Specialty Systems Of Care (STEMI, Stroke, Burn, & Trauma) S-SV EMS MICN Course Module 5 Specialty Systems Of Care (STEMI, Stroke, Burn, & Trauma) S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) STEMI Patients Criteria for EMS transport directly to a STEMI Receiving Center (SRC): Prehospital 12-Lead or paramedic interpretation of STEMI < 45 minute ground or air ambulance transport to a SRC S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) STEMI Patients Base hospital/SRC destination consultation required for the following: STEMI pt. outside the 45 minute transport catchment area Critical STEMI pts: Cardiac arrest Unmanageable airway Unstable v-tach 2nd degree type 2 or 3rd degree heart block S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) STEMI Patients Prehospital 12 lead acquisition and transmission: A minimum of the pts last name and first initial must be entered into the monitor prior to 12 lead acquisition Any 12 lead consistent with a STEMI (computer or EMS personnel interpretation) shall be transmitted if transmission and receiving capabilities are available S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) STEMI Patients STEMI pt. interfacility transport (IFT): SRCs have agreed to accept all IFT STEMI pts, unless the SRC is on internal disaster, the cardiac cath lab is out-of- service, or other pts being treated would prevent the IFT pt. from receiving intervention in less than 90 minutes from STEMI referral center (SRF) arrival If SRF arrival-to-SRC intervention is anticipated to be greater than 90 minutes, administration of lytic agents should be considered in eligible pts S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) STEMI Patients STEMI pt. interfacility transport (IFT): The 911 system may be utilized to request an ambulance for transport of a STEMI pt. to a SRC – an air ambulance or ALS/CCT IFT provider may also be utilized if appropriate Unless medically necessary, avoid using medication drips that are outside of the paramedic scope of practice to avoid STEMI pt. transfer delays S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) Stroke Patients EMS assessment/treatment: Cincinnati Prehospital Stroke Scale (CPSS) Blood glucose check Determine time of symptom onset or when patient last known well Transport as soon as possible, on scene procedures should be limited to critical interventions S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) Stroke Patients Criteria for EMS transport directly to a Stroke Receiving Center: Onset of symptoms ≤ 24 hours (including wake-up stroke) < 45 minute ground or air ambulance transport time to a stroke receiving center S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) Stroke Patients Stroke pt. interfacility transport (IFT): The 911 system may be utilized to request an ambulance for transport of an acute stroke patient to a stroke receiving facility – an air ambulance or ALS/CCT IFT provider may also be utilized if appropriate Pt transport should not be delayed if complete documentation is not available S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) Stroke Patients Additional stroke pt. notes: Blood draws may be obtained by EMS personnel (per pre-arranged agreement with stroke receiving center) EMS personnel may provide minimum necessary patient identifiable information (name, DOB, MR#, etc.) over a secured line if requested by the stroke receiving center EMS personnel may contact the closest base/modified base hospital for destination consultation of a possible acute stroke patient if necessary S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) Burn Patients Electrical burn pts shall be transported for evaluation Base hospital destination consultation is required for the following types of burn pts: 3rd degree burns of the hands, feet, face, perineum, or > 2% of any body surface 2nd degree burns > 9% of body surface Significant electrical or chemical burns When transport to a burn center is in the pts best interest S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Agency MICN Training (Updated 12-2018) Trauma Patients Pts meeting trauma triage criteria should be transported as soon as possible On scene procedures should be limited to: Triage/assessment Airway management External hemorrhage control Immobilization S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Trauma Triage Criteria Physiologic trauma triage criteria (one or more): Respiratory rate <10 or >29 breaths per minute (<20 in infants < 1 year of age) or need for ventilatory support GCS ≤ 13 SBP < 90 S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Trauma Triage Criteria Anatomic Trauma Triage Criteria (one or more): All penetrating injuries to the head, neck, chest, torso, and/or extremities proximal to the elbow or knee Chest wall instability or deformity (e.g. flail chest) Two or more proximal long-bone fractures Paralysis Pelvic fractures Amputation proximal to wrist or ankle Crushed, degloved, mangled, or pulseless extremity Open or depressed skull fracture S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Trauma Triage Criteria Mechanism of Injury Trauma Triage Criteria (any): High-risk auto crash (one or more of the following) Ejections (partial or complete) from automobile Death in the same passenger compartment Intrusion, including roof: > 12 inches at occupant site or > 18 inches at any site Non-automotive crash >20 mph (motorcycle, ATV, go-cart, bicycle, skateboard, watercraft, aircraft, etc.) S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Trauma Triage Criteria Mechanism of Injury Trauma Triage Criteria (cont.): Auto vs pedestrian/bicycle: thrown, run over, or with significant impact (>20 mph) Adults who fall > 20 feet Children who fall > 10 feet or 3 times their height Other high energy impact S-SV EMS Agency MICN Training (Updated 12-2018)

S-SV EMS Trauma Triage Criteria Special Considerations Trauma Triage Criteria (any): Adults ≥ 65 years of age: Low impact mechanism (e.g. ground level falls) might result in severe injury SBP < 110 might represent shock Current pt. use of anticoagulation or antiplatelet medication, or history of bleeding disorder Pregnancy > 20 weeks S-SV EMS Agency MICN Training (Updated 12-2018)

Spinal Motion Restriction (SMR) Pts with penetrating trauma to the head, neck, or torso and no evidence of spinal injury should not be stabilized on a backboard S-SV EMS Agency MICN Training (Updated 12-2017)

Spinal Motion Restriction (SMR) SMR with a backboard is required for pts with: Gross motor/sensory deficits or complaints High energy impact blunt trauma patients meeting anatomical &/or physiological trauma triage criteria Unstable pts where removal of a backboard would delay transport, or backboard utilization is necessary for other treatment priorities SMR without a backboard should be utilized for all other pts who meet SMR criteria S-SV EMS Agency MICN Training (Updated 12-2018)

EMS Trauma Patient Destination S-SV EMS Agency MICN Training (Updated 12-2018)

EMS Trauma Patient Destination S-SV EMS Agency MICN Training (Updated 12-2018)

Trauma Patient Transfers S-SV EMS Agency MICN Training (Updated 12-2018)

Trauma Patient Transfers S-SV EMS Agency MICN Training (Updated 12-2018)

Trauma Patient Transfers S-SV EMS Agency MICN Training (Updated 12-2018)