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[[Medical Director Authorization]]
[[Medical Director Authorization]]
[https://roaddoc.com/scems/index.php/Special:RecentChanges?hidebots=1&limit=50&days=60&enhanced=1&urlversion=2 Changes in past 60 days]


===Section 1 - Administrative Policies===
===Section 1 - Administrative Policies===
Line 18: Line 21:
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
| 1.04 || [[Physician or Nurse on Scene]] || March-09 ||
|-
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16 ||
| 1.05 || [[Initiation of CPR and Determination of Death]] || April-25 ||
|-
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
| 1.06|| [[Determination of Death in Trauma]]|| March-09 ||
Line 34: Line 37:
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
| 1.12|| [[Medical Patient Transport Decision]]|| April-14 ||
|-
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| October-20 ||
| 1.13|| [[Obstetrical Patient Transport Decision]]|| June-25 ||
|-
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09 ||
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| 1.16|| [[EMS Offload Policy]]|| March-09 ||
| 1.16|| [[EMS Offload Policy]]|| March-09 ||
|-
|-
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| July-23 ||
| 1.17|| [[EMT and Paramedic County Certification Procedure]]|| April-25 ||
|-
|-
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
| 1.18|| [[EMS Quality Improvement Program]]|| March-09 ||
Line 52: Line 55:
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
| 1.21|| [[Freestanding ED Transport Criteria]]|| April-23 ||
|-
|-
| 1.22|| [[Hospital Capability Chart - DRAFT|Hospital Capability Chart]]|| May-24 ||May-24
| 1.22|| [[Hospital Capability Chart]]|| May-24 ||May-24
|-
|-
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
| 1.23|| [[Documentation Guidance]]|| June-24 ||June-24
Line 75: Line 78:
|-
|-
||2.05||[[Drug Assisted Intubation]]||December-16
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06
|[[Patient Assist]]
|January-25
|}
|}


Line 87: Line 94:
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
| 3.02|| [[Carbon Monoxide Inhalation]]|| June-19
|-
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
| 3.03|| [[Foreign Body Airway Obstruction]]|| October-24
|-
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
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|4.02 || [[Asystole]]||December-22
|4.02 || [[Asystole]]||December-22
|-
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||April-20
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-25
|-
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
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|5.03||[[Altered Mental Status (AMS)]]||April-17
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|-
|5.04||[[Suspected Stroke Transcient Ischemic Attack TIA|Suspected Stroke or Transcient Ischemic Attack]]||May-24
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-15
|-
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|5.05||[[Drug Overdose Poisoning]]||March-09
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|-
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|-
|5.23
|[[CORE Opioid Addiction Recovery]]
|October-24
|}
|}


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|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|-
|6.06||[[Extremity Injuries]]||January-24
|6.06||[[Extremity Injuries]]||November-25
|-
|-
|6.07||[[Head Injuries]]||September-24
|6.07||[[Head Injuries]]||September-24
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|6.11||[[Suspected Sexual Assault]]||March-09
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|-
|6.12||[[Trunk Penetrating Injuries]]||January-24
|6.12||[[Trunk Penetrating Injuries]]||November-25
|-
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|6.13||[[Hemorrhagic Shock]]||October-18
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|-
|-
|[[Atrovent]]||April-16
|[[Atrovent]]||April-16
|-
|[[Buprenorphine]]
|December-24
|-
|-
|[[Calcium Chloride]]||April-16
|[[Calcium Chloride]]||April-16
|-
|-
|[[Cardizem]]||July-17
|[[Cardizem]]||July-17
|-
|[[Ceftriaxone|Ceftriaxone/Rocephin™]]
|November-25
|-
|-
|[[Cyanokit]]||April-16
|[[Cyanokit]]||April-16
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|-
|-
|[[Flumazenil]]||April-16
|[[Flumazenil]]||April-16
|-
|[[Geodon]]||April-16
|-
|-
|[[Glucagon]]||April-16
|[[Glucagon]]||April-16
|-
|-
|[[Hypertonic Saline]]||January-24
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|-
|[[Keppra]]||January-24
|[[Keppra]]||September-24
|-
|-
|[[Ketamine]]||November-20
|[[Ketamine]]||November-20
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|[[Pepcid]]||April-16
|[[Pepcid]]||April-16
|-
|-
|[[Pontocaine]]||November-17
|[[Pontocaine]]/Tetracaine||November-17
|-
|-
|[[Promethazine]]||April-16
|[[Promethazine]]||April-16
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|[[Toradol]]||August-24
|[[Toradol]]||August-24
|-
|-
|[[TXA]]||October-20
|[[TXA]]||July-25
|-
|-
|[[Xopenex]]||April-16
|[[Xopenex]]||April-16
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|-
|-
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|9.41||[[Controlled Substance Disposal Procedures]]||Mar-24
|-
|9.42||[[LifeVac]]||Oct-24
|-
|9.43||[[Elegard - Adult]]||Mar-25
|-
|9.44||[[Elegard - Pediatric]]||Mar-25
|}
|}


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|-
|-
! Subject !! Effective Date
! Subject !! Effective Date
|-
|[[Memo - Stroke Alerts]]
|2025-05-12
|-
|[[Memo - Medical Clearance]]
|2025-03-31
|-
|[[Memo - Patient Assists]]
|2025-03-31
|-
|[[Memo - Face to face Medical Director meetings]]
|2025-03-31
|-
|-
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
| [[Memo - Hurricane Ian – EMS OPERATIONS]]|| 2022-09-28
Line 521: Line 554:
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
| [[Memo - Transporting of Overdose Patients to AdventHealth Altamonte|Transporting of Overdose Patients to AdventHealth Altamonte]]|| 2019-08-12
|-
|-
| [[Memo - EMS Reports on Lift Assists|EMS Reports on Lift Assists]]|| 2019-03-01
| [[Memo - EMS Reports on Lift Assists|<s>EMS Reports on Lift Assists</s>]] - RESCINDED|| 2019-03-01
|-
|-
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23
| [[Memo - Blood Draws - Nurses refusing tubes|Blood Draws - Nurses refusing tubes]]|| 2018-08-23

Latest revision as of 23:53, 26 November 2025

TABLE OF CONTENTS

Medical Director Authorization


Changes in past 60 days

Section 1 - Administrative Policies

Section Description Revision Date Reviewed Date
1.01 General Measures March-24 March-24
1.02 Radio Report Format July-21
1.03 Refusal of Service October-17
1.04 Physician or Nurse on Scene March-09
1.05 Initiation of CPR and Determination of Death April-25
1.06 Determination of Death in Trauma March-09
1.07 Crime or Unattended Death Scene March-09
1.08 Medical Evaluation of Person in Police Custody March-09
1.09 Trauma Transport Protocol February-19
1.10 Emergency Transport March-09
1.11 Criteria for Helicopter Transport March-09
1.12 Medical Patient Transport Decision April-14
1.13 Obstetrical Patient Transport Decision June-25
1.14 Emergency Inter Facility Transport March-09
1.15 EMS Saturation Disaster Response Levels April-16
1.16 EMS Offload Policy March-09
1.17 EMT and Paramedic County Certification Procedure April-25
1.18 EMS Quality Improvement Program March-09
1.19 Post Exposure Prophylaxis (PEP) November-21
1.20 Scope of Practice July-23
1.21 Freestanding ED Transport Criteria April-23
1.22 Hospital Capability Chart May-24 May-24
1.23 Documentation Guidance June-24 June-24
1.24 School Medication Authorization Forms June-18

Section 2 - Primary Care

Section Description Revision Date
2.01 Initial Medical Assessment and Care March-09
2.02 Initial Trauma Assessment and Care September-17
2.03 Rapid Trauma Assessment, Focused History and Physical Exam Sept-15
2.04 Analgesia and Sedation December-20
2.05 Drug Assisted Intubation December-16
2.06 Patient Assist January-25

Section 3 - Respiratory

Section Description Revision Date
3.01 Acute Asthma or COPD with Wheezing February-19
3.02 Carbon Monoxide Inhalation June-19
3.03 Foreign Body Airway Obstruction October-24
3.04 Infectious Upper Airway Obstruction - Croup or Epiglottitis April-16
3.05 Severe Respiratory Pathogens November-10
3.06 Anxiety or Hyperventilation February-11

Section 4 - Cardiac

Section Description Revision Date
4.01 Chest Pain Acute Coronary Syndrome Mar-22
4.02 Asystole December-22
4.03 Atrial Fibrillation Atrial Flutter June-25
4.04 Pulseless Electrical Activity (PEA) January-16
4.05 Premature Ventricular Contractions (PVC) May-12
4.06 Supraventricular Bradycardia and AV Blocks April-24
4.07 Supraventricular Tachycardia January-20
4.08 Ventricular Fibrillation Pulseless Ventricular Tachycardia December-16
4.09 Ventricular Tachycardia with a Palpable Pulse July-12
4.10 Wide Complex Tachycardia Uncertain Origin January-20
4.11 Acute Cardiogenic Pulmonary Edema Pneumonia March-09
4.12 Code Cool Post ROSC Induced Hypothermia March-09
4.13 Adult Immediate Post-Cardiac Arrest Care April-12
4.14 Ventricular Assist Devices March-22

Section 5 - Medical

Section Description Revision Date
5.01 Acute Abdominal Pain April-16
5.02 Allergic Reaction Anaphylactic Shock March-19
5.03 Altered Mental Status (AMS) April-17
5.04 Suspected Stroke or Transient Ischemic Attack May-15
5.05 Drug Overdose Poisoning March-09
5.06 Cold Emergencies April-12
5.07 Heat Emergencies August-15
5.08 Hazardous Materials July-22
5.09 Severe Hypertension March-09
5.10 Hypo or Hyperglycemia April-16
5.11 Psychological Behavioral Emergencies March-09
5.12 Seizure April-16
5.13 Non-Hemorrhagic Shock October-18
5.14 Sickle Cell Anemia Crisis March-09
5.15 Syncope March-09
5.16 Vertigo March-09
5.17 Sepsis Septic Shock Jan-24
5.18 Suspected Kidney Stone April-16
5.19 Cyanide Poisoning April-16
5.20 Excited Delirium or Drug Induced Agitation November-17
5.21 Ebola Virus Disease Patient Management October-14
5.22 Acute Adrenal Insufficiency June-18
5.23 CORE Opioid Addiction Recovery October-24

Section 6 - Trauma

Section Description Revision Date
6.01 Animal Bites Stings August-18
6.02 Burns - Thermal, Electrical, Chemical March-09
6.03 Selective Spinal Immobilization August-14
6.04 Chest Injuries March-09
6.05 Decompression Sickness or Dysbarism March-09
6.06 Extremity Injuries November-25
6.07 Head Injuries September-24
6.08 Near Drowning March-09
6.09 Ophthalmic Injuries March-09
6.10 Suspected Abuse Neglect March-09
6.11 Suspected Sexual Assault March-09
6.12 Trunk Penetrating Injuries November-25
6.13 Hemorrhagic Shock October-18

Section 7 - Pediatric and Obstetrical

Section Description Revision Date
7.01 Pediatric Asystole April-16
7.02 Pediatric Pulseless Electrical Activity PEA April-16
7.03 Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia April-16
7.04 Pregnancy Induced Hypertension (PIH) April-20
7.05 Preterm Labor November-17
7.06 Emergency Childbirth November-17
7.07 Childbirth Complications November-17
7.08 Newborn Care April-16
7.09 Post Partum Care November-17
7.10 Pediatric Febrile Emergency April-16
7.11 Vaginal Bleeding March-09
7.12 Trauma In Pregnancy March-09

Section 8 - Medication Guidelines

INTRODUCTION The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Seminole County EMS:

Medication Name Revision Date
Acetaminophen March-09
Adenosine January-20
Albuterol April-16
Amiodarone July-17
Ancef January-24
Aspirin March-09
Atropine July-17
Atrovent April-16
Buprenorphine December-24
Calcium Chloride April-16
Cardizem July-17
Ceftriaxone/Rocephin™ November-25
Cyanokit April-16
Dextrose 10% April-16
Dextrose 50% April-16
Diphenhydramine April-16
Dopamine April-16
Epinephrine April-16
Flumazenil April-16
Glucagon April-16
Hypertonic (3%) Saline September-24
Keppra September-24
Ketamine November-20
Lasix April-16
Lidocaine July-17
Magnesium Sulfate April-16
Morphine Sulfate November-16
Naloxone April-16
Nitro Drip April-17
Nitro Spray April-17
Nitro Tablets April-17
Nitrous Oxide November-16
Oxygen March-09
Pepcid April-16
Pontocaine/Tetracaine November-17
Promethazine April-16
Racemic Epinephrine April-16
Sodium Bicarbonate April-16
Solu-Medrol January-17
Toradol August-24
TXA July-25
Xopenex April-16
Valium April-16
Versed April-16
Zofran April-16
Medication Infusion Tables March-09

Section 9 - Procedure Guidelines

Section Description Revision Date
9.00 Lucas Device November-21
9.01 Autovent March-09
9.02 Blood Alcohol Draw on Scene March-18
9.03 Blood Draw using Vacutainer Tubes March-09
9.04 Blood Glucose Test March-09
9.05 Buretrol Usage March-09
9.06 Cardiac Monitor April-12
9.07 Cardioversion March-09
9.08 Continuous Positive Airway Pressure Device March-09
9.09 Cricothyrotomy Needle March-09
9.10 Cricothyrotomy Surgical March-09
9.11 Defibrillation March-09
9.12 Defibrillation Pediatric March-09
9.13 End Tidal CO2 Monitoring and Capnography March-09
9.14.1 Intraosseous Infusion - Femoral February-15
9.14.2 Intraosseous Infusion - Humeral Head December-16
9.15 Intubation Endotracheal March-09
9.16 Intubation Nasotracheal March-09
9.17 IVAC Medsystem III MultiChannel Infusion Pump March-09
9.18 King Tube March-09
9.19 Medication Administration Intramuscular March-09
9.20 Medication Administration Nasal Atomizer March-09
9.21 Medication Administration Nebulizer March-09
9.22 Medication Administration Subcutaneous March-09
9.23 Nasogastric/Orogastric Tube March-09
9.24 Oxygen Administration March-09
9.25 Peripheral IV Administration March-09
9.26 Pleural Decompression March-09
9.27 Removal of Taser Probes March-09
9.28 Reconstitution of Medications March-09
9.29 ResQPOD Impedance Threshold Device March-09
9.30 Transcutaneous Pacing Procedure March-09
9.31 ResQGuard Impedance Threshold Device April-11
9.32 Emergency Chest Wall Escharotomy April-11
9.33 Venous Lactate Monitoring Procedure May-12
9.34 Central Venous Access Devices June-12
9.35 Medication Administration Cross Check Jun-12
9.36 Combat Application Tourniquet Jan-14
9.37 Zoll LifeVest Wearable Defibrillator Dec-14
9.38 iTClamp Hemorrhage Control System Feb-15
9.39 I-gel Supraglottic Airway February-24
9.40 T-POD Pelvic Stabilization Device Sept-23
9.41 Controlled Substance Disposal Procedures Mar-24
9.42 LifeVac Oct-24
9.43 Elegard - Adult Mar-25
9.44 Elegard - Pediatric Mar-25

Section 10 - References

Section Description Revision Date
10.01 Abbreviations March-09
10.02 Apgar Score March-09
10.03 Glasgow Coma Score March-09
10.04 Pediatric Vital Signs March-09
10.05 Adult Trauma Alert Criteria March-09
10.06 Pediatric Trauma Alert Criteria March-09
10.07 Pediatric Trauma Score March-09
10.08 Nitroglycerin Drip March-09
10.09 Checking Range of Motion March-09
10.10 Rule of Nines March-09
10.11 Florida Statutes March-09
10.12 Evaluation and Treatment Flow Chart March-09
10.13 Spinal Injury Assessment Critical Criteria March-09
10.14 Celox Gauze Powerpoint April-12
10.15 Sepsis and Venous Lactate Powerpoint April-12
10.16 LVAD EMS Guide Sept-18
10.16.1 HeartMate III LVAD - Green Sept-18
10.16.2 HeartMate II LVAD - Red Sept-18
10.16.3 HeartWare LVAD - Dark Blue Sept-18
10.16.4 Jarvik 2000 LVAD - Lavendar Sept-18
10.16.5 Thoratec LVAD - Light Blue Sept-18
10.16.6 DuraHeart LVAD - Purple Sept-18
10.16.7 Total Artificial Heart LVAD - Pink Sept-18

Section 11 - Medical Director Memos

Subject Effective Date
Memo - Stroke Alerts 2025-05-12
Memo - Medical Clearance 2025-03-31
Memo - Patient Assists 2025-03-31
Memo - Face to face Medical Director meetings 2025-03-31
Memo - Hurricane Ian – EMS OPERATIONS 2022-09-28
Memo - Masks Required in ED's 2022-08-22
Memo - QA/QI Program 2022-03-21
Memo - Additional EMS Skills 2020-09-01
Memo - Transport of SEPSIS Patients to Freestanding ED's 2020-07-15
Clarification on Destination Choices 2019-11-14
Transport to the OD Hospital – Advent Health Altamonte Clarification 2019-11-07
Transport to the OD Hospital – Advent Health Altamonte 2019-11-04
Further clarification on Advent Health OD Facility 2019-08-26
Transporting of Overdose Patients to AdventHealth Altamonte 2019-08-12
EMS Reports on Lift Assists - RESCINDED 2019-03-01
Blood Draws - Nurses refusing tubes 2018-08-23
Clarification of Baker Act patients transported by EMS 2018-04-11
Opening of Oviedo Medical Center 2017-01-29
Blood Draws - Florida Hospital 2017-01-25
Medical Alerts 2016-04-27
Florida Hospital East Pediatric ED 2015-11-23
Discontinuation of Central Venous Access 2013-08-03
Shortage of Atropine 2013-04-11
EMS Blood Draws for SSCH 2013-03-07
Respiratory/Breathing Treatments 2012-12-19
OB Transports 2011-01-14
Aspirin Administration Documentation 2010-12-01
Transport of Psychiatric Patients 2010-05-17
Alert Terminology 2010-05-06
Transport of STEMI Patients 2010-03-19
Aircare Update 2010-03-19
Delayed Offloads with Critical or Unstable Patients 2010-02-25
Transport of STEMI Patients 2010-02-19
Response to Physicians Offices 2009-10-14
Patient Reports Being Given to Hospitals 2009-09-23
Patient Medications 2009-07-20
H1N1 Update 2009-06-24
Multiple Patient Refusal - Wording 2009-06-04
Request for Call Reviews 2009-05-14
H1N1 Update 2009-05-05
Clarification on Selection for Spinal Immobilization 2009-04-30
EKG Strips 2009-04-23
Patient Medications 2009-04-23
Leaving run reports at the E.R. 2009-02-03
Hyperbaric Chamber at CFRH 2008-10-16
Stemi Transport Destinations 2008-07-22
STEMI Alerts to Winter Park Hospital 2008-02-04
Documentation of Medications 2005-01-27

Section 12 - Paramedic Clinical Assessment Program

Section Description Revision Date
12.01 PCAP Guidelines Jan-19
12.02 ALS Contact Form June-10
12.03 Evaluation Form - Equip Jan-13
12.04 Evaluation Form - Protocols Jan-13
12.05 ALS Contact Definition June-10
12.06 Daily Performance Eval Sept-17
12.07 MD Meetings Roster May-13
12.08 Mentor Evaluation May-13
12.09 Verification of EMT Skills May-13
12.10 PCAP Completion Checklist Sept-17
12.11 Verification of Paramedic Skills May-13
12.12 ALS Contact Form Example 1 Dec-14
12.13 ALS Contact Form Example 2 Dec-14
12.14 Incapacitated Patient Management Dec-14

Section 13 - COVID-19

Section Description Revision Date
13.01 MD Memo - Please use Common Sense 2020-03-13
13.02 Hospital Screening and Procedures 2020-03-26
13.03 Dispatch Screening and Procedures 2020-04-01
13.04 Strict Respiratory Precautions Question Card 2020-04-01
13.05 American Red Cross Changed Response Procedures 2020-03-31
13.06 Clearance of COVID Positive, symptomatic and or exposed individuals from our previous advice 2020-07-15
13.07 Updated COVID Transport to FSED 2020-07-20


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