Santa Clara County Paramedic Protocols
Latest Graded A+
12-lead indications - ANSWER-Substernal pain
Discomfort or tightness radiating to the jaw, left shoulder or arm
Symptoms indicating cardiogenic shock
Nausea
SOB
Diaphoresis
Anxiety
Syncope/dizziness
"suspicious symptoms"
elderly, female, and diabetic patients may present atypically
Known treatment for ACS
A physician on scene may... - ANSWER-Relinquish patient care
Assist in patient care
Manage patient care
He must show proper identification
Activated Charcoal adult dose - ANSWER-1g/kg PO, if time of ingestion is less than 1
hour, max dose 50gm
Charcoal is contraindicated if patient lacks gag reflex and cannot self-administer, or has
ingested substance(s) not bound by charcoal; such as: caustics, lithium, metals,
ethylene glycol, iron, methanol, other alcohols, or hydrocarbons
Activated Charcoal pediatric dose - ANSWER-Patients less than 1 year old and time of
ingestion is less than 1 hour:
1g/kg PO, max dose 25gm
,Patients greater than 1 year old and if time of ingestion is less than 1 hour:
Activated Charcoal 25g PO
Charcoal is contraindicated if patient lacks gag reflex and cannot self-administer, or has
ingested substance(s) not bound by charcoal; such as: caustics, lithium, metals,
ethylene glycol, iron, methanol, other alcohols, or hydrocarbons
Activation 1 - ANSWER-Multiple vehicle accident; small aircraft collision; multiple
shooting victims at a contained scene with no "active" shooter threat; etc. Focus is on
scene management, providing resources to support the incident, and the rapid
transportation of patients to appropriate facilities. Does not affect normal operations.
Generally no measurable impact to County 911- EMS System. Up to 10 patients.
Activation 2 - ANSWER-Ongoing "active" shooter event with no containment; fire at
multiple family occupancy; mass transportation incident; etc. Generally overwhelms the
initial first response requiring additional units. Focus remains on scene management,
providing resources to support the incident, and the rapid transportation of patients to
appropriate facilities. May require contingency activations to maintain County 911-EMS
System i.e., Standard Dispatch Orders. Up to 20 patients.
Activation 3 - ANSWER-Aircraft collision; skilled nursing facility evacuation; large motor
vehicle collision; etc. The focus is on the management of the scene and resources
necessary to mitigate the problem and maintaining the County's 911-EMS System. It is
necessary for the County to make modifications to the daily 911-EMS System to support
the incident and stability of the System. Up to 100 patients.
Activation 4 - ANSWER-Large aircraft collision; hospital facility evacuation, isolated
natural event, etc. The focus is on the management of the scene and resources
necessary to mitigate the problem and maintaining the County's 911-EMS System. It is
necessary for the County to make modifications to the daily 911-EMS System support
the incident and stability of the System. This includes the use of mutual aid resources
and the aid of external partner management organizations. Up to 1000 patients.
Activation 5 - ANSWER-Significant events involving a large number of patients. The
focus is on the management of the scene and resources necessary to mitigate the
problem and maintaining the County's 911-EMS System. It is necessary for the County
to make modifications to the daily 911-EMS System support the incident and stability of
the System. This includes the significant use of mutual aid resources from state and
federal partners. Over 1000 patients.
Active Seizure with Vascular Access administer - ANSWER-Midazolam 2.5 mg IV
(slowly titrated to effect in increments of no more than 2.5mg); not to exceed a total
dose of 15 mg
BASE CONTACT: if additional Midazolam above 15 mg total is needed
, Active Seizure without Vascular Access administer - ANSWER-.Midazolam 10 mg IM
After IM midazolam establish Vascular Access (IV), TKO If unable to establish IV
access and patient has continued seizure, Midazolam 5 mg IM; not to exceed a total
dose of 15 mg.
Adult Trauma Alert - Physiologic Criteria - ANSWER-Motor <6
SBP <90
Resp distress
Respiratory rate less than 10 or greater than 29 breaths per minute
ADULT TRAUMA CENTERS - ANSWER-RSJ
SUH
VMC
Advanced pediatric care center - ANSWER-GSH
KSC
SUH
VMC
Albuterol dose - ANSWER-5mg in 6ml normal saline via handheld nebulizer device,
may repeat if respiratory distress continues
Allergic Reaction ALS treatment - ANSWER-Rash, itching, swelling
Diphenhydramine 50mg IV / IO / IM
ALS Burn Treatment - ANSWER-Assess for inhalation injury and be prepared to
intubate early
For major burns (greater than 20% TBSA) establish two (2) large bore IVs and
administer fluids (macro drip set) as indicated below: Administer IV fluids at a rate of 10
mL/min, or 100 gtt/min (1-2 gtt/sec) If patient is hemodynamically unstable administer
1,000ml fluid bolus; otherwise do not bolus fluids
Consider pain management Morphine 2-5mg IV / IO, every 3-5 minutes, titrated to pain,
max dose 20 mg
OR, Morphine 5-10mg IM, may repeat in 20 minutes, max dose 20 mg
BASE CONTACT: if additional Morphine above 20 mg is needed
ALS Determinization of death - ANSWER-Asystole
Arrest not witnessed by EMS
No return of spontaneous circulation (ROSC) prior to transport.
No shock was delivered by AED or manual defibrillator.
Patient does not have a functioning ventricular assist device (VAD)
Latest Graded A+
12-lead indications - ANSWER-Substernal pain
Discomfort or tightness radiating to the jaw, left shoulder or arm
Symptoms indicating cardiogenic shock
Nausea
SOB
Diaphoresis
Anxiety
Syncope/dizziness
"suspicious symptoms"
elderly, female, and diabetic patients may present atypically
Known treatment for ACS
A physician on scene may... - ANSWER-Relinquish patient care
Assist in patient care
Manage patient care
He must show proper identification
Activated Charcoal adult dose - ANSWER-1g/kg PO, if time of ingestion is less than 1
hour, max dose 50gm
Charcoal is contraindicated if patient lacks gag reflex and cannot self-administer, or has
ingested substance(s) not bound by charcoal; such as: caustics, lithium, metals,
ethylene glycol, iron, methanol, other alcohols, or hydrocarbons
Activated Charcoal pediatric dose - ANSWER-Patients less than 1 year old and time of
ingestion is less than 1 hour:
1g/kg PO, max dose 25gm
,Patients greater than 1 year old and if time of ingestion is less than 1 hour:
Activated Charcoal 25g PO
Charcoal is contraindicated if patient lacks gag reflex and cannot self-administer, or has
ingested substance(s) not bound by charcoal; such as: caustics, lithium, metals,
ethylene glycol, iron, methanol, other alcohols, or hydrocarbons
Activation 1 - ANSWER-Multiple vehicle accident; small aircraft collision; multiple
shooting victims at a contained scene with no "active" shooter threat; etc. Focus is on
scene management, providing resources to support the incident, and the rapid
transportation of patients to appropriate facilities. Does not affect normal operations.
Generally no measurable impact to County 911- EMS System. Up to 10 patients.
Activation 2 - ANSWER-Ongoing "active" shooter event with no containment; fire at
multiple family occupancy; mass transportation incident; etc. Generally overwhelms the
initial first response requiring additional units. Focus remains on scene management,
providing resources to support the incident, and the rapid transportation of patients to
appropriate facilities. May require contingency activations to maintain County 911-EMS
System i.e., Standard Dispatch Orders. Up to 20 patients.
Activation 3 - ANSWER-Aircraft collision; skilled nursing facility evacuation; large motor
vehicle collision; etc. The focus is on the management of the scene and resources
necessary to mitigate the problem and maintaining the County's 911-EMS System. It is
necessary for the County to make modifications to the daily 911-EMS System to support
the incident and stability of the System. Up to 100 patients.
Activation 4 - ANSWER-Large aircraft collision; hospital facility evacuation, isolated
natural event, etc. The focus is on the management of the scene and resources
necessary to mitigate the problem and maintaining the County's 911-EMS System. It is
necessary for the County to make modifications to the daily 911-EMS System support
the incident and stability of the System. This includes the use of mutual aid resources
and the aid of external partner management organizations. Up to 1000 patients.
Activation 5 - ANSWER-Significant events involving a large number of patients. The
focus is on the management of the scene and resources necessary to mitigate the
problem and maintaining the County's 911-EMS System. It is necessary for the County
to make modifications to the daily 911-EMS System support the incident and stability of
the System. This includes the significant use of mutual aid resources from state and
federal partners. Over 1000 patients.
Active Seizure with Vascular Access administer - ANSWER-Midazolam 2.5 mg IV
(slowly titrated to effect in increments of no more than 2.5mg); not to exceed a total
dose of 15 mg
BASE CONTACT: if additional Midazolam above 15 mg total is needed
, Active Seizure without Vascular Access administer - ANSWER-.Midazolam 10 mg IM
After IM midazolam establish Vascular Access (IV), TKO If unable to establish IV
access and patient has continued seizure, Midazolam 5 mg IM; not to exceed a total
dose of 15 mg.
Adult Trauma Alert - Physiologic Criteria - ANSWER-Motor <6
SBP <90
Resp distress
Respiratory rate less than 10 or greater than 29 breaths per minute
ADULT TRAUMA CENTERS - ANSWER-RSJ
SUH
VMC
Advanced pediatric care center - ANSWER-GSH
KSC
SUH
VMC
Albuterol dose - ANSWER-5mg in 6ml normal saline via handheld nebulizer device,
may repeat if respiratory distress continues
Allergic Reaction ALS treatment - ANSWER-Rash, itching, swelling
Diphenhydramine 50mg IV / IO / IM
ALS Burn Treatment - ANSWER-Assess for inhalation injury and be prepared to
intubate early
For major burns (greater than 20% TBSA) establish two (2) large bore IVs and
administer fluids (macro drip set) as indicated below: Administer IV fluids at a rate of 10
mL/min, or 100 gtt/min (1-2 gtt/sec) If patient is hemodynamically unstable administer
1,000ml fluid bolus; otherwise do not bolus fluids
Consider pain management Morphine 2-5mg IV / IO, every 3-5 minutes, titrated to pain,
max dose 20 mg
OR, Morphine 5-10mg IM, may repeat in 20 minutes, max dose 20 mg
BASE CONTACT: if additional Morphine above 20 mg is needed
ALS Determinization of death - ANSWER-Asystole
Arrest not witnessed by EMS
No return of spontaneous circulation (ROSC) prior to transport.
No shock was delivered by AED or manual defibrillator.
Patient does not have a functioning ventricular assist device (VAD)
