EMS Just the Facts guide
Welcome to our EMS Just the Facts guide. Just tap on one of the tabs below to access the essential information you need in the field. We appreciate your help providing expert care to patients when they need it most. Indexed below are vital patient care guidelines and protocols often referenced in the field when delivery of care is in your hands, having facts at your fingertips is critical.
Sepsis Criteria
Goal is to identify early septic shock
All 3 criteria must be met:
- Suspected infection
- SIRS criteria met (≥2 of the following):
- Temp ≥ 100.4° F (38° C) or < 96.8° F (36° C)
- Pulse > 90 bpm
- Respiratory rate > 20 bpm
- Sign of hypoperfusion (1 or both)
- Systolic BP ≤ 90 mmHg
- Lactate ≥ 4 mmol/L (if available)
If all 3 above criteria are met, notify receiving hospital of Possible Sepsis.
BACKCommunication EMS Hand-Off
- Patient Name and Age
- Chief Complaint
- Other Specific Related Information
- Events leading up to Transport
- EMS Interventions and Response if Pertinent
- Vital Signs
- Medical History
- Complete List of Medications
- Allergies
- Last Oral Intake
- Most Recent Vital Signs
STEMI Alert
Inclusion Criteria:
- Symptoms compatible with ACS (chest pain, diaphoresis, dyspnea, etc.)
- 12-lead ECG showing ST-segment elevation (STE) at least 1 mm in two or more anatomically contiguous lead
- Age 35-85 years old (If STEMI patient outside age criteria, contact receiving hospital for consult)
* Your service may include New or presumably new LBBB as a criterion, please see your local protocol if unsure.
Exclusion Criteria:
- Wide complex QRS (paced, rhythm, BBB, other)
- No paced rhythms
- Symptoms NOT suggestive of ACS (e.g. asymptomatic patient)
- If unsure if patient is appropriate for Cardiac Alert, discuss with receiving hospital MD
12-Lead Injury Pattern Chart
| Lead 1 | aVR | V1 | V4 |
| Lateral | Septal | Anterior | |
| Lead 2 | aVL | V2 | V5 |
| Inferior | Lateral | Septal | Lateral |
| Lead 3 | aVF | V3 | V6 |
| Inferior | Inferior | Anterior | Lateral |
| Posterior MI Suspicion |
|
| EKG Lead Changes | Related Artery | Related Damage |
| V1 to V2 | LCA: LAD/Septal branch | Septum, His bundle, Bundle branches |
| V3 to V4 | LCA: Diagonal branch | Anterior wall of left ventricle |
| V5 to V6 | LCA: Circumflex branch | High lateral wall left ventricle |
| I & aVL | RCA: Posterior descending branch | |
| II, III, aVF | RCA: Proximal branch | Inferior & posterior wall of left ventricle |
| vR4 | LCA: LAD/Septal branch | Right ventricle, inferior & posterior wall left ventricle |
| V1 to V4 ST depression |
Either LCA-circumflex or RCA-posterior descending branch | Left ventricular posterior wall |
BACK
Stroke Alert
REMEMBER: Even though the patient meets tPa exclusion criteria (taking ASA, Coumadin, past CVA, etc.), he/she is still considered a STROKE ALERT patient if assessment is positive.
STROKE ASSESSMENT
Facial Drop: Have patient show teeth or smile.
- Normal - both sides of face move equally.
- Abnormal - one side of face does not move as well.
Arm Drift: Patient closes eyes and holds arms outright for 10 seconds.
- Normal - both arms move the same or both arms do not move at all.
- Abnormal - one arm does not move or one arm drifts down compared with other.
Abnormal Speech: Have patient say the words:
"You can't teach the old dog new tricks".
- Normal - patient uses correct words with no slurring.
- Abnormal - patient slurs words, uses the wrong words, or unable to speak.
BACK
DOPAMINE: 1,600 MCG/ML
|
DOPAMINE INFUSION CHART (Based on a 1,600 mcg /ml Concentration) |
||||||||||||
| Dose: 2 to 20 mcg / kg / minute | ||||||||||||
| Dopamine Calculation Chart | ||||||||||||
| mcg/kg/min | Patients Weight In Kilograms | |||||||||||
| 2.5 | 5 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 2 | - | - | 1 | 2 | 2 | 3 | 4 | 5 | 5 | 6 | 7 | 8 |
| 5 | - | 1 | 2 | 4 | 6 | 8 | 9 | 11 | 13 | 15 | 17 | 19 |
| 10 | 1 | 2 | 4 | 8 | 11 | 15 | 19 | 23 | 26 | 30 | 34 | 38 |
| 15 | 1 | 3 | 6 | 11 | 17 | 23 | 28 | 34 | 39 | 45 | 51 | 56 |
| 20 | 2 | 4 | 8 | 15 | 23 | 30 | 38 | 45 | 53 | 60 | 68 | 75 |
| **With a 60 drop per ml drip set this is the number of drops per minute or (ml/hr)** | ||||||||||||
BACK
DOPAMINE: 800 MCG/ML
|
DOPAMINE INFUSION CHART (Based on a 800 mcg /ml Concentration) |
||||||||||||
| Dose: 2 to 20 mcg / kg / minute | ||||||||||||
| Dopamine Calculation Chart | ||||||||||||
| mcg/kg/min | Patients Weight In Kilograms | |||||||||||
| 2.5 | 5 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 2 | - | - | 2 | 4 | 4 | 6 | 8 | 10 | 10 | 12 | 14 | 16 |
| 5 | - | 2 | 4 | 8 | 12 | 16 | 18 | 22 | 26 | 30 | 34 | 38 |
| 10 | 2 | 4 | 8 | 16 | 22 | 30 | 38 | 46 | 52 | 60 | 68 | 76 |
| 15 | 2 | 6 | 12 | 22 | 34 | 46 | 56 | 68 | 78 | 90 | 102 | 112 |
| 20 | 4 | 8 | 16 | 30 | 46 | 60 | 76 | 90 | 106 | 120 | 136 | 150 |
| **With a 60 drop per ml drip set this is the number of drops per minute or (ml/hr)** | ||||||||||||
BACK
Important Hospital Numbers
| ED Direct Line | (706) 651-6080 |
| Bruce Bailey, Trauma Manager | (706) 651-4641 Cell: (706) 829-9317 |
| Lisa Smith, EMS Coordinator | (706) 651 6560 Cell: (706) 466-3603 |
Adult Trauma Score Card
| CRITERIA: | |
|---|---|
| 1. Meets color-coded triage system (see below) | |
| 2. GCS ≤ 12 (Patient must be evaluated via GCS if not identified as a trauma alert ) | |
| 3. Meets local criteria (specify): ____________________ | |
| 4. Patient does not meet any of the trauma criteria listed above but, in the judgement of the EMT or paramedic, should be transported as a trauma alert (document): ____________________ | |
| COMPONENT | ||
| AIRWAY | RESPIRATORY RATE OF 30 or GREATER | ACTIVE AIRWAY ASSISTANCE1 |
| CIRCULATION | SUSTAINED HR OF 120 BEATS PER MINUTE or GREATER | LACK OF RADIAL PULSE WITH SUSTAINED HEART RATE (>120) or BP < 90 mmHg |
| BEST MOTOR RESPONSE | BMR =5 | BMR = 4 or LESS or PRESENCE OF PARALYSIS, or SUSPICION OF SPINAL CORD INJURY or LOSS OF SENSATION |
| CUTANEOUS | SOFT TISSUE LOSS2 or GSW TO THE EXTREMETIES | 2ND OR 3RD ° BURNS TO 15% or MORE TBSA or AMPUTATION PROXIMAL TO THE WRIST or ANKLE or ANY PENETRATING INJURY TO HEAD, NECK, or TORSO3 |
| LONGBONE FRACTURE4 | SINGLE FX SITE DUE TO MVA or FALL 10 ‘ or MORE | FRACTURE OF TWO or MORE LONGBONES |
| AGE | 55 YEARS or OLDER | |
| MECHANISM OF INJURY | EJECTION FROM VEHICLE5 or DEFORMED STEERING WHEEL6 | |
| R = RED any one (1) - transport as a trauma alert | B = BLUE any two (2) - transport as a trauma alert |
- Airway assistance beyond administration of oxygen.
- Major degloving injures, or major flap avulsion (>5 in.)
- Excluding superficial wounds in which the depth of the wound can be determined.
- Longbone (Including humerus, (radius, ulna), femur, (tibia or fibula).
- Excluding motorcycle, moped, all terrain vehicle, bicycle, or open body of a pickup truck.
- Only applies to driver of vehicle.
BACK
Pediatric Trauma Score Card
| CRITERIA: | |
|---|---|
| 1. Pediatric Trauma Triage Checklist(se below): The individual is assessed based on each of the six (6) physiologic components listed below (left column). The single, most appropriate criterion for each components is selected (along the row to the right). Refer to the color-coding of each criteria and legend below to determine the transport destination | |
| 2. Meets local criteria (specify): ____________________ | |
| 3. Patient does not meet any of the trauma criteria listed above, but the EMT or Paramedic can call a “Trauma Alert” if, in his or her judgement, the trauma patient’s condition warrants such action. Must be documented on run report pursuant to 64E-2.013, (F.A.C.): ____________________ | |
| COMPONENT | |||
| SIZE | > 20 Kg (44+ lbs.) | > 11-20 Kg (24-44 lbs.) | WEIGHT ≤ 11 Kg or LENGTH ≤ 33 INCHES ON A PEDIATRIC LENGTH AND WEIGHT EMERGENCY TAPE |
| AIRWAY | NORMAL | SUPPLEMENTED O2 | ASSISTED OR INTUBATED (1) |
| CONSCIOUSNESS | AWAKE | AMNESIA OR LOSS OF CONSCIOUSNESS | ALTERED MENTAL STATUS (2) OR COMA or PRESENCE OF PARALYSIS OR SUSPICION OF SPINAL CORD INJURY or LOSS OF SENSATION |
| CIRCULATION | GOOD PERIPHERAL PULSES;SBP > 90 mmHg | CAROTID OR FEMORAL PULSES PALPABLE, BUT THE RADIAL OR PEDAL PULSE NOT PALPABLE or SBP < 90-mmHg | FAINT OR NON-PALPABLE CAROTID OR FEMORAL PULSE or SBP < 50 mmHg |
| FRACTURE | NONE SEEN OR SUSPECTED | SINGLE CLOSED LONG BONE (3) FRACTURE (4) | OPEN LONG BONE (3) FRACTURE (5) OR MULTIPLE FRACTURE SITES OR MULTIPLE DISLOCATIONS (5) |
| CUTANEOUS | NO VISIBLE INJURY | CONTUSION OR ABRASION | MAJOR SOFT TISSUE DISRUPTION (6) OR MAJOR FLAP AVULSION OR 2° OR 3° BURNS TO >10% TBSA OR AMPUTATION (7) or ANY PENETRATING INJURY TO HEAD, NECK, OR TORSO (8) |
| R = RED any one (1) - transport as a trauma alert | B = BLUE any two (2) - transport as a trauma alert | G = GREEN follow local protocols |
- Airway assistance includes manual jaw thrust, continuous suctioning, or use of other adjuncts to assist ventilatory efforts.
- Altered mental states include drowsiness, lethargy, inability to follow commands, unresponsiveness to voice, totally unresponsive.
- Long bones include the humerus, (radius, ulna), femur, (tibia or fibula).
- Long bone fractures do not include isolated wrist or ankle fractures.
- Long bone fractures do not include isolated wrist or ankle fractures or dislocations.
- Includes major degloving injury.
- Amputation proximal to wrist or ankle.
- Excluding superficial wounds where the depth of the wound can be determined.
BACK