1. 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 )

2. S-SV EMS Agency MICN Training (Updated 07-2017)
STEMI Patients
Criteria for EMS transport directly to a STEMI Receiving Center (SRC):
Prehospital 12 lead ECG interpretation of a STEMI with paramedic or AEMT verification
< 45 minute ground ambulance or EMS aircraft transport time to a SRC
S-SV EMS Agency MICN Training (Updated )

3. S-SV EMS Agency MICN Training (Updated 07-2017)
STEMI Patients
Base hospital/SRC destination consultation required for the following:
STEMI patient outside the 45 minute transport catchment area
Suspected STEMI patient without prehospital 12 lead ECG computer confirmation
Critical patients:
Cardiac arrest, unmanageable airway, unstable v-tach, 2nd degree type 2 or 3rd degree heart block
S-SV EMS Agency MICN Training (Updated )

4. S-SV EMS Agency MICN Training (Updated 07-2017)
STEMI Patients
Prehospital 12 lead acquisition and transmission:
A minimum of the patients 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 interpretation) shall be transmitted to the appropriate facility if transmission capabilities are available
S-SV EMS Agency MICN Training (Updated )

5. S-SV EMS Agency MICN Training (Updated 07-2017)
STEMI Patients
STEMI patient interfacility transport (IFT):
SRCs have agreed to accept all IFT STEMI patients, unless the SRC is on internal disaster, the cardiac cath lab is out- of-service, or other patients being treated would prevent the IFT patient 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 patients that meet thrombolytic eligibility criteria
S-SV EMS Agency MICN Training (Updated )

6. S-SV EMS Agency MICN Training (Updated 07-2017)
STEMI Patients
STEMI patient interfacility transport (IFT):
The 911 system may be utilized to request an emergent ambulance for transport of a STEMI patient to a SRC. An air ambulance or contracted ALS/CCT provider may also be utilized if necessary/appropriate
Unless medically necessary, avoid using medication drips that are outside of the paramedic scope of practice to avoid any delays in transferring of STEMI patients
S-SV EMS Agency MICN Training (Updated )

7. S-SV EMS Agency MICN Training (Updated 07-2017)
Stroke Patients
EMS assessment/treatment:
Cincinnati Prehospital Stroke Scale (CPSS)
Blood glucose check
Determine time of symptom onset or when patient last seen normal
Transport as soon as possible, on scene procedures should be limited to critical interventions
S-SV EMS Agency MICN Training (Updated )

8. S-SV EMS Agency MICN Training (Updated 07-2017)
Stroke Patients
Criteria for EMS transport directly to a Stroke Receiving Center:
Onset of stroke symptoms ≤ 4 hours
< 30 minute ground ambulance or EMS aircraft transport time to a stroke receiving center
S-SV EMS Agency MICN Training (Updated )

9. S-SV EMS Agency MICN Training (Updated 07-2017)
Stroke Patients
Stroke patient interfacility transport (IFT):
The 911 system may be utilized to request an emergent ambulance for transport of an acute stroke patient to a stroke receiving facility. An air ambulance or CCT (RN) provider may also be utilized if necessary/appropriate
Patient transport should not be delayed if complete documentation is not available
S-SV EMS Agency MICN Training (Updated )

10. S-SV EMS Agency MICN Training (Updated 07-2017)
Stroke Patients
Additional stroke patient 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 )

11. S-SV EMS Agency MICN Training (Updated 07-2017)
Burn Patients
Electrical burn patients shall be transported by EMS for evaluation
Base hospital destination consultation required for the following types of patients:
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 may be in the best interest of the patient
S-SV EMS Agency MICN Training (Updated )

12. S-SV EMS Agency MICN Training (Updated 07-2017)
Trauma Patients
Patients 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 )

13. 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
Glasgow Coma Score ≤ 13
Systolic blood pressure < 90
S-SV EMS Agency MICN Training (Updated )

14. 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 )

15. 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 )

16. S-SV EMS Trauma Triage Criteria
Mechanism of Injury Trauma Triage Criteria:
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 )

17. 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 patient use of anticoagulation or antiplatelet medication, or history of bleeding disorder
Pregnancy > 20 weeks
S-SV EMS Agency MICN Training (Updated )

18. S-SV EMS Agency MICN Training (Updated 07-2017)
Spinal Stabilization
Patients 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 )

19. S-SV EMS Agency MICN Training (Updated 07-2017)
Spinal Stabilization
Spinal stabilization with a backboard should be implemented for trauma patients who meet any of the following criteria:
Midline spinal pain or tenderness
Limited cervical spine active range of motion
Gross motor/sensory deficits or complaints
High energy impact blunt trauma patients meeting anatomical and/or physiological trauma triage criteria
S-SV EMS Agency MICN Training (Updated )

20. S-SV EMS Agency MICN Training (Updated 07-2017)
Spinal Stabilization
Spinal stabilization with or without a backboard should be considered for trauma patients who have an unreliable H&P:
Altered mental status (i.e. dementia or delirium)
Intoxicated (drugs or alcohol
Injury detracting from or preventing reliable hx & exam
Language barrier preventing reliable hx & exam
Extremes of age < 5 or > 65 years old
S-SV EMS Agency MICN Training (Updated )

21. S-SV EMS Agency MICN Training (Updated 07-2017)
Spinal Stabilization
Helmet removal guidelines:
Football helmets should not be removed prior to spinal stabilization unless they fail to hold the head securely, interfere with the airway, or prevent proper stabilization
Motorcycle, bicycle and other types of helmets should be removed prior to spinal stabilization
S-SV EMS Agency MICN Training (Updated )

22. EMS Trauma Patient Destination
S-SV EMS Agency MICN Training (Updated )

23. EMS Trauma Patient Destination
S-SV EMS Agency MICN Training (Updated )

24. Trauma Patient Transfers
S-SV EMS Agency MICN Training (Updated )

25. Trauma Patient Transfers
S-SV EMS Agency MICN Training (Updated )

26. Trauma Patient Transfers
S-SV EMS Agency MICN Training (Updated )