Whatcom County EMS Protocols (2025 Edition)

Vocabulary practice flashcards covering clinical algorithms, procedures, pharmacology, and diagnostic criteria from the 2025 Whatcom County EMS Protocols.

SALT Triage System

The primary mass casualty incident triage framework consisting of Sort, Assess, Life-saving interventions, and Treatment/Transport. Categories include Immediate (Red), Delayed (Yellow), Minimal (Green), and Deceased (Black), with the former 'Expectant' category removed.

AEIOU TIPS

A clinical diagnostic mnemonic used to identify underlying causes of altered level of consciousness: Alcohol, Epilepsy, Insulin, Overdose/Oxygen, Underdose/Uremia, Uremia, Trauma/Tumor, Infection, Psychosis, and Stroke.

Decision-Making Capacity (Refusal Criteria)

A four-part assessment requiring the patient to demonstrate Understanding of their medical problem and treatment options, Appreciation of potential consequences of refusing care, Reasoning regarding their choices, and Communication of a clear decision.

Double Sequential External Defibrillation (DSED)

A resuscitation technique indicated for refractory ventricular fibrillation or pulseless ventricular tachycardia after $\ge 3$ unsuccessful shocks, involving applying a second set of pads in an anterior-lateral orientation and delivering two sequential shocks within $1\,\text{second}$ using the same hand.

ResQPOD (Impedance Threshold Device)

An impedance threshold device applied during CPR with a bag-valve mask or advanced airway that prevents the influx of respiratory gases during the chest wall recoil phase, generating intrathoracic negative pressure to enhance venous return (preload) and cardiac output; it must be removed upon return of spontaneous circulation (ROSC).

Sgarbossa Criteria (Occlusive Myocardial Infarction)

Electrocardiographic criteria used to identify acute myocardial infarction in the presence of left bundle branch block or paced rhythms: concordant ST elevation $\ge 1\,\text{mm}$ in $\ge 1$ lead, concordant ST depression $\ge 1\,\text{mm}$ in leads V1-V3, or excessively discordant ST elevation $\ge 1\,\text{mm}$ that is $\ge 25\%$ of the preceding S-wave depth.

Code Stroke

A time-critical hospital alert and transport pathway for acute ischemic stroke patients who present within $4.5\,\text{hours}$ of their Last Known Well (LKW) time, qualifying them for evaluation for intravenous tenecteplase (TNK) thrombolysis.

Stroke Standby

A prehospital notification protocol for stroke patients testing positive by BEFAST criteria whose Last Known Well is between $6\,\text{hours}$ and $24\,\text{hours}$ and who have a LAMS score $\ge 4$, designating them as potential candidates for endovascular mechanical thrombectomy.

Los Angeles Motor Scale (LAMS)

A validated prehospital stroke motor assessment tool scoring facial droop ($0\text{--}1$), arm drift ($0\text{--}2$), and grip weakness ($0\text{--}2$) on a scale from $0$ to $5$, where a total score of $4$ or $5$ indicates a high probability of large vessel occlusion (LVO).

ZODIAC Trial Finding (Stroke Positioning)

Evidence-based practice incorporated into protocol mandating that all suspected large vessel occlusion stroke patients be transported with the head of the bed (HOB) flat to optimize cerebral perfusion prior to thrombectomy.

M.A.R.C.H. Algorithm

A trauma assessment and intervention prioritization sequence addressing Massive hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head & Neck.

Dead on Arrival (DOA) Criteria (Traumatic Arrest)

Conditions permitting the withholding of traumatic resuscitation: decapitation or injuries incompatible with life, burns beyond recognition, definitive signs of prolonged death (rigor mortis, decomposition, lividity), avalanche cardiac arrest with an obstructed airway, or presentation with apnea, no signs of life, and asystole or PEA with rate $<40\,\text{bpm}$.

SamThorasite®

A landmarking device for needle thoracostomy that places an Axilla Hook into the axillary fossa and points an Alignment Arrow toward the iliac crest to locate the appropriate intercostal space within its Safe Zone Window.

Continuous Positive Airway Pressure (CPAP)

A non-invasive positive pressure respiratory therapy that increases intrathoracic pressure to decrease preload and afterload, elevate transmural cardiac pressure, and enhance oxygenation; contraindicated in patients with systolic BP $<90\,\text{mmHg}$, active vomiting, or age $<8\,\text{years}$.

Amiodarone

A broad-spectrum class III antiarrhythmic agent administered during adult pulseless VT/VF arrest as an initial $300\,\text{mg}$ IV/IO bolus, followed by a repeat dose of $150\,\text{mg}$ IV/IO for refractory dysrhythmias.

Atorvastatin

An HMG-CoA reductase inhibitor (statin) administered at an acute oral dose of $80\,\text{mg}$ PO for patients meeting Occlusive Myocardial Infarction (OMI) criteria to attenuate acute inflammation, platelet adhesion, and reperfusion injury.

Buprenorphine (Suboxone)

A long-acting partial opioid agonist administered sublingually/orally at an initial dose of $16\,\text{mg}$, followed by $8\,\text{mg}$ after $10\,\text{minutes}$ as needed, for patients experiencing active, symptomatic opioid withdrawal.

Droperidol

A butyrophenone antipsychotic that antagonizes dopamine and alpha receptors, administered at $1.25\,\text{mg}$ IV for severe nausea/vomiting or $5\,\text{mg}$ IV / $10\,\text{mg}$ IM for combative agitation in adult patients under $65\,\text{years}$ of age.

Ketamine

A dissociative phencyclidine derivative administered for analgesia ($0.2\,\text{mg/kg}$ IV, max $25\,\text{mg}$), combative agitation ($2\,\text{mg/kg}$ IV or $5\,\text{mg/kg}$ IM), and rapid sequence intubation ($2\,\text{mg/kg}$ IV, halved to $1\,\text{mg/kg}$ in shock).

Tranexamic Acid (TXA)

An antifibrinolytic lysine analog that competitively blocks plasminogen activation; administered as a $2\,\text{g}$ slow IV/IO push within $3\,\text{hours}$ of injury for severe uncontrolled hemorrhage, severe traumatic brain injury, or postpartum hemorrhage.

Cyanokit (Hydroxocobalamin)

A cyanide antidote that complexes with cyanide molecules to synthesize non-toxic cyanocobalamin (Vitamin B12); prepared by reconstituting $5\,\text{g}$ with $200\,\text{mL}$ normal saline and infused over $15\,\text{minutes}$ through a dedicated line.

Push-Dose Epinephrine

A temporary vasopressor formulation mixed to a concentration of $10\,\text{mcg/mL}$ ($1:100{,}000$) by diluting $1\,\text{mL}$ of $1:10{,}000$ epinephrine with $9\,\text{mL}$ of normal saline, delivered in adult boluses of $10\text{--}20\,\text{mcg}$ ($1\text{--}2\,\text{mL}$) every $3\text{--}5\,\text{minutes}$.

Termination of Resuscitation (TOR) Criteria (Medical Arrest)

The clinical standard allowing consideration of resuscitation termination via Medical Control after $20\,\text{minutes}$ of ALS care for unperfused asystole or PEA $<40\,\text{bpm}$ in two leads without respiratory effort, or after $\ge 30\,\text{minutes}$ of non-perfusing rhythm with $\text{ETCO}_2 \le 10\,\text{mmHg}$.

Nebulized Epinephrine (Pediatric)

The prioritized prehospital pharmacological intervention for pediatric croup or epiglottitis accompanied by stridor at rest, administered as $5\,\text{mg}$ ($5\,\text{mL}$) of the $1:1{,}000$ solution via nebulizer.

Spinal Motion Restriction (SMR) Technique

A spine management strategy emphasizing clinical assessment over routine rigid backboards; long spine boards are restricted to extrication only, while definitive transport relies on a cervical collar and immobilization via a vacuum mattress.

Epinephrine Intramuscular Injection Procedure

A parenteral injection administered at a $90^\circ$ angle to the skin surface into the anterolateral thigh (preferred, especially in pediatric patients) or middle deltoid using a vigorous alcohol prep scrub.

Kendrick Traction Device

The designated prehospital traction splint applied in Whatcom County for the stabilization and alignment of suspected isolated mid-shaft femur fractures.

Haloperidol Decanoate

A long-acting, first-generation typical antipsychotic dopamine antagonist administered by Community Paramedics up to an initial maximum dose of $100\,\text{mg}$ IM once monthly for diagnosed schizophrenia or chronic psychosis.