IFT - Revision history

Shadmin: Added Protocol 1012

2026-02-12T15:53:45Z

Added Protocol 1012

← Older revision		Revision as of 15:53, 12 February 2026
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	### FiO2 100% to start		### FiO2 100% to start

	[[~~index~~.php?title=File:~~Vent_Management~~.png\|link=https://ems.shermancountyks.gov/File:Vent_Management.png\|left\|frame]]		[[Index.php?title=File:Vent Management.png\|link=https://ems.shermancountyks.gov/File:Vent_Management.png\|left\|frame]]


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	## Any cardiac or pulmonary arrest of the mother remains an acute reason to divert to the closest facility as well.		## Any cardiac or pulmonary arrest of the mother remains an acute reason to divert to the closest facility as well.

	== '''Protocol ~~1101~~: IFT Maintenance of Urinary Catheters''' ==		== '''Protocol 1011: IFT Maintenance of Urinary Catheters''' ==
	SCOPE: EMT-B, AEMT, Paramedic		SCOPE: EMT-B, AEMT, Paramedic

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	# A patient may continue to receive whole bladder irrigation if it has been initiated by the transferring facility. In the event of a complication during transport, effort should be made to contact the sending facility or Medical Control for further guidance (eg a catheter no longer flushing easily).		# A patient may continue to receive whole bladder irrigation if it has been initiated by the transferring facility. In the event of a complication during transport, effort should be made to contact the sending facility or Medical Control for further guidance (eg a catheter no longer flushing easily).
	# Crews may further secure or modify the securing devices of urinary catheters to ensure they are not snagged		# Crews may further secure or modify the securing devices of urinary catheters to ensure they are not snagged

			== '''Protocol 1012: IFT Chest Tube Management''' ==
			SCOPE: Paramedic

			# Chest tubes may be placed by sending facilities for evacuation of air or fluid from the pleural space. The chest tubes are placed to a water seal drainage system which provides for escape of air or fluid into a drainage bottle. Placement should be performed by the ending facility. Although placement is out of the scope of the prehospital provider, prehospital providers may be called upon to manage these systems during transport.
			# Transferring prehospital providers should understand why these systems have been placed and be comfortablewith monitoring them.
			## Prior to transport, the prehospital provider should review and document;
			### The reason for chest tube placement, assessment of lung sounds and proper functioning of the drainage system.
			### Review documentation for administration of analgesia and sedation.
			## Make sure the chest tube and tubing are secured to the patient with tape.
			## Assess the function of the chest tube and drainage system before initiating patient transport.
			### Gentle rise and fall of the water level, which corresponds with the patient’s respirations is called “tidalling” and indicates that the system is functioning properly.
			### Continuous air bubbling in the water seal chamber confirms a constant air leak from a tube connection or from the patient's chest (e.g., unresolved pneumothorax).
			### Intermittent bubbling in the water seal chamber confirms an intermittent air leak from the patient's chest.
			### No air bubbling in the water seal chamber confirms no air leak from the patient's chest and no air leak from a tube connection.
			## The drainage system should be lower than the patient’s chest and remain upright at all times.
			## Evaluate breath sounds and vital signs and reassess for development of a tension pneumothorax.
			## All tubing and connections should be monitored with all patient movements to maintain patency of the system.
			### Ensure the dressing remains dry and occlusive.
			### Ensure there are no kinks or dependent loops (e.g., a loop or turn in the tubing that forces the drainage to move against gravity to reach the collection chamber) in the tubing.
			### Amount of water in the water seal chamber; if the water level appears low ask a staff member if it requires refilling prior to departure.
			## The tubing should not be “milked” as it increases intra pleural pressure.
			## Frequently assess vital signs and the amount and color of the drainage from the drainage system. Document drainage amount during transport.
			## Assess for pain and treat per pain protocol 1002.
			## Contact Medical Control for any of the following:
			### Chest tube inadvertently dislodged i. If entire chest tube is inadvertently dislodged from the chest, cover with a sterile occlusive dressing. ii. If a tension pneumothorax develops, release one corner of the dressing. If releasing dressing is unsuccessful and patient develops respiratory com[promise or hypotension, needle decompression may need to be considered.
			### Excessive constant bubbling in the water seal chamber, which may indicate an air leak in the drainage system. Leaking and trapping of air in the pleural space may result in tension pneumothorax.
			### If the drainage system is crushed or broken open or the chest drain becomes detached from the chest tube .
			### Sudden increase in bloody drainage from a hemothorax.

	== '''Protocol 1111: IFT Magnesium Sulfate Drip''' ==		== '''Protocol 1111: IFT Magnesium Sulfate Drip''' ==
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	* Patients may experience pain at the site of administration. If discomfort is significant enough to warrant discontinuing the infusion, contact sending facility or Medical Control for further guidance.		* Patients may experience pain at the site of administration. If discomfort is significant enough to warrant discontinuing the infusion, contact sending facility or Medical Control for further guidance.

	[[~~index~~.php?title=File:~~Serum_K~~.jpg\|link=https://ems.shermancountyks.gov/File:Serum_K.jpg\|none\|frame]]		[[Index.php?title=File:Serum K.jpg\|link=https://ems.shermancountyks.gov/File:Serum_K.jpg\|none\|frame]]

	== '''Protocol 1114: IFT Hypertonic Saline (3%) Drips''' ==		== '''Protocol 1114: IFT Hypertonic Saline (3%) Drips''' ==
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	* Tachyphylaxis is a condition where, due to the patient’s ultimate neurologic and cardiovascular collapse, the body requires higher and higher doses of epinephrine each time it is administered to achieve the same hemodynamic effect. While not specific, it indicates a poor prognosis. When noted, this information should be provided to receiving facility of the need for increasingly higher doses.		* Tachyphylaxis is a condition where, due to the patient’s ultimate neurologic and cardiovascular collapse, the body requires higher and higher doses of epinephrine each time it is administered to achieve the same hemodynamic effect. While not specific, it indicates a poor prognosis. When noted, this information should be provided to receiving facility of the need for increasingly higher doses.

	[[~~index~~.php?title=File:~~Dirty_EPI_Drip~~.png\|frameless\|600x600px]]		[[Index.php?title=File:Dirty EPI Drip.png\|frameless\|600x600px]]

	[[~~index~~.php?title=File:~~Push_Dose_Eip~~.png\|link=https://ems.shermancountyks.gov/File:Push_Dose_Eip.png\|frameless\|600x600px]]		[[Index.php?title=File:Push Dose Eip.png\|link=https://ems.shermancountyks.gov/File:Push_Dose_Eip.png\|frameless\|600x600px]]

	== '''Protocol 1232: IFT Dopamine Drip''' ==		== '''Protocol 1232: IFT Dopamine Drip''' ==

Shadmin: Splitting IFT from Protocols

2025-05-01T15:15:20Z

Splitting IFT from Protocols

← Older revision		Revision as of 15:15, 1 May 2025
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			== '''Protocol 1007: IFT Intermittent Suctioning, Airway and Gastric suctioning''' ==







	== '''Protocol 1007: IFT Intermittent Suctioning''' ==

	# AEMTs and Paramedics may initiate nasotracheal suctioning intermittently if requested by the sending facility.		# AEMTs and Paramedics may initiate nasotracheal suctioning intermittently if requested by the sending facility.
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	## Consider use of 5 ml of saline to loosen the mucous, flushed down the ET tube.		## Consider use of 5 ml of saline to loosen the mucous, flushed down the ET tube.
	## Apply soft tip suction catheter for the full length of the ET tube, plus approximately 5 cm, suctioning as the catheter is removed, for no longer than 10 seconds at a time.		## Apply soft tip suction catheter for the full length of the ET tube, plus approximately 5 cm, suctioning as the catheter is removed, for no longer than 10 seconds at a time.
			# The recommended pressures for suctioning are as follows:
			## Neonates: 60-80 mm Hg
			## Infants: 80-100 mm Hg
			## Children: 100-120 mm Hg
			## Adults: 100-150 mm Hg
			# Negative pressures should not exceed 150 mm Hg as higher pressures have been shown to cause trauma, hypoxemia and atelectasis.
			# In regards to gastric suctioning, both nasogastric and orogastric suctioning, current equipment available does NOT allow for intermittent suctioning, only continuous suctioning. Therefore, these tubes should be capped for the duration of the transport.

	== '''Protocol 1008: IFT CPAP/BiPAP''' ==		== '''Protocol 1008: IFT CPAP/BiPAP''' ==

	# '''Scope of practice''': AEMT, Paramedic.		# '''Scope of practice''': AEMT, Paramedic.
	# ~~interfacility~~ transfers do not change the scope of practice referenced in medication protocols. Personnel may only administer procedures relevant to their scope of practice. If a higher level of medication is required, then the higher certified individual must attend on the patient.		# Interfacility transfers do not change the scope of practice referenced in medication protocols. Personnel may only administer procedures relevant to their scope of practice. If a higher level of medication is required, then the higher certified individual must attend on the patient.
	# CPAP may be initiated under EMS Protocol 207 during transport if the patient meets criteria. Since the sending provider knows the underlying condition of the patient best, every attempt should be made to discuss initiation of CPAP with the sending provider, either before or shortly after initiating CPAP, as there are respiratory conditions where it may appear useful but could inadvertently be detrimental to the patient.		# CPAP may be initiated under EMS Protocol 207 during transport if the patient meets criteria. Since the sending provider knows the underlying condition of the patient best, every attempt should be made to discuss initiation of CPAP with the sending provider, either before or shortly after initiating CPAP, as there are respiratory conditions where it may appear useful but could inadvertently be detrimental to the patient.
	# BiPAP requires am AEMT or Paramedic to be in attendance. Either the facility’s BiPAP machine or the agency’s ventilator on BiPAP settings may be used, provided the paramedic is familiar with and comfortable with the settings and operability of the machine. In instances where the equipment appears significantly unfamiliar as to pose a risk of equipment failure during transport, the transport crew should consider either contacting Medical Control and/or declining the transfer.		# BiPAP requires am AEMT or Paramedic to be in attendance. Either the facility’s BiPAP machine or the agency’s ventilator on BiPAP settings may be used, provided the paramedic is familiar with and comfortable with the settings and operability of the machine. In instances where the equipment appears significantly unfamiliar as to pose a risk of equipment failure during transport, the transport crew should consider either contacting Medical Control and/or declining the transfer.
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	* These medications have to be mixed/prepared very carefully, and should be prepared by the sending facility, not the paramedic.		* These medications have to be mixed/prepared very carefully, and should be prepared by the sending facility, not the paramedic.
	* This medication can cause sudden emboli to form. Any sudden change in patient’s mental status, or new changes in vitals or complaints should be taken seriously and investigated thoroughly (eg 12 Lead if complaint of chest pain, SpO2 if complaint of trouble breathing, neuro exam if stroke symptoms).		* This medication can cause sudden emboli to form. Any sudden change in patient’s mental status, or new changes in vitals or complaints should be taken seriously and investigated thoroughly (eg 12 Lead if complaint of chest pain, SpO2 if complaint of trouble breathing, neuro exam if stroke symptoms).

			*

Shadmin: Intial copy from Protocol Page splitting IFT and 911

2025-05-01T14:22:43Z

Intial copy from Protocol Page splitting IFT and 911

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