbr\u003e\n3.\t2 or more proximal long-bone fractures\u003cbr\u003e\n4.\tCrushed, degloved, mangled, or pulseless extremity\u003cbr\u003e\n5.\tAmputation proximal to wrist or ankle\u003cbr\u003e\n6.\tPelvic fractures\u003cbr\u003e\n7.\tOpen or depressed skull fracture\u003cbr\u003e\n8.\tParalysis\u003cbr\u003e\n\u003cbr\u003e\nMECHANISM OF INJURY CRITERIA (\"Level 2\")\u003cbr\u003e\nConsider transport to any level Trauma center if ANY of the following are present and NONE of the PHYSIOLOGIC or ANATOMIC criteria are present:\u003cbr\u003e\n1.\tFalls \u003e20 ft. (\u003e10 feet or 2-3x height for children)\u003cbr\u003e\n2.\tHigh Risk Auto Crash-Intrusion, including roof \u003e 12 inches at occupant site or\u003cbr\u003e\n\u003e18 inches anywhere\u003cbr\u003e\n3.\tEjection (partial or complete) from automobile-Death in same compartment\u003cbr\u003e\n4.\tAuto vs. pedestrian/bicyclist thrown, run over, or with significant (\u003e20 mph) impact\u003cbr\u003e\n5.\tMotorcycle crash \u003e20 mph\u003cbr\u003e\n\u003cbr\u003e\nSPECIAL CONSIDERATIONS/PROVIDER JUDGEMENT \u003cbr\u003e\nConsider transport to appropriate Trauma center if ANY of the following are present:\u003cbr\u003e\n1.\tOlder Adults\u003cbr\u003e\n2.\tAnticoagulants and bleeding disorders\u003cbr\u003e\n3.\tPregnant patients \u003e20 week gestation\u003cbr\u003e\n4.\t\u003cbr\u003e\nSPECIAL NOTES\u003cbr\u003e\n\u003cbr\u003e\nIf the ETA of the helicopter is greater than the ground transport to the Level 3 center, consider ground transport if that is in the patient’s best interest. If the time difference is insignificant and the patient is clearly a Level 1 or 2 patient, consider helicopter response.\u003cbr\u003e\n\u003cbr\u003e\nThe decision of the first on scene EMT with the highest-level license should stand and not be countermanded by later arriving EMTs from the fire department or ambulance service except by mutual agreement. If conflict arises consider consulting on-line medical direction from the Level 3 center.\u003cbr\u003e\n\u003cbr\u003e\nAll Level 3 patients can go to Mountain View and if necessary, because of patient volume at Mountain View, to MMC (Level 4 center). As of 2024 Three Crosses Regional Hospital does not accept pregnant patients over 20 weeks gestation for any reason.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049962"}],"data":false,"categoryData":{"catName":"TRAUMA","catId":2128883,"catIcon":""},"parentCategoryData":{"catId":2114007,"catName":"GUIDELINES"}},"match":{"hostname":"www.lcfdapp.com","page":"services_1582148118880_5","category":"2128883"}}},"page":"/[...slug]","query":{"slug":["services_1582148118880_5/2128883"]},"buildId":"1234567890","isFallback":false,"dynamicIds":[1204],"customServer":true,"gip":true,"scriptLoader":[]}