Lisbon Fire Department Standard Operating Guidelines and Policies

The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:

• 
  Assure scene safety and observe universal precautions (see guideline #107).
  
• Assure patent airway. (see guideline # 101,201).
• Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).
• 
  Allow the patient to assume the position of comfort unless contraindicated by medical condition.
  
• 
  Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.
  
• 
  Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
  
• 
  Complete the history and focused physical assessment (see guideline # 103, 1001)
  
• 
  Document history of hematemesis (vomiting blood), melena (black, tarry stools) or bright red rectal bleeding.
  
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  Question pregnancy status if of child-bearing age. Consider content of OB/GYN guideline.
  
• 
  Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
  
• 
  Consider intravenous access (see guideline # 3002-3004).
  
• 
  Consider pain management, contact medical control as required (see guideline #112)
  

• 
  Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guideline.
  

• 
  The patient should have nothing to eat or drink.
  

• 
  Consider 12-lead electrocardiogram (see guideline #3008).
  
• 
  Contact medical control for orders as necessary.
  
• 
  Reassess and document the patient’s respiratory and cardiovascular systems frequently.
  
• 
  Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Document reasons for any deviation from the preceding Guideline/Standard of care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:

• 
  Assure scene safety and observe universal precautions (see guideline #107).
  
• 
  Allow the patient to assume the position of comfort unless contraindicated by medical condition.
  
• Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).
• 
  Determine the degree of respiratory distress (mild/moderate/severe).
  
• 
  Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.
  
• 
  Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
  
• 
  Complete the history and focused physical assessment (see guideline # 103, 1001)
  
• 
  Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
  
• 
  Attempt to identify the allergen and its route into the body.
  
• 
  Consider intravenous access (see guideline # 3002-3004) for patients in moderate/severe respiratory distress or hypotension.
  

• 
  Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
  

• 
  Consider drug therapy.
  
• 
  For patients with mild to moderate symptoms (e.g. itching, hives), consider IV or PO diphenhydramine (Benadryl) (see drug profile # 008).
  

• 
  For patients with moderate to severe signs/symptoms including respiratory distress and/or hypotension:
  
• 
  Epinephrine IM (see guideline # 009).
  
• 
  Diphenhydramine (Benadryl) (see drug profile # 008).
  
• 
  Solumedrol (see drug profile #027)
  
• 
  Contact medical control for orders as necessary.
  
• 
  Ice may be applied to the injection site with the exception of snake bites. Ice should be wrapped to prevent direct contact with the patient’s skin.
  
• 
  Reassess and document the patient’s respiratory and cardiovascular frequently.
  
• 
  Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Document reasons for any deviation from the preceding Guideline/Standard of care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:

• 
  Assure scene safety and observe universal precautions (see guideline #107).
  
• Assure patent airway. (See guideline # 101,201).
• Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).
• 
  Determine the degree of respiratory distress (mild/moderate/severe).
  
• 
  Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.
  
• 
  The bag-valve-mask will be kept immediately available to all patients with a provider assessment of altered level of consciousness who are in moderate/severe respiratory distress.
  
• 
  Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
  
• 
  Complete the history and focused physical assessment (see guideline # 103, 1001)
  
• 
  Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
  
• 
  If the cause of the decreased level of consciousness is established (trauma, cardiac, respiratory, diabetic, CVA, etc.) and the circumstances warrant physician intervention, contact medical control for specific orders. Apply the appropriate standard of care.
  
• 
  Consider intravenous access (see guideline # 3002-3004).
  

• 
  Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
  
• 
  Measure the blood glucose level (see guideline #4001).
  
• 
  Consider drug therapy if blood glucose is less than 60 mg% (See Dextrose/Glucagon guidelines #006, 011).
  

• 
  Three minutes after administration of dextrose, check the blood glucose level.
  
• 
  If the patient continues to have an altered level of consciousness and the blood glucose level is still less than60 mg%, repeat the initial dextrose dose.
  
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  If the patient does not respond to dextrose or the initial blood sugar is greater than 60 mg%, administer naloxone (see drug profile #014).
  
• 
  Assess and consider other causes of altered mental status including hypoxia and CVA. (AEIOU TIPS V)
  

• 
  Consider 12-lead electrocardiogram (see guideline #3008).
  
• 
  Contact medical control for orders as necessary.
  
• 
  Reassess and document the patient’s respiratory, cardiovascular and nervous systems frequently.
  
• 
  Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Document reasons for any deviation from the preceding Guideline/Standard of care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:

• 
  Consider personnel, family and bystander safety.
  
• 
  Observe universal precautions (see guideline #107).
  
• Assure patent airway. (see guideline # 101,201).
• 
  Allow the patient to assume the position of comfort.
  
• 
  Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient if appropriate.
  
• 
  Complete the history and focused physical assessment (see guideline # 103, 1001)
  
• 
  Attempt to rule out common physical causes for patient’s abnormal behavior (hypoglycemia, hypoxia, etc.). Consider concurrent trauma, medication overdose or toxic exposure (see guideline #412, 506)
  
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  Minimize external stimulation if possible.
  
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  Evaluate suicidal potential.
  
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  Interview with open-ended questions.
  
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  Protect patient, family, bystanders and EMS personnel from potential harm. Obtain additional help as necessary. Consider need for assistance from law enforcement officers.
  
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  Consider the need for physical and/or chemical restraint (see guideline #108).
  
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  Assess the patient’s level of consciousness, level of activity, body language and affect.
  
• 
  Maintain non-threatening attitude toward patient.
  
• 
  Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals.
  

• 
  Contact medical control for orders as necessary.
  
• 
  Reassess and document the patient’s respiratory and cardiovascular systems frequently.
  
• 
  Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Document reasons for any deviation from the preceding Guideline/Standard of care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:

• 
  Assure scene safety and observe universal precautions (see guideline #107).
  
• Assure patent airway. (see guideline # 101,201).
• Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).
• 
  Determine the degree of respiratory distress (mild/moderate/severe).
  
• 
  Allow the patient to assume the position of comfort unless contraindicated by medical condition.
  
• 
  Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.
  
• 
  Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
  
• 
  Complete the history and focused physical assessment (see guideline # 103, 1001).
  
• 
  Evaluate for specific problems associated with envenomation:
  

HYMENOPTERA (BEES)	SPIDERS	SNAKES
Localized pain Wheal and flare reaction Anaphylaxis (see guideline #402)	Muscle spasm, cramps, pain Abdominal rigidity Paresthesias Headache, dizzy Nausea, vomiting Edema	Pit vipers (rattlesnake, cottonmouth) Bleeding disorders Convulsions Localized swelling, Coral snakes Slurred speech Dilated pupils Difficulty swallowing Respiratory paralysis

• 
  For bites from non-venomous animals, see trauma guidelines.
  
• 
  Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
  
• 
  Consider intravenous access (see guideline # 3002-3004).
  

• 
  Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
  

• 
  Provide specific emergency care.
  

HYMENOPTERA (BEES)	SPIDERS	SNAKES
Immobilize and elevate site Scrape/brush stinger out Consider diphenhydramine (Benadryl) (see drug profile # 008). Consider epinephrine (see guideline # 009). Consider solumedrol (see guideline #027)	Apply dressing to site Ice Consider diazepam for muscle spasm (see drug profile # 007) Consider opiate for pain (see drug profile # 013) Transport for antitoxin	Immobilize and keep site lower than rest of body Keep patient at rest Expedite transport for antivenom

• 
  Consider 12-lead electrocardiogram (see guideline #3008).
  

Bites and Stings (cont.)

• 
  Contact medical control for orders as necessary.
  
• 
  Consider contact with Poison Center.
  
• 
  Reassess and document the patient’s respiratory and cardiovascular systems frequently.
  
• 
  Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Document reasons for any deviation from the preceding Guideline/Standard of care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:

• 
  Assure scene safety and observe universal precautions (see guideline #107).
  
• Assure patent airway. (see guideline # 101,201).
• Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).
• 
  Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.
  
• 
  Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
  
• 
  Complete the history and focused physical assessment (see guideline # 103, 1001).
  
• 
  Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
  
• 
  Consider intravenous access (see guideline # 3002-3004).
  

• 
  Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
  
• 
  Monitor the blood glucose level (see guideline #4001).
  

• 
  Consider drug therapy if blood glucose is less than60 mg%. (See Dextrose/Glucagon guidelines #006, 011)
  

• 
  Three minutes after administration of dextrose, check the blood glucose level.
  
• 
  If the patient continues to have an altered level of consciousness and the blood glucose level is still less than60 mg%, repeat the initial dextrose dose.
  
• 
  If the patient’s initial blood sugar is greater than 400 mg%, consider establishing an IV of 0.9% NS. If no history of CHF or renal failure, run IV at 250 ml/hr and transport patient.
  

• 
  Consider 12-lead electrocardiogram (see guideline #3008).
  
• 
  Contact medical control for orders as necessary.
  
• 
  Reassess and document the patient’s respiratory, cardiovascular and nervous systems frequently.
  
• 
  Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Document reasons for any deviation from the preceding Guideline/Standard of care.
  

GUIDELINE/STANDARD OF CARE