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TABLE OF CONTENTS

Medical Director Authorization

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	July-16
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	October-20
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	July-23
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

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	April-20
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 Transcient Ischemic Attack	May-24
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	January-24
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	January-24
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
Cyanokit	April-16
Dextrose 10%	April-16
Dextrose 50%	April-16
Diphenhydramine	April-16
Dopamine	April-16
Epinephrine	April-16
Flumazenil	April-16
Geodon	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	November-17
Promethazine	April-16
Racemic Epinephrine	April-16
Sodium Bicarbonate	April-16
Solu-Medrol	January-17
Toradol	August-24
TXA	October-20
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

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 - 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	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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