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EMS Patient Treatment Protocols

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.

Bibliography of Standard Texts   Rev 1/2009
Pediatric Definitions  Rev 1/2009
Abbreviation List  Rev 1/2009

Treatment Protocols

Protocol Updates - 10/23/2019
Treatment Protocol Index

Section 1 – General Treatment Protocols

G00 - Guide to Protocol Utilization
G01 - Routine Medical Care
G02 - End of Life Care
G03 - Ventricular Assist Devices
G04 - MCI Triage

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
CA03T - Refractory V-Fib/Pulseless V-Tach Mills Peninsula Pilot Program
CA04 - Post Resuscitation
CA05 - Obvious Death

Section 3 – Adult Cardiac Dysrhthmia Treatment Protocols

CD01 - Symptomatic Bradycardia
CD02 - Narrow Complex Tachycardia
CD03 - Wide Complex Tachycardia

Section 4 – Adult Respiratory Distress Treatment Protocols

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 - Agitated 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 and CVA and TIA
A34T - Stroke and CVA and TIA - Mobile Stroke Unit (CT-1)
A35 - Syncope and Near Syncope
A36 - Upper GI Bleeding
A37 - Vaginal Bleeding

Pediatric Treatment Protocols

Allergic Reaction
Altered Mental Status
Apparent Life Threatening Events (ALTE)
Cardiac Arrest: Asystole
Cardiac Arrest: Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Cardiac Arrest: Overview
Dysrhythmias: Bradycardia
Dysrhythmias: Tachycardia
Interim Pain Assessment & Management
Nausea and Vomiting
Neonatal Resuscitation
Patient Assessment/Routine Medical Care
Poisoning and Overdose
Respiratory Distress

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
F06 - Airway Foreign Body Removal
FP07 - Airway King Airway
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

Reference/Drug Lists

Adult Drug Reference Rev 4/2020
Pediatric Drug Reference Rev 10/2019

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