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EMS Field Treatment Guidelines

General information


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

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. See Routine Medical Care (G01) under General Care.

Care Outside of Protocol Guidelines

No set of protocols can cover all patient problems. 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. Refer to Routine Medical Care (G01) for more information. 

Prehospital personnel who are exposed to potentially infectious materials should immediately follow the reporting procedures set up by their agency. 

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 May 23, 2018 updated U.S. Public Health Service guidelines for the Management of Occupational Exposures to HIV and Recommendation for Post Exposure Prophylaxis. Emergency departments are expected to follow these guidelines when managing prehospital exposure to potentially infectious substances.

Treatment Guidelines

RF03 - Approved Abbreviations
Treatment Protocols Index

Section 1 – General Treatment Protocols

G00 - Guide to Protocol Utilization
G01 - Routine Medical Care
G02 - End of Life
G03 - Ventricular Assist Devices
G04 - MCI Triage
G05 - Law Enforcement - Suspected Opioid Overdose

Section 2 – Adult Cardiac Arrest – Non-traumatic Treatment Protocols

CA01 - Cardiac Arrest - Non-traumatic  
CA02 - Asystole and PEA  
CA03 - V-Fib and Pulseless V-Tach  
CA04 - Post Resuscitation  
CA05 - Obvious Death  

Section 3 – Adult Cardiac Dysrhthmia Treatment Protocols

CD 01 - Bradycardia (Symptomatic)
CD02 - Narrow Complex Tachycardia
CD03 - Wide Complex Tachycardia

Section 4 – Adult Respiratory Distress Treatment Protocols

A03 - Anaphylaxis
R01 - Airway Obstruction and Choking
R02 - Respiratory Arrest and Respiratory Failure
R03 - Respiratory Distress and Bronchospasm
R04 - Respiratory Distress and CHF and Pulmonary Edema
R05 - Respiratory Distress Other
R06 - Inhalation Injury
R07 - Smoke Inhalation Injury
R08 - Cold and Flu Symptoms
R09 - Submersion and Drowning
R10 - Carbon Monoxide and Cyanide

Section 5 – Adult Environment Treatment Protocols

E01 - Electrocution
E02 - Hyperthermia
E03 - Hypothermia and Cold Injury
E04 - Stings and Venomous Bites

Section 6 – Adult Toxic Exposure Treatment Protocols

X01 - Hazmat Exposure and Skin Exposure
X02 - Alcohol Intoxication
X03 - Overdose and Poisoning and Ingestion
X04 - Dystonic Reaction
X05 - Hyperactive Delirium

Section 7 – Adult Behavioral Treatment Protocols

B01 - Behaviorial and Psychiatric Crisis

Section 8 – Adult Medical Treatment Protocols

A01 - Abdominal Pain and Problems (GI and GU)
A02 - Allergic Reaction
A03 - Anaphylaxis
A04 - Altered Level of Consciousness (ALOC)
A05 - Chest Pain - Not Cardiac
A06 - Chest Pain - STEMI
A07 - Chest Pain - Suspected Cardiac
A08 - Childbirth (Mother)
A09 - Diarrhea
A10 - Dizziness and Vertigo
A11 - ENT and Dental Problem (Unspecified)
A12 - Epistaxis
A13 - Eye Problem (Unspecified)
A14 - Fever
A15 - General Weakness
A16 - Genitourinary Disorder (Unspecified)
A17 - Hyperglycemia
A18 - Hypoglycemia
A19 - Hypertension
A20 - Hypotension
A21 - Lower GI Bleeding
A22 - Nausea and Vomiting
A23 - No Medical Complaint
A24 - Non-Traumatic Body Pain
A25 - Non-Traumatic Extremity Pain and Swelling
A26 - Non-Traumatic Headache
A27 - Palpitations
A28 - Pregnancy Complication
A29 - Pregnancy and Labor
A30 - Seizure - Active
A31 - Seizure - Post
A32 - Sepsis
A33 - Shock
A34 - Stroke/CVA/TIA
A34T - Stroke/CVA/TIA - Mobile Stroke Unit (CT-1)
A35 - Syncope and Near Syncope
A36 - Upper GI Bleeding
A37 - Vaginal Bleeding
A38 - Opioid Withdrawal

Section 9 – Pediatric Cardiac Arrest Treatment Protocols 

PC01 - Cardiac Arrest
PC02 - Aystole and PEA
PC03 - V-Fib and Pulseless V-Tach
PC04 - Post Resuscitation
PC05 - Obvious Death

Section 10 – Pediatric Cardiac Dysrhythmia Treatment Protocols 

PD01 - Bradycardia
PD02 - Tachycardia (Stable)
PC03 - Tachycardia (Unstable)

Section 11 – Pediatric Treatment Protocols – Respiratory 

P03 - Anaphylaxis
PR01 - Airway Obstruction/Choking
PR02 - Respiratory Arrest/Respiratory Failure
PR03 - Respiratory Distress - Bronchospasm
PR04 - Respiratory Distress - CHF/Pulmonary Edema
PR05 - Respiratory Distress - Other
PR06 - Inhalation Injury
PR07 - Smoke Inhalation
PR08 - Cold/Flu Symptoms
PR09 - Submersion/Drowning
PR10 - Carbon Monoxide

Section 12 – Pediatric Treatment Protocols – Environmental 

PE01 - Electrocution
PE02 - Hyperthermia
PE03 - Hypothermia/Cold Injury
PE04 - Stings/Envonomations

Section 13 – Pediatric Treatment Protocols – Toxic Exposure 

PX01 - Hazmat Exposure/Skin Exposure
PX02 - Alcohol Inxotication
PX03 - Overdose/Poisoning/Ingestion
PX04 - Dystonic Reaction
PX05 - Agitated Delirium

Section 14 – Pediatric Treatment Protocols – Behavioral 

PB01 - Behavioral/Psychiatric Crisis

Section 15 – Pediatric Treatment Protocols – Medical 

P01 - Abdominal Pain/Problems (GI/GU)
P02 - Allergic Reaction
P03 - Anaphylaxis
P04 - ALOC - (Not Hypoglycemia or Seizure)
P05 - Brief Resolved Unexplained Event (BRUE)
P06 - Chest Pain - Not Cardiac
P07 - Diarrhea
P08 - Dizziness/Vertigo
P09 - ENT/Dental Problem - Unspecified
P10 - Epistaxis
P11 - Eye Problem - Unspecified
P12 - Fever
P13 - Pediatric General Weakness
P14 - Genitourinary Disorder, Unspecified
P15 - Hyperglycemia
P16 - Hypoglycemia
P17 - Hypertension
P18 - Hypotension
P19 - Lower GI Bleeding
P20 - Nausea/Vomiting
P21 - No Medical Complaint
P22 - Non-traumatic - Body Pain
P23 - Non-traumatic - Extremity Pain/Swelling
P24 - Non-traumatic - Headache
P25 - Palpitations
P26 - Seizure - Active
P27 - Seizure - Post
P28 - Pediatric Shock
P29 - Stroke/CVA/TIA
P30 - Syncope/Near Syncope
P31 - Upper GI Bleeding
P32 - Vaginal Bleeding
P33 - Newly Born

Section 16 – Trauma Treatment Protocols

T01 - Trauma Triage
T02 - Extremity Trauma
T03 - Head Trauma
T04 - Multi-System Trauma
T05 - Traumatic Arrest
T06 - Burns

Section 17 – Field Procedures

FP01 - 12-Lead ECG
FP02 - Airway BLS Management
FP03 - Airway Bougie Device
FP04 - Airway: BVM with In-Line Nebulizer
FP05 - Airway Direct Laryngoscopy Intubation
FP06 - Airway Foreign Body Removal
FP07 – Supraglottic Airway Device
F08 - Airway Stomal Intubation
FP09 - Airway Tracheostomy Tube Replacement
FP10 - Airway Video Laryngoscopy Intubation
FP11 - Childbirth
FP13 - End Tital CO2 (EtCO2) Monitoring
FP14 - External Pacing
FP15 - Eye Irrigation
FP16 - Helmet Removal
FP17 - In-Line Nebulizer for Flowsafe II CPAP Device
FP18 - Intraosseous Access
FP19 - Mechanical Compression Device
FP20 - Needle Decompression
FP21 - Pediatric Assessment
FP22 - Spinal Injury Assessment
FP23 - Spinal Motion Restriction
FP24 - Tourniquet
FP25 - Valsalva (Modified) Maneuver
FP26 - Vascular Access
FP27 - Wound Packing - Hemostatic Gauze
FP28 - Intramuscular (IM) Injection
FP29 - High Performance CPR

Section 18 – Reference/Drug Lists

RF01 - Pediatric Dosing Guide
RF02 - Adult Dosing Guide
RF03 - Approved Abbreviations

Epidemic/Pandemic Protocols

EP01 - Assess and Refer

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