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Item C08 } C.8 `, County of Monroe �y,4 ' �, "tr, BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 �1 nff `ll Mayor Pro Tem David Rice,District 4 -Ile Florida.Keys Craig Cates,District 1 Eddie Martinez,District 3 w Mike Forster,District 5 County Commission Meeting August 18, 2021 Agenda Item Number: C.8 Agenda Item Summary #8540 BULK ITEM: Yes DEPARTMENT: Emergency Services TIME APPROXIMATE: STAFF CONTACT: Steven Hudson (305) 289-6342 N/A AGENDA ITEM WORDING: Issuance (renewal) of a Class A Certificate of Public Convenience and Necessity (COPCN) to Islamorada Village of Islands — Fire Rescue for the operation of an ALS transport ambulance service for the period October 1, 2021 through September 30, 2023. ITEM BACKGROUND: In September of 2019 a Class A COPCN was issued as a renewal to Islamorada Village of Islands — Fire Rescue to operate an ALS transport ambulance service. This certificate will be expiring on September 30, 2021. In view of the foregoing, Islamorada is applying to renew this COPCN for the period October 1, 2021 through September 30, 2023. PREVIOUS RELEVANT BOCC ACTION: 9/27/17: MCBOCC approved the issuance (renewal) of a COPCN to Islamorada Village of Islands — Fire Rescue for the operation of an ALS transport ambulance service for the period October 1, 2017 through September 30, 2019. 9/18/19: MCBOCC approved (C5) the issuance (renewal) of a COPCN to Islamorada Village of Islands — Fire Rescue for the operation of an ALS transport ambulance service for the period October 1, 2019 through September 30, 2021. CONTRACT/AGREEMENT CHANGES: The Class A COPCN renewal being applied for will cover the period October 1, 2021 through September 30, 2023. STAFF RECOMMENDATION: Approval. DOCUMENTATION: Islamorada Class A COPCN Renewal Application—Redacted Islamorada COPCN Class A Certificate 10-01-2021 to 09-30-2023.pdf Islamorada COPCN Renewal Application Letter FINANCIAL IMPACT: Packet Pg.393 C.8 Effective Date: 10/01/21 Expiration Date: 09/30/23 Total Dollar Value of Contract: N/A Total Cost to County: N/A Current Year Portion: N/A Budgeted: N/A Source of Funds: N/A CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: N/A REVIEWED BY: Steven Hudson Completed 07/30/2021 1:09 PM Pedro Mercado Completed 07/30/2021 1:26 PM Purchasing Completed 07/30/2021 1:27 PM Budget and Finance Completed 08/02/2021 11:42 AM Maria Slavik Completed 08/02/2021 1:48 PM Liz Yongue Completed 08/02/2021 4:03 PM Board of County Commissioners Pending 08/18/2021 9:00 AM Packet Pg.394 C 8.a MONROE COUNTY, FLORIDA APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY (COPCN) CLASS A EMERGENCY MEDICAL SERVICE (PRINT OR TYPE) ❑ INITIAL APPLICATION-$950.00 ® RENEWAL APPLICATION-$475.00 c 2 IF RENEWAL,PLEASE LIST NUMBER OF PREVIOUS CERTIFICATE:# 19-06 A 0 1. NAME OF SERVICE Islamorada Villaee of Islands Fire Rescue U CL BUSINESS MAILING ADDRESS_ 86800 Overseas Hwy., I"Floor, Islamorada, Ft, 33036 BUSINESS PHONE NUMBER _ 305-664-6490 EMERGENCY PHONE NUMBER 305-289-2351 y 2. TYPE OF OWNERSHIP(i.e. Sole Proprietor,Partnership,Corporation,etc.) Municipality DATE OF INCORPORATION OR FORMATION OF THE BUSINESS ASSOCIATION December 31 1997 e 3. LIST ALL OFFICERS,DIRECTORS,AND SHAREHOLDERS(use separate sheet if necessary): NAME AGE ADDRESS TELEPIRONE# POSITION/TITLE Budk Pinder 86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Mayor cn Peter Bacheler 86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Vice Mayor A Mark Gregg86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Council Member Henry Rosenthal 86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Council Member w David Webb 86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Council Member 0 4. LEVEL OF CARE TO BE PROVIDED: ❑ BLS or ® ALS IF ALS: ®TRANSPORT or ❑ NON TRANSPORT CL 5. DESCRIBE THE ZONE(S)THAT YOUR SERVICE DESIRES TO SERVE. (Use separate sheet if necessary.) U From the West end of the C hamiel Two Bridee,(woroxinlately mile marker 7 . ), to the West end of the 'Tavernier, y Creek BridoeLapproxitnately mile marker 90.8), inChiduig the entire island of Plantation Key, Windley Key. Uppg U Matecumbe Kev. Lower Matecurnbe lie ' and`I"eatable Key and all land, filled !n,between the islands,all connected by c U.S. One,Overseas Hiehwav:,all wof,the above within Islamorada. Village of Islands,Florida. (ZONE 3) N 6. LIST THE ADDRESS AND/OR DESCRIBE THE LOCATION OF YOUR BASE STATION AND ALL SUB-STATIONS (Use separate sheet if necessary.) E BASE STATION Islamorada Fire Rescue Station 21 U.S. One&MM 86.8 86800 Overseas I Iwy. I"l looi,. lsl im.rvad,t, I'1.33030 cu SUB-STATION Islamorada Fire Rescue Station 20 U.S. One&_it M 81.5 81850 Overseas Hwy., Islamorada, FL 33036 IslamoradaFire Rescue Station 19 U.S. One& IVIM 74 74070 Overseas Hwv.. Islamorada.FL 33036 Page 1 of 7 Packet Pg.395 C 8.a 7. DESCRIBE YOUR COMMUNICATION SYSTEM (Attach copy of all FCC licenses): FRE- UENEIIE+S CALL NUMBERS #OF MOBII.ES #OF PORTABLE, - - Monroe County Public Safety Communications System 800 mhz radios stem with 400 mhz paging system 12 50 c 0 CL 8. LIST THE NAMES AND ADDRESSES OF THREE (3) U.S. CITIZENS WHO WILL ACT AS REFERENCES FOI U YOUR SERVICE. NAME ADDRESS Frank Derfler 88005 Overseas Hwy., 10-120, Islamorada, FL 33036 CJ Dr. Sandra Schwemmer 160 Key Heights Dr.,Tavernier, FL 33070 c Joe Roth 127 Valencia Dr, Islamorada,FL 33036 9. ATTACH A SCHEDULE OF RATES WHICH YOUR SERVICE WILL CHARGE DURING THE COPCN PERIOD. 10. PROVIDE VERIFICATION OF ADEQUATE INSURANCE COVERAGE DURING THE COPCN PERIOD. y N It. ATTACH A COPY OF YOUR SERVICE'S CONTRACT WITH A MEDICAL DIRECTOR. 12. ATTACH A COPY OF ALL STANDING ORDERS AS ISSUED BY YOUR MEDICAL DIRECTOR. 13. ATTACH A CHECK OR MONEY ORDER IN THE APPROPRIATE AMOUNT, MADE PAYABLE TO THI MONROE COUNTY BOARD OF COUNTY COMMISSIONERS. I,THE UNDERSIGNED REPRESENTATIVE OF THE ABOVE NAMED SERVICE, DO HEREBY ATTEST MY SERVICI MEETS ALL OF THE REQUIREMENTS FOR OPERATION OF AN EMERGENCY MEDICAL SERVICE IN MONROI COUNTY AND THE STATE OF FLORIDA. I FURTHER ATTEST THAT ALL THE INFORMATION CONTAINED IP THIS APPLICATION,TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. CL SIGMA J 'E PLICANT/AU I IIO IZ D REPRESENTATIVE y Ca jW EVjtj Public Stab of Florida G Swaney NOTARY SEAL Myommission GG 3097138 s 0410512023 ns N s. NOTARY'`" NATURE DATE ns Page 2 of 7 Packet Pg.396 C 8.a PERSONNEL-PARAMEDICS NAME PARAMEDIC CERTIFICATION First,Middle,,Last SOCIAL SECURITY# CERTIFICATION# EXPIRATION DATE Terry Lee Abel 205452 12/1/22 Andres Felipe Ardila 526411 12/1/22 Wesley Dennis Be 528224 12/l/22 y Jason Christian Bryant 511516 12/1/22 2 Adrian Castellanos 526853 12/1/22 CL U Marcio Cemin 523649 12/1/22 Anwar Elias Cure-Twede 535002 12/1/22 CJ Keith Thomas En elme er 538279 12/1/22 Alexander Kristo her Franklin 533734 12/1/22 Jean-Michael In elmo 536217 12/1/22 Maria Isabel Jones 538071 12/1/22 Michael Jeremy Kimes 523643 12/1/22 N Randall Lebron 521428 12/1/22 Jason Alan Luna 519294 12/1/22 w Jason William Lyman 205524 12/1/22 Carlos Manuel Martin 509736 12/1/22 2 Steven Cesar Mejia 531833 12/1/22 0. Abdon Carlos Moreton 520725 12/l/22 Erica Bastos Oliveira 520615 12/1/22 Stephen Alan Pollock 517032 12/1/22 CL Dustin Brian Rivers 529704 12/1/22 U James Philli Ru les 520868 12/1/22 y Anthony Leonard Sardinas 529378 12/1/22 CJ Daniel Patrick Self 519016 12/1/22 c Filin Iva lov Todorov 524782 12/1/22 N George Thomas Toth 503039 12/1/22 Lester Robert Young 514855 12/l/22 Page 3 of 7 Packet Pg.397 C 8.a ..... ON-CALL PERSONNEL PARAMEDIC CERTIFICATION PARAMEDICS CERTIFICATION# EXPIRATION DATE Jason George Swensson 17623 12/1/22 Michael James Ham son 529844 1 12/1/22 c 2 ch 0 u CL PERSONNEL—EMERGENCY MEDICAL TECHNICIANS u NAME EMT CERTIFICATION y First,Middle,,Last SOCIAL SECURITY# CERTIFICATION# EXPIRATION DATE y CJ Mark Joseph DiRusso 563362 12/1/22 c Ronald Carl Jacobs 308660 12/1/22 = Victoria Elaine Price 565784 12/1/22 Ta ler Russell 572960 12/1/22 Christian Orozco 561466 12/1/22 N James David Griffeth 300527 12/1/22 �- Jordan Phillips Brown-Herlth 573900 12/1/22 e ON-CALL PERSONNEL- EMT Heidi Leeann Hunglin 523330 12/1/22 Warren Harding_Long Jr. 550431 12/1/22 .2 CJ CL CJ CJ c N Page 4 of 7 Packet Pg.398 sselo a jO fly a) a nss) p9pep9U—uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8wg3B44 V is N N N ^ N N vl 00 N N N N O O O N O O o0 N N " N N ,� O N N O N N ® ® N N N ® N N N 0 0 0'® O N N O 0 0'N O ® N O O p O N N N 0 0 0 0 0 N N - - N - - — N N N N N 0 N N N N N N N.N N 00 ® N N N N N CV M N ^ [� to d" 00 O r' M N O M ,� N N N N 0O 'w N CDC [- N ^ O Os r. V N p M w ^ N "T ^ Vl M N W o -o -o 'c -o �'-o -d •b -5 -2 .27d -12 "272 o -o 0 0 0 o c -o -o ' 'i. Y. 'L 4. . L S.+ 'i. L Y. 'Sr. L u. s. 1. L. L. L+ 'L. ' 'L. 'Y+,...i-i L. L 'i.. 'i-i 'i. 'L.'''L L ^ 0 0 0 0 0 0 22 0 0 0 0 0. O O o...... O O O O O O O O O' O O o 0 o 0 o O' O O O o ww � a. wwU. LL. wwwwU.: L" ri, wr�. wwc= a. u, � w �. ww �. wwww. w z O 0 0 N �F �-. 00 t� d' in .n vl i _ c'� �['� r� �O O� T \O a1 00 a w r� A' III A w F O � 0 w a �, 00 v� MN F* �i D U W a Q U 0 ca Z _ - 'a pal ❑ cG o o a� > o a > N 'a -O F~ o � ca O ° O W c w , UUw U � � UU c� E� Wawa � F Q°• -� ai � ° -� W v a U o L c > ° Lcd ¢ W c C7 cd >j s4cq3 a X O O s.. O O C O i b i., o m � � � � =a ° Uv� QWUv�,> L1 �'F- L1Qr� C7 WOx3 =; � sselo a jO fly a) a nss) p9pep9U-uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8wq3B44V C, �a o 14 V CL CL a c� a � $ O w ILCL 8 Z C w w w A wO O a A c w z w m � d' cz. w o O _> � a d � w zQ F a w d � as i oLT., w N O Or N w a w � p cG Y N w � Q z U OQ � . E=ram; w � -- [� N O Ca W W O v C7 G C � sselo a jO fly a) a nss) p9pep9U-uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8wg3B44 r R o V a F h+ O � wFa' m 0 0 0 0 � t2 tC a W� as �z F O «M `A C a, ca 00 O., N N O 00 kn >� N N LZ ¢ x LL U� >C X N �C F U U U U C C) N 44 V m......, �....... 00 _.... z u u M 00 1- 00 ci c� a a� s ci 04 0 0 00 00 C) w o 0 0 0 N N N N V CW W Q •Y W a F, j CG f� CC CC C.8.a `�` BOARD OF COUNTY COMMISSIONERS County of Monroe �€ �`° s Mayor Michelle Coldiron,District 2 The Florida Keys y c Ma or Pro Tem David Rice,District 4 � �� ` Craig Cates,District 1 „ Eddie Martuiez,District 3 0 r ,1 Mike Forster,District 5 E Monroe Cotmty Fire Rescue 0 490 63rl Street Ocean Marathon,FL 33050 C40) U CL Phone(305)289-6088 U MEMORANDUM 0 TO: Nicole Rhodes FROM: Cara Johnson N SUBJECT: Check for Deposit DATE: July 28, 2021 i Attached please find Check dated 07/26/2021 in the amount of$475.00 to be deposited in the General Fund. This check has been issued for the renewal application of a Class A Certificate of Public Convenience and Necessity for Islamorada Village of Islands. U CL Thank you, c Cara Johnson N Packet Pg.402 IBMGUGU NDdOD V SSBIDPBJOW ' :4u8ua 3 44 M ' 00 Q v CD N J CD ON a N \ O cc � , No Lu N � N t73 U3 O W ( � Q CDV5 iF w �r U z z 1 i x o i r m � iF ( u * z Q O iF O * u m * 4 � Z t O * v* � *' f0 * � V I I LU z Y Of W U O w Z N U Z r O O �n Nca CD N v o o U ~ m OU r N Z (n 2 z U — D O Q O U LL o O LL U no J O LL Z NF- Qcl 0 J co oC OD = m O c Q Cl) O co W V = o co > m W O v LL � > v O (/) cD H � � I Z N Q a Q Z -p O LJd Z) > JZcwnQm p � u o "' ( Q u N >FWoo v 3 o Q LL �' W � = wzIF-: � = ❑°Coav 0 o LL X V, > z z Q a Y Q o 0 w OC r, Q =LL O O J I—O (A O w O Q p o O J O Q CC L1J j, — w N LL 0 2 1 > n C 8.a ` M DATE(MMIDD/YWY)� ' "' CERTIFICATE OF LIABILITY INSURANCEF10/v2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI; CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE: BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement or this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER _... NC AM :CT Jenne Jennings uwv World Risk Management, LLC a Member of: Ballator Insurance Group PHONE — FAX --......� - N 20 N. Orange Ave., (p 074452414 � NRI 407 445-2868 ." O E-MAILtL - Suite 500 ,ADM s _lain if>v ennings rml@C.ca _ .. Orlando FL 32801 INSURER(S)AFFORDING COVERAGE NAIC At CL ... _.m. INSURER..Public Risk Management of FL( mmm_ „e— INSURED ISLAMOR-01 Islamorada, Village of Islands INsuRERe: __ CJ 86800 Overseas Highway INSURER C: in Islamorada FL 33036 INSURER 0: in INSURER�: w,.. ...... .......... INSURER F i COVERAGES CERTIFICATE NUMBER:1226736369 REVISION NUMBER:. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD _— INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 4rR $119ftE POLICYEFF POLICYEXP TYPE OFINSURANCE INSR ADOL, POLICY NUMBER MMI pIYYYY MM1 LIMITS YYYY Az; X COMMERCIAL GENERAL LIABILITY PRM020-007-083 I. 10/1/2020 10/1/2021 EACH OCCURRENCE i$2,000.000 /U ,.a OA CLAIMS-MADE ;� OCCUR YISl EMIS�ES( a qrr n��$2 000 000 _ cu MED EXP(AAty one person) $EXCLUDED 0 PERSONAL&ADV INJ URY $2,00000N..."N-0...m.� "_ (n . GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ W ......... POLICY JERO LOC PROOUCTS-OOMPFOP AGG _$ _.....-.w.......m ,..w.....-,� - ,OTHER:. ' ! COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY PRM020-007-083 10/1/2020 10/1/2021 $2,000,000 )( ANY AUTO BODILY INJURY(Per person) $ --,... OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY .,M �_.9 AUTOS ........_. .,., ..X__.HIRED X NON-OWNED PROPERTYDAMAGE $ ......... ._........_..... 0 AUTOS ONLY ... AUTOS ONLY ,..(Per accident) .® X APO APO DEDUCTIBLE $1,000 'UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE; AGGREGATE $ DIED.... RETENTION S A WORKERS COMPENSATION PER O;H- AND EMPLOYERS'LIABILITY Y/N PRM020-007-083 10/112020 10/1/2021 X STATUTE ER ._ .."__.. rU O F daA�IJYPRl ry(nEIE EXCLUDED,X;.i;4J"IVE', ❑ N t A .._E L DISErwSE E.L_EACH IEA E,Mf*LOYEE'�.._$1,000,000 0) NH) $1,000,000 0 yes,describe under :.. ........, -......--..�.._.,�.� .. _ ..__._ DESCRIPTION OF OPERATIONS ueluw E,L DISEASE POLICY LIMIT a 1 00'0,000 L) CIL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) N With respects to the listed coverage held by the named insured,as evidence of insurance. y U O M CERTIFICATE HOLDER CANCELLATION N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 0) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Florida Department Of Health Bureau Of Emergency ACCORDANCE WITH THE POLICY PROVISIONS. U Mngmt. Oversight EMS Section 4052 Bald Cypress Way BIN A22 AUTHORIZED REPRESENTATIVE ¢ Tallahassee FL 32399-1722 ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Packet Pg.404 }' *f Islamorada Village of Islands Fire Rescue 86800 Overseas Highway Islamorada, FL 33036 Ambulance Fee Schedule NOWN Big CL A0428 BLS $600.00 BLS NON RESIDENT $700.00 A0429 BLS EMERGENCY $600.00 CD BLS/E NON RESIDENT $700.00 A0426 ALS1 $647.00 ALS1 NON RESIDENT $747.00 y N A0427 ALS1 EMERGENCY $647.00 ALS1/E NON RESIDENT $747.00 A0433 ALS2 $911.00 ALS2 NON RESIDENT $1011.00 a- A0425 MILEAGE $12.00/I II A0434 SCT $940.00 SCT NON RESIDENT $1040.00 A0999 Extrication $250.00 CL Packet Pg.405 AGREEMENT BETWEEN 0 ISLAMORADA,VILLAGE OF ISLANDS,FLORIDA AND PROFESSIONAL EMERGENCY SERVICES,INC. U FOR MEDICAL DIRECTOR SERVICES This Agreement is between Islamorada, Village of Islands, Florida, a municipal corporation organized and existing under the laws of the State of Florida, its successors and assigns, hereinafter referred to as the"VILLAGE" 0 AND 0 Professional Emergency Services,Inc.(hereinafter referred to as the"CONSULTANT"), whose principal place of business is 10 High Point Road, Tavernier, FL 33070 and who is represented by Dr.Sandra Schwemmer. In order to establish the background,context and form of reference for this Agreement and N to generally express the objectives,and intentions, of the respective parties herein, the following statements,representations and explanations shall be accepted as predicates for the undertakings and commitments included within the provisions which follow and may be relied upon by the patties as essential elements of the mutual considerations upon which this Agreement is based. 'e 0 WHEREAS,the VILLAGE,as a provider of Emergency Medical Services to its citizens, i is required by Chapter 401,Florida Statutes,to contract with a licensed physician to serve as the VILLAGE'S "MEDICAL DIRECTOR", also referred to as the "FIRE DEPARTMENT PHYSICIAN";and WHEREAS,the VILLAGE prepared and advertised a Request for Proposals("RFP 20- 09") for EMS Medical Director Services, a copy of which is attached hereto and incorporated herein by reference;and 0 WHEREAS, the CONSULTANT meets the qualifications necessary to provide Medical Director services to the VILLAGE and the VILLAGE desires to utilize the services of the CONSULTANT;and WHEREAS, on September 17, 2020, the VILLAGE accepted the proposal from y CONSULTANT and authorized the proper VILLAGE officials to enter into an agreement with CONSULTANT to render the services more particularly described herein below. NOW, THEREFORE, in consideration of the mutual terms and conditions, promises, covenants and payments set forth below, the VILLAGE and the CONSULTANT agree as 0 follows: N m I � Packet Pg.406 C 8.a ARTICLE I SCOPE OF SERVICES y 0 1.1 Under the direction of the Fire Chief, and as defined in Florida Administrative z Code. Chapter 64E-2.004,Medical Direction,the CONSULTANT shall perform the services of c, Medical Director for the VILLAGE'S Fire Rescue/Emergency Medical Services Department as more particularly set forth herein. 1.1.1 Under the direction of the Fire Chief; advise, consult, train, and counsel the Village's emergency medical services system,overseeing appropriate quality assurance,but not including administration and managerial functions. 0 1.1.2 Develop medically correct standing orders or protocols that permit specified ALS and BLS procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. 1.1.3 Issue standing orders and protocols to the VILLAGE to ensure that the VILLAGE transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. N 1.1.4 Assist and advise in the development of a comprehensive plan for prompt medical review of all possible infectious exposures reported by Village of islamorada EMS and firefighter personnel and for post-exposure medical follow-up when indicated,in compliance with State and ca Federal requirements. Assist in the training of the individual EMS and firefighters regarding the exposure policy. The Medical Director or designee shall be available for consultations with field i personnel to determine the significance of any bodily fluid exposure and to suggest appropriate action for such an exposure. 1.I.5 Provide continuous 24-hour-per-day, 7-day-per-week medical direction, which shall include in addition to the development of protocols and standing orders, direction to _ VILLAGE personnel as to availability of medical direction "off-line" service to resolve problems, system conflicts, and provide services in an emergency as that term is defined by section 252.34(3)Florida Statutes. 1.1.6 Develop and implement a patient care quality assurance system to assess the c, medical performance of Paramedics and Emergency Medical Technicians("EMTs"). U 1.1.7 Audit the performance of system personnel by use of a quality assurance program Ch to include but not be limited to, a prompt review of nun reports, direct observation, and Ch comparison of performance standards for drugs,equipment,system protocols and procedures. 1.1.8 Participate as appropriate in any other quality assurance program developed by the Department: e 2 i-1.9 Possess a DEA registration, to provide controlled substances to the VILLAGE. N DEA registration shall include the address at which controlled substances are stored. Proof of 2 Packet Pg.407 C.8.a such registration shall be maintained on file with the VILLAGE and shall be readily available for inspection. The Village will forward all renewal documents as received to Medical Director i? to assure continuous registration and will reimburse Medical Director for cost of such registration. 0 1.1.10 Ensure and certify that security procedures for medications,fluids and controlled Z substances are in compliance with Chapters 499 and 893,Florida Statues,and Chapter 64F-12, Florida Administrative Code. CL U 1.1.11 Assist and coordinate with the Fire Chief written operating procedures creating, authorizing and confirming adherence to rules and regulations regarding all Ch b'u aspects of the Ch handling of medications, fluids and controlled substances by the VILLAGE. 1.1.12 Notify the Department of Health in writing,when applicable,of each substitution by the VILLAGE of equipment or medication. 1.1.13 Assume direct responsibility for the use by an EMT of an automatic or semiautomatic defibrillator,the performance of esophageal intubation by an EMT;and on routine inter-facility transports,the monitoring and maintenance of non-medicated IV's by an EMT.The Medical Director shall ensure that the EMT is trained to perform these procedures,shall establish written protocols for the performance of these procedures;and shall provide written evidence to the Department documenting compliance with provisions of this paragraph. N 1.1.14 Review and approve a 30-hour EMT refresher course. 1.1.15 Complete a minimum of ten(10)hours per year of continuing medical education related to prehospital care or teaching or a combination of both. i 1.1.16 Coordinate, approximately four(4) hours per month of in-service education to include classroom teaching and review of EMT and Paramedic performance. ARTICLE.2 METHOD OF PAYMENT 2.1 The VILLAGE agrees to pay the CONSULTANT as full compensation for the services described in Article I a fee of$54,600.00 to be paid to the CONSULTANT in twelve CL equal monthly installments of 54,550.00.The CONSULTANT shall be entitled to a fee increase of five percent(5%)upon renewal of this Agreement and subsequent renewal hereunder if the Agreement is renewed pursuant Article 6. This fee includes all costs and expenses of CONSULTANT. 2.2 The VILLAGE agrees that it will use its best efforts to pay the CONSULTANT within thirty(30)calendar days following the month in which the CONSULTANTS services arc rendered. e N 3 Packet Pg.408 TICLE 3 DEFINITIONS c 2 3.1 "Department"means the Department of Health and Rehabilitative Services. y 0 3.2 "Emergency medical technician" or "EMT"' means a person who is certified by U the department to perform basic life support. U 3.3 "Medical direction"means direct supervision by a physician through a two-way voice communication or, when such voice communication is unavailable, through establishedCh standing orders,pursuant to rules of the department. 3.4 "Medical Director" means a physician who is employed or contracted by a licensee and who provides medical supervision,including appropriate quality assurance but not76 including administrative and managerial functions for daily y operations and training. 3.5 "Paramedic"means a person who is certified by the Department to perform basic W and advanced life support. 3.6 "Physician"means a practitioner who is licensed under the provisions of Chapter 458 or Chapter 459, Florida Statutes. N 3.7 "Fire Department Physician" means a licensed doctor of medicine or osteopathy who has been designated by the fire department to provide professional expert in the areas of occupational safety and health as they relate to emergency services. 3.8 "Fire Chief'means the highest ranking officer in charge of fire rescue services. ARTICLE 4 CONSULTANT OBLIGATIONS 4.1 In accordance with Section 401.265, Florida Statutes, and Rule 64E-2.004, Florida Administrative Code,the Medical Director shall possess and maintain through the term of this Agreement a Florida license to practice medicine and shall maintain board certification in emergency medicine. 4.2 Dr. Sandra Schwemmer, D.O., FACOEP, FACEP of Professional Emergency Services,Inc., is designated as the Medical Director/Fire Department Physician for the Village's y Fire Department.The Medical Director shall designate an Associate Medical Director who shall be available if the Medical Director is on vacation,sick or otherwise unavailable. The Associate Medical Director shall be subject to riot approval b the Village Manager or his designee. J P aPP Y $ g es c 4.3 Through the term of this Agreement, the Medical Director shall possess and maintain current registration as a Medical Director with the U.S. Department of Justice, Drug N 4 Packet Pg.409 C.8.a Enforcement Administration ("DEA"), to provide controlled substances to the VILLAGE. A COPY of the registration shall be provided to the VILLAGE prior to execution of this Agreement. 4.4 CONSULTANT shall maintain active participation in a regional or statewide y physician group involved in prehospital care. e 4.5 The CONSULTANT shall perform such other duties and responsibilities as now CL are imposed or may be imposed during the term of this Agreement by Florida law,including but not limited to the applicable provisions of Chapters 252 and 401,Florida Statutes,and Rule 64E2, Florida Administrative Code,as may be amended from time to time. 4.6 Inter-facility Transfers: CONSULTANT will develop BLS and ALS medical evaluation and treatment protocols and approve operating procedures as related to BLS and ALS inter-facility patient transfers. CONSULTANT will provide training for EMT's related to monitoring BLS and ALS patients during inter-facility transfers.CONSULTANT will develop a patient care quality assurance system for inter-facility patient transfers. CONSULTANT is not responsible and assumes no liability for the choice or appropriateness of the receiving facility. CONSULTANT is not responsible and assumes no liability for the medical treatment provided to patients by physicians and/or other medical personnel at the sending and/or receiving facilities. CONSULTA.T is not responsible and assumes no liability for any complications or negative patient outcome before,during or after the inter-facility transfer. N ARTICLE 5 VILLAGE ORLIGATIONS 5.1 The VILLAGE shall assist the CONSULTANT by placing at its disposal all i available information pertinent to the services to be performed by the CONSULTANT. 5.2 The VILLAGE shall provide for the CONSULTANT'S use during the term of this Agreement, a Medical Director's identification badge, and appropriate administrative support services as approved by the Fire Chief. ARTICLE 6 TERM 6.1 This Agreement shall commence on October 1,2020,and shall continue through September 30, 2025, unless terminated earlier under Article 7. The VILLAGE shall have the option to renew this Agreement for two(2)additional two year terms subject to the same terms and conditions,by providing the CONSULTANT with written notice to renew no less than thirty (30)days from the expiration date. c 2 N 5 Packet Pg.410 ARTICLE 7 TERMINATION c 7.1 If through any cause the CONSULTANT fails to fulfill its obligations under this e Agreement, the VILLAGE shall have the right to immediately terminate this Agreement upon providing written notice to the CONSULTANT. 0. 7.2 This Agreement may be terminated by the VILLAGE without cause upon thirty (30)days written notice to the CONSULTANT. If the VILLAGE terminates without cause,the CONSULTANT shall be compensated for all services performed and approved by the VILLAGE y prior to the termination date,provided that all property belonging to the VILLAGE is returned prior to release of final compensation to the CONSULTANT. 0 7.3 The CONSULTANT acknowledges that the VILLAGE is a bona fide governmental entity of the State of Florida with the VILLAGE'S fiscal year ending on September 30 of each calendar year. If the VILLAGE does not appropriate sufficient funds to purchase the services required under this Agreement for any of the VILLAGE'S fiscal years subsequent to the one in which the Agreement is executed and entered into,then this Agreement shall be terminated effective upon expiration of the fiscal year for which sufficient funds for the services provided for under this Agreement were last appropriated by the VILLAGE. The VILLAGE shall not,in N this event,be obligated to pay for services beyond said fiscal year. W ARTICLE 8 MISCELLANEOUS i 8.1 Ownership of Documents/Deliverables Any files, documents, studies, run reports, — training curriculum and other data prepared by the CONSULTANT in connection with this Agreement arc and shall remain the property of the VILLAGE, and shall be delivered to the VILLAGE no later than seven(7)days after termination of this Agreement.VILLAGE is a public agency subject to Chapter 119, Florida Statutes.To the extent that CONSULTAN.r is acting on behalf of VILLAGE pursuant to Section 119.0701,Florida Statutes,CONSULTANT shall: a. Keep and maintain public records that ordinarily and necessarily would be required to be kept and maintained by VILLAGE were VILLAGE performing the services under this agreement; cJ b.Provide the public with access to such public records on the same terms and conditions that the County would provide the records and at a cost that does not exceed that provided y in Chapter 119,Florida Statutes,or as otherwise provided by law; c. Ensure that public records that are exempt or that are confidential and exempt from public record requirements are not disclosed except as authorized by law;and c d.Meet all requirements for retaining public records and transfer to VILLAGE,at no cost, all public records in possession of the CONSULTANT upon termination of this N 6 Packet Pg.411 C.8.a Agreement and destroy any duplicate public records that are exempt or confidential and exempt.All records stored c=ULTANT y must be provided to the VILLAGE. 8.2 No Contingent Fee. warrants that he/she has not employed or retained any company or person other than a bona ride employee or agent contractor working solely for the CONSULTANT to solicit or ecure this Agreement and that it has not paid or agreed to pay any person,company, corporai ion, individual or firm, other bona fide employee working solely for the CONSULTANT a iy fee, commission, percentage, gift, or other consideration contingent upon or resulting fro the award or making of this Agreement. For the breach or violation of this provision, the 19LLAGE shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover,the full amount of such fee,commissi on,percentage,gift or consideration. 8.3 Poll or Non-Discriminatio The CONSULTANT shall not discriminate against any employee or applicant for emplo ent for work under this Agreement because of race,color,religion,sex,age,marital status o l national origin,physical or mental disability. I 8.4 Lnftendcnt Contractor.The C NSULTANT is an independent contractor under W this Agreement. Personal services pro ided by the CONSULTANT shall be by employees/agents of the CONSULTANT and ubject to supervision by the CONSULTANT,and not as officers,employees,or agents of the V LAGE. Personnel policies, tax responsibilities, y social security and health insurance, employco benefits, purchasing policies and other similar administrative procedures applicable to services rendered under this Agreement shall be those of the CONSULTANT. 8.5 Agg-i ument:Amendments It i 8.5.1 The parties recognize that the services contemplated by the CONSULTANT are of a unique and personal nature and as such t14s Agreement shall not be assigned,transferred or otherwise encumbered, by the CONSULTANT, without the prior written consent of the VILLAGE. 8.5.2 It is further agreed that no renewal modification, amendment or alteration in the terms or conditions of the Agreement,shall be effective unless contained in a written document executed with the same formality as the Agreement. ARTICLE 9 INSURANCE 9.1 The CONSULTANT shall maintain in force and effect for the term of this v, Agreement the insurance described below. 9.1.1 Professional and General Liability.The VILLAGE will provide professional and general liability insurance with minimum limits of $1,000,000.00 per occurrence for the CONSULTANT during the term of this Agreement. The VILLAGE will maintain such professional and gerneral liability insurance for a minimum of three (3)years from die date of termination of this Agreement. N 7 Packet Pg.412 C.8.a 9.1.2 The VILLAGE will provide such coverage to the CONSULTANT within thirty (30)days of the execution by the VILLAGE of this Agreement. The CONSULTANT will be responsible for the payment of any deductible and/or self-insured retentions in the event of a v, claim. 9.1.3 To the fullest extent permitted by law, the CONSULTANT shall indemnify, CL defend and hold harmless the VILLAGE, its officials,agents, employees,and volunteers from and against any and all liability, suits, actions, damages, costs, losses and expenses, including attorneys' fees, demands and claims for personal injury, bodily sickness, diseases or death or y damage or destruction of tangible personal property or loss of use resulting therefrom, arising out of any errors, omissions, misconduct or negligent acts of the CONSULTANT, its officials, agents, employees, volunteers or subcontractors in the performance of the services of the CONSULTANT under this Agreement. 9.1.4 Representative of the VILLAGE. It is recognized that questions in the day-to-day conduct of this Agreement will arise. The VILLAGE designates the Fire Chief or his designee, as the person to whom all communications pertaining to the day-today conduct of this W Agreement shall be addressed 9.1.5 All Prior Agreements Superseded. This document incorporates all negotiations, y correspondence,conversations,agreements or understandings applicable to the matters contained N in this Agreement and the parties agree that there are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Accordingly, it is agreed that no deviation from the terms shall be predicated upon any prior representations or agreements,whether oral or written. i 9.1.6 Notices. Whenever either parry desires to give notice to the other,it must be given by written notice,sent by certified United States mail with return receipt requested addressed to the party for whom it is intended,at the place last specified,and the place for giving of notice in compliance with the provisions of this paragraph. For the present, the parties designate the following as the respective places for giving of notice,to wit: For the VILLAGE: Terry L.Abel,Fire Chief Department of Fire Rescue and Emergency Management Wamomda, Village of Islands CL 86800 Overseas Hwy U islamorada,Florida 33036 Telephone:(305)664-6490 y Facsimile:(305)852-5195 With a copy to: c Roget V. Bryan,Village Attorney Ishunoradn, Village of Islands N 86800 Overseas Hwy 8 � Racket Pg.413 C.8.a Islamorada,Florida 33036 Telephone:(305)664-6418 0 Facsimile: (305)504-8989 2 For the CONSULTANT: e 0 Dr. Sandra Schwemmer U 160 Key i leights Drive CL Tavernier Florida 33070 c, 9.2 Consent to Jurisdiction. The parties irrevocably submit to the jurisdiction of any Florida state or federal court in any action or proceeding arising out of or relating to the U Agreement,and unanimously agree that all claims in respect of such action or proceeding may be heard and determined in such court. Each party further agrees that venue of any action to enforce this Agreement shall be in Monroe County,Florida. 9.3 Govemina p.Law/Attorne 's Fees The parties a Ji agree that this Agreement shall be construed in accordance with and governed by the laws of the State of Florida. If either the W VILLAGE or the CONSULTANT is required to enforce the terms of this Agreement by court proceedings or otherwise, whether or not formal legal action is required, the prevailing party shall be entitled to recover from the other party all such costs and expenses including but not y limited to court costs,and reasonable attorney's fees. �+ 9.4 Headings. Headings are for convenience of reference only-and shall not be considered on any interpretation of this Agreement. 9.5 Exhibits. Each Exhibit referred to in this Agreement forms an essential part of i this Agreement. The Exhibits, if not physically attached, should be treated as part of this Agreement,and are incorporated by reference. 9.6 S cycrability. If any provisions of this Agreement or its application to any person or situation shall to any extent be held invalid or unenforceable,the remainder of this Agreement, _ and the application of such provision to persons or situations other than those,as to which it shall have been invalid or unenforceable shall not be affected, and shall continue in full force and effect,and be enforced to the fullest extent permitted by law. U CL c 2 N 9 Packet Pg.414 C.8.a IN WITNI"ISS W!-Ik;RI:OF, the parties have made arid executed this Agm-€ernew cart til respective slat" under each sian;nattare: The VILLAGE, signing Irk, and through its Village a"wa a r. .ati(hcsrtzc al to cxceute 141,11C by the Villa, �C t€ � y >I r �a 020,and bu its clash atatho t-iz d rcplcsentative. m 0 CL VILLAGE, u Bv: .1 cn ArMaridI' Bassa;tt,Acting V illtagc, iVl�an,a,,a r AT 11,.4YIµ: 0 CJ Date 0 Kee I catla, L'� aw c Clerk � APPROVED AS O FORNt AitilD "`xf,.,..1 l`It.`illvt I o-er V'. Hry an . iliatrc A{tor, c„,. I C'tlN S'EILT;:hNI adai.S; f t ' Nain its rt as y J '�j at r"' r: w htic a U lXatc N Packet Pg.415 C 8.a ISLAMORADA FIRE RESCUE STANDARD OPERATING PROCEDURES Section: 700: EMERGENCY MEDICAL SERVICES Mon Subject: TRAUMA TRANSPORT PROTOCOLS S.O.P. 701.00 Effective: 10/1/99 Revised: 3/1/2021 Page 1 of 13 Y� m Initiated B Dr. Sandra Schwemer C 47P 6 Approved By: Terry Abel, Fire Chief 0 Forms Required: CL I. DISPATCH PROCEDURES Monroe County is unique in the State of Florida, in that it is comprised of a chain of islands stretching one hundred and thirteen miles in length, and connected by only one main highway. Islamorada Fire Rescue (IFR) ALS transport vehicles are located at strategic points throughout the Village of Islamorada, from MM 72 to MM 91.5 and are supplemented by numerous Fire/Rescue vehicles and one reserve ALS transport vehicle which are activated as first responder support for EMS personnel, and for secondary inter-facility transport if needed. 1. Calls are received via an enhanced 911 system (Monroe County Sheriffs Office Central Dispatch Center) located in Marathon, Florida. y N 2. The Dispatcher obtains information from the caller regarding: A. Name of person calling B. Nature of incident C. Type of injury i D. Call back number E. Number of patients F. Location of incident G. Extent and severity of reported injury 3. The Dispatcher selects the EMS response vehicle(s) closest to the location of the incident. The Dispatcher immediately transmits the appropriate alert tone, followed by the command "Rescue (assigned unit), be en route to...", after which the nature, location, and known details of the call are transmitted. This information is transmitted via 450 mHz (UHF) pagers and 800 mHz radios carried by all EMS crewmembers, and all Fire-EMS ou Supervisory personnel. 4. Should all IFR units be actively engaged, the Dispatcher will call the closest G geographically located ALS Fire Rescue unit(s) for"mutual aid". c II. PRE-HOSPITAL REQUIREMENTS FOR TRAUMA CARE--64J-2.002 1. Islamorada Fire Rescue (IFR) shall ensure that upon arrival at the location of an N incident, an EMT or paramedic shall assess the condition of each adult trauma patient using the adult trauma scorecard methodology to determine the transport destination, OE as provided in Rule 64J-2.004, F.A.C., and the transport destination of each pediatric patient by using the pediatric trauma scorecard methodology included in Rule 64J- 2.005, F.A.0 1 Packet Pg.416 C 8.a 2. IFR shall transport, or cause to be transported, every trauma alert patient to a State Approved Trauma Center (SATC) or State Approved Pediatric Trauma Center (SAPTC) nearest to the location of the incident via the most readily available helicopter transport agency. A request for emergency air transport service to respond shall be made by the IFR Incident Commander or on scene Lead Paramedic on duty. If no helicopter agency is available, trauma patients shall be transported to the nearest y medical facility. Pediatric trauma alert patients shall be transported to the nearest Level 1 SATC or SAPTC to the location of the incident. If a SATC or SAPTC further ca from the location of the incident has a special resource(s) that the nearest SATC or SAPTC does not have, such as burn center or hyper baric chamber, which is needed for the immediate condition of the trauma alert patient, the EMS provider may transport y to the SATC/SAPTC having that special resource(s) even if the SATC or SAPTC is not nearest to the incident. 0 3. An Islamorada Fire Rescue Patient Care Report will be completed on every patient as defined in section 64J-1.001(17), F.A.C. by the IFR personnel that were on-scene. This form and a copy of run report will be forwarded to the receiving facility when completed. The field report will accompany every patient transported by air to the SATC/SAPTC. The IFR Patient Care Report will also be completed for all trauma victims found deceased on scene. N 4. IFR will ensure that a pre-hospital "Trauma Alert" is issued upon determining that a trauma patient meets the requirements of Rules 64J-2.004 and 64J-2.005, F.A.C. The words "Trauma Alert" shall be used when notifying the trauma center, or hospital that EMS (or air transport) is enroute with a trauma patient. IFR medical director (Dr. Schwemmer) or the receiving physician at the trauma center (or hospital), are the only people authorized to change the trauma alert status (downgrade). IFR shall provide the receiving trauma center or hospital with information required under subsection 64J1.014(5), F.A.C., and the information listed below at the time the patient is transferred _ to the air medical crew, or the personnel at the receiving trauma center or hospital: A. Time of injury if different from the time of the call; B. Date of injury if different from day of call; C. County of injury; D. County of residence of patient; 0. E. Cause of injury; F. Injury site/type; y G. Trauma alert criteria if met as defined in Rule 64J-2.004 or 64J2.005, F.A.C., and H. Protective devices if motor vehicle crash, bicycle or marine crash. The information listed above shall be documented on the patient care record of the transporting unit that delivered the patient in accordance with the requirements of Rule 64J-1.014, F.A.C. N 5. If the patient does not meet the trauma criteria, the EMT or paramedic can call a "Trauma Alert" if, in his or her judgment, the patient's condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a "TRAUMA ALERT", it shall be 2 Packet Pg.417 C 8.a documented as required in section 64J-1.014, F.A.C. and criteria met shall be noted as "Paramedic judgment based upon...". 6. Air Transport Guidelines: A. If the patient is considered a TRAUMA ALERT patient as outlined in Section III and Section IV and/or y B. Blockage of the Main road or failure of the drawbridges, C. Extrication time greater than fifteen (15) minutes, U D. If ground transportation is not available and is not expected to be available within a reasonable time, E. If a helicopter is needed to gain access to the patient or needed to transport the y patient out of an inaccessible area, F. Possible MCI (mass casualty incident). 0 III. ADULT TRAUMA ALERT CRITERIA-- 64J-2.004, F.A.C. 1. The EMT or paramedic shall assess all adult trauma patients using the following criteria (RED criteria) in the order presented and if any one of the following conditions is identified, the patient shall be considered a Trauma Alert patient: y A. Airway: The patient requires active airway assistance beyond the administration of oxygen or has a respiratory rate of less than 10 or greater than 29 breaths per minute. 1. Drowning or near drowning patients. B. Circulation: The patient lacks a radial pulse or has a blood pressure of less than 90 mmHg or patients age 65 or older with a blood pressure of less than 110 mmHg. C. Disability: The patient exhibits a GCS score of 13 or less or exhibits the presence OF paralysis or there is the suspicion of a spinal cord injury or the loss of sensation. .2 D. Soft Tissue: Patients exhibiting any of the following are considered Trauma Alerts: 1. 2nd or 3rd degree burns to 15 percent or more of the total body surface area; 2. amputation at or above the wrist or ankle; 3. any penetrating injury or GSW to the head, neck, torso or extremity; 4. chest wall instability or deformity (suspected flail chest); 5. crushed, degloved, mangled or pulseless extremity; 6. dislocations of the hip, knee or ankle. Superficial wounds of the torso, head or extremity, where the depth of the wound can be determined, are excluded. E. Longbone Fracture/ Skeletal: The patient reveals signs or symptoms of two or more longbone fracture sites. Long bone fracture sites are defined as the (1) shaft of the y humerus, (2) radius and ulna, (3) shaft of the femur, (4) tibia and fibula. F. Mechanism of Injury: Patients exhibiting any of the following are considered Trauma Alert: 1. Severe facial injury/fractures with potential airway compromise; 2. Electrocution or lightning injury with loss of consciousness or visible signs of injury; c 3. Blunt abdominal trauma or chest trauma in a patient with history of paralysis (paraplegia or quadriplegia); 4. Pregnant patients > 20 weeks with abdominal pain after blunt trauma. 2. Should the patient not be identified as a Trauma Alert using the RED criteria listed in (1) of this section, the trauma patient shall be further assessed using the BLUE criteria listed in this 3 Packet Pg.418 C.8.a section and shall be considered a Trauma Alert patient when a condition is identified from any two of the seven components included in this section: A. Circulation: The patient has renal failure and is on dialysis; B. Disability: The patient has head injury with loss of consciousness, amnesia or new onset of altered mental status; y C. Soft Tissue: The patient has soft tissue loss from either a major de-gloving injury involving muscle and/or nerve, or a major deep flap avulsion greater than 5 inches. D. Long Bone Fracture/Skeletal: The patient has an obvious or suspected single long bone fracture due to MVC, or any patient with an obvious or suspected single long bone fracture on Coumadin or other"high risk" anticoagulants; E. Age: The patient is 55 years of age or older (special consideration should be given to y patients age 65 and older exhibiting minimal signs/symptoms after traumatic injury); F. Mechanism of Injury: Patients exhibiting any of the following criteria: i. The patient has been ejected or thrown from an automobile, motorcycle, golf cart; ii. The patient has been ejected from a horse (with or without loss of consciousness) with suspected anatomical injury; iii. Blunt head, chest, or abdominal trauma in patients on Coumadin or anticoagulants with high risk of bleeding (see attached list, page 12, of Thinners with High Risk of Bleeding); iv. There is a traumatic death in the same passenger compartment of the motor vehicle; v. There is intrusion of more than 12 inches in the roof or occupant side of the motor N vehicle or more than 18 inches intrusion into any site of passenger compartment; vi. Vehicle telemetry data consistent with high risk of injury (vehicle telemetry data, when available, collected at the time of the crash and relayed to dispatch to assist in predicting serious injury); vii. Falls from 10 feet or more; i viii. Pedestrians or bicyclists that are struck, thrown, or run over by motorized vehicles traveling at speeds greater than or equal 20 miles per hour; ix. Motorcycle, golf cart or ATV crash at speeds greater than 20 miles per hour. 3. In the event that none of the conditions are identified using the criteria in (1) or (2) of this section in the assessment of the adult trauma patient, the EMT or paramedic can call a Trauma Alert if, in his or her judgment, the patient's condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a Trauma Alert, it shall be documented as required in accordance with the requirements of Rule 64J-1.014, F.A.C. The results of the U patient assessment shall be recorded and reported in accordance with the requirements of Rule 64-J-1.014, F.A.C. 4. Islamorada Fire Rescue shall provide the trauma center or hospital with information required under subsection 64J-1.014(5), F.A.0 and the information listed below at the time the patient is transferred to the personnel of the receiving trauma center or hospital: A. Time of injury if different from the time of the call; B. Date of injury if different from day of call; C. County of injury; N D. County of residence of patient; E. Cause of injury; F. Injury site/type; G. Trauma alert criteria if met as defined in Rule 64J-2.004 or 64J-2.005, F.A.C. H. Protective devices if motor vehicle crash, bicycle or marine crash. 4 Packet Pg.419 C.8.a The information listed above shall be documented on the patient care record of the transporting unit that delivered the patient in accordance with the requirements of Rule 64J-1.014, F.A.C. c 5. An Islamorada Fire Rescue Patient Care Report will be completed as defined in section 64J — 1.001(18) F.A.C. by the Rescue personnel that were on-scene. Additionally, a hand written y "Patient Care Field Report' containing information pertinent to the patient's identification, patient assessment, and care given will be provided by the EMS ground crew to accompany all Trauma patients transported by Trauma Star. A final ePCR report must then be sent to the CL receiving Trauma Center as soon as completed, or within 24 hours of the incident. A Patient Care Report will also be completed for all "dead on the scene" trauma patients, regardless of whether MFR transports the body. y c N i U CL N 5 Packet Pg.420 C 8.a Islamorada Fire Rescue Adult Trauma Scorecard Methodology The EMT or paramedic shall assess the condition of those injured persons with anatomical and physiological characteristics of a person sixteen (16)years of age or older for the presence of at least one of the following three (3) criteria to determine whether to transport as a Trauma Alert.These four criteria are to be applied in the order listed,and once any one criterion is met that identifies the patient as a Trauma Alert,no further assessment is required to determine the transport destination: y 1. Meets color-coded triage system(see below) 2. Meets local criteria(specify): 3. Patient does not meet the trauma criteria listed,but was transported to a trauma center due to EMT or paramedic judgment(reason for transport must be justified in run report). CL RED BLUE AIRWAY AC FIVE A!RWAY ASS IS FANC E ,. E E ..10 , >29 BPM DR0 N NCB OR NEAR DR0 =NINC. � CIRCULATION CAC:K.OF RADIAL PI.LSE:>-BP.:-90:I'mr'HC1 PATIENTS WITH RENAL FAILURE ON DIALYSIS CJ BP<1 10 IN PATIENT OVER YEAS` DISABILITY Ci:S < 13 or PRESENCE ENC I OP PARALYSIS, S r.C!ON OF HEAD INJURY WITH LOSS OF CONSCIOUSNESS,AMNESIA or SPINAL CORD NJ..fflY: O SS C ENS ATION NEW ALTERED MENTAL STATUS SOFT TISSUE 2"OR 2 DEG'rE Mi RN .O ;�: MORE RE .BSA SOFT TISSUE LOSS 0) AMP! FATION AT OR ABOVE THE WRI;S F or ANKLE U ANY PENETRATING l\ NG lNJlk..CRY.>r C:i,:,ty. PO HEAD,NECK, RRSO; OR EX PR E M FY" DIS LOCATION OF HIP,KNEE OR ANKLE W ;HES F iv'e'ALL:Nu FABILI`Y c'DE OR ITY(PLA:L CHEM T) � U M..(SHED,MANCiLE ,DECiLO VED OR P'1 LSELESS EX FIDEMITY l_C)NG BONE P RAC F1 MIE OF TEVO c;r MORE LO NCi BONES' SINGLE LONG BONE FX SITE DUE TO MVC° FRACTURE/ SINGLE LONG BONE FX IN PT ON COUMADIN or /ANTICOAGULANTS WITH HIGH RISK OF BLEEDING AGE 55 YEARS OR OLDER MECHANISM 01= HEAD PRAi.WA 1 PATIEI FS ON WAR"APHIN(t:C,i.WAD111)or EJECTION FROM AUTOMOBILE,MOTORCYCLE,GOLF CART INJURY ANTIt C.A ri..(CAN FS WiTH HIGH RISK OF CED1 C:i OR HORSE WITH ANATOMICAL INJURY SEVERE FACIAL 1NJgJRY ',AC::iJRES W;rH PO HEN`:AL AIRWAY BLUNT HEAD,CHEST OR ABDOMINAL TRAUMA IN PATIENTS COMPROMISE ON ANTICOAGULANTS WITH HIGH RISK OF BLEEDING ELEC:`',C7t:.. :ION OR LIGHTNIN(.i!NJg..!'Y W;lFH LOSS OF DEATH IN SAME PASSENGER COMPARTMENT INTRUSION INCLUDING ROOF>12 INCHES OCCUPANT SITE; Ca BLIk!N F ABDOMINAL HES r PRAgk WE IN PA !EN r t `H >18 INCHES ANY SITE INTO THE PASSENGER CL HISFO RY OF PA A Y I'S (rA'AP ECdA ),(1 JAD'IC EC.iIAi COMPARTMENT � PREC:iNANCY>20wks tv' !HH ABDOMINAL PAIN AND BLi.!NT VEHICLE TELEMETRY DATA CONSISTENT WITH HIGH RISK OF � TRAi.WA INJURY' y FALL 10 FT or MORE AUTO VS.PEDESTRIAN/BICYCIST THROWN,RUN OVER or WITH IMPACT GREATER THAN 20 MPH MOTORCYCYLE CRASH>20mph_ ?— M ICED =any one(1)-transport as a trauma alert BLUE =any two(2)-transport as a trauma alert 1. Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. tv 2. Crushed,major de-gloving injures,mangled extremity or deep flap avulsion(>5 in.) 3. Excluding superficial wounds in which the depth of the wound can be determined. 4. Long bone fracture sites are defined as the(1)shaft of the humerus,(2)radius and ulna,(3)femur,(4)tibia and fibula. 5. Vehicle Telemetry Data when available will be relayed to dispatch;the data can assist in predicting potential serious injuries from the data collected at the time of the crash. 6 Packet Pg.421 C 8.a IV. PROTOCOL FOR PEDIATRIC TRAUMA 1. Upon arrival at the location of an incident, the EMT or paramedic shall assess the pediatric 00 trauma patient by evaluating the patient's status for each of the following components: Size, Airway, Circulation, Disability, Soft Tissue, Long Bone Fracture/Skeletal, and Mechanism of v, Injury. In assessing the pediatric patient, the criteria for each of the components in (2) and (3) of this section shall be used to determine the transport destination for pediatric trauma patients. 2. The EMT or paramedic shall assess all pediatric trauma patients using the following RED Ou criteria and if any of the following conditions are identified, the patient shall be considered a pediatric Trauma Alert patient: y A. Airway: If the patient requires active airway assistance including manual jaw thrust, continuous suctioning, or use of other adjuncts to assist ventilator efforts, has a respiratory rate of < 20 in an infant less than one year of age, or a respiratory rate of < 10 in children age 1-15 years old. 1. All drowning or near drowning patients. B. Circulation: The patient has a faint or non-palpable carotid or femoral pulse or the patient cc has a systolic blood pressure of less than 50 mmHg. 0) C. Disability: The patient exhibits an altered mental status that includes: drowsiness, lethargy, the inability to follow commands, unresponsiveness to voice, totally unresponsive, or is in a coma or there is the presence of paralysis; or the suspicion of a spinal cord injury; or loss of N sensation. D. Soft Tissue: The patient has a major soft tissue disruption, or major flap avulsion or 211 or 0 31 degree burns to 10 percent or more of the total body surface area or amputation at or above the wrist or ankle, or a major de-gloving injury. The patient exhibits a dislocation of the hip, knee or ankle. i E. If there is any penetrating injury or GSW to the head, neck or torso or extremity (Superficial 2 wounds where the depth of the wound can easily be determined are excluded from this criteria), F. Long Bone Fracture/Skeletal: There is evidence of an open long bone fracture or there are multiple fracture sites or multiple dislocations. Long bone sites are defined as the (1) shaft 76 of the humerus, (2) radius and ulna, (3) shaft of the femur, (4) tibia and fibula. G. Mechanism of Injury: Patients exhibiting any of the following criteria will be Trauma Alerts: i. Electrocution or lightning injury with loss of consciousness or visible signs of injury; ii. Severe facial injury with airway compromise or potential airway compromise; ii. Penetrating injury to the extremity at or above the elbow or knee; iv. Blunt abdominal trauma or chest trauma in patient with history of paralysis (paraplegia or quadriplegia); y v. Blunt head, abdominal, or chest trauma in patient with bleeding disorder or taking anticoagulants (see list page 12); vi. Auto versus pedestrian or bicyclist thrown, run over, or impact resulting from speeds more than 20 mph; vii. Ejection from automobile, ATV, golf cart or horse with visible signs of injury. N 3. Should the pediatric patient not be identified as a Trauma Alert using the RED criteria listed in (2) of this section, the trauma patient shall be further assessed using the BLUE criteria listed in this section and shall be considered a Trauma Alert patient when a condition is identified from any two of the five components included in this section: A. Size: The patient weighs < 22 kilograms (44 pounds). 7 Packet Pg.422 C.8.a B. Circulation: The carotid or femoral pulse is palpable, but the radial or pedal pulses are not palpable or the systolic blood pressure is less than 90 mmHg. C. Disability: The patient exhibits symptoms of amnesia or there is loss of consciousness. D. Soft tissue: The patient sustains a dislocation of the upper extremity, excluding fingers. E. Long Bone Fracture/Skeletal: The patient reveals signs or symptoms of a single closed long bone fracture or dislocation. Long bone fractures do not include isolated wrist or ankle y fractures. F. Mechanism of Injury: Pediatric patients exhibiting any of the following criteria: i. Ejection, partial or complete, from an automobile, ii. Death in the same passenger compartment, iii. Intrusion of more than 12 inches in the roof or occupant side of the motor vehicle or more than 18 inches intrusion into any site of passenger compartment, y iv. Vehicle telemetry data consistent with high risk of injury, v. Fall > 10 feet or 2-3 times the length or height of the child, c 4. In the event that none of the criteria in (2) or (3) of this section are identified in the assessment of the pediatric patient, the EMT or paramedic can call a "Trauma Alert" if, in his or her judgment, the trauma patient's condition warrants such action. Where EMT or paramedic judgment is used as the basis for calling a Trauma Alert, it shall be documented as required in accordance with Rule 64J-1.014, Florida Administrative Code. N i c 2 N 8 Packet Pg.423 C 8.a Islamorada Fire Rescue Pediatric Trauma Scorecard Methodology The EMT or Paramedic shall assess the condition of those injured individuals with anatomical and physical characteristics of a person fifteen (15)years of age or younger for the presence of one or more of the following three(3)criteria to determine the transport destination per 64J- 2.005, Florida Administrative Code, F.A.C.): 1. Meets color-coded triage system(see below); 2. Meets local criteria(specify); y 3. Patient does not meet the trauma criteria listed,but was transported to a trauma center due to EMT or paramedic judgment (reason for transport must be justified in run report). RED BLUE CL SIZE WEIGHT<22 Kg U Al RWAY AC FIVE AIPtv''Y'AY ASSISTANCE' ,E P 'A HE,:: 'ia N ..HILDREN '1Y' Yi' N U D?O WNINC:i OR NEAR D?O WNINC:i CIRCULATION C Ul_ATICJNFAIN or NC PALPABLE PADCC .;A'C,T:D FE1 C; AL Pi. SE or CAROTID or FEMORAL PULSES PALPABLE,BUT THE RADIAL SDP<':0:-1 kH; OR PEDAL PULSE NOT PALPABLE or SBP<90-mmHg DI SABILI-ry ALTE_';ED MEN FAL S FA P�S PRESENCE OP PARALYSIS rr AMNESIA or LOSS OF CONSCIOUSNESS !SP t IC,N OF SPINAL CORD INJ..'Y Ct „OP W SENSATION SOFT MAJOR St :F` �E DIEM�r :ON UPPER EXTREMITY DISLOCATION 0) TISSUE MAJOR AV!� cN of SKIN 2 Jr'Mi !DNS Tt 0 TD A y N ANY P ENE:RA NG INJ..CRY OR CiSW Lo Me HEAD,NECK, TORSO;OR EX`REMI lFy, AMP! TATION AT OR ABOVE THE W!'S F or ANKLE � DISLO CATION OF THE HIP,KNEE OR ANKLE 0) LONG BONE OPEN CC7NCi BONE PRAt ARE`(), Wk�L r C LE PRAC r!ARE SINGLE LONG BONE3FRACTURE SITE'or DISLOCATION FRACTURE/ ».:ES 1 k..!C`r LE D SLO CA.ON Si rES SKELETAL M MECHANISM ELEt.:`', �Ok HON OR LIGHTNING S FIDHIKE t J:`H LOSS OF EJECTION(PARTIAL or COMPLETE)FROM AUTOMOBILE � OF INJURY CONS;t,C, !SNESS OR VISIBLE SIGNS O INJ�.RY 0. DEATH IN SAME PASSENGER COMPARTMENT 0. SEVERE FACIAL:NJ..!RY Wi lFH A:-'tv.AY COMPROMISE INTRUSION INCLUDING ROOF>12 INCHES OCCUPANT SITE; (B PENE`RAT NC:i N-LIRY`C;`HE EX FI'EMI FY A r ABOVE THE >18 INCHES ANY SITE INTO THE PASSENGER COMPARTMENT ECG C; KNEE VEHICLE TELEMETRY DATA CONSISTENT WITH HIGH RISK OF 0) BUki NT ABDOMINAL,,. CHEST PRAi.WA IN PA HEN TW!" rH INJURY' HISTt;'Y OP PA',ALYSIS,(rAI'APLECdA or t?.JAD'IP LE(.'iIA) FALL>10 FT OR 2-3 TIMES THE HEIGHT OF THE CHILD U CL BUki NT HEAD,t,:HES T,ABDOMINAL PRAi.WA IN PT tv !, FH BLEED NCi DISORDER OR ON Col WADIN AN FICOACilk..!CANTS (, W!lFH HIGH RISK K OF BLEEDINC:i Ai TC;L,.;.PLDr,:; ',IAN B t,Y.:;Llt``H';C;WN, '0k..�N CAVE', lFH IV"•.PAt:T C:ii'EATEi'THAN 20 V"•.PH U EJEt:T ON FROM Alk F0,ATV,CK) F CA-`OR HORSE W!:FH SIC:iNS OP INJi.RY 0 �EQ =any one(1)-transport as a trauma alert BLUE =any two(2)-transport as a trauma alert 1. Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. vs 2. Altered mental states include drowsiness,lethargy,inability to follow commands,unresponsiveness to voice,totally unresponsive. 3. Long bone fracture sites are defined as the(1)shaft of the humerus,(2)radius and ulna,(3)femur,(4)tibia and fibula. 4. Long bone fractures do not include isolated wrist or ankle fractures or dislocations. 5. Includes major de-gloving injury. 6. Excluding superficial wounds where the depth of the wound can be determined. 7. Vehicle Telemetry Data,when available,can be relayed to dispatch;the data can assist in predicting potential serious injuries from the data collected at the time of the crash. 8. See list of Anticoagulants with High Risk of Bleeding. 9 Packet Pg.424 C 8.a V. EMERGENCY INTER-FACILITY TRANSFER OF TRAUMA PATIENTS There are no state approved trauma centers in Monroe County. The closest available service for air transport is Monroe County Trauma Star in Marathon, FL and will be used as first call. When 12 Trauma Star is unavailable, back up air transport (Miami Dade Air Rescue or Life Net-Air Methods) may be utilized. Occasionally, when air transport is unavailable, a TRAUMA ALERT ' patient may be transported by ground to a local hospital for stabilization/treatment prior to transport to a SATC or SAPTC. Should air transport be unavailable, TRAUMA ALERT patients identified in the field may be y taken to the nearest local hospital and should be stabilized and transported as expeditiously as possible to the nearest SATC/SAPTC. The initial receiving facility will arrange the most rapid air/ground transportation of the patient to the nearest SATC/SAPTC. IFR may be called upon to assist the local hospital in ground transportation of a trauma patient should expedient air transport not be available, and ground transport is approved by the IFR Operations Chief. Should supplemental personnel, such as medical or nursing staff, respiratory therapy staff, etc. be necessary to assist the EMS crew for optimal patient care during transport, the transferring hospital will coordinate the necessary personnel to accompany the EMS ground transport N personnel. All cases of TRAUMA ALERT patients taken to local Hospitals will be reviewed by W the IFR Medical Director. i VI. TRAUMA TRANSPORT PROTOCOLS MEDICAL DIRECTOR APPROVAL 64J-2.003 These protocols have been submitted by Islamorada Fire Rescue and have the approval of the _ agency Medical Director, Sandra Schwemmer, D.O, FACOEP-D, FACER VII. APPROVED TRAUMA CENTERS AND INITIAL RECEIVING HOSPITALS Approved Trauma Centers and Pediatric Trauma Referral Centers 1. LEVEL 1 - Ryder Trauma Center, University of Miami/Jackson Memorial Hospital Medical Center Adult and pediatric trauma care 2. LEVEL 1 — Kendall Regional Medical Center, adult and pediatric care N 3. LEVEL II — Jackson South Community Hospital 4. LEVEL 1 - Nicklaus Children's Hospital, pediatric trauma only 10 Packet Pg.425 C 8.a Local Critical Access Hospitals-Receiving Facilities 1. Mariner's Hospital, Tavernier, FL 2. Fishermen's Hospital, Marathon, FL 0 VIII. DISTRIBUTION OF TRAUMA TRANSPORT POLICY c, The SATC, SAPTC, and receiving facilities to which Islamorada Fire Rescue initiates trauma transport of TRAUMA ALERT patients have been provided a copy of the criteria which are y used to determine trauma transport destination. CL 0 2 N 11 Packet Pg.426 C 8.a ANTICOAGULANTS 0 High Risk of Bleeding: �+ 0 Trade Names: Generic names: CL Aggrenox(ASA+ dipyridamole) Anagrelide(Agrylin) Agrylin (anagrelide) Apixaban (Eliquis) Brilinta (ticagrelor) Cilostazol(Pletal) Coumadin (warfarin) Clopidogrel (Plavix) Effient (prasugrel) Dabigatran (Pradaxa) t, Eliquis (apixaban) Dipyridamole(Persantine) Jantoven (warfarin) Dipyridamole +ASA(Aggrenox) Plavix(dopidogrel) Edoxaban (Savaysa) Persantine (dipyridamole) Pentoxifylline(Trental) Pletal (cilostazol) Prasugrel (Effient) Pradaxa (dabigatran) Rivaroxaban (Xarelto) W Savaysa (Edoxaban) Ticagrelor(Brilinta) Ticlid (ticlopidine) Ticlopidine (Tidid) Trental entoxif (line (p Y ) Vorapaxar(Zontivity) y Xarelto (rivaroxaban) Warfarin (Coumadin, Jantoven) Zontivity (vorapaxar) '✓ Injectables: Activase(alteplase) Aggrastat(tirofiban) Angiomax(bivalirudin) Argatroban 2 Arixtra(fondaparinux) Fragmin(dalteparin) Heparin Innohep(tinzaparin) Integrilin(eptifibatide) Iprivask(desirudin) Lovenox(enoxaparin) Reopro (abciximab) CL Streptokinase Tenecteplase (TNKase) Urokinase CJ 0 April 2016 2 N 0 0 U 12 Packet Pg.427 C 8.a c 0 U CL TRAUMA TRANSPORT PROTOCOLS MEDICAL DIRECTOR APPROVAL I, Sandra Schwemmer, D.O., Pre-hospital Medical Director for Islamorada Village of Islands Fire Rescue, certify to Islamorada Village of Islands Fire Rescue and the Department of Health, Bureau of Emergency Medical Services that I have reviewed and approve the Trauma Transport Protocols, dated March 1, 2021. y N E4 3/1/2021 Sandra Schwemmer, D.O, FACOEP, FACEP Date FL OS 4022 c 2 N 13 Packet Pg.428 a nss) p9pepeU—uoge3qddiV lemauell pNOdOO V sselD ePeJOwelsi :4u8wq3e44V 0 R N 00 le U tm a m ac IU LUa CL U LU z W W LLa Cn W LU COLL U LL t at k �f O O w uj Q Q � o J a nss) p9pep9U-uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8ua 3 44 c tC co a d aC 0 m Ln a l"I O � � aO+ � O a > a U W E •N a N O W p ._ LL -a O L 6 E dA � co CC a O GJ L w u — i O � O E L .V .a L O � O — s � O }+ W S � a nss) p9pep9U—uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8wg3B44 Ch U a . mLO co co co co ti ti M M M M M J r r r r V N N N � ' oo 00 ti I- O r r r r m 2 O O O' c co U � O U, N _ U OU O coU HCY3 �O (U z, U t +• — L _J ^ Oa) cuW U U O 0 > cn 43 U O O O EL � O (n c W i v to Q R U � O J J to O W O >+ E CO to �` O _cc � O � - I (n Q i to Q > E +. 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L 00LO U a CL N CO W _ d C 4J Qj � Q n O L Q yj cn W LA 0 `� 4J C UJ 0 N ZO' U m G. .a O 'a0 Qj QjQtw q O +' >: Z O p ii OC L � OC 0 CA L N f; m N O 0 O N N �' '0 cc � N .L O E duo Z E aA O E aA d :E Lan- r cf U U Li- _ Q J 0to Q J O Q J V i 0 Ma �j d E O 'a C O O 0 E a, N Q 'L O CL o ° ° o L 0 i O CL 'a O O 4J M .a 'i p M he m O tn tw L = _ L Q� v O N L ACLII II o = t tC tC f� tC E aj E E Lu '� L O O w O O ui t {�j� c C c r Q 0LLI LAQ uQ Q 9-11 a nssi) 43 — em ail IMOILIOU NOdOO V ssBID BIPWO111121sl :4u8wg3e44 c RLO Lall, Ti..r Fe,,."JEL f a m V a t P, Last time Pt,was wen wjosymptoms? �'r!ig' its k EoCT iF�F�T F�'IF x�i I n List be F= N,,,, N "4�%uke p Sb�,s l;ct � T i SPEECH' cnn L Phane You can't teach an oM defy new trkks" Question Patient for: Age, Mouth Ilir II F FTI LS F i :�Z Commands::Closes Eyes, nESTs SPEECH CF�,4.NIAL.NERVES ' 4 ou can't te ach arl aid doe nv°v t:r:eks" Fatial0r Shw Teeth or,Sinile Repeats 5ertraxl:Correctly t ,sual Fields;F,xv Quadrants m U Aphasic( rongorinapp ire a Words) Horizontl aae:Side To Side N 12 c Dra rthria(Slurredu UnobietoS k) LLA1 BS MbtorJ �C i O V ii a CRANIAL NERVES MOTOR: � Fa6al Droop:ShowTeeth or Srvk Arrn Dn a Cloa eyes,Hold Ixetn arins out, V O _.e.-_._.e._._.e._._.e._._.e._.e._._..._._..._._...-._...-._....._ ENormal=Igo Facia I aroap Leg Drift, G Akrnmrrn a l=Ter 5 ided DrnrJp Opens eyes and lifts each leg, telly � Abnorm j I z Akft Sided Droop SEN50RY: LIMES iEa e1o.,r) Arms:!0%e eyes',touch then nch Arm D i ift;C:ose 2yes,Hol d houth aria:s out Legs;;Cloi c eM°es,touchy the n pimr h hlorrmal=NDdift 00ORDI NATl tON: AbnormtaI+te t drifitor unable to move ems::FiN;east we 4bnon'naI+RiO dr-ift or unable tu move Lego Heelto5hh, 5I3DPmrEF2m 1,F-,kaS,,,,Ptvu'i.-,r,vds'LfP;�� &G Ifd o-J'+aI ra'o& ia.PN.'��r-, � y`,.��63Yi9(�.�+�rx�4"?.��'PE.7 '��,.l7l�f�t�l,lh�i3,k�fi.;�;�ll��?�k. .:.C l�z�u��: St 3n� _�1p�,v�d Ear;`�%lro�r�:o�r�ip��;�_E€ul[N`�y�NEr��O=E wr�nl; -F - _ - Comments. 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U) U) z U) CL a. z LU 0 (10 06 6 - .2 L.11f) C4 cli .4 L6 6 r-� o L) 9-14 .......................................... ...... a nss) p9pep9U-uoge3ijddV 1Bm8u8U N3d03 V ss l BPBJ0wBls1 :4u8ua 3 44 LnLn a. 00 Date Cre" Rcicue C- t PaueartN2me 31 p I11 a Time oHnjurr Alechmmismciajur GIES E ANY NE = TU-.UMA ALERT (_only chino e orviej � 3 A Acti e A,1Rv-9rrAr s.Aarco OR Resoir tar;Fats r r�2ci cn L CIRCULAMO No Radial Pul6,€;a FF-,90 0 R 6 110..ri Ps'ter€°o' r6E,.,`I' cn O IRIUTY E9 S<13 PAFALYSIS Srrk,ia�onrf p,na€GcrrdInLI R a L3,;,,;r,t S emsA cn [ o rrprltton-tcr,bo 9tn;,,,"yrisl o nkl L'F Any-FenPtrr-,t#ng Injuro,3the Hc,3 ,Neck sr7ors kT TI rrPerl@ire.I�L<iriael., [oE t,e-nitiesAo ac ,@are,@Or E lbevv; C #';hey= .alir It? crC➢el o�I i'FI-ailChe--fi Crushel %la n lr ,Lc Io,o,tnrPl_Ilse E tror ltkr LONG, ?n l�aore®;®„rg1®cheFractures ED FRACTURES � F'evere�o dal injrm:r "Fr,ct_r m vx,1 olcrtAAir,,%a�. °sramprxdse Q EIoctr0rir.1orerLrhtrlo Irrur' 4,v L ,C o r Is1I"I� tg,nq r1fiftfs - MECHANISM 1 o a EIurtAD s=ori he �0 OF INJURY .riRrr1�.r�atl�rt�i:R JParai��is F��r�klee a��.�ua kl�e a o , Precnao- eeks %�ADD,-jai IandElr-IrtTr,;,rrrna � i C (L ANY T Q,= TRAUMA ALERT lonlY ChoQge o) U. c UIRCU TtO l Radp-Mgvfj'Fe E;;i! Elllureon Di E D11SI ILITY HleticirjllrvyrL v.A rrne;i;;or NekvAlereJklentalStatus i Sof 1 Tlssu e Lc s 111jlar idrUsMdig- lavirc1{crC� Flap vuis!on inch V SIFT Tll F C a Fenctalln,r, rrjrarrto the Exrornlies Di t ItoIt@ElDnwor nop E LONG BONE ing le,LonCCBoneFra3tumi,d etc, C-,or1n,aRnti nlon ntcoagularb � F ACTUR m- AGE 55'Yem CAd L F- M E9edonfromrAutrr-old le,M oto rcycl e r oll aorHorse tuWHead.Che.stcrA DTraumcinPEt€entsonAr.icoa_mulart De2th ira Same Faasser€cer E-orr err-fft MECHANISM Ir€trusicr,inclu#dingHcot5t_`inchasar€Omirant Site or 8ind)e.otAr€`vSit-A.into C OF [INJURY Fassenger€'orrp gment. Falb 20 Fg t A_Itovs P d'esinan.' IC'�dis!.Threvvi.RufiOe`erora'6im'Qti;ct>201'AF k1ctorcv:JG,Golf C;aiit or 7j Crash>20 LIFH Pfob'5vc'mcdvKaarenctmat warrants Surma a#�r Sere ara�v€e�a a ark n�era ra rr,d�d E da cr den R ranited4"judg eon 2 CocAlln2sr"Jpcdo'fv.aJ.m Jmj7?Ap- :Ph-Jq f",ff #".�'%W, -3.u*1 ai�f_v.7:ld�dvar. I L:k.n ,k6r_'6r rn.o'a ilk' ITry�g 91._'g'��gA' !flafi",'ivv� g2''�Y,U'l M"�J J' F.m ."mA "a Mc ft'vi� "' _ R RNA'.' T REPORT 305-585"l 148-`-�XTELAUEI CODE ST. LARY** '1171IT.T l L16117�FJ AI' `T—L®,�L't,-" TL�t �L.� �. � F �l'°� - � F r_ �� 9-15 a nss) 43 — ®D ail 11?mGuGU N3d03 V ss l P1?J0w lsl :4u8ua 3 44 I R Ln 00 ' ' U m Date crew Rescue rL:mt v htit!Rt_ame DOB 111JU ,1 a Tint@ of injury ieckaaisra o jm-t, ` E Q E ® T ALI .I_E T onl �rhoose gne o 3 AIRWAY Act1v's, 1rP�'�,`yAssista!1"�' F�a�lr�ti� ';R I� 2,DI:,rltL��ot '�',n'r°= ® 2 L Rgso1 r�=t r'd`R-,I o a 1 J$e,!'!@ r- F;9 G M fRCULA.PON Cn L DIMBUTY Al.e red l'olentai 'atUS� DR PARAL'r°3IS a Sus,;irianofSpnalCo d r:urrr 2n c cr rdlLeg r e e DLirnsa 10 1BS.A r l lIt all on-ts F'.r,QVP T1P IAl31 o"Adarl0 OFT TI FrE �r�'Penetratinglnll ir0 I:a ad I1 or T rya €< n F n Ir ring1n.LIrwt Ex�rernrie,�trro,tc,ve r; ,�YEIh 'A t� * ;s;I ecff,,'valIins nrilit5t irCAtcrmi IFlaiI C h * rdij r S oft Tis,suPC,isruplio910 1:1,a3°A3AIISbr,OfScr !" In,De-GI,avin;lnjUr�.` i LONG BONE'FXr'P-rrnLoa,E€ono` R kiutll`-31eDk-locatlonyopl=radUr itey d ,` SKELETAL a c Sevem Faoial injrll r•t rnr�€bon a r nt rt ! ,€ ,;� :or r rrli° c roc,,-r.iartrrLlglrtr€tnc nt_t� t ! E CcrVS!bleS11crsjo�linjurI/ i O E I. . D or hesItra,I-1a In oats rt3� Fl X'of Pa vesi�.'F rap c-,giaL�ua�i`i;Ds,e9gi;3;, E$�LIaI��a1 I a OF INJURY F—jocllonfrolri itolrol10 '4al01or ° e,GCI:Cs,, I to c;rre G� En.mr.Hr. Chp- r!or.A DTra=_nnMgFairom:sonAntc.eigUart3 c =a ,I_,tJ 5 Redestrian��BS c d,Is!,Th;ra'Jrrn,Ru90,er it�olioi-pad aS I=�1 FH � 'i A.N' TWO TRAUMA ALERT jonly choose twvo, � 'i SIZE Vie!glit-�9-0V:g EIU CIRCULATION Ra d h,IorFeCaIFrIP-nof Palr,Ve ORSystriicFF<90 El Rf I I IILtT r n s.iac=rLc s€ '°c=rucia€rtan a FTTISSUE GS"f"°or Fen etraringinupyhelo the E llbc rnrKneeEI � LQNG BONE FX FinjeI nr4 Bone Fra ftire511 orLillm-At€cn El SKELETAL R Death in Same Fa�senger4 c;rr aimeni MECHANISM $ Inlrsicn,ire;�u it oYf -1 :inc ie,on OccupantSits cr5 161richesofAn°Sit int= El OFINJURY Faun nger-Co=r admen'. * Fslir 10F EIOR'-LET€mestheheightoftheG h ild ffab owe crrreria are,notrnerarrdpanierprcorrdri won-vas aTaomna alert.Meteceparamed4cjudgmerrtirclAebriefdeac rip dor I`r&ra Fri P,d lu 11^.rrIgni;,-[Jr 1`�xrr�t^�_�t��-��b��r�x�e�'3�v-��n� ,avr�n��.�;��t,a�t�.rs. •.iris =�? :t-s'rm�sa.s��d,�,r��iYa AS e jrV �� rLg r :.- ,.- ;.r_x , r � 6 _ m � Exc,,Yjld'g wxr%JfJr,M"D* ifa_,�4:to-)r F.rE vest ---rbefv-.--m,l' '`,.. L�rng arc;Iecr-rf_{ ^i;°uk3w<-r,+6-=;rxmerwz _wctle ,_,,svor,+a. COXaEP T n :iTtL FL.I�,r-J CiS�T J. VLLLC T 'tT�r_� CE-' LF F P1111;Ct.T a nss) p9pep9U_uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8ua 3 44 LO coLO 00 U a m ac 0 LUa V LU OC Q LUN v�pit � 5} {I; (� }f i All, 19e. 4 1� ��A1� Q �q Q O J 93uenssi) p9pep9U-uoge3ijddV lBmGuGU NDdOD V ssBID BPBJOwBlsl :4u8wq3B44V LO LO a. J4 z 0 o -i cj ro 5 Ln io r� oo cr) o -i:cj:ro:-:t Ln:1,o: r�' OP T 0:0:0 o o o o o o o o o o 0 0 0 0 6 o o 0::6::6::6 0::0:: LLI Q) C tao Q)C 0 vo: 0 : : u Cl. i : o 4� Q) 0 @ 2 U Q) t:)LO 0 < V) 4� Q) < ® u 4� 0 Q) 0 u ro E co cu =3 0 0, -Eb -.OF x 4MI X 0 U u < -0 u 0 0 Q) 4— 06: 0, 0 Ln 0 4� C V) V) -i :(D u 0 i 0 i 0 0 0: v): E::— 0 Q) cu cu - 4-1 io cu u 0 4-1 4Z i 4Z i (10 (10 Q) Q) QJ Ln o U 4� ;(010 0 4- 0 4� OjZjZj V) 0 4-1 4-1 (10 > U x 0: 0: : z E 0 io i a-i Q) 0 > 41 LI) Ln - -a i — CU i—i r- <=3 QOJ 2 E 0 Ln Ln cu 0 0: U 4-1 E Qji Uio: u co cu cu M V) • 41-11 E 0: Q):-0 E w 0 0: 1— El-al 0 X: -0 -t:)LO: =3. =,: : :4-' 'a •'a =3 :(D Q): 0 0 QJ (lj _0 Q) Q) V) — 0: 0: M 0 Lu a o o z "X' 0- 0 0 on > ro cu 0 E v) � — I =3 4-1 4-1 CU 0 Z:Z: 0: Z: :0<:<:< < < < u u as enssl) p943ep9 — oi4eall lBmGuGU N3d03 V ssBID epeaouaelsl 4uauay3e44 LO R Adenosine Triphosphate (Adenocard°) , a wl"a(JP v ACTIONS: Adenosine exerts its effects by decreasing conduction through the AV �4I �„, ro*4*4 a mode.The half-life of Adenocard (Adenosine)is less than 10 seconds.Thus, Y( f� its effects, desired and undesired,are self-limited. E 3 INDICATIONS: Cn {{} �( Adenocard is indicated for paroxysmal supraventriculartachycardia (PSVT), } including that associated with accessory bypass tracts (Wolf-Parkinson- in White Syndrome). o 1f1ts la s #sii 1s'; `` r Adenocard is contraindicated in second-or third degree AV block and sick sinus syndrome(except in patients with a functioning artificial pacemaker) , 7ssrists ss� sl�ssi t ls.s (i sss} sis }� and known hypersensitivity to Adenosine. ( i �} Yp Y s�l�is�1 Ss�s it�sssl�s�'sslS s st\ t �l t V fit ii 7 t r;i�I ki�V i�� j�1+ t WARNINGS: " s(�o4 �s t { Y {j sd � �{ Adenocard may produce a short lasting first, second, or third degree heart block. In extreme cases transient asystole may result.At the time of conversion to normal sinus rhythm,a variety of new rhythms may appear Ott, ' lr' (PVC's PAC's sinus bradycardia sinus tachycardia skipped beats and �, }(? varying degrees of AV block and generally last only a few seconds without Y g g ) g Y Y � t�4 �( intervention. I Rl.:CA U OONSz ....................................................... The effects of Adenosine are antagonized by methylxanthines such as caffeine and theophylline.Thus, larger doses of Adenosine may be required for Adenosine to be effective.Adenosine effects are potentiated by dipyridamole(Persantine).Thus, smaller doses of Adenosine may be effective.Adenosine may produce bronchoconstriction in patients with asthma. ADVERSE REACTIONS AND SIDE EFFECTS: Cardiovascular: Facial flushing, headache,and rarely:sweating, palpitations,chest pain, and hypotension. Respiratory:Shortness of breath,chest pressure,and rarely:hyperventilating, metallic taste,tightness in throat and head pressure. CNS: Light headedness and rarely:dizziness, blurred vision,tingling and numbness in extremities, apprehension. DOSAGE: Adult dosage: 6 mg rapid IVP immediately followed by 20 ml NS flush. Repeat in 2minutes at 12 mg IVP followed by 20 ml NS flush PRN. edlatHc.dosage: 0.1 mg/kg(maximum 6 mg) rapid IVP immediately followed by 5 ml NS flush. Repeat in 2 minutes,at 0.2 mg/kg (maximum 12 mg) rapid IVP followed by 5 ml NS flush PRN. Tirne/Action Profile: Onset: Peak Duration IV: immediate unknown 1-2 minutes 10-1 as nssl) p943 pa — oge3iI IBmGuGNI N3d03 V ssBID BPBJ0wBIs1 :4u8uay3 44 R Albuterol (ProventilCJ Ventolin@) a. , U ' tC a E s u N co ACTIONS: $ c Cn Albuterol is primarily a beta-2 sympathomimetic and as such produces bronchodilation. Because L of its greater specificity for beta-2 adrenergic receptors it produces fewer cardiovascular side ° effects and more prolonged bronchodilation than isoproterenol. INDICATIONS: Albuterol inhaler is indicated for relief of bronchospasm in patients with reversible obstructive airway disease including asthma, and COPD. CONTRAINDICATIONS: I ICA,TIOI S: Albuterol is contraindicated in patients with a history of hypersensitivity. g aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaar Use cautiously in patients with coronary artery disease, hypertension, hyperthyroidism, and diabetes. In adults, do not give Albuterol if heart rate is > 150. Exception: If patient remains in sinus tachycardia and systolic blood pressure remains > 100 Albuterol treatments may be continued.The rationale must be clearly documented.The benefits must outweigh the risks. Administer cautiously to patients on MAO inhibitors or tricyclic anti-depressants. Beta-Blockers and Albuterol will inhibit each other. POSSIBLE V S REACTIONS AND SIDE EFFECTS: Cardiovascular:Tachycardia, hypertension, and angina. CNS: Nervousness, tremor, headache, dizziness, and insomnia. GI: Drying of oropharynx, nausea, and vomiting, unusual taste. Adult: 2.5 mg of Albuterol in 3ml of NS to nebulizer and flow oxygen 8 liters/min. Child: If> 1 year or > 10 kg: 2.5 mg of Albuterol in 3 ml of NS (0.083%) to nebulizer and flow oxygen 6 liters/ min. If< 1 year or < 10 kg: 1.25 mg of Albuterol in 1.5ml of NS (0.083%) to nebulizer and flow oxygen 3 liters/min. (2.5 mg divided in half).Treatment will be delivered over approximately 5 to 15 minutes. Time/Action Profile: Onset Peak Duration Inhaled: 5-15 minutes 60-90 minutes 3-6 hours 10-2 a nss) 43 — oge3ij 1BmGuGU N3d03 V ssBID BPWOLUBIsl :4u8wg3B44 N R Amiodarone (Cordarone) a. ACTIONS: a IN Amiodarone suppresses recurrent VF,prolongs intranodal conduction and refractoriness, negative inotropic effect. E d 3 Cn INDICATIONS: 0 Ventricular Fibrillation Cn 0 Pulseless VT o ` 0 PVC's greater than 12 min with Consult ER Dh—jr-jr-k Ventricular Tach cardias Wide and Narrow with a pulse Y ( ) Y mt ti CO .f. 1 lC `f°l0 5: • Any known allergy • Cardiogenic Shock • Sinus Bradycardia • 2nd and 3rd degree AV blocks REACTIONSPOSSIBLE ADVERSE EFFECTS: None in Ventricular fibrillation. DOSAGE: Adult dosage: Pulseless Arrest: 300 mg IV/IO May repeat with 150 mg IV/ IO With Pulses: Infusion loading dose: 150 mg IV (150 mg in 100cc NS) infused on a macro drip over 10 minsl.5gtts/sec. Pediatric dosage. Pulseless Arrest: 5mg/kg IV/IO may be repeated once. No single dose greater than 300 mg. (15mg/kg max) Time/Action Profile: Onset Peak Duration IV/I0: Unknown Unknown Unknown 10-3 a nssl) p943ep9U_uoge3ijddV IBmGuGU N3d03 V ssBID BPBJ0wB1s1 :4u8uay3 44 co , R W LO Aspirin (Bayer, ° Bufferin°) a. ACTIONS: a Aspirin is an analgesic, anti-inflammatory and anti-pyretic,which also appears to cause an inhibition of synthesis and release of prostaglandins. d Aspirin also blocks formation of thromboxane A- 2. (Thromboxane A - 2 causes platelets to aggregate and arteries to constrict). Reduces overall mortality from acute myocardial infarction. RW INDICATIONS:, Aspirin is indicated in the Acute Coronary Syndrome setting to prevent Me further clotting. CONTRAINDICATIONS: A known allergy to Aspirin (i.e. urticaria, dyspnia, etc.), active GI ulceration or bleeding, hemophilia or other bleeding disorders, during pregnancy, children under 2 years of age. POSSIBLE V S REACTIONS AND SIDE EFFECTS: GI: Nausea, vomiting, heartburn, and stomach pain. OTIC:Tinnitus. Hypersensitivity: Bronchospasm, tightness in chest, angioedema, urticaria, and anaphylaxis. Adult: 324 mg (4) 81mg chewable tablets for Acute Coronary Syndromes Time/Action Profile: Onset Peak Duration (Oral) PO: 5-30 minutes 1-3 hours 3-6 hours 10-4 as nssi) p943 pa — oge3ii IBmGuGU N3d03 V ssBID BPBJ0wB1s1 :4u8ua 3 44 LO Atropine Sulfate as Cardiac Agenta. � J4 ACTIONS: a Atropine is a potent anticholinergic(parasympathetic blocker, parasympatholytic)that reduces vagal tone and thus increases automatically d Sulfate the SA node and increases A-V conduction. Cn �I L - - INDICATIONS: Cn • Sinus Bradycardia accompanied by hemodynamic compromise, (i.e. o hypotension, confusion, frequent PVC's, pale, cold, clammy skin). • In children (< 1 year) bradycardia of less than 60 beats/minute should be treated if symptomatic even if BP is normal. CONTRAINDICATIONS: I ICA,TIOI S: None in emergency situations Too small of a dose (< 0.5 mg) or if pushed too slowly, may initially cause the heart rate to decrease. Antihistamines and antidepressants potentiate Atropine. A maximum dose of 0.04 mg/kg should not be exceeded. For 2nd degree AV block type II and 3rd degree AV block, omit Atropine and go to external pacer. POSSIBLE V S REACTIONS AND SIDE EFFECTS: CNS: Restlessness, agitation, confusion, psychotic reaction, pupil dilation, blurred vision, and headache. Cardiovascular: Increase heart rate, may worsen ischemia or increase area of infarction, ventricular fibrillation, ventricular tachycardia, angina and flushing of skin. GI: Dry mouth and difficulty swallowing. Other: Urinary retention. Can worsen pre-existing glaucoma. Adult: Bradycardia: 0.5-1 mg IV/10, may repeat every 3-5 minutes until improved or total of 2mg is reached. ed'I,tr'iic 0.02 mg/kg IV/10 (minimum dose is 0.1 mg and maximum single dose is 0.5mg child, 1 mg adolescent). May repeat once. Time/Action Profile: Onset Peak Duration IV/10: Unknown Unknown Unknown 10-5 a nssi) p943ep9U—uoge3ijddV IBmGuGU N3d03 V ssBID BPBJ0wB1s1 :4u8uay3 44 LO Atropine Sulfate as Antidote for Poisoning , a. J. ACTIONS: a Atropine is a potent parasympatholytic that binds to acetylcholine receptors thus diminishing the actions of acetylcholine. d Sulfate 3 INDICATIONS: L g�O, L,M Anticholinesterase syndrome poisoning such as; Organophosphate (e.g. Parathion, Malathion, Rid-a-Bug) and Carbamate (Baygon, Sevin and many o common roach & ant sprays). Signs of organophosphate poisoning are: Salivation Lacrimation Urination Defecation GI distress, Emesis,) Miosis (Pinpoint pupils, bradycardia, and excessive sweating. CONTRAINDICATIONS: None when used in the management of severe organophosphate poisoning. It is important that the patient be adequately oxygenated and ventilated prior to using Atropine as it may precipitate ventricular fibrillation in a poorly oxygenated patient. Even after Atropine is administered, the patient may require intubation and aggressive ventilatory support. POSSIBLE V S REACTIONS AND SIDE EFFECTS: Victims of organophosphate poisoning can tolerate large doses (1000 mg) of Atropine. Signs of atropinization are the end point of treatment:flushing, pupil dilation, dry mouth, and tachycardia. Adult: 0.03 mg/kg IV/IO, repeat every 5-10 minutes until atropinization occurs. ed'i,tflc� 0.05 mg/kg (maximum 3 mg) IV/IO, repeat every 5-10 minutes until atropinization occurs. Time/Action Profile: Onset Peak Duration IV/IO: Immediate 2-4 minutes 4-6 hours 10-6 as nssi) p943 pa — oge3ii IMOUIGNI N3d03 V ssBID BPBJ0wBIs1 :4u8uay3 44 LO Calcium Chloride 10% a. ACTIONS: a NW, " ' Calcium chloride increases the force of myocardial contraction; calcium � a may either increase or decrease systemic vascular resistance. In normal hearts, calcium's positive inotropic and vasoconstricting effects produce a Cn CA MUM predictable rise in systemic arterial pressure. j CHLORIDE Cn INDICATIONS: U IMP SP Calcium chloride is indicated during resuscitation for the treatment of f hypocalcaemia and calcium channel blocker toxicity (i.e. Verapamil or Cardizem overdose) and Magnesium Sulfate overdose. It also protects the heart from hyperkalemia as may occur in patients with end-stage renal I , disease. CONTRAINDICATIONS: Cardiopulmonary arrest not associated with calcium channel blocker toxicity, hypocalcaemia, or hyperkalemia. f i� 4� 'a 11tiA�� >t�st � 9 i4tltit �12y s l Calcium chloride should not be administered in the same infusion with Sodium Bicarbonate, since calcium will combine with sodium bicarbonate to form an insoluble precipitate calcium carbonate Calcium chloride should be given with extreme caution, and in reduced dosage, to persons g g Y Y talon digitalis because it increases ventricular irritability and may precipitate digitalis toxicity. POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS: If the heart is beating, rapid administration of calcium can produce slowing of cardiac rate. Adultdosage: For hypotension following administration of calcium channel blockers (i.e. Cardizem, Verapamil): 4mg/kg IV slowly If patient is taking digitalis, 2 mg/kg IV slowly. Repeat every 10 minutes PRN. For calcium channel blocker overdose and hyperkalemia: 8-16 mg/kg IV slowly Asystole/PEA(if on calcium channel blockers) 1gm IVP Time/Action Profile: Onset Peak Duration IV/IO: Immediate Immediate 2-5 hours 10-7 as nssi) p943 pa — oge3iI IBmGuGNI NOdOO V ssBID BPBJOwBIs1 :4u8uay3 44V LO Cyanokit° a. J4 ACTIONS: m a Hydroxocobalamin is an antidote to cyanide. It is marketed as CYANOKITO in the US. It removes cyanide directly from the blood without converting any of the hemoglobin and therefore does not Cn interfere with oxygen transport. It combines with the cyanide to form " cyanocobalamin which is a derivative of vitamin B-12. Both the Hydroxocobalamin and B-12 are harmlessly excreted in urine. `n INDICATIONS:0 Exposed to products of combustion in an enclosed space 0 Soot present in their nose, mouth, or sputum ' Altered mentation Does not meet trauma alert criteria • At least 18 >years old Common Signs & Symptoms include: Symptoms Signs Headache Altered Mental Status Confusion Seizures Dyspnea Mydriasis (dialated pupils) Chest Tightness Tachypnea (early) Bradypnea (late) Nausea Hypertension (early) hypotension (late) Cardiovascular collapse Vomiting CONTRAINDICATIONS: I ICA,TIOI S: None WARNINGS: Do not use the following medications in the same IV line: • Diazepam Propofol Ascorbic acid • Dobutamine Thiopental • Fentanyl Sodium Nitrite • Nitroglycerin Sodium Thiosulfate • Pentobarbital Whole Blood DO NOT RELY ON PULSE OXIMETRY FOR ACCURATE READINGS Please refer to detailed infusion instructions located within the CYANOKIT° itself. or in protocol 3-2. Several multi-dose kits are carried in the Battalion Chiefs vehicle 10-8 as nssi) p943 pa — oge3ii IBmGuGU N3d03 V ssBID BPBJ0wB1s1 :4u8uay3 44 LO Dextrose 50 % and 25 % (d-glucose) a. J4 c� ft ,� ACTIONS: a A monosaccharide, which provides calories for metabolic needs, spare body proteins and loss of d y I electrolytes. Readily excreted by kidneys producing Cn diuresis. Hypertonic solution. p tl{ C Y Cn$4 I I INDICATIONS:ArW o � + Hypoglycemia "11 + • Coma of unknown origin. CONTRAINDICATIONS: DICA,TIOI S: Intracranial or intraspinal hemorrhage (in a patient q with normal BGL). • Blood glucose Level > 60 mg/dl. e� POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS: • Cardiovascular:Thrombosis Sclerosing if given in peripheral vein • Local: Tissue irritation or necrosis if infiltrates. • Others: Acidosis, alkalosis, hyperglycemia, and hypokalemia. Adult: (> 30 kg) 50 ml of a 50% solution; (25 gm) IV/IO. ed'I,tflc� (< 30 kg) 2 ml/kg slow IV/IO of a 25% solution. Newb :rr,,� (< 10 kg or< 1 month of age) 5 ml/kg IV/IO of 10% solution (dilute D50 4:1 with NS). Time/Action Profile: Onset Peak Duration IV/IO: < 1 minute Depends on degree of hypoglycemia 10-9 as enss) p943ep9 — Olean IMOUIOU N3d03 V ssBID epeaouael l 4118LUL,131244V LO Diazepam Hydrochloride (Valium°) a. r , a a d ACTIONS: fn A member of the benzodiazepine family, Diazepam,depresses the limbic system,thalamus,and hypothalamus resulting in calming effects. Diazepam produces a sedative effect and is also a muscle relaxant. in INDICATIONS: o • Status epilepticus, Premedication prior to cardioversion,Agitation due to acute alcohol withdrawal, Drug induced psychosis,Short-term relief of acute anxiety,Cocaine intoxication CONTRAINDICATIONS: • Alcohol Intoxication • Pregnancy(except for seizure control associated with eclampsia) • Neonates Do not mix Diazepam with any other drug, precipitates with almost all medications.When injecting IV administer slowly through the IV tubing as close as possible to the vein insertion. Do not administer into small veins such as those on dorsum of the hand—causes local irritation and possibly venous thrombosis in small veins. PREC;AUMNS, • Pregnancy(except for control of seizures associated with status epilepticus or eclampsia) • Neonates. POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS: • CNS:Confusion, muscular weakness, blurred vision, drowsiness, respiratory depression, respiratory arrest, and slurred speech. • Cardiovascular: Bradycardia,hypotension,and cardiovascular collapse. • G.I.: Nausea,vomiting,abdominal discomfort and hiccups. • Respiratory: Respiratory depression. • Other: Potentiates MAO's, barbiturates,tricyclics and phenothiazines Potentiated by Cimetidine, ETOH and other CNS depressants. DOSAGE: Adult: To be administered in 5 mg increments. Dosing ranges from 5-20 mg IV/IO/IM depending on specific protocol. The IV route should be administered slowly-no faster than 5 mg/min. IM 20 mg maximum dose per injection. IM injections are painful. If IM route used inject deeply into the deltoid for maximum absorption. Pediatric Status epilepticus 0.2 mg/kg IV/IO slowly(max 5mg). Rectal Dose 0.5 mg/kg, may repeat either route x 1 in 5 mins. Time/Action Profile: Onset Peak Duration (Sedation)IV/IO: 1-5 minutes 15-30 minutes 15-60 minutes IM: 15-20 minutes. 5-1.5 hours Unknown Rectal: Unknown 1-2 hours 4-12 hours 10-10 a nss) p9:l3ep9U—uoge3ilddV lBmGuGU N3d03 V ssBID 12PWOU1121sl :4 8ua 3 44 c Diphenhydramine (Benedryl) LO a. DRUG FORMULARY 0 a a Diphen` ydra one Hydrochloride (Be d E d ACTIONS: Diphenhydrarnine is an antihistamine with antis lln r ic:(drying)and sedative side effects.Antihistamines appear to compete with histamine for � cell receptor sites on effector cells,Dilphenhydramme prevents,but does noto reverse histar ione mediated resp ,ns s„particularly histamine effects on the r4s Smooth mine of the bronchial airways,gastrointestinal tract,uterus,and blood vessels, Il'l DICATI'ONSA fAllergy symptoms,anaphylaIdS. ` { Sedation of violent pat' t_ Dystnnic reactions from pher thin ne overdose(Le. HMO, Companne, 7hor`dzine„and Stelazine). ' Diphenhydrami'ne:is not,to be used in newborn or premature infants._ Dipherrhydrarnine is not to be used in patients with acute asthma attack WARNINGS, in infants and Children especially,antrhrstalnunes in averdlow may cause hallucinations,convulsions,or death.As in adults,antihistamines may diminish mental alertness in children. In Voung children,they maV produce excitation.Dip-henhydramine has additive effete with alcohol and other ' depressants tits,sedatives,tranquillizers,etc.).Antihistamines are more likely to cause dizziness,sedation,and hVpcitension in the elderly years,or older)patient ADVERSE REACTIONS AND SIDE EFFECTS' Cars Orowsiness,confusion,insomnia,headache,ver go le fly in the€ldedyl,. d ufar:Pal r ,t ycardra, Fsand hypotension. spina :Thickening of b T sevvtions,Inghtness of the cheA wheeanig,n . wf.Nausea,womitin&diarrhea,dry mouth,and constipation. Dysuna,urinary retention, :S : Ache: 25-so mg iv/ia ae So mC deep ripe. f rnd'kg s ,rfo M('maximum 25 mgli, Tirne/Action ProfiW onset Peak Duration' fr: rapid unknown hones [�r.Srrr,rf.r�, [ 03 h enhydramine Hydrochloride (BenadaM 10-11 a nss) p943ep9U—uoge3ilc1dV IMOUIOU N3d03 V ssBID 1213WOLUBIsl 41,181-UL131244V LO Dopamine Hydrochloride (Intropin°) a. J4 ACTIONS: 0 ,�:, � a „ � Dopamine stimulates dopaminergic beta-adrenergic and alpha-adrenergic receptors of the sympathetic nervous system. It exerts an isotropic effect on C � the myocardium resulting in an increased cardiac output. Dopamine produces �,. less increase in myocardial oxygen consumption than does Isoproterenol and Cn its use is usually not associated with a tachyarrhythmia. Dopamine dilates renal and mesenteric blood vessels at low doses that may not increase heart rate or blood pressure.Therapeutic doses have predominant beta adrener is Cn p p p g� receptor stimulating actions that result in increases in cardiac output without o marked increases in pulmonary occlusive pressure.At high doses, Dopamine has alpha receptor stimulating actions that result in peripheral 4 ``t vasoconstriction and marked increases in pulmonary occlusive pressure. INDICATIONS: To treat shock and correct hemodynamic imbalances, improve perfusion to -- _ vital organs and to increase cardiac output. COB TRAii UC, TiOB S: Dopamine should not be used in patients with pheochromocytoma or hypovolemic shock. <I Do not administer Dopamine in the presence of uncorrected tachydysrhythmias or ventricular fibrillation. Do not add Dopamine to any alkaline diluents solutions since the drug is inactivated in alkaline solution. Patients who have been treated with monoamine oxidase(MAO) inhibitors will require substantially reduced dosage.MAO inhibitors include: furazolidone(Furoxone°), isocarboxazid (Marplan°),pargyline hydrochloride (Eutonyl°),pargyline hydrochloride with methyclothiazide(Eutron°), phenelzine sulfate(Nardil°),procarbazine hydrochloride(Matulane°), tranylcypromine sulfate(Parnate°). POSSIBLE A VERSE REACTIONS AND SIDE EFFECTS: Cardiovascular:Tachycardia,palpitations,angina pain,ectopic beats,and hypotension GI: Nausea and vomiting Local: Necrosis and tissue sloughing with extravasations, use a large vein to reduce this incidence Other: Piloerection,dyspnea and headache. DOSAGE: Adult andPediatric: Pre-mixed bag Begin infusion at 5 mcg/kg/min. and titrate to effect(Maximum dose 20 mcg/kg/min.) Vial(400 mg)To yield a concentration of 1600 mcg/ml mix 400 mg of Dopamine into 250 ml of D5W. Time/Action Profile: Onset Peak Duration 4 minutes 10-15 minutes Continuous with infusion 10-12 a nssi) p943ep9U_uoge3i1ddV IBm8u8U N3d03 V ssBID BPBJ0wB1s1 :4u8wg3B44 N LO R r Duo-Dote"' a (Atropine and Pralidoxime Chloride) a ACTIONS: • Blocks nerve agents effects and relieves airway constriction and secretions in the lungs and gastrointestinal tract. Cn r; Acts to restore normal functions at the nerve ending by removing the nerve agent and reactivating natural function Cn INDICATIONS: Suspected or confirmed nerve agent exposure 9T , CONTRAINDICATIONS: Both medications in the kit should be used with caution (but not withheld) in patients with preexisting cardiac `1° disease, HTN or CVA history. ,4 POSSIBLE V S REACTIONS AND SIDE EFFECTS:Chest pain , exacerbation of angina, Myocardial infarction, Blurred vision , 4 Headache, Drowsiness, Nausea ,Tachycardia , Hypertension, o Hyperventilation �µ DUODOTE TM — Each auto injector contains BOTH: Atropine 2.1 mg and Pralidoxime 600 mg Adult: For Nerve Agent Exposure (SLUDGE symptoms): Up to 3 auto injectors may be used for one patient based on signs (1-2 kits for self treatment— up to 3 for buddy treatment with severe symptoms) iw°edit, ,r ic: DuoDotes TM are not authorized for the use of children under the age of 9 years. 10-13 as nssl) p943 pa — ol4 all lBmGuGU N3d03 V ssBID BIPWOLUBIsl 4LIML13 44 Ln Epinephrine 1:1,000 a V Cn i d co Cn ACTIONS: 0 Epinephrine is a sympathomimetic,which stimulates both alpha and beta-adrenergic receptors causing immediate bronchodilation,increase in heart rate and an increase in the force of cardiac contraction. Subcutaneous dose lasts 5-15 minutes. INDICATIONS: • Asthma • Anaphylaxis • Angioneurotic edema COB TRAIT I ICATi0l S: None in the cardiac arrest situation. Hyperthyroidism, hypertension,cerebral arteriosclerosis in asthma. Caution should be used with Epinephrine administration when the patient is older than 40 years old or has a history of heart disease.The benefit must outweigh the risk. Do not administer Epinephrine if heart rate is> 150. WA R M G F.: Epinephrine is inactivated by alkaline solutions-never mix with Sodium Bicarbonate. Do not mix Isoproterenol and Epinephrine- results in exaggerated response.Action's of catecholamine is depressed by acidosis-attention to ventilation and circulation is essential.Antidepressants potentiate the effects of epinephrine. POSSIBLE ADVERSE REACTIONS AND SIRE EFFECTS: • CNS:Anxiety, headache and cerebral hemorrhage. • Cardiovascular:Tachycardia,ventricular dysrhythmias, hypertension,angina and palpitations. • GI: Nausea and vomiting DOSAGE: Adult: SQ 0.1-0.3 mg (0.3 cc). Repeat every 3-5 minutes(Asthma/Anaphylaxis may repeat once in 15 minutes). Pediat:ici I 0.01 mg/kg up to 0.5 mg. Time/Action Profile: Onset Peak Duration SQ: 6-12 minutes 20 minutes 1-3 hours 10-14 a nss) p9:l3ep9U_uoge3ijddV IMOILIOU NOIJ03 V ssB13 BPBJ0wB1s1 :41,181111431244V 00 ISLAMORADA FIRE RESCUE a DRUG FORMULARY ac IU ' C' ,a Epinephrine 1:10,000 E d 3 a, Epinephrine is a soympathounimetic,which 5tirnulate5 both Alpha and Btu- c ( t receptors s a result of itsmyocardial and cerebral blood flow are increased drain dtaing ventillation and chest compression.Epinephrine increases o 4 systemic vascular resistance hus may enhance defibrilation. Alt Pulseless Arrest kAsystole r Ventriccilw Fibrillation unreqronsive to defibrillation.- r » PEA W1.fiF W IM.Yi Other pediatric indicationv hypotension in,patients with circulatory inability,bra +cardia(before Atropine),. a None in the cardiac arrest SrtUatrcnn- Epinephrine is inactivated by alkaline solutions m never mix with Sodium Bice na .Do not mix isoprt. $and Epinephrine-results in exaUgWed resporae.Actions of catedwiamines are depressed by acidosis -attention to arentil.ation and circulation ciorculation is essential.Antidepressants potentiate the effectsof epineph n r iM. UAR51L 11E&0056=111l�tE C1 .Anxiety,headache and cerebral lhemixthage- CawdiovasctAar.Tachycardia,weatricular dysrhythmias,,hypertension,angina d palpitation& Gb Nausea and vomiting- Adult: (1r10R 0)1 mg(10 ml)W or 10,repeat ever* 35 minutes.Repeat ever -S mmutes.if patient is in SEVERE anaphylaxis with marked hypotension,you may start an fV and adarairi r 3_5 cc of a L10,000 solution W slow over 2 minutes, l edIatrac 0,,01 tt.t rwvl,/kg IV or 40 .Repeat every -5 rnfironessa Pediatric s POST ARRM 0,1i r E min Mix truag of t pn hitca tlt 0nnll NS=Concentration of 1-mcglMl Tmime/AxAiu n A oofity'i :a Diwen Pea& Duie'luun lv/la Rapid 1-2 minutes 20minutrs Epinephrine I10,0010 or sal rya„0, t 10-15 anss) 43 — ®ball IMOILIOU N3cJ03 V ssl laa®ualsl :W8111344 00 ISLAMORADA FIRE RESCUE a DRUG FORMULARY ac IU ' Furosem C' ;a id (Las . E 3 s ca N ro L AMCMIL fn l- A suffonamide derivative teri diur [ic,which inhibits,the reabsorption af o sodium and chlorides in the pr )d al and digital renal tubules as well,as in the Loop Henley.Has a direct dlia-tiring of in;acute pulmonary edema.With IV' administration,onset of verioditating is generally within S-10 minutes,diurmxsis will = usually occur in 20-30 minutes IN lC TH°nthS Pulmonary edema Ant n a.Should be used in pregnancy only when benefits clearly outweigh risks. urosermmide should he protected from lightDehydration and electrolyte imbaiarwe can result excessive dosa, es,Rapid duviresis can Karl to,bypoterision and thromboemboNc episodes. t+ i C :Dizziness,tinnitus,hearing loss,heady ,bI. vision and weakness 6L Anorexia,vomiting and nausea Cardicivascutan Hypotension Othen Pruritus,urttcaria and musde cramping, krl iut° I' double the patient dose up to Amax 100 mg. Carol 'S r 40 mg IV slowly over 2 minutes(l1 systolic blood pressure is >than 100 rrtm .) Tone/Acbon Profile� Onset Pe A Duration iv/10", 5 minutes 30 minutes 2 hours Fu rose u ide (L -SI ) Car. i S uet Do,, 10-16 3 nss) p9pep9U—uoge3ijddV IMOILIOU NDdOD V ssBID 12PBJ0111121sl :41-18111W1244V 00LID ISLAMORADA FIRE RESCUE a DRUG FORMULARY ac IU C' a Cn L , 4TtlON S G M Cn Beta-adirenergic agonistcausing bronchodiatbn and retaxation of smootho mu sides of all airways mat has a duration of up to 8 ha urs,. m&l."(111 il`ItihmiliBMi i�m'nliinSlllmil'infl-1 oiiiil't5fi1f$iii Hypersensitivity u,Xopenex or r nic a i, Sho uld be discontinued rf OT prolongadon,:ST segment depression, -paradoxical bronchospasm or hypersensitivity reaction occurs,such as urticaria.,angicedema, rash or ar, edema. eft Headache,Nefvousness,Seizure.,Weakness,Syncope,Tremors drdiovaa-- acid ' Taaarh,"rdiaa,CNftt pain, 'PAIp onse HyfAA errua, Hy r_ t� DOSAGE 4 Y" rte Ffik �4 d uttL (>I2 yew of age)0.63(3m,0 m. g via newszer erfi"At n."' (6-11 years cf age)0,31 (3 ll)ing via nebulizer Chi: -the age of 12 may reveive 1-25 mg,via neibulizer for&evere asthma that has not responded to the initial dosage of 0-63 Dr. S D , 10-17 anss) 43 — ®Dail I ssl Pa®ualsl 4GIuay344 t• 00 ISLAMORADA FIDE RESCUE a ac IU ' C' DRUG FORMULARY ;a Magnesium, Sulfate n Magnesium pnevents or controls convul0ons by blocking neuromuscutar transrisission and decreasing amount of acetVichallme liberated at the mate by the motor c nerve irn urn it said to have a depressant effect an the central nervous in a system,but it does not affect the mother,fetus or neonate when used as dit ected in edlaffpsta and psis magnesium acts peripherally to produce va"latation therefore a drop in sysixillic BP is to be anticipated. Prevention and controll of `tares in edampsia Ted es de poinites f Suspected by lie, c akohofsm and.dwork use of diuretics) w Refractory ventriciiiiairfibrillation Refractory Asthma Qd J 2- Parenterall administration of the drug is contraindicated in patients with heart.Mock or myocardial damage,, Intravenous use of Magnesium Sulfate Should run be given to s towernia of pregnancywith imminent detivery,magnesium suffate injection usp,5 must he lwa Riifril td' diluted to a concentration of 2 or less Furor to IV infusion far 9„ aaa, because magnesium is remmed from the body soWy by the ludoWs,the drug should be used rixfi caution in patients with r Monitoring the p . ntss din", status is essential to avoid the,consequences of overdose in a- sia calcium chloride should be antwedimely available to counw.act the paterrhalhazards of,magnesium intoxication in eclat a Signs ofivepennaCresium include resp at depressionj absence of patefiar reflex,etc, ' ialit ... �i ati itrs ! ie i€ rrcT , Adverse effete of Magnesium Sulfate N are us; May the result of miagriesium intoxication. signs of hypennagnesenna include sweating,hypotansion,depression of reflexes,flaccid paralysis,,hypothe.nnia,and circWatory collapse,depression of cardiac function central nefvow system depression,These symptoms can precede fatal parattym DOSAGE �nuit Fnr edarnbc S&W=a Cm in 20 cc IV over 2 mimfies. For Tqrsocles,do and r tt. 'ice t- gm�mixed i n- 50 rrd of Ns and a4mirettered oar 1- minutes)Wowed by a maintenance infion It, in 250 ml of NS administered at 60 gttslmkn,l, Ti Ad,fis n Pnt Vie` oftset Posh Dumb n Pit Dop: immediate Unknown 30 minutes Magnesium Sulfite Cyr.,SartWa,&-ftwainver,0 . 10-18 a nssl) 43 — ®D ail IBm8u8U N3d03 V ssBID BPBJ0wBIsI :4u8ua 3 44 00 00Ln IS IAA FIFE RESCUE a D:RUV FORMULARY ac IU a Methylpreduisolone (Selo o1 , A Methapred) Cn Cn E Decreases inflarnmatory effects, via its potent a i n arrrmatory o synthetic steroild.. Asthma ' . Ainaph faxes Head injury OP Unconscious with known Addison"s disease wn u� None in the emergency setting III P SSW LE ADVtR5,t REACT10 '4s ANL)SI'M LMCISr , ( I hemorrhage,reduces Ie k rtrines of immune stls err n and increases potenbal for infections. SAGE, AdWv 125 mg IV slow over 2 minutes Pe Pk7k�Hr�[ 2 r (max 125 rig)FV slew over 2 minutes Tirrne/Ac-Hon Profile., Onset beak Durahon W/1 Unkn w n Unknown Unknown et,h 1predini olone Solu- dr l ethapr +d Dr.samva s 10-19 a nss) 43 — oge3ij 110mOLIOU N3dO3 V ssl013 10P10JI0111101sl41JI81111431044V ' 00 IS IAA FIRE RESCUE a DRUG FORMULARY ac IU ' C' a Morphine Sulfate E u � i tlrtmh4utu�„xu t� a` Cn "". L Cn pp�� L 1 r�a�mW`wi1 Morphine is a narcotic anakgesic„which whic-h depresses the centra4 nervous and respirattirtt sWern and sensitivity to pain,Morphme,also increases venous capacitance,decreases venous return and pfoduces min[ peripheral ilatatrnri.. 1 1111,;wiC.-AtTI'i:iN • Bain • Bain a:sseciatedw,Oiwiamdextre.mftyfrafctum renai curlic,tauarns Cifti TRAj 0ijC 'iii.,if , ,�.... Voh a depletion CfL hypotension • head trau ., Acute asthma • Knownhypersensit~oMS „2111 1 Morphine is detoxified by the fiver.It is potentiated by sprats antihistamines,barbiturates„sedatives and beta mock CND.Euphoria,drowsiness,pupiftary constricW. n and re*iratory arrest:., Cardiovascular-Bradycardia and hypot:ension- Gh Decreases gastric motility,nausea and vomiting;. U Urinaryreternom ae ira Cory rz�n Fen rrs'�ri,cti ry and decroase cough reflex- DOSAGE: Adulln 2 mg increments iV slowly.Repeat every 5 minutes until desired response is achieved (maxwnuurri dose 10 m l.,Cairn be givers I , Ci-1 rnC/kg Ili slowly.May repeat the initial dose X1 in -5 minutes, 1nf it 0.05 milt IV slowly.May repeat the initial',dose X1 in d-S nninurrtes, T�me/Action,RTofde On se-t Peak Duration i' a Rapid 20 minutes 4-5 hour M rplh�ine sulfate S Dr. ,c,0, 10-20 a nss) p943ep9U—uoge3ilcIdV lBmGuGU N3d03 V ssBID BIPWOLUBIsl :4u8wLI3BW 00 Ln Naloxone Hydrochloride (Narcan®) a IU C' l S } t E Cn L N L ACTIONS: Naloxone antagonizes the effects of opiates by competing at the same receptor sites.When given IV,the action is apparent within two minutes. IM or SC administration is slightly slower. INDICATIONS: •Naloxone is indicated for the complete or partial reversal of central nervous and respiratory system depression secondary to opiate narcotics or related drugs such as, but not limited to: *Heroin, Meperidine(Demerol), Codeine, Morphine, Methadone, Lomotil, Hydromorphone(Dilaudid), Pentazocine (Talwin), Propoxyphene(Darvon), Percodan, Fentanyl (Sublimaze) (Known on the street as"White China") CONTRAINDICATIONS: Known hypersensitivity to Narcan. WARNINGS: Naloxone should be administered cautiously to persons including newborns of mothers who are known or suspected to be physically dependent on opiates it may precipitate an acute abstinence syndrome. If patient is intubated and airway is controlled do not administer Narcan (excludes cardiac arrest). May need to repeat Naloxone since duration of action of some narcotics may exceed that of Naloxone. Naloxone is not effective against a respiratory depression due to non- opiate drugs. Use caution during administration as patient may become violent as level of consciousness increases. POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS: CNS:Tremor, agitation,belligerence, pupillary dilation,seizures, increased tear production,sweating and seizures secondary to withdrawal. Cardiovascular: Hypertension,hypotension,ventricular tachycardia,pulmonary edema and ventricular fibrillation. GI: Nausea and vomiting. DOSAGE: Adult: An initial dose of 2 mg may be administered IV/IN/IO/IM (outer thigh) PRN. If no response after 8 mg,then condition may not be due to narcotic. (Fentanyl overdose may require larger doses of Naloxone to reverse effects). Pediatric 0.1 mg/kg IV/IO/IM/IN PRN. Time/Action Profile: Onset Peak Duration IV/IN/IO: 1-2 minutes unknown 45 minutes IM: 2-5 minutes unknown >45 minutes Naloxone Hydrochloride (Narcan°) 10-21 anss) p9l3ep9U—ucige3ilddV IMOIJOU NOdOO V ssBID BPBJOwBlsl :4u8uay344 Roo 00 ISLAMORADA FIFE RESCUE a DRUG FORMULARY m ac 0 M ;a Nitroglycerin (Nitrosuw@ MtrolhAgual@ Spray) Cn d 3 u AC TONS,, Nitroglycerin is a direct vasod4lator,which acts principally on the VenoUs o system although it a1w produces diet coronary arteryvasoclifaution as Cn L well_There is a decrease in venous return,which decreases the workload o n the hart and thus,decreases myocardial n demand..Subfingual nhroglycerin is rapidly absorbed,. pairs relief occurs within one to two minutes and therapeutic effects can last up to 30 minutes. f rA M'C AM NS MChestpain or discomfort associated with suspected AML Pulmonary edernHa with hypertension. (ONT °Systolic BP<100 mmHg Children under 1 Patients can erectile dysfunction drugs that falls within time parameters(i.e.,<36 hours) Know hypersensitivity to the drug Evidence of a positive V4R in the setting of an inferior mall I PR CAU IOIIIlS. Nitroglycerin tablets are.inactivated by light, heat, air and isrure Must be kept in amber glass containers with tight-fitting lids. Do not leave cotton in container,Once opened,nitroglycerin has a shelf life of 3 months.Do not shah Nitr lien ual spray:.Alcohol will accentuate venodflaning and hypcatensina effects.., „ ,, Chl5.Headache,dizziness,flushing,nausea and vomiting. Cardiovascular: HypotensJon,reflex to cardi „and bind rdia_ SAG E: dKulny 0.4 m (f tablet or I spray sublingual)-May repeat an - ',minutes lip ' Time/ ctican Prolilea, Onset Peak Cured= SL t._ ,minutes unknown minutes Nitroglycerin (NitrostatV Nitrolir goal Spray) or,sanV3 smwffrffw,D.0, 10-22 93uenssi) p943ep9U—uoge3iIddV IMOLAOU N3d03 V ssBID BIPWOLUBIsl :4u8wq31?44v 04 00 00 Ln IS,LAMORADA FIRE RESCUE a. DRUG FOB MULMY J4 a. Nitrous Oidde (Nitronoy.,NO) E Cn ACTION�S: C Decreases GNS,perception of pain tias a potent analgesic effect M Cn M DICAO ION S� Pain management for trauma or medical emergencies 1E.- renal calculus,ABLE pain, bums without respiratory involvement-extremity injuries where shock I hypotens- ion are rout problems- Hypotensive AM L.01UMS a W,DI ISI.,Al L-1 H Any altered LOC such as ETOH or drug abuse COPID CHF Suspected head Injury,facial or chest trauma low Any fbmr of shock or hypotension except AMI AM w NEVER in DIVE Emergencies Patients should receive oxygen at 4 [pin fGr 110 minutes alfter discontinuance of Nitrous Oxide POSSMLE ADVERSE REACTIONS AND SIDE EFFECTS: Sedation,nausea & vGmiting, ap-nea, drowsiness DOSAGE: Adlu',W Self administered by the patient face mask, blended mixture with 50%Nitrous Ide and 50%Oxygen. Tjnvaj1At,,,fli,on Pwfile� On se I pckak Du ratiown Setf Administered Rapid 2-3 minutes Short'acting, Nitroglycerin (NI'trostatlD NitrolinguaI110 Spray) Dr,Samn Smwmu*r,D. , 10-23 93uenssi) p9:la ep9U—uoge3ijddV 1Bm8u8U NDdOD V ssBID BPBJ0wB1s1 :4u8wq3B44V 00 00 Ln ISLAMORADA FIRE RESCUE a. DRUG FORMULARY ac IU a. Oral Glucose i(Insta Glucose)i E Cn C oil Gi ACI'101`45� Increas,--s blood glUCOSe Je_VelS StOWN,_ 2LL Lf-d1ij 1r,WIV. IDS>60 mgdl,patients who are altered but alert enough to take the command to swaflow, CQNTRAINNCATIQNS,� Patients unable to swallow or Stroke Wmiptams- None when patient can swa How,risk of aspiration,if given Improperly, ADVERSE REACTIONS ATA D SIDE EFFECTS- Gk Nausea DOSAGEt AdWv I tube P,�-J�at",i C, 1,tube 'rune,jAmon,'Praffieq rmet PeA Duratian P,O,: lommum unknown Qnknown 0-ral Glucose (In sta Glucose) 10-24 a nssl) p9l3ep9U—uoi4e3iIddV IMOLA811 NDdOD V ssBID BPBJ0wBIsl :4u8ua 3 44 Ln R ' 00 00 ISLAMORADA FIDE RESCUE a DRUG FORMULARY ac IU ' C' a Sodium i bona d 3 s u Cn c r Increases PH to reverse acidases. in r f ii Metabolic acidosis in cardiac arrest . Tricydic.overdoses with 5:> -1 W Flectr cutbris Hypertalernia Methanol I Ethylene glycol toxicity . Severe ketoacidoses CONE li=lill:ATI Ix& a�� HF and Alkaloticstates Fr�ii+ Excessive therapy inhibits oxygen release,,reduces the ability to, defibrillate,may precipitate other medications and administration should be guided biciod gases. Do not give concurrently any other medication,flush the line before and after administration. SSIBLf ADVERSE ,C h ,abolic alkalosis,and may crystallize in N'sulutions,. D5W Add t 1 E g IV push,then 'the dose 10 miins. Electrocutions E 'IVP uatl it; 1-2 rnEq/kg diluted 5 . 0 with Normal Saline Time,/ cti rn Profile. Onset Peak Duration IV/10- Unknown Unknown Unknown Sodium Bicarbonate 10-25 a nss) 43 — ®I4 all lBmGuGU N3d03 V ssBID BIPWOLUBIsl :4u8ua 3 44 Ln LO R00 00 ISLAMORADA FIFE RESCUE a DRUG FORMULARY ac IU C' a Versed of E d FY Cn L Dresses CNS,muscle relaxant,strong sedative,h pn tit,and o amnesia, Cn �r L INDI ATiONS: Control of seizures,sedation forcardiaversion&pacing,and sedation for-airway management, i Respiratory depression ` Hypwol.en n ET0F ; lil and drugs PP: � t. �s',;1r `!.` Monitor patient for respiratory and CNS depression.and vital signs after adrniri Lion_ POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS: 5 Retrograde arnnesia,,altered mental status and dizziness, Cardiovascular. Bradycardia,hypotension, P 's,I ch caul and nodal rhythms: 1:nausea and vomiting,hiccoughs and coughing Respiratory: spiratory depression,lalryngosl and bronchospasm 2.5-5 mg basedl on,patient's ei t up to 10 mg wmax i I years of age(0-1 g to Not AdministrE to pediatric Iess than 1 year of age 1'iinmFeys ttion Profile: Onset Peal: Duration IV 1-2 minutes, -5 minutes Weight dependent id lam (Ver Dr,Samva S 10-26 / uensm} p9pepeU-uoge3qddiV lemauell pNOdOO V sselD ep Owelsi :4u8wq3e44V « \ 00to \ \ LO < to\ \a: \ �\ a. 2 j0 (l a) a nss ) j - - -6 04 L -L - LOW3111POD V ssBID NodOo BPBJOwBlsl :4u8ua ° 44 s3 co U �+ a d ';tC a cd p zn N f:4 O z 0 z 0 N U � N `'0 a O N N * N z cd +, co O O a •� ,O c) U U NU � c •� N � O z c NZ (~ ED � � O W o o Z) Cl) bn u U Cl) C aQ � � � vicd q f:4 o `tip ° ° d � °' � '� � � � M � Z, � O U 0 0 N Cl) 00 cd ° z W Z o t2 y * U 9 O Cl) Wz co o � o � . - �, � odd GJ a coZ)� ri, z Cd o o o W a C) cd o W ej z p _ U cd z o co � � � N z bpi W �D U o o co U p LO U Oj N CO � U 'd �, O W O p p '� N cd Q W W coW U W N N - O ) � E_ 0 d '—' Cd U C.8.c TiQge of IsCands �� py e,paCElY7ePEt or 1[e; C5CUe � AGE QF Otyiiceofthe FIRE CHIEF 0 N 0 July 26, 2021 L) CL Steven Hudson Monroe County Fire Chief y 490 63rd St. Marathon, FL 33050 0 Re: APPLICATION RENEWAL FOR CERTIFICATE OF PUBLIC CONVENIENCE CD AND NECESSITY Dear Chief Hudson: Please find enclosed the application for renewal of the Certificate of Public Convenience y and Necessity for the delivery of Emergency Medical Service for Islamorada, Village of Islands. The insurance coverage expires October 1, 2021 and will be renewed prior to that date. We will then furnish you with the updated certificate of insurance. Islamorada, Village of Islands respectfully requests this item be put before the Monroe County Board of County Commissioners' agenda for the August 18, 2021 meeting. If you have any questions or need additional information, please contact me at your earliest convenience. Thank you! ISLAMO DA IRE RESCUE CL lap Terry L Abel Fire Chief N 96800 OV,RSEAs FiIGMAt OOP- SLA.M0ra,%DA F,OPIDA 33036 FET E a 305-664-6490 FAX-305-852-5195 E FA IL.fu-in x ill rl�,�r a fs Packet',Pg. 588