About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.14 - Poisoning / Substance Abuse / Overdose
Note:
Naloxone should only be administered in suspected overdose patients with inadequate respirations and respiratory rate.
Treatment should progress toward the restoration of adequate respirations.
Patients with inadequate respiratory rates may need to be ventilated until their respiratory rate increases.
Treatment should progress toward the restoration of adequate respirations.
Patients with inadequate respiratory rates may need to be ventilated until their respiratory rate increases.
First-Responder (Standing Orders)
EMT-Basic (Standing Orders)
- 1.0 Routine Patient Care
- Naloxone 2 mg-4 mg via Nasal Atomizer (IN) or 0.4 mg via auto-injector (IM).
- If no response after 3-5 minutes, give second dose.
- First Responders may only administer if trained and authorized.
- If suspected or confirmed hypoglycemia, treat per protocol.
EMT-Advanced (Standing Orders)
- ADULT: 0.4-4 mg IV/IO/IM/IN. May be repeated as indicated.
- PEDI: 0.1 mg/kg IV/IO/IM/IN May be repeated as indicated.
EMT-Paramedic (Medical Control)
- Calcium chloride 10% 20 mg/kg IV/IO administer slowly over 5 minutes to a maximum dose of 1 gram. (e.g., for calcium blocker toxicity).
- Sodium bicarbonate 0.5 – 1 mEq/Kg IV/IO (e.g. TCA or Aspirin overdose).
- Atropine:
- ADULT: 2- 5 mg IV/IO (e.g., organophosphate poisoning management).
- PEDI: 0.02 mg/kg IV/IO.
- Albuterol 2.5-3 mg by nebulizer (e.g., bronchospasm management).
- Furosemide
- ADULT: 40 mg IV/IO (e.g., pulmonary edema management).
- PEDI: 0.5 mg/kg IV/IO
- Midazolam
- ADULT: 2 – 6 mg IV/IO/IM/IN.
- PEDI: 0.05mg/kg IV/IO/IM/IN.
- Amyl nitrite: administer vapors of a crushed inhalant or pearl under the patients nose for 15 out of every 30 thirty seconds with intermittent 100% oxygen administration.
- CYANIDE ANTIDOTE KIT if available by EMS service and/or industrial site:
- Two (2) amyl nitrite inhalants.
- 3% sodium nitrite (stop Amyl nitrite):
- ADULT: 10 mL slow IV/IO over 2-4 minutes.
- PEDI: 0.2 mL/kg (up to 10 mL) slow IV/IO over 5 minutes.
- Sodium thiosulfate 25%:
- ADULT: 50 mL IV/IO.
- PEDI: 5 mL Sodium Thiosulfate per 1 mL Sodium Nitrate given. NOTE: If hypotension develops, STOP all nitrites, treat for shock, and consider administration of norepinephrine or dopamine.
- Hydroxocobalamin
- ADULT: 5 g IV/IO over 15 minutes
- PEDI: 70 mg/kg (to maximum 5 g) IV/IO over 15 minutes
- Glucagon
- ADULT: 1 – 5 mg IV/IO/IM for beta-blocker or calcium-channel blocker overdose.
- PEDI: 0.5 or 1 mg IV/IO/IM (per online Medical Control).
If suspected or confirmed nerve agent exposure, treat per protocol.2.09 Nerve Agent / Organophosphate Poisoning
Caution:
Poison Control may be reached at: 800-222-1222