SNHD Paramedic Protocol Questions And
Answer latest updated
1. Waiting room criteria - ANSWER Upon arrival in the ED, if transfer of care has
not occurred in accordance with NRS 450B.790, any patient, excluding patients on
a legal psychiatric hold, meeting ALL criteria may be placed in a waiting room
2. Internal disaster - ANSWER If a hospital declares internal disaster, that facility
is to be bypassed for all patients except patients in cardiac arrest or in whom the
ability to adequately ventilate has not been established
Operational exceptions may be initiated in regard to transport to hospitals on
internal disaster.
3.General Adult Trauma Assessment - ANSWER 1. General Adult assessment;
cervical stabilization
2 GCS
<8 Ventilation management BVM if O2 sat < 94%
>8 Oxygen Keep SPO2 > 94%
3. Palpable radial pulse>
No -> vascular access, 1 L NS or LR bolus
Yes -> Vascular access
4. Secondary survey:
Suspected tension pneumothorax -> Paramedic
Sucking chest wound -> apply 3-sided occlusive dressing
Control active hemorrhage -> Hemorrhage control
Obvious fractures -> Immobilize fractures; assess distal pulse
Suspected traumatic brain injury -> Raise head of bed 30 degrees
,Open wounds -> cover with gauze; wet trauma dressing for abdominal evisceration
5. Transport and radio contact to appropriate trauma center based on TFTC
3. General Adult Trauma History - ANSWER Time and mechanism of injury
damage to structure or vehicle
location in structure or vehicle
other injured or dead
speed and details of MVC
restraints/protective equipment
past medical history
medications
4. General adult trauma signs and symptoms - ANSWER Pain, swelling
Deformity, lesions, bleeding
AMS or unconscious
Hypotension or shock
Arrest
5. General Adult Trauma Differential (life threatening) - ANSWER Tension
pneumothorax
Flail chest
Pericardial tamponade
Open chest wound
Hemothorax
Intra-abdominal bleeding
Pelvis/femur fracture
,Spine fracture/cord injury
Head injury
Extremity fracture
HEENT (airway obstruction)
Hypothermia
6.General Adult trauma Pearls - ANSWER Recommended exam: mental status,
skin, HEENT, heart, lung, abdomen, extremities, back, neuro
Transport should not be delayed for procedures; ideally procedures should be
performed enroute when possible
Geriatric patients should be evaluated with a high index of suspicion; occult
injuries may be present and geriatric patients can decompensate quickly
BVM is an acceptable method of ventilating and managing an airway if pulse ox
can be maintained >90%
7.Abdominal/Flank Pain, Nausea & Vomiting - ANSWER 1. General adult
assessment
2. Signs of hypovolemia
Yes: Vascular access, 500 mL NS or LR bolus; may repeat up to 2000 mL
No
3. Nausea or vomiting
Yes: Paramedic
No
4. Consider Chest Pain (Non Traumatic) and Suspected Acute Coronary Syndrome
protocol
5. Continue General Adult Assessment
8.A patient is defined as - ANSWER A person who has a complaint or mechanism
suggestive of potential illness or injury; A person who has obvious evidence of
, illness or injury; or A person identified by an informed 2nd or 3rd party caller as
requiring evaluation for potential illness or injury
9. Pediatric patient considerations - ANSWER For patients < 18 yo, use the
Pediatric Patient Destination protocol; Pediatric treatment protocols are to be used
on children who have not yet experienced puberty.
10.Signs of puberty include - ANSWER chest or underarm hair on males, and any
breast development in females.
General Adult Assessment - ANSWER 1. Scene safety / scene size up; NOI/MOI;
PPE/BSI; Bring all equipment to patients side
2. Level of consciousness -> unresponsive -> check pulse-> none -> Cardiac arrest
Airway -> sigs of compromised or non protecting -> Ventilation management
Breathing -> inadequate or resp. distress -> Resp. Distress
Circulation -> bleeding -> General trauma
Disability -> Altered or confused -> altered mental status/syncope
3. History - HPI & AMPLE
Vital signs and physical exam
blood glucose testing if indicated
Special treatment protocol as indicated
Cervical Stabilization as indicated
Comfort measures (splint, position of comfort)
Vascular access as indicated
Oxygen therapy to keep SPO2 > 94%
4. Radio contact for all trauma center patients, Code 3 returns, need for telemetry
physician & as per protocol
Answer latest updated
1. Waiting room criteria - ANSWER Upon arrival in the ED, if transfer of care has
not occurred in accordance with NRS 450B.790, any patient, excluding patients on
a legal psychiatric hold, meeting ALL criteria may be placed in a waiting room
2. Internal disaster - ANSWER If a hospital declares internal disaster, that facility
is to be bypassed for all patients except patients in cardiac arrest or in whom the
ability to adequately ventilate has not been established
Operational exceptions may be initiated in regard to transport to hospitals on
internal disaster.
3.General Adult Trauma Assessment - ANSWER 1. General Adult assessment;
cervical stabilization
2 GCS
<8 Ventilation management BVM if O2 sat < 94%
>8 Oxygen Keep SPO2 > 94%
3. Palpable radial pulse>
No -> vascular access, 1 L NS or LR bolus
Yes -> Vascular access
4. Secondary survey:
Suspected tension pneumothorax -> Paramedic
Sucking chest wound -> apply 3-sided occlusive dressing
Control active hemorrhage -> Hemorrhage control
Obvious fractures -> Immobilize fractures; assess distal pulse
Suspected traumatic brain injury -> Raise head of bed 30 degrees
,Open wounds -> cover with gauze; wet trauma dressing for abdominal evisceration
5. Transport and radio contact to appropriate trauma center based on TFTC
3. General Adult Trauma History - ANSWER Time and mechanism of injury
damage to structure or vehicle
location in structure or vehicle
other injured or dead
speed and details of MVC
restraints/protective equipment
past medical history
medications
4. General adult trauma signs and symptoms - ANSWER Pain, swelling
Deformity, lesions, bleeding
AMS or unconscious
Hypotension or shock
Arrest
5. General Adult Trauma Differential (life threatening) - ANSWER Tension
pneumothorax
Flail chest
Pericardial tamponade
Open chest wound
Hemothorax
Intra-abdominal bleeding
Pelvis/femur fracture
,Spine fracture/cord injury
Head injury
Extremity fracture
HEENT (airway obstruction)
Hypothermia
6.General Adult trauma Pearls - ANSWER Recommended exam: mental status,
skin, HEENT, heart, lung, abdomen, extremities, back, neuro
Transport should not be delayed for procedures; ideally procedures should be
performed enroute when possible
Geriatric patients should be evaluated with a high index of suspicion; occult
injuries may be present and geriatric patients can decompensate quickly
BVM is an acceptable method of ventilating and managing an airway if pulse ox
can be maintained >90%
7.Abdominal/Flank Pain, Nausea & Vomiting - ANSWER 1. General adult
assessment
2. Signs of hypovolemia
Yes: Vascular access, 500 mL NS or LR bolus; may repeat up to 2000 mL
No
3. Nausea or vomiting
Yes: Paramedic
No
4. Consider Chest Pain (Non Traumatic) and Suspected Acute Coronary Syndrome
protocol
5. Continue General Adult Assessment
8.A patient is defined as - ANSWER A person who has a complaint or mechanism
suggestive of potential illness or injury; A person who has obvious evidence of
, illness or injury; or A person identified by an informed 2nd or 3rd party caller as
requiring evaluation for potential illness or injury
9. Pediatric patient considerations - ANSWER For patients < 18 yo, use the
Pediatric Patient Destination protocol; Pediatric treatment protocols are to be used
on children who have not yet experienced puberty.
10.Signs of puberty include - ANSWER chest or underarm hair on males, and any
breast development in females.
General Adult Assessment - ANSWER 1. Scene safety / scene size up; NOI/MOI;
PPE/BSI; Bring all equipment to patients side
2. Level of consciousness -> unresponsive -> check pulse-> none -> Cardiac arrest
Airway -> sigs of compromised or non protecting -> Ventilation management
Breathing -> inadequate or resp. distress -> Resp. Distress
Circulation -> bleeding -> General trauma
Disability -> Altered or confused -> altered mental status/syncope
3. History - HPI & AMPLE
Vital signs and physical exam
blood glucose testing if indicated
Special treatment protocol as indicated
Cervical Stabilization as indicated
Comfort measures (splint, position of comfort)
Vascular access as indicated
Oxygen therapy to keep SPO2 > 94%
4. Radio contact for all trauma center patients, Code 3 returns, need for telemetry
physician & as per protocol
