SNHD AEMT PROTOCOLS CERTIFICATION
PREPARATION REVIEW
◉ 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
1. Normal vital signs
Heart rate 60-100
Respiratory rate 10-20
Systolic BP 100-180
Diastolic BP 60-110
Room air pulse ox > 94%
A&Ox4
2. Did not receive any parenteral medications during EMS transport
except a single dose of analgesia and/or an anti-emetic
3. In the judgment of the Paramedic, does not require continuous
cardiac monitoring
4. Can maintain a sitting position without adverse impact on their
medical condition
5. Is left with a verbal report to hospital personnel
,◉ 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.
◉ 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
◉ 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
◉ General adult trauma signs and symptoms.
Answer: Pain, swelling
Deformity, lesions, bleeding
AMS or unconscious
Hypotension or shock
Arrest
, ◉ 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
◉ 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
PREPARATION REVIEW
◉ 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
1. Normal vital signs
Heart rate 60-100
Respiratory rate 10-20
Systolic BP 100-180
Diastolic BP 60-110
Room air pulse ox > 94%
A&Ox4
2. Did not receive any parenteral medications during EMS transport
except a single dose of analgesia and/or an anti-emetic
3. In the judgment of the Paramedic, does not require continuous
cardiac monitoring
4. Can maintain a sitting position without adverse impact on their
medical condition
5. Is left with a verbal report to hospital personnel
,◉ 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.
◉ 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
◉ 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
◉ General adult trauma signs and symptoms.
Answer: Pain, swelling
Deformity, lesions, bleeding
AMS or unconscious
Hypotension or shock
Arrest
, ◉ 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
◉ 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
