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Item C04
C4 BOARD OF COUNTY COMMISSIONERS COUNTY of MONROE Mayor Craig Cates,District 1 The Florida Keys Mayor Pro Tern Holly Merrill Raschein,District 5 Michelle Lincoln,District 2 James K.Scholl,District 3 m' David Rice,District 4 Board of County Commissioners Meeting September 20, 2023 Agenda Item Number: C4 2023-1367 BULK ITEM: Yes DEPARTMENT: Fire Rescue TIME APPROXIMATE: STAFF CONTACT: James K. Callahan, Fire Chief AGENDA ITEM WORDING: 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, 2023 through September 30, 2025. ITEM BACKGROUND: In September of 2021, 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, 2023. In view of the foregoing, Islamorada is applying to renew this COPCN for the period October 1, 2023 through September 30, 2025. 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. 8/18/21: MCBOCC approved(C8)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, 2021 through September 30, 2023. 131 CONTRACT/AGREEMENT CHANGES: STAFF RECOMMENDATION: Approval. DOCUMENTATION: Islamorada Class A COPCN 10.01.2023 to 09.30.2025.pdf Islamorada Village of Islands Fire Rescue Class A COPCN Application 2023—Redacted.pdf FINANCIAL IMPACT: Effective Date: 10/01/23 Expiration Date: 09/30/25 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 132 M M ^ c 0 U) NU Cd° N ° N Q p) O N a x O a 0 N Z N �' ) Cd 4 U) N N N — O Ocd U U � o N O N co N H U V! O U N ,(•U cd b Z O Cd Q cd O Uco N W Z U � � o a o a� • d uLO � O W U a ° ° ° °o' o Cl) °° cd O o ° o d WZ o Z, '� � °' � 0 o � a, , co CL) Az Q,U Cl) Q U o C) N N co QL) Cd QL) , a) � � U WEy U - I N ° N ") UM ° cdQ, cdCd ��, & p O cd 1 M p 1.4 N � � c U � .� co U "� N O W ) co � '� x a' N v o o a? b Cd d 00 N p � U � pj N O U '� �, WO W N N U N _ N �. U O 41 N �" Cd (n W *, *' +� co ` N O N H U �i U U p N C O C) Cd W � W � WUW � � � 40 � � � � U W QL) o co 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 IF RENEWAL,PLEASE LIST NUMBER OF PREVIOUS CERTIFICATE: # 21-05 1. NAME OF SERVICE lslamorada Village of Islands Fire Rescue BUSINESS MAILING ADDRESS . ..„mm86800 Overseas Hwy.,, I11 1„lo 1, Islarztoradga 1_I�, 33036 BUSINESS PHONE NUMBER 305-664-6490 EMERGENCY PHONE NUMBER 305-289-2351 2. TYPE OF OWNERSHIP(i.e.Sole Proprietor,Partnership,Corporation, DATE OF INCORPORATION OR FORMATION OF THE BUSINESS ASSOCIATION December 31 1997 3. LIST ALL OFFICERS,DIRECTORS,AND SHAREHOLDERS(use separate sheet if necessary): wwwww NAMEmIT mm w.AGE r ADDRESS TELEPHONE# POSITION/TITLE Buddy Pinder 86800 Overseas Hwy Islamorada, FL 33036 305-664-6400 Mayor Sharon Mahoney 86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Vice Ma or Mar„Gregg � 86800 Overseas Hwy, Islamorada, 305-664-6400 Council Member FL 33036 e Henry Rosenthal 86800 Overseas Hwy, Islamorada, FL 33036 305-664-6400 Council Member Elizabeth John 86800 Overseas Hw , Islamorada, FL 33036 305-664-6400 Council Member —wwww .... .. .....�.................................................................................... .......�....................._...................... .........................................................a.................................., 4. LEVEL OF CARE TO BE PROVIDED: ❑ BLS or ® ALS IF ALS: ®TRANSPORT or ❑ NON TRANSPORT 5. DESCRIBE THE ZONE(S)THAT YOUR SERVICE DESIRES TO SERVE. (Use separate sheet if necessary.) From the West mend_olmllro C 17arimcl 1 wvo l r dga (a)1 i,,e altl t .15 na�)c 4 ak 1. 2 ,m1c tl�J "hest crid of the 1 avergier� U� r k E raelge, aOr rta dl� a lywal�ile crlaarket-99. l), wrtclu rrg,t,11e entire isla:iid of Plantation Key, W racjgy ey, 1pla r Matecumbe Key, Lower Matecumbe Keyand Teatablg Ke and all land filled in between the islands all connected b y Y U.S. One,Overseas Hi hwa all of the above within Islamorada Villa e of Islands, Florida. ZONE 3 �eeee _,eee�.eem ee ...eeeee .... _ g _.r. ( e . 6. LIST THE ADDRESS AND/OR DESCRIBE THE LOCATION OF YOUR BASE STATION AND ALL SUB-STATIONS. (Use separate sheet if necessary.) BASE STATION Islamorada Fire Re,sc_ue Station U.S.O......n.....e......&..........M........M...........8....6........8.................8....6.....8....0.....0.......O.......v.....e....seaw jj)r t-1,.3.:....t...._-.. SUB-STATION Islamorada Fire Rescue Station 20 U.S.,...One...&....M„M....8..1.5 8..1..8„5,0O,verseas Hwy sslamoradaFL,33036,,,,,, Islamorada Fire Rescue Station 19 U.S.One&MMa74� 74070 Overseas Hwv;.Islamorada, FL 33036 Page 1 of 7 134 7. DESCRIBE YOUR COMMUNICATION SYSTEM (Attach copy of all FCC licenses): FREQPENCIES CALL NUMBERS #OF MOBILES #OF PORTABLES ................ ... .... .... Monroe County Public Safety Communications System 800 mhz radio_�y agLng sy tern 12 50 p_ _s._ .............. ........... 8. LIST THE NAMES AND ADDRESSES OF THREE (3) U.S. CITIZENS WHO WILL ACT AS REFERENCES FOR YOUR SERVICE. .............. ........ ... ....... ........ NAME ADDRESS Frank Derfler 88005 Overseas Hwy., 10-120, Islamorada,Fl,33036 ................ . Dr. Sandra Schwernmer 160 Key Heights Dr.,Tavernier, FL 33070 .. .......... ..... Joe Roth 127 Valencia Dr, Islamorada, FL 33036 ................................---11— -- -—-------...........................................................................-..........................................--..........................--.................... 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. 11. 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 THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS. 1,THE UNDERSIGNED REPRESENTATIVE OF THE ABOVE NAMED SERVICE,DO HEREBY ATTEST MY SERVICE MEETS ALL OF THE REQUIREMENTS FOR OPERATION OF AN EMERGENCY MEDICAL SERVICE IN MONROE COUNTY AND THE STATE OF FLORIDA. I FURTHER ATTEST THAT ALL THE INFORMATION CONTAINED IN THIS APPLICATION,TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. SIGNATURE Of sSENTXi'WE7;----) API'Lle,' NCI" AUTHORIZED REPRt Notary Public State of Florida Debra S Naiw My Comffli"an GG 953678 Expires 0007/2024 NOTARY SEAL NOTARY SIGNATURE DATE Page 2 of 7 135 PERSONNEL-PARAMEDICS ............. . _... ...... . .. _..._.... . w.v� .m....... _ ....._....._...p�. .. NAME PARAMEDIC CERTIFICATION Firsts Middles Lastmmm SOCIAL SECURITY# CERTIFICATION# EXPIRATION DATE .�.mm_ �.. Term Lee Abel 205452 12/1/24 Andres Felipe Ardila 526411 12/1/24 Wesley Dennis Berm 528244 12/1/24 Jason Christian Bryant 511516 12/1/24 Adrian Castellanos 526853 12/1/24 Marcio Cemin 523649 12/1/24 Michael Benjamin mm......._. ............... e. ........ amin Cortina .............�...�. .._��������� 540545 12/1/24_..9,__ ,. .....,,.,,,,,,,,,.,,�.............................. Anwar Elias Cure-Twede 535002 12/1/24 �m /24 Keith Thomas Engelmey er 538279 12/1 w� ._ .... A...n.n.� ..... .... Alexander Kristoff er Fran m � 533734 mm 12/l/24m„m mm Maria Isabel Jones 538071 12/1/24 chael Jeremy Kimes r„r„r„r 523643 12/1/24 Anthony Loboperrero 539709 12/1/24 Jason Alan Luna 519294 12/1/24 Jason William Lyman 205524 12/1/24 o 543185 12/1/24 Eduardo Raul Medran ......_w ___............,, ........._— _ ____.,_...... .— 24 Steven Cesar Media 531833 12/1/ ... _........___.................................... Abdon Carlos Moreton 520725 12/1/24 Erica Bastos Oliveira 520615 12/1/24 Misael Alejandro Oro pesa............ 536349 12/1/24 Stephen Alan Po oc.... 517032 2/1/24 .........�..... -------- Victoria Elaine Price 565784 12/1/24 Michael Anthony Rodriguezmm 522249 12/1/24 James Phillip Ruggles 520868 12/1/24 JorgeLuis Sanchez �. 534.2.70.......................................................e..e�_........ 12/1/24 .........................�.�.......n..........................�..._� Daniel Patrick Self 519016 12/1/24 Filip Ivaylov Todorov 524782 12/1/24 Lester Robert,Young 514855 12/1/24 g ... Page 3 of 7 136 ....... - -- ON-CALL PERSONNEL PARAMEDIC CERTIFICATION PARAMEDICS _�_�... CERTIFICATION# EXPIRATION DATE Jason Georize Swensson 17623 12/1/24 Carlos Manuel Martin 509736 12/1/24 PERSONNEL—EMERGENCY MEDICAL TECHNICIANS .... _...... . ...................... .-......�..................... NAME.. _....._ .. ... _ .. ...___ ........... EMT CERTIFICATION First Middle,Last SOCIAL SECURITY# CERTIFICATION I EXPIRATION DATE Mark Joseph DiRusso 563362 12/1/24 Ronald Carl Jacobs 308660 12/1/24 Ta ler Holman Russell 572960 12/1/24 Christian Orozco 561466 12/1/24 James David Griffeth 300527 12/1/24 Jordan Phillips Brown Herlth 573900 12/1/24 Cristian Peter Berry www 577668 12/1/24 Alan Alonso 568125 12/1/24 Mohammed Abukahok 561484 12/1/24 Brun Gonzalez __________--. 404 12/1/24 565�..................� � _...__ Jus11-1-1-11111tin Brvan Nichols 575864 12/1/24 Michael Anth _ony„Sloan 575379 12/1/24 ... � ON-CALL PERSONNEL- EMT Heidi Leeann Hun lin 23 12/1/24 G. .... .....�.............................._........_............�......_._..�.._._._._�..5......... ,3330 330 �................................................................................................................................... Warren Harding Long Jr 550431 12/1/24 Page 4 of 7 137 w 0 W own cl, rn 01 r- d' r, r.. "' Nt P`, 00 Q1 kn O. 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" mWx •, N o >a ww rnCD 0 J C7 p U U U U O all N 00 x Q w Ll w a M' r. 0 0O0 ool c✓ CW7 � �" W x rn o 00 00 w o 0 0 0 N N N CrY La Ct W ❑ V] Lz Li F• W � m Q _ ..................................______ _________ 140 is amorada, Ti a, e of Is a ds Department ofFire Rescue qN � Office of the FIRE CHIEF June 5, 2023 Jim Callahan Monroe County Fire Chief 490 63rd St. Marathon, FL 33050 Re APPLICATION RENEWAL FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY Dear Chief Callahan: Please find enclosed the application for renewal of the Certificate of Public Convenience and Necessity for the delivery of Emergency Medical Service for Islamorada, Village of Islands. The insurance coverage expires October 1, 2023 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 July 19, 2023 meeting. If you have any questions or need additional information, please contact me at your earliest convenience. Thank you! ISLAMORADA FIRE RESCUE Terry. Abel Fire Chief 868000VERSEAS HIGHWAY,Ise FLOOR•ISLAMORADA,FLORIDA 33036 OFFICE.305-664-6490 FAX•305-852-5195 E-MAIL I'd-in is aora hm. A 141 �� BOARD OF COUNTY COMMISSIONERS County of Monroe ' 'IP t Mayor Craig Cates,District 1 The Florida Keys 1 Mayor Pro Tem Holly Merrill Raschein,District 5 f Michelle Lincoln,District 2 James K.Scholl,District 3 - ��.�'' David Rice,District 4 Monroe County Fire Rescue 490 63Td Street Ocean Marathon,FL 33050 Phone(305)289-6004 �" MEMORANDUM TO: Nicole Lyons FROM: Cara Johnson SUBJECT: Check for Deposit- COPCN DATE: June 12, 2023 ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Attached please find Check#dated June 8, 2023 in the amount of$475.00 to be deposited in revenue account 141-342000-RC 00345.This check has been issued for the renewal application of a Class A Certificate of Public Convenience for Islamorada Village of Islands Fire Rescue. Thank you, ?� �6� Cara Johnson 142 1 ISLAMORADA VILLAGE OF ISLANDS a*, „r 8 1-2 7WB25 OPERATING ACCOUNT x� 86800 OVERSEAS HIGHWAY ISLAMORADA,FL 33036 SLAMORADA,FLORIDA 33036 06/08/2023 (305)664-6400 �w....�._ _.........�._._..... PAYTOTHE BOARD F COUNTY COMMISSIONERS*********************************- 475.00 MONROE COUNTY O O ORDER OF w. ..... ............. ---Four Hundred Seventy Five Dollars and 00/100 Cents--- . ...... DOLLARS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN:FINANCE P.O. BOX 1980 ...._.....�. �.__��_.._ m...._.._..��.... �_-.._. " KEY WEST, FL 33041- _.�, _..w_._.,_.____ .� _ m ._ W .u w MEMO 7WQ SIGNATURES REQUIRED I ISLAMORADA VILLAGE OF ISLANDS VENDOR: 0101 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 06/08/2023 6/5/2023 COPCN Fee Cert of Publ Conv&Nec CI A EMS 10/1/23-09/30/25 475.00 CHECK TOTAL 475.00 143 ISLAMORADA VILLAGE OF ISLANDS FIRE RESCUE FEE SCHEDULE: A0425 MILEAGE $12.00/MILE A0426 ALS-NON EMERGENCY $547.00 NON-RESIDENT RATE $647.00 A0427 ALS-EMERGENCY $547.00 NON-RESIDENT RATE $647.00 A0428 BLS NON EMERGENCY $500.00 NON-RESIDENT RATE $600.00 A0429 BLS EMERGENCY $500.00 NON-RESIDENT RATE $600.00 A0433 ALS LEVEL 2 $811.00 NON-RESIDENT RATE $911.00 A0434 SCT/CRITICAL CARE TRANSPORT $840.00 A0998 EXTRICATION $250.00 A0999 TREAT NO TRANSPORT N/A 144 to DATE(MM/DD/YYYY) CC> CERTIFICATE OF LIABILITY INSURANCE 9/20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER s�a�nln s World Risk Management PHONE- Je "' """"""""" "'�"" FA7t 20 N. Orange Ave., _ NO 4af 445 2868 d Np.C�It Suite 500 hDDRES„ jenlnit eriir tT s rnntN .corm E-MAIL y tom... Orlando FL 32801 INSURERIS)AFFORDING COVERAGE NAIL# INSURER A Public Risk Management of FL(® INSURED .�.�L.FkMG�7Pt,....® _. .... ,® "' islamorada, Village of Islands INsuRER6 86800 Overseas Highway iNSURERC ......... Islamorada FL 33036 INSURER 0: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:327004199 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. INTR TYPE OF INSURANCE ADDCiU'�I�I POLICY NUMBER .fMMIpDIYYYY MMID p/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PRM022-009-083 10/1/2022 10/1/2023 EACH OCCURRENCE $2,000,000 Aisr�_ X OCCURlJAMkGC ro014~ NT fa RC WB$kS{Ea a1 Ga�rarwr t 2 000 000 MED EXP iA,,.tay..one flwtd.,....,, ,.,..$ .EXCLUDED,, PERSONAL D.... PER OVAL$ADV INJURY $2 110.cUa . GEN'L.AGGREGATE LIMIT APPLIES PER: GENERAL"AGGREGATE E I:f1Y- rsClu..l4)Y fECT 4..C74:`„ PRODUCTS-COMP/OP AGO `6 d)Tlltmt�i:: A ..AU'TOMOSILELIAWL['T'Y PRMn77-nn9-nR:i 101112027.... . 10/l/2023 C31ABIN'FD SING f,C,:LIMIT $2,000000 ;Iw'.a acrx)onq X ANY AUTO BODILY INJURY(Per person) T' _.. __. ,. _... ULED OWNED BkO.D.IL.Y.,INJUR Y ,...f,P,.e.r accident) C$ AItrR,3 ONLY AUTOS 1 X HIRED x NON-OWNED .^ PrRTY DAMAo ,TOV Y AO ONLY09'm ......... ....,,,..., X APO DEDUCTIBLE 31,000 _ UMBRELLA LIAB OC":C:UR EACH OCCURRENCE '5 EXCESS LIAB CLAIMS-MADE AGGREGATE 9 C1EI':;a c:7f:16C'NT113N„1 4 WORKERS COMPENSAnON _ SI , L!T.E m AND EMPLOYERS'LIABILITY Y/N.. .. :�ECa ...... ..., PRM022-009-083 10/1/2022 0/1/?_023 X ANYPROPRIE_"TORIPARTNER/EXF_CUTIVF E L EACH ACCIDENT S"Y 000 000 OFFICERIMEMBF.R EXCLUDED?UDED? �,�' N/A .... ....... .. (Mandatory in NH) ....... E L.,)ISEASE A E'NIPt.t')YEE $1,000,000 fibnis,,idlycriibeu�IM^ti"k'er'afl"Id'FM1T"OR NM:,,,a�,nl�,fartrr I� .� .,.�..� ,.., _ ....... . If +ss,dpsrnhe under / r I lIL,I A.rh- "a)I OCY I..IIVfI A s 1000 000 ............. ._..._ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES fACORD 101,Additional Remarks Schedule,may be attached if more space is required) With respects to the listed coverage held by the named insured,as evidence of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Florida Department Of Health Bureau Of Emergency ACCORDANCE WITH THE POLICY PROVISIONS. Mngmt. Oversight EMS Section 4052 Bald Cypress Way BIN A22 AUTHORIZED REPRESENTATIVE Tallahassee FL 32399-1722 r �.. .__... 1988-201 O 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 145 AGREEMENT BETWEEN ISLAMORADA,VILLAGE OF ISLANDS,FLORIDA AND PROFESSIONAL EMERGENCY SERVICES,INC. 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" AND 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 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. WHEREAS,the VILLAGE,as a provider of Emergency Medical Services to its citizens, 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 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 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 follows: I 146 ARTICLE I SCOPE OF SERVICES 1.1 Under the direction of the Fire Chief, and as defined in Florida Administrative Code. Chapter 64E-2.004,Medical Direction,the CONSULTANT shall perform the services of 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. 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. 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 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 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 medical performance of Paramedics and Emergency Medical Technicians("EMTs"). 1.1.7 Audit the performance of system personnel by use of a quality assurance program to include but not be limited to, a prompt review of run reports, direct observation, and 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: i-1.9 Possess a DEA registration, to provide controlled substances to the VILLAGE. DEA registration shall include the address at which controlled substances are stored. Proof of 2 147 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 to assure continuous registration and will reimburse Medical Director for cost of such registration. 1.1.10 Ensure and certify that security procedures for medications,fluids and controlled substances are in compliance with Chapters 499 and 893,Florida Statues,and Chapter 64F-12, Florida Administrative Code. 1.1.11 Assist and coordinate with the Fire Chief written operating procedures creating, authorizing and confirming adherence to rules and regulations regarding all aspects of the 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. 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. 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 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. 3 148 TICLE 3 DEFINITIONS 3.1 "Department"means the Department of Health and Rehabilitative Services. 3.2 "Emergency medical technician" or "EMT"' means a person who is certified by the department to perform basic life support. 3.3 "Medical direction"means direct supervision by a physician through a two-way voice communication or, when such voice communication is unavailable, through established 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 not including administrative and managerial functions,for daily operations and training. 3.5 "Paramedic"means a person who is certified by the Department to perform basic and advanced life support. 3.6 "Physician"means a practitioner who is licensed under the provisions of Chapter 458 or Chapter 459, Florida Statutes. 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 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 prior approval by the Village Manager or his designee. 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 4 149 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 physician group involved in prehospital care. 4.5 The CONSULTANT shall perform such other duties and responsibilities as now 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. ARTICLE 5 VILLAGE ORLIGATIONS 5.1 The VILLAGE shall assist the CONSULTANT by placing at its disposal all 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. 5 150 ARTICLE 7 TERMINATION 7.1 If through any cause the CONSULTANT fails to fulfill its obligations under this Agreement, the VILLAGE shall have the right to immediately terminate this Agreement upon providing written notice to the CONSULTANT. 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 prior to the termination date,provided that all property belonging to the VILLAGE is returned prior to release of final compensation to the CONSULTANT. 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 this event,be obligated to pay for services beyond said fiscal year. ARTICLE 8 MISCELLANEOUS 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; 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 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 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 6 151 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 j national origin,physical or mental disability. 8.4 In end t Contractor.The CI a s NSULTANT is an independent contractor under this Agreement. Personal services pro ided by the CONSULTANT shall be by employees/agents of the CONSULTANT and gubject to supervision by the CONSULTANT,and not as officers,employees,or agents of the V LAGE. Personnel policies, tax responsibilities, social security and health insurance, employ 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 8.5.1 The parties recognize that the services contemplated by the CONSULTANT are of a unique and personal nature and as such dos 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 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. 7 152 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 claim. 9.1.3 To the fullest extent permitted by law, the CONSULTANT shall indemnify, 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 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-to-day conduct of this Agreement shall be addressed 9.1.5 All Prior Agreements Superseded. This document incorporates all negotiations, correspondence,conversations,agreements or understandings applicable to the matters contained in this Agreement and the parties agree that there are no commitments, agreements or understandings conceming 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. 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 86800 Overseas Hwy islamorada,Florida 33036 Telephone:(305)664-6490 Facsimile:(305)852-5195 With a copy to: Roget V. Bryan,Village Attorney Ishunoradn, Village of Islands 86800 Overseas Hwy 8 153 Islamorada,Florida 33036 Telephone:(305)664-6418 Facsimile: (305)504-8989 For the CONSULTANT: Dr. Sandra Schwemmer 160 Key i leights Drive Tavernier Florida 33070 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 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 Law/Attorney's Fees. The parties agree that this Agreement shall be construed in accordance with and governed by the laws of the State of Florida. If either the 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 limited to court costs,and reasonable attorneys 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 this Agreement. The Exhibits, if not physically attached, should be treated as part of this Agreement,and are incorporated by reference. 9.6 Scycrability. 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. 9 154 IN WITNFSS WHEREOF', the pm lies 1mve umde and excaded His Pyrunwol on the rvs�[Iectivc dziles under each si.911,11tire: The VILLAGE, signim,,! by and through its Village Manager alulkitized to oxecuW ganiv hY the Map Council action on dic day of and by its ciu y authorizcd reprvsernafive, Q J lri< T. Kassctt, Acting VdIage N1,111,16ul. ATTEST: Daw 30 Avg 0 L �)ffi, V/i age "T APPPR()VI,,.'D ASTO FORN4 All Ro,g,er Bryfw ViNage A"orney A ME 11111�'}""',........ ............ Dalc� ✓ j .......... ... ..... 1whit Name: 155 ISLAMORADA FIRE RESCUE STANDARD OPERATING PROCEDURES Section: 700: EMERGENCY MEDICAL SERVICES Subject: TRAUMA TRANSPORT PROTOCOLS S.O.P. 701.00 Effective: 10/1/99 Revised: 3/1/2021 Page 1 of 13 ; Initiated By: Dr. Sandra Schwemmer �` � � Approved By: Terry Abel, Fire Chief Forms Required: 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. 2. The Dispatcher obtains information from the caller regarding: A. Name of person calling B. Nature of incident C. Type of injury 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 Supervisory personnel. 4. Should all IFR units be actively engaged, the Dispatcher will call the closest geographically located ALS Fire Rescue unit(s) for"mutual aid". 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 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, 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 1 156 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 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 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 to the SATC/SAPTC having that special resource(s) even if the SATC or SAPTC is not nearest to the incident. 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. 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; E. Cause of injury; F. Injury site/type; 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-1.0147 F.A.C. 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 2 157 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 B. Blockage of the Main road or failure of the drawbridges, C. Extrication time greater than fifteen (15) minutes, 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 patient out of an inaccessible area, F. Possible MCI (mass casualty incident). 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: 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. 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 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; 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 3 158 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; 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 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 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; 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 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; 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. 4 159 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. 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 "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 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. 5 160 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: 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). 1kI11Z1111) BLUE AIRWAY A('I'I\/1 C,11:1V AY ASSIS'FAlNCI <10 cur>20 I:11:11M I II'°1YJVVIVI IVY;YJl i IVI Xl i 6:I111JVVIVII'V�I t.lIRK,'UL.A"I lON C,CK CI liA IIXI PUI SI" cur 111'<00 i7 mi—ki PATIENTS WITH RENAL FAILURE ON DIALYSIS 131:1<110IN I''X'I'11 NI"0\/111i G!iYI".LGI::tS FJIISABIIL.I111Y GCS < 1J or 11Ii1 SIEiINO 01' pIC,IiAlYSIS, or SUSPICION 01:' HEAD INJURY WITH LOSS OF CONSCIOUSNESS,AMNESIA or 51:"flNAl P`oi:'l 1 IN JUI:'rY or I OSS CI SI!IINSAI"10IV NEW ALTERED MENTAL STATUS S(. EI.."I..IISS UE 2"''0Ii3 'III,f.;1i11 111.J1'::'1NS1"01R;1`X,orIM0Ii1 111SS SOFT TOSSUELOSS2 C,111I1:"U1"A1"10IIN Al"01::'rCROVI I'k411 VVIrhSI ourCNKI IEi ANY 1:11 N1 1"I:'i"al'ING PINJUIiY or GSVV I'G I-41 Al I,N1 CK, 1"01:tSo Sli I!EXFIiI 1MI1`Y' I IISL.0CA1'ICJI'V CI 1-411:1,K N I 1 01:::1 CNKI IEi P`I-41;iS1'VVC,1I.. NSI'C,1111..II'YorIII!EIC1::'1I I1"Y(11X11.(;1-41,SI..) Cl:'k.JS1-41 I I,IMANGI I S,III G1 0VIEiI I SIi 1:1.JI SI I I SS I XI'lil IMI 1""Y L.O10U(3 BONE 1 i"C I"Ul:'d 01:'' I"VVO or VlICl111 I.ONG 11CJ1NI S° SINGLE LONG BONE FX SITE DUE TO MVC° N:�mtAts.i.l.J�m�IL/ S KELIEIAL,n SINGLE LONG BONE FX IN PT ON COUMADIN or /ANTICOAGULANTS WITH HIGH RISK OF BLEEDING A(13E 55 YEARS OR OLDER IVIIEC'HANIIS FV11I OF: 1-41 Al 11' lA.IMA IN F'C,I PI N I'S ON WAIi1'C,E:'MN(P`CJIJII AI IN)or EJECTION FROM AUTOMOBILE,MOTORCYCLE,GOLF CART 11NJUFl� )( AN 1"If`lJFIfVI.II..AN I'S VV1'I'1-4 1-41Gld I11SIM 01: I11 1 1 1 IIN I OR HORSE WITH ANATOMICAL INJURY SI \/IEili1 1:ACIAI IIV.JI.JI'tY/ It P`I'1.JltI S VVI'1"ld 1101"Ii;lN 1"l x1 C,IIl BLUNT HEAD,CHEST OR ABDOMINAL TRAUMA IN PATIENTS COIM111:101(IIS1:, ON ANTICOAGULANTS WITH HIGH RISK OF BLEEDING I C I'111J1`l!'I'10IV 0I i I..[Gid 1"NING INJI.II''°iY VVI I'1-4 Loss 01:' DEATH IN SAME PASSENGER COMPARTMENT l;ONSCIOUSI'VI SS 0I''°i VIS1111 I,SIGNS 01 1NJ1.I:Y INTRUSION INCLUDING ROOF>12 INCHES OCCUPANT SITE; 111 UN I'ARI KJIMINC,1..or Odl S'I"11iF\1 IMA IN I'S l'I IEiIN I'VVI Lk 4 >18 INCHES ANY SITE INTO THE PASSENGER 1-415'FSIiY 01 p'IAIiAl YSIS(P IiA1'1 I GIX or C UAl I1:'dl'1 I GIA) COMPARTMENT 11Ii1 GI'VC,INCY>70w k VVI I'1-4 A111::I0111I11NAI PAIN ANI 1111 UN I VEHICLE TELEMETRY DATA CONSISTENT WITH HIGH RISK OF 11:',A.!IMA INJURY' FALL 10 FT or MORE AUTO VS.PEDESTRIAN/BICYCIST THROWN,RUN OVER or WITH IMPACT GREATER THAN 20 MPH MOTORCYCYLE CRASH>20mph Ffli I:'1 =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. 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. 6 161 IV. PROTOCOL FOR PEDIATRIC TRAUMA 1. Upon arrival at the location of an incident, the EMT or paramedic shall assess the pediatric 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 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 criteria and if any of the following conditions are identified, the patient shall be considered a pediatric Trauma Alert patient: 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 has a systolic blood pressure of less than 50 mmHg. 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 sensation. D. Soft Tissue: The patient has a major soft tissue disruption, or major flap avulsion or 2nd or 31d 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. E. If there is any penetrating injury or GSW to the head, neck or torso or extremity (Superficial 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 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); 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. 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). 7 162 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 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, 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, 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. 8 163 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); 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). 1111:i:i::11) BLUE SIZE WEIGHT<22 Kg AIIIRWAY r,CI"I\/I All:'ffiAYASSIS1"AI CI ' it SIP I i!V 1'l;i<20 IN I N I:''C,IV I'<1 Y4':r it SI'""Ii!V1'IEi<10IN P`dlI I Ilil,lN 1YIi 1!iY4':t I II'°iVJVVNING VJIi NI XIi I:IIi1JVVNIING "'IIImIIsiuIL.A"l ION I AIIN 1'or I' OIN IIXI II I CAI:'CJ'1'll I or I Ii;1 PUI SI or CAROTID or FEMORAL PULSES PALPABLE,BUT THE RADIAL S11I'<!x0 i infl-ki OR PEDAL PULSE NOT PALPABLE or SEP<90-mmHg CSIa" A&LJ1 y Al 1'1 I:',l 11111I1!EIN I'Al C1A1"US'or p1IiI SI NO 01: IIAI:'rAl YSIS or AMNESIA or LOSS OF CONSCIOUSNESS SUSPICION 01: SPIINAI ('01:'I I II'VJUIiY or TOSS SI SI IN SA I"1 O I'V SC.)I::-11 MAJOR SOI:'I" 1'ISSUI I:IIS1:'R I'1'IVJI'V UPPER EXTREMITY DISLOCATION 1 11a"ia"Il.,➢If'', or Vl(F JOI'i /VU1 SIOIN of SKIN e 211or3l'RUI':il'VS 1'0>10% 1"RSA ANY I1I NI 1'I':'"Al"II G II'VJUIiY 01::'r f,SVV to Yho Idl Al:,NI CK, 1'OI':1S001iIi',X11iI IMI'I ye CIM1:"l!1"A1'ICJI'VA1"01::rA1:30/I 1"IdI VVIrIS1 orAIVI<Illi I IISL.0CA1'IOI'V CI 1"1dI I-4I11,I<IVI Ili 0I:':1 All IVI IEi L.ON(.3 BONE 0I1I!EIN I OI G I''.1OIV1 I: :'SACI"Ul:'d "or 111I11I 1II1I I I i,+CI"UIiI!li SINGLE LONG BONE'FRACTURE SITE°or DISLOCATION 111d�1s'I'Lfl-'1E/ SI 1'I:iS or 11lIUl..'1'II1I I I IISI OCAl"IOIV S11'I!IS S K E L E"I"AL. IVIIIILC'H,/ NIISIVIII I I I C 1'lillf`l!'1'10IV 0Ii I..IGid 1'IVING S 1"IDdIMI:',VV11'Id LOSS 0I'' EJECTION(PARTIAL or COMPLETE)FROM AUTOMOBILE OF I11NJI.J COI'VSCIOUSI'VI SS 0I1 VISIRI I SIIGIvS OI IIv.JUI:I1y DEATH IN SAME PASSENGER COMPARTMENT SI \/I:',IiI I ACIAI IIV.JI.I:Y VVI 1'I;4 All?VVAY(;011 PIiOl1(IISI:', INTRUSION INCLUDING ROOF>12 INCHES OCCUPANT SITE; I'I NI Ei 11:'FAl'II G IIVJUI:'rY 1'0 1'IdI I".IX1'lil 111fI'1'Y Al or ARO\/I '1"IdI >18 INCHES ANY SITE INTO THE PASSENGER COMPARTMENT 1111OVV or KI'VI".;Ili VEHICLE TELEMETRY DATA CONSISTENT WITH HIGH RISK OF 11I t.Jl'V 1'ARI KJI IIINAI..or Odl S'I" 11iF\1 IMA IN I'C,1'II!EIN 1'VVI'1"Id INJURY' IdIS'1'0IiY OI p'IAIiAl YSIS(P i 111 I GIX or QUAI I11II'lI I GIX) FALL>10 FT OR 2-3 TIMES THE HEIGHT OF THE CHILD 11It.Jl'V1'IdlAl:,P`dlSI ARIKJIIIIINAI 11:'FA.Jl1AINI:1'1'VVI'1"Id 11I I I I MING I IISOIiI II I':r CIi OIV COlJ11 AI MN/AIV 1'ICOAG J1..0IN1..5 VVI'1"Id kflGid 1:1ISIK CI 1:31 1r.I I I NU> AU 1 C\/S I1I I::II S 1'I:iIC,I'V/RICYCI..IS 1' 1'I-4I':1OVVIV,I1l.Jl'V O\/I I::1 or VVI`1"Id 111(II ACI fVlil A1'I',I''1 1'I-AIN 201 I JI,C l"IOIV I I'::1O111I AU 1"0,A 1"V,(501 I CAI:'1'1"OI i Idol::rSI VVI'1"Id SIB II'VS OI IIVJI.I:Y dll- % =any one 111 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. 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. 9 164 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 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 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 personnel. All cases of TRAUMA ALERT patients taken to local Hospitals will be reviewed by the IFR Medical Director. 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 3. LEVEL II — Jackson South Community Hospital 4. LEVEL 1 - Nicklaus Children's Hospital, pediatric trauma only 10 165 Local Critical Access Hospitals-Receiving Facilities 1. Mariner's Hospital, Tavernier, FL 2. Fishermen's Hospital, Marathon, FL VIII. DISTRIBUTION OF TRAUMA TRANSPORT POLICY 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 used to determine trauma transport destination. 11 166 ANTICOAGULANTS High Risk of Bleeding: Trade Names: Generic names: Aggrenox (ASA+ dipyridamole) Anagrelide(Agrylin) Agrylin (anagrelide) Apixaban (Eliquis) Brilinta (ticagrelor) Cilostazol(Pletal) Coumadin (warfarin) Clopidogrel (Plavix) Effient (prasugrel) Dabigatran (Pradaxa) Eliquis (apixaban) Dipyridamole(Persantine) Jantoven (warfarin) Dipyridamole +ASA (Aggrenox) Plavix (clopidogrel) Edoxaban (Savaysa) Persantine (dipyridamole) Pentoxifylline(Trental) Pletal (cilostazol) Prasugrel (Effient) Pradaxa (dabigatran) Rivaroxaban (Xarelto) Savaysa (Edoxaban) Ticagrelor(Brilinta) Ticlid (ticlopidine) Ticlopidine (Ticlid) Trental (pentoxifylline) Vorapaxar (Zontivity) Xarelto (rivaroxaban) Warfarin (Coumadin, Jantoven) Zontivity (vorapaxar) .......................................................................... Injectables: Activase(alteplase) Aggrastat(tirofiban) Angiomax(bivalirudin) Argatroban Arixtra(fondaparinux) Fragmin(dalteparin) Heparin Innohep(tinzaparin) Integrilin(eptifibatide) Iprivask(desirudin) Lovenox(enoxaparin) Reopro (abciximab) Streptokinase Tenecteplase (TNKase) Urokinase May 2023 12 167 June 5, 2023 To Whom It May Concern: There have been no changes in the March 2021 Trauma Transport Protocols for Islamorada Fire Rescue. I approve the TTPs submitted. Should you require any further information, please contact me. 1? r` i- Sandra Schwemmer, D.o., FACOEP-D, FACEP Medical Director SSchwemmer@gmail.com 305-451-8965 13 168 a) cfl M N_ LU N O LU LU z W W L w� �w C) w LU100 ULU U LL VAF 00, o O 0 w 50 � o J 0 ti M N � � H N i O � � U L •� 0 O a > " U WCL GJ E Q N Q H LL GJ G! i 4-0 a. 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W U D o 'O O E N vi C- ca E O O U� C 6c 0) � U U � O U E E U E c 0 '0 0 W N c o VC) CL U (n � � oo � � co Qna) o inm CL E E E E c k m � No co ca a) NHHHHHH N vOiY U v E > 0 cn v a) U .� v to h co E N cn o y c Q U OjS o CL U s O cn O U m J N Q E c " o co Cu � i = ca o o Co 'F c o ?� E QE O c G� o •ca ��� � U � > O' o ° `moo QQ-0 QQQ 2-8 co ..................................................................... 0) (3) (1) cu 0— E E (u E 0 (D 4 (D co -0 0Q co _0 0 2>2(3) 0 cli 0 0 >1 70 cn cu C: cn 0 a) 0 > 0 U 4-- 0 a) cn (n E E 0 CL a) > U CD 0- cn 0 (n a) cn-0 Cl) a) .. .................. cu a) — -0 0 E C)- 0 0 U0 a) N a) 0 CL U E 0 cn 6 > >;0 0 z 0 U C:0 C-) a) U c E a) L- c 0) 0 0) 0- cr E E [2 4 0 CD� uj C) 0 a) co O 'D LL 0) E >, Co Lf) E a toW E Cl) c 0- W (D m u) E 0CL m 0 a) c M C.) 0 a- cu m cu >, a) 0 - = s -Flo 0 a) m C: < M -0 C)- m C.) .................... _0 70 CL Lp E FU c a) < 0 cn E 0) CD _0 �c cn a) a) Z5 0 CD C**4 Q � m �' � (n > U Ec700Ll-- -0CL< > 0 — A >0 > E a) 0) c-) cn a) �+- c: (n CU -0 .Ln CL) .2 U) b > Z -E > a) E 5; T— 0) an) (n — >N (n "D C) 0 a) 0 > cn (n < 0- 0- 0 < E < a) w IL 2-9 � V r � � y. N N N O CN cu cu V wc�000� Ncu t/1 U y V s O ""fi 0 c 0 Uf% d R O 0) R 70 "7i cu Z 0 c .- -Q > > o O X O to O.- a) (Cf L... X i O O W W i r„ zzzzl .. ......................i r 4t ii � . O C) v cn i �i........................ 0 G� O v 0 O Or d F- li L d � 06 Fm i � V O m i V ,,,,,, 0 r� L ��1� a VJ /A L = VJ O o O U) � U c � N OL O L W O m Z vi j If M .�i d N Z > Z,, (Lf C O (0 O C coQ V O (0 � O O N � O C CD O cn com'rc 2-10 o c *� o + N k x ,,,,,,,,,,,,,,,,,,,; a� N ... .. ;"? s O Eli .. .... >. co m ` cu a� c a� Nwowo � Q O Nwo 57 70 O � ccc0 U wC C47 vO all > O : ca F+ < U a 0 w o C inO U) zO �Ny E Ow a) + v Ni o i� fn O Q (t CO No 0 0a o mm ia� U)= O L o N — p (n to O LU O C -p .N N cu N Q "- = N� O NR a> 0. 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N N N o a CY `- Ocn > O U cu > E s — co -aO Q >% U cn i U 3 y ++ cn p QL cn = cn 0 1= co cn � co ` 30 � cu > Mm � cu > � o > m R cn 4— �+ cn W M o cu co cn �+ > .— O 0 C cn O N o O U CU CU O V/ W V > W W .0 W '� cn aF .0 YL cu Q E NLE cn _ c6 >+ p C� N O N > 0 �' oaocnU � a � l— zomcno � oa0o aw m v yy • • • • • • • • • • • • • • • • • • • • • • 0 d V L d �O 0) CL L CL O a) cn d cn cu a) c4 N V N _ — cn 'o U cm cn cn a) a) 3 i z _ U N Q a) cn � cn O co 1= Q. N p Q C O �a) ItU d O N o W O = a) E 0- N c6 Cfl a) w 0 i o a cu W' p 0 i U O w N p Z a w N cn W p Q. c A p = G1 3 i o W � `�- >_ mro a) N N c6 N Q Q Q w V Q +(n +' d ' U NN >' N O N O O 3 O O) U U_ c0 N U ,C: o-+ ) O X•_ � C cn `- U O CO CL ago >+ cn U C m O F+ _ E LL ! '� to O O Q = V N O CO Q i V O E _ - N Q N CO U N 'a > >' O cu Cn 4+ C V d _ .> >+ c6 cu Gs p Q N Z III III s: d '> 0 o z W d 3-3 LO 0 N M N ` O N E E 3 s co v c R co c O o O E U � U O O ` LO �+ N c cn a) O U O) i U a) a) c O D a) U " 0 � W O V m Q c . . O cn cu p L a) 0. 0 Co C U CU > O' E „ N L p Co 0 O UCL 0- U) O `0 _ (Q O) O O' 0 co O co U NO ,N N L S �_ o J O mmi O �Itl i ,, ulluu i�i�'mioioiu O vi O J U Zto .co 70 E N ca � Q-' v 10 m � o > O "' _ � � E c c Q c w — 4 L cu O _ W O 70 O U "O to i O �- co co � u. oO " nU70 -Q OO O Q O W U < U) 0- wQw > � '> U E c c� � w v w a 3-4 cfl o CU a) >' N U � _ cu M c6 _ ycu c0 c Q a) cn c6 Cl) -0 to a) _ -0 a) to N E = a) — � O cn E cn cn 3 a) _ N v O c X a) f cn cn cn a) cn L o co cn cn c o to � a) co O d O O U O p = O Q Q O cn cncn cn E a) cncv O cu 0) U a) O O L ,, L Cl) "� _ U 0 C � 0 O O c0 = cn co — — co O O a) E O E O m Q c6 4-cu p c6 to t U > L C L 0. - L Y U cn In � U) cnO � c6 _ O Q) N v ,- x Q N O c A)cu 0 O a- Y am ¢ N Cl) cn a) a) (D LL L � O a) An U) •Z3 cC = a) -0 v 0 O �' "' L s= cn O .1.+ 0 "_ _ c0 � _ 5 >%j O cn CU C m — N 0 U = � c c0 c0 Q U L U U cn 0 V to �- N G a) cn cv to N � O = O O L O � cn co `� O _ `� Ln O O M C a� � cn - Q r RS �- -0 '— — 0 c6 ai O 04 N 0) a) c0 cu a) c0 = a) cn ft: i a) c6 O cn U = U + WO O p p �CU C > cu C Q a) r 00 r.N a: O a) c6 L cn �O m N cu `n o cuO ca a) _ c > oo) O ca cn E U cu O ..cn CU -0 W a=i U 0cn = ca W > C Lu (nL m� Jam) o -CU ca 0 -0 cU >' o ai ° o Q cu o n m U u0n a) U a) a) > cu N on ca) N cu >to W cn 0 cu Z oO -0 WC =— No s = -0 -0 � Q ON a) a °'� Q � L = x a) EY 0.— 0 oV z o � cn Q. wacn0 > Q m o E � 7575 E Q > Y m w a m U)i CU a 3-5 0 N U) N CM Co 0 E �c� °E 3 Co a) o Coo co ca co m � C- = LO > CO m m � o o Q m � U � o c .(n 1 0 Q cn c o' � N .0 a, = m 3 � � Q w ° o — F= Co a) ° pia co N cn > 0 to , ca � �co 0 ° m Etca) 1 � o ; ;u o -a (n 3 N N co N c�a N o c' ° o > M > CO Q) Q) Q W Q Q C "M � CO � � Ica m co 30 � � � co U) a W a N N d N E c —= CO � '� — o� co ° N c cn CO o �- ° ° m Co � � ca > � 0 ca > Co ° mr. 0- CO ar W N CO ca o Q o N o _ Cf) _ � �Z> ° M ( I E N a ' co m m cn N O r 0 W 5,. Q g _ FL W 0 - O d Ok .. co ♦0� E C0 ai 0 T! ,, Ln nCL �w n�mra c m m CL Al Ln N N N N 0 ttry m - p E � r C 3 > m 0 3-6 o cn N is p N w m M00 — � U;no 0cf) o Q � 3 M (� is + N 0 E > � c-, N � cn •0 0 U _ z C)- C: `�'Cf) Q �' � SQL " � o ° � 3 � �° Lo w n3En3 � � � E `'- � � `�' co � � com � E � QOCo0 p cz >, a) cf) a �_ a �_ (o � � E � co �_ � L o w c "O-- O N Q) p >, Q) N Y N > - O � (o 'O - C C to O7 N 0 � (o C (o > Q) � p v a cn >,.— -0 vi cn Q) p Q) O O E w Laa) F= 0 ' O O � �CL a) � E OE Q - Q O � OooOi > � E co LLJ � � Oczco � EEvSCL � cEooai (Eo '> a) cnCo v (Oom � � E > 3 c> Cf) s o � Co >, ° vo-i' �° °a m m > Y o a, o ac°i = m Q moX � � � � _ oO � n3m � � � � � � 0 gym J CL N V Q) E to C� N N N (n Co 07 Co UL � Oio � O E �' O � c�aa (o � � °� Y � o � � v, oN R Q) p L N Cf) p 0 N E C Q) 0 b � Cf) V O (A Q � Co �� co C) w " �� ai � > � � ^ o � � ° viA o w m _ 0 Q o_'� Q io io � '� o•}>-• 0) co � Y �° m = QE (Eo � E _ � Eco a� � o � � •( '� a� � (3) C) o_ No' x Lm 2 3 v > o _ C) C) • a) O U • .� (a 3 m • .� v, v, o • .� o_ c° 3 (o - cn Co o c _ o O (n o p (o V (0n N Co C-) c (o a� E a p Q 0 L 0 (n "0 Co co 0 co > LY. OO a L � 0 0_ c}v � (n LLa C .0 Q � a) N � +� co N (nn > co Co N .�[2 � o o a vi � O E t� O o as i co co U � Co 0 .� a m co cnc N 0E 0 Co Q w CL CL 0 c - 0 accoo V. >, A c o 0 0 c 0) c w E E _ 0 ® o cn E t- p Q Y Q m x O cn coc a) c.4 4 a) , = O O c� � ) � � �� � ocoo > 0co � YZ= a' m 0) aNE QE > 0) QEco CD 0in Eio � � � � cz00 E � Eai °� � E � C � C: C� c coYo `- QCON EQ� �- � � ° �_c .0 c co c c p a) N °o p Q 0 E c > inEa a) (nc' � (° coc - U mcuia) om NOOo EinYioQ mmozc- co 0p, O o mO m m Q E o � O C) o ° 0 y �- - ( � c L = Oom N > w � 0, E >,w > � v� ` m m Co Q a U o -�• o c s o (n a) Co c > o E N x Eco (n E '� 0 x QQvoim � QQ .� pco � ^ w oOc� 'v 0 w ° � � E o � � -"• roc' L m c m0 ` arc oc .0d 0 0 O (n m �- o o co a N o in a� .� co O 0 m O c cn `- � m m c ioE c oQQEo > E > ° o0c0) o_ coo 4- Vic( � c Ocn � c cw c (n .0O ' o > 0 - (n Qo � N Qo >,.- W—na > p • 0 a� E o m a� Es o O c E o �'E o O > '= cOo v E ° >,� � a p ° > mco ° cL° m X o c c a) Qom m `�° o Q� EY o CL E > wOU- o � Cl) co cot 0 E � Q Q E � QI— w x Ml =1 3-7 �+ N cu O co L -0 L >' cn 0 O M o CU c� CU 0 0 m — O — (n � O CU � N N °U Q OLO W '0 C � r_ a) � co >, O GCl Z c0 O 0 cu G W cu U O `� N co > O 5 a, O L O �' "_ cn C O a •U � c6 >' a) cn a) N -0cn 0 cu s co _ dj a) cn � a) ^ L cn co = co = R m o � E C0 Qm L) cam) ^M LL �? � o - >' o J LL O DLo2! 0 cu cn � � � m m .c L �. L Q �. .... a) E O .0 r c6 N Q � N a) CU ) 0 L) N CU a) L to to L U �> �:co v� � n Q � . L L N L N Q cn O � C a) .L • • • cn C cn c6 a) co (1) >% co L a) 0 O >+ LL �o Q- U c6 = U 75 Q E CO U ! m �o N cn � ° 0 O L L O 0. cC d C 0) cu •� 'a m 4+ cu O O c E L N 1 cu m cu V! cn V j, t a) d cn 0 d o ., «s 0 N E CU Q `cn p Q cu 'C a 0 a) � LL CL > Q U CL Q c o Z co U C C O .cn. OO ©O m>> +O C cn to cu C 'a C 0 cn O Q p D cn Q 0 � � m � U) (U U � � � .� cu x a) �' cu CD Q cn r � p � m m E to (A m Q Q•— c O co 'a 'C W � L � � � � O � to � ..-.>1 cuL. O p) N cn (6 O a) cp � V cn 0 0 � to O C = a) cn O a) O "- C a) U N w w E r a) a) cuU �' O 0 > d' V) 0 0 O 0 °U "- a) O O " � ° U to c co 0 ' E 3: 2 0— ate) CU 0 0 cu cn � �- �- (n W o ° o — E O E N cn > Ortf .. d v L o = a) -0 c =cu cn cn cLa cLa o mm `� OLQ Q ° � m *� m mcomcuQ oo � LoLm U � ao Z non = � � c EE � _ � > °>,' d > > > 0 �? EoE � am mm ° c� ° oox o Q m LLB � O �a °' 0 4-r_ ) � I— � � a � Q � UO cLa d Q > r,) '25 a U � Q • • • • • • • • m • • 0 -a • d • CL • • W M U. Q G. fn 3_8 0 N M cu O O N � � O E E cu co cn cn 0 y � O O Q co 0) > N = m Q O c cu = O U U i c6 Cl) O O >, " VN CU 0 i 0. u a N ccn u � �O "O Q cu L) o cn o .co E r L O ,� 0 O U _ 4-W � a = _ : E [2 L.v V Y N " L d d p 0 0) �_ O Q N 04 N 0 " cu O -in 0 N N N 0 Cl) d U U 1) 0 � In �' .0 � a) O1� i = ctt O cn cn _ co 0- E cn I W LI.I `- _ ca � N c o N o _ 0 cn cu cn cn � R v — N N f! 0 4 O N O >+ O cuC 110 i "J cuC G U 0 to c0 U C ftS 4 N W cn `� ma r- a) CU cn co W cu ) cu _ n .� 0 n 0 O Q ) cU N a ,` ICI i _ � CU Q Q 0):,- _ � '� cu 3 4 = III^ cn a o O 0 = 0 O 0 L c Q O N 0" G1 .> co .- (n � C O "'� Qf"j N Q = � _ 0 Z cu Q E c OU 'a , Cn z to r L. 0 cu S cu ¢ CU >+ N �. _ U � . p N c3 m N c6 N d a Z � O Lk� , U. U coi cu >, cu cn ci m o . 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Wt be Q W.M"Wd It Up Whe' SPEECH Man# `Ymii canll each an o4d came Emir s" Us'dict]Rd lijtrht f0f: ke, Wrath CawmatA!!Close E,;,21,;,,lopefiE�es UIIUX'0 111 Salle —1� SPEECH CRANIAL NERYS, "YOL,:an"I'tea,"h an olld do,.,invi trict" Pariah Drxq Show Teerii cr�rn!le Klpalti S-121UACE WHaloy T,,,,sual Fijek ;--3x-Quz,dranhi Urn 413,;i�c Mr) cr litmippropfine Wontl 3aze 3,de'To x i12 12 Dysarlhria:S IturrEb ar U mableto 5 peal: 0 LI NIB(Wor) LL CL CWHAL.NERVES, 2u W5 Dr Shag Teerii or 5 mile Ann Dlvklmaevs,Holdbo.................................................0 E NUMEk!'JC F,atij31l Draxp Leg Drift: m Abmwal=AR&ad Xwo opem aps and Hms eachl Wg spauld'y Abomuk Abda gilded Droop LI%1195(Il3t 3r) ;Vmv!Close?y 2,1,Ecuchi dweni 0 Isth .......................................................................... kin Dr-ft:Clu6al qe�,h1oldboothiims out Legs,0 me ego tOKh term WA Nawlzl�w'dcdilift COOMMNABON: Ab"larwld*LEfttiift or unahte b mwe Ams:Hitgers1c,mee .......................................................................... 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CO 00 4.0 1, Iced tp Old Mid v J�m � N yUJ 0 ;' ia a o �I 0 LEI v a u� Q o =a W °' F- M 2 CL _ Lul rn . 96 Li 2 Ln Ln Ln Ln -a ILL rm W" u �hG � � � � � im� � rig 10 ICI 11 0 101 9-13 »»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»» to N — E 02 O to a N a) > O °C Q O N O U O O LO a) a) N W Q- c aC E V o C '+>- co E O O 'C O_ p c> p y cn CL co cn > O 'O a) p Co — -O Q Q a) cn N coN +J O Q t- � � �- 0 Q- Coc0 a) 'a cn co cocn 0 O L E Q a O Q co co co > Q (0 N co 0 .. cocn V Q i a) Q cn Co p = U Q Q co = i O cocn cC N L v W > > 0 in y > O ,0 co co cC O O p a) O O cn N V Q > N N y Q � U - O c0 a ++ 7 •- co a) m ai ) a) Q co o o o =o y- a' a cn E ° o u - cn a Z E - ° a) s y cn Co cn 0 cn V ° E o a� 'o E ° 0Q ) ao)> 0 Ln v m O m O o _ � O NM o °a ° ,cn o Co > �m O � v a m W CL O C0 O o ca +�+ }? 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J �- — cn CL cn m ° m o > U -�4 0 >i y- L c a) O V d E •Q O 'O CO � > (/� Q M d d Q O co a) Q O N O .� .a N O > „C V L ° OI oou E 0 y = m c o ° W > Q cn s ca _Q d O '� L V = c d N >+ •a C m .o — > ca E cn a) .0 L'L � I i — = OLu F c m y lcB a� an3 LL �n3 E y O > c_ v O Z co ° .�cd�nE W ? n 0 .0 _ 'a m O -0 L at° C • Q c cn cn O oo � ° � � yo= ; CL Amy a a Q azw Qy0Z •• M � 9-14 H W' N M of L6 t0 1l� O 2 ao a) Q V ti N `I 00 ADULT TRAUMA CRITERIA FORM CJ N DATE: CREW: / RESCUE UNIT: p PT NAME: AGE: DOB: `N TIME OF MECHANISM E INJURY OF INJURY N 3 AVDI 11 D:11'MIE „TII1A1.J IA AV I:::R l'(D`1NE"11 C":11tl 1()SE ONE) y I'"I AVE'I1bCA'h1 T 'or 1,,1, MIN . ', ::I'r1 C I Mf 1111 I„Mlrl MI I III Y IrIC I I 11"rr'e'oeldl,� as C HD'�:;1..PEATOD;:C1d I I N i EC1SAE1111HIV°Y �51 S I or 111,1"'71'':I'I+ I I d S111+ 11"I1I IN S1:1l"O'l + 1"I'',Ir 11'IIII IVY'or I1)SS IN S1 I'Is Mt"If"I',I � If1+51U!'I I I1 Is"tI!) Y S'6,'::rrIS101M trs''i'M 11.Ifrt Mt11"I',I '"M't 1"16''MI',"I I tld1'1fiF'11 Ti;rr'"MI',Ibll!!' SDCE"'1"'TOSSI.E SMt11"I'111011III'IIIIh,''ri,rrr Ml'Illtllrldl 'Mf:'r;IV111 t1:"F';I"0orl'JXTF,ll'�11t."'r'' IIIMY '"fST 1f M I IV11;T M I I t"'r'"'::rr DI 11:"001 t f t 1 L"M11 + III ST',1 h,II,SHI D I00,I'A51 I D DI+511A"I Dor I11 Y I I.SS I TIM!'I'rUFY' LONG V:IhD":,1NE I 1 + 't"IIIU IN .�,.1Nl)1"1',I1r1c:r1,,1 I1NIA5 I 1"I'11">' I RAD.T1 HlE .1.+ B M r MI 111,10,111 1,''0 11 11'�'t I"' r111 M'+',1 M+, ' tf,l'I0oM.,M',,or MI'It1+ 1"M II dS lNlltId Id1+ IdMY<IN III I IMPA ,a ;1'SIIU IM M111'I11II r I1''„1V tIIII"ry1Nli Id1'1"tJI'ItlMI MII'',1ii Mr+ 1"I'r1111'1'Q11"Mi''' 7 \AE0MPIIHS22N I I1t1',1Nr I g I i!)11,I or I K5 I ITl,,l I\I+5 II'IIIIIVY iItI I',)SS I"I + I."I'I_( I INISll'1 16or N N OF I11P101..pR''I' VIY1111 I 1 I;1"I'II'IIIIIVY V 111 1III1,It MI 11 1Mi 1101I',Iod or+ Idl::. T t%'d...I I'r1 o+,II'd I''"M't II I',It 1i1l I' Id'M)IVY'1"I I 'Y'S":> E L i d E E C L ,I+5,r, + r ["1i'1i '';rt"1MM:r1Io, 5 ' M' r ::',"..I ' t t"rr"+,1. 1, LL i A IA ALER"F(ONCY C'11 HOSE C"'WO) M _ 'a C; C"111 ."ULAC"'IIION PA7I"Ir:INTS W1'T1111 RI INAI.r'AII IURIF CDIN C71AI NSIS ._ !a U i 0 � SCEEIIrAIIIS�1�C,� HEN")I1N 1J11N WI 1I�1II I GDru,1,u G'DI C.GDIN,1,pC':IGDIJ ulNl"'u,1,Q,AI`s111N1'.,1,QIr"i,1plr NEW Al1I I'G"el'!I::b I`s111 IN1I'AI 1,Q7Lr"i11'1,JQ 11 E '1.+ TISS y LONG BONE SIINGHE I DING17MINIF FRAC:TIURI rbl,Jr:'TO 1EIV'C:1 U FRAC',E"'C, RE •SIIN(,1 E DING17MINIF FRAC':TIURIF A PT ON C OIJIEIAI:)'IIN/AIN'TIC.CSA^C UI AINTS W1'T111 1 1GI111 RISK OF I7S11':I'I::bIw 11 � AGUE 55 YEARS OR 01.1..b1.1't 11 E r IEC:TICDIN 1'''1R01\11 AI,JITDIV CD1'Mll r.,1\110'TORC.Y0 1'':,G01 1'''C:ArD'T/A'7I"V oir 111CS1'1"IF W1'T11 AINATCDIG1C.A1.INJURY h rS1 I,JIN'T 1111 Arb,CI 1 ST oir AI'SrbCDIVIIINAI.'TRAI,JIVIA A IPATIr:IN'T S CDIN AIN'1I"IC OA('UI AINTS WI'TI 111 1 IGI 111 RISK OF 17s1 r r I")I1NG NIEC'11 CAINIIISM rbr.A'TI 111 I IN SAIV IF IPA Scar IN('IFIR C 01\1I'ArD1l'IVIr:IN'T N'7I RIJ"'101N IINC':L.I,JrbIING GDOO '>12 IINC.I IIrS ONOC,C IJFSAN'T rS11T.„oir>111^S IINC.I IIr!S ANYrSITIF INTO 1I'1'Ilre ISA•SrSI!INGI IR OFIIIN.ICJIGY C.CDIV I'ArD1l'IVII':IN'T VF1 111CHE 1T r 1VIFi'TRY"bA'TA C.01"IrS1 IFINT WI'TI 111 111(3111 RISK OF INJURY, FAH,1.1.1.0 r r FT o it IVI O RIF AIJ'TO V S I'r rbr:,'u1'r IAIN/I'SIC':NC.I Irp1"'"1IIrDCDWIN,rDIJIN CDVI':rDcplr WI'"1II IIVI'AC.'('arDl':A'r.rD'"1IIAIN 217IGI'1II m, IVICD'7I"CDrDC.NC.I r:/A1'V C.rDA,r'u1II W11I I II rSl�'r::l'I,b •2471`aflll�'111 rra car r I" l r+rr""&n'Anr°�n"° In I h0k,q M"r,r rn"° r"r rt.rnrn alert. r'M'r "Cron rr rr'rrrl ;tuf,p r'n n" Im ft',.1V�I'ro°Y C+,,r, PARAMEDIC JUDGMENT: ❑ 1.Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. 2.Excluding superficial wounds in which the depth of the wound can be determined. 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.Crushed,major de-gloving injures,mangled extremity or deep flap avulsion(>5 in.) 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. COMMENTS: ***DETERMINE PT.DESTINATION HOSPITAL FROM TRAUMA HELICOPTER AND CALL HOSPITAL WITH PT.REPORT*** 9-15 00 0) N `I PEDIATRIC TRAUMA CRITERIA FORM CJ N DATE: CREW: / RESCUE UNIT: p c PT NAME: AGE: DOB: y TIME OF MECHANISM E INJURY OF INJURY y 3 AVDV 11 ONE:::: TllTAV,U IA All EVT"V"'(D`61'''11 C":1 VD 1()SE,ONE) N AVE'IWA''h1 t V1 TMII+' I _;'I'�',0F,'[011I 1'r1,II.II "MI,It , ` r II"IIj r I 1 110 01'l 1:JVTV::1..PLATV1':1VrJ N r.,TI"I 1+ 1 , "ClrnrnlIlF M t F1,,1:'.I M 01 'd"d"''d .mT Mt L..IS or 1'1,1"71!!:N+ I IN '',�"MI'+I M r.m":;;";::rr.ml ,m1'1+ 11;"' IN S 1:11 No",1 r 1"I11:J 1' II II'1"r°"'::rr 11)SS IN p VEVaVN1''!IVV..V "hV' 1 'I";M't 11 11P "r.+ ;1 rl+ Irk!!'1 110 11 1.'S"t I!) A V";'b"';:;rr 11,1 1M t'fr's''':'r I 1111:1 010I'J'''"M't 016''M I''"fA F' t l d l:'.lfli F'11.,T l!!'. SOFE"'TVSSP .PE 1 1::11 1'11 t R,10"1011'I II'I ILI IVY'or+51AVi 1!)1Il 'M1::'M;Ill 1, t 0160 or XTIM I'01 t"''Y" IrI",11:N Mt11"I'I IN IIll 1 PII I: or MITI 11 0 o r 1011 S"+1 t t'1161 11 1 r l",m U 11't 11,111'I or I I Y 1,11'�'I"':t f:i.K I I"1`t LONG V':16ti:1NE 0I1I:I1,I L 1"I'I+5 I''."1:"I',I I 'I h„MT 't"L.I Irl or I'r11.1 I t II'I I I"I'1,'M+ t I I Irl .f>I"t F.;or I'r11.1 I t II'I I IFI"f>I 0+ Mt"11:"I'I.;I t f.''> I V V r.AV.TV..uRj:, 'i I IIINI Id MIM r IdI';T MI I01111'I MI t RPJ11 l ,ll',11'Mul l''f SlN'ItId l I I I IrllIA5IFI"'i""tlrlrl l'1or1"I'I+ I:NIII'0o+J;'r11',I or �F+ MI'It1+ C"Mr`III MI',I"fS; N'ItId I d K5 I USK IN I I I f:'r11l � .;1 VI U MT I'"M1 I I'I II I r I "b''V t I I IU"S;1 I t I d 'MI I'11f M'r+0110 1:1�1"I',11";1!' 'a N \AEON°TUwMVDVVEUUN II tRiNr IlI1i1!)NIiIrlIK5 I ITl'IIl1+ IITI,II'V'tN'ItIt II )SS I!)II M III"I 1I r1" 'SllIrSI IMl' ;1+.:SS or IY111 "IsI!"I II',I.II.II'VY' V (. N — OF IIVwoVUV.U 'I', I I III'I d" MI 11 1 H)1'r111',l o"J or Idl!!'. T t%'d..I I'r1 o+,I 11''011 INt 1f1il Id Id'M)10 1"I ''r"SI' i 0 1I i!)VS,111 1rl"fSTl,l MI'I,I 1+'r+ I I";T d"Id1 1"VI\i ;I'll.11'I 1"'M 11'1orlN'I'"Id 1110l MT t +`Irl!'r+,t I Ir tI1 o'"+,I'I 0I104'11d L LL d I I11 f II!)I'1 I I111"I'r1 MII q1";r''M't"''M +`IN I +:r"MIor 11011,C1 1Nl'I" .,1+ I'IS 1"I'"11NI1 III'VY' O M — ANY E"'WO=I RATUNIA ALER"F(ONLY C"11 VC'EOSE E"'WO) LL P .V C.IIIVG."WAE"'IIION C.AbDCD'V II b or 1 FeIVORAI 111JL,F,u1 S hIAH.IAISI F 17UJ'T'TI III.RAI")IAI OR h'Fl`)Al h^FJI tali.NOV F^Al IhIAISI ll oir '90 Irrdlrnl o 'a '16- E d DIIIISABIIII1.111"VI"Y 11 Al")IIN.JURY WI'TI11 GDruS OF C.CDINSC:ICDFJ AI"'uS,AIVIINF:,F,QIA V! CaO IIIF I IIIICaCaUE .JF11117""e f XV'RIF1a'111'T I'blruL.G'DC': 'V"IG'DIN 'L LONG'S BONE V mr rpIINC,I.I'r:I CDINC,I'aC'DINI I"GDAC"V FJIDF rQIV'Flr'rrlr I'blr'QL.G'DC':A'V"IC'DIN I] FRAC'1 1UVGE R= SAFE WIFIGI IT<221C(f3 E 1 IEC:TICDIN QF'ARTIAI orC:CDIVI'I FTF:)F'FDCDIV AUTCDIVCDFSII.F: I F.A'T111 I IN•uAIV F:F'A SF INC IFR CO L NICIIANIIS F VI I INTRJ,,10I'NINip1`JF IN bIGR 00 F'>1.21N C.IIIFS G'DIN 0C.C1,J F^AIN'TS1VT.„o r C.>181N1111'!SA IN YS1TF1N1011 1F'11I^A•uSFNG R E I I VIF1 111CHE TF FIVIFe'TFDY`)A'TAC01"ISTI'IINTWI'T111 IIIC'J111lOF'IIN.II,JFDY' FAH,1.0 1 1 1 V or 1EICDIRIF or 2-3 V MIFF V 1 F II IGI TOF V I IIF CI I11111b' Y"r"Mrr�n""" tn+fr"h:r�n r"r"rr rV"° r"r rt.mn rr1+° '',IvIIVO Y"rr r rvrlr+ p"dgrrvgs rn,h1V I'ro°Y D+,,r, PARAMEDIC JUDGMENT: ❑ 1.Airway assistance includes manual jaw thrust,continuous suctioning,or use of other adjuncts to assist ventilatory efforts. 2.Altered mental states include drowsiness,lethargy,inability to follow commands,unresponsiveness to voice,totally unresponsive 3.Excluding superficial wounds in which the depth of the wound can be determined. 4.Includes major de-gloving injury 5.Long bone fracture sites are defined as the(1)shaft of the humerus,(2)radius and ulna,(3)femur,(4)tibia and fibula. 6.Long bone fractures do not include isolated wrist or ankle fractures or dislocations. 7.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 COMMENTS: ***DETERMINE PT.DESTINATION HOSPITAL FROM TRAUMA HELICOPTER AND CALL HOSPITAL WITH PT.REPORT*** 9-16 N N LU _ 0 O CU O O QL LU < > LU 7070 rr� 71, y t Yt � O Cn LL m a) .. L (6 fn f a T f cn din O O � W O � 5 a Q a) a) J L 0 0 0 M : o . 2 e � m It m 3 » I e \ % % S 5 \ $ % q % \ %:\:2:\ &:\: : 0 6:6:6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6:6:6:6 6:6: : LLI E C § \ '6 \ 3: u: : o t 'E »' _:•-: : ®: : e G o 2 § Q) ® ® s: : s: o: < e & 2 t s �:t:� <:®:_ u o = — e u \ u e 2:2:�:� : co e E : .:2 m 0, : 3:> / / _ s _ / ±: X & : _ '- a .��g o: = : � « o e U < y G ¥ o = � > elm: =:— � % o I — t o o: oig 3 ¥ 9 @ @ y e 3 .e E x \ $ e »: �: �: � (10 �: e: o e e e m = @ 2 0 0 •- 0 2 = e u:t;t;� >: s ® ._ •- .- e e @ o # P:2:2 ° o: o: : 2 '-: 0: / / '_ % E 2 Q Q 5 .@ e s:�: e:� 2: ~: o L _ _ >: _: 0. e — > s, e �:s: : o = _ c I = e e e f s � I 'z:•-: m u;.-: e:—: = m s = = E ; o U > e < .� .� 9 e = E e e: U�O: U •-: : « '-: B: % / / � ° \ •E 4-1 � 1_ \:� � CO : v ¥:3s .E •- •- E ) E o e $ a :� E:s: : c .g .� � ,= 2 e / s e e — _ 2 0- x: \: /:Q =: e: e: o P ° ) § § / % G /:/:/im' � E � � a \ ) ._ ._ \ =3 = e 0 2: <:<:< < < < U U 2 2 2 2 2 w W LL > > > 2 2 2 0 ;> 0 M Adenosine Triphosphate (Adenocard°) o f11r�fff' 1/1� Wa *,w* o�; ACTIONS: Adenosine exerts its effects by decreasing conduction through the AV o mode.The half-life of Adenocard (Adenosine)is less than 10 seconds.Thus, �i its effects, desired and undesired,are self-limited. E Adenocard is indicated for paroxysmal supraventriculartachycardia (PSVT), � including that associated with accessory bypass tracts (Wolf-Parkinson- co White Syndrome). o u4yV1"fl"IIZ,i IIV1Vfll(i flllON%.' Adenocard is contraindicated in second-or third degree AV block and sick sinus syndrome(except in patients with a functioning artificial pacemaker), and known hypersensitivity to Adenosine. / WARNINGS: Adenocard may produce a short lasting first second or third degree heart Yp g g block. In extreme cases transient asystole may result.At the time of t f conversion to normal sinus rhythm,a variety of new rhythms may appear (PVC s, PAC's, sinus bradycardia,sinus tachycardia,skipped beats, and varying degrees of AV block)and generally last only a few seconds without intervention. P II'`.V".fe A hJi.11��'ION,�;� ........................................................ 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. Ile o°Jiiiafi 0c 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. Thi cue/AdJoin I�Iiroflille: Oinset I)ealc [MiratJoin IV: immediate unknown 1-2 minutes 10-1 N O M Albuterol (Proventil®, Ventolin®) C5 0 All 3 s co R AC"IFI OILS: a Albuterol is primarily a beta-2 sympathomimetic and as such produces bronchodilation. Because o of its greater specificity for beta-2 adrenergic receptors it produces fewer cardiovascular side effects and more prolonged bronchodilation than isoproterenol. I IN D ICA°I"I GINS: Albuterol inhaler is indicated for relief of bronchospasm in patients with reversible obstructive airway disease including asthma, and COPD. COIII "I""III' IIIIIIIw' IIIC "I""IIIOIIIS: Albuterol is contraindicated in patients with a history of hypersensitivity. 1AVAIIC II I`YYI III I`YYI(„3S: 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 AP.M S RE .C"I"IONS AND SIDE E F F.E.C."I"..S.1 Cardiovascular:Tachycardia, hypertension, and angina. CNS: Nervousness, tremor, headache, dizziness, and insomnia. GI: Drying of oropharynx, nausea, and vomiting, unusual taste. DOSAGE: Adult: 2.5 mg of Albuterol in 3ml of NS to nebulizer and flow oxygen 8 liters/min. Chlld: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 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 Desk Duration Inhaled: 5-15 minutes 60-90 minutes 3-6 hours 10-2 M O M Amiodarone (Cordarone) o ACTIONS-. � o � Amiodarone suppresses recurrent VF, prolongs intranodal E conduction and refractoriness, negative inotropic effect. E 3 j s Co INDICATIONS: IONS: y� �M, 7k d Ventricular Fibrillation R Co "We Pulseless VT o i JNAC Tf 0, PVC's greater than 12 min with Coiasul FP I Iu� Msiusuaus Ventricular Tachycardias (Wide and Narrow) with a pulse :WO* COI I'I AI NDICATIONS • y known allergy � Cardiogenic Shock • Sinus Bradycardia • 2nd and 3rd degree AV blocks .P.0.5..5.I.B.11 A VF2SF 2 .AC.T.1.QN5 ANP SIDE F.F.F.F.CT. ..® None in Ventricular fibrillation. DOSAGE: Adult dosage—. Pulseless Arrest: 300 mg IV/10 May repeat with 150 mg IV/ 10 With Pulses: Infusion loading dose: 150 mg IV (150 mg in 100cc NS) infused on a macro drip over 10 minsl.5gtts/sec. ��'n1"" 'M14111a���III III:: M14 �aioa�I� &1:" Pulseless Arrest: 5mg/kg IV/10 may be repeated once. No single dose greater than 300 mg. (15mg/kg max) Tirne/Action l'rof'ife: Onset Peak Duration IV/10: Unknown Unknown Unknown 10-3 d 0 Aspirin (Bayer, ° Bufferin°) o .. .... ..... ...... .... .. ........ ............. AC IFIOII' S: o LO o � Aspirin is an analgesic, anti-inflammatory and anti-pyretic,which also appears to cause an inhibition of synthesis and release of prostaglandins. a Aspirin also blocks formation of thromboxane A- 2. (Thromboxane A - 2 U causes platelets to aggregate and arteries to constrict). Reduces overall mortality from acute myocardial infarction. co IINI I °riGN , Aspirin is indicated in the Acute Coronary Syndrome setting to prevent 'W � further clotting. � mot � 'Ado" COIII i"III'° II III'� IIIC ''i""IIIOIIICSm A know allergy to p������ n aller��� As irin (i.e. urticaria, dyspnia, etc.), active GI ulceration or bleeding, hemophilia or other bleeding disorders, during pregnancy, children under 2 years of age. POSSIBLE A M RS RE .C"II"IONS AND SIDE E F F.E.C."I"..S..;.1 GI: Nausea, vomiting, heartburn, and stomach pain. OTIC:Tinnitus. Hypersensitivity: Bronchospasm, tightness in chest, angioedema, urticaria, and anaphylaxis. DOSAGE: Adult: 324 mg (4) 81mg chewable tablets for Acute Coronary Syndromes Time/Action (Profile: Onset Desk Duration (Oral) PO: 5-30 minutes 1-3 hours 3-6 hours 10-4 L0 0 M Atropine Sulfate as Cardiac Agent C5 LO At° :;11O S o o � Atropine is a potent anticholinergic (parasympathetic blocker, E parasympatholytic)that reduces vagal tone and thus increases automatically 3 the SA node and increases A-V conduction. co ` 1INIICA"nQNS: � • 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. C0111 "I""III' IIIIII1�' IIIC "I""11101115: .................................................................................................................... None in emergency situations 1AVA IIC3�'�I`IYi III�I`YYi(3 S: 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 urnaxlirnuiirn Y;luse 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 ADVERSE RE .C"I"IONS AND SIDE E F F.E.C."I"..S.1 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. DOSAGE: Adult: Bradycardia: 0.5-1 mg IV/10, may repeat every 3-5 minutes until improved or total of 2mg is reached. 1'°e64lla i�c: 0.02 mg/kg IV/10 (minimum dose is 0.1 mg and arnaxirnuirn 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 cfl 0 M Atropine Sulfate as Antidote for Poisoning o LO ,M. AC"IFIONNS., o o � Atropine is a potent parasympatholytic that binds to acetylcholine receptors thus diminishing the actions of acetylcholine. a 3 IINI ICA'nGNS: m Anticholinesterase syndrome poisoning such as; Organophosphate (e.g. Parathion, Malathion, Rid-a-Bug) and Carbamate (Baygon, Sevin and many CO common roach & ant sprays). Signs of organophosphate poisoning are: Salivation Lacrimation Urination Defecation GI distress, Emesis,) Miosis (Pinpoint pupils, bradycardia, and excessive sweating. Nome IIIW.neNlusedll1011lt.he«� management of severe organophosphate poisoning. %AA/`A III3I'I"YI III I"YI('��3 m°�18� 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 ADVERSE RE .CwI"IONS AND SIDE EFFECwI"Sn 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. DOSAGE: Adult: 0.03 mg/kg IV/IO, repeat every 5-10 minutes until atropinization occurs. F'°e64Itii,'k: 0.05 mg/kg (maximum 3 mg) IV/IO, repeat every 5-10 minutes until atropinization occurs. Time/Action IPurofHe: Onset Peak Duration IV/IO: Immediate 2-4 minutes 4-6 hours 10-6 ti 0 M Calcium Chloride 10% o AC"IFIONNS., o o � Calcium chloride increases the force of myocardial contraction; calcium may either increase or decrease systemic vascular resistance. In normal E hearts, calcium's positive inotropic and vasoconstricting effects produce a predictable rise in systemic arterial pressure. CO C CHLORIDE CO I iNDICA'nONS: olljecban,UP Calcium chloride is indicated during resuscitation for the treatment of 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 disease. O / S�j ��o� IIIlll� uIIIIIIL�lll ararrest ... i III OIII pm y ar rest not associated with calcium channel blocker toxicity, hypocalcaemia, or hyperkalemia. %A/ ��`IY III I`Yv�(.ii m°�ii: j Calcium chlo ofride 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 taking digitalis because it increases ventricular irritability and may precipitate digitalis toxicity. POSSIBLE AVERSE REAwi"IONS AND SIDE EFFE "i"Sn f / If the heart is beating, rapid administration of calcium can produce slowing of cardiac rate. DOSAGE Adult dosage., 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 IProfiie: Onset Desk Duration IV/IO: Immediate Immediate 2-5 hours 10-7 0 0 M Cyanokit° o (� LO C."IFIONS: ° 0 o Hydroxocobalamin is an antidote to cyanide. It is marketed as E CYANOKIT° in the US. It removes cyanide directly from the blood a without converting any of the hemoglobin and therefore does not CO interfere with oxygen transport. It combines with the cyanide to form R cyanocobalamin which is a derivative of vitamin B-12. Both the Hydroxocobalamin and B-12 are harmlessly excreted in urine. CO IINDI "AnGNS: /1f Exposed to products of combustion in an enclosed space �< Soot present in their nose mouth orsputum 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 COIII ""l""III'° Illlllll' IIIC ""l""IIIOIIIS: .................................................................................................................... None 111\11,A�,tA\,III��',1,'lll�lllll�i��',3S: 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 DOSAGE: 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 0 0 Dextrose 50 % and 25 % (d-glucose) o AC"IFIONS: o 9 A monosaccharide, which provides calories for 501/ mi metabolic needs spare body proteins and loss of a electrolytes. Readily excreted by kidneys producing DEXTROSE �t' diuresis. Hypertonic solution. co Injection, n" y INDI A'n NS: o Ulf mmm ICU�ulu�III iu�drJ ii Hypoglycemia • Coma of unknown origin. "n�Ilueru�rr 0111 �lintrlllacraniallllhlll �.„. • traspinal hemorrhage (in a patient with normal BGL). �r0 Blood glucose Level > 60 mg/dl. POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS: �n ............................... • Cardiovascular:Thrombosis Sclerosing if given in peripheral vein • Local: Tissue irritation or necrosis if infiltrates. • Others: Acidosis, alkalosis, hyperglycemia, and hypokalemia. DOSAGE: Adult: ( 30 kg) 50 ml of a 50% solution; (25 gm) IV/10. F'°'Ie64tii,Tloc: 30 kg) 2 ml/kg slow IV/10 of a 25% solution. l\JeyvA�tl°:o 11,' 10 kg or<� 1 month of age) 5 ml/kg IV/10 of 10% solution (dilute D50 4:1 with NS). Time/Action Profile: Onset Desk Duration IV/10: 1 minute Depends on degree of hypoglycemia 10-9 0 M Diazepam Hydrochloride (Valium°) o lffi in Q o a E E 3 s ACtf`I GINS: can R 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. y IIMDICATIOIMSw o • Status epilepticus, Premedication prior to cardioversion,Agitation due to acute alcohol withdrawal, Drug induced psychosis,Short-term relief of acute anxiety,Cocaine intoxication CON'TRMNMCA"i MSS ................................................................................................. • 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. I511ll CAL II Illl \,lS: ...................................................................... • Pregnancy(except for control of seizures associated with status epilepticus or eclampsia) • Neonates. POSSIBLE ADVERSE REAC"TlONS 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. 1,1 e rluflaiR:ric 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 IPiroiiile: Onset Pealc 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 M Diphenhydramine (Benedryl) DRUG FORMULARY o � o - L O Olphienhydramline ffidrochloride [S nadr I E E AC'�p �I d Ai yy��? m L Dilphierthydramine is an antilhistaminewith a;rntNlydn011in r dry(drying),arntd R sedative sidle effects.Andhisaamines appear to co miIil with,histamirve for CO L c ff receptur sites oin effector c dd^s,.Di h tnhydrairl prewents,but does noto reverse rs histarnine mediated responses, art Irby histarnine effects on the snvaotrh mumsrJ ttmrtrrnchiadl airways, ,astrr mien rn d traM uterus,and Wood vesse ds., Allergy symptom,anaphylaxis. d tNl a w'iol rnf paUent, Dystrmmi-c r a tlNrtrns from phNernrtthd t.Nirn cNerdose(i.e.ddaillidol, Comill Th rm,t um�m ,and t ill ,rdlm ). ddn h rnhy drarrmine is nod dry be used in,newborn:born:or premature infants. Diphenhydramine is,not to be used dlmi patients h acute asthima attack WA Ini i n^d lmdrs and chidlldir rn s �e d idldy,,arma�tihdnst amiilrn s in,owerdlose may cause hadluicNNrN tla Nms,convulsions,or death.As in adiults,antilnes may inninish mentat r*ss in,children. In young clhlldlr im,they may proldisce rdidation.DiphenhVdirairnine his additive effects with alcohal and orthi r CNIS, depressants,(hydro; tics,sedatives,tranquilizers,etc.).Antihistamines are ri fikelyto arose d INw ss,sedation,and hyWtension in the Id rl �60+ears,or o r)patient AMME REACTMAIS,AND SIM IF1FTNON"r5; Drowsiness,canfuroon,irtsomnia,headactive,vedigo(espedailly iin the edderto1. cardsovwcWar-Palptations,tadWicariffia, fir and hypotension, Wiratt N Thidening lolf brN achiadi setretkim,fiotneu of the udot,,whee:ft mill stuffiness,. +IIr Nausea,vomitA&dai dry m,oAh,andl csrr bp9 W Nt snnrna ,urinary uvinary ret niNd m. P9M n 6& ',,,,.,, -so,inn Ifi or 5o mg,deep nlrrr. Y"vHavfilatrk"':, t W10 w im( slilrmu 2,5 b ). TimeOction Profflc Cirmt peak Ouuratu rn Ii Ir ri L I Dr,Sain=Saftmm"tn,.cm. 10-11 N Dopamine Hydrochloride (Intropin°) M 0 Dopamine stimulates dopaminergic beta-adrenergic and alpha-adrenergic "fj yf receptors of the sympathetic nervous system. It exerts an inotropic effect on the myocardium resulting in an increased cardiac output. Dopamine produces less increase in myocardial oxygen consumption than does Isoproterenol and � its use is usually not associated with a tachyarrhythmia. Dopamine dilates co g ' renal and mesenteric blood vessels at low doses that may not increase heart rate or blood pressure.Therapeutic doses have predominant beta adrenergic co 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 vasoconstriction and marked increases in pulmonary occlusive pressure. INDOICATIONS To treat shock and correct hemodynamic imbalances, improve perfusion to vital organs and to increase cardiac output. CON Dopamine shouldslhoulld not b 5 e used in patients with pheochromocytoma or hypovolemic shock. WXl \fl ot .... I II� , Don 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°). POSSIIBLE ADVERSE REACTIIONS AND SIIDE 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: Adlulllt and I11,1erJk'I a ic: 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 DSW. Time/Action IPirofiile: Onset Pealc Duration 4 minutes 10-15 minutes Continuous with infusion 10-12 M M Duo-Dote T"" o (Atropine and Pralidoxime Chloride) o � o � AC;1 I O N S: E • Blocks nerve agents effects and relieves airway constriction 1-5 3 and secretions in the lungs and gastrointestinal tract. a co • Acts to restore normal functions at the nerve ending by removing the nerve agent and reactivating natural function R co 411 o INDICA' IONS: Suspected or confirmed nerve agent exposure � II *, 1 i � � OIII I III III 1 Illedicatilon Both medications �IIIO s in the kit should be used with caution (but not withheld) in patients with preexisting cardiac disease, HTN, or CVA history. POSSIBLE ADVERSE REACTIONS AND SIDE EFFECTS Chest pain , ........................................................................................................................................................................................................................................................................ exacerbation of angina, Myocardial infarction, Blurred vision , Headache, Drowsiness, Nausea ,Tachycardia , Hypertension, D' Hyperventilation lu DOSAGE: 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) !I )H'1C: DuoDotes TM are not authorized for the use of children under the age of 9 years. 10-13 d� M Epinephrine 1:1,000 0 err / 1i co R ^,�Y^s�^,Iy coAC' lIs„��I S 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. lNDlt';A'IIIE1NS • Asthma • Anaphylaxis • Angioneurotic edema C �IT`II'AIIIII�IICATIIIS': ...................................................................................................... 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 IINI If NI G S: ....................................................... 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. P�055.1§ .IE AD1/ERSE REAC'T"l®NS AND SIDE EI=I=EC'T S: ....................................................................................................................................................................................................................................... • CNS:Anxiety, headache and cerebral hemorrhage. • Cardiovascular:Tachycardia,ventricular dysrhythmias, hypertension,angina and palpitations. • GI: Nausea and vomiting DOSAGE: AdUIlt: SQ 0.1-0.3 mg(0.3 cc). Repeat every 3-5 minutes(Asthma/Anaphylaxis may repeat once in 15 minutes). Ill'e:o„:Jiiiafi1c I 0.01 mg/kg up to 0.5 mg. Time/Action IRrof le: Onset: Pealk Duration SQ: 6-12 minutes 20 minutes 1-3 hours 10-14 LO M ISLAMORADA FIRE RESCUE DRUG FORMULMY o 0 L 0 pinkph " e 11:10 000 E a 3 CO Epinephrine a r om.iametpc hick st*nulates 1w1h Atpha and IB c recepmrsa As, ,resuft of ks e'feds,myacardWi and cerebral� IY k)odl flows are CO increased dlLwing ventwfabmnrm arrdl chest a trnrrmpwiessmrsrm. EWephrime irKreases 0 systernit vasc.War ras s arm a andi'dws rrna ardn;arrca dafi rriMatiorm.. a � 0, M Ilis l s Arrest VenteicWar Fibrillabon uniresponsiv* d ' oFIIllat ��ratlr ��m Orbef adb tric kndk34°isaarmsm hypoterujon in p;abeats»with circulatory Ytl M!6"MlM1 MM✓MMM finstabilky,bradycardwa(Ikr fwe Atraone)(. ,,� Itraf�rrrmicmoii �1 tlMM"Jl==n s� 1 Norma knii the cardiac arrest situaftion. Epinephrine is mrmar_° ad Vb ailklkne,saadrnais'-never msama+rriaw Sc&> m t ale,Its not mKx lsopra ar irwAl and Epinephrine-rasu llts in exaggerated re.Wime.Acfions,of catechiMamines,arts depressed by acidosis -arstmarnti n rim ventilabon and cWWamt rn is a'ssmamrmatnlaL Antidepressants essarnts petenfiale the act of epinephnne.,,. IL ILLMLL", Anxiety,hoadlache and tarn brW Iheow . Cardiovascular.Tachycairdia,mmarnrracmsaN,ar d)sr�ai nthmias,M hypertenswn,angina and IpMpimions, Gk Nausea and,vomiting. Adult: (1.1;0, )I,trod(10 rrn of 11V or 0,ralp vwy 3-5 minutes. apaat ;a" - minutes.If Patient is in SEVERE arena "aams with mairkmdi hypotension,you may stars an Wand adrrrrcrn ar 3-S tar of a 110,000 soluboviM siolw ovw 2 minutes, rrti rrum"a (L irjkg,,Its.t rrmit/kg W m)r I10,I Repeat eves —5 a mrmlirr�mw r,s� rmrtr ltm'iurc;r POST AftACST,i0Amm,cg/k jnr'miuu;m IMix 1mg w;,mt Up mirmrmr 11) A INS- a rmirv, *,r mwrboiran of Iuura,;;g/im l T-jWraw/AL4ivm rmuuffle; Orin et P mnerfrci Dzu tlmaipim n Nebo: ai�wsd 1-,2 mirmuras 2,01mrrminutes, Epinephrine 1:1�0,0010 Dr,daramra r,DO. 10-15 cfl IS Lek MORADA IFIIIR IE IRMUE DRU1U UORMULARY 0 Ci ............... ............... ............... ............... ............... ...............11111111"'I'll............... ............... ....... L CD 0 Furosemilde (LasixO 1 E E CO CO A stiftinamMe deeivative atumid patert diurefic,which inhibits the reabsoqn ion of a sodium and chlovide in the ipnrtwsimal and distal renal tubules as well as in the iLoop of innHenley.Has a direct wenaditainn effect.in,ac!u:te puinwnary edema.With IV administratiDn,onset of venodilating,is generally within 5-10 minuties,diuresis will usuaRy oaur in 2D-30 mimAes PWrilonary,edema Antnia,Should The uised iin pwegnancy on,fiy when benefrt3 cWarly outweigh risks, Furosernide should be protectedfrom fight. hydr i sand efectrolyte imbalance can iresuift from,excessive idlosages,IRapiid dhoestscao leadl to hypotemwon and thnawnboembolic episodes, CM;IDizziiness,,tinnitus,,,hearing iloss'headache,bduirredviskm and weakness Oil:Anorexia,vornitinc and nausea Carldoowascukw:lHypotension Otfwn lPrurit�uis,urtica ern a and mpuscle czarnping. Aduk IIIF.80mgllVPcwdoltd),Ie tau eW�iemit dloseup,t�ofmiaxl,00:mg. Cardiiop"ic'Shodt.40 rng IV stowly oveir 2 minutvs(If systollic Woold pressure is>than 100 mm,Hg,), firnp/Ainion llPrcfihe Onselt Peak Dur-afion rMa S Minutes 30 minutes 2 hours Fur oseml:iidt (Lasik*) OF.San&a&Mvnmrw,0,0. 10-16 ti ISLAMORADA �FIRE RESCUE DRUG FORMULARY 0 Ci ................................................................................................................................................................................ CD E Ux,dbmls, j:Ql Mitt E CO 31 COO Beta-adirenev&agionist causing bronchiodflationi and refaxabon ofsM1004h rntsd4s of Wl always that has,a durabico of up to,8 hours. Treatment for bronchospasm., Hypersemi)W4 to,Xopervex or racernic A&LAerol. Should be d °nuad if Off'Prolongadon,ST segment delpression,paradoxicW bran chospasm cw hy per sensAvvity reactiDn occurs,such as urtcada angicedlema. 2) rash or wal edefna. CNS'll Headachle., Neivousness,Seizure.,Weakness,,Syncope,Tremors Catdvvat*culaw- T&Jrycawdia,Ct�A pain, F`WpAatk,ns, Hypoka$*Knia,Hypef- Hypotenvoin, ll' D,OSAG,E-, Mutt, 1'5V yeaws of age),0.63 JUA)mg viia nebuft-w (6-111 years,of age)0.31 (3ml)mg v*a neburwer Chikkmover Ow age 012 miay 1.25 nV via,nobvWer for eves asdma that hao not moponded to#to ini"d4sage of 043 Levalbuteirol (Xopenex) Der.Sandrai SOiwwr"r,D.O, 10-17 00 wr M ISLAMORADA FIRERESCUE O DRUG FORMULARY p MagnesiumSulfa E CO Mapwsum pfevemU, rds rmma mrd by Mocking neuranvuscular tunsrWssion and decreasing theanmnt of acetWicholine fiberated at the,end-piate lbq,the nwwr c rnerw ivnpWse.magmsaum is said!to hwe a,dtressant~on the reMad nermus CO t s"tem„but is does attactmother,fetus or,necoate wfien,used as,directed am 0 artar ms is an of jtr siia Mag n trarrn arts pard Dy to „ a wrasc>tdidatati mm therefwe a drop iorsystWic.lair is to be anticoatet Prevention and corarci of semures in,edampsia Suspected,hyqomagneAsmc swe,[i. .ctwonic alkohiolism chrook use of diuretics), wN acta m mtt r ar Wil4tion Wrartmy Asthma MIRMINWIGHL Parpnteirad adifimislTabonofthe*ugrm aindi t in pat wants;with htart r!k or mityardisi n aigrmai ,. tlrd�r r p r IY i f s 61x�°�, Nnontrarrarrooaas use of ttta nesvarn White should not be gwarm to mothers wkb toxerria of 4AUTION, pregnancy with armt defivero.Magnegum Stud ate inpection,tr must be h i s INA641 iiU a ancentration Ids prior to W utmt'am because rrma nmavurn ts rentmed from the body w1eily by the knineys,the drug should be used with cautirm in,patients aawwltt renalOrnpairFrent..Monkorktg the patient's diti ah' status ns ementiali to avoid the cansequonces of an+wmarrdan a in eclampsia.caldum t adarr s rnooul d be kranediately wvagaNe,to,coun—teract the,jpotewtW hazards of, stnrrrr oflaxicatmnin artao to nms ad hypennagnesiumirKtude r a e ras absarmra of Waddar(eflex,etc- Advefse ns"wts of dl tWas a mt Suffate rr"are uwa y the rasonnht of magnesium hrrtr x"Wnt,.. Signs oslNf hypermagresernia iWude.flushing,sweating,hypotension,dew„ ion of reftexes,farmed,paratos,h pathanrmm 3,arnad rNrn:mr amary rarbpse,depression of cardiac kwiction;M rarotmfll nerems system d prays -;ymptwm can precede fatal Parai vets.. t Cm in,20 rr W over a:rmmirntstas P ( i as r9k' a- � is r snid,Wmimaered over 1-2 rnm mites;)t dared bar a maintenance trntsaisio (t gm in 250 ammdl of NS aadrrn*mstaraof at 60 'rrn u). "t'iMP,I/Af"' M Prrmt'NA� :".. set. Poak auratraM: Iiii �: Ommegfiate U4wwin 30MMMW Ntr.r- a w 0. , 10-18 ` may,, D RC RESCUE M DRUG FORMULARY O ci ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, L O lACTI,IDNI R Decreases inftammatory effects, via its I t an dimlan mat m o synthetic steroid. r, Ast hixai AnaphylaxLs Head Inju.r" jCDPD None in time emergency setting. i GI hemlDrrhage,reduces leukarrines ofimmunesysteim and increases potential for infections SAG dnnllt 125 migslow over 2 minilutes f'I,.,arron; ig/ (imax 125 I )rV slow over 2 minutes Time/Action Profile: Oinset Peak Duraition iW10" Unknown Unknown Unknown t yll rednis N rl 'e (Soler der a uapred Or,San&a ,,, w 10-19 0 N M ISLAMO"DA FIFE RESCUE O DIRUIG FORMULARY � O Ci .,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, L O Morphine Sulfate, (NS) E I � L Morphine rgst ine is a n ro tir ,raftefir which d*Wesses the ,Ir l orm s,and reyspirworV,s,^ t Iran avid s mms tMitV to tt mrm„Moriftne ahoincreases v,einous capackance,decreases venous reWim and Utr duuces mild perq*er' dU mr. adddl ,t tdturm,. i INabdUdlVt, �N"N ��d";� Pain associated wait m uH tedl extre.mkV fracture,renal'cafic,,burns, Head tfa(Unla Acute asthirna Known hypersermsdtiiv tdw to MIS, ll 2GrU ui I d ma,N Morphine hire is detoxified by the liver,It is pefternfi ted by alcohol,antjh iunes,bs rbkuur a sedatives, nd beta Mockers, IK t SE IR 111l t t mt 111`t Iq�u"t N&Euphoria,drttttusi ness,IpupiollUerwy con mict rt and respiratory arrest,. Cardiovascular: Bra(dVcardia and hypotension, E Decreases gastric motifity,nausea and vomhing. U-.:Urinary retention, Rosoiratorr Opomchoconstriction,anddecrease cou&reflex, DOSME: ,d uitt .mg,increments lid slloramw'dy,,Repeat every 5 minutes tmrmtnl desired response,is dcd evedl ( maruaom°u'rw!rn dose LDrng).Can two Oven 111M, P'aw't4arate 0,1 Ism gj lIV slowly,Imo,repeat the WWII those X1 in day minlines. ki 0.05 mg/kg mg/kg IN slowly,delay,meat the,initial dose XI in 3-5 rtmunuste:s. U' ° e id '>lp minutes s Iltuetur Morphine, ; lull S Or, r,D0 10-20 T- N M Naloxone Hydrochloride (Narcan®) co o � o � r co i At",tf IIOINS° 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. iI IN Di CATI1 GINS: �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") CON't"RAINDICA'11ONS� ................................................................................................. Known hypersensitivity to Narcan. ...................................................... 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. P(.SSII.BL.E ADVERSE REACTII(�NS AND SIIDE E fl.CTS: ........................................................................................................................................................................................................................... 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/10/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). 1,1 e rJiu):rIIc 0.1 mg/kg IV/10/IM/IN PRN. Time/Action IPirofiile: Onset Pealc Duration IV/IN/I0: 1-2 minutes unknown 45 minutes IM: 2-5 minutes unknown >45 minutes Naloxone Hydrochloride (Narcan°) 10-21 N N M ISLAMORADA FIRFE RESCUE0 DRUG FORMULARY � O Ci ., ., ., ., ., ., ., ., c Nitroglycerin, (Ni s N"Itr li al Spray) CO Nitrogivicerin t,a direct VaSodifator,which acts principaill on aline venous stem,although it also produces direct coronary arteryvasoditatation at CO L well,There e is it decrease in venous retuim,which d trea ss the workload ❑ on the heart and,thin,decreases mVccardral Mgen demand.Sublingual nitroglycerin is rapidly,abitmbed Pain relief occur it ,one to two minutfes and therapeutic effects rarm last up to 30 minutes., Chest paiirm or discomfort associated withsospected AMIL Pulmonary edema mt hypertension., Ui llltIA]RE)KfiftDNS'; Ga srtrtmc I II 0 m"rum i i l Children under t . Patients on erectile dW' uruttirtru drugs that fall within time parameters(Le. c.36 I uumui-sli Know hypersensitivity to the drug Evidence of a p s ive V4R is the,settinE,of arm lutterior wafll MII lMlffitt.AILI'l lu,.,➢III°If mew rtraigly erin tablets are irrmartiurutted by light,hear,air and Maistuvre. Must be,Ikept in ambe.r glass contaifters with fight-fitting buds.Do not Leave cotton in container Ante opened,mmitr yteiriru has a Muff, fide of 3 rttonthis.Do not shake l itruuling ual sprW.Akohol amumlll accentuate tteturtdluMating,and hypotensive. effects.. N .Headache,dizziness,hushing,rims and voTnitirr .. Cardiovascular. tesm� onm rieftex tadyK irdliia,and trradycardiva. l G g Ault: ll mg( tablet or I spray sublingual),May repeaut in .. ',minutes pltl . Time/Action IlProfife., ilirtuuet Peak Duration l; 1-3 minutes unknown 0-60 minutes Nitro l From (NitrostatID NIliitrurufinguall Spray) trm. W ,. 10-22 M N M ISLAMORADA FIRE RESCUE 0 DRUG FORMU LARY' � o 0 .. ... ... ... ... L O Nitrous�Oidd e E CO v IDecreases CND p r rm l f pain, has apotentanal effect n L df idwdil.,Af I�.��NS: l a m Irn , aglement for trauma or medicad emergendies El renal calctitus,ABD p n, bums withoutrespiratory invioNeiment extremity intunes whem shock thypotenston are not yr W- n . Hyvotens'�lve f LOBi U �NMuo"�Mi�ircullmNN112 L Any altered LOC such as ETOH or drug abuse COPD CIF Sum^ p m fed head drmimrry,fati ll or chest trauma Any umrrrn�of shock oir hypotension m xcept AM I NEVER urm C I F Emergencies vai 'Patients ou ld receive oxygen at 4 Ipm f(m ,10 Irminintrdes after discor"m lrmur rtce of Nitrous Oxide POSSIBLE.AE)VERSEREACTIONS AND SIDE EFFECT& Sedation, nausea;sea; orrmrdtmr g, alynea,dtawsiness r 1 DOSAGE. Achill* Selfrmmarnint the pefient ,:a a face d mixture ur % Nitrous, d 50' Oxygen dl°rne,,°°> ct:,,vo i Prcoldd Of smm f f du Duraboxi Ilmumrmf r .' Rapid 2-3 immutes Shaft actiry Nitroglycerin, it r s Nitrolln ual Spray), Ulf.sarwra SOMMMr,D. , 10-23 Iq CN m ISLAMORAVA FIRE RESCUE DRUG FORMULARY E O'rah ,Glucose (meta Glucose) E ❑ ACTFIONS�, increases blood glucose levels stoWy J kL1 BS>60,rTTd1,patterylts w,hio are aftered but a len enough,to take the commend�t allow, Patients unable to swaflow or Stroke symil p R F" UIT,I() (111 v .......... Noine when patient can swaIllow,risk of aspiraticm rf given:impiroWly, ADVER E RIEACTIOINS A111D SIDE EFFE(TS- Gil:Nausea DOSAGE: Adullt., 1 tube 1,tube I ime/Anion l Onset PeAk, Ouriftleft ll 10 ml�nlwtes unkrwmi UnkrKm" 011 Glucose (Rasta Glucose) Dr,San&a Sduwmmwf,D,Q 10-24 N M ISLAMOR,ADA FIRE RESCUE DRUG FORMULARY U!R ARY � O Ci L 0 Sodium Bicarbonate E a 3 CO L db � 1 Increases PH o revel rsa a ldlm ^s. � r � rrtl �af� � h��w � �L 1 ,� Ina ❑ � ,C' ll .I Dl ����"�GII' r Melabofic arudrsis ral cardiac afrest�. o��u�il flwi� * Tricychic averiloses,with CIRS ,m * Electrocutions cations * I° e alemiai * Severe ket a rldos s i2l°;1 ,i°loll MM aq� CHF and Alkalofic states uuuuuuuiu�uuiuuuuuuuuuuuuuu��iuop�ipuipupupolippi � f r Excessive therapy trnihillbil s oxygen release,reduces the,ability to ' I�Ill�ll�ll�����l�ll�f Ill 11 l li�ul l l l l l l �li�li�li�i�li�li�li�li�li�li defibiriflate,may precipitate Gther medications aind administralion should be guijdleldl by blood gases,plus not give concurrently with an of fair miedlicatioln,flush the Rine Loire and after aIdmINr administration. Metalmolk alkalosis,and inay crystallize in l V solutions,, bons.. 2 I Aduftu W push,then"l thie dDse q 10 rrrrrrs. U ctur cr boils:2 mE 'NP, ��ouF,rrUr�rl i it, -2 m kg Nuted 5050 vvith,NormalSallne lrrmur/At,fi rri Profile; Onsass Peak Duradl�w II /III.: Unknown own Unknown Unknown Sod�iu�m Bicarbonate OIr.Sarwa SWOMMer,0,. ,. 10-25 co N DRUG EM I � o 0 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, L O L V C0 r Depresses CN5,muscW retaxant, strong sedative,hypnotic,and R G rrmnesmi .. Q Control of s irures"sedaticin for cardioversiion& pactng,,and � 1 r�iiri /r Ip spiur tucy depression f l Hypolension� u ��;°;g.. �'M;�T,Yf furl [�o .;� rttmr p tm urt fbr respiratory nd CNS depmSsion,and spt dll signs after administration. P(')S.SMUE ADVERSE III,711 IS AND SIDE li Ili CTS. CN ' RetTograidle aminesia,aftered mentailstatus,and dizziness, Cardi'ovasc ull rr Bradycardia,hyp t nsio-mttm,,PVC ,tachycardia and nodal rhythms 61.rm urs a armed satmrrmitiru "hiccou s and coughing, Respiratory. Re-spiratMrs dl per ss,3on,I&Mgospasm and mroruchalsp&:sans .2.5-5 rang based on pm bent"s mrr mgut maup to 10 rang urriums F"Ceii,rila o,; )l I yeairs of age(0..91 mg/kg)IQU Not 6arninjj=Ltol pediatric Ness than"t dr of agei Tirmupe/Acti rm Perm fie : Onwt Peak Duralion 1V 1-2 minutes, 3-' rrui juat s, Weight d p mrd rmt N I olam (Verse , Or,Sandra w 10-26 ti N M Fentanyl o N N AC IIQMS: o N Fentanyl Binds with stereospecific receptors at many sites within the CNS, increases pain threshold,alters pain E reception, inhibits ascending pain pathways. Fentanyl binds to brain receptors, relieving pain. It decreases the 3 feeling of pain and a person's response to pain. Fentanyl is 50-100 times as potent as morphine;morphine 10 mg I.M. =fentanyl 0.1-0.2 mg I.M.;fentanyl has less hypotensive effects than morphine due to minimal or no co histamine release. c R co • oral r�Uai�i/, Moderate to severe pain in patients>10kg • Acute Coronary Syndrome—Chest Pain (Adult) IMP" • Pain associated with isolated extremity fracture, renal colic, burns,etc. Pt�, u l ff CCUNTIRAII N II)ACAS IIONS • Epistaxis or bilateral blocked nares � • Known hypersensitivity to fentanyl • MAOI use in p Ji UI ast 2 weeks • Unstable hemodynamics or altered \SSA IR II\If IINI G S: ....................................................... Use with caution in patients with bradycardia,hepatic, renal,or respiratory disease or those with increased ICP, head injuries,or impaired consciousness; patients must be monitored until fully POSSIBLE ADVERSE REA."TI®NS AND SODE EI=I=E." S: ....................................................................................................................................................................................................................................... • CNS: Drowsiness,sedation, increased intracranial pressure • Cardiovascular: Bradycardia, hypotension, peripheral vasodilation • GI: Nausea,vomiting • GU: Urinary tract spasm • Respiratory: Respiratory Depression • SLOW IV PUSH-Rapid push may cause chest wall rigidity decreasing,or eliminating ability to ventilate. DOSAGE: AaS'UIltP 1-2 mcg/kg IV/IO/IN (first initial dose 50-75mcg,followed by 50mcg doses 15 mins later if needed) or 100 mcg IM *USE WI II I i C t d II IQ:N ON GUiflA l fRES DUE II 0 SElIVSI'I IC I Y* le oJliiafi 0c 1 OKG 0.5 mcg/kg IV/IO/IN/IM May repeat half the original dose administered 0.25mcg/kg Time/Action Prof le: Onset: Pealk Duration IN: 2-10 minutes 30-60 mins IV: immediate 30-60 mins 10-27 FENTANYL