1. Preface, Format & Operations Intermediate, Critical Care and Paramedic Levels

2. Disclaimer: This is intended to supplement the new protocols. It is not a substitute for carefully self study of the complete protocols. If there is a disagreement between the published protocols and these slides: follow the published protocols.

3. Distribution Distribution is the responsibility of the individual regional councils. The WREMAC is working with the program agencies and regional councils to create multiple paper and electronic formats for the protocols

4. Rollout All advanced providers must be in-serviced on protocols to continue to practice in the region Agency must transition to these new protocols between June 1 and Sept 1, 2011. Agencies, provider and medical directors should work together is assure a orderly transition to these new protocols.

5. In-services Protocols in-service may be accomplished by watching the WREMAC video series or attending a live in-service given by a WREMAC approved medical director Providers must watch/attend the appropriate modules and receive a 70% or better on each module exam.

6. Preface These Protocols serve four levels of EMS providers: AEMT-P, AEMT-CC, AEMT-I and EMT. They are not intended to be absolute treatment doctrines, rather guidelines which are sufficiently flexible to accommodate the complexity of patient management. They are not a substitute for sound clinical judgment. Deviations from these protocols may be deemed necessary by the Medical Control physician depending on the clinical situation.

7. Preface AEMT-Ps may perform all of the interventions contained in these Protocols and approved by their Medical Directors. Some interventions (e.g. RSI) require special training and credentialing. AEMT-CCs may perform all of the interventions contained in these Protocols which have been approved by their Medical Directors, but, they must be current in regional pediatric CME criteria in order to perform any pediatric standing orders. They may only perform interventions that are listed past the CCT stop lines after contacting MC. These interventions may not be made standing orders by service medical directors.

8. Preface AEMT-Is may not perform any interventions that are past their stop line unless explicitly indicated in the protocols. Cardiac monitoring for AEMT-I has been completely eliminated from the current protocols.

9. Format Color coded Identifies Stop line Touching lines means same protocols for multiple levels EMT skills included

10. Operational: INCIDENT SCENE REHABILITATION

11. Operational: TRANSFER OF CARE PROTOCOL Useful for multi- agency responses Expands standing orders for hand downs When in doubt DON’T hand it down!

12. Operational: ADULT NERVE AGENT EXPOSURE Scene safety is key, don’t make more victims!! Atropine is dosed for airway, not pulse. For MCI, involve medical control and establish unified command early. Review Peds Protocol

13. Operational: SUSPECTED CARBON MONOXIDE EXPOSURE Asymptomatic patients with levels < 12, generally do not require treatment or transport