REMAC 5

CFR/EMT

100

If delivery is not imminent, place the patient in a _______  lateral recumbent position

LEFT

200

Acute Coronary Syndrome / Suspected Myocardial Infarction / Chest Pain (Adult)

EMT- If available, assist the patient with their prescribed Nitroglycerin SL for chest pain every 5 minutes as needed (maximum ______ doses) only if the patient’s SBP > 120 mmHg

3 Doses

300

Ventilate at a rate of 40-60 breaths/min with room air, if the neonate has ANY of the following 

(Need all three)

Persistent central cyanosis  

Respiratory rate < 30 breaths/min 

Heart rate < 100 beats/min

400

Emergency Childbirth

Suction the mouth first by inserting the syringe no more than _______ inches into the newborn’s mouth 

Suction the nose by inserting the syringe no more than____inches into the newborn’s nose

1.5

0.5 

500

Decompression Sickness (Adult and Pediatric)

Neurologic: abnormal gait, _______ , extremity weakness/numbness 

• Cardiac/Respiratory:________, difficulty breathing, hypoxia 

• Gastrointestinal: abdominal pain,_____ , vomiting 

• Musculoskeletal: _______, painful range of motion 

• Skin: rashes or _________

dizziness

chest pain

nausea

joint/muscle pain

itching

APPEND/GOP

100

Appendix B: Universal Approach to the EMS Call

Scene Size-Up 

• Body substance isolation •______  • Mechanism of injury/nature of illness •________ 

General 

• General patient impression •__________  

• Chief complaint

Scene Size-Up • Body substance isolation • Scene safety • Mechanism of injury/nature of illness • Spinal precautions as needed

• General patient impression • Level of consciousness 

• Chief complaint 

200

Complete 

• APGAR score interpretation: 

• 8-10______ 

• 5-7________

 • 3-4_______

• 0-2_______

• An APGAR score _______  requires immediate intervention

 • 8-10: Normal 

• 5-7: Need for supplemental oxygen 

• 3-4: Need for assisted ventilation with BVM 

• 0-2: Need for CPR 

• An APGAR score ≤ 7 requires immediate intervention

300

Appendix M: Needle Decompression of a Tension Pneumothorax 

Patients are considered to have a tension pneumothorax if they have the following criteria:

Absent or decreased breath sounds on the affected side AND • ANY of the following: 

• Severe dyspnea or tachypnea 

• Cyanosis or hypoxia 

• Hypotension

400

Wherever the term “appropriate oxygen therapy” is used throughout these protocols, oxygen therapy shall be administered via a non-rebreather mask (NRB) at ______ or a nasal cannula (NC) at ______  and is required for any of the following conditions: 

• SpO2 ______  • SpO2 is _____  • Other signs/symptoms of ___________

10-15 liters/min

2-6 liters/min

< 92%

unavailable

respiratory distress

500

Criteria for ALS to Transfer Care to BLS 

Page 21

Hemodynamically stable 

• Ability to follow simple commands (patients with suspected intoxication who are able to follow simple commands and have a BGL > 60 mg/dl may be transported by BLS) 

• NOT received any medications or treatments under ALS protocols 

• NOT expected to require any ALS interventions during transport 

• NO reports of acute coronary syndrome either ongoing or within the past 24 hours

(When ALS and BLS providers are both providing care for the same patient, the Paramedics may transfer care to the BLS unit for purposes of transporting the patient to the hospital if the patient has ALL of the following conditions: )

KEY POINTS

100

Calcium Chloride and Sodium Bicarbonate should be given in separate IV lines or separated by a flush of at least

20 ml of crystalloid fluid

200

PEDIATRIC: Patient with a dysrhythmia associated with ANY of the following:

(Need Both Physical Signs and Formula)

• Depressed mental status and absent peripheral pulses • Hypotension (systolic blood pressure < 70 mmHg + [2 x age in years])

300

Heat Emergencies (Adult and Pediatric) 

Special populations who are at high risk for adverse outcomes:

• Elderly patients 

• Patients with comorbidities, on diuretics, or psychiatric medications 

• Athletes

400

Naloxone relative contraindications:

• Cardiopulmonary arrest 

• Active seizure 

• Evidence of nasal trauma, nasal obstruction, or epistaxis

500

Bone and Joint Injuries (Adult and Pediatric)

Do not attempt to reduce _____ or _____  dislocations

intra-articular or superior patella

PROTOCOLS

100

Asthma (Medic Protocol) 

For ADULT and PEDIATRIC patients (age ≥ 2 years or age ≥ 18 months with a history of Albuterol use), administer _________________. Repeat as needed (maximum 3 doses)  

0.083% Albuterol Sulfate 3 ml (1 unit dose) nebulized over 5-15 minutes.

200

A patient weighing 80 kgs how much fluid would the pt receive under Severe Nausea / Vomiting (Adult and Pediatric) protocol

For signs of dehydration, administer crystalloid fluids 20 ml/kg IV (maximum 1 L)

20ml x 80 kgs= 1600mL however max 1L

300

Ventricular Tachycardia with a Pulse / Wide-Complex Tachycardia of Uncertain Type (Adult) 

Stable Ventricular Tachycardia with a Pulse, administer one of the following: 

 OPTION A: ________________________

OPTION B: _________________________

Amiodarone 150 mg IV (diluted in 100 ml D5W) over 10 minutes 

Lidocaine 1 mg/kg IV (maximum 100 mg) over 2 minutes

400

For ADULT patients who remain in shock after the initial 20 ml/kg IV bolus, administer one of the following to maintain SBP > 90 mmHg or MAP > 65 mmHg: 

.______________

.______________

._____________

OPTION A: Additional crystalloid fluids 20 ml/kg IV (cumulative fluid bolus 40 ml/kg) 

 OPTION B: Norepinephrine 2 mcg/min continuous IV infusion (maximum 20 mcg/min). Titrate as needed every 3-5 minutes 

OPTION C: Epinephrine 10 mcg IV over 1 minute. Repeat as needed every 3-5 minutes

500

Procedural Sedation 

For an ADULT patient requiring procedural sedation (e.g. synchronized cardioversion, transcutaneous pacing), administer one of the following: (DRUG, ROUTE, MAX NEEDED FOR FULL CREDIT)  

OPTION A: 

OPTION B: 

OPTION C: 

OPTION D: 

OPTION E:

Etomidate 0.15 mg/kg IV (maximum 20 mg) 

Ketamine 1 mg/kg IV (maximum 100 mg) 

Midazolam 0.1 mg/kg IV (maximum 5 mg)

Diazepam 0.1 mg/kg IV (maximum 10 mg)  

Lorazepam 0.02 mg/kg IV (maximum 4 mg)

< > or equal to

100

Administer Nitroglycerin 0.4 mg SL every 5 minutes as needed for chest pain only if the patient’s SBP ____ 120 mmHg

>

200

Systolic blood pressure ____160 mm Hg OR a diastolic blood pressure ____ 110 mm Hg

≥  

≥  

300

 Obtain blood glucose level (BGL) and request ALS assistance for patients with a BGL ___ 300 mg/dl AND any of the following conditions: altered mental status, tachypnea, or signs of dehydration 

>

400

If available, pediatric AED/monitor pads and cables shall be used for all pediatric patients age  9 years

<

500

Fill in the Blanks

Administer Sodium Bicarbonate 1 mEq/kg IV (maximum 44 mEq) for any of the following: 

• Suspected Salicylate overdose
• Any suspected overdose with prolonged

QTC ____ 500ms  or  QRS ____ 100ms

QTc > 500 ms or QRS > 100 ms