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Patient Care Protocols

General information

Introduction (Combined Intro PDFs) (Note: Drug lists are under revision for 2014)

Mission Statement

Emergency Medical Services (EMS) provides an integrated and coordinated system of services to ensure appropriate, timely, and respectful emergency medical care to meet the needs of patients and their families in San Mateo County.

Pre-Hospital Care Values and Ethics Statement

Developed by the Quality Leadership Council

Our Emergency Medical Services community consists of a team of health care professionals representing many professions including EMT-1’s, paramedics, firefighters, nurses, physicians, dispatchers, educators and administrators. This team is composed of all who care for our patients directly or indirectly through the continuum of the patients’ pre-hospital emergency care. This Statement defines our vision, code of conduct, and ethical responsibilities and is beneficial in guiding our practice.

We affirm that:

  • Our purpose is to provide the highest quality of pre-hospital emergency medical care, including transportation, for the residents and visitors of San Mateo County.
  • Skilled pre-hospital medical care must be provided with compassion, respect, and regard for the human dignity to all persons, regardless of nationality, race, creed, gender, economic status, sexual orientation, age, nature of illness, or responsiveness to our care.
  • We, as professionals, are accountable and responsible for providing pre-hospital medical care to the best of our ability and for accurately documenting such care.
  • Patients who are competent have the right to determine the level of service and treatment that they shall receive; to either accept or refuse medical care; and to know the risks and the responsibility resulting from their decision.
  • We respect the confidential nature of our work and respect the privacy of our patients and co-workers.
  • We are committed to honesty, integrity, and truthfulness in our professional relationships with our patients and our colleagues in all matters pertaining to patient care.
  • We uphold the highest standards of professional conduct when providing medical care and when interacting with other members of the pre-hospital community. These standards include maintenance of personal competence, confidentiality, and mutual respect.
  • We are responsible for upholding the standards of our profession, including participating in activities that strengthen the EMS system as well as benefit our community.
  • We respect and obey the law and regulations of our profession and do not participate in any unethical activities. We do not let personal considerations such as economic gain or convenience influence our level of patient care.
  • We refrain from conduct and activities, which may impair our professional judgment and our ability to act competently.
  • When differences of opinion or conflicts of interest occur, our professional judgment should always be guided by the ultimate objective, which is providing the best possible care for our patient.
  • We treat all members of the pre-hospital team with respect. Constructive comments are welcomed and encouraged; gossip and other activities that are potentially destructive to the individual or the team are discouraged.

We affirm the elements of this statement as a measure of our commitment to excellence in fulfilling our professional obligations to those we serve.

How to Use These Protocols


The use or possession of the protocol book does not exempt field personnel from the responsibility to know the information in the San Mateo Policy and Procedures Manual. This Protocol book does not replace the Policy and Procedures Manual and is provided as a tool for their reference.

Basic Life Support

Each Treatment Protocol section begins with Basic Life Support techniques and then proceeds to Advanced Life Support techniques. This is done to facilitate continuity of care between BLS and ALS personnel responding to the same patient. Start by instituting BLS measures, then proceed to ALS measures as dictated by your skill level and your patient assessment. Utilize good judgment and consider additional resources as needed.

Routine Medical Care

A group of standard assessments and treatments, including but not limited to airway, breathing and circulation, and the use of routine monitoring devices. Routine Medical Care (RMC) is described in the Primary and Secondary Survey Sections. RMC is provided to every patient as guided by your assessment of the scene and the patient’s condition.

Care Outside of Protocol Guidelines

No set of protocols can cover all patient problems. When dealing with a situation not addressed by a Standard Treatment Protocol, utilize other pre-existing standard life support guidelines, including PHTLS, ACLS, PALS, and good medical judgment. We encourage the use of Base Physician contact in such events.

Universal Precautions

Disease agents may be present in any body substance or fluid, and the presence of disease agents may or may not be known. Clinically healthy individuals may carry and be capable of transmitting these agents. Precautions with all patients shall include routine use of appropriate barrier precautions to prevent skin and mucous-membrane exposure when contact with blood or other body fluids is anticipated.

Prehospital personnel who are exposed to potentially infectious materials should immediately follow the reporting procedures set up by their agency. Notification should not routinely be made to the EMS Agency or to the San Mateo Department of Public Health.

Hospital emergency departments have specific requirements for managing exposure to body substances experienced by prehospital care personnel. Emergency departments are expected to actively assist prehospital personnel in evaluating risk and recommending and/or providing appropriate prophylactic care when needed. Emergency responders are expected to identify the source patient to the hospital, and to comply with emergency department procedures (e.g. Royce log) when reporting potential exposure to infectious materials.

Prophylactic care recommendations for health care workers are found in the CDC June 7, 1996 MMWR “Provisional Public Health Service Recommendations for Chemoprophylaxis After Occupational Exposure to HIV”. Emergency departments are expected to follow these guidelines when managing prehospital exposure to potentially infectious substances.

Drug Lists

Adult Treatment Protocol

Adult – Combined Adult Treatment Protocols PDF Rev 2/2014
Adult – Abdominal Pain PDF Rev 2/2013
Adult – Pain Assessment PDF Rev 2/2013
Adult – Allergic Reactions PDF Rev 2/2013
Adult – Altered Mental Status/Seizure PDF Rev 3/2013
Adult – Bites and Stings PDF Rev 2/2013
Adult – Burns PDF Rev 2/2013
Adult – Cardiac Arrest: Overview PDF Rev 1/2012
Adult – Cardiac Arrest: Pulseless Electrical Activity (PEA) and Asystole PDF Rev 1/2012
Adult – Cardiac Arrest: Ventricular Fibrillation/Pulseless Ventricular Tachycardia PDF Rev 1/2012
Adult – Chest Pain: Suspected Acute Coronary Syndrome  PDF Rev 1/2009
Adult - Decompression Illness PDF Rev 2/2013
Adult – Dysrhythmias: Overview PDF Rev 1/2012
Adult – Dysrhythmias: Symptomatic Bradycardia PDF Rev 1/2012
Adult – Dysrhythmias: Narrow-Complex Tachycardia PDF Rev 1/2012
Adult – Dysrhythmias: Wide-Complex Tachycardia With a Pulse PDF  Rev 1/2012
Adult – Hyperthermia PDF Rev 2/2013
Adult – Hypothermia PDF Rev 2/2013
Adult – Nausea and Vomiting Nausea Vomitting Rev 1/2012
Adult – Near Drowning PDF Rev 2/2013
Adult – Obstetrical Emergencies/Childbirth  PDF Rev 2/2013
Adult – Patient Assessment Routine Medical Care Primary and Secondary Survey PDF Rev 1/2012
Adult – Poisoning and Overdose PDF Rev 2/2013
Adult – Respiratory Distress PDF Rev 2/2013
Adult – Snake Bite PDF Rev 2/2013
Adult – Stroke PDF Rev 2/2013
Adult – Trauma Evaluation and Management PDF Rev 2/2013

Pediatric Treatment Protocols

Combined Pediatric Treatment Protocols PDF Rev 2/2014
Pediatric – Allergic Reaction  PDF Rev 2/2014
Pediatric – Altered Mental Status PDF Rev 2/2014
Pediatric – Apparent Life Threatening Events (ALTE) PDF Rev 2/2014
Pediatric – Burns PDF Rev 2/2014
Pediatric – Cardiac Arrest: Overview PDF Rev 2/2014
Pediatric – Cardiac Arrest: Asystole/PEA PDF Rev 2/2014
Pediatric – Cardiac Arrest: Ventricular Fibrillation/Pulseless Ventricular Tachycardia PDF Rev 2/2014
Pediatric – Dysrhythmias: Bradycardia  PDF Rev 2/2014
Pediatric – Dysrhythmias: Tachycardia PDF Rev 2/2014
Pediatric – Nausea and Vomiting Nausea Vomitting - Pediatric Rev 2/2014
Pediatric – Neonatal Resuscitation  Neonatal Resuscitation Rev 2/2014
Pediatric – Pain Assessment PDF Rev 2/2014
Pediatric – Patient Assessment/Routine Medical Care  PDF New 2/2014
Pediatric – Poisoning and Overdose PDF Rev 2/2014
Pediatric – Respiratory Distress PDF  Rev 2/2014
Pediatric – Seizures PDF Rev 2/2014
Pediatric – Shock PDF Rev 2/2014
Pediatric – Trauma Evaluation and Management  (See Adult Protocol) PDF Rev 2/2013