[AMR] Protocols/Navigating SCC

Highway 101 going southbound, what are all the big crossroads in order? (start at EPA)

University Ave: (can lead to stanford ED)

Oregon Expy: (Can lead to palo alto VA)

San Antonio: (Can lead to Palo Alto VA)

Highway 85: (Can lead to El Camino Mtn View, Later: el camino Los Gatos, good sam, or kaiser SJ)

Highway 237: (Can lead to El Camino Mountain View)

Lawrence Expy: (Can lead to Kaiser Santa Clara)

San Thomas Expy: (Road in between Lawrence Expy(W) & i880(E)

Highway 87: (Goes on the right of the airport, crosses with 880, Leads down to 85 before kaiser sj)

Highway 880: (Leads straight to VMC / O'Connor, Down more to el camino Los Gatos, good sam)

Highway 280/680: (North 680 leads to Regional, South 280 leads to oconnor/VMC)

Blossom hill road: (can lead to Kaiser San Jose, take endicot u turn to cottle),

Highway 85: (can lead to Kaiser SJ, or north more, good sam, el camino Los Gatos),

Masten Ave: (can lead to St Louise Hospital off exit)

Which 3 highways cross to form a triangle near El Camino Mountain View?

237, 82(elcamino), 85

Where does highway 87 start and finish and cross through?

Starts in South San Jose off of 85, going through capitol expy, 280, 82(elcamino/Alameda road/esantaclaraST), then 880 right by the airport, and ends at highway 101.

Where does San Tomas Expy start and finish and cross through?

Starts in between Los Gatos and Campbell running from highway 17 to the left and north. It crosses through Moorpark ave then quickly after 280, Stevens Creek, 82 (El Camino), Central Expy, 101, then becomes Montague expy which crosses through, 880, Capitol Ave, then 680. Ends in south Milpitas.

In-Extremis Transport Criteria:

• Breech/Limb Delivery Presentation

• Bleed that cannot be controlled by EMS w/ Pressure/Tourniquet

• Can’t ventilate adequately after BLS & ALS airway adjuncts and procedures attempts.

Trauma Alert Criteria For Falls:

• Fall from > 10 feet

• Skull Deformity / Suspected Skull Fracture

• Suspected spinal injury WITH motor or sensory loss

• Suspected pelvic fracture

• Chest Wall Instability, deformity, or flail chest

• Suspected Fracture of 2 or more proximal long bones

• Unable to follow commands (GCS motor response <6)

• Fall with significant head impact (EMS Judgement)

• Minor Traumatic Injuries on anticoagulant/bleeding disorder

Advanced Pediatric Criteria:

• Cardiac dysrhythmia

• Evidence of poor perfusion and/or Cyanosis

• Severe respiratory distress

• Persistent altered mental status

• Status epilepticus

• Brief Resolved Unexplained Event (BRUE)

• Paramedic discretion

Advanced Pediatric Centers:

Kaiser Santa Clara,

Valley Medical Center,

Stanford Health Care,

A pediatric patient who does not meet trauma, in-extremis, or critically ill

criteria as listed above shall be transported to what type of facility?

(paramedic discretion also applies):

A General Pediatric Centers

Which hospitals are the General Pediatric Centers?

Every Hospital except El Camino Los Gatos, EPS, & PAV.

Which hospitals are the Adult Trauma Centers?

Regional Medical Center,

Valley Medical Center,

Stanford Health Care.

Which hospitals are the Pediatric Trauma Centers?

Valley Medical Center,

Stanford Health Care.

What are the only 2 hospitals besides PAV and EPS which don’t have a STEMI center?

El Camino Los Gato, St Louise Hospital

Which 5 hospitals have comprehensive stroke centers?

El Camino Mountain View, Good Samaritan, Kaiser Santa Clara, Regional Hospital, Stanford Hospital

Which hospitals don’t have a primary stroke center?

PAV and EPS.

Which hospitals have a VAD Center?

Kaiser Santa Clara, Stanford

Which hospitals don’t have labor & delivery?

EPS, PAV, Regional

High Risk Injury Pattern (Red Criteria)?

A. Penetrating injuries to head, neck, torso, and proximal extremities

B. Skull deformity, suspected skull fracture

C. Suspected spinal injury with new motor or sensory loss

D. Chest wall instability, deformity, or suspected flail chest

E. Suspected pelvic fracture

F. Suspected fracture of two or more proximal long bones

G. Crushed, degloved, mangled, or pulseless extremity

H. Amputation proximal to wrist or ankle

I. Active bleeding requiring a tourniquet or wound packing with continuous

pressure

Mental Status and Vital Signs (Red Criteria)?

J. Unable to follow commands (motor GCS <6)

K. Respiratory rate less than 10 or greater than 29 breaths per minute

L. Respiratory distress or need for respiratory support

M. Room-air pulse oximetry less than 90%

N. Vital signs below the following parameters:

1. Age 0-9 years: Systolic BP less than 70 mmHg + 2x age years

2. Age 10-64 years: Systolic BP less than 90 mmHg

3. Age older than 65 years: Systolic BP is less than 110 mmHg

4. Age 10 and older: Heart rate is greater than Systolic BP.

Moderate Risk Mechanism of Injury (Yellow Criteria):

O. Auto crash with partial or complete ejection

P. Auto crash with intrusion > 12 inches occupant site, > 18 inches any site,

or need for extrication

Q. Death in passenger compartment

R. Child (age 0-9) unrestrained or in unsecure child safety seat

S. Vehicle telemetry data consistent with severe injury

T. Rider separated from transport vehicle with significant impact (eg.

Motorcycle, ATV, horse etc.)

U. Rollover with unrestrained occupant

V. Pedestrian/bicycle rider thrown, run over, or with significant impact

W. Fall from height > 10 feet (all ages)

If during an assessment certain criteria come up then the PT is no longer allowed to be transferred to BLS care, what are those criteria? If these criteria are met ALS must be requested

Chief Complaints:

3.1.1 Foreign body airway obstructions.

3.1.2. Abdominal pain (associated with fever, syncope, severe pain, possible ectopic

pregnancy).

3.1.3. Acute cardiac dysrhythmias.

3.1.4. Suspected cardiac chest pain.

3.1.5. Overdose or poisoning.

3.1.6. Seizures or postictal.

3.1.7. Suspected sepsis.

3.1.8. Hypoglycemia (less than 60 mg/dl)

3.1.9. Altered mental status (altered for the patient).

3.1.10. Any specialty care alert (Trauma meeting “Red Criteria”, Stroke, STEMI, Burns,

Advanced Pediatrics).

3.1.11. Water related submersion incidents.

3.1.12. Pregnancy related complications.

3.1.13. Need for ALS medication administration.

Vital signs:
Respiratory rate equal or less than 10 breaths a minute.

Respiratory rate greater than 24 breaths a minute.

Pulse oximetry (SpO2) of 93% saturation or below with supplemental oxygen.

Systolic blood pressure less than 90 mmHg.

Sustained blood pressure exceeds 180/100 mmHg, (either systolic or diastolic).

Pulse rate is less than 60 beats per minute and symptomatic.

Sustained pulse rate greater than 120 beats per minute.

Blood Glucose (BGL) is greater than 400 mg/dl.

Temperature is less than 95°F

Temperature is greater than 103.0°F

Eye opening numbers:

"1-4" No response up to Spontaneous

Verbal Response numbers:

“1-5” none up to orientated.

Motor response numbers:

“1-6” none up to obey commands

Eye: 4

Verbal: 5

Motor: 6

Eye: 4

Verbal: 5

Motor: 6

Eye opening

3?

2?

to sound

to pain

Verbal Response

4?

3?

2?

Confused conversation but able to answer questions

Words / inappropriate responses

Sounds / incomprehensible

Motor Response

5?

4?

3?

2?

localizing to pain (feeling to where pain is) (purposeful movement to pain)

Withdraws to pain

abnormal flexion to pain

abnormal extension to pain