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Palm beach county fire-rescue


PALM BEACH COUNTY FIRE-RESCUE
RESCUE OPERATIONS

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Palm Beach County Fire-Rescue will be implementing a new Protocol Manual effective
December 1, 2004. The majority of the new manual will be utilized for providing both pre-
hospital Basic Life Support and Advanced Life Support medical care. However, there are some
sections or portions of a protocol, which will not be, utilized by Palm Beach County Fire-Rescue.
The following is the disclaimer list of protocols which will not be utilized or require a change in
the written protocol:
Chapter 1, General Protocol 1.1, “Intent and Use of Protocols”, pg. 3, ALS 1 and Throughout the protocol the classification of ALS 1 and ALS 2 are
utilized to distinguish between actions, which require medical
direction, and those which do not. Palm Beach County Fire-
Rescue paramedics will not need medical direction or orders
for any protocols contain within the protocol manual.

Chapter 1, General Protocol 1.4, pg.14, Death in the Field, Section III However, once a DNRO is presented to EMS personnel, the EMT
or PARAMEDIC with an order from medical direction may
terminate resuscitation. Palm Beach County Fire-Rescue
paramedics will not need medical direction to terminate
resuscitation after being presented with a DNRO.

A PARAMEDIC with an order from medical direction may
terminate resuscitation provided the following criteria are met. If
the following criteria are met Palm Beach County Fire-Rescue
paramedics will not need medical direction to terminate
resuscitation.

Chapter 1, General Protocol 1.5, pg. 16, “Strenuous Activity/ Firefighter a) Two SCBA’s and/or thirty minutes of strenuous activity. Palm
Beach County Fire-Rescue will utilize the following: “Two
SCBA’s and/or 45 minutes strenuous activity.

Chapter 1, General Protocol 1.6, pg. 20-25, “Helicopter Safety” This protocol will not be utilized by Palm Beach County Fire-
Rescue.

Chapter 1, General Protocol 1.7, pg. 26 & 27, Medical Communications: PRIORITY IV will not be utilized by Palm Beach
County Fire-Rescue.
Will not be utilized by Palm Beach County Fire-
Rescue.
Chapter 1, General Protocol 1.8, pg. 31, “Refusal of Care”, “Refusal Procedure” 1. (a), (b), (c), (d) in these situations Palm Beach County Fire-Rescue will contact an EMS Captain instead of Medical Direction for consultation. Chapter 1, General Protocol 1.10, pg. 56, 57, 60, “Trauma Transport Protocol”: B. Palm Beach County Fire-Rescue will not need to
submit the data on the appropriate state form for each trauma patient. Section III “Helicopter Transport Procedure” A. Safety Criteria (Helicopter will NOT be used.) The statement (Helicopter will NOT be used) does
not apply to Palm Beach County Fire-Rescue.

B. Operational Criteria (Helicopter will be used) 1. If the Trauma Center that the patient would be taken to by ground transport is farther away
than twenty (20) minutes (30 minutes for High
Index patients) driving time. The statement 30
minutes for High Index patients will not be
utilized by Palm Beach County Fire-Rescue.

4. Extrication time greater than twenty (20) minutes. Palm Beach County Fire-Rescue
will utilize extrication time greater than 15
minutes.

C. Palm Beach County Fire-Rescue will not use this
section regarding High Index of Suspicion
Trauma Patients.

Chapter 1, General Protocol 1.11, pg. 61, “Protocol Revision Procedures” This protocol will not be utilized by Palm Beach County Fire-Rescue.
Adult Protocol, 2.2.2, pg. 82, “Asthma/Bronchospasm” The bullet stating: For severe dyspnea, Magnesium Sulfate 2 gm IV
(mixed in 50 ml of D5W given over 5-10 minutes), PRN. Palm Beach
County Fire-Rescue will not utilized this treatment for
Asthma/Broncospasm.

Adult Protocol 2.2.4, pg. 84, “Pulmonary Edema – CHF” Palm Beach County Fire-Rescue will not administer Morphine Sulfate
in the Pulmonary Edema – CHF patient unless the patient has
associated chest pain and you are following the “Suspected
AMI/Acute Coronary Syndrome” protocol.
If the systolic BP $90, Nitroglycerin (Nitrostat or Nitrolingual Spray) 0.4
mg SL, repeat every 3 minutes (maximum dose 1.2mg) (b)(c). Palm
Beach County Fire-Rescue will not utilize a maximum dose of
Nitroglycerin, therefore, nitroglycerin may continued to be
administered every 3 minutes as long as the BP
$90.
Adult Protocol, 2.3.2, pg. 89, “Bradycardia” (a) Bradycardia with hypotension may be due to inferior wall MI
associated with right ventricular MI (confirmed on 12 lead ECG
V4R ST elevation). When an inferior wall MI is associated with
right ventricular MI, avoid use of nitrates (Nitroglycerin). Palm
Beach County Fire-Rescue will use the following: “Nitrates
may be used with caution” if the patient is hemodynamically
stable and the bradycardia and hypotension has been resolved.

Adult Protocol, 2.4.2, pg. 100, 101, “Suspected AMI/Acute Coronary Syndrome” (a) Bradycardia with hypotension may be due to inferior wall MI
associated with right ventricular MI (confirmed on 12 lead ECG
V4R ST elevation). When an inferior wall MI is associated with
right ventricular MI, avoid use of nitrates (Nitroglycerin). Palm
Beach County Fire-Rescue will use the following: “Nitrates
may be used with caution” if the patient is hemodynamically
stable and the bradycardia and hypotension has been resolved.
e.g. pacing and/or IV fluids.

(c) Nitrates may be used with caution if the patient is
hemodynamically stable, EXCEPT if Viagra, Levitra, or Cialis
has been used within the past 24 hours then nitrates shall be
avoided.

Adult Protocols, 2.6.2, pg. 116,“CNS Depressant Overdose” and 2.6.5 The bullets that state “Draw blood sample prior to drug administration”.
Palm Beach County
Fire-Rescue will not be drawing blood on patients
unless requested to do so by a law enforcement officer and a blood
sample kit is provided.

Source: http://pbcgov.net/fire/pdfs/TrainingAndSafety/COPD/EMS/PT_ManualDisclaimer.pdf

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