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Item C10
BOARD OF COUNTY COMMISSIONERS COUNTY of MONROE Mayor Michelle Lincoln,District 2 The Florida. Keys Mayor Pro Tem David Rice,District 4 p Craig Cates,District I James K. Scholl,District 3 - Holly Merrill Raschein,District 5 Regular Meeting June 10, 2026 Agenda Item Number: CIO 26-32172 BULK ITEM: Yes DEPARTMENT: Fire Rescue TIME APPROXIMATE: N/A STAFF CONTACT: R.L. Colina, Fire Chief AGENDA ITEM WORDING: Approval to renew a Class A Certificate of Public Convenience and Necessity (COPCN) to Southernmost Medical Transport, LLC for the operation of Advanced Life Support (ALS) emergency medical transport services in Monroe County, Florida, except for within the city limits of Marathon, for the period July 18, 2026 through July 17, 2028. ITEM BACKGROUND: Southernmost Medical Transport, LLC currently holds a Class A COPCN for the period starting on July 18, 2024 and ending on July 17, 2028. In view of the foregoing, Southernmost has applied to renew the COPCN which, if approved, will become effective on July 18, 2026. PREVIOUS RELEVANT BOCC ACTION: 07/17/24—BOCC approved Southernmost's application for a new Class A COPCN for the period July 18, 2024 through July 17, 2026. INSURANCE REQUIRED: Yes; Mandated by SOF. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval. DOCUMENTATION: Southernmost Medical Transport LLC Class A COPCN Application_Redacted.pdf COPCN_Certificate_for Southernmost Expires_07.17.28.pdf FINANCIAL IMPACT: Effective Date: 07/18/2026 Expiration Date: 07/17/2028 Total Dollar Value of Contract: $0.00 Total Cost to County: $0.00 Current Year Portion: $0.00 Budgeted: No Source of Funds: N/A CPI: N/A Indirect Costs: $0.00 Estimated Ongoing Costs Not Included in above dollar amounts: $0.00 Revenue Producing: Yes If yes, amount: $475.00 renewal application fee Grant: No County Match: No MONROE COUNTY, FLORIDA APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY (C'OPCN) CLASS A- EMERGENCY MEDICAL SERVICE (PRINT OR TYPE) INITIAL APPLICATION-S950.00 L@ RENEWAL APPLICATION-$475.00 ***ALL APPLICAVON FERS ARK N0N-RFFUNDADLE*** IF RENEWAL, PLEASE LEST NUMBER OF PREVIOUS CEWIIFICATE.# 'X -0 3 Part 1:General Informatin 1. LE(;ALNAMt.'OF.SFRVI('F,-. Souith:ern:mostMedlicalTiranspoirtLLI�. _. BUS:INE,SS,MAILliNGAD�DRES�S: i�s,,�'J(A'nll�f,4�%���e,���l'��r%,l,,,, KeyWestFL33040 BUSINESS PHONE NUMBER: 31015-393-9275 EMERGENCY PHONE NUMBElt: 727-,687-1668, E MAIL ADDRESS- fro bt uiicd for all correspondence.) 2. 'TYPE OF OWNERSHIP(i.e.Sole Proprietor,Partners)ip, Corporation,etc.):.LLC. DATE OF INCORPORATION OR FORMATION CIF THE BUSINli"SS ASSOCIATION, 9�27=22 NOTE, NO'9111 EMERGENCY SCENE RESPONSE WORK WITHIN MONROE COUNTY WILL BE PERMITTED FOR AGENCIES OTIJER THAN MUNICIPALITIES AND,SPECIAL TAX.INC DISTRICTS. IS THE ENTITY A MUNICIPALITY?.nio, ........................................ ... ........................... IS THE ENTITY A SPECIAL TAXING D(STRICT? 110 1 LIST ALL OWNERS,OFFICERS,DIRECTORS,AND S11AREHOLDERS(Use separate sheet,if necessary): NAME AGE ADDRESS 'I'LLEPHONE# EMAILADDDRESS POSITIONJITLE Paula Turner 43 160a iwrzii�brKW IA40, 727-687-1:1668 Operating Manager ..................................... ..................... Jami,es, Caton 518 '719ThotriasSIM33040 434-962-1589 member ..... .......................... -----------...... Annabelle Boyd 5:5; 71gThom,asS�tKW33040 :434-466-4727 member .............. ........................ ...................... ...... ............ ........................ ............ ............................................................. .......... .............. ........................................ ------- .......... ................ ----------------------- ............. 4. LEVEL OF CARET0 BE PROVIDED- CIBI'Sonly()4 A LS& BLS or ALS;only IF'ALS: IFI','TRANSPORT'or[:]I:NON'fRANSPORT F Air Ambulance 5, DESCRIBE THE GE0GRAPHICAREAS,OR ZONE(S)THAT YOUR SERVICE DESIRES TO SERVE: (Use separate sheet if necersary) interfacilfty trains:fe�rs with:in Monroe County to Miami Dade;mostly based!out of Key West from Lower Keys Medical Center Page I of? 16. LIST THE ADDRESS AND�/OR DESCRIBE THE LOCATION OF YOUR BASE STATION LOCATED IN MONROE COUNTY,AND ALL SUB-STATIONS(Use separate slicet if Necessary): BASE STATION 9,55 Caro:linie Street ste #101, IKey West FL 3:3,0'40 ............. suB-STATIONS) .................................— ............ .................. 7, DESCRIBE YOUR COMMUNICATION SYSTEM(Attach copy of all FCC licenses); OF MOBILES #OF PORTABLES FREQUENCIES CALL NUMBEkS 800 m,hiz ip2�5 MCS01 2 ...................... . .......................—'................ ........................ ...... —--—------ .......................................... ........... ............ ..........................L.- — --I"' ... ........--- 8'. LIST THE NANYES AND,ADDRESSES OF THREE(3)U.S, CITIZENS WHO,WILL ACT AS REFERENCES FOR YOUR SERVICE: ............. .......... ... ....... NAME ADDRESS, B111 Lay 1965,8 Serninole St, Summerland Key, 33042 ... .......................................... Johan Toppino P01 Box 787 K'W,, FL 3301401 ............. . ....... 1 KellyN�orm,an 21016, Patterson Ave, KW' 330,40, A.- ................................... .............. 9. ATTACH THE SCHEDULE OF RATES THAT YOUR SERVICE WILL CHARGE DURING THE COPCN PERIOD FOR ALL PROPOSED,SERVICES. 10. PROVIDE VERIFICATION OF ADEQUATE INSURANCE COVERAGE DURING THE COPCN PERIOD. NOTE: Pursuant to Section 401.25�,F.S.,adequate insurance means,(he level of insurance or certificate of self-insurance required b�y D,O'H to issue an AI,S/B1,;S license in the State of Florida. Currently, DOII has established MINIMUM insurance limits for Bodily Injury at $1001,000143010,00 and pr'operty damage at $50,010�O for non-government owned :services. Bodily injury and property damage for government services is $200,000, total. For air ambulance licenses, medical malpractice/professional liability insurance for all air medical crew members and medical director is required. It. ATTACH A COPY OF YOUR SERVICES,CONTRACT WITH A MEDICAL DIRECTOR FOR THE COTCN PERIOD. 12. ATTACH A COPY OF ALL STANDING ORDERS AS ISSUED BY YOUR MEDICAL DIRECTOR. 13. ATTACH A CHECK OR MONEY ORDER IN THE APPROPRIATE A PPLICATION FEE AMOUNT,MADE PAYABLE TOT HE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS. 14. AT'I'ACH A COPY OF AN AUDIT PERFORMED BY AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT OF THE ANNUAL OPERATING STATISTICS, ACCOUNTS, AND RFCORDS. OF THE SERVICE INVOLVED,, SAID AUDIT IS TO'BE DONE ANNUALLY TO COINCIDE WITH THE END,OF THE BUSINESS YEAR OFTHE ,SERVICE. 15. BY COMPLETING' AND SIGNING THIS APPLICATION, TIRE SERVICE, ACTING BY AND THROUGH ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES, UNDERSTANDS, AND AGREES TO COMPLY WITH SECTIONS 11-151 TfIROUGII 11-178, MONROE COUNTY CODE,, AS SAME MAY BE AMENDED FROM TIME TO TIME. A PENALTY FOR FAILURE TO, COMPLY WITH THE LAW MAY INCLUDE, BUT IS NOT LIMITED TO', RECOVATION OF ANY C'OPC'N PREVIOUSLY GRANTED, [Proceed to the following pages for Part 11: Personnel&Vehicle Information] P'age 2 of 7 Part II: Personnel&Vehidkja farms ion PFRS�ONNEL—PARAMEDICS NAME PARAMEDIC CCEIHF1 CATION Firit Middle Last SOCIAL SIEC'URIT'Y# CERTIFICATION# EXPIRA'FlON DATE Brian:: Rose PUD521924 12,11/2026 ............................................................................. ...... ........................................ Andy Harris PMD5�153:7'2 12/1'/2026 .......................................................................... ---—--------------...... ........................................ ........ ...... ............ ............... ............................................................. .......... ........ ..... ......... ........... .... .................................................................... ............... ................ ............... .............. .......... ...... ............................ ...... ....... ................. ............................................... .................. ... .......... ............................................ ...................... .......... ................................. .......... ...................... ................................................................................................... ........................... —----- .............. ................ ............... ... ...................................................... ...................... ...... .................................................... .......... ...... .... ............ —-———--------........ ............. .............................................. Pap,3,or 7 PERSONNEL—EMERGENCY MEDICAL TECHNICIANS NAME EMTCER Terrence its 2 122 m�_.. . � �, .. ..... Flom 114 l/20 , III ........, M . .....__.. .... .. ...... . . .e.. .....�, _. .� o .. _..e.. mm..............�.... ee�....... __eve . .._ ......... _. .._ m.. ...... _ ---------- ....... ... �,. ...... . _�.._.. ................................................ �___�...a..�.G................... PERS,()NNEL QRLYYM ..................... ...... NAME STATE F'irst,Middle,Last SOCIAL DATE OF DRIVER LICENSE# OF EXPULATION SECURITY# BIRTH ISSUANCE DATE ................................................................................................... .................. ....................................... ---—---------------- ............... ... ..... .......................................... .................................. ................-—-------- ................................ ... . . .......... ............. ............... ................... ...... ...............-- ----------- ....... ................... ............... ............................ ...........--...........................................................................-—-—-------------------------- .......... —------------- .......... ............... —-------- Pursuant to Section 92.525(2),Fla.Stat.,under penalties of perjury,I declare that I have read the foregoing list of named drivers,and I hereby certify that the above-named dirivers, and any named on a separate sheet, meet all of the requirements of Section 401.281, Fla.Sitat.,and Rule 64J-1.013,F.A.C.,and that the facts stated hereinp�e, SUINATURE PRINTED NAME&TITLE Page 5of 7 VEHICLES For Each Vehicle Operated By Ygur Seryklgftase PmWe the Folio in,Information(Use Separate Shcet f(N essay _ ... _. .... ....__._._.. ... _ _ __ _ ..... ......... ....... p DOH S edf LICENSE VEHICLE i ALS or BLS; CHASSIS# TAG PERMIT# Transport or AGE NUMBER Non-Trans ort VEHICLE TYPE � MODEL � YEAR,....r MILEAGE C'HAS. dvo.................. .._.._.........��.� v�„���... ..,w._... w .�,.. .. ...... 0 � RCRK57 0026509 ALS transport Type II 2023 65050 1...... _ .ry I, THE UNDERSIGNED REPRESENTATIVE OF THE ABOVE-NAMED SERVICE, AM SOMEONE WHO POSSESSES THE REQUISITE LEGAL AUTHORITY TO SUBMIT THIS APPLICATION ON BEHALF OF THE SERVICE,AND I DO HEREBY ATTEST THAT THE SERVICE MEETS ALL OF THE REQUIREMENTS FOR OPERATION OF AN EMERGENCY MEDICAL SERVICES PROVIDER IN MONROE COUNTY AND THE STATE OF FLORIDA. I FURTHER ATTEST THAT ALL OF THE INFORMATION CONTAINED IN THIS APPLICATION,AND ALL INFORMATION PROVIDED IN ANY SEPARATE SHEETS ATTACHED HERETO,IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. Signature Paula Turner Printed Name operating manager!owner STATE OF FLORIDA Title of authorized representative of company COUNTY OF Monroe applicable The foregoing document was acknowledged before me, by means of Dphysical presence or ❑ online notarization, this 1 day of June 2p2s by Paula Turner as operating manager!owner [p'erson's Title] of Southernmost Medical Transport,LLC [ENTITY], a Florida (Not for profit / For profit) Corporation / LLC, if applicable. Who is ,rpersonally ktl wrl to me or ( ) has produced a driver's license as identification. 'm Name Print/Stamp Commissioned otary: tY'\ one° Name of SIG ( m ,w Static of onda RE OF NOTARY Page 6 of 7 v MARTHA ARENCISIA A `a Notary Public-State of Florida ' Commission#HH 721393 My Comm.Expires Sep 17,2029 Ionded through National Notary Am. FOR USE Y MONROE COU1 'I"'V()F—FI.C.E STAFF ONLY The l' of roe County Dire Rescoc Department shall perform a life safety rurspection of each lousiness location placed on the applicatiour prier to the beginning of operations within Munroe County. The!COPCN applicant is required to maintain a business location in Monroe County throughout the tenun the COPCN remains active. The CC}PCN a pplicantfawar€lee is required to notify flue Administrator of any change to the business location,any changes in the fee schedule, and notify the Administrator least 30 days prior to ten-nination or reduction ofany service,or be subject to cancellation of the issued.COPCN. Notes of Inspection .for each facility listed in Section 6 of the application. Location l: Bate Inspection occurred : Inspection Results Location Date Inspection occurred Inspection Results . --,,,. .. ,.,, [Add additional for additional loc.a�tions.] _._. sheets .. Page 7 of 7 ' y ~M BOARD OF COUNTY COMMISSIONERS County of MonroeAfi�t Mayor Michelle Lincoln,District 2 1� The Florida Keys Mayor Pro Tem David Rice,District 4 Craig Cates,District I . ' James K. Scholl,District 3 Holly Merrill Raschein,District 5 Monroe County Fire Rescue 7280 Overseas Highway Marathon,FL 33050 Phone(305)289-6004 MEMORANDUM TO: Nicole Lyons FROM: Cara Johnson SUBJECT: Check for Deposit- COPCN DATE: May 21, 2026 Attached please find Check_ dated May 9, 2026 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 Southernmost Medical Transport, LLC. Thank you, ca'4'e'- i62QdrL Cara Johnson I PSI �a lidlie { 9. Am V � I� 1. Ili W�. 'a UA �Lu tyyir i�". 010 Ica a ire -n jom ��a-a ILL AGRUNWN'T hetweell THEMONHOE MOM SITEIMT'S OFT,ICH and S011THERNMOST MEDICAL TRANSPORT 1JC for USE 01"P25 RADIO SYMM THI'S A(3RF'FMENJ , rn,,j,.ki and cutured iiiw on the day and yCar last sipnc4 bcjow,by thy:,: Mon.=ea=y sbvriff's Office, tt sut),Ali vision of the State of Florida("evICSO"), and Southemnm t Medical 'frarqxm, 11C. a priyate corporalwn,coBoric y("thc Parties") IV I"I'N E S S E T It: WURFAS, MC SO 1,,as porch aeAl vul is operaWIS a radios t rr, I.bot is us—cd b) verzl local "JM Cmergesicy services entitics("Shared 'Usm"), and IVHERY'ASµ Sumhor-ullm"t Wdical 'Tunspot LIX'providcs c.,rerguicy trammyri scrvice.q mithir Wnror Cowity,JIoridu and WITEREAS.lie por'.im have detelmixted that &110%inp, Ll C' wcv;s ut MCSO*� rudic system will rcswIl in a pub4c safcly hom4ii of veroperabflity, uld NOWTHEREFORE, iu c�mjumtion With: ftuvxua)Covemulls"p-ontiscs a[u) reprusemadmis conlamed heroiv, thr,Partite agree as follows, 8FCT10N P P]iRPOSE AND DKMMONS 1,11 The purpmc(if Li4s Agrecine fl d o to set fottfi the, under whicb IMC.So lAiL Ina'ke Acct.�s to'15, 800 NITLe,P25 Tudw S)?5teM tO SU',1XthCM=%t Medica.' "-'Tamsport.I LC Nvk'-em Thc 800 MK? P2,5 ra&n sys-,cm ftuided, rmrohh�rd, inquilh,,d. amim.,var I(A and Owned by MCS0. '11,e ,vurrmcludcs fixed In-,,mmitfing mid recx.,ivmg, cquipment,T-1 tele.ihone .in foi commmealing hvA-,-cr—mtm �ymnm cv—rol nd i w tall age;,jent cqnipmenl'dispitch eomsolcs, i controller located o, tim- prin,tt, and 1,0ated, IM i Sha,,e. Uscrl'- uip:rent: Also km0%,1 v" m agey radlu Sou� me dt mmus 1. Medicai -- t54 TfArLsporl� (m Tadjo.n alic Ccm?tOlsTatio-is thim have illy.nhhty tc be progrunmev! -ird used on NICSO's 800 MH?. ?2S radio symern 1,04 'Me lie-sm dcs�gna-ed by MCSO to be re4p,n� ililc for 3t�m-W;xi-ation of the S),item and—scrving,as dr,�iguuk"J,con(act Nn%on puruant toVd� Southd,numvt M ' cAlical Tvm,;,uq Ll,(,' Rc p e� l�rcscnk 11C pwswl,J d b osipaw ) Soutliermnum Nlcnical Transymin,LI Agrtvincr,t, SF(A ION2; S)INTENI AI)NffM, STRATION ANT) INEPRIXTImal,'�s IM, MCSO Out',I eidrninisiry Olartd the Svq,ejrl, 2.02 Thr S4slcm -JI devOwn proccdLNT'V, V'1 1;.;IanEjaud Operwing ,mxwJun-;. &vuIbrrr.Tnoqt Nfudical'Trausp(m.i-LC agj=b to c�djapj)"wid,wly enfortemcm, aclion rocpircd by thc,,r j-,,oU6e,%and jxnwrdutes for,-0-mc or ahu%c,r)Ftjjc S)scem, 2.04 costs 2,s Svdimn I w,d I Ova mallocatc4l ol the first d,,tv taf Odol,",cr afta a mw Shared Uwr gains uxes,,, to the Sysl,=. SEX"TION 3;StiALRED USER EQUIPMEN-FAND RESPONSIBILITIF.S 3.01 Idl slumd Wa cquiptnew%x ill Ix!A MHz P25 mN)flc,jx)mb!c,!,:mcj c<grtrr)U station qwpmew ProgranimexI for uw on Lk Symyr, Ilie quipment uvi�shfol he 803 NI I I? P25 comphiai wmmuni6,;.1611�sy.scervis quiprima,aml Hp.1,nmetj by pic Smthcmrnos[ Niedwa'TrarLsjwi-,t,.l ?C i','r(WHiTcA to 4cp tlw cqu:pmvv i0l,Pr OM 01VIrat!fit,cOnd R im S lA tha mmcw Mcdk. 'r,ail w'Pkq , f"powsiblc loi mairi'mance of Lhmr radfis e(pipmem, NV Ulun 0 m days(yftht,cK-ution of Lhis AgTeewct,(, Sow,h m enul IvIc4culTm yapon, LLC,musl d"SignAe,9 Rcp:csOwt,"wO wbo wi�l a,Utvc al,it, Ninsk,poill,uft,Qnlad fur _WMaj,q rchl(vir to fli i r�Agra vam- i n 0 5)days of ai:c cxf,cud Ob:of W s Agmement. Sn wdi emn iom ki:7d T vri, L LC%vmst prov id e ICI(,,St)wi 01 a 14(of pabonr Who udlul i exd w I cquest programrwng Oanges to Njcvikalk Tlw.lslxlq LLC wfll 1101 mdio,�wt.dmat appruit a] of die 3�tcat Adminisumo:-. W-Inezi 214wimflon from d"C'Symem Adminwrator mid Scitanunit,.u5t�jcdjcw Daxmpore 11C Repicsenwwc 6- rcqj�re(l fv'r Jw Mons): shulf,' s Office I°rwgcncy Corrminiations J) 03 M--i' W PO- PIXII,U11k grkq4x,, into Shared Usn ra,!j()s, IvIedic.,J TrAMPOO.,UC MaY n,o,rr-quc,,,l thm Qthct (Iscr'A talk sr6x,6ps be pro,evanumd into dictr radio kvi6ou,wimor,aklthoriyatlthl of uh,,.-ouhcv Shated disc: Kv Souvamtrnatwr MrA1'-',ctd Trans,pxwn,LLC wWh�-rcquwf w progrtun t1he(,L)ftimon Coumy%,de'FsJk Orotips Am rnkk un dw Symmi km un hy hwed Uso-rs Ox yntetaptncy corrununicatkwx imo is rKas. 'Renc cWhig tilt groups, inwidbon to cum Opermlont Wk pxnup for qw applicable,di":ipjinc, %hal. bt ic-quired as as MIMMUM, Shamd I kus nin iwWe addiflonal Conti=111k Grou, to meet Qij OP!1"111,011A requireiswril�,, Pianos Wk group) sh,�:M bc inadditiorl to thculutual 16 channels required by,Ow Florid-i Rcginrizil 111an. SumheiTum-ini llodiLnaP Tmnspoxl,LLC it, t�cilcly ri;bpw-uth e for if,.e perf0 r,O wmc grad of Shan.A t6a CVMPMVA aml an) dungFe ur fiAllilk M,51116TIg pMU� Cie Ube bemnL ShnWd NICSO idcnffymal�vnctiorr ng Shwvd LAT cqwpmenL 11CSO %11 rcqtmwt the shan'gj Usc� RcpreicnLefive W discon0m�t�wog ref thcs�pcwf tc devicc Until TCPlJrS arc,rear` PICU& v a door is aausitq.s 4uzTrcrexx to flic symcm.NICSO may d1sWe the eVopnien, hum Te sywu rt. In is r,,asc of stuien c); Ins!equtnw- Southcntmosr LLC wfll bmywdiizWy nwify hKAD Emcrgcnq C"brnnlufdmtixt� in WUNW nr YK wisl awbovidug WISO to Twable the ccp4p;nno, SO'1iwhCmMn-1 hilewM Panspor;131- will pievide the Rg&p )numbet and dw saW nwnky of the radio hV'SO Eanggwuy Corruiivak;atiozi.- will ndvisc back via c-mail whcr the mdio hss"hccn dk4fled 1.)isablaJ rid tak wffl oc zcac,i,i vate4i t)nly upor, w7itg¢r,n muml Amm A Souffiernm,(w U-CReplesentitivC. W A%of iris timeohe Sysmm W mm mqTnn Me u e u:ju=Ont�" IM"'ale Call, or telepholic trot eiconnec,t In Lhe tw.irc % A 1('-!SO "'MY NOW sonve w 211 of Owse Jeat'xes shwld TC UmdWg of dic sysicni Llkj%v, Soalhan urn usl WON Wanopwit LIA: may =4 PPOPIM th fe2tawv, , inT Their radio, It roaiain& ph"i-c cafl,o� telepikulle ac oc utcsystcm in Me Own SowJwt-fu,:us! Mcdirzl'l)an�p4�Sri, U.ClLay'"t their awr expeubc. rcprujna,tl Slairro U,,Pr rad% MCSU wOl pvtovide an amendntew zo ths Agiczownt dWIMUg UP WC5 UIL requiredprupyamrnmg shofld thew Jeaturts bcuoir.L avai^nble on the Syscui. ADF SOJOwm7nuht Iledicl Twpart LLC ig requircd to V�,'ovgde tc, NICSC)siji inytritor)"of Q wdios un die WASO systw Scmdenwiast Nled:`cz ToLnApon, ILC sludl junv�,Ic U)r [chowing iidrjrmwmn to Z xadlo%crial 41ujj,,l,+ers A,. Ke%j,1cstcd to tic progran,imcd 4. Lis� o,' an) mqusted mdw pwgmmmWg cM4gn I IWL lamp,required 6, CUnrrwn ta,;-groupt, rqL.-.rcd Otlxr-gcLu,r Lalk groups roquixcd M("SO wid Compile d4Ls Jor-nianon and uanunil ock w Somi,cri-amosa Nlk�fical I C' I rnat& of dw: appiwed ut!k rrwp%al,aa�cs ;�Jjd r4dj(A 11,,) Pwr R of A, Mo6csd "ray s�n�.1 '.„p'..G(.;wiN err-qnuMb!u for adhc,a 4.ig&'c'r the Lis jup silo sadfaa ID akuiLons se'.up by mrso, 109 WhAS in bus A rccnc:gt s&saxj itclIMSCIR a ccpina'r:'raaaaac by Nlcs(j aror Iac rwm!a Zroed m; rasa stia sv t"; C ka� a:t�aray°portj,rvr cf sr a� Ataaa st,�u uyra J "a«aaa Gw ra. .a...:° a;a maz zz M MCSO SO hoc msgrmos fair as t'armaM W Spar,�w'y acr73 .S 02 TWO MUM be respnnsibic ax aN W%Mw,QQw,as W Ons wnwaaEa d ws2b A Amapa SEX3 ION 6� CHu((;�, 61, Each SUMCA"up SMEW M kcso sy stern v" H he eharprcl SEAUX-o thc,tiEoc the aj� �s prognimnx.�d for sy4tem &C2 Soudmmmum TdcdkM j%nWaM I L(,, of 525J)0 Pve Lmlysiollv"eCqnepn 1qff0g?Qmink.,g of radio wN g-,vPup,,. 6.0-1 In sex rvtm of wq UmMakEn W U6 ,AgreerneAK,acembs and rprograniming charges NviR wk be wieNuNcxI. SPVMIYN'7� MAINTUNANCK CO-,"I' "i 0:1 NICS$0 mlivs am nh fiW do CS0 commwlieem';"Division to�Xltre'toabj-'e und pmvmdve ngdmenwwc an It Slum, its unownmcc hykm UMWC shwAq nd mAhl all mpMn on as zsrl/Uz5 tmo, air well n jxvf0'qrJag', prevellike COUMMIwn M Ow MOM SVMM UWWHIM U in MW A WE eqhp=nL d'=1"q'striri,tawer�,�iviKl equipul-sit�Nhdlvsa b-v'kup pow� c� p1mum,WEd andkown. ?Am SW1WU=" HE WOPU MMMMMM Com MW YW h"6 wwc 10 rue for 30231026 ss Smz rwr uj,,i,_ 111c of niain&cnxi,-,-e%Affl [it ievkwcd cash yon. ToEure costs 5,nau be adju5tcd for Or,foj�(i%vang fisca: near. If fWi Err,wnm —!;-arc N 1('$0%v ill&trut wn tien n0do '10 11CWAFH W"A wn two ywL Wwnwmm! ams WW IV mumd an a pro rasa basis blmd on EJIC-rumt1v2 0,CaJiow so'Aernmosk hlcd CM Trarnporl,'d LC vvi S�wAYM ljsprs are awh0r-':'/ej!0 U"an of symun W I'd Apd; 8 oft%wli yejr, NI",CTIONS.- BUJANG S(ArEDU1,E AC0055 8rd dWW�,'Xt tklC M Wll„rC,$ZaTdkro5 Of 01C 61,M Of ahln yt�,'kr dw M65MO mh A Wdcd to We Systcizj 0:rcprogranin:vd. Tncie fcn,)�tjj rjol tlx-plo, rmcd from the time of &V2 Syocm Usus Ydil phy drscHnd ijiScxxio.,i 7 .kjajNcjj,Luc,, cha-,rc,s ar.-,doc cac�-d oc'mrphc,, 1,ont yt-ar m adva no. '.-- ;"WQ ' 6,01 Upon roceirA of any QuQfftln,tq l:al"W yquaTt ally Wepaniona b4c5(1 wk1lin 10 day4 Of rrCe:pl. payniew wfli to MHO vuhl 30 IT*of muipt qj at nvoj(:ta Paroeal,�w0l be seni lo! 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M"CLION lfi: kNT)RE A(MYEMPN1 TH15 Agrkxnii cut and ExhV N.N Uwmx a d MY end All c4hvr wa. or a rawll am,51,10 bu dumcd w he wwrged mic Os Agreeniow,rxmpi i�1jejeu-1 Mcmuc PmvWmL gmsulsolucri Mnanum "aNev atmigc cu admism IV ums Agmemmu shM:be Ujwll%upon XJCS0 0a SU�jfljerYmknl kwg und Sq jwdby hcth pwi c�,, P"w 7 W A AG E aMNT UP 'RbUf.)E: Any pri'ur s tttetll's„wheftl maj Or%mil",hew sli aan(m)\fe i i'll"I"`rNsajs xa n' S..:LC regarding tho scab t mait r oftftis.oars At gre bereby femiroloed cff ive IN"WT,f"NV ; d "',NI.c pani $hVC e813s th6 Aptrnnem ur I t°x jttexi;, i.&t+NlY F'FF S Of F CL � �&y° it P GENERAL COVWEL DATE NatNtlt rrat rs aMedf J'rumB port,Fal, J ule, u ' outhier'rhrnolst MIedlicail Iran port, LILC li 4l, COPCN Application .�11[10 u Appendixn.- Southernmost Aledical Transport Schedule of'Rates BLS,Transport Base Lees: Basic Life Support 650 *' Loaded M�illes 17/miille ALS Transport Fees: Advanced Life Support (LEVEL 1), 010 Advanced Life 'Suipport (LEVEL 2), $qoo Criticab Care Transports (CCTi) 1,00m • Loaded Miles 1 /mille Neon-Emierge'nt Base Lees: w' Wheelchair (WC) $45 • Ciurniey/Stiretcher (STR)i 150 Arnb iulaitory (AMB)i 4 a Baker Acts 45 Loaded Mh illes 91.50/rruile All fees billed are inclusive to include the correct licensed staff members, equiipr ent, and supplies for each transport. All fees are in accordance with regulatory standards and found'to, he in line with today's market for service and in Iliinie wiith My edlicare reimbursement fee schiedlules. I DATE CERTIFICATE� F LIABILITY INSURANCE �O/Y 05/113/2026 THIS CERTIFICATE IS ISS�UEB AS A FATTER OF INFORMATION ONLY AND CONIFERS 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' CONS�TITUITE A CONTRACT BETWEEN THE ISSUING IINS'IURER'(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,,,AND THE CEIRTIIFlIICATE(HOLDER. IIh PORTANIT. It the certificate holder its an ADDITIONAL IINI'S'UIR'IEB,the polllicy(k?s)Imust halve ADDITIONAL INSURED provisions or be endorsed. If SUIB'RO ATIONl IS WAIVED, su1Cb]ec�t to,thie te�rrms and conclillons of the polIIc�Y, cert'eMn polllcle�s may re�gluilre an endorsement. A Statement on, this certificate does not corder ril Ihts to the c4 ntiTic�ate h�olld'or In lllevi of ss�ulch,a ndlalrso m ent(s). PRODUCER CONII ACT Nu ichaellKontadliakos �.. MCP INSURANCE SERVICES PHONE Py..L,xlrt, (727)9H2-t49 9 FAX (127)934 QS83 WC-PHONE 119,WW TARPON AVE STIE A E-NAIL SeruticeC CPVn rtulra�sllLe corm APPRE$$ INISUiRER15i AFFOR04NC1 C OVE AGIE M me# TAR'P'ONIS�PIRPNG,S FL 3,AEn'829-34,72 INSURER AI; G'etl�e�raiStanr' � 3'73'162. _ ......... INSURED; INSURER B; Na�t,llam�al Imdemnndty Caampany ofthe So�ult,h 4211137 Sout4ernlm05t Mledlca l Transport LL�C INSURER 116�06 Jaimniaica Dr INISURER D: ® ....... ...... INSURE . ............. Key West FL 33040 INSURERF; COVERAGES CERTIFICATE NUMB( ER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF PNSURAN'(1E LISTED BELOW HAVE BEEN ISSUED TO PH,E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NCT'WVITH5�TANDIINIG�ANY REQUIREMENT TERM CAR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT�WITH RES,P'EICT TO WHICH THUS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED IBY THE POLICIES DESCRIBED H�EREIIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POI.,IC'IES,LIMITS SHOWN I MAY HAVE BEEN REDUCED BY PA I)CLAIMS, INSR lA«OOL1SUit3IW„ POlUC'YEFF POLICY Exp L TYPF OF INSURANICE POILICV NIUM EER _ LIMITS X COMMERCIAL GENERAL LIABILITY EACHCYWURRENlGE s' 11,0100,0010 1 ��wC:CLR' aAIWAGETORENTED :5i1,CI00 CLAIMS-MADE k�5F,IEa cmwieo ) $ �....... 7G¢7 SxP(Apy,gne.P9R:aq $ 2,000 A DCAIHO11256 01/28d2026 01/26)2027 PEV•2547NAL&ADV INJURY 11,99119010 GENLAGGREGATE LIMIT APPLIES PER; $ 3,C1i0IF,00p1 R7'C)LIICY F_JE LL1c ---py!C s-Cb?u9PrL P ACaG $ 3,0100,00,0 T R: AUTOM OMILE LIA81LITY �tf COAitlI11NU NE�V)SRNOLL LIMIT s 11 0100 00 011 ANY AUTO BODILY INJI.IRY(Per Leman) $ l3 AtIT JNL7 x 54JHEDI U'LEUA 7':4APS11309911 01/26J2012A 0:11/26/2027 ;BODILY INJURY War meddlaantl $ US HIIREIC) MEIN-OWNED I PR OPERTYDAMbAGE AUTOS ONLY AUTOS ONLY "�r,aeeNmtQnrtrt,,. �......... ..... ... .. _ _ �.... ....... P'IIP $ 1101,000 i rl OCCLNI FACR I CJQ CU EXCESS 4IA RTRCFWCC $ CLAIMS-MADF AGGREGATE $ DED RFTEIhVfTION$ r... $ WORKUSCOMPENSATIuON PEP CThI- ANIO EMIIPLOYER&"LMAI3NLITY YIN ANYPR OPPIETOFVPARTH1EMEXEC'U TIUU C,L LAGN AL LRpENI $ 0IFFICERIAIEM BERICXCILUrJEI 7 IMandatarry in NHi S,L,G715 qSE-EA PAKOYEE $_ w yams despribp under D7E'SCRIiPTIO I Or OPERATIONS daeianer EA.DISEASE-POLICY I.,IIM IT �$� I ......__ .. .. ........ .... ... .................. DESCRIPTION OF OPERATIONS d LOCATIONS I VEHICLES JACORD 101,Additional Remarks Schedule,mmay be allaOcd it mnaarm spooe is mquire�dl� 2023 Dodge Ram,3 C6LR"VDGl PEI57939�9 512�6sO 0 Coinp/Coln Ded 1,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABIOVE,DESCRIBED P'CILICIIES BE CANCELLED BEFORE THE EXPIRATION DATE'. THEREOF, NfOTtCE WILL BE DELIVERED INI IMlornroa County ISOCC ACCORDANCE WITH THE POLICY PROVISIONS, 111010 Si'montomn St. Key Wast Ft 33040 O�R'EPIRESENTATIVE @ 19,88.201 a'ACORCI CORPORATION. All rights reSeryedl, ACORt9 25120,1+9I03), The ACORtD namlle and logo are regiistured marks of ACCO'RID � Southernmost Medical Transport, LLC rig i COP NIAIpplica�tion Appendix E: Agreement with Medical Director AGREEMENT BETWEEN Southernmost Medical Transport,LLC. AND Bruce Guerdain,M.D. For This is an agreement between Southernmost Medical'Transport,,LLC.a limited flabUVity company organized and existing under tthe lawns of the;State of Florida (hereinafter referred to as,SMT) AND Bruce Cuerdan,M.D. (hereinafter referred to as CONSULTANT)whose principal pllace of business Is 1800 Atlantic Blvd IB117, IKay Fast FL,33040.. WHEREAS,Sli Is a,provider of basic and advanced late support medical transport services,and is required by Chapter 401,Florida Statutes,to contract with a licensed physician to serve as SMT"s"MEDICAL DIRECTOR",and WHEREAS,the CONSULTANT provides Medical Dinactorsemvices and SST desires to uti'iir a the services of the CONSULTANT, NOW,THEREFORE,iin consideration of the rnuturall terrors and conditions, Promises,,covenants and Payments set forth below, SMT and CONSULTANT agree as follows: MTICLS'1 ER 1.1 U.fndler the directian of SMT'D1rectar of Operations as defined In Florida Administrative Code Chapter 64.11-1.004 for medical transport only,the CONSULTANT shall provide!a quallfiedphysiclan to serve as Medical Dilrector'for the S 's Emergency Medical'T'ransport.Services,Programs as��more particularly set forth herein: 1.111.1 Envelop transport protocols that perTniit specibledi ALS and ELLS procedures when communication cannot be established with a,physician during medical, transport when a delay in patient care and treatment would threaten the cite or,the health of the patient 11.2 Medical Director will be available.,"o'ff llimne"to resolve adrminlstradve problems„system conflicts,and provide services In an emergency as that temrr is diet ned by Section 2'5 �.34(8), Florida Statue. Such'off-line*services will be provided, at a rate of$,300.00 per hour or at a rate mutually agreed upon by the CONSULTANT and SM'T"s Chief:of Operatlons. cu,ruuthie,rnmost Mf el dicai Trainsport, LLC r COP�CN Application 1.1.3 Develop and implement a transport patilent care givality assurance programs to assess the medical performance of Sill 's Paramedics, Eful'Ts and Cnbcal Care Numes. Clerical and administrative support will be provided by SMT. 1.1.E Audit the performance of t rs,personnel from time to time by use of a quality Improvement program,to Include but not limited to,a prompt review of transport. reports, direct observation, and comparison of performance standards for diruigis, equipment,protocols and procedures. 1.1.5 Provide a D7EA registration for SMT In order to provide equipment, medications,„including controlled substances,to SMT, 9 needed. C,EA registration shall Include the address at which controlled substances are stored. Proof of such registration,shall be maintained on file with SMT and shall be readily available for inspection. SMT will forward any and all renewal documents and rrespon�dience received regarding the DEAto Cl1NSULTAlNTto assure continuous registration and will play for the cost of the CEA certificate or reimburse CONSULTANT for the cos of such registration. 1.1.6 Review SIVIT"s s uurity procedures for medications,flulds,and controlled substances to ensure they are In compliance with Chapters 499 and'393, Floridan State,and Chapter 0-1�2,Flodd�ia Administrative Cade, 1.1i.7 Assist and'coordilNnate,with the Chief"of Operations, written operatingi pro cures, creating,authorizing and ensuring adherence to rules and regulations regarding all aspects of the handling of medications, fluids,,and controlled l substances by SIFT certified personnel In,accordance with State and Federal regulations. 1.1,8 Notify the Department of Health in wvrifing,when applicable,afeach, substitution by the S,MlT of equipment or medication.. 111.9 Review,and approve training i for EMT/Paramedic continuous education training and/or refresher courses for the purpose of EMT re-certification, 1 w1.119 Assume responsibility for the use by an EMT/P of an automatic or semi- automatic defibrillator;the performance of esophageal lntubaution by an EMT/P;,and,the monitoring and maintenance of non-rrredicated N 's by and EMT/Pm as well as the use of epinephrine for allergic reactions,when necessary. 1.1.11 Advise and implle'rnent a Mean for prompt medical rrel of bible infectious exposures reported to,the Chief of Operations and/provide medical folllow-up when,Indicated, in compliance,with,Stale and,Federal requirements. Medical follow-up care to SMT employees will include a$3,000 retainer due May 1,2024,with deductions based l on consultation hours billed at$300.00,per hour ABIIQi QOMPENSATION 6NO,METHOD Of PAYMENT 2 A SMT agrees to pay the'CONSULTANT as full compensation for the services described/in Article 1 an annual'fee of$40l,tlti0.00 to be paid to the CONSULTANT in Southernmost, Me ical Transport, LLC COPICINI Application twelve consecutJve equal monthly installments of$3,33334. This fee Includes all costs and expenses of CONSULTANT. Services requested beyond the scope of this contmot it be invoiced separately as a rate of$300.00 per hour, subject to approval of SMT Chief of Operations. 2.2 T agrees to pay the CONSULTANT on the first y of each month for which the CONSULTANrs service are rendered, 6RIIQLEFl lTl N 31 "Department"means the Department of Health, Bureau of EMS . 'Emergency Medical Tech n1dan" _M means a person who'Is certified by the Department to perform basic life support. 3.3 "Medical Director means a physician Is employed or contacted by CONTRACTORwho provides medical supervision, including appropriate quality assurance but not Including administrative and manageirial l5unction,for daily operations and training. A " ar dice Bans a person who Is certified by the Department to perform basic and advanced life support 3,5 "Physician"means practitioner o Is licensed under the provisions of Chapter 8 and Chapter 459, Florida Statutes. .6 "Chief of Operationsm means the highest ranking medical professional In charge of T's medical transport se �Ii".F_ Q T RRESEMIBILIIIES 41 In accordance with Section 401.265, Florida Statutes, and Rule 4J- .004, Florida Administrative Code, the Medical Director shall possess and maintain through the term of this Agreement a Florida license to practice medicine. 4,2 The Medical Director may designate an alternate Medical Director,when needed, who shall be available In the absence of the Medical Director. The AAernate Medical Director will have an understanding of ALS and BLSmedical transpods and report to e Director of Operations, 4.3 The CONSULTANT shall perform such other duties and responsibilities as now re imposed or may be imposed during the term of this Agreernent by Florida Law, Including but not limited to the applicable provisions of Chapters 252 and 401, Florida Statutes,and Rule , dv1, Florida Administrative Code,as may be amended from We to time. e Southernmost Medical Transpom LLC CO�PCN Application, ART CLE 5 SIVITE RESPONSIBILl &1 The! SIVIT shall assist the CONSULTANT by ipllaciing at Its disposal all availlable information, perlinleint to the services to, be performed by the CONSULTANT, Including access to, all EMT/P,, EIVIT, a�ndl RN employment records and patient medical transport records. 52 SM�T'will provide CONSULTANT appropriate administrative support lincluding secretarial support services and other eq�uifpment as may be needed from time to ti me to provide oversight to EMTfP,, EMT's,and RN's. 5�.3 S,MT wiilll comply with FL Chapter 64J-1 In, alll aspects relatedl to the performance of mediicall transport operations. ARTICLE 6 1F.RM 6.1 This agreement shall commence on May 1, 2026, The Mledlicail Diiirector rolle and salary commence on July 1,2'0125, and shall continue through, June 30, 2012�7, unless termiiniated earl,ler under Article 'T. SNIT shall have the,option to renew this agreement for 4 add iitiional 2-year terms suibjiect to the same terms and conditions, by providing the CONSULTANT written, notice to renew no less than, 30,days prior to the expiration date. If this agreement Is renewrwedl under Article 6,the CONSULTANT shall be enti�tledl to a fee Increase of five percent annually for each,subsequent renewall. ART QLE 7 TERbd[NATION, 71 If througih any cause, the CONSULTANT fails to fulfill Its obligation under this agreement,SIVIT shall have the right to terminate this agreement upon providing written 9101-day niotice to the CONSULTANT. 72 T'hiis agireemienit may be terminated by SIVIT without cause upon, 90 days written, niotice�tothie CONSULTANT., If SMT terminates w,ithout cause,,the CONSULTANT shall be compensated for all services performed prior to the termination, dlate, provided that all property belonging to SIVIT Is returned prior to release of final compensation to the CONSULTANT. 73 CONSULTANT may terminate,the agreement, with or without cause upon providing written, 901-day notice to SIVIT, If CONSULTANT termiiniates, without cause, SIVIT shall compensate CONSULTANT for all services performed prior to te,rminatilon date. ABjIQLEj8 MISCgLLANgOUS Southernmost Medical Transport,, LL C�y i� dry, p OP�^N Application 8.1 Ownership of ocuments Deliverables: Any piles,documents,studies, transport report reviews, training curriculum, and ether data prepared y the CONSULTANT (excluding standing medical orders,medical treatment protocols,infection contmi manuals),in connection with,this agreement are and shall remain the property of CONSULTANT,and shall b ,delivered to the CONSULTANT, upon requiest, no later than 60 days after termination of this agreement. &2 Policy on Non-aiscrirminati+om: The CONSULTANT shall not discriminate against any employee or applicant for employment for wock under this agreement because of race,color, religion, sex.Age, marital status or nation of origin, physical or mental disability 8.3 Independent Contractor The CONSULTANT Is an independent contractor under this,agreement. Services provided by the CONSULTANT shall be by ermploye # ntrect of the CONSULTANT and subject to supervision by the CONSULTANT, not as officers, employees,, or agents of$MT. Personnel policies, responsibilities,social security and health Insurance,employee benefits, purchasing policies and rather similar administratIve procedures applicable to service rendered under this agreement shall be those of the CONSULTANT. �,IN U NCi 9:1 The SNIT shall maintain In force and,effect for the team of this agreement the Insurance described below. 91.1.1 Professional and General Liability: SIVIT shall provide profes.silonal (liability insuronce,for the CONSULTANT and Medical Director during the term of this agreement. SNIT shall be responsible for maintaining this professional liability insurance for a minimum of 3 years from the date of termination of This contract, 9.2 Consent to uriisdiction The pa des Irrevocably submit to the jurisdiction of any Florida state or federal rt In any action,or proceeding arising out of at relati ng to the agreement, and unanimously agree that all claims in respect of such action or proceedings may be heard and determined in such oourt. Each party further agrees that venue of any action to enforce this agreement shall be in Monroe County, Florida. 9.3 Headings. Headings are for convenience of re(ereince only and shall not be considered on any Interpretation of this agreement. 9.4 Exhibits: Each Exhlbft referred to!in this agreement forms an essential part of is agreement The Exhiblts,If not physically attached,should be treated as pairt of this agreement, and are Incorporated for referaince. 9,6 Severability, 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 that S,oluthiernimiolst Medical all Transport, LLC COPCN Application those as to which,It shall have,been invalid or unenforceable shall not be a ems, and shall continue in,foil force„and be enforced to the fullest extent permitted by law. IN WITNESS WHEREOF,the parties hereto have set their hands and seal the day and year first written above.. BY. WlTN'BSS. _. .. B u da ,,lww+1',Cm. Southernmost edical'Transport i LLC. BY. RL-:'� Chief Operations,C t r: Paula Turner WITNESS: �� Southi rnmio t Me uc�al Trainispoirt, ILI!C COIPCNi Application Append& G: Standing r erslProtocol , IN'TER'FA C LITY TRANSFER and TRAUMA PROTOCOL Table gj'Confe ►ts l.. Procedures and Polliciies a. 1'ntroductiani b. Documentation c, Transport Crew Levels d. Contacting Medicai Contr6l by P"a�ramedlics/CCs, e. Transferring Patients with Drugs and Devices f Requesting,Additional Personnel iII. Drui s a. Cardiovascular Drugs a i.Antilarryrthmiics a.H.Beta-Blockers a.iuuii.Blood Pressuire Lowering,Agents a.iv.Calciurn ChannieU Blockers a,wi.hlepariin Driip, amiLinotropes a.viii.Nitroglycerine Drip aJx. hro rnbolytic Theraipy b, Sedation and Paralytic Agents b.i.B naodiia ep ine I ripis b.ii.Ib oderaite Sedation Agents Southernmost Medical Transport, LLC f. III; CO:,PCN Application h.iiii.0pl oid Drugs/Drips. hI.iv,Paralytiic Agents e. CNS Drugs c,ii.Anticonvul'sants c,iiii,Mannitvl c,ili,51eroid51 d. HlyperaliirmentatiunjUNI, Insulin and Electrolytes d.i.Hype rallimentat on/Ti N d..flAnlsulin d.iiii.Potalssiurm CIhIIoriidle e. Obstetric Drugs e.i.I'a+lag,,nesi'u rn Sulfate e,iii.�O�xytecini (Pit�oclin) f. Antii-Iinfective Ther,apy f;i.Antibitiics and Antilviirals f,iiAntifuinigals g. Pain IClulntrol gJ.0pioid Driips g;ii,PC (Patienit.Controlled Anesthesia) Pumps and Subcutaneous Pumps g.iiii,Sprays and Gels K Antidotes h.i.Nl-Acetyl Cysteiine or N C (, cetadalte) Ih,ii.CyanideAntidote Kiit(Amy! Nitralte, Sodium Nitrate, Siodiuim Thiosluudlfate) h.iili,Thialmine h,iv.Bicarbonate Drip h.v.P'yridvxiin�e(Vitarnin I36) Ih.vi.Atrmlpine/ -PA11111 ii. GI Drugs r.i.Antiemetic Agents outhernm o,st Medical Transport, ILLC COPCN Application ii.iii. cid Reduction ii.iiii.Gll BIleed Rell'ated Medications Ill. Devices c.i.'pernporary Cardiac Paciinig c,ii'.Thoracosto my Tubes (Chest Tubes) c.iuii.V ntricular Assist Devices(VaADs)i c.v.Tracheostorny Care. c.v.&Pap Machines, c.viAnvasive Cardiiovascullair Monitoring c.vii.Intracranial Pressure(ICP) Monitors c.viJAnsulin Pump's c.ii .Central Vascular Access IV. IPedliatri'c:Tiranisfer Protocols d,i.Anticonvullsaints d.iii.Cvntinuous,Allb'uteNrol Nebulization d.piii.lnsuliin Drip, d.i .11V Antibiotics, V. Special Sii4uaitions e.u.Thel Hospice Patient eAl.The Pediatric Patient ainid 'Consent Issues e.iiii,.The Therapeutically Cooled Patient 'll°II. Gll'o'ssary and Abbreviiaitions Y.. I III � Southernmost Mediicail Transport, L C COPCN Application Procedures and Policies o. Introduction la. Documentation c. Transport Crew Levels d. Contacting Medical Control e. Transferring Patients Mth Drugs and,Devices f Requesting A dditional'Personnel !` S,oluthernmo t MedG i:Cal Transploirt, LLC CO1P'CN Application a,. Introduction, The dlecisiion to transfer a patient rests with the transferring physician(or other caire providler,. such as a physician assistant).This physician bears responsibiipiity for the transfer decisions. It is the tranisferriing physician who rnust: 1. Determine whether the benefits of transfer outweigh,the risks. , Ensure that the patient is properly stabilli ed prior to adieparture.. , Be responsible for compllyinig wiith currentlly accepted community standards of practice regaird�ing interfacillity transfer. The Paraimedlics/CCs RN's and Medical)Control Physician (MC) assume responsibility fair management of the patient,given the cilrculrmstances of the Ipatilent`s condition, while en route between facilities. This protocol recognizes there will be situations wvhe�re potentially uinstablle patients, will ireq,uiire transfer to another facility to obtain a higher level of care.. b. Documentation, It is the responsibility of the trainsfe�rriing h�ospiita�ll/physician to providle appropriate documentation which, includes,a transfer form or other documentation indicating compliance w ithi current statutes or laws regairdiing patient transfers. Iniclluded should l be identifying information (name,,adidress, dlalte of birth, etc.), treatments, test results, pirepiminary diagnosis, reason for transfer, names of transferring/aicceptin physidans/institutiuns, pertinent medical) records and orders. c. Transport Crew (Levels The following its a, description of whuich Newels.of care may transpolrt what druigs and devices. EIVIIT Sailiine lock Patients with PCA pumps with settiings unchanged for > 6 hours Sta,blle patient with, no anticipation of further iinterventions en route EMT P lusted pluis:All Intubated patients Southernmost edical Transport,rt, L C COPCN Application, Listed pllus:; Arterial and �wwanin-Manz line- not to be RINI: used for monitoring by paramedic The rnedlical dliirecto�r of the trains porting service shall insure thiat all trainsportiing providers are credentia�led and trained for initerfacilit�y trainisf�er and may trainisport drugs in the so n�aimedl categolriies at th,eiir dliscreti,oni. d. C'ontacting Medical Control by IPararnedlics CCs Medical Control IMIIUI be contacted in the following circumist�ainices�, ,. Q,ngo�ing administration of lblood products or resuscitative medications� 2. Intubatedl patients 3. Patients with chest tubes . Patients with temporary pacemakers , CIhain�ges in symptoms/ signs/conditions po�tenti�aJIGy indicating deterioration b. Unstable vitail signs 7. �Me�dli'�catiions not specifically liis,ted in,the protocol Patients wwiith the first four,(listed items should be contacted before airriwadl, and pireferaiblly before the patient lleaives the sending facility. Patients with thie 5uri,ainid 6tiiilistedl items should have MC called en route as these occur.. Patients on medications not specifically l,i t�ed in thie protocol may be transported l by EMT-Ps or RN ON Y.These rmedlircatiions will need to, be, reviewed by MC and must faill into ai siimiillair category as other drugs(ALREADY LISTED in,thie prot�o�co�l. A patient receiving a completely new� category of drug rmaiy not be transported with�out�further pe�rsonine�ll trained In the use of that drug IMleldiical Controll (MIIC) may be defined as either the transporting service agency Medical Director,the transferring or receiving IVID and as a last resort the ED, physician of the trainsferring or receiving hospital. The Medical Director,of the transporting service may set addliitiional standairds regarding contacting MC. dww rn�Ilu I�iirn. oiuith rnimio st Medical Tiran port, LLC GPCN Application we. Transferring Patients with IlDriu �s and Devices [wring interhospitail transfer crew members sYhiaill fol'ilow olll BLS/ALL algorithms and protocols via American Heairt Association guidelines pier crew members certifications in the event of patient status chitin, a with contact with IVIC. In,addition, patients on medications aind devices at piiclk up may only be,train�sportedl if the respective drugs have been initiated at!the transferring hospiitail by the transferring physician/care proviidler.At the discretion of M�C, the,dlrug,rates/doses may be altered or discontinued depending on the piatiient"s clinilca,l condition. Where indicated, EMT- Ps aind' N's may tiitraite a drug up or clown o nic:e depending on parameters oieiliineatedl in the specific protoicoll. The folll'owing precautions shouild be kept in mind by trainsferring providers: 1. All mediiicabions have potential to cause allergic reactions. 2. Some medications cause local irritation arounid the IV site.Severaill may even cause tissue necrosis if there its infiltration.. If thiere is infiltration of any Iliine, the IV should be Immediately discontinued. . Many of the listed dlruigs acre Incompatible with, other mediicatiions. Therefore, additiiobnai medication should be giivein,through a, separate Its line, or, if one is not. established,the Infusion should be stopped aind the line flushed before administering a second miedlicatioini.This should)only, be drone unider direct. IVIC guidance. . Most require infusion pumps anidl/or cardiac,monitoring. 5. MC should be contacted if thiere its any change in patient condition or if any, medication needs to be emergentllly discontinued during trainsp�oirt. h. If the need) airises for emergency medications to be given, infusions may nie�ed to,be discontinued; contact MC.. 7. The MC physiciian may determine that the number or types of drugs/devices may require the presence of additional personnel (such as,ai second paramedic, nurse or physiciian). S. Transfer of Ipatilenits,with ongoing infusion of medicaition outside the scope of Practice and) training of the tra�insporting crew(eithier,because of llaick of cireclentialing, or miedicatiion not Misted) in the protocol) can not be accomplished withiout additional personnel who possess a higher level of traiiniing,. a Southernmost Medical!Transport, LLC. C©,PCN Application f. Requesting Additional Personnel When the EMS,provider ainiticiipaites thiat they will requilre more assistance to appropriiaitely care for the patient during transfer; they shiailll request the transferring physician/health,care prolvidler to provide appropriately traiined hospital staiff to accolrnplany the patient and assist. The EMS Provider rnuist contact for,medical d!irectioun in alll situatiloins whe�re they are not comfortable with the circumstances of the transfer.The transfer will not occur unlless the EMS provider and MIC are confidlent the personniell andl equipment are appropiruate for transfer. �NI Southernmost M ducal: Trail ni p'oirt, ILLC COPCN Applitatilon, 11. Drugs a. Cardiovascular Drugs b. Sedation and Paralytic A ents c. CN`5 Drugs d. HALITP , Insulin and Electrolytes e. Obstetric a rurgs Anti-in ecHve Therapy gr. Pain Control b. Antidotes i. GI Drugs Southernmost Medical: Transport, LLCIIIIII . II0 01 a., Cardiova cular Drugs i. Anti-arryrthmic Drags ii. Beta B'ioickers W. Blood Pressure Lowering Drugs iv. Calcium Channel B'iaickers v. Heparin Drip. wi. irro ropes vii.Nitroglycerine Drip wiii.Thrombioly tic Therapy Southernmost M" edical' Transport, LLC p� COP N Application ordiovascufor Dlrugs ai.i,�Anitiarrythmi'cs, Ulse: Treatment and cardioversion of Atriiail iF'iibrillhla�tio�n or Atrial Flutter Treatment and p�r�op�hVIaxis of refractory Ventricular Tachlyca�rdia Adverse Effects • Hypotension • QT prolongation • Tairsadles. • VentriicullarTachycardiai AV Block Amiio&rone, • Infuse: 3,00 mmg IVP 1st dose; 150, mg IV 2n,d dose. Piltiiaxerm fCardixemf • Bolus: * 0.25, mg/kg mg/kg over 7 minutes (20 mig for average Ipatient) If needed l may repeait bolus in 1.5 miliimnutes, @ 0.35 m, g/k ,(25, mg in the avier�age paitiient) over 7 5 minutes • Infusion: Cliilute 1.25 mg,(25rml) in 1010 rmll N5/D5�W * Drip @5 —15 mg/hour tiitrated to desired hieairt rait�e Ma,,neslymi Sulfate • Boluis:1-2 grams over 5 minutes • Infusion (Hours: 5-1.7 grams over 24s f na t • Bolus:2 mg/kg in 7.5-,70 minutes; followed Ika�y • Infusion: 0.00�67-0.0078 mg/'kg,/minute ouithie�r'nim�o�st Medic Il Trainisport, LLC COPCN Application Speciial Considerations., • We infusion puim:p for drips • May not be comipatiible with,hiepairin, Nidlocaine, amiodarone or bicarb Frequent. RP checks,for hypotension • Increased risk for ve�ntricuilar dlysrythmias if on certain antihistamines or anti-nausea medications Transport by EMT Ps or RNW's only Cardiovascular Drags a.H.Beta-Blockers Use: • Slow ventricular response In SST; Atrial Fibrillation and Atrial • Flutter Slaver sinus node rate Adverse Effects, • Hypotensiion, bradycardlia • Hypoglycemia (diiabletwics on medications); uisuial signs and symptoms are masked • Irolnchoispasrm Minus node a arrest Dosing,: AtgnQAILLRngrmjW • Infuse: 5 mg over 5 minutes o May be repeated in 10,rmiinuites Esmolol '.p'rvyib! • Bolus: Bolus: 500,mcg/kg(0.5 rnglkg) over,one minute • Infusion: 50 rmcg/kg/m,inute for 4 rmimuite ouithernmiost Mled Kcal Transport, LLC i" CO,PCN ApiplNcaition If inadequate response, repeat lbollu�s,and iincrease drip rate by 0 m�cg/kg/minute up to 3 times (total dose of 2000 mcg bolus and in fuisiion @ 2001 icg/kg/minute) i ruig comes in, a 100 mg (10 mig/ml)vial or 2500 mg,aimpulle Ninitm 250 mll (10 m /ml) or 500 mil (5 mg/mll) NS or D5W Labetallol ormgdyn+e. • Infusion: 2 mg/rninuite (concentration 1.mg/ml; • 2ml/mi'n) duration from 25 miinutes to 2.5 hours MetogmWLftgff".wb • Inject: 2.5 mg iIW slow push over 2. m,inutes • MN ay repeat does up to,5 times every,5 minutes for a total does of 1.5 mg Swatolol Qe ,p;K ) • Bolus: 1-1.5 mg,/kg;followed b�yr • Infusion: 0.008 mg/kg/minute—g mcg/kg/min, Spewciiail Considerations: • tllse infusiioln pluimip • Check BF frequently; monitor heart rate • Carefully monitor for hypotension,excessive biradycardia or new AV blocks, • Patient with:DIABETES, may have symptoms of hy,pog,llycernia masked;watch carefully for mental status chamg,es. • Contact MC iif develop adfverse reaction, Caardiovascu)ar D'rugs ai.ilii. load Pressure Lowering Agents Uses: Short term parenteral treatment when oral)treatment is not feasible Nw iiitrolpirussiidle may be used in,CHIF to reduce both preload and afterload (reduces work of the heart) Adverse Effects: • Hypotension, braclycardlia,, dysrythmiais Palpitations,f1us,hiing, angina • Headlache, restlessness, drowuusiiness, confusion, or slurred speech Southernmost Medical Transport, LLC COPCNII Application Diosiing: HyArailazin • 5-40 mg,IV plush over 1-2 m,inut�es • U 'suailly given as repeat.. bollluis,doses every 2.0- 0 mini desiredl • Rarely given as dlriip: 1.-10 rmg,/�h�ou�r Nlicardii erne LCMAUId • Diiilute to: 0.1 mg/mil • Infusion: Stairt. @ SO ri (5 rmg,/hr) • M' aiyr increaise rate by 2.5 mig/hr every 15 miinutes until' BP is reached l for ai maximum douse of 15 mi,g/Ihir hllitrciorus ide • lnfusioni:Continuouis to mainitain BP See dlos.age chart below; armount listed) is in rot1hr Nitroprussiidle: • Smaillll boduses or sllight increases in infusion rate may produce profound Ihypotension, • Solution miuist be wrapped) in foil to protect it from tight • Coo not miix other rmediicabons in the sarme Ilene Check BP and heart rate every 5 minutes • I-liy pio�tens,iorni can be alleviated by decreasing the infusion,r�aite Nles'urit1dle: • Caution in preeginant or lactatiinig patients • Contact MC for worseniing signs/symptoms, significant BP change or if BP<910, Blood Pressure Lolvuering Drugs shouilld be transported by IIVIT-Ps or RN's only. m vluthernrnnst MW edical Transport, LLC "WA COPCIN Application � ml NITROPRUSSIDE DOSING CHART CONCENTRATION 2 IICCWL loomcmdmL MGQSCML Pat 19w✓1 MCGfKGf M11NUTE h Kg 0'5 11 2 3 4 5 6 7 8 91 10 111 12 13 114 115 35 5 111 21 32 42 53 63 74 84 95 1105 116 126 137 147 158 40, 6 12 24 36 48 60 72 64 9S 108 120 1132 144 166 168 180 45 7 14 27 41 54 68 81 95 i918 122 135 149' 162 176 1'89 203 so 8 15 30 45 160 75 98 105 120 135 150, 165 100, 195 2'10 225 55 8 17 33, 50 166 83 99 1116 132 149, 165 182 198 216 231 246 60 9 18 36 54 72 90 168 126 144 162 160 198 21'6 234 252 270 65 18 2D 39 59 78 98 117 137 156 176 195 215 234 2,54 273 293 78 111 211 42 53 84 '105 126 147 168 189, 210 231 252 273 294 315 75 11 23 45, 66 90 113 1135 158 180, 203 225 248 278 293 315 336 s 112 24 48, 72 95 120 11" 1168 1192 216 240 264 288 315 335 368, 851 1,3 25 51 77 1182 128 1533 1179 2D 239 255 2811 3W 332 357 3833 90 1,4 27 54 81 148 135 1162 1!89 216 243 270 297 324 351, 378 4475 95 114 219 57' 66 114 143 1171 2W 228 257 285 314 342 371, 399, 426 1470, 115 397 60 98 120 150 11186 210 248 270, $ 338 360 390 420, 460, 105 115 32 63 95 156 1544 11891 221 252 2,04 315 347 378 4110 441 473 110,, 117 33 66 99 132 i68 119$ 2311 264 297 338 363 3% 429 462 4915 1'IS 117 35 69 104 138 173 207" 242 276 $11 345 380 414 449 483 518 120, 118 36 72 108 144 160 21�6 = 2881 324 360 396 432 468 504 540 Cardiol oscvPar Drugs a.N.CaMaiulrm Channel &Mockers Uses: Venitricu�lar Rate Cantrall in A Fib, Atrial Hultter, MAT air SVT Adverse Effects: Ml ay cause Atrial Fiulttelr, AV' Block, Bradlycardia, Chest Pain, CHF, Ventricular Arrh�ythmias, nausea/vorniting, dyspiniea or hypotension, Southernmost ri r n rt LLC i `'S111 Vb �010 11 C PCN application Dosiing: DRtkigna di • Bolus: * 01.25, mg,/kg,over 2 rmiiniu,tes (20 mg for average patient) * if needled may repeat b�olluis in 15 minutes @ Off. 5 mgl/kg (25, mg in the average patient) over 2 5 minutes • Infusion: a Dilute 125 mg (25ml) in 1010 ml NIS/D5W • CDrip @5 15 mg/'hiour tiitratedl tol dlesiiiredl hieart raite N'ie'ardiipene(C,ardene) i Dilu't.e to: p�.1 rng,/mill • Infusion:Start @1 50 rmll/hir(5 um1g/hr. Mary increase rate by 2.5 rmg/hr every 15 minutes until BP is reached for a, rmaixiimurm close of 15, mg,/hr Special Considerations: Carefully rmonitor for hypotension/excessive bradlycardiia/new, /V block PVC's can occur with, conversion to, NISR • Don't use in thie presence of a WIDE COMPLEXTACHYCARDIA Nicardipenie: • If hypotensive or tachiycairdilc, discontinue dlripi. M ay resume when,stable @' -5 rmg/hr *' llnf'usiion site must be changed after 1.2 hours •, Use with caiuitilon in, patients,with liver failure, siince it is metabolized in the lliver: •' May, be contraindicated in sewere Aortic Steino�sis as may decrease preload. S�houild not be infused in same IV with other drugs Ca'ra°iavoscula'r Drugs aM.Hlepariin Drip Uses; Prevents blbolod clotting, especially in the following situations: Acuite M 1, Pulmonary Emblolus,, Deep Vein Thrombosis Southernmost is l Transpoirt, LLC COPCN Applicaboin Adverse Effects: NHemorrhage from various sites including needle sticks, GI tract, CNIS bleed's Dosing: • Bolus: 15-18mg/kg • Infusion: 800_1 U0 mg/holur Infusion rates may be, outside this range and shoulldl not rewire adjuistmient dluiring transport Special!Considerations: • Use infusion pump • U/C immediately for onset of major bleeding or aicute mental',status chainge Contaict. MC for ainy bliieeding such as IV sites or gums Cardiovascular Drugs a.vlii.lnotrop s Uises: • Short term intravenous treatment of patients with acute dlecompensatedl heart failure • Severe CHF/C'ardiogenic Shuck • To increase cardliac output by increasing rmyocairdiail contractility and stroke • Hemiodlyna mica,Ily signiificanit hypotension not resulting from, hypovolemila, Adverse Effects: • Maly develop hiypokailemia resulting from increased cardiac output and/gar diuresiis Maly have tachycardia, ventriculair dlysrhyth�wia�s or ectopy, hyperteinsian, anginal or vorniitiln�g iischem:ilc chest pain Dobu�tairnine many also caiuse hypiotension Dopaimine may cause nervouisness, headache, palpitations, dyspneai Southernmost t Medical 7rain,spo:rt, LL+ „ OPCN'1 Ap'pliieat on, �cablultarnilrye; • 2. —20 me /kgg/mire continulo'u infulsion; • onset may be 10'miinultas See dosing chlairt bellow for different concentration solutions r)osvT^1+/11'.1r r=VOSINO CHART CONCENTRATION 2Mi3A'11e111.... 101"5001 'ML OR 1'00dw G/501'V1L 'pa"'0UMGJ25[1'ML PAT WW MCO/K IMINU1TE �....... IN I�Ca 1 3 4 E3 1 1Q 111 12 13 14 1'5 16 1i7 18 1'9' 211 25r 311 4C1 35 1 21, 3 41 5 6 71 8 9 11 12113 14 15 18 17' 18 19 20 211 26 321 37 42 40 1 211 4 5 I 6 7 al 110 111 112 113114 1 U 17 181 19 217 22 23 24'30 315 42 4 46 1 31 4 5j 8 91 1111 12... 14 15 119 10 20122 23 24 26 27 34 41. 47 84 541 2 :31 5 6 8 9 1111 12 1:4 15 17 18 20 21 23 24 213 27 2€1 30 36 46 53 60 55 2 3, Sl 7 8 110 12, 113 115 117 1A ; tJ6 211 23 25 26 2,8 1 30 3-1 33 41 50 58 !fi6 BCY 2 41 S7 0 '11 13 114 1113 18 2Q'22 23 2_ 27 L 311 1 32 34 36 45 54 C33 72' 4"s '2 4 8' 81110 '12. 1.4' 16 118 2'[11.. '21 23 25 2'7 29....,. 31 33 35 3�7 39 49 5 61r 78 70 4 6 8 11 113 15 17 19, 2'1 23 25 27 28 32 34 36 38 4t1 42 53 63 74 04 75 2 5 7 '111 114 18 110 20 23 25 27 2a 32 34 '36 i 38 41 43 45 56 68 79 90 13r1' 2 5I, 7 1¢a '1'2 1I4 17 1g7 24 2 31' 34 3 3 41 43 46 4 1 724 96 85 3 5 8 10 '113I 15I 18 2C1i 23 76, 28 31133 36 38. 41 43 46 48. 51 64 77 8,91 1102 gip 3 5 5 11 -114 16 101 22ITITIT24 27' 301 32 35 38 41143 4's 411 511 54 68', 811 05 11118 9'6 3 6 1i 1 14 1,7 '20 23 K6 29 31 34 31" 40 43 46 46 51 " 57 71 06 11010 1 14 1 CC7' 3 dro 12"' 15 111 2 11 24 27 3C1 33 313 39' 42 45 48'I 61 �w4 I F7 4311 75 *1CM!, 11m5 112C1i 105 3 5 f9 13 16 113 22 25 2 32 35 313 41 44 47 5c1 54 57 80 63 7k} 95 11�7 12.6 1¢1 3' 7 1 f1 11 17 2G13 213 3 33 30.9 413 4+8 5tI'' S3 5 59 6«1 6a 13 1113 1115, 132' "115 3 7 1 b 14........ 1'7 1. 24.. 2.A. 31 35 38� r11 15 4.8 52Sr. 541b 1 82 E11� Ei1�' 8'E� 111+4.; 121 '1:3,131 12Q 4 ,1 14 18, 22I 25 23' 3 38 4[1 1 47 5Ca »111 RS1 as 1 FE 72 8� 1�DEf 12E1 1��N' 11n1 ! hr or drops/min. using 1m'11niidrip tuibi g,, 60 drops/ ird ou'thiernimost Meldilc ll Transport, ILILC Nx>U L.IE CONCENTRATION I OR U"I!""AMINE CEO iNG CHART CONCENTRATION 4141iG/PA1IL 10190IM 126a19W- SOOMG/125M.L. PAT"V°VT IMC (3fGCC"a'/1Yi111NUT ' IN KG., 1 1 21 3' 41 51 61 7 9 91 10 111 121 13 1'-4 161 16 117', 1181 191 201 25 301 361 40 35 1 1 2 3 4 4 & 5 15 6 "7' 7 8 8 9 91 10 1 1 13 15 119 2'11 40 1 i 1 2 2 3 4 4 8 6 7 7 j 9 8 9 10 10 11 11 12; 115i 1 8' 21 24 45 1 1 2 3 3 4 5 5 8 7' 7" a 9, 91 119, 1',1 1 1 12 13 14 117 20 24 27 SO 1 2.....2 3 4 5 5 8 _.7 0'' 8 £1'', 110, 111 11'' 12 1'3 _14� 14 1�S. 119 23 213 30 55 1 2' 3 4 5 "7 7 81 9 -101 111 12 12 13 14 16 i 16 17 21 25 29 33 GO 1 2 3 4 4 5 6 7 8' 9 1 10 11 112 13 14 114 15 110 1'7 18 23 27 32 313 65 11 2' 3 4 5 9 7 49 11 117E 12 113 14 115 16 17' 18 19 2r1 24 29 34 39 70 1 2' 3 4 63 6 7 8 9 11 131114 18, 1G' 1'7 16 19 20 21 20 32 3"7I 42' 76 1 2 3 6+ +B 7 B 9 1, 1 11 141, 115 18 117 18 19 2Cr 21 23 211 3e1 31 4'S so 1 2 4 5 43 7 8 111 1'1 12 14r 17 18 1'9 20 22 23 ,24', 3C1 38 42, 48 85 1 3 4 5 +F3 8 9 10 1°1 13 115 18' 119 20 2ry2 23' 2'4 25 32 38 45 51 99 11 3 4 5 "7 8' 9 11 12 14 15 16 111 20 22 3 24 26 27 34 411 ' 47 54 95 1 3 4 6 -7" 9 10 11 13 14' 15 1720121 23 24 26 1 77 29 354 S9 67 1Q19 2; 3 5 B 8 9 11 12 14 151 -1'7" 1 118 21 23 24 26 27 29 301 313 45 53 nO 195 2'' 3 5 G r1 9 11 13 14 16 17 19 2,2 2'4 25 27 28 30 3'2 39 47 516 6,3 119 2 3 5 7a 10 '12 13' 1'/5 1°7 111 2a9 23 25 26 28 3GF 31 3'k 41 5P 58 5 1'15 2' 3' S 7 9' 117 12 14 18 17 19 21 24 25 28 2f9 311 33 35 43 52 N317 Ia9 9, 11p 13 '14 1.. 23 29 2'7 29 31 32 34 38 45 54 63 72 1 2 c9 2' 4 ,r 7 18, 241 241 rni/h r or ri'ropsl nin. using rnir9.id rip tubing--= 60 diiropslrar9l. l�l? �In1'71n1f�'; • 1.-20 mic /k /mnin Iconitinulous infusioln ' Onset may be 10 minutes See closing chart below for different renit concentration solutions. u il�kv�6Southernmost Medical Transport, LLC COPCN Application 00pamlinne 003ing Chart l3ou ble, C'c me nntrsmihion 3,2 rm g/ml me °1c T riv&u to _ .... r... ._...,. .,,,,,� Q,....._� �..�._. �.._ 0 .. 1 2� 2, 3 7 50, 1 ' 1 lAi I 1 11 21 3 4 10 15' 2.1 C] 11 2 3 5 6 ill -I 2 Z 6 1 2 5 612' Is 2 ........ _._.._—. in Kg 4QJ 2 3 i 1.. 2 3 30 1}p 2 3.wwwww— 7 .._.1 2i-9 4 __.�. . 11 C74 2 4 !d' 1i 3 3-11 41 � 1.11 — - 11.l ..... 2.2 32 43 12 1. 11"1 2: ,....... 1... . 4�- rxaUhr -or drops/min. usfing rmuirnidri x t>wubis-A � 60 dro�ps/ml� M*tj rnrmri <-,'bm w-t ia� rm��'��aramNL✓r1vr��"I t.)rnxs�im�u o anninic DOSInichall Riing,le Co ncentratio n 1.6 mg I rrti 800 mg/500 mmml 400 mg 1250 m l mcg&0 Imimr.nte 11 2 4 5 10, 15 20 35 1 3 4 5 7 13 2 2 50 2 4 6 a 9 19 28 35 55' 1 C 1 21 w.....w "i I 41 t 65 2 a 71 -10 12 24 1 37 49 n 7'0 3 5 81 11 1 2 5?' c�1 75 _. ._.... I 12 14....... _- 321 8QI ww. ... 3 19,1 131� _,1 45 60 1 1 9 95 4 7. 11 14 18 - 53 71 10 4 al 11 15 19 36 5fj 7 105 4 12: 1 q_ 20 3 - r .79 11 4 8 12 1171 1 4�11 .. .1' ._.._.� 83 115 4, 13 # , 22 43 * 3t1 90 12C1 5' 14 1 2 4 f 1 m,i lir or drops/'mien. using,minidlrip tubing 60 al�ropsloill •' Epinephrine: 1.-10 mnlcg/mnimi titrated to desliired effect •' No re�piimlephrime:0,5-1l.0 rmc�g/rriim •, (L�e!voph,edl):Titirated,up to 30 rmc / ,i1m to dlesire'd he�modlynarmic effect 4 OM Southernmost lrMedmr.al.l Transport, LLC j9. COPCN Application, Special Considerations: • Monitor for cardiac dlysrythmiials; these may brie caused by hypokalen ia, preexisting arrlhythlmlias, abnormal drug levels, cathieter placement, etc, • Check blood pressure and heart rate frequently, Discontinue briefly if develop hypotenlsion secondary to valsodillataltionl • Cv iT-ps aln,d RN's maiy titratl up/downs one iinicremient Without calling MC. • Contact MC for any adverse affects arc i v .s ular Drugs a.viii.hllitroglyeriine Drip Uses: • Acute Coronary Syndrome, CHF, Hlypertension. • Decreases preload, and to a Messer extent, affterlload Adverse Effects. • Excessive hypotension vuhlich caln provoke angiinlal, (headache, restlessness., • palpliltaltions,tachycardia) or dizziness Dosing; • Continuous infusion titratedl to malliinitaiinl therapeutic effect while alvoiidinlg, hlypotenls,ionl. • usual range 10-200 mcg/miin. (May be hlligher in treatmlenit of pu Imo nalry edema. Special Considerations: • Use Infusion pump Monitor heart rhythm • Check RIB and HR frequently (every 51 minutes); may decrease to every 10,minutes if alt the same rate for>1 hour Do not mix other medications in the same line • Hlypotenision can be ableviiateld by decreasing the rate of infusion D/C unfuision if Rip systolic its <60mm Hg,and colntalc�t MC Contact MC for+ ors,enling,or persisting adlverse sbgns/symiptomsl or fair persisting BP< 910 mmHg Southernmost Medical Transport, LL r;4nvw ... .... COPCN Application NITROGLYCERIN DOSING 1CONCENTRATION CONCENTRATION 2 I L Nil Y ICJ DOSI RT 5 /250 ML 100 MG1250 ML PUNIP PUMP P PUMP PUMP 10 3 160 48 10 2 160 24 20 6 170 51 20 3 170 25 40 12 190 57 40 a 190 25 50 15 200 88 50 8 200 30 60 18 211 9 210 3 70 21 220 66 70 11 220 33 ea 24 230 69 80 12 230 35 go 27 240 7 110 14 240 38 100 30 250 75 1!00 18 2,50 38 1 0 36 260 78 120, 18 28 130 39 270 81 130 20 270 41 140 42 280 84 140 21 280 4 1 45, 1 2 Southernmost c st Medical Tra!nsport, LLC i 40 CO;PCN Application Cardiovascular Drug a.i .Thrornhoill tic Therapy uses'. Dissolves clots in blood vessellls Generally used in the setting of Acute MI o,r+ VA; occasionally used Pulmonary Emb6lus AdverseEffects: * Minor hemorrhages from IV sites and gums * Major hemorrhage from G1 and i tr cr nial air spinal sites * Reperfusion dysrhyt m!ias often occur about 30-60 minutes after staring infusion Allergic reactions inciluding anaphylaxis inrnay occur with,Streptokinase or AP SAC Dosing: Strepato Ina .,._ or T * Chose to bei determined by transferring physician! (determined by patient weight and indication for therapy) Rate s of lld not require adjusting en route T;necte_ollase weight-lbas d one time dose, administered over 5 seconds Pt weight: * <60 kg Dose. 30 mg ;t . <70 kg 35 mg * ?70 -<80 40 mg �! _ <90 45 mg * 90 0 mg }ccasioirnally used as continuous infusion for peripheral arterial thrombus 7 ,.'. .. mg/hour u to 48 hours Special Considerations: • Use Infusion pump * Monitor heart rhythm * Check BP and H,R frequently * Do not mix with other medications in the same line „GSouthernmost Medical Transport, LLC P iiation D/C infusion immediately it there is cardiac arrest, major hemorrhage, anaphylaxis or change in mental status AND call MCJ svuthierni mast. Medical Tr nspoirt, LLC OP N Apphcation bi.. Sedation, and Paralytic Agents L Benizodiazep ne Drips li. Moderate Sedation Agents iii. 01pioi'd Drips iv Paralytic Agents Only to be used by EMT P or RN"s Southernmost i al Transport, LLC COPCN Application b.L131=nizoludliazepine Driip IUlses: Sedation for patients who,are in�t�ub�atedl (and ofle�n concurrently on a paralytic drip) May be used to treat Status l pilepticus Adverse. Effect : Mia be more prone to hy�potenision if uise�ld with an culpio�iidl dlrug,Can cause paradoxical agitation, hypertension or tachyrcardiiai Dosing: Lo zzepprn La?l',u^a :n • Loading dose: 0.5-4.01 mg IV bolus; may be repeated l in, 10 rmiin, • Infusion: 0.012-01,�1 mg/kg/hour Miidazolla (Versed) • Loading,close:0.01-0.1. mg/kg IV boluis • llnfusion O.01 -0.1 m,g,/kg/hour Speciail Coinisiidleraiti'�ons; • Oinlyr to be uisedl In lintubated patiients Southernmost Miedi al Trainspvrt, LLC CCIPCN Application Sedation and Paralytic agents b.iii.N'Mloderaite Sedlatiloin Agents Rises:. Sedation for patients who are intuibated hand often concurrently on a plaralytic driip),. Ml aiy also be used for refractory seizures or therapeutic comma Adverse Effects: • Mlay be more prone to hypotenision if used wiith an opiloiid drug Can cause paradoixicall agitation, hypertension or tachycardia Dosing, Pr000fol: •' Loading dose: 01.5-5 mg/'kg (Maintenance infusiion;2-1 rng,/kg/hiour Q,irbijurates:Pentobarbital � rn AM uused, •, Loaiding dose: 10 nr........g/kg; infuis�e uip to mng,/irmin, Mu'Vaintenance: 1.-. ,rmg,/'Ikg/houTir Ketar nirne• Loading dlose: 1-5 rmg/kg, * Maintenance infusiloin;0.01-0.05 rng/lkg,/hour Speciall Considlerations: • Oinlly to be used) in intuibated paitiients ASouthernmost Medical Transport, LLC u' , C0Ii Application Sedation and Paralytic A rents Wii.Opioid Drugs/'Drips. T"Picatw<ypa of a sedo,tion com,bina o�n for patients who aire intubated Occasionally for paiIn control Adverse Effects: IMiay cause hypotension, especially in volurma diepleted patients or those wwaithi right-silded heart failure Dicisiing. carahine® Loading dlose: 2 mg increments given every -10,minruites until aideguate plaiin control; typdicailly miaix dose is 10 mig miaiy be higher in patients on chronic pain therapy " Infusion. 1-10 mg/hour Egii ' Loading dose, 1--5 rmicg/kg giiven IV plush ' Iniuisiion: 1 5 mcg kg/hour Specialll Considerations: ' Ni+at adlvisabilie to,give patients on narcotic driips Naloxone, as this miaiy precipiitate acute wiiithid rawva ll ' Antihistamines both I I1 amid H112) may counteraict hypotension; thiis dis an I'w'IIC contact drug,.. Southernmost Medical Transport, LLC N .'u COPCN Application Sedation and P'aralyticArgents ba v.Paral tic ,agents Uses: • Total muscular paralysis whien patiienit moverment mray:. 1. Comiprumise airway cmntrolll (e.g.caiuisilnig unwanted extubatiion) . Exacerbate a read or potential illness car injiury e.g.spinal cord injury from a spine fracture) 3. Endanger the platienit, EMIS care provider mlr others ,adverse Effects: • Brmnchmspasm, f1ushiing, hypaltenisian and tachycardia have been rarely reported Dicrsiing: • Initial closel 10,mig IV push • Repeat dlnlse of 10 mg,, IIV plush every 0-40 rmlinuites as • Maiinteniaince infusion, may be an alternative: 1.1 mg/k /m,iin R�eurc>Hm�urrt: • Loading dose 0,6 mg/kg • May reballus O,2 mg/kg mg/kg every 3045 minutes. • Maintenance infusion may be an alternatiive:1.1--0.15 mg,/'kg/min Special C�on�siidlerations:. • Produces COMPLETE APNEA, therefore an intact airway (e. ,. endiutracheal intubation), • Indications: adequate ventilation/'uoxy enaction My UIST RE ESTABLISHED PRIIO,R TO ADMINISTRATION. Likewise, personnel and egluiipmient with the ability to restore an airway,ventilation and o y, +eniaition must ble available during tr inisplort. Nolte: Paralysis may alter the cliinicalU exam. For example, motor selzuire activity will not be seen, but the brain will continue to,under,go seiizuirel activity, aind this must be treated! Allsn, conditions such as shack, hypoxiai, pain, intracrainiial injury, hypoglycemia, etc. maybe the cause of this unwanted, spaintaineouis patient movement in the first pilac+e. These candiltions must be addressed bust rmaiy be masked bly the puarra�lytk agent! NSouthernmost Medical Transporl, LLC u '0 QPIN!Application c. CIS Drugs I. Anticonvuls ruts h. Mannitoll h4 Steroids � Southernmost Medical' Transport, LLC OPN Application CS Drugs 6.AntiC'onv'ulsaints Uses: Prevention and treatment of seliures Adverse Effects: • If intravenous phenytoliini is,given too rapidly, many resullt in: * Cardliac dysrhythrnias iinclAing ve nitric ullar fiibriiillaition or asystoile * Hiyppiotensiion • Subcutaneous extra,vasa�tuon of intravenous;phenytoiin may cause tissue necros,iis or pailin at the IV site Dosing: Rheim toiir :. 100-12 0mg 1V piggy back in normal saltine, • Rate not to exceed Sp mg/min NKe ra et Loading dose: 01 nag/IkgIV over 10, mien (nio�t to exceed 4500,,mg max close) Then 0-30 mig/kg IV maintenance Vail 40-60 mig/kg. • Rate up to,31 mg/kg/min Special Coinsiderations: Ulse infusion puimp Monitor heart rhythm, Check BiP frequently; vital sign monilitor recommended D/C iinfusion and contact MC for any adverse effects I Southernmost IMedicall Transport, LLC. ,F CO,PCN Application MIS Drugs c..H.M nnitoll Uses: Treatment of increased iintracranial pressure or sellected fluid evedoad Adlverse (Effects: • Hyperinatrem is Volume Depilet a�n Dosing: • 25 501 grams IV push, o�r bolus,iin:fuisiion (iin SOcc.D,S"W over 20,rnilnutes) SpecialConsiderations: • Patients receiving rnannitio] shicluld'.have a Folley to mionitor flluid Status CNN Drugs c.i'rli. t roils Uses: Spinal)cord)injury to decrease edema, • Cerebral edema clue to injury or CNS mass or lesion Adverse Effects: • u,l Bleed) • Electrolyte dGsturbaince aind hylperglycernia Hypertension,oar, cute CHIP • Agitation • Corticosteroid hormonal suppression (hypoglycemia, hypotension, hypothermia) Higher rink for infection or masking symptoms of infection Southernmost t e i N Transport, � LC �,�u�rm�ry +, °r" C PCN Application Dosing: • Initial biolus: 30 mg,/kg over 15 minutes • Mart infusioln 45 minutes later. 5,4 mg/kg/hour for 23 hours Dexa methaso ie f pecadron • 0.1-0.6 mti ,/k 'daffy • May he given as III"dlrip of 2 mg/kg over 2 hours Special Considerations: • Cointact. IVIC fair question of adverse effect k Southernmost Mediica l Transport, LL COPCN , pipllicatiom. IN erali pentation TM, In�sullin and Electrolytes i. H p' 'roUmentataa' /MN'' h. Insulin Drip W. Potassium Chloride Southernmost Mled cal! Transpoirt, LLC w� ,1 ... COPCINI Application HyperalimentationlI TM, Insulin, Electrolyte solution dl.i.H peralimenitatiloni/TP N uses; 41 intravenous nutrition Adluerse Effects; is, Catheter related sepisis 01 Air embolism if central ve,niolus IV tubling becomes disconnected Suibicutaneo,us extravasation of solution can cauise tissue necrosis Diiisconit nuiaition of infuision may cause hypogllyrcemia Dosage; Continuous infusion usually thiirough central venous catheter blut occasionally through a, peripheral IV l'iine.. Rate should) not regluiire adjustment enroute. SpeciiallConsiderations; • Use iinfusiion pump.. • Do not administer ainy other medication thurnuigh the same IV Mine, • Contact MC for any,adverse effects listed above • Consider use of a cardiac mioniitor COPCN'Application Hyperalimentotion17-PiNi, Insulin, Electrolyte sofu virr d.il .lnsullliin uses: •' Lowers biloodl glucose •' Usedl in diabetics especially with ketoacidosis or hiyperosrnolar nionketainic coma,. Adverse Effects: •' Hypoglycernia related (tachycardia, diaphoresiis, mental status changes,and, seizures) Dosage: •' 5-15 uiniits per hour but dosages outside this range may be used,. Special Considerations- di Use infuision pump • Do not administer medications in the same IV line except D,SO,. If symptoms of hypoglycemia develops: • turn off iinfusioni, a perform a D-stick • a dim!niister 25.graims, (one AMA P,)i D50) if gllulcose<80, (-r contact MC,. • Monitor blood sugar every 30 minuites dluiring;trans,piort. • Cardliac moniitoriing, required ii Southernmost dica r rt, LLB r e3sr r � r N COPCN Application H p rolimenta tionlTiPN, Insulin, Electrolyte solutions d.N.Potassium, Chillorilde Uses,: 0 Repola�cerne'nt therapy for h�ypoka�lernia Adverse Effects: As Cardllaic dysrythmias (,pralllanged pit lntervall; wide QRS cornpllex; depressed)ST seg,mment; talll" peeked T wwaives; heart block;card4a�c arrest)Subcutaneouis extravasation of solution can cause tissuie necrosis Dosage: • Usual range us up to 20 rnEcIl/her.,continuous infusion. May be mixed with, various IV solutions in varioluis sized baigs iinclluiding "piggy back" solutions. Raite should not require adjiustrnent en route. Special Coinsidleratiionis.. • Monitor heart rhythm • Often cauuis,es buirn'ung,during;infusion, contact IVIC if this is probillermatc • Contact MSC for changes in EKGi configuration and)/or dlysrythmiaus S Lit ern o f Medical Transport, LLC wi1 COPCN Application e. Obstetric ring i, Magnesium Sulfate Southernmost Medical Trainisport, LLC COPCNI Application Obstetric Drugs e.ii.Magnesiium, Sulfate Uses: • Treatment of pre-ecllam,psiiai and ecllamptic seizures Premature rupture of m1eirnbraunes Adverse Effects: • L.ethairgy, nausea,vomiting, hypotonia, respliratolry depression, dysryt.h mia Noising: • Loading close: 2-6 grams IV over 15 minutes(may give 2 grams over 5 min) • Followed by eitRhier; * 5 grams IiM in each buttock * Maintenance infusion: 1-2 grarms/hr Special!Considleraitions: • Monitor reflexes • For symptomatic toxicity: 10 mmLs of 10% Calciiurn Chloride and contact MC may also request furosermide aind/oar NS boluis as IIf CO • In, renal faulure, patilent may require ermergency diaily:sis %t°' Southernmost Medical Transport, LLC i/, e 1 N � J��,,,, COPCNi Application Olbstetrie Drugs e.iii.Oxytocini (Piitocin) Uses:. Stimulates p�o�st-pairtuim,contraction of the uterus to cont,rol IWeeding, Adverse Effects: • hypertension,taichycardliai,, dysrythmiiais Dosing: • 10-,4�0 unlit�s Budded to 10100 mll.. 1V Fluid to control he�.mor�rha�g;e • Usual rate its 10-20 miilliunits/mini Special Considerations: • Use iinfusiion pumip • Monitor heart rhythm, • Check BP freguiently;vital sign mmniiitcr recommended • Contact. G+'yIC for any adverse effects Southernmost Medical Transport, LLC 01 COPCN Applicaton f. Anti-Infective Therapy L A tib�,ioti s ii. Ant`fungals ww Southernmost, Medical Transport, LLC PCN, pplicat on �!,vi rr«im rJ r�ll Anti-Infective Therapy f:i.Anifibiaatics and Ant�ivirlTaii Vises: Bacterial or Viral int+ectiions (treatment and prophylaxis) Adverse Effects: • Allergic signs and symptoms, iinclludin anaphyllaxis Dosaige: • Vary dlepending on the antibiotic • Generally given as a "piggyback" solution Rate should not reaiuiire adjustment en route Speciial'Considera'tiiaxn. • D/C infusions if there are any allergic signs or syrnp'torns,then contact, MI C. Most Commonly used. • Aucyclovir • Azrtbrcamyc1'ra • lZi'throma'x)C'ef"ar'zal'rn • (Aincef),Ce tri xone • (RocepFrin)Gentaamirin • Lewfloxacin(Levaq uin) • Metronidazaal'e(Flogyrl), • piper c ffinlTazoibact r (Zosyn) i Southernmost Medical Transport, l_L.C. �m i.fr OIP' N AppHtation, Anti-lnfective T ropy l Antifungals, Uses: • Fungal infections, • Often in immuunl -com prorniis dl patients,thus on: chemotherapy or chlranic antibiotics iotics Adverse Effects, • Nlauisea or diiarrhiea 4 Amp�hoteriicin-fever, riig,ors,. chills Dolsinlg, Am h u itericin B. A oles or"F "j w Usualllly given as bollus dosiin ,once dla,irly to TI1 10 May be given as continuous bladder iriri ation: 50 mg/liter Over 24 hours @ 42 rill/hour Special Considerations: Drug interactions maly occur with statiins, couurnadiin, antiviralllls, benzodliazepunes, oral hypoglycernic drugs and transplant anti-rejectionls drugs Side effects can be pre-treated with Acetaminophen or Di�ph�einhydrarnine Southernmost Medical Transport,rt, COPCN Application . Pain Control i. Op ioid Qirlpis pf. P' A Pumps and Subcutaneous Pupas N. Anesthetic Sprays or Topical Gels S,ouithernimios,t Medical Transport, LLC. Q �� i ! u„ 11000IPCN':Applicator Pain,, Control g.6.Opiioid Driips Uses: Controll of pain Adverse Effects • May caiuse hypotension, especially in volume depleted patients or those with ri ht-siidiedl heart failure • Respiratory Depression Dosiing- hone; • Loading dose 2 mg increments,given every 5-10 minutes uintil adequate pain control; typicalllly max dose its 10 rm m iaiy he higher 1patients on chronic pain therapy • Infusion: 1-10 mig/hiouir renitanvi., • Loading dose: 1. 5 mcg/kg given IV push • Infusion: 1-5 micR/k /hour R drormorphone(1lilaudiidl: • Loadliun dlose: 0.5-4 mg IV slow • Continuous infusion: 1-10I mi /hour Special Considerations: • Avoid Naloxone ais thus could precipitate acute withdrawal • bump malfunction could precipitate withdlrawall • Ant¶histarnines (both H11.and 1-12) may couinteraict hypotension;thins is air MC option, Southernmost lost edica ran rt, LILC Pal Application 11%m Pain Controf g.ii.PCA (Pl tiient. Controlled Ani stlhesia) lumps anid Subicutaneouis Pumps Uses: • Treatment fo,r patients with p�ailliiative care,or chronic pain con&tilons to em PO,analgesia is niot feasiible Adverse Effects: 0'� IHypotensiioni Respiratory depression • Catheter site iinifectio�n or irritation Dosing: • PCA(Pi Controlled Analgesia) Pumps • Morphine, Fentainyl and Hydrornoarphoine are most co nimonly uised. • Pre-pirogra�nnimed settings for Ipatient ., Patient many require assistance to,"sielf-adminis,t.er" medication „nexus„Catheter puumnnis Mpr hiine„,rmotstmcomMpnll used, • Ulp to 2 m Ls volume at a time regairdllless of concentration • May also give IV fluiids at ai usuail rate of 1-10 rrol.s/hour; MAX of 25 m,Ls/hr Special Considerations. • Encourage patient to uise rmiedi'cation as needed void Naloxone ais thiis,coWd precipitate acute withdrawal • Pump mrnalfumictiion could precipitaite withdrawal • Subcutaneous catheter sites need to IEbe changed every,r dlaiy D �outhernmoc s,t Medical Transport, LLC' �� OP, N Application ����o� 1111�� Pain Control gAii. prays and Gie'I Uses: Topical pain contrpll- usually prior to a, procedlure Adlverse Effects: • Allllergy to miedicatialn • Depressed gag reflex if used orally • U'suailllyr 2 sprays,to desired area Topical gels: • Enough to thiinly cover area • Diuraituon, can be minutes to hours Special'Considerations: • Some can induce Methiemoglobi per lia • Watch for hypoxia Southernmost Medical Transport, LLC „ o C0PCN Applicat on d. INAC H. Sodium T iosulf'ate W. Thiamine iv, Bkorbonate Drip. v. Pyridoxine A AtropinO-pA PSouthernmost Medical:Transport, LLC� COPCN Application Antidotes hil,N-Acetyl Cysteinie, or NNIAC (Acetadote), Uses. Acetairmiincip�hein, overdose-toxic rtuaintities� Adverse E fects. • Anaph^ lactoid type reactions u.......rticar'ia,flushing, hypotension and......... bronchospasm Dosing:: • Loading close: 154 mg/kg over 15_ m,iniutes • Maintenance infuisiion: 50 mg/kg over 4 hrs then 100,mig/kg over 16 Ihcours Special Considerations: • lid al Mime of onset of treatment is w,ithuin 8-1p1 hiouirs of inn ,estion • Anaphiy!llactoid reaictions may be treated with, IV diphenhydramine • IM^ainit�e�nanice infusion muis�t be doubled at the 4�-hour period S,ouithernmiost Medical Transport, LLC COPCN Application Antidotes h�.ii,C aini'de Antidote Kit (Amyl NIitrate, Soldiluim, Nitrate, Sodliuim Thiiosulfate) wises: Cyaniide poisoniin Adverse Effects: 4 Mary cause rmethernoglobinermia: DIosim : • Dosing,as described) iin kiit; weight baisedl for children Special Considerations: 0 Not to, he used with Corb�on Monoxide aide poisoning, i�� outhernmiost Medical:Transport, LLC Of CORCINJI Application Antidotes h.iii.Th,ia�rnfine Uses: Wernicke's Encephapop�athy Adverse Effects: 0 Poissiib,lle anaphylactic reactions Dosing: • 100 mig lV over 1 — 0 minutes Speciall Considerations: • luicose adrniniistraitiion in nutritionalllly dieplleted paitients shioulld he accompanGied Ilbly thiamine Anddotes Wv.Bicarbonate Drip, Uses: • Tricyclic,aspirin or other acidotic overdoses • Renad protection after IV contrast or with,sever a muisclle breakdown (rha bdomyolysis) Adverse Effects. Sodium load Dosing: Titratedl to urine p-I > ^ by hospital staff Special Caonsiiderations: Usually will', have a Foley to check urine IpH and outpuit. Southernmost Medic all Transport, LLC COPCMI Application n� • May the assw'ciated with lhypokalerniia, Antidotes hx.P riidoxine (Vitairmin B ) Uses: Is,oniiaizide (liNiH)Overdose Adverse Effects: • to II upset. • Headache or slleepiniess • Tingling or burning:of hiands/f et. D oisiing: • 5 grams IV over 3-5 minutes; repeat every - 0 minutes until seizures resolve Special Considerations: • Often paitient its in statues epflepticus; seizures may respond)to henzadll'azepines h.vii.Atrnpine/2-13AM Uses: For SEVERE Cholinesterase Inhibitor poisoning (,e.g. pesticides, nerve agent) Adverse Effects: • Blurry vision, dlry mouth Southernmost Medical Transport, LLC. r Y441it p Application Dosing: spine° ®4 mg given every minutes until signs of atrophiization (this may t ke 5-5 ) ri' li eai o e * 1 gram slow IV iinjection; if muscle weakness persists, give 500 mg after 30 rninUtes Special Considerations: -PAM! shouild be given WITH Atropine Southernmost Medhiaal Transport, LLC �M II. Gill D'r a g's 1. Antielm'e lcagent ir. Acid Reduction iii. GI Bleed Related Medications Southernmost Medical Transport, LLC COPCN Application .1000 Gil Drugs i.i.Anti ermetic Age nits Uses: • IEor control of severe nau.seai aind vomiting Adlverse Reactions: • Drowsiness, dizziness, blurred vision,skin reactions, hypotenision • iExtralpyram idall symptoms ( p' )— motor restlessness, dystoniic reaictionis, pseudo parkinsonism, tardive dlysklnesia with remietaclloprairmide, prochlorperazine,or piromiethiazi ne • Headache or dizziness, may occur with ondlansetroin Dose: [ ,etacloprarnidle (Reg llain) • 10 rmg, IV over 2 minutes If needed, dose may be repeated once in 10 minutes Plr hl r r ziine Co—mpazine • mg III over 2 miinutes * if needed, dose may be repeated once in 10 m,inutes Promethazirre n.� • 25 mg IV over 2 miiinuites * if needled, dose may be repeated once in 10 minutes Oindansetron jZQfran) 4 mg slows IV over 2 minutes or I'MI * if needed, dose may be repeated once in 10 mminuites SpecialConsiderations: • Extra-pyramidal sym7ptorms rmay be treated by administering; Diphenhydrarmine (0enadryl) 50,mg IV over 2 minutes • Confilrrn with, MD regairding IV aidrministration of Promethaziine due to "bllaick box warning' outhle�rr m,oiist Medical: Transport, LLC NO %r �i l , OP N Application G/ Drug 5 Lfl.Acid Red� uctionl Uses: Decrease secretion of gastric acid or chronic reflux. Patients wvith 11 1 Bleed Adverse Effects • (al ralre)l • Occasional CNS symptoms, — more so in the elderly Jaundice • Gil uipset. Dios sing,: njx • Bonus: 80 mg over 5 minutes; • Infusion: 8 rmi /houir nl pIzale 'P�revaci�d) • Eolluis: 30-60 mig over 30 m6nlutes • Infusion: m ,/hiour aniitii 'Imle Lzan c� • Bolus: 50 mg over 0-30 minutes • Ilnfu�sio�n:,1501 mig over 24 hours Special Considerations: • laly he used for antihistamine effects � r„ Southernmost Medical Transport, LLC 110 CO,PCN Application Lfli.Gll Bleeds Related Medications Uses: • Variice�.ail Upper GI Bleed Adverse Effects: • Gall Bladder sludging or stones • Diairrhea and • Gill Upset iHypoglly+cennia Dosing: • 50, micg IV boluis,then 50 rmcg/hiouir Special Considerations: • ,filters the bailance between iinsulin/gllucagon, could result in eiither hypoglycerniai or hypergiycerniia Vas©pressiin is presently rairelly used due to its potent vaisoconstricti,ve and catecholarniine inducing piroperties. Southernmost Medical': Transport, LLC „G ,' COPCN Application //I. Devices a. Temporary Cardiac Pacing b. Chest Tubes c. VA Ds d. Trachesotolmy Care Inivos"ive Cardiovascular Monitoring . 1CP Monitors h. Insulin, Pumps 1. Central VascularAccess °MEN Southernmost MedicalTransport, LLC COPCNApplication Devices vices c.I.Temporairy Cairdiiac paiciing Uses: o ensure adequate heart rate; Mlost common use is for symptomatic bradycard a or heart block. AdverseEffects,; • Problems, related to trans noun/transthoracic insertion- pericardial tarnponade,. pneu mothora , myocardialperforaition, aiir embolus sepsis and thrombophlebitis • Failure to pace due to: displacement of(pacing electrode (most common complica 'on�)loose connecdon,,faulty generator, myocardial ischernia • Failure to sense due to: patient's na,bve beats not sensed) by the pacemaker and the output pulse may occur after a spontaneous beat whiieh may induce dysrhythrmias • Catheter induced dysrhytlhmias Pacer Box Settings: • Rote control: usually between 60-100 beats/minute • Output(electric current used to stimulate iyocar ium)~ usually between 5-20 mm reps • Sensitivity controh used to sense,heart's native electric acti vity(Q S deflection) Special Considerations: • Monitor(heart rhythm. A functioning pacemaker usually reveals a pacer spike followed the QRS by a bundle branch pattern on the monitor strip • Contact MC if dlevelops a bradycardia with no pacer spikes or anon capturing of consider initiating transthoracic pacing if patient is unstable Southernmost Medical Transport, LLC COPCN Application Devices c.H.Thoraclosto my Tuibes (Chlest Tu blles) Uses: • To evacuate an abnormal collection, of Muir(pneurmothorax), blood (hemiothorax) or fiulidl (pleura] effulsion) from,the pleural spaice Complications: • Mechanical problemis:tube dis,ioldgermlent from: the wall, air leaks from tuibing, dlrafinage site or sikinl siite • Blocked draiinage: kiiniked tube or clots • Bleediing; local' incision hlematorma, artery or,vein Maceration Visceral perforation • Be-expansion pulmonary edema Procedure • Usually plalced in the miclaxiflary line at the fifth-seventh intercostal space, or in the rmidclavicullair line at thle second intercostal slpalce. • Tube is sutured)to thie chest waill and Vaseline gauze and an adhesive bandalge are placed over the site, • The distal 1part of the chest tube its connected to a chest drainage sy51tem(under a water seat) which incll'uides an, air seaull, al drainage reservoir and suction,capability Special)Considerations: • Avoid tralction on the chest tube; this could dislodge the tube • The chest tube dlrainlage system, shlouild remain below the chest levell • avoid kinkiing or cllalmpling the dlralinage system • Contact MSC if any of thle above complications develop, or if the patient devellops. shortness of breath o�r change in vital signs 011 Southernmost Medlrcal Tra�n�spc�rt, LLB „r 01P N Application Devices c.rriM ntrrcul it As,s,rst Deviice�s (VAN) C.lise�. • Irmplantablpe external heart pump used to treat patients with debilitating heart failure • May be used in patients who are not candidates for transplant as well as those tra nslla nt FAQs: • There are many types of VAID units; • some have Ipulses (usually pulse will not be ln sync with the patient's rhythm) and some acre continuous flow units resulting in no pulse Co plica 'a VAD Pump Failure. c: Need to initiate hand purnpin ata irate of 60-90strokes/min; rrhythrnia- appropriate may be a i-VA with two (pumps. * Disconnect power source first, prime pump with a purge valve before use VAD Working- lood FlowLow-ECG Abnormal: Usually with a single VAD device; patient's function is influenced by may need to treat the rhythm if patient is symptomatic: n LVA (Left-sided A ) patient irnay re unre large amounts of IV fluids RVAD (Right- sided VAI ) patient should not get IV fluids VAD Working- lood FlowLow- ECG Norni o Hypo llemi p could be internal bleeding if symptomatic initiate therapy to treat cause of Ihypovolemia Procedures: • If need to transport a STABLE patient • Heartmonitor: ECG may not match pulse Large bore IV should be star • Firing companion with patient if available who is able to hand (pump the VAIt • bring bac .ujp equipment: Hand purmps, extra batteries, primary and baickup available Sorut�hier'n most. Medical Train!sport, LLC � CUPCENI Application Sp,ecialll Coin sidleratiolns: Need to ask patient. 1, Cain II perfoirrn CPR.on you? '. IF not- is there a, hiaind purnup? '. If the dlevice slows dlowuni- will allairms go off for low flow state? 4. How can II speed) up the device? 5, Does patient need hepairin, if the device s,iorvs dlouw,n? . Can paatilent be d�efiibrilllated vvhille connected to the device? 7. If can be defibrillated, do I need to disconnect ainiythiin first? 8, Does the patient usuaillllyr have a, puIse with,the device? 9. What are acceptable vital) sign parameters? 101. Can patient be ext:ernalllyr paiced? Contact Patient's Cardliac Care Team ASAP for problems and prior to,trainsfer Unstable VAd platients shiould be transferred with,a higher level of care Devices c.iv.Trach o tomy Care U-ses: • Inadequate airway Respliratoryr Insufficiency Excessive secretions • Nleed for prolonged mechanical ventilation Adverse Effects: r Dislodgement of trac.heostoirny tube Obstruction,of tube or stornai M I' ailfuinction off mec.haniea!l vent ilator or Ilos,s o�f O�2 s�upipil.y Procedures: LustwMinc • Sterile,glloves Southernmost Medical Transport, �LLC CGi Application • Suction with 12(),-lSOmrnH (adullts); i -100miim Fly (pediatric) Hyperventilate with, 1(l10 • Suction up,to 10 seconds (adult); p to —4 seconds (pediatric) If mucus plugs/thick secretions may instill 3-5cc sterile spline BronchodilatQrAdmini,s ration-, • Assemble n buli er assembly as usual Attach trachi collar to reservoir tublin • Connect to oxygen source at a flows rate sufficient to produce imisting Fit trach collar over stoma and have (patient breathe slowly and deeply. ftorna lnt Lion, • Select largest tube able to fit in stoma without force; cuif'fed for adult,for pediatric Sterile gloves • Hyperventilate with 100% 02 Suction, if necessary. • Fuss the ET"tube and inflate the cuff, The tube will protrude several • Hold the tube and watch for chest rise with ventilation, secure the tube. Auscultate the lung fields. Cheick for subcutaneous emphysema. Allow no longer than 30 seconds for the procedure, Special Cons i era i s: Avoid oral iintubaon if possible DO NOT T'USE DEMAND VALVE WITH l'Vll'y`lll Devices c.v.BiPap Machines Uses, • Qbstrucbve Apneas * Respiratory Insufficiency Adverse Effects; • Chance of Pnieurnothorax. • Mechanical failure • Disconnected tubiin . Southernmost Medical Transp ort, LLC . COPCN Application Misfit of facial)/niasail mask • Drying of rmouthi/naisal' passages Specia�ll Coin sidle rations: • Usually will not involve intervention, by EMS-shoulld be pare-set If fails, may need to,switch to CPAP or supplemental 02; conitact MC. Devices cxi.11nvasive Cardiovascular MV oiniittaring. For uise by I MT-P"s and RNW's only Uses: • Usually used to, monitor Cardliiac Olutpuit. Used in ICU setting with ICU, monitors-not for EMS, use Complications: Aftrilal Line Pressure Monitor I-Iermatomas Distaill ischiermia/thrornb'ois is, l isconrmection aind hemorrhage Ina dvertenit dlrug, injection Swpin-Ganz catheter: • Arrythrniias • Knotting and dlisplacernent Cardliiac Vaillve trauma Pulmonary Artery Rupture Balloon Rupture • Catheter thrombosis or embolism Monitor components. Arterial Line Pressure MIoini r *" Arterial cannudla •' Moniitoir'iing lime • Trainsducer IMonitoiriing system Southernmost Medliical Transport,, LLC 10 5W4n:!ganz catheter:. • Bailllolon,tiippedl catheter thirough,central vein;floated throlu h,right side of heart Into plulm<rolnary artery • Monitoring line • Transducer Monitoring System, Special Considleratinimis: i Require prolo�ng,edl pressure if llilnes are pulped out Devices c.vlu.Irntracrarniial Pressure (IGP) Monitors IUlses: • Measurement of Intracraniall pressure bin ICU, setting • M' aiy,also he used to rel!iieve pressure as well Adverse Effects:. • Infection at skin site into brain Dlislod'gement of cathieter 5peciall Considerations: If puills out._ apply sterile dressing; may have SCSI= leaiking from site Southernmost Medical Transport, LLC f'smma l/i/4 71f IK( ri g COPCN Application Devices c.~'viii.11nsullin Pumps Uses: Computerized device delivering a steady dose of insulin (basal rate) throui h a flexiible sulibcutaneovs catheter Adlverse Effects: • Hyp'o lyceirniial can o�ccu�r • Patient has a pre-set basal rate and pre-programmed correctiiolns Speciiaill Considerations: • If hypoglycemic treat as pier protocol • if seemingly in D,KA (Diab,etic Ketolaciidosiis), make sure the pump is working or the catheter its intact. SHICUULD, NOT REQUIRE ANY DIRECT INTERVENTION By TRANSPORTING CRI W' UNLESS. PATIENT B'ECO�MIES HYPOGLYCEMIC; IN I THI,AT SCENARIO,TURNI f7,FF THIE PUMP Devices c.iix.Central Vas+cullalr ,access Vises: • Specialty vascular access In patient with piroblernatic access or re�q,uiirinR irequienit inifus,ioln of medication or parenteral nutrition Adverse Effects: • Line infection can cauise bactermia/sepsis • Complications cain be related to insertion of line such as pneurnothorax, hermaitomas, vascular ruipiture Southernmost Medical Transport, LIL . CC PCN Application Different Types: Triii Mlle L ime�n_Central Venous Catheter: • Can be in Femoral, Internal 1u ullair or Subclavian location, • 4.Usualiy red hub is for blood) dlra s- it is typically thie most certain Iliine of the three ports. Indwellliin Catheter • External Access(Broviac, Hickman,, Groshung) catheters. Llsuiaillly placed in S'ubclaivian region * Usualiy contaiinis hepa:rin; draw 10 miL awra�ste before iinfusiionis • Ilmp'lainted parts (Part-a-cath, Baird Port): o Regluire hlubler needle to access • Shirley. Usually used for dialysis a Usually containis heparin; draw 10 nit.waste before iinf'usiians,then flush saline if needled iini emergency siituatiainis • Peripherally Inserted Central Catheter(PLCC) Ilinie: • Location usually in,the anitii-cubitall regions • Usually contains heparin, draw 1.0 rmL waste before iinfusians Special Considerations: STERILE TECHNIQUE its imperative! lIy to, be accegegl in in "' ' i outh:ernm:os Medical Teanspart, LLC. COPCN: Application IV Pediatric Transfer Protocols a. Anbconvulsonts b. Continuous A16uterol Nebulization c* Insulin, Drip d. I' Antibiotics Southernmost Medical Transport, LLC. C01PCN Application P'ediotr'ic Tra'n'5fiers d i.Anticonvul ants (Uses Prevention and treaitment of seizures Adverse Effect's: Ventricuilar dlysrhythmias or hypotension if phenytiolin given too rapidly •' Respiratory dlepressioni,especiialll'y with benzod!iazepines or phenobarbitail Subicutaneous extravasa�tiioin many cause tissue necrosis, Dosing: Phenytoin.,, • 101- .0,m,g./lkg; IV piggy back.in NWS • pate not to exceed 50, mig/min Piro ofoll.: • Loading dose: 3, mg/kg: • Maintenance infusiian:501 rmc /k ,/rmiin • May increaise up to, 250,me ,/k /main 5peciiall Considerations: • Monitor heairt rhythm • Use infusion pumip • Check BP frequently; vital) sign moniiit+or if aivaillablle D/C Infusion and contact NIC for adverse reactionis V Southernmost i al Transport, LLC R,/ �l ICI IIIlf �, �.0 I CCP N Application ' uwmm�ry uUl '� Pedivatrie Tranisfers d.H.Contiinuious Albiuterol Nebulization Uses: Treatment of statues asthmatiicuis Adverse Effects; • Tachycardia • Nervousness, he Bache, shakiness Nausea/vorniidin Hlypokaille rniia Doosiing: • 0.5 mg/kg/hour or othierwiise directed by MC. Speciiall Considerations: • Need to use a special large vol uime neblulIizer designed for cionti nu ous aid rninistratiion, • Cardiac monitor • Should have IV running conicuirrently Pediotrie Tronsfers cl. ii.insuhn l riip Uses: Lover blood l glucose and treat diabetic ketoaciidlosis Adverse Effects: • Hypoglycemia (tachycardia, diaphoresis, mental status change,, seizure) Hl pokaiernia (occurs as acid'osiis lmproves) r i w Southernmost (Medical Transport, LLC u � COPICN Application aaising: • 0.05µ0.1 uinits lk /hour; may be varied depending on glucose response by patient Sipeciial Considerations: • Gilucose must be chieckedl every hour • If hypo lycemiiai occurs, D/C insu ilin dlrip and adlrminiister D25 (2-4 mL/k ,), Pediatric Tram sfers dlAv.1V Antibiotics Uses: Treat infections andl prnplhiylaixls Adverse Effects: .Allergic signs andl symptvrrns, iinicludi'ng anaphylaxis • 'dairies depending on anbbiotiic and patient weight/size • Cben�erallly given as a piig, yback iinfuisiogn, • Rate shimul'd not require clhain ,e en route Special Considerations: • D /C infusion, if allllergiic signs andl symptoms, • Contact ITC Southernmost Medical Transport, LLC qfl l ' COPCN Application V Special ,itu- ation a. The Hospice Patient b. The Pediatric Paden any d Coinsenit Issues c. The Psychiatric Patent d. The, Therapeutically Cooled Patient i%rM, Southernmost Medical Transport, LLC 1110 COPCN Application Special Situa!tions e.i.The Hospice Patient Introduc°tl6n, The Hospice patient presents a, uinque situation in regards to care and transport. These ipaitients have often been deemed) to be ini the terminal stages of a disease process,for which treatment is no longer effective in reversing,or arresting the pirolgress of the disease.Care becomes focused on patient and family comfort,which often flies in the face of usuaill resuscitative care. What might be considered'i ais an unstable patient might. well be in lline with the course as planned by the patient's cairegiivers. Family members are often torn between, stilcking with,thie recognized treatment plan versus emotion as they see their loved i one approach their end. It is important to II<eep In mind that these patients do not have a situation that can be filxed. it is often up to us to gently encourage the family to adhere to the goad of patient cormfoirt.The Hospice patient truly haws needs that are not those of the usuail' prehlospiital patient and special, consiideratiions need to be maidle in the respionse of the prehospiital pirovider Assessment The assessment of the Hospice patient requires a redefinition of what is considered an "unstable" vitail sign regiuiiiring actioln. A terminal patient might have either lover or higher parameters in temperature, hieart rape, respiratory rape or blood i pressure. The ABC's might alsio be altered.This its not uinexplected, n important part of the aissessmenit its evaluation of the DNIR staitus. IF the patiienit or family do,not.have a copy of the DNR oar MIO,LsT form, Hospice staff is often able to, fax ai copy,, or at Illeast confirm the existence of the DNB'status if necessary. Treatment In,general,the only measures that should) be imipleimented are oxygen or stretcher positioning. Narcotic administration might be in, order; holwever, medical control should be contacted) if thiere are questions regardiing adlm,iinistration. Typically, Hlospiice patients should not receive an IV or be pilaced on, ai cardiac mio�nii:tor, unless there has been directiion by (-hospice to do so. "I heir imediicaitiioins are uisuiaillly given oir4llly,, transcutaineouisly (,e,g. opioidl drug patch) or suibcuit ineouslly per Hospice. Southernmost Medical Transport, LLC ,,. COPCN Applicatiori Morphine may be given as per ALS panto Protocol if this has been approved in the patient's Hospice care plan. Medical Direction The Hospice patient isstill under Medical Control by a abase Station meldical physician. However, since these patients are in a situiatton that is more similar to an "Interfacility Transport", input may be made by the Hospice physician.The (patient's plan of carer may be confirmed with them. Transport If the decision is made for the (patient to be transported to the Hospice Inpatient Unit either for an acute intervention or for an inpatient bed, then there are considerations t be made. The des 'nalJon of the patient should be as directed) by Hospice, This might include direct transport to an inpatient unit at a hospital, bypassing,the Emergency Dept. The medications that the patient is can should accompany the patient to the Hospice Inpatient Unit. However, if the patient is being brought to a Hospice Unit in a hospital, family members should bring the medications a list is adepuiate). In keeping with the goal of patient comfort, lights and sirens should not be used during transport, If the patient expires in the ambulance anytime during transport,the patient should be taken to the previously instructed facility. DO NOT tape the patient back Lorne. Spp cial.Situaltions. e.iii. the Pedliatric Patient aind Consent Issues 1. Introduction Transport and treatment of a pedliatric patient is met with uinipoue issues,. The pecliatric patient is unable to give consent/ref�usadll as,they are a m,ino�r, Usually, the paitient's, parent or guardian will be available to give consent. However, there are times when either the Illegal guardian is not avaiilablle or does not have lle ail aibillity to consent,. The following is a review of situations.where consenit mii ht be giiven by someone anther than the child's le ad guardian. The Emiaincip,ated Minor r Southernmost Mediical Transport, LLC i i , u COPCN,Application a minor is considered emancipated if the folllowing events have occurred`. He or she its married.. He or she is in the armed l services. • He or she has established a home and is financially independent. • His or her parent hats failed to fulfill parental suippoirt obliigationis and the minor seeks emanclpatfoin. The,CPS,p�otient Occasionally a, child' presents with, a picture of abuse or niegligence, and the suspected perpetrator is the legal guardian. Mandated reporters muist make a report to Niew York State Child Protective Serv, ces (CPS). After-a prelhiminary investigation, CPS miiight decide to,taike cuistodly of the child.There should be documentation of the CPS custody with the patient's chart.This will ailll'ow care of the child to proceed. The G uordian is Urrova lable In situaitions where.a child's guairdlian its unable to,be reached l or are incapacitaited, administrative conisent might be obtaiined. This can be confirmed with the trainisferring facility. .Special S'etuat one s e.,iiii.Thie Therapeutically Cooled! Patient i, Introduction There has been a recent resurgence of the,raip,eutiic cooping, used in patient care scenariios.These require maintenance of specific hypoitlhermic tairget temperature. The current two most likely indications are those of the post cardliac,airrest patient,the stroke patient and the traumatic brain or spinal cord) iinjiury pabent.. The theory behinds therapeutic hypothermia is to decrease circulation of iischiemic andl injury mediators. Further, rmeta,boliism is decreased thus preventing,further infl,amrmatolryr response. The balance thait must be maintained is to provide adequate colliingto achieve the above but to avoid' acidosiis and damage from the hypothermiia itself. Patients must be intubated and paralyzed to pirevent shivering, The hypotherm�iia is achiieve+d by surface and internal cooling.Surface cooling is achieved with,ice (applied at head, neck, axillae and groiin),, cooping blankets and/or heat exchange Southernmost: Medi�cal Transport, LLC COPCN Applicaton surface cooling devices Internal cooling is achieved either by cooled fluids or by endovascular heat exchange catheters.These usually invollve a femoral line placement. Clinical tlses of Therapeutic Hypothermia The Past Cardiac Arrest Patient In 2005 the American eart Association offered guidelines regarding the use of hypothermia in unconscious patients with return of spontaneous circulation after Out-of-huspitail cardiac arrest. It is recommended that these patients be cooled to - 34C for - 4 hours. The coaling should occur within 6 hours post cardiac arrest.They should have a systolic blood pressure of>90mrn hi . The Acute Strolke Patient There is evidence that Ih poth rmia, reduces the volume of infarct and may preserve brain tissue. However, a Marge study has yet to be done showing clear benefit. The Troumotic groin Injury(T )Patient Mild therapeutic hypothermia has been shown to be effective in T I with high iintracranial pressure. These patients have better outcomes with longer hypothermia (5 days), The Traurnotic Spinal Ford Injury( I)Potie at There have miot been lame scale reviews or studies to demonstrate benefit of hypothermia with SCL However, case reports suggest that there may in fact be. some advantage in using hypothermia to treat patients with SCL Trans orting the Therapeuticafly Cooled Patient "These patients are often critical and may require adldlitional personnel. Not only must the cooling, apparaitus be kept in attention, but the patient must be carefully watched with frequent vital signs (every 10-15 minutes during transport), Consideration should be given for backup cooling alternatives should there be device failure. m aSouthernmost Medical Transport, LL i uwwwmm "m'm� OPN,Application VI. Gl'olssary and A lure iat'ons ALS Provider lnclud'es EIVI'T-II and EMTP (Advanced Life Support Provider) BiIPAP Bi-phiasiic Positive Airway Piressuire BP Blood Pressure BVM Bag-Valve Mask CHF Congestive Heart Faiilure CIS Central Nervous System COPD Chronic Obstructive Pullrnonary D)iisease CPAP Continuous Positive Airway,Pressure D/C Discontinue DKA Diabetic Eetoacidosis D NR Do Not Resuscitate EMV T-D (Emergency An individual trained to,perform paitient assessment, handle Medical Technician- emergencies using Basic Life Support egluiipm,ent, perform CPR;,. Defibrillation) control hemorrhage,, providle non-invasive shiock treatment,fracture and spinal stabilization, manage environmental emergencies, emergency ch:ildbirth and use a defibriilla�tor, EMT-P (Emergency An, individual trained to perform all EMT-II skiills and utilii aitioln of Medical Technician- equipment. In adldGitiion, is able to perform undlerAdvanced l Cairdliiaic Paramedic) Life.Support(ACLS) and Adlvance,d Traiuma Life S�upplort Standards (, TLS), its knowledgeable and competent in,the use of cardiac monitor/defibrillator, IIV drugs and fluids,The EMT-P has reached the highest level of pre-hospital certification. EPS (Extralpyramid!al A.variety of motor and sensory nervous system,dlisorders related) to Symptoms) mediicatio�ns or dlis,ea,se processes,. ETA Estimated)Time of Arrival ET tube Endotracheal tube FB EoreG n Bodly Southernmost e ical Transport, LC ° CO CN Application G HI Gastrointestinal H/O History of HIR Heart R rate Huber nieed'lle A needle designed)to access an indwelling vascular port, It has a niinety-degree benidl,. IIm Intramuscular IV IntravenDUS JVD Juigular Venous Distention RVO Keep Vein Open; usuially, indicates an IV rate of 20-60mL/hour Large Bore IV 14 or 16 gauge Ilv Load'ing dose Initial aimount of medication, required to,establish a therapeutic effect LR Lactated Ringers, Solution IVIIC(Medical Control 1. A physician IMedlical Diirector or designee) responsible for the care or Medical of a patient who its being served by an EMw S provider. '2. (aka Medical) Cormrmamdl) dliirectioln)The process of providing responsibility for the care of a plabienit who its being,served) by an EMS proviider, MICO, Medical Control,Option Medical Director The physician who,has authority and responsibility over all clinical and plaitilenit care aspects of the, EMS providler.Thais includes responsibility for off-Hine MC Methermogllobinernia, a condition rhe�re the herno�gllobiin is allte�red in a wary which decreases its ability to eair,ry and release oxygen to tissues rnillligrarn millliigram , MI Myocardial Infarction m,L rmillliilliiter ISIS Norrmail'Saline, usuailly ref ers to,0.9 normal saline OD Overdose , r Southernmost Medii al Transport, LLC z.� COPCN Application Off-line MlediGail Provision of care in accerlirdanice wiithi patient care protocols developed Control) anid promulgated by physiiciaiins.This also includes training,testini , certifications, continuing education, operational policy and procedures, d'ieveloprment and conitiinuiouis quality irnlp rove rnenit. On-line,IMedical Provision of care via direct voiice communication with,a physiciain Control PIO orally P RIVI Ass needed PVC Premature ventricullair c€alintraction Q Every SL SublliinSual! SQ Subcutaneous Standling oirders Treatment al oriithimis for the ALS pirovildler to follow prior to contacti'ng MI C Status Epilelpticus Ongoing oing seiizuire activity o�r,a series of seizures with separation of less, than or equiail to one Ihouir Syst Systolic TID "three d mies per day VS 'vital siinis CEMEmammmummmomommm Cu(rent and r rovion Year w Joan 1,2025 May 19,2926 w TRAINSPLHTk NO�1�p��rsPra�r�� .,: e O TH�ERa1sAWt1l"ONO;-326 RMf7kiF5 C7 1k1 Y 5 ju 1G, 341 i3:o 4p 46 504 DAY$ pow %.C.olx3nrn5. A19 January 25 To 35 Pubruaary 24 10 34 W'ard;h 23 4 27 Aperl 17 14 31 may 29'' 15 44 June 22 22 July :3 36 September 27 2:7 r:lctataer 21 21 November 7 Dce(tuber 12 12 70hall 72 69 93 40 24 29 326 Page:1'of 1 a o ci z co0 0 a Q � U � Cl) ° o o _ U o o O o O W + CO p t co N N Si O zel W Z U ,Z� gz� o o v, W Z p p o U o +- co a o w Nco Cd x z Cd W O N o o ° N -", t o IZ u � ^� 1 to o U a c) col co W v o v Cl) o a� H 14 U U O N 7 N N S*"- W w L=O co It co co CO 4J LU