REMS Clinical Guidelines 08.01.2023

Rice University Emergency Medical Services Clinical Guidelines Protocols

Valid as of August 1st, 2023Cameron Decker, MD, LP, FACEP, FAEMSDate Medical Director

Table of Contents

  • Preface

  • General Rules for Following the Clinical Guidelines

  • Authorization Level

  • Infectious Disease Precaution Recommendations

  • Post-Exposure Prophylaxis Recommendations

  • Informed Patient Consent & Refusal

  • Multiple Patient Scenarios / Mass Casualty Events

  • Patient Destination Determination

  • Equipment & Procedure Guidelines

    • Automated External Defibrillation (AED): Adult and Pediatric

    • Cardiac Monitor Operation: Lifepak 15 (LP15)

    • Cardiac Pacing

    • Synchronized Cardioversion

    • Medication Administration

    • Venous Access: Intravenous

    • Venous Access: Intraosseous

    • Airway Assessment

    • Airway Suctioning

    • Oxygen Administration

    • Bag-Valve Mask Management

    • Nebulization Therapy

    • Supraglottic Airway

    • Waveform Capnography

    • Blood Glucose Analysis

    • Reference Scores

      • Los Angeles Prehospital Stroke Screen (LAPSS)

      • Rapid Arterial oCclusion Evaluation Score (RACE)

      • APGAR Score

  • Medical Assessment & Treatment

    • Medical General Assessment: Adult and Pediatric

    • Abdominal Pain, Nausea, Vomiting, and Diarrhea

    • Allergic Reaction and Anaphylaxis

    • Altered Mental Status

    • Behavioral Emergency

    • Cardiac Arrest

    • Cardiac Rhythm Abnormalities (Non-Arrest)

    • Chest Pain of Unknown Etiology

    • COVID-19

    • Dyspnea of Unknown Etiology

    • Environmental: Cold Illness

    • Environmental: Heat Illness

    • Fever

    • Hypertensive Emergency

    • Neonatal Resuscitation

    • Obstetric Emergencies

    • Pre-eclampsia/Eclampsia

    • Vaginal Bleeding

    • Labor and Delivery

    • Uncomplicated Delivery

    • Prolapsed Cord

    • Presenting Limb

    • Breech Presentation

    • Shoulder Dystocia

    • Uterine Inversion

    • Oleoresin Capsicum (OC) Spray Exposure

    • Respiratory Arrest

    • Seizures

    • Stroke/CVA

    • Trauma Assessment & Treatment

      • Trauma General Assessment: Adult and Pediatric

      • Animal Bites and Stings

      • Amputation

      • Burns

      • Percent Body Surface Area (BSA) Estimation Chart

      • Chest, Abdomen, and Pelvis Trauma

      • Pelvic Binder Application

      • Compartment Syndrome

      • Eye Injury

      • Head, Neck, and Spinal Trauma

      • Spinal Motion Restriction (SMR)

      • Life Threatening Hemorrhage

      • Tourniquet Application

      • Hemostatic Agent Application

      • Extremity Injury

      • Sexual Assault: Adult and Pediatric

      • Splinting

      • Trauma and Hypovolemic Shock Supportive Care

      • Water Submersion Events

  • Operations Guidelines

    • Fire Extinguishers

    • Hazardous Materials Response

      • Additional Resources about Hazardous Materials for EMS Providers

      • Initial Response to Suspected Hazardous Materials Incident

Preface

  • EMS providers and physicians deserve the finest clinical treatment protocols.

  • The guidelines aim to assist Rice University EMS providers in delivering quality prehospital care while ensuring professional medical training and compliant practices.

  • Providers should consult medical oversight when patient conditions deviate from guidelines.

  • Follow scopes of practice established by training, certification, or medical director authorization.

General Rules for Following the Clinical Guidelines

  1. Overlapping clinical guidelines should prioritize life-threatening issues.

  2. Maintain the maximum total medication dose when transitioning treatments.

  3. Provider judgment is critical in applying guidelines based on individual patient conditions.

  4. Licensed personnel require authorization for treatments beyond guidelines during emergency transfers.

  5. These guidelines are adaptable based on device availability or national medication shortages.

Authorization Level

  • Activities authorized for personnel vary based on training level and local protocols.

  • All BLS activities authorized by standing orders.

  • ALS activities authorized on a case-specific basis; medical director authorization is required for advanced procedures.

Infectious Disease Precaution Recommendations

  • Follow CDC immunization guidelines (e.g., Hepatitis B, Flu).

  • Use gloves and eye protection during patient care.

  • Ensure distance when administering treatments to reduce infectious risk.

  • Handle contaminated materials with caution to prevent exposure.

Post-Exposure Prophylaxis Recommendations

  • Wash exposed areas with approved methods.

  • Collect information about exposure events.

  • Report exposures immediately, regardless of time, for follow-up procedures.

Informed Patient Consent & Refusal

  • Consent is required before treatment.

  • Adults may refuse treatment after being informed; minors require guardian consent.

  • Notify law enforcement for mandatory treatment situations associated with detentions.

Multiple Patient Scenarios / Mass Casualty Events

  • Follow NIMS guidelines for incident command and patient management.

  • Maintain a unified command team for coordination during mass casualty events.

Patient Destination Determination

  • Rice EMS offers ambulance transport for patients, clarifying appropriate facilities based on care priorities.