{ "schemaVersion": 1, "publisher": "OC Medic", "audience": "OCEMS clinicians", "editorialUrl": "https://www.ocmedic.com/editorial/", "guides": [ { "slug": "abdominal-pain", "title": "Adult abdominal / flank pain", "description": "Treat perfusion, pain, and nausea while screening for cardiac or aortic emergencies.", "category": "Medical", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-005", "sourceCodes": [ "SO-M-005" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult abdominal / flank pain Treat perfusion, pain, and nausea while screening for cardiac or aortic emergencies. SO-M-005", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Initial assessment", "items": [ "Maintain the airway and suction when needed. Assess onset, location/radiation, associated vomiting, pregnancy possibility, vital signs, and perfusion.", "Upper abdominal discomfort may be an anginal equivalent; consider a 12-lead with cardiac history or suspected cardiac origin." ] }, { "heading": "Perfusion and nausea", "items": [ "For dehydration or poor perfusion with clear lungs/no CHF, give normal saline 250 mL IV and reassess; repeat to a maximum 1 L as needed for perfusion.", "For nausea/vomiting when pregnancy is neither known nor suspected, the source lists ondansetron 8 mg ODT OR 4 mg IV, with one repeat 4 mg IV dose after approximately 3 minutes for recurrent symptoms." ] }, { "heading": "Severe pain", "items": [ "With systolic BP above 90, morphine is 5 mg (or 4 mg carpuject) IV/IM, with one repeat after 3 minutes as needed. Alternative fentanyl is 50 mcg IV/IM or 100 mcg IN, with one repeat after 3 minutes.", "Choose the applicable pathway, count prior doses, and reassess BP, respiratory effort, oxygenation, mental status, and pain." ] }, { "heading": "Aortic concern and destination", "items": [ "Sudden abdominal/back/flank pain with shock or abnormal pulse rate can suggest AAA disruption. A pulsatile mass or lost distal pulses may be absent.", "Risk factors in the source include age above 50, male sex, hypertension, known/family AAA, or vascular disease. Contact base for suspected AAA and possible trauma-center triage.", "Otherwise transport to the nearest ERC, with ALS escort when medication or saline is given, or obtain base direction as needed." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Known or suspected pregnancy excludes the source’s ondansetron branch.", "Do not miss a cardiac or vascular cause while treating pain and vomiting." ], "related": [ "ondansetron", "morphine", "fentanyl", "normal-saline", "chest-pain" ], "url": "https://www.ocmedic.com/guides/abdominal-pain/", "sources": [ { "code": "SO-M-005", "title": "Abdominal or Flank Pain, Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12031.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-005", "title": "Abdominal or Flank Pain, Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12031.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/abdominal-pain.md" }, { "slug": "acetaminophen", "title": "Acetaminophen", "description": "OTC analgesic/antipyretic listed for the FS-ARN program.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "acetaminophen otc analgesic/antipyretic listed for the fs-arn program.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/acetaminophen/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/acetaminophen.md" }, { "slug": "adenosine", "title": "Adenosine", "description": "Regular narrow-complex tachycardia: adult treatment and pediatric base-order guidance.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-025", "PR-115" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "adenosine regular narrow-complex tachycardia: adult treatment and pediatric base-order guidance.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "For a regular narrow-complex tachycardia with a pulse. The adult SO-C-025 pathway distinguishes mild symptoms from hemodynamic instability.", "For mild symptoms at a rate of at least 150/min, attempt Valsalva before the medication pathway." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Regular narrow-complex tachycardia ≥150/min", "12 mg rapid IV. If the rhythm persists, repeat 12 mg once after 3 minutes." ], [ "Unstable presentation", "Follow the synchronized-cardioversion branch of SO-C-025; do not delay urgent electrical treatment to complete a medication sequence." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "I-20 marks pediatric adenosine as requiring a base hospital order. It provides separate first- and second-dose rows for each weight band.", "Use the ordered dose and the matching weight-band chart; do not apply the adult 12 mg initial dose to a child. I-20 uses a 3 mg/mL preparation." ], "id": "pediatric" }, { "heading": "Pediatric weight bands — base-ordered adenosine", "id": "pediatric-weight-bands", "items": [ "I-20 pages 1–10: base hospital order required. Rapid IV route; preparation 3 mg/mL. PR-115 states adenosine is not effective through an IO site.", "These are the published I-20 band doses, not exact-weight calculations. Confirm the actual order and prepared volume against the linked chart; do not extrapolate outside its listed bands." ], "table": { "headers": [ "I-20 weight band", "First dose — rapid IV", "Second dose — rapid IV" ], "rows": [ [ "3–5 kg", "0.4 mg", "0.8 mg" ], [ "6–7 kg", "0.6 mg", "1.2 mg" ], [ "8–9 kg", "0.8 mg", "1.6 mg" ], [ "10–11 kg", "1 mg", "2 mg" ], [ "12–14 kg", "1.2 mg", "2.4 mg" ], [ "15–18 kg", "1.5 mg", "3 mg" ], [ "19–23 kg", "2 mg", "4 mg" ], [ "24–29 kg", "2.5 mg", "5 mg" ], [ "30–36 kg", "3.5 mg", "7 mg" ], [ "37–49 kg", "4.5 mg", "9 mg" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Record the rhythm before and after administration and reassess perfusion and symptoms.", "Confirm the actual syringe concentration and dose. A vial or syringe size is not the ordered dose." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Do not use for a wide, irregular rhythm.", "PR-115 specifically identifies IO administration as ineffective for adenosine; this pathway is rapid IV." ], "related": [ "narrow-complex-tachycardia" ], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/adenosine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-025", "title": "Narrow Complex QRS Complex Tachycardia", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/34670.pdf", "checked": "2026-09-16" }, { "code": "PR-115", "title": "Intraosseous Infusion", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12408.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/adenosine.md" }, { "slug": "adult-cardiac-arrest", "title": "Adult cardiac arrest", "description": "Use the OCEMS arrest sequence, track medication totals, and coordinate post-ROSC destination.", "category": "Cardiac", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-C-010", "sourceCodes": [ "SO-C-010", "PR-025", "PR-230" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult cardiac arrest Use the OCEMS arrest sequence, track medication totals, and coordinate post-ROSC destination. SO-C-010", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Organize the first cycles", "items": [ "Use a coordinated CPR approach with minimal compression interruptions and compressor rotation about every 2 minutes. Follow the source’s initial 200-compression/about-2-minute assessment sequence.", "Support oxygenation/ventilation with the indicated airway method. Passive ventilation is limited to its own witnessed-arrest procedure; do not apply it without its criteria. Obtain IV/IO without interrupting compressions." ] }, { "heading": "Shockable rhythm", "items": [ "For coarse VF/pulseless wide-complex tachycardia, follow the source’s shock steps at maximum energy or the programmed/manufacturer-recommended setting, with CPR between assessments.", "The local source treats fine VF differently: continue CPR for another 2 minutes and reassess; persistent fine VF follows its PEA/asystole instructions.", "For persistent shockable arrest, epinephrine is 1 mg IV/IO using 0.1 mg/mL every approximately 3–5 minutes. Amiodarone is 300 mg IV/IO, then 150 mg in approximately 3–5 minutes if indicated; alternative lidocaine is 1 mg/kg, then 0.5 mg/kg once." ] }, { "heading": "PEA / asystole and later care", "items": [ "Continue CPR, ventilation, IV/IO access, and epinephrine 1 mg every approximately 3–5 minutes. Assess reversible causes. The source lists 250 mL saline boluses up to 1 L; reassess lungs and stop saline if rales develop after ROSC.", "At the source’s 10-minute step, follow its airway and sodium-bicarbonate instructions: 50 mL of either 7.5% or 8.4% solution IV/IO. Keep the solution concentration and volume explicit.", "At 20 minutes without ROSC, the source lists continued scene care, transport, or base contact; at 30 minutes select transport or base contact for further orders/pronouncement consideration." ] }, { "heading": "ROSC and movement", "items": [ "After ROSC, ventilate/oxygenate, address reversible problems, obtain a 12-lead when possible, and contact base for CVRC destination.", "Follow the complete policy for mechanical compression during movement/transport, advanced airway timing, implanted devices, and other special circumstances. Report rhythm, shocks, ETCO₂, cumulative medications, and ROSC time." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "This is the OCEMS local sequence, not a substitute for the complete resuscitation policy.", "Base contact is required for CVRC destination after ROSC; adult push-dose epinephrine authorization is governed by current PR-230." ], "related": [ "epinephrine", "amiodarone", "lidocaine", "sodium-bicarbonate", "shock" ], "url": "https://www.ocmedic.com/guides/adult-cardiac-arrest/", "sources": [ { "code": "SO-C-010", "title": "Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf", "checked": "2026-09-16" }, { "code": "PR-025", "title": "Passive Ventilation Procedure", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/76427.pdf", "checked": "2026-09-16" }, { "code": "PR-230", "title": "Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-C-010", "title": "Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/adult-cardiac-arrest.md" }, { "slug": "albuterol", "title": "Albuterol", "description": "Nebulized treatment for bronchospasm, with adult and pediatric protocol distinctions.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-035", "SO-P-035", "SO-P-060", "PR-900" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "albuterol nebulized treatment for bronchospasm, with adult and pediatric protocol distinctions. ventolin proventil bronchodilator", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used for wheezing/bronchospasm, including asthma or COPD, and selected smoke-inhalation and crush-injury pathways.", "Persistent severe bronchospasm may require additional base-directed treatment; bronchodilator delivery does not replace ventilatory support." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Nebulized solution", "5 mg in 6 mL by continuous nebulization, as tolerated, under the relevant standing order." ], [ "Metered-dose inhaler listed in I-15", "90 mcg per actuation: 2 puffs every 2 hours until symptoms resolve. Check that the applicable MDI procedure and agency authorization apply." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-035 specifies 5 mg in 6 mL by continuous nebulization for wheezing/suspected asthma. SO-P-060 also uses this regimen for anaphylaxis with wheeze or hypoxia.", "I-20 lists 2.5 mg in the 3–5 kg newborn band. This differs from the general pediatric respiratory standing-order wording: reconcile the neonatal dose with base rather than treating the table and condition order as interchangeable." ], "id": "pediatric" }, { "heading": "Pediatric dose by age / weight", "id": "pediatric-dose-rules", "items": [ "SO-P-035 / SO-P-060: continuous nebulization for the specified wheezing/respiratory indication. Weight does not independently establish treatment eligibility." ], "table": { "headers": [ "Weight / use", "Pediatric dose", "Volume / route" ], "rows": [ [ "3–5 kg newborn band", "Resolve source difference with base", "I-20: 2.5 mg / 3 mL; general SO-P-035: 5 mg / 6 mL" ], [ "Other eligible pediatric patients", "5 mg", "6 mL by continuous nebulization as tolerated" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Nebulizer stock is commonly 2.5 mg/3 mL; confirm the total medication and volume.", "Reassess air movement, work of breathing, oxygenation, and heart rate. Consider CPAP only when its separate age and clinical criteria are satisfied." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Anaphylaxis requires epinephrine; albuterol is an adjunct for bronchospasm.", "If pediatric respiratory status worsens or treatment fails, contact base; a pediatric-capable base is preferred." ], "related": [ "respiratory-distress", "pediatric-respiratory-distress", "cpap" ], "sourcePage": 1, "pediatricDoseType": "fixed-or-conditional", "url": "https://www.ocmedic.com/guides/albuterol/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-035", "title": "Respiratory Distress", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-P-035", "title": "Acute Respiratory Distress - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-P-060", "title": "Allergic Reaction / Anaphylaxis - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" }, { "code": "PR-900", "title": "State of Emergency - Use of Spacer-Metered Dose Inhaler in Place of Nebulizer for Administration of Albuterol", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/114647.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/albuterol.md" }, { "slug": "alteplase", "title": "Alteplase (tPA) infusion", "description": "Interfacility monitoring of a stroke thrombolytic infusion and its explicit stop criteria.", "category": "Transport medications", "kind": "medication", "medicationGroup": "Transport medications", "population": "Adult & pediatric scope", "scope": "IFT-ALS", "section": "medications", "sourceCode": "PR-233", "sourceCodes": [ "PR-233" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "alteplase (tpa) infusion interfacility monitoring of a stroke thrombolytic infusion and its explicit stop criteria.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "Receive the sending team’s report: drug, dose, infusion rate, start time, destination, and transfer records. Record baseline consciousness, rhythm, heart rate, and BP.", "Use a transport infusion pump at the rate prescribed by the sending RN/physician. PR-233 does not authorize selecting a new thrombolytic dose in the field." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "No separate pediatric dose or field-initiation pathway is provided. Pediatric use must be governed by the treating team and transport authorization; do not extrapolate an adult stroke regimen." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "Use the sending team’s patient-specific transport order and authorized scope. The cited transport procedure supplies no independent pediatric initiation regimen." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Assess BP, heart rate/rhythm, and consciousness every 5 minutes. Protect the patient from injury during handling because hemorrhage is a major risk.", "Immediately stop for new altered consciousness, a new headache, uncontrolled vomiting, systolic BP above 180, diastolic BP above 110, or a focal/generalized seizure.", "Record findings and the stop time; proceed to the receiving facility and report the event immediately on arrival. New bradycardia prompts immediate reassessment of vitals and consciousness." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "This page covers alteplase/tPA continuation under PR-233, not field thrombolysis or another thrombolytic product.", "The source’s stop criteria must remain visible during monitoring." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/alteplase/", "sources": [ { "code": "PR-233", "title": "Monitoring TPA during Interfacility Transports", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/75246.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-233", "title": "Monitoring TPA during Interfacility Transports", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/75246.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/alteplase.md" }, { "slug": "altered-mental-status", "title": "Altered mental status", "description": "Support the airway, check glucose, assess stroke criteria, and treat poor perfusion or suspected opioid toxicity.", "category": "Neurologic", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-020", "sourceCodes": [ "SO-M-020" ], "version": "See linked source for document revision and implementation dates.", "keywords": "altered mental status support the airway, check glucose, assess stroke criteria, and treat poor perfusion or suspected opioid toxicity.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Initial priorities", "items": [ "Protect the airway and support ventilation as needed. Determine whether stroke-neurology criteria are met.", "Monitor cardiac rhythm and document a strip. If SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated." ] }, { "heading": "Check glucose & treat the patient", "items": [ "SO-M-020 treats glucose at or below 60 mg/dL and permits treatment in the 60–80 range when hypoglycemia is suspected.", "Options: oral glucose if airway reflexes are intact; D10 up to 250 mL IV, titrated to improved consciousness; or glucagon 1 mg IM if IV cannot be established.", "IO dextrose is a narrow exception for an unconscious patient with glucose below 60, no IV, and no response to IM glucagon." ] }, { "heading": "Perfusion & breathing", "items": [ "For hypotension or poor perfusion with clear lungs/no CHF, establish IV and give 250 mL saline boluses up to 1 L. Reassess lungs and clinical response.", "For respiratory depression at about 12/min or fewer, the order lists naloxone: 0.8, 1, or 2 mg IN/IM, or 0.4–1 mg IV, repeating every 3 minutes as needed; a preloaded 4 mg nasal product is also listed. Continue ventilatory support." ] }, { "heading": "Repeat assessment & handoff", "items": [ "Document response after each intervention, including consciousness, breathing, BP, and glucose-related findings. A single reversible cause should not end the assessment.", "Provide ALS escort to the nearest ERC or contact base as needed. Use the stroke pathway when its criteria apply. Pediatric patients have a separate SO-P-065 pathway and different doses." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "No oral glucose without intact airway reflexes.", "Persistent respiratory depression requires ventilation support while naloxone is being administered." ], "related": [ "gcs", "stroke", "dextrose", "glucagon", "naloxone", "normal-saline" ], "url": "https://www.ocmedic.com/guides/altered-mental-status/", "sources": [ { "code": "SO-M-020", "title": "Altered Mental Status", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-020", "title": "Altered Mental Status", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/altered-mental-status.md" }, { "slug": "amiodarone", "title": "Amiodarone", "description": "Separate cardiac-arrest dosing from treatment of unstable wide-complex tachycardia with a pulse.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-010", "SO-C-040", "SO-P-040" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "amiodarone separate cardiac-arrest dosing from treatment of unstable wide-complex tachycardia with a pulse.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "An antiarrhythmic option in the OCEMS VF/pulseless-VT sequence and the unstable wide-complex tachycardia pathway.", "Stable adult wide-complex tachycardia is generally monitored and transported under SO-C-040 without cardioversion or antiarrhythmic treatment." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "VF / pulseless VT", "300 mg IV/IO; may repeat 150 mg once after 3 minutes in the resuscitation sequence." ], [ "Unstable wide-complex tachycardia with a pulse", "150 mg slow IV/IO after unsuccessful initial cardioversion. Follow SO-C-040 for repeat cardioversion and the second 150 mg dose." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-040: for persistent VF/pulseless VT, 5 mg/kg IV/IO; it permits repeat 5 mg/kg doses at 5 and 10 minutes and lists a maximum dose of 450 mg. Follow the full arrest sequence and obtain base contact.", "I-20 marks VT with a pulse as a base-order indication and lists infusion over 10 minutes. Use the ordered dose and the correct weight-band entry; do not substitute the arrest administration method." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Persistent VF / pulseless VT", "id": "pediatric-weight-1", "items": [ "Source: SO-P-040. Dose rule: 5 mg/kg; route: IV/IO.", "Initial arrest dose: 5 mg/kg IV/IO. The source permits repeat doses at 5 and 10 minutes and states a maximum of 450 mg; account for medication already given before any repeat.", "Base contact is required. This table is for pulseless arrest, not VT with a pulse. The base-ordered perfusing-VT regimen is a separate slow infusion.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO", "Volume at 50 mg/mL" ], "rows": [ [ "3 kg", "15 mg", "0.3 mL" ], [ "4 kg", "20 mg", "0.4 mL" ], [ "5 kg", "25 mg", "0.5 mL" ], [ "6 kg", "30 mg", "0.6 mL" ], [ "8 kg", "40 mg", "0.8 mL" ], [ "10 kg", "50 mg", "1 mL" ], [ "12 kg", "60 mg", "1.2 mL" ], [ "15 kg", "75 mg", "1.5 mL" ], [ "20 kg", "100 mg", "2 mL" ], [ "25 kg", "125 mg", "2.5 mL" ], [ "30 kg", "150 mg", "3 mL" ], [ "35 kg", "175 mg", "3.5 mL" ], [ "40 kg", "200 mg", "4 mL" ], [ "45 kg", "225 mg", "4.5 mL" ], [ "50 kg", "250 mg", "5 mL" ], [ "60 kg", "300 mg", "6 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight bands — VT with a pulse", "id": "pediatric-perfusing-vt", "items": [ "I-20 pages 1–10: base hospital order required; infuse over 10 minutes using the ordered route. This is not the pulseless-arrest bolus.", "Values below are the published I-20 band doses. Confirm the base order and chart; do not extrapolate beyond these bands." ], "table": { "headers": [ "I-20 weight band", "Base-ordered dose over 10 minutes", "Volume at 50 mg/mL" ], "rows": [ [ "3–5 kg", "20 mg", "0.4 mL" ], [ "6–7 kg", "30 mg", "0.6 mL" ], [ "8–9 kg", "40 mg", "0.8 mL" ], [ "10–11 kg", "50 mg", "1 mL" ], [ "12–14 kg", "70 mg", "1.4 mL" ], [ "15–18 kg", "75 mg", "1.5 mL" ], [ "19–23 kg", "100 mg", "2 mL" ], [ "24–29 kg", "125 mg", "2.5 mL" ], [ "30–36 kg", "150 mg", "3 mL" ], [ "37–49 kg", "150 mg", "3 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "The listed preparation is 50 mg/mL. Confirm ordered milligrams and the matching volume.", "Maintain rhythm and perfusion monitoring. Medication is one part of the electrical-treatment/resuscitation pathway." ] } ], "cautionTitle": "Check before giving", "cautions": [ "A pulse changes the administration sequence and rate.", "Slow administration in patients with a pulse is important: SO-C-040 warns about profound hypotension." ], "related": [], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/amiodarone/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-010", "title": "Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf", "checked": "2026-09-16" }, { "code": "SO-C-040", "title": "Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf", "checked": "2026-09-16" }, { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/amiodarone.md" }, { "slug": "anaphylaxis", "title": "Allergic reaction & anaphylaxis", "description": "Separate rash-only reactions from angioedema and systemic anaphylaxis.", "category": "Medical", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-015", "sourceCodes": [ "SO-M-015" ], "version": "See linked source for document revision and implementation dates.", "keywords": "allergic reaction & anaphylaxis separate rash-only reactions from angioedema and systemic anaphylaxis.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Classify the presentation", "items": [ "Rash/urticaria only, stable vital signs, and no anaphylaxis history follows the mild-reaction branch. If SpO₂ is below 95%, use the anaphylaxis branch.", "Anaphylaxis findings include hypotension, wheeze, hypoxia, stridor, intraoral swelling, GI symptoms, or impending obstruction.", "Facial/cervical angioedema alone has a separate treatment branch: one 0.5 mg IM epinephrine dose, held if an auto-injector was already given, plus oxygen and diphenhydramine as specified." ] }, { "heading": "Treat anaphylaxis promptly", "items": [ "Give epinephrine 0.5 mg IM into the lateral thigh using 1 mg/mL. Count a prearrival auto-injector as the first dose.", "Give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. Establish IV/IO; for hypotension, saline 250 mL boluses up to 1 L to maintain perfusion.", "For wheeze or room-air hypoxia below 95%, give albuterol 5 mg/6 mL by continuous nebulization as tolerated." ] }, { "heading": "Persistent severe symptoms", "items": [ "After 5 minutes, continued hypotension, respiratory distress, or impending airway obstruction permits a second 0.5 mg IM epinephrine dose OR 0.3 mg IV/IO using 0.1 mg/mL.", "Give diphenhydramine 50 mg IM/IV once after initial epinephrine; do not give it if taken before arrival." ] }, { "heading": "Contact & transport", "items": [ "Anaphylaxis requires base contact and ALS escort to a base-designated ERC. Reassess airway, breathing, BP, and recurrence after every intervention.", "Patients who self-treated with an epinephrine auto-injector still require ALS escort and evaluation even when symptoms are resolving." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Epinephrine precedes diphenhydramine in anaphylaxis.", "The IM and IV/IO epinephrine concentrations differ tenfold; confirm indication, concentration, route, and dose." ], "related": [ "epinephrine", "diphenhydramine", "albuterol", "normal-saline" ], "url": "https://www.ocmedic.com/guides/anaphylaxis/", "sources": [ { "code": "SO-M-015", "title": "Allergic Reaction / Anaphylaxis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-M-15%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-015", "title": "Allergic Reaction / Anaphylaxis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-M-15%20Allergic%20Rxn%204-2023.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/anaphylaxis.md" }, { "slug": "antacids", "title": "Antacid preparations", "description": "Liquid or tablet OTC antacids under SO-F-02.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "antacid preparations liquid or tablet otc antacids under so-f-02.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/antacids/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/antacids.md" }, { "slug": "antifungal-products", "title": "Antifungal powders & sprays", "description": "OTC antifungal product categories listed for fire-service personnel.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "antifungal powders & sprays otc antifungal product categories listed for fire-service personnel.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/antifungal-products/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/antifungal-products.md" }, { "slug": "aspirin", "title": "Aspirin", "description": "Adult suspected cardiac ischemia and the limits of pediatric and fire-service use.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-015", "SO-F-02" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "aspirin adult suspected cardiac ischemia and the limits of pediatric and fire-service use.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "The 9-1-1 standing-order indication is adult/adolescent chest pain of suspected cardiac origin or an anginal equivalent.", "Obtain a 12-lead promptly; a normal tracing does not exclude serious ischemia." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Suspected cardiac chest pain", "Four 81 mg tablets (324 mg total) or one 325 mg tablet, once. SO-C-015 instructs the patient to chew." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "A pediatric cardiac aspirin regimen is not provided in I-20. Do not scale down the adult chest-pain dose or present adult standing-order authority as pediatric authorization.", "Use the applicable pediatric assessment and base-directed care when cardiac disease is suspected." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "No routine pediatric field regimen is supplied by the cited OCEMS sources; do not scale an adult dose by weight." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Ask specifically about medications already taken and document the amount administered.", "SO-F-02 separately lists aspirin for eligible firefighting personnel using package directions through an FS-ARN program; that is not a general pediatric or ALS dosing pathway." ] } ], "cautionTitle": "Check before giving", "cautions": [ "SO-C-015 withholds aspirin for reported allergy, anticoagulant/antiplatelet medication use, or direct midline mid-back pain suggesting possible aortic dissection.", "Apply the OCEMS contraindications as written; a general cardiac guideline from another jurisdiction may differ." ], "related": [ "chest-pain" ], "sourcePage": 1, "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/aspirin/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "checked": "2026-09-16" }, { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/aspirin.md" }, { "slug": "atropine", "title": "Atropine", "description": "Symptomatic bradycardia and organophosphate poisoning require different doses and pediatric rules.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-020", "SO-P-045", "SO-M-050", "SO-P-085" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "atropine symptomatic bradycardia and organophosphate poisoning require different doses and pediatric rules.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Use the indication-specific pathway: bradycardia is not the same regimen as organophosphate/nerve-agent toxicity.", "Adult symptomatic bradycardia includes a rate at or below 60/min with hypotension, poor perfusion, altered consciousness, chest pain, or dyspnea/pulmonary edema." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Symptomatic bradycardia", "1 mg IV/IO/IM. SO-C-020 permits repetition about every 3–5 minutes to a total of 3 mg; I-15 summarizes a 3-minute interval." ], [ "Organophosphate poisoning", "2 mg IV or IM; may repeat once under SO-M-050." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-045 prioritizes oxygenation/ventilation, CPR when indicated, epinephrine, and base contact. If base contact cannot be established, atropine 0.02 mg/kg IV/IO is listed for persistent symptomatic bradycardia, increased vagal tone, or primary AV block: minimum 0.1 mg, maximum single dose 0.5 mg; may repeat once.", "SO-P-085 organophosphate pathway: 0.02 mg/kg IV, repeat once as needed; alternative 0.1 mg/kg IM, repeat in 5 minutes as needed, maximum single dose 2 mg." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Symptomatic bradycardia", "id": "pediatric-weight-1", "items": [ "Source: SO-P-045. Dose rule: 0.02 mg/kg; route: IV/IO.", "0.02 mg/kg IV/IO; minimum 0.1 mg, maximum 0.5 mg per dose. May repeat once.", "Prioritize oxygenation/ventilation and the pediatric bradycardia pathway. The standing order specifies atropine if base contact cannot be established for persistent symptomatic bradycardia, increased vagal tone, or primary AV block.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO", "Volume at 0.1 mg/mL", "Volume at 1 mg/mL" ], "rows": [ [ "3 kg", "0.1 mg", "1 mL", "0.1 mL" ], [ "4 kg", "0.1 mg", "1 mL", "0.1 mL" ], [ "5 kg", "0.1 mg", "1 mL", "0.1 mL" ], [ "6 kg", "0.12 mg", "1.2 mL", "0.12 mL" ], [ "8 kg", "0.16 mg", "1.6 mL", "0.16 mL" ], [ "10 kg", "0.2 mg", "2 mL", "0.2 mL" ], [ "12 kg", "0.24 mg", "2.4 mL", "0.24 mL" ], [ "15 kg", "0.3 mg", "3 mL", "0.3 mL" ], [ "20 kg", "0.4 mg", "4 mL", "0.4 mL" ], [ "25 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "30 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "35 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "40 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "45 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "50 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "60 kg", "0.5 mg", "5 mL", "0.5 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Organophosphate poisoning — IV", "id": "pediatric-weight-2", "items": [ "Source: SO-P-085. Dose rule: 0.02 mg/kg; route: IV.", "0.02 mg/kg IV; may repeat once as needed. SO-P-085 lists a maximum single dose of 2 mg. This indication does not use the bradycardia maximum of 0.5 mg.", "The IV and IM regimens differ. SO-P-085 also permits its listed medications by IO.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV", "Volume at 0.1 mg/mL", "Volume at 1 mg/mL" ], "rows": [ [ "3 kg", "0.06 mg", "0.6 mL", "0.06 mL" ], [ "4 kg", "0.08 mg", "0.8 mL", "0.08 mL" ], [ "5 kg", "0.1 mg", "1 mL", "0.1 mL" ], [ "6 kg", "0.12 mg", "1.2 mL", "0.12 mL" ], [ "8 kg", "0.16 mg", "1.6 mL", "0.16 mL" ], [ "10 kg", "0.2 mg", "2 mL", "0.2 mL" ], [ "12 kg", "0.24 mg", "2.4 mL", "0.24 mL" ], [ "15 kg", "0.3 mg", "3 mL", "0.3 mL" ], [ "20 kg", "0.4 mg", "4 mL", "0.4 mL" ], [ "25 kg", "0.5 mg", "5 mL", "0.5 mL" ], [ "30 kg", "0.6 mg", "6 mL", "0.6 mL" ], [ "35 kg", "0.7 mg", "7 mL", "0.7 mL" ], [ "40 kg", "0.8 mg", "8 mL", "0.8 mL" ], [ "45 kg", "0.9 mg", "9 mL", "0.9 mL" ], [ "50 kg", "1 mg", "10 mL", "1 mL" ], [ "60 kg", "1.2 mg", "12 mL", "1.2 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Organophosphate poisoning — IM", "id": "pediatric-weight-3", "items": [ "Source: SO-P-085. Dose rule: 0.1 mg/kg; route: IM.", "Alternative route: 0.1 mg/kg IM; maximum 2 mg per dose. May repeat after 5 minutes as needed.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IM", "Volume at 1 mg/mL" ], "rows": [ [ "3 kg", "0.3 mg", "0.3 mL" ], [ "4 kg", "0.4 mg", "0.4 mL" ], [ "5 kg", "0.5 mg", "0.5 mL" ], [ "6 kg", "0.6 mg", "0.6 mL" ], [ "8 kg", "0.8 mg", "0.8 mL" ], [ "10 kg", "1 mg", "1 mL" ], [ "12 kg", "1.2 mg", "1.2 mL" ], [ "15 kg", "1.5 mg", "1.5 mL" ], [ "20 kg", "2 mg", "2 mL" ], [ "25 kg", "2 mg", "2 mL" ], [ "30 kg", "2 mg", "2 mL" ], [ "35 kg", "2 mg", "2 mL" ], [ "40 kg", "2 mg", "2 mL" ], [ "45 kg", "2 mg", "2 mL" ], [ "50 kg", "2 mg", "2 mL" ], [ "60 kg", "2 mg", "2 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Check concentration: the inventory permits different atropine formulations, and I-20 includes more than one concentration row.", "If adult pacing is urgently needed, do not wait for vascular access. Reassess rate, perfusion, and blood pressure." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Do not make atropine the first response to hypoxic pediatric bradycardia.", "Stop adult atropine dosing when pacing captures, as directed in SO-C-020." ], "related": [ "bradycardia", "duodote" ], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/atropine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-020", "title": "Symptomatic Bradycardia - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-C-20%20Bradycardia.pdf", "checked": "2026-09-16" }, { "code": "SO-P-045", "title": "Bradycardia - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf", "checked": "2026-09-16" }, { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "checked": "2026-09-16" }, { "code": "SO-P-085", "title": "Substance Overdose / Poisoning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/atropine.md" }, { "slug": "bacitracin", "title": "Bacitracin ointment", "description": "Topical bacitracin listed in the FS-ARN OTC program.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "bacitracin ointment topical bacitracin listed in the fs-arn otc program.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/bacitracin/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/bacitracin.md" }, { "slug": "base-contact", "title": "Base contact: common triggers", "description": "A quick check for medical-control contact before transport or escalation.", "category": "Operations", "population": "Adult & pediatric", "scope": "ALS", "section": "operations", "sourceCode": "310.00", "version": "Revised February 28, 2025 · Final implementation October 1, 2025", "keywords": "base hospital bhc bho medical control unstable ama refusal stroke trauma", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Contact base when…", "items": [ "The applicable standing order requires contact; do so before transport. Contact base when care beyond standing orders is needed.", "An adult is unstable without an applicable standing order: pulse below 50 or above 130, respirations below 12 or above 26, or systolic BP below 90.", "Specialty destination criteria apply, including stroke, trauma/replantation, burns, or cardiovascular receiving-center criteria.", "A patient requests refusal/AMA after an ALS procedure, or decision-making capacity/refusal criteria are uncertain.", "Field helicopter transport or MCI destination coordination requires contact; follow the policy’s MCI contact-point exception." ] }, { "heading": "Children younger than 15", "items": [ "A pediatric-capable base (CCERC) is preferred. Triggers include respiratory distress, circulatory compromise, BRUE (even resolved), arrest/ROSC, drowning, suspected assault, trauma, or burns.", "Without an applicable standing order, unstable pediatric thresholds include pulse below 60 or above 200, respirations below 12 or above 50, or systolic BP below 80." ] }, { "heading": "Make the contact useful", "items": [ "State the patient’s age, presenting problem, vital-sign trend, mental status, and why base contact is required. Include treatment and response when requesting further medical direction.", "For pediatric respiratory or circulatory compromise, a reported BRUE, arrest/ROSC, drowning, suspected abuse, or specialty destination needs, follow the pediatric contact provisions even if a symptom has resolved." ] }, { "heading": "Standing orders & subsequent care", "items": [ "Standing orders apply to on-duty OCEMS-accredited paramedics working for approved providers. Need for treatment beyond the standing order calls for further online medical direction.", "After base contact, follow base orders. If contact is discontinued, 310.00 allows resuming the appropriate standing order.", "PR-230 effective April 2026 removes the adult push-dose epinephrine order/contact requirement for that procedure. PR-205 still requires a pediatric order; the two pathways must not be conflated." ] } ], "cautionTitle": "Common triggers, not the full policy", "cautions": [ "Contact is also appropriate whenever the patient would benefit. After contact, follow base orders. Use 310.00 and the applicable standing order for complete requirements." ], "related": [ "stroke", "sepsis", "pediatric-assessment", "epinephrine" ], "sourceCodes": [ "310.00", "PR-230", "PR-205" ], "kind": "clinical", "url": "https://www.ocmedic.com/guides/base-contact/", "sources": [ { "code": "310.00", "title": "9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf", "checked": "2026-09-16" }, { "code": "PR-230", "title": "Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf", "checked": "2026-09-16" }, { "code": "PR-205", "title": "Preparation and Dosing of Push Dose Epinephrine - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf", "checked": "2026-09-16" } ], "source": { "code": "310.00", "title": "9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf", "version": "Revised February 28, 2025 · Final implementation October 1, 2025", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/base-contact.md" }, { "slug": "bls-naloxone", "title": "BLS naloxone: 4 mg nasal spray", "description": "Use the preloaded 4 mg NARCAN device for suspected opioid overdose under SO-B-002.", "category": "BLS", "population": "See source criteria", "scope": "BLS", "section": "standing-orders", "sourceCode": "SO-B-002", "version": "Final implementation October 1, 2017", "keywords": "narcan opioid overdose narcotic respiratory depression intranasal", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Check & support breathing", "numbered": true, "items": [ "Confirm ALS is responding. Use PPE and attempt stimulation.", "Suspect opioid exposure from history or the scene, with poor responsiveness and slow/shallow breathing, or unresponsiveness without breathing.", "Provide BVM ventilation or CPR as appropriate. For the medication pathway below, a pulse is present but response to stimulation and breathing are inadequate." ] }, { "heading": "Use the 4 mg device", "numbered": true, "items": [ "Administer the full preloaded 4 mg dose into one nostril.", "If breathing or consciousness improves only partially, the source permits another 4 mg dose into the opposite nostril.", "Continue checking breathing and consciousness. Maintain airway support, prepare transport, and await ALS." ] }, { "heading": "Reassessment & positioning", "items": [ "Observe breathing and consciousness after treatment. If improvement is inadequate, continue BVM ventilation or CPR as indicated by the assessment rather than waiting for naloxone to work.", "When CPR is unnecessary and positioning allows, the source recommends the left lateral position to reduce aspiration risk. Watch for agitation, abdominal cramping, sweating, or vomiting." ] }, { "heading": "Keep the product and scope clear", "items": [ "SO-B-002 also describes a 2 mg syringe-and-atomizer option, split between nostrils, with a separate repeat instruction. That is not the same device as the 4 mg preloaded spray.", "The ALS medication guide uses separate doses and repeat intervals. Record the device strength, doses already given, response, and the continuing need for ALS care." ] } ], "cautionTitle": "Product-specific pathway", "cautions": [ "This guide covers the preloaded 4 mg nasal product on equipped BLS units. The 2 mg atomizer method has different instructions in SO-B-002.", "Anticipate agitation, withdrawal, or vomiting. If CPR is unnecessary and positioning permits, use the left lateral position to reduce aspiration risk." ], "related": [ "naloxone", "poisoning", "gcs", "bls-scope-of-practice" ], "kind": "clinical", "sourceCodes": [ "SO-B-002" ], "url": "https://www.ocmedic.com/guides/bls-naloxone/", "sources": [ { "code": "SO-B-002", "title": "Naloxone Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-B-002", "title": "Naloxone Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf", "version": "Final implementation October 1, 2017", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/bls-naloxone.md" }, { "slug": "bls-oral-glucose", "title": "BLS oral glucose: gel / paste", "description": "Confirm the patient can swallow, give small portions, and reassess at 5 minutes.", "category": "BLS", "population": "See source criteria", "scope": "BLS", "section": "standing-orders", "sourceCode": "SO-B-003", "version": "Final implementation October 1, 2017", "keywords": "hypoglycemia diabetes low sugar altered mental status dextrose", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Check eligibility first", "items": [ "Altered mental status or an acute neurologic deficit, with diabetes treated by insulin/oral medication, and/or the source glucose criteria: below 60 mg/dL, or 61–80 mg/dL when hypoglycemia is suspected.", "Ensure ALS is responding or present. The patient must be able to swallow and have an intact gag reflex.", "Do not give oral glucose to an unresponsive patient or one unable to swallow or without a gag reflex." ] }, { "heading": "Give & reassess", "numbered": true, "items": [ "Confirm the product is intended for oral use.", "Place small portions of gel/paste between the cheek and gum on both sides, continuing until the tube is empty.", "Watch for choking, gagging, drooling, or uncontrolled coughing. Support the airway and suction when needed.", "Reassess mental status and vital signs at 5 minutes, then every 5 minutes until ALS arrives.", "Document the indication, administration time, route, amount, and response." ] }, { "heading": "Other formulations in SO-B-003", "items": [ "For an oral solution, give small amounts as tolerated until the intended product amount is taken.", "For chewable tablets, the source lists two tablets, or one for a child younger than 12. No gram strength is specified, so do not invent a dose in grams without checking the product." ] }, { "heading": "Document the response", "items": [ "Record why glucose was indicated, the preparation and amount, the route, the time, and the patient’s response. Repeat the initial assessment with mental status and vital signs every 5 minutes until ALS arrives.", "Maintain airway observation throughout. Improvement after sugar does not replace continued assessment or the required ALS response." ] } ], "cautionTitle": "Use the matching product instructions", "cautions": [ "This guide covers gel/paste. SO-B-003 gives separate instructions for liquid and tablets. Follow the source for those formulations." ], "related": [ "oral-glucose", "dextrose", "glucagon", "gcs", "bls-scope-of-practice" ], "kind": "clinical", "sourceCodes": [ "SO-B-003" ], "url": "https://www.ocmedic.com/guides/bls-oral-glucose/", "sources": [ { "code": "SO-B-003", "title": "Glucose Oral Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69066.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-B-003", "title": "Glucose Oral Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69066.pdf", "version": "Final implementation October 1, 2017", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/bls-oral-glucose.md" }, { "slug": "bls-scope-of-practice", "title": "OCEMS BLS scope of practice", "description": "A practical OCEMS BLS guide for Orange County EMTs: scope of practice, CPAP, medication assistance, ALS support, and transport limits.", "category": "BLS", "population": "Adult / pediatric — follow each procedure’s criteria", "scope": "BLS", "section": "operations", "sourceCode": "315.00", "sourceCodes": [ "315.00", "SO-B-001", "SO-B-002", "SO-B-003", "PR-120" ], "sourceIds": [ "315-00-ocems-emt-scope-of-practice-ems-ocems-accredited", "315-00-ocems-emt-scope-of-practice-field-reference-guide-attachment-i", "so-b-001-basic-life-support-standing-orders", "so-b-002-naloxone-administration", "so-b-003-glucose-oral-administration", "pr-120-continuous-positive-airway-pressure-cpap" ], "version": "Policy 315.00 and Attachment I: effective November 15, 2025. SO-B-001, SO-B-002, and SO-B-003: implemented October 1, 2017. PR-120: implemented April 1, 2026.", "keywords": "EMT basic life support scope practice expanded scope new EMT orientation Orange County accreditation BLS skills transport ALS assist infusion PICC CPAP positive airway pressure", "status": "published", "updated": "2026-09-16", "kind": "clinical", "cautionTitle": "Start with your authorized role", "cautions": [ "This is an orientation to OCEMS-accredited EMT practice, not a complete treatment protocol. A listed skill still requires the applicable training, equipment, indications, and OCEMS/agency authorization.", "Assisting a paramedic does not authorize independent ALS procedures. Use the specific BLS instructions for a medication or device; an ALS medication page does not expand EMT scope." ], "sections": [ { "heading": "Orange County BLS: where to start", "id": "overview", "items": [ "Basic Life Support (BLS) is the EMT-level assessment and care described in Orange County Emergency Medical Services (OCEMS) policies. Policy 315.00 defines the local scope; SO-B-001 provides the BLS standing orders. This independent OC Medic guide helps you navigate both." ] }, { "heading": "1. Start with assessment and BLS care", "id": "core-care", "items": [ "Assess the patient, obtain vital signs, and recognize immediate threats. SO-B-001 includes primary and secondary assessment, mental status, blood pressure, pulse, breathing, pain, skin signs, and pupils as indicated.", "Provide oxygen and BVM ventilation when indicated. Perform CPR and use an AED as appropriate; approved mechanical CPR devices are included.", "Control bleeding with approved tourniquets and hemostatic dressings. Apply indicated splints and spinal motion restriction; assist with extrication and field triage.", "Policy 315.00 includes oral/nasal airway adjuncts and suction. Equipped, trained BLS providers can also apply and monitor CPAP as described below." ] }, { "heading": "BLS can use CPAP when equipped", "id": "cpap", "items": [ "OCEMS-accredited EMTs can apply and monitor CPAP when their unit has the equipment and they are trained and authorized to use it. SO-B-001 specifically includes CPAP in BLS standing orders.", "Use particular caution: ALS should be en route or already on scene. Patients needing CPAP can deteriorate and may need care beyond BLS scope.", "Check the patient’s eligibility and all contraindications before starting. Continuously monitor breathing, mental status, oxygen saturation, blood pressure, and mask tolerance. Be ready to remove CPAP and provide appropriate BLS airway support if the patient deteriorates; follow the stop criteria in the CPAP guide." ], "links": [ { "label": "Open the CPAP guide: criteria, pressures, and stop instructions →", "href": "/guides/cpap/" } ] }, { "heading": "2. Keep medication pathways separate", "id": "medications", "items": [ "Suspected opioid overdose: SO-B-002 requires ALS to be responding and an equipped unit. Support breathing and follow the instructions for the exact naloxone product; the nasal spray and syringe/atomizer use different doses.", "Suspected hypoglycemia: SO-B-003 requires a responsive patient who can swallow and protect their airway, with an intact gag reflex. Ensure ALS is present or responding. Do not give oral glucose to an unresponsive patient or one unable to swallow.", "Epinephrine auto-injector: Policy 315.00 permits use for suspected anaphylaxis or severe asthma. Follow the applicable OCEMS procedure and device criteria; this does not authorize drawing up injectable epinephrine.", "The patient’s prescribed medication: Attachment I requires ALS response for assistance with prescribed nitroglycerin, albuterol, epinephrine auto-injectors, or aspirin for cardiac chest pain. Assistance is distinct from independently choosing an ALS medication.", "Nerve-agent antidote auto-injectors: Policy 315.00 includes DuoDote/Mark-1 use for yourself or others under ALS direction. Follow the specific exposure and device instructions." ] }, { "heading": "3. Assist ALS within the stated limits", "id": "als-assistance", "items": [ "Attachment I requires an OCEMS-accredited paramedic on scene or responding for ECG lead placement, IV-fluid preparation, and preparation for ALS airway procedures.", "Preparing IV equipment is not starting an IV. Placing ECG leads is not interpreting the ECG. Helping prepare an advanced airway is not independently placing it." ] }, { "heading": "4. Check transport suitability and existing devices", "id": "transport", "items": [ "The transferring physician must determine that BLS transport is appropriate. Device presence alone does not establish that the patient’s care needs fit BLS.", "Attachment I lists preset infusions of normal saline, lactated Ringer’s, TPN, folic acid, thiamine, and multivitamins. Sending-facility staff set the prescribed rate.", "Policy 315.00 permits maintaining a preset rate for specified glucose/isotonic IV fluids and stopping flow. This does not authorize starting a new infusion or independently titrating a medication.", "Patient-operated pumps have a limited transport role; the policy lists preset insulin, morphine, and TPN. This is not general authorization to manage critical care infusion pumps.", "Existing feeding tubes, ostomies, urinary catheters, tracheostomies, and other listed devices require the policy’s conditions. Chest tubes must be clamped or connected to a closed drainage system.", "Arterial lines are excluded. Central vascular lines used for monitoring or infusing fluids/medications are also excluded, even though long-established central lines appear elsewhere in the device list. Resolve device or infusion uncertainty before accepting BLS transport." ] }, { "heading": "5. Build a reliable learning routine", "id": "getting-started", "items": [ "Before your shift, review the BLS protocols for equipment your unit actually carries. Locate the full policy and identify what requires ALS response or assistance.", "For naloxone, reassess breathing and consciousness and continue necessary airway support while awaiting ALS. Medication response does not remove the need for reassessment.", "For oral glucose, reassess mental status and vital signs after 5 minutes and every 5 minutes until ALS arrives. Record the indication, product/amount, time, route, and response.", "When a scope question comes up, pause the proposed intervention, continue appropriate BLS care, and seek clarification through your agency’s clinical chain. Discuss unfamiliar cases with your preceptor or educator." ] } ], "related": [ "bls-naloxone", "bls-oral-glucose", "gcs", "cpap" ], "seoTitle": "OCEMS BLS Scope of Practice | Orange County EMT Guide", "seoDescription": "OCEMS BLS guide for Orange County EMTs: scope of practice, CPAP, medication assistance, ALS response, and transport limits, with official source links.", "url": "https://www.ocmedic.com/guides/bls-scope-of-practice/", "sources": [ { "code": "315.00", "title": "OCEMS EMT Scope of Practice: EMS-OCEMS Accredited", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/315.00%20EMT%20Scope%20%2811-2025%29.pdf", "checked": "2026-09-16" }, { "code": "315.00", "title": "OCEMS EMT Scope of Practice: Field Reference Guide - Attachment I", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/315.00%20Attachment%201%20%2811-2025%29.pdf", "checked": "2026-09-16" }, { "code": "SO-B-001", "title": "Basic Life Support Standing Orders", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69064.pdf", "checked": "2026-09-16" }, { "code": "SO-B-002", "title": "Naloxone Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf", "checked": "2026-09-16" }, { "code": "SO-B-003", "title": "Glucose Oral Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69066.pdf", "checked": "2026-09-16" }, { "code": "PR-120", "title": "Continuous Positive Airway Pressure (CPAP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "315.00", "title": "OCEMS EMT Scope of Practice: EMS-OCEMS Accredited", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/315.00%20EMT%20Scope%20%2811-2025%29.pdf", "version": "Policy 315.00 and Attachment I: effective November 15, 2025. SO-B-001, SO-B-002, and SO-B-003: implemented October 1, 2017. PR-120: implemented April 1, 2026.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/bls-scope-of-practice.md" }, { "slug": "body-foot-powders", "title": "Body & foot powders", "description": "Talcum/corn-starch body powders and foot powders in the FS-ARN list.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "body & foot powders talcum/corn-starch body powders and foot powders in the fs-arn list.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/body-foot-powders/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/body-foot-powders.md" }, { "slug": "bradycardia", "title": "Symptomatic bradycardia", "description": "Treat poor perfusion, prepare pacing, and obtain required base contact.", "category": "Cardiac", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-C-020", "sourceCodes": [ "SO-C-020", "PR-230", "PR-110" ], "version": "See linked source for document revision and implementation dates.", "keywords": "symptomatic bradycardia treat poor perfusion, prepare pacing, and obtain required base contact.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Decide whether it is symptomatic", "items": [ "The source defines symptomatic bradycardia as a rate at or below 60/min plus hypotension, poor skin perfusion, altered consciousness, chest pain, or dyspnea/pulmonary edema.", "Monitor/document rhythm; assess BP and oxygenation. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated.", "Obtain IV access; consider IO if IV is unsuccessful or impractical. In a patient without poor-perfusion symptoms, obtain a 12-lead and assess for acute MI." ] }, { "heading": "Atropine & pacing", "items": [ "Give atropine 1 mg IV/IO/IM about every 3–5 minutes as needed, to 3 mg total.", "If access cannot be obtained or 1 mg atropine fails to improve rate, initiate transcutaneous pacing and follow PR-110. Do not delay urgently needed pacing for access.", "Once pacing captures, stop atropine and contact base for possible CVRC destination." ] }, { "heading": "Perfusion & pacing discomfort", "items": [ "With systolic BP below 90 and clear lungs, use the source’s 250 mL saline boluses up to 1 L; contact base if BP remains below 90 or CHF is evident.", "For extreme pacing distress with systolic BP above 90: titrate midazolam up to 5 mg IV. If IV cannot be established, 5 mg IN divided between nostrils may repeat once after about 3 minutes. Support ventilation if depressed." ] }, { "heading": "Escalation & transport", "items": [ "Base contact is required; provide ALS escort with CVRC destination coordination.", "Consider toxicologic/metabolic causes and request additional direction. Current PR-230 addresses adult push-dose epinephrine and removes that procedure’s base-order requirement; the bradycardia contact requirement still applies." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Pacing should not wait when access delays stabilization.", "An implanted pacemaker does not exclude treating symptomatic bradycardia. Reassess mechanical perfusion as well as monitor rate." ], "related": [ "atropine", "midazolam", "epinephrine", "normal-saline" ], "url": "https://www.ocmedic.com/guides/bradycardia/", "sources": [ { "code": "SO-C-020", "title": "Symptomatic Bradycardia - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-C-20%20Bradycardia.pdf", "checked": "2026-09-16" }, { "code": "PR-230", "title": "Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf", "checked": "2026-09-16" }, { "code": "PR-110", "title": "Transcutaneous Pacing (TCP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/PR-110%20TCP%204-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-C-020", "title": "Symptomatic Bradycardia - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-C-20%20Bradycardia.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/bradycardia.md" }, { "slug": "burns", "title": "Burns & smoke inhalation", "description": "Support oxygenation, address pain and perfusion, and recognize burn-center referral criteria.", "category": "Trauma", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-E-005", "sourceCodes": [ "SO-E-005", "PR-130" ], "version": "See linked source for document revision and implementation dates.", "keywords": "burns & smoke inhalation support oxygenation, address pain and perfusion, and recognize burn-center referral criteria.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Initial care", "items": [ "For enclosed-space or heavy-smoke exposure, give high-flow oxygen by mask as tolerated. Pulse oximetry may be misleading with carbon-monoxide exposure.", "Use cooling measures for a still-symptomatic burn. For wheeze/suspected smoke inhalation, the source lists albuterol 5 mg/6 mL by continuous nebulization as tolerated." ] }, { "heading": "Pain & circulation", "items": [ "Do not inject analgesics or place IV access through burned skin. With systolic BP above 90, options include morphine 5 mg (or 4 mg carpuject) IV/IM, or fentanyl 50 mcg IV/IM or 100 mcg IN; one repeat after 3 minutes is permitted as specified. Morphine IO use is limited to already-established access for saline.", "For systolic BP at or below 90 or shock signs, establish access through unburned skin and give 250 mL saline boluses up to 1 L to maintain perfusion." ] }, { "heading": "Burn-center contact", "items": [ "Contact base for suspected inhalation injury, electrical/lightning injury, or chemical burns; burns involving face, hands, feet, genitalia, or perineum; circumferential burns; or relevant complicating disease.", "The source also includes second-degree burns above 10% TBSA and any third-degree burn. Base coordinates the burn-unit destination." ] }, { "heading": "Chemical & electrical injuries", "items": [ "Brush away residual dry chemical. The source generally directs copious continuous water/saline irrigation, but specifically warns that some chemicals react dangerously with water; identify the substance and use appropriate hazard guidance.", "Small-looking electrical wounds can conceal major deep injury and rhythm risk. Provide cardiac monitoring and ALS escort for the high-voltage exposure described by the source.", "For suspected cyanide exposure, use PR-130/base-directed hydroxocobalamin rather than assuming every smoke exposure needs an antidote." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "SpO₂ may look reassuring despite significant CO exposure.", "Burn size alone does not determine destination: location, depth, mechanism, and comorbidities also matter." ], "related": [ "oxygen", "albuterol", "hydroxocobalamin", "fentanyl", "morphine" ], "url": "https://www.ocmedic.com/guides/burns/", "sources": [ { "code": "SO-E-005", "title": "Burn (Thermal, Electrical, Chemical) - Adult", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "PR-130", "title": "Hydroxocobalamin for Cyanide Toxicity", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-E-005", "title": "Burn (Thermal, Electrical, Chemical) - Adult", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/burns.md" }, { "slug": "caladryl", "title": "Caladryl or equivalent", "description": "Topical OTC preparation listed for eligible firefighting personnel.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "caladryl or equivalent topical otc preparation listed for eligible firefighting personnel.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/caladryl/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/caladryl.md" }, { "slug": "chest-pain", "title": "Chest pain & suspected ACS", "description": "Obtain an early 12-lead, check medication exclusions, and coordinate a cardiac destination.", "category": "Cardiac", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-C-015", "sourceCodes": [ "SO-C-015" ], "version": "See linked source for document revision and implementation dates.", "keywords": "chest pain & suspected acs obtain an early 12-lead, check medication exclusions, and coordinate a cardiac destination.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Recognize & assess", "items": [ "Suspect an anginal equivalent with unexplained diaphoresis, sudden weakness, dyspnea, anxiety, or atypical chest discomfort. Heartburn-like, pleuritic, or musculoskeletal-sounding pain does not exclude cardiac disease.", "Monitor rhythm and obtain a 12-lead as soon as practical before leaving the scene. A normal/non-STEMI tracing does not rule out acute MI." ] }, { "heading": "Initial treatment", "items": [ "If no source contraindication applies, give four 81 mg aspirin tablets (324 mg) or one 325 mg tablet to chew.", "When room-air SpO₂ is below 95%, provide mask oxygen or nasal cannula at 6 L/min as tolerated.", "For discomfort, give nitroglycerin 0.4 mg SL if systolic BP is above 100; repeat about every 3 minutes, up to 3 EMS doses while BP stays above 100. Prior self-doses are not included in that EMS count." ] }, { "heading": "Persistent pain or nausea", "items": [ "If 3 nitroglycerin doses fail or nitroglycerin cannot be given, the source permits morphine 5 mg (or 4 mg carpuject) IV, or fentanyl 50 mcg IV. Either may repeat once after about 3 minutes; hold if systolic BP is below 90.", "For nausea/vomiting without known or suspected pregnancy: ondansetron 8 mg ODT or 4 mg IV, with one IV repeat after about 3 minutes if needed." ] }, { "heading": "Destination & reassessment", "items": [ "Suspected/identified acute MI requires base contact for a CVRC with an available catheterization lab. Otherwise provide ALS escort to an appropriate ERC.", "Reassess pain, BP, breathing, rhythm, and treatment response. If a patient with a performed 12-lead requests AMA, contact base before leaving the scene." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Hold aspirin for allergy, anticoagulant/antiplatelet use, or direct midline mid-back pain raising concern for dissection.", "Do not give nitroglycerin after sildenafil, vardenafil, or tadalafil within 24 hours. Avoid IO in potential CVRC patients because of possible thrombolysis-related bleeding." ], "related": [ "aspirin", "nitroglycerin", "fentanyl", "morphine", "ondansetron" ], "url": "https://www.ocmedic.com/guides/chest-pain/", "sources": [ { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/chest-pain.md" }, { "slug": "claritin", "title": "Claritin / OTC antihistamine", "description": "The non-prescription antihistamine example named in SO-F-02.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "claritin / otc antihistamine the non-prescription antihistamine example named in so-f-02. loratadine claritin antihistamine allergy", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/claritin/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/claritin.md" }, { "slug": "cough-products", "title": "OTC cough preparations", "description": "Alcohol-free liquid or tablet cough preparations in the FS-ARN list.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "otc cough preparations alcohol-free liquid or tablet cough preparations in the fs-arn list.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/cough-products/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/cough-products.md" }, { "slug": "covid-19-vaccine", "title": "COVID-19 vaccine", "description": "COVID-19 vaccine: historical OCEMS program scope, adult/pediatric limits, and current-authorization requirements.", "category": "Vaccination references", "kind": "medication", "medicationGroup": "Vaccination references", "population": "Adult & pediatric scope", "scope": "Program-specific", "section": "medications", "sourceCode": "PR-150.10", "sourceCodes": [ "PR-150.10" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "covid-19 vaccine legacy ocems vaccination-program reference with current authorization and product guidance required.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "The linked 2020 procedure describes trained OCEMS-accredited paramedics administering IM influenza/COVID-19 vaccine under an approved public-health program during the COVID-19 Disaster Declaration.", "It is conditional program guidance, not evidence that this historical optional scope remains active today. Verify current OCEMS/public-health authorization and the specific product guidance before planning administration." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "PR-150.10 described a public program for age 14 and older. It does not establish a current vaccine dose, schedule, or authorization for younger children.", "Use current program authorization and age/product-specific clinical guidance; do not derive a pediatric vaccine regimen from this historical document." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "The historical program document does not establish a current pediatric vaccine dose or active program authorization." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "The source describes training, consent/screening, aseptic IM technique, observation for reactions, and emergency readiness. Current product requirements govern formulation, eligibility, and dosage.", "Program documentation includes administration date, patient, site, product/manufacturer, lot number, consent, and vaccine-information material, plus appropriate adverse-event reporting." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "Historical/conditional scope: current program authorization has not been established by this reference.", "No current vaccine dose or schedule is asserted here." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/covid-19-vaccine/", "sources": [ { "code": "PR-150.10", "title": "Paramedic Administration of Intramuscular Influenza and/or COVID-19 Vaccine to the Public", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/118399.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-150.10", "title": "Paramedic Administration of Intramuscular Influenza and/or COVID-19 Vaccine to the Public", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/118399.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/covid-19-vaccine.md" }, { "slug": "cpap", "title": "CPAP: adult & pediatric", "description": "Select an eligible patient, check exclusions, apply the correct pressure, and reassess for deterioration.", "category": "Airway & breathing", "population": "Adult / pediatric age 8+", "scope": "BLS / ALS", "section": "procedures", "sourceCode": "PR-120", "version": "Revised March 27, 2026 · Implemented April 1, 2026 BLS authorization: SO-B-001, implemented October 1, 2017.", "keywords": "continuous positive airway pressure respiratory distress ventilation oxygen", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "BLS and ALS use", "id": "scope", "items": [ "SO-B-001 authorizes OCEMS-accredited EMTs to apply and monitor CPAP. BLS units can use it when equipped and providers are trained and authorized for the device.", "For BLS providers, use particular caution and have ALS en route or already on scene. Monitor continuously and be prepared for deterioration requiring additional airway or ventilatory support.", "Medication and advanced-airway steps must stay within the provider’s own scope. CPAP authorization alone does not authorize independent albuterol administration or advanced-airway placement." ], "links": [ { "label": "Review the Orange County BLS scope-of-practice guide →", "href": "/guides/bls-scope-of-practice/#cpap" } ] }, { "heading": "When CPAP is indicated", "items": [ "PR-120 applies to patients age 8 and older with moderate–severe nontraumatic respiratory distress and at least one qualifying finding.", "Qualifying findings include SpO₂ below 90% despite routine oxygen; respiratory rate above 26/min (above 30 in children) with SpO₂ below 95%; accessory-muscle use/retractions; wheeze, rales, or rhonchi not improving with routine therapy; or fatigue with decreasing breathing effort." ] }, { "heading": "Check contraindications before applying the mask", "items": [ "Do not use with altered consciousness or inability to protect the airway; inability to sit; respiratory arrest/agonal failure; cardiac arrest; nausea/vomiting; oral/nasal bleeding; suspected pneumothorax; penetrating chest trauma; facial trauma/abnormality; upper GI bleeding; or stomach surgery within the previous month, including lap-band surgery.", "The entry contraindication is systolic BP below 90 in adults or below 80 in children, or other poor-perfusion signs." ] }, { "heading": "Set up the treatment", "numbered": true, "items": [ "Provide oxygen. Albuterol for wheezing requires separate authorization within your scope. Let the patient sit comfortably and explain what to expect.", "Document baseline lung sounds and SpO₂. Assemble the device and connect oxygen.", "Start at 5 cm H₂O. Apply a well-sealed mask and ETCO₂ monitoring; use inline albuterol only when appropriate and authorized within your scope.", "Adults/adolescents: increase gradually to 7.5, then 10 cm H₂O as tolerated and clinically needed. Pediatric maximum: 5 cm H₂O." ] }, { "heading": "Reassess & document", "items": [ "Continuously observe the patient. Reassess/document lung sounds before treatment, after starting, and every 5 minutes.", "Record initiation time, pressure, vital signs, and consciousness. Notify the receiving ERC early. If removed, document the time and reason.", "A DNR order alone does not exclude CPAP; the source permits its use when otherwise appropriate." ] } ], "cautionTitle": "Stop & reassess", "cautions": [ "Remove CPAP for nausea/vomiting, oral/nasal bleeding, intolerance, or systolic BP below 90. PR-120 lists this removal threshold without a pediatric exception, even though its pediatric entry contraindication is below 80.", "Escalate airway/ventilatory support if arrest, agonal respirations, or hypoventilation develops. Watch for gastric distention and aspiration." ], "related": [ "respiratory-distress", "pediatric-respiratory-distress", "albuterol", "oxygen", "bls-scope-of-practice" ], "kind": "clinical", "sourceCodes": [ "PR-120", "SO-B-001" ], "url": "https://www.ocmedic.com/guides/cpap/", "sources": [ { "code": "PR-120", "title": "Continuous Positive Airway Pressure (CPAP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-B-001", "title": "Basic Life Support Standing Orders", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69064.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-120", "title": "Continuous Positive Airway Pressure (CPAP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf", "version": "Revised March 27, 2026 · Implemented April 1, 2026 BLS authorization: SO-B-001, implemented October 1, 2017.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/cpap.md" }, { "slug": "dextrose", "title": "Dextrose 10% (D10)", "description": "Treat hypoglycemia with a titrated adult dose or measured pediatric volume.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "PR-085", "SO-M-020", "SO-P-065", "SO-P-075" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "dextrose 10% (d10) treat hypoglycemia with a titrated adult dose or measured pediatric volume.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used for symptomatic or suspected hypoglycemia in the applicable altered-mental-status, seizure, shock, and other condition-specific pathways.", "Adult PR-085 treats glucose at or below 60 mg/dL, and permits clinical judgment in the 60–80 range when hypoglycemia is suspected. Other standing orders use their own threshold wording." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Hypoglycemia", "D10 up to 250 mL IV, titrated to improve consciousness. Reduce to a keep-open rate when baseline mental status returns." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-065: glucose below 60 mg/dL → D10 5 mL/kg IV, maximum 250 mL. The seizure and overdose standing orders have their own threshold wording; use the applicable source.", "PR-085 allows a measured IVPB dose or slow IV administration from a syringe. For IVPB, remove excess fluid so the bag contains only the intended pediatric dose." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Hypoglycemia — D10", "id": "pediatric-weight-1", "items": [ "Source: SO-P-065. Dose rule: 5 mL/kg; route: IV.", "D10 (100 mg/mL): 5 mL/kg IV, maximum 250 mL. These values are fluid volumes of D10, not milligrams and not volumes of D50.", "For altered mental status, treat glucose below 60 mg/dL. Other pediatric standing orders have indication-specific thresholds.", "IO under SO-P-065 requires unconsciousness, glucose below 60, inability to establish IV, and no response to IM glucagon. Remove excess fluid from an IVPB bag so only the intended pediatric dose remains.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes." ], "table": { "headers": [ "Exact weight", "Dose — IV" ], "rows": [ [ "3 kg", "15 mL" ], [ "4 kg", "20 mL" ], [ "5 kg", "25 mL" ], [ "6 kg", "30 mL" ], [ "8 kg", "40 mL" ], [ "10 kg", "50 mL" ], [ "12 kg", "60 mL" ], [ "15 kg", "75 mL" ], [ "20 kg", "100 mL" ], [ "25 kg", "125 mL" ], [ "30 kg", "150 mL" ], [ "35 kg", "175 mL" ], [ "40 kg", "200 mL" ], [ "45 kg", "225 mL" ], [ "50 kg", "250 mL" ], [ "60 kg", "250 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Verify glucose, weight when pediatric, concentration, and intended milliliters.", "Follow PR-085 when giving other medications through the line; flush as directed. Document glucose, mental status, administered volume, and response." ] } ], "cautionTitle": "Check before giving", "cautions": [ "D10 is 10% dextrose; do not substitute a different concentration while retaining the same volume.", "The usual IO exception requires an unconscious patient, glucose below 60, inability to obtain IV access, and no response to IM glucagon. Check the exact condition order." ], "related": [ "altered-mental-status", "glucagon", "oral-glucose" ], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/dextrose/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "PR-085", "title": "10% Dextrose Solution Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/63886.pdf", "checked": "2026-09-16" }, { "code": "SO-M-020", "title": "Altered Mental Status", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf", "checked": "2026-09-16" }, { "code": "SO-P-065", "title": "Altered Mental Status - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf", "checked": "2026-09-16" }, { "code": "SO-P-075", "title": "Seizure / Convulsion - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/dextrose.md" }, { "slug": "diphenhydramine", "title": "Diphenhydramine (Benadryl)", "description": "Allergic and dystonic reactions: weight-based pediatric dosing and adjunctive use in anaphylaxis.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-015", "SO-P-060", "SO-M-050", "SO-P-085" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "diphenhydramine (benadryl) allergic and dystonic reactions: weight-based pediatric dosing and adjunctive use in anaphylaxis.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used in specified allergic/angioedema pathways and medication-induced extrapyramidal reactions.", "For anaphylaxis, epinephrine is given first. Diphenhydramine does not replace treatment of airway compromise or shock." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Allergic reaction / dystonic reaction", "50 mg IM or IV once." ], [ "IO use in I-15", "Only when an IO is already established for fluid administration." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-060 allergic/anaphylactic pathway: 1 mg/kg IM/IV/IO once, maximum 50 mg.", "SO-P-085 extrapyramidal reaction: 1 mg/kg IM/IV, maximum 50 mg, once; consult the complete order for IO provisions." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Allergic reaction / anaphylaxis", "id": "pediatric-weight-1", "items": [ "Source: SO-P-060. Dose rule: 1 mg/kg; route: IM/IV/IO.", "1 mg/kg IM/IV/IO once; maximum 50 mg. Use the anaphylaxis pathway when indicated; diphenhydramine does not replace epinephrine.", "Do not administer another dose if diphenhydramine was taken before EMS arrival under SO-P-060.", "SO-P-085 uses the same 1 mg/kg, maximum 50 mg, for extrapyramidal reactions, with its own route provisions.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IM/IV/IO", "Volume at 50 mg/mL" ], "rows": [ [ "3 kg", "3 mg", "0.06 mL" ], [ "4 kg", "4 mg", "0.08 mL" ], [ "5 kg", "5 mg", "0.1 mL" ], [ "6 kg", "6 mg", "0.12 mL" ], [ "8 kg", "8 mg", "0.16 mL" ], [ "10 kg", "10 mg", "0.2 mL" ], [ "12 kg", "12 mg", "0.24 mL" ], [ "15 kg", "15 mg", "0.3 mL" ], [ "20 kg", "20 mg", "0.4 mL" ], [ "25 kg", "25 mg", "0.5 mL" ], [ "30 kg", "30 mg", "0.6 mL" ], [ "35 kg", "35 mg", "0.7 mL" ], [ "40 kg", "40 mg", "0.8 mL" ], [ "45 kg", "45 mg", "0.9 mL" ], [ "50 kg", "50 mg", "1 mL" ], [ "60 kg", "50 mg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "The inventory preparation is 50 mg/mL. Use patient weight and the maximum dose when calculating pediatric volume.", "Reassess airway, respiratory effort, perfusion, and mental status. Document prior self-treatment and the response." ] } ], "cautionTitle": "Check before giving", "cautions": [ "The allergy standing orders say not to give another dose if diphenhydramine was taken before arrival.", "A rash-only stable reaction has a different pathway from facial/cervical angioedema or anaphylaxis; assess the full presentation." ], "related": [ "anaphylaxis", "pediatric-anaphylaxis" ], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/diphenhydramine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-015", "title": "Allergic Reaction / Anaphylaxis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-M-15%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-P-060", "title": "Allergic Reaction / Anaphylaxis - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "checked": "2026-09-16" }, { "code": "SO-P-085", "title": "Substance Overdose / Poisoning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/diphenhydramine.md" }, { "slug": "drowning", "title": "Adult non-fatal drowning", "description": "Support oxygenation and ventilation, assess associated trauma, and use CPAP only in the appropriate conscious patient.", "category": "Environmental", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-E-015", "sourceCodes": [ "SO-E-015", "PR-120" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult non-fatal drowning Support oxygenation and ventilation, assess associated trauma, and use CPAP only in the appropriate conscious patient. SO-E-015", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "First assessment", "items": [ "Use spinal motion restriction for a diving or shore-break accident. Assess consciousness, airway patency, breathing, perfusion, and oxygen saturation.", "For SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. Treat arrest using the adult arrest pathway." ] }, { "heading": "Ventilation and wheeze", "items": [ "Monitor and document rhythm. For bradycardia, clear the airway and assist ventilation with BVM and high-flow oxygen.", "For wheezing, albuterol is 5 mg in 6 mL by continuous nebulization as tolerated. Reassess effort and air movement; inadequate ventilation needs ventilatory support." ] }, { "heading": "Persistent respiratory distress", "items": [ "A conscious patient with persistent distress after suctioning/coughing to clear the airway may receive CPAP under its separate criteria. Guard against vomiting and reassess continuously.", "If unconscious or unable to protect the airway, follow the advanced-airway pathway and confirm placement. Do not use the conscious-patient CPAP step in someone who cannot protect the airway." ] }, { "heading": "Transport", "items": [ "Provide ALS escort to the nearest appropriate ERC. Contact base for suspected spinal injury, other trauma, or additional direction as needed.", "Report mechanism, submersion history if known, respiratory/neurologic findings, oxygen and ventilation support, response, and any vomiting or associated trauma." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "CPAP requires its own inclusion/exclusion criteria and ongoing reassessment.", "Children have a separate drowning order and destination rule." ], "related": [ "cpap", "albuterol", "oxygen", "adult-cardiac-arrest", "pediatric-drowning" ], "url": "https://www.ocmedic.com/guides/drowning/", "sources": [ { "code": "SO-E-015", "title": "Non-Fatal Drowning", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12028.pdf", "checked": "2026-09-16" }, { "code": "PR-120", "title": "Continuous Positive Airway Pressure (CPAP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-E-015", "title": "Non-Fatal Drowning", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12028.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/drowning.md" }, { "slug": "duodote", "title": "DuoDote (atropine / pralidoxime)", "description": "Combination auto-injector for organophosphate/nerve-agent toxicity, with age and weight restrictions.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "BLS / ALS", "section": "medications", "sourceCode": "B-035", "sourceCodes": [ "B-035", "325.00", "SO-M-050", "SO-P-085" ], "version": "See linked procedure for revision and implementation dates. Source checked September 16, 2026.", "keywords": "duodote (atropine / pralidoxime) combination auto-injector for organophosphate/nerve-agent toxicity, with age and weight restrictions.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "For possible/known organophosphate insecticide or nerve-agent exposure with a compatible cholinergic syndrome.", "B-035 uses salivation, tearing, urination, defecation, GI upset, emesis, and constricted pupils to describe the syndrome." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Respiratory distress with cholinergic findings", "2 auto-injectors under the B-035 table." ], [ "Severe respiratory distress with agitation and cholinergic findings", "3 auto-injectors under the B-035 table." ], [ "No signs/symptoms", "Monitor for findings every 15 minutes; the table does not instruct prophylactic injection." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "For patients younger than 12, B-035 requires a weight of at least 30 kg to receive an IM auto-injector.", "For a smaller child, do not improvise a partial auto-injector dose; use the pediatric poisoning standing order and medical direction." ], "id": "pediatric" }, { "heading": "Pediatric dose by age / weight", "id": "pediatric-dose-rules", "items": [ "B-035: weight determines eligibility in children younger than 12; clinical signs determine the number of complete devices. Do not divide an auto-injector." ], "table": { "headers": [ "Age / weight", "Clinical findings", "IM auto-injectors" ], "rows": [ [ "Younger than 12 and below 30 kg", "Any findings", "Not eligible under B-035; pediatric poisoning pathway/base direction" ], [ "Younger than 12 and at least 30 kg, or age 12–14", "Respiratory distress with SLUDGEM", "2 devices" ], [ "Younger than 12 and at least 30 kg, or age 12–14", "Severe respiratory distress, agitation, and SLUDGEM", "3 devices" ], [ "Eligible child; no symptoms", "No respiratory distress / SLUDGEM", "Monitor every 15 minutes; no prophylactic dose" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Use the mid-anterolateral thigh. Remove the safety release, apply the injector at 90°, and hold for at least 10 seconds as specified by B-035.", "Control/dispose of the exposed needle safely. Document product, time, and site; seek medical evaluation after the incident." ] } ], "cautionTitle": "Check before giving", "cautions": [ "For patients older than 65, B-035 requires weight of at least 80 kg to receive an auto-injector.", "Do not exceed 3 devices unless definitive medical care is available. Ensure scene safety and move to a safe area when possible." ], "related": [ "atropine", "poisoning" ], "sourcePage": 1, "pediatricDoseType": "fixed-or-conditional", "url": "https://www.ocmedic.com/guides/duodote/", "sources": [ { "code": "B-035", "title": "DuoDote Antidote Autoinjector", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12434.pdf#page=1", "checked": "2026-09-16" }, { "code": "325.00", "title": "Advanced Life Support (ALS) Provider Unit Minimum Inventory", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/325.00%20ALS%20Minimum%20Equip%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "checked": "2026-09-16" }, { "code": "SO-P-085", "title": "Substance Overdose / Poisoning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf", "checked": "2026-09-16" } ], "source": { "code": "B-035", "title": "DuoDote Antidote Autoinjector", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12434.pdf", "version": "See linked procedure for revision and implementation dates. Source checked September 16, 2026.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/duodote.md" }, { "slug": "epinephrine", "title": "Epinephrine", "description": "Anaphylaxis, cardiac arrest, and push-dose shock treatment: concentrations and age-specific rules.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-015", "SO-P-060", "SO-C-010", "SO-P-040", "PR-230", "PR-205", "B-045", "SO-P-045" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "epinephrine anaphylaxis, cardiac arrest, and push-dose shock treatment: concentrations and age-specific rules.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Epinephrine has several OCEMS indications with different concentrations, routes, and authority. Select the indication before selecting a syringe.", "Bronchospasm that does not improve with albuterol may prompt a base-order request for IM epinephrine; do not assume the anaphylaxis standing order applies to isolated asthma." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Anaphylaxis — first dose", "0.5 mg IM into the lateral thigh using 1 mg/mL. Count a prearrival auto-injector as the first dose." ], [ "Persistent anaphylaxis after 5 minutes", "A second 0.5 mg IM dose OR 0.3 mg IV/IO using 0.1 mg/mL, under SO-M-015." ], [ "Cardiac arrest", "1 mg IV/IO using 0.1 mg/mL; I-15 lists repetition every 3 minutes in the arrest pathway." ], [ "Push-dose shock treatment — PR-230", "10 mcg (1 mL of 10 mcg/mL) IV/IO every 3 minutes, titrated to systolic BP above 90. PR-230 effective April 2026 states that base contact/order is no longer required for this procedure." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "Anaphylaxis: 0.01 mg/kg IM of 1 mg/mL, maximum 0.5 mg. If qualifying symptoms persist after about 5 minutes, repeat IM OR give 0.01 mg/kg IV/IO of 0.1 mg/mL, maximum 0.3 mg, under SO-P-060.", "Cardiac arrest: 0.01 mg/kg IV/IO of 0.1 mg/mL. SO-P-040 uses about 3-minute intervals for VF/pulseless VT and 3–5 minutes for PEA/asystole. Base contact is required.", "Push dose: PR-205 still REQUIRES a base order. Give 1 mcg/kg (0.1 mL/kg of 10 mcg/mL), maximum 10 mcg per dose, every 3 minutes as ordered. Target systolic BP above 70 + 2 × age through age 9; from age 10, above 90.", "BLS auto-injector procedure B-045 lists 0.3 mg for adults and 0.15 mg for children younger than 12, with an ALS response required. This is a separate product/scope pathway." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Anaphylaxis — IM", "id": "pediatric-weight-1", "items": [ "Source: SO-P-060. Dose rule: 0.01 mg/kg; route: IM.", "0.01 mg/kg IM using 1 mg/mL; maximum 0.5 mg. For qualifying symptoms persisting after about 5 minutes, the source allows a repeat IM dose OR the separate IV/IO regimen.", "Count an epinephrine auto-injector given before EMS arrival as the first IM dose in the anaphylaxis pathway. The isolated facial/cervical angioedema branch holds its one-time IM dose if an auto-injector was already given.", "Base contact is required for the pediatric anaphylaxis pathway. Do not use this 1 mg/mL volume for IV administration.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IM", "Volume at 1 mg/mL" ], "rows": [ [ "3 kg", "0.03 mg", "0.03 mL" ], [ "4 kg", "0.04 mg", "0.04 mL" ], [ "5 kg", "0.05 mg", "0.05 mL" ], [ "6 kg", "0.06 mg", "0.06 mL" ], [ "8 kg", "0.08 mg", "0.08 mL" ], [ "10 kg", "0.1 mg", "0.1 mL" ], [ "12 kg", "0.12 mg", "0.12 mL" ], [ "15 kg", "0.15 mg", "0.15 mL" ], [ "20 kg", "0.2 mg", "0.2 mL" ], [ "25 kg", "0.25 mg", "0.25 mL" ], [ "30 kg", "0.3 mg", "0.3 mL" ], [ "35 kg", "0.35 mg", "0.35 mL" ], [ "40 kg", "0.4 mg", "0.4 mL" ], [ "45 kg", "0.45 mg", "0.45 mL" ], [ "50 kg", "0.5 mg", "0.5 mL" ], [ "60 kg", "0.5 mg", "0.5 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Persistent anaphylaxis — IV/IO", "id": "pediatric-weight-2", "items": [ "Source: SO-P-060. Dose rule: 0.01 mg/kg; route: IV/IO.", "After the source-specified IM treatment and reassessment: 0.01 mg/kg IV/IO using 0.1 mg/mL; maximum 0.3 mg. This is an alternative to repeating IM when qualifying symptoms persist.", "Base contact is required. The IV/IO maximum differs from the IM maximum; confirm the concentration and route before administration.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO", "Volume at 0.1 mg/mL" ], "rows": [ [ "3 kg", "0.03 mg", "0.3 mL" ], [ "4 kg", "0.04 mg", "0.4 mL" ], [ "5 kg", "0.05 mg", "0.5 mL" ], [ "6 kg", "0.06 mg", "0.6 mL" ], [ "8 kg", "0.08 mg", "0.8 mL" ], [ "10 kg", "0.1 mg", "1 mL" ], [ "12 kg", "0.12 mg", "1.2 mL" ], [ "15 kg", "0.15 mg", "1.5 mL" ], [ "20 kg", "0.2 mg", "2 mL" ], [ "25 kg", "0.25 mg", "2.5 mL" ], [ "30 kg", "0.3 mg", "3 mL" ], [ "35 kg", "0.3 mg", "3 mL" ], [ "40 kg", "0.3 mg", "3 mL" ], [ "45 kg", "0.3 mg", "3 mL" ], [ "50 kg", "0.3 mg", "3 mL" ], [ "60 kg", "0.3 mg", "3 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Cardiac arrest", "id": "pediatric-weight-3", "items": [ "Source: SO-P-040. Dose rule: 0.01 mg/kg; route: IV/IO.", "0.01 mg/kg IV/IO using 0.1 mg/mL. Repeat approximately every 3 minutes for VF/pulseless VT or every 3–5 minutes for PEA/asystole under SO-P-040.", "Base contact is required. These arrest volumes are not the IM anaphylaxis or diluted push-dose volumes.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO", "Volume at 0.1 mg/mL" ], "rows": [ [ "3 kg", "0.03 mg", "0.3 mL" ], [ "4 kg", "0.04 mg", "0.4 mL" ], [ "5 kg", "0.05 mg", "0.5 mL" ], [ "6 kg", "0.06 mg", "0.6 mL" ], [ "8 kg", "0.08 mg", "0.8 mL" ], [ "10 kg", "0.1 mg", "1 mL" ], [ "12 kg", "0.12 mg", "1.2 mL" ], [ "15 kg", "0.15 mg", "1.5 mL" ], [ "20 kg", "0.2 mg", "2 mL" ], [ "25 kg", "0.25 mg", "2.5 mL" ], [ "30 kg", "0.3 mg", "3 mL" ], [ "35 kg", "0.35 mg", "3.5 mL" ], [ "40 kg", "0.4 mg", "4 mL" ], [ "45 kg", "0.45 mg", "4.5 mL" ], [ "50 kg", "0.5 mg", "5 mL" ], [ "60 kg", "0.6 mg", "6 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Bradycardia with poor perfusion despite ventilation", "id": "pediatric-weight-4", "items": [ "Source: SO-P-045. Dose rule: 0.01 mg/kg; route: IV/IO.", "After oxygenation/ventilation, heart rate below 60/min with continued poor perfusion triggers CPR and the pediatric bradycardia sequence. Epinephrine is 0.01 mg/kg IV/IO of 0.1 mg/mL; may repeat every 3–5 minutes.", "Base contact is required. This is a resuscitation dose, not the diluted pediatric push-dose regimen.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO", "Volume at 0.1 mg/mL" ], "rows": [ [ "3 kg", "0.03 mg", "0.3 mL" ], [ "4 kg", "0.04 mg", "0.4 mL" ], [ "5 kg", "0.05 mg", "0.5 mL" ], [ "6 kg", "0.06 mg", "0.6 mL" ], [ "8 kg", "0.08 mg", "0.8 mL" ], [ "10 kg", "0.1 mg", "1 mL" ], [ "12 kg", "0.12 mg", "1.2 mL" ], [ "15 kg", "0.15 mg", "1.5 mL" ], [ "20 kg", "0.2 mg", "2 mL" ], [ "25 kg", "0.25 mg", "2.5 mL" ], [ "30 kg", "0.3 mg", "3 mL" ], [ "35 kg", "0.35 mg", "3.5 mL" ], [ "40 kg", "0.4 mg", "4 mL" ], [ "45 kg", "0.45 mg", "4.5 mL" ], [ "50 kg", "0.5 mg", "5 mL" ], [ "60 kg", "0.6 mg", "6 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Push dose — base order required", "id": "pediatric-weight-5", "items": [ "Source: PR-205. Dose rule: 1 mcg/kg; route: IV/IO.", "1 mcg/kg (0.1 mL/kg of 10 mcg/mL), maximum 10 mcg / 1 mL per dose. May repeat every 3 minutes under the base order.", "Base contact AND an order are required before giving pediatric push-dose epinephrine. For cardiogenic shock with pulmonary edema, contact base without a fluid bolus.", "PR-205 preparation: retain 1 mL of the 0.1 mg/mL cardiac preparation and add 9 mL normal saline; mix to make 10 mL at 10 mcg/mL. Independently verify the dilution.", "Target systolic BP above 70 + 2 × age in years through age 9; for age 10 and older, above 90.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO", "Volume at 10 mcg/mL — diluted preparation" ], "rows": [ [ "3 kg", "3 mcg", "0.3 mL" ], [ "4 kg", "4 mcg", "0.4 mL" ], [ "5 kg", "5 mcg", "0.5 mL" ], [ "6 kg", "6 mcg", "0.6 mL" ], [ "8 kg", "8 mcg", "0.8 mL" ], [ "10 kg", "10 mcg", "1 mL" ], [ "12 kg", "10 mcg", "1 mL" ], [ "15 kg", "10 mcg", "1 mL" ], [ "20 kg", "10 mcg", "1 mL" ], [ "25 kg", "10 mcg", "1 mL" ], [ "30 kg", "10 mcg", "1 mL" ], [ "35 kg", "10 mcg", "1 mL" ], [ "40 kg", "10 mcg", "1 mL" ], [ "45 kg", "10 mcg", "1 mL" ], [ "50 kg", "10 mcg", "1 mL" ], [ "60 kg", "10 mcg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Push-dose preparation in PR-230/205: retain 1 mL from a 1 mg/10 mL cardiac epinephrine syringe, add 9 mL normal saline, and mix. The resulting 10 mL contains 10 mcg/mL.", "For pediatric cardiogenic shock with pulmonary edema, PR-205 directs base contact without a fluid bolus.", "Older adult condition orders may still mention a push-dose base order. The April 2026 PR-230 revision explicitly changes that requirement; other condition/destination contact requirements still apply.", "Continuously reassess rhythm, blood pressure, respiratory status, and perfusion; document concentration, dose, route, and response." ] } ], "cautionTitle": "Check before giving", "cautions": [ "1 mg/mL, 0.1 mg/mL, and 10 mcg/mL are different preparations. Never interchange their volumes.", "PR-230 excludes hypovolemic shock before fluid replacement, a perfusing non-shock state, and suspected stimulant intoxication. Pediatric PR-205 has corresponding exclusions and retains the base-order requirement." ], "related": [ "sepsis", "anaphylaxis", "pediatric-anaphylaxis", "bradycardia" ], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/epinephrine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-015", "title": "Allergic Reaction / Anaphylaxis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-M-15%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-P-060", "title": "Allergic Reaction / Anaphylaxis - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-C-010", "title": "Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf", "checked": "2026-09-16" }, { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "checked": "2026-09-16" }, { "code": "PR-230", "title": "Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf", "checked": "2026-09-16" }, { "code": "PR-205", "title": "Preparation and Dosing of Push Dose Epinephrine - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf", "checked": "2026-09-16" }, { "code": "B-045", "title": "Epinephrine Auto Injector (BLS Optional Equipment)", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12436.pdf", "checked": "2026-09-16" }, { "code": "SO-P-045", "title": "Bradycardia - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/epinephrine.md" }, { "slug": "eye-drops", "title": "Moisturizing eye drops", "description": "OTC ocular-lubrication products listed in SO-F-02.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "moisturizing eye drops otc ocular-lubrication products listed in so-f-02.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/eye-drops/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/eye-drops.md" }, { "slug": "fentanyl", "title": "Fentanyl", "description": "Adult and pediatric analgesia, route-specific doses, and the young-child base-contact requirement.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-015", "SO-T-005", "SO-E-005", "SO-P-015" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "fentanyl adult and pediatric analgesia, route-specific doses, and the young-child base-contact requirement.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Opioid analgesia in applicable painful-injury/burn pathways, and IV treatment of cardiac pain not relieved by nitroglycerin or when nitroglycerin cannot be given.", "Assess pain, perfusion, respiratory status, and mental status before selecting an analgesic." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Pain — IV or IM", "50 mcg; may repeat once after approximately 3 minutes for continued pain." ], [ "Pain — IN", "100 mcg, divided as 1 mL per nostril with 50 mcg/mL stock; may repeat once after approximately 3 minutes." ], [ "Cardiac pain", "50 mcg IV; may repeat once after approximately 3 minutes. Follow SO-C-015 and withhold if systolic BP is below 90." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-015 severe-injury pain: 2 mcg/kg IN/IV/IM, maximum 50 mcg per dose. May repeat once after 3 minutes; total maximum 100 mcg.", "SO-P-015 requires base contact for children age 2 or younger. I-20 uses a “younger than 2” note; retain the condition-specific age-2 contact requirement rather than dropping it." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Severe injury pain", "id": "pediatric-weight-1", "items": [ "Source: SO-P-015. Dose rule: 2 mcg/kg; route: IN/IV/IM.", "2 mcg/kg IN/IV/IM; maximum 50 mcg per dose. May repeat once after 3 minutes; total maximum 100 mcg.", "Base contact is required for children age 2 or younger. Monitor ventilation, mental status, and blood pressure.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IN/IV/IM", "Volume at 50 mcg/mL" ], "rows": [ [ "3 kg", "6 mcg", "0.12 mL" ], [ "4 kg", "8 mcg", "0.16 mL" ], [ "5 kg", "10 mcg", "0.2 mL" ], [ "6 kg", "12 mcg", "0.24 mL" ], [ "8 kg", "16 mcg", "0.32 mL" ], [ "10 kg", "20 mcg", "0.4 mL" ], [ "12 kg", "24 mcg", "0.48 mL" ], [ "15 kg", "30 mcg", "0.6 mL" ], [ "20 kg", "40 mcg", "0.8 mL" ], [ "25 kg", "50 mcg", "1 mL" ], [ "30 kg", "50 mcg", "1 mL" ], [ "35 kg", "50 mcg", "1 mL" ], [ "40 kg", "50 mcg", "1 mL" ], [ "45 kg", "50 mcg", "1 mL" ], [ "50 kg", "50 mcg", "1 mL" ], [ "60 kg", "50 mcg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Stock listed in I-15 is 100 mcg/2 mL. Confirm concentration and the selected route.", "Document pain before and after treatment, dose times, total dose, blood pressure, and respiratory response." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Keep micrograms (mcg) distinct from milligrams (mg).", "Adult injury/burn analgesia requires systolic BP above 90 in the relevant source. Continue airway and ventilation assessment after dosing." ], "related": [ "trauma", "burns", "chest-pain", "ketamine", "ketorolac" ], "sourcePage": 2, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/fentanyl/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "checked": "2026-09-16" }, { "code": "SO-T-005", "title": "General Injury and Trauma - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-E-005", "title": "Burn (Thermal, Electrical, Chemical) - Adult", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-P-015", "title": "General Injury and Trauma - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/fentanyl.md" }, { "slug": "gcs", "title": "Glasgow Coma Scale", "description": "Score eye, verbal, and motor responses. Report each component and the total.", "category": "Assessment", "population": "Adult & pediatric", "scope": "Assessment", "section": "procedures", "sourceCode": "PR-002", "version": "Revised November 13, 2023 · Final implementation October 1, 2024", "keywords": "gcs consciousness neuro mental status eyes verbal motor coma", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult scoring", "table": { "headers": [ "Component", "Score → response" ], "rows": [ [ "Eyes", "4 spontaneous · 3 voice · 2 pain · 1 none" ], [ "Verbal", "5 oriented · 4 confused · 3 inappropriate words · 2 incomprehensible sounds · 1 none" ], [ "Motor", "6 follows commands · 5 localizes pain · 4 withdraws from pain · 3 abnormal flexion · 2 extension · 1 none" ] ] } }, { "heading": "Pediatric scoring: age 2 and younger", "table": { "headers": [ "Component", "Score → response" ], "rows": [ [ "Eyes", "4 spontaneous · 3 sound · 2 pain · 1 none" ], [ "Verbal", "5 smiles/coos, tracks or interacts appropriately · 4 irritable crying/inappropriate interaction · 3 cries with pain · 2 inconsolable or moans with pain · 1 none" ], [ "Motor", "6 purposeful spontaneous movement · 5 withdraws from touch · 4 withdraws from pain · 3 abnormal flexion · 2 extension · 1 none" ] ] } }, { "heading": "Use a reproducible report", "items": [ "Record eye, verbal, and motor components separately so a later clinician can distinguish a change in one response from a change in another. Add the total after the components.", "Use the pediatric descriptors for age 2 and younger; infant interaction and purposeful movement differ from the adult verbal/command tasks." ] }, { "heading": "Connect the score with the clinical pathway", "items": [ "A GCS below 13 is one of four qualifying findings in the adult suspected-sepsis criteria; infection plus at least two findings is required. GCS alone does not diagnose sepsis.", "In adult traumatic brain injury, SO-T-005 directs establishing the airway by the most appropriate available means at GCS 8 or below, with concurrent oxygenation, ETCO₂, and blood-pressure management. Interpret the score with the rest of the patient’s assessment." ] } ], "cautionTitle": "Report the components", "cautions": [ "Give eye / verbal / motor scores in that order, followed by the total. Example: E4 V5 M6 = 15.", "The minimum total is 3, not 0. Use the age-appropriate scoring table." ], "related": [ "sepsis", "stroke", "trauma", "pediatric-assessment" ], "sourceCodes": [ "PR-002", "SO-M-055", "SO-T-005" ], "kind": "clinical", "url": "https://www.ocmedic.com/guides/gcs/", "sources": [ { "code": "PR-002", "title": "Glasgow Coma Scale (Score)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/PR-02%20GCS%20%28Score%29%2011-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-M-055", "title": "Suspected Sepsis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf", "checked": "2026-09-16" }, { "code": "SO-T-005", "title": "General Injury and Trauma - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-002", "title": "Glasgow Coma Scale (Score)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/PR-02%20GCS%20%28Score%29%2011-2023.pdf", "version": "Revised November 13, 2023 · Final implementation October 1, 2024", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/gcs.md" }, { "slug": "glucagon", "title": "Glucagon", "description": "IM hypoglycemia treatment when IV access cannot be established.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-020", "SO-P-065", "SO-P-075", "SO-P-080" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "glucagon im hypoglycemia treatment when iv access cannot be established.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "A hypoglycemia option when IV dextrose cannot be given because IV access cannot be established.", "Use the glucose threshold from the patient’s applicable condition order and continue airway/ventilation support." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Hypoglycemia without IV access", "1 mg IM once. I-15 covers glucose at or below 60 mg/dL or below 80 with symptoms suggesting hypoglycemia." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-065 lists 0.5 mg IM when IV access cannot be established for glucose below 60 mg/dL. The pediatric seizure, shock, and poisoning orders also list 0.5 mg.", "The pediatric dose in these OCEMS standing orders is not the adult 1 mg dose. Consult the appropriate pediatric condition order for its threshold." ], "id": "pediatric" }, { "heading": "Pediatric dose by age / weight", "id": "pediatric-dose-rules", "items": [ "SO-P-065: hypoglycemia below 60 mg/dL when IV access cannot be established. Other pediatric orders have their own glucose thresholds." ], "table": { "headers": [ "Weight", "Pediatric dose", "Volume / route" ], "rows": [ [ "Any eligible pediatric weight", "0.5 mg — fixed dose", "0.5 mL IM when reconstituted to 1 mg/mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "The inventory includes a 1 mg vial with diluent. Reconstitute the supplied product according to its labeling and verify the resulting concentration.", "Reassess glucose and consciousness, maintain airway support, and document the clinical response." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Do not give oral glucose to a patient without an intact swallow/airway reflex.", "If an unconscious hypoglycemic patient cannot receive IV dextrose and fails to respond to IM glucagon, check the source’s IO dextrose exception." ], "related": [ "dextrose", "altered-mental-status", "oral-glucose" ], "sourcePage": 2, "pediatricDoseType": "fixed-or-conditional", "url": "https://www.ocmedic.com/guides/glucagon/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-020", "title": "Altered Mental Status", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf", "checked": "2026-09-16" }, { "code": "SO-P-065", "title": "Altered Mental Status - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf", "checked": "2026-09-16" }, { "code": "SO-P-075", "title": "Seizure / Convulsion - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf", "checked": "2026-09-16" }, { "code": "SO-P-080", "title": "Shock (Symptomatic Hypotension) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/glucagon.md" }, { "slug": "heat-illness", "title": "Adult heat illness / hyperthermia", "description": "Move promptly to cooling and escalate when mental status or perfusion is abnormal.", "category": "Environmental", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-E-025", "sourceCodes": [ "SO-E-025" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult heat illness / hyperthermia Move promptly to cooling and escalate when mental status or perfusion is abnormal. SO-E-025", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Recognize severity", "items": [ "Mild/moderate features include malaise, tachycardia, nausea, or vomiting while conscious. Confusion/altered consciousness, hot dry skin, or hypotension activates the severe pathway.", "Assess the exposure, work/exertion, fluid intake, medications, mental status, and circulation. Reassess frequently for progression." ] }, { "heading": "Mild or moderate illness", "items": [ "Move away from the heat to shade/cooler air with good airflow; use a fan when available.", "Encourage water or a balanced electrolyte drink without caffeine/stimulants if oral intake is safe. Use cool wet towels or cold packs as tolerated." ] }, { "heading": "Severe illness", "items": [ "Check SpO₂ and provide the source’s oxygen support when room-air saturation is below 95%.", "For hypotension/poor perfusion with clear lungs/no CHF, give saline 250 mL IV and reassess; repeat to a maximum 1 L to support perfusion.", "Use available active or passive cooling, including cold packs at the axillae, posterior neck, and groin, plus airflow with appropriate skin exposure." ] }, { "heading": "Transport and reassessment", "items": [ "Provide ALS escort to the nearest appropriate ERC; contact base if further stabilization orders are needed.", "Continue cooling and monitoring during transport. Report mental-status and perfusion trends, exposure, cooling methods, fluids, and treatment response." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Do not give oral fluids to someone who cannot safely protect the airway.", "Pediatric fluid doses and required base contact differ; use the pediatric thermal guide." ], "related": [ "normal-saline", "shock", "pediatric-temperature-emergencies" ], "url": "https://www.ocmedic.com/guides/heat-illness/", "sources": [ { "code": "SO-E-025", "title": "Thermal", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12029.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-E-025", "title": "Thermal", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12029.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/heat-illness.md" }, { "slug": "heparin", "title": "Heparin infusion", "description": "Monitoring a prescribed infusion during interfacility transport; not a field initiation protocol.", "category": "Transport medications", "kind": "medication", "medicationGroup": "Transport medications", "population": "Adult & pediatric scope", "scope": "IFT-ALS", "section": "medications", "sourceCode": "PR-220", "sourceCodes": [ "PR-220" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "heparin infusion monitoring a prescribed infusion during interfacility transport; not a field initiation protocol.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "PR-220 addresses a pre-existing heparin infusion. Obtain the prescribed rate, bleeding history, and relevant transfer records from the sending RN/physician.", "Use a working infusion pump at the sending facility’s prescribed rate. The procedure does not provide an independent field loading dose or titration schedule." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "The source supplies no distinct pediatric dosing regimen. A pediatric transfer needs the sending team’s explicit order and appropriate transport authorization; do not weight-scale an adult heparin infusion from this page." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "Use the sending team’s patient-specific transport order and authorized scope. The cited transport procedure supplies no independent pediatric initiation regimen." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Secure the vascular access and verify the pump. Continuously observe vital signs, rhythm, and bleeding.", "Stop the infusion and transport to the nearest appropriate ERC for bleeding, systolic BP below 90, or a systolic decrease greater than 20 mmHg from the initial measurement, as directed by PR-220.", "Document the ordered rate, monitoring, any stop time/reason, and the patient’s condition at transfer of care." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "This is continuation/monitoring authority during an authorized IFT, not routine 9-1-1 heparin administration.", "Bleeding and falling BP require action under the procedure." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/heparin/", "sources": [ { "code": "PR-220", "title": "Monitoring Heparin Infusion during Interfacility Transports", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/49721.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-220", "title": "Monitoring Heparin Infusion during Interfacility Transports", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/49721.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/heparin.md" }, { "slug": "hydroxocobalamin", "title": "Hydroxocobalamin (Cyanokit)", "description": "Adult and pediatric cyanide-antidote treatment with base authorization and a dedicated infusion line.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "PR-130", "sourceCodes": [ "PR-130", "SO-M-050", "I-20", "325.00" ], "version": "See linked procedure for revision and implementation dates. Source checked September 16, 2026.", "keywords": "hydroxocobalamin (cyanokit) adult and pediatric cyanide-antidote treatment with base authorization and a dedicated infusion line.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "For known/suspected cyanide toxicity, including concerning smoke from burning plastics or petroleum products.", "PR-130 requires base contact for an order and consideration of burn-center destination." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Base-ordered cyanide treatment", "5 g in 200 mL normal saline, IV/IO over approximately 15 minutes, per SO-M-050 and PR-130." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "70 mg/kg IV/IO over approximately 15 minutes, maximum 5 g, with a base hospital order.", "I-20 supplies weight-band volumes for the 25 mg/mL mixture. Verify the weight, ordered dose, concentration, and maximum before infusion." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Suspected cyanide toxicity", "id": "pediatric-weight-1", "items": [ "Source: PR-130. Dose rule: 70 mg/kg; route: IV/IO over approximately 15 minutes.", "70 mg/kg IV/IO over approximately 15 minutes; maximum 5,000 mg (5 g). Base hospital order required.", "For the 5 g Cyanokit described in PR-130, add 200 mL normal saline to produce 25 mg/mL. Rock/invert to mix; do not shake. Do not run other medications simultaneously through the same IV/IO site.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO over approximately 15 minutes", "Volume at 25 mg/mL after reconstitution" ], "rows": [ [ "3 kg", "210 mg", "8.4 mL" ], [ "4 kg", "280 mg", "11.2 mL" ], [ "5 kg", "350 mg", "14 mL" ], [ "6 kg", "420 mg", "16.8 mL" ], [ "8 kg", "560 mg", "22.4 mL" ], [ "10 kg", "700 mg", "28 mL" ], [ "12 kg", "840 mg", "33.6 mL" ], [ "15 kg", "1050 mg", "42 mL" ], [ "20 kg", "1400 mg", "56 mL" ], [ "25 kg", "1750 mg", "70 mL" ], [ "30 kg", "2100 mg", "84 mL" ], [ "35 kg", "2450 mg", "98 mL" ], [ "40 kg", "2800 mg", "112 mL" ], [ "45 kg", "3150 mg", "126 mL" ], [ "50 kg", "3500 mg", "140 mL" ], [ "60 kg", "4200 mg", "168 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "For the 5 g Cyanokit described by PR-130, add 200 mL normal saline using the transfer spike. Invert/rock for about 60 seconds; do not shake. Confirm a dark-red solution without visible particles.", "Remove the patient from exposure, provide high-flow oxygen and airway support, and monitor during infusion.", "Reddish skin/mucosal discoloration and increased blood pressure can occur. Notify the receiving team of administration before arrival." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Known allergy to hydroxocobalamin is a contraindication in PR-130.", "Do not simultaneously give other medications through the same IV/IO site." ], "related": [ "burns", "poisoning" ], "sourcePage": 1, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/hydroxocobalamin/", "sources": [ { "code": "PR-130", "title": "Hydroxocobalamin for Cyanide Toxicity", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf#page=1", "checked": "2026-09-16" }, { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "325.00", "title": "Advanced Life Support (ALS) Provider Unit Minimum Inventory", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/325.00%20ALS%20Minimum%20Equip%2010-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-130", "title": "Hydroxocobalamin for Cyanide Toxicity", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf", "version": "See linked procedure for revision and implementation dates. Source checked September 16, 2026.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/hydroxocobalamin.md" }, { "slug": "hyperglycemia", "title": "Adult hyperglycemia / suspected DKA", "description": "Use glucose together with mental status, breathing, vital signs, and comorbidity to choose support and transport.", "category": "Medical", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-010", "sourceCodes": [ "SO-M-010" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult hyperglycemia / suspected DKA Use glucose together with mental status, breathing, vital signs, and comorbidity to choose support and transport. SO-M-010", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Assess more than the glucose", "items": [ "Measure and document glucose, mental status, vital signs, oxygen saturation, hydration, and associated symptoms. Deep labored breathing may be Kussmaul respirations.", "Look for fever/infection, vomiting, abdominal pain, and significant comorbidity. Consider sepsis as a cause or coexisting problem." ] }, { "heading": "Recognize the ALS / suspected DKA branch", "items": [ "At glucose at least 400 mg/dL, the source directs ALS transport.", "At glucose above 250 with confusion/lethargy, heart rate above 120, respiratory rate above 20 with labored breathing, fever history, or SpO₂ below 94%, transport ALS and consider DKA." ] }, { "heading": "Supportive care", "items": [ "For the suspected DKA branch, provide oxygen as tolerated, monitor the rhythm, and establish IV access.", "Without evidence of fluid overload, give normal saline 250 mL IV and reassess; may repeat to a maximum 1 L for adequate perfusion. Consider ETCO₂ assessment for acidosis. No insulin administration regimen is provided in this field order." ] }, { "heading": "Lower-acuity transport criteria", "items": [ "BLS consideration requires normal mental status, vital signs, and pulse oximetry and no other complaint requiring ALS. The source separates glucose below 250 from glucose above 250 but below 400; the latter also requires absence of relevant comorbidity.", "Consider ALS with active cancer, renal failure, liver disease, immunosuppression, abdominal pain with vomiting, CHF, organ transplant, or frailty. Do not infer a BLS decision solely from one glucose value or a boundary not explicitly addressed in the source.", "Document serial findings and the full rationale for the chosen level of transport." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "This adult/adolescent order is not a pediatric DKA fluid protocol.", "Do not treat a normal-looking glucose threshold as a substitute for assessment of breathing or perfusion." ], "related": [ "normal-saline", "shock", "altered-mental-status", "pediatric-shock" ], "url": "https://www.ocmedic.com/guides/hyperglycemia/", "sources": [ { "code": "SO-M-010", "title": "Hyperglycemia - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/102906.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-010", "title": "Hyperglycemia - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/102906.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/hyperglycemia.md" }, { "slug": "hypothermia", "title": "Adult hypothermia", "description": "Warm, handle the slow pulse deliberately, and follow the hypothermic-arrest pathway when indicated.", "category": "Environmental", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-E-025", "sourceCodes": [ "SO-E-025" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult hypothermia Warm, handle the slow pulse deliberately, and follow the hypothermic-arrest pathway when indicated. SO-E-025", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Patient with a pulse", "items": [ "Remove wet clothing, cover to conserve heat, and initiate available active warming. Monitor and document the rhythm.", "Expect a slow heart rate and weak pulse. The thermal order directs against trying to reverse hypothermic bradycardia in the field." ] }, { "heading": "Apparent arrest", "items": [ "When not obviously dead, assess for a pulse for 30–45 seconds before initiating CPR. If no pulse is detected, follow the adult cardiac-arrest standing order.", "Assist ventilation with BVM without hyperventilation. Continue warming and limit unnecessary interruptions in resuscitation." ] }, { "heading": "Contact and transport", "items": [ "Contact base when further stabilization orders are needed. The hypothermia pathway directs against field pronouncement.", "Provide transport to the nearest ERC, with ALS escort for the apparent-arrest branch. Continue monitoring for rhythm and perfusion changes." ] }, { "heading": "Handoff", "items": [ "Report environmental exposure, wet clothing, initial and serial pulse findings, warming measures, arrest/ROSC times if applicable, and all resuscitation treatment.", "Keep the thermal diagnosis visible during handoff so the slow rate is not mistaken for an unrelated routine bradycardia presentation." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Use the longer 30–45 second pulse assessment specified for apparent hypothermic arrest.", "Do not merge ordinary bradycardia treatment into the source’s hypothermic-with-a-pulse pathway." ], "related": [ "adult-cardiac-arrest", "bradycardia", "pediatric-temperature-emergencies" ], "url": "https://www.ocmedic.com/guides/hypothermia/", "sources": [ { "code": "SO-E-025", "title": "Thermal", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12029.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-E-025", "title": "Thermal", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12029.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/hypothermia.md" }, { "slug": "ibuprofen", "title": "Ibuprofen", "description": "OTC NSAID listed for the FS-ARN program.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "ibuprofen otc nsaid listed for the fs-arn program.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/ibuprofen/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/ibuprofen.md" }, { "slug": "influenza-vaccine", "title": "Influenza vaccine", "description": "Influenza vaccine: historical OCEMS program scope, adult/pediatric limits, and current-authorization requirements.", "category": "Vaccination references", "kind": "medication", "medicationGroup": "Vaccination references", "population": "Adult & pediatric scope", "scope": "Program-specific", "section": "medications", "sourceCode": "PR-150.10", "sourceCodes": [ "PR-150.10" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "influenza vaccine legacy ocems vaccination-program reference with current authorization and product guidance required.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "The linked 2020 procedure describes trained OCEMS-accredited paramedics administering IM influenza/COVID-19 vaccine under an approved public-health program during the COVID-19 Disaster Declaration.", "It is conditional program guidance, not evidence that this historical optional scope remains active today. Verify current OCEMS/public-health authorization and the specific product guidance before planning administration." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "PR-150.10 described a public program for age 14 and older. It does not establish a current vaccine dose, schedule, or authorization for younger children.", "Use current program authorization and age/product-specific clinical guidance; do not derive a pediatric vaccine regimen from this historical document." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "The historical program document does not establish a current pediatric vaccine dose or active program authorization." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "The source describes training, consent/screening, aseptic IM technique, observation for reactions, and emergency readiness. Current product requirements govern formulation, eligibility, and dosage.", "Program documentation includes administration date, patient, site, product/manufacturer, lot number, consent, and vaccine-information material, plus appropriate adverse-event reporting." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "Historical/conditional scope: current program authorization has not been established by this reference.", "No current vaccine dose or schedule is asserted here." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/influenza-vaccine/", "sources": [ { "code": "PR-150.10", "title": "Paramedic Administration of Intramuscular Influenza and/or COVID-19 Vaccine to the Public", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/118399.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-150.10", "title": "Paramedic Administration of Intramuscular Influenza and/or COVID-19 Vaccine to the Public", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/118399.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/influenza-vaccine.md" }, { "slug": "ketamine", "title": "Ketamine", "description": "OCEMS analgesia for eligible patients age 15 and older; pediatric exclusion is explicit.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "PR-70", "I-20" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "ketamine ocems analgesia for eligible patients age 15 and older; pediatric exclusion is explicit.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "PR-70 addresses moderate–severe pain (4–10) when fentanyl is not a safe or appropriate choice. Examples include opioid intolerance/refusal, hypotension, or concern about airway/ventilatory status.", "This is the analgesia procedure, not a field dissociative-sedation or pediatric ketamine protocol." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "IV — preferred when practical", "0.1 mg/kg slowly over 1–2 minutes, maximum 10 mg. May repeat once after 15 minutes." ], [ "IM", "0.5 mg/kg, maximum 50 mg. May repeat once after 15 minutes." ], [ "IN", "1 mg/kg, maximum 100 mg. The procedure does not list an IN repeat dose." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "Age younger than 15 is a contraindication in PR-70. No pediatric analgesia dose is supplied by this OCEMS procedure or I-20.", "Do not extrapolate these doses to a child. Use an authorized pediatric analgesia pathway and base direction." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "PR-70 excludes patients younger than 15. No OCEMS pediatric analgesia dose is provided." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Concentration is determined by the provider agency; confirm route-appropriate stock before drawing up the dose.", "Record weight, indication, pain before/after, intoxication assessment, response, and ongoing vital signs, SpO₂, consciousness, and cardiac rhythm. Watch for dissociation, tachycardia, or hypertension." ] } ], "cautionTitle": "Check before giving", "cautions": [ "PR-70 excludes pregnancy, ketamine allergy, psychosis history, and GCS below 14.", "Concurrent alcohol/drug intoxication is a relative contraindication: the source allows consideration only after base contact when intoxication is not significant and the patient is not lethargic or otherwise impaired." ], "related": [ "fentanyl", "ketorolac", "trauma" ], "sourcePage": 2, "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/ketamine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "checked": "2026-09-16" }, { "code": "PR-70", "title": "Ketamine Analgesia", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/PR-70%20ketamine%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/ketamine.md" }, { "slug": "ketorolac", "title": "Ketorolac (Toradol)", "description": "Non-opioid analgesia with strict age, renal, bleeding, and pregnancy exclusions.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "PR-075" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "ketorolac (toradol) non-opioid analgesia with strict age, renal, bleeding, and pregnancy exclusions.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "For moderate–severe pain (4–10), as an alternative or adjunct to an opioid when PR-075 criteria are met.", "Examples include opioid intolerance/refusal, moderate pain where opioids may not be appropriate, inability to obtain IV access, or additional analgesia after fentanyl." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Eligible adults", "15 mg IV/IO/IM once. IV is preferred when a line is present." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "For eligible children age 2 and older: 0.25 mg/kg IV/IO/IM once, maximum 15 mg.", "Age below 2 is a contraindication. Use measured weight in kilograms and record it." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Pain — age 2 and older only", "id": "pediatric-weight-1", "items": [ "Source: PR-075. Dose rule: 0.25 mg/kg; route: IV/IO/IM once.", "Age 2 and older: 0.25 mg/kg IV/IO/IM once; maximum 15 mg. Children younger than 2 are excluded regardless of weight.", "Check all PR-075 exclusions, including renal disease, bleeding risk, designated trauma, recent GI bleeding, NSAID allergy/use, pregnancy, and breastfeeding. Weight alone does not establish eligibility.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO/IM once", "Volume at 15 mg/mL" ], "rows": [ [ "3 kg", "0.75 mg", "0.05 mL" ], [ "4 kg", "1 mg", "0.067 mL" ], [ "5 kg", "1.25 mg", "0.083 mL" ], [ "6 kg", "1.5 mg", "0.1 mL" ], [ "8 kg", "2 mg", "0.133 mL" ], [ "10 kg", "2.5 mg", "0.167 mL" ], [ "12 kg", "3 mg", "0.2 mL" ], [ "15 kg", "3.75 mg", "0.25 mL" ], [ "20 kg", "5 mg", "0.333 mL" ], [ "25 kg", "6.25 mg", "0.417 mL" ], [ "30 kg", "7.5 mg", "0.5 mL" ], [ "35 kg", "8.75 mg", "0.583 mL" ], [ "40 kg", "10 mg", "0.667 mL" ], [ "45 kg", "11.25 mg", "0.75 mL" ], [ "50 kg", "12.5 mg", "0.833 mL" ], [ "60 kg", "15 mg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "The inventory concentration is 15 mg/mL. Verify the ordered milligrams and volume; the dose is not 15 mg/kg.", "Document indication, exclusion screening, baseline pain, pediatric weight, response, and any adverse reaction." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Do not give above age 65, for suspected cardiac pain, NSAID hypersensitivity, renal disease/transplant, pregnancy/suspected pregnancy, or breastfeeding.", "Exclude active ulcer disease, GI bleeding/perforation within 3 months, trauma-center designation, active/high-risk hemorrhage or coagulopathy, recent major surgery within 6 weeks or planned major surgery, and concurrent NSAID/anticoagulant use. PR-075 makes an exception for low-dose aspirin." ], "related": [ "fentanyl", "ketamine" ], "sourcePage": 2, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/ketorolac/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "PR-075", "title": "Ketorolac for Patient Analgesia", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-05/PR-75%20ketorolac%205-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/ketorolac.md" }, { "slug": "lidocaine", "title": "Lidocaine", "description": "Separate antiarrhythmic dosing from preservative-free IO-infusion analgesia.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "PR-115", "SO-C-040", "SO-P-040" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "lidocaine separate antiarrhythmic dosing from preservative-free io-infusion analgesia.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "I-15 lists lidocaine for VF/pulseless VT, wide-complex tachycardia with a pulse, and pain during IO infusion.", "These are distinct pathways. For unstable VT with a pulse, follow the cardioversion sequence in SO-C-040." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Cardiac indication", "1 mg/kg IV/IO; may repeat 0.5 mg/kg once in 3–5 minutes under the applicable sequence." ], [ "IO infusion pain", "20 mg of preservative-free 2% lidocaine slowly through the IO over 1 minute. May repeat once, total 40 mg. I-15 lists a 3-minute repeat interval." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-040 persistent VF/pulseless VT: 1 mg/kg IV/IO, maximum 100 mg, one dose only, as the alternative to amiodarone in the arrest sequence.", "PR-115 IO pain in children age 14 and younger: 0.5 mg/kg preservative-free 2% lidocaine, maximum 20 mg, slowly over 1 minute. Do not repeat." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Persistent VF / pulseless VT", "id": "pediatric-weight-1", "items": [ "Source: SO-P-040. Dose rule: 1 mg/kg; route: IV/IO once.", "1 mg/kg IV/IO, maximum 100 mg, one dose only, as the arrest alternative to amiodarone. Base contact is required under the arrest pathway.", "This arrest regimen differs from the smaller IO-infusion pain dose.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO once", "Volume at 2% = 20 mg/mL" ], "rows": [ [ "3 kg", "3 mg", "0.15 mL" ], [ "4 kg", "4 mg", "0.2 mL" ], [ "5 kg", "5 mg", "0.25 mL" ], [ "6 kg", "6 mg", "0.3 mL" ], [ "8 kg", "8 mg", "0.4 mL" ], [ "10 kg", "10 mg", "0.5 mL" ], [ "12 kg", "12 mg", "0.6 mL" ], [ "15 kg", "15 mg", "0.75 mL" ], [ "20 kg", "20 mg", "1 mL" ], [ "25 kg", "25 mg", "1.25 mL" ], [ "30 kg", "30 mg", "1.5 mL" ], [ "35 kg", "35 mg", "1.75 mL" ], [ "40 kg", "40 mg", "2 mL" ], [ "45 kg", "45 mg", "2.25 mL" ], [ "50 kg", "50 mg", "2.5 mL" ], [ "60 kg", "60 mg", "3 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — IO-infusion pain", "id": "pediatric-weight-2", "items": [ "Source: PR-115. Dose rule: 0.5 mg/kg; route: IO over 1 minute.", "Age 14 and younger: 0.5 mg/kg preservative-free 2% lidocaine slowly over 1 minute, maximum 20 mg. Do not repeat.", "Use only the preservative-free 2% (20 mg/mL) preparation. Follow PR-115 placement confirmation and flush instructions.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IO over 1 minute", "Volume at Preservative-free 2% = 20 mg/mL" ], "rows": [ [ "3 kg", "1.5 mg", "0.075 mL" ], [ "4 kg", "2 mg", "0.1 mL" ], [ "5 kg", "2.5 mg", "0.125 mL" ], [ "6 kg", "3 mg", "0.15 mL" ], [ "8 kg", "4 mg", "0.2 mL" ], [ "10 kg", "5 mg", "0.25 mL" ], [ "12 kg", "6 mg", "0.3 mL" ], [ "15 kg", "7.5 mg", "0.375 mL" ], [ "20 kg", "10 mg", "0.5 mL" ], [ "25 kg", "12.5 mg", "0.625 mL" ], [ "30 kg", "15 mg", "0.75 mL" ], [ "35 kg", "17.5 mg", "0.875 mL" ], [ "40 kg", "20 mg", "1 mL" ], [ "45 kg", "20 mg", "1 mL" ], [ "50 kg", "20 mg", "1 mL" ], [ "60 kg", "20 mg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "A 2% solution contains 20 mg/mL; inventory lists 100 mg/5 mL. Verify the formulation and indication.", "Confirm IO placement and monitor the limb for extravasation. For cardiac use, reassess rhythm and perfusion and follow the full resuscitation/electrical-treatment sequence." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Do not interchange IO analgesia and cardiac doses.", "Preservative-free formulation is specifically required for IO infusion analgesia in PR-115." ], "related": [ "amiodarone" ], "sourcePage": 2, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/lidocaine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "PR-115", "title": "Intraosseous Infusion", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12408.pdf", "checked": "2026-09-16" }, { "code": "SO-C-040", "title": "Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf", "checked": "2026-09-16" }, { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/lidocaine.md" }, { "slug": "loperamide", "title": "Imodium A-D (loperamide)", "description": "The OTC antidiarrheal product listed in the fire-service source.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "imodium a-d (loperamide) the otc antidiarrheal product listed in the fire-service source.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/loperamide/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/loperamide.md" }, { "slug": "midazolam", "title": "Midazolam (Versed)", "description": "Seizure control and indication-specific sedation, with distinct adult and pediatric limits.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-040", "SO-P-075", "SO-C-020", "SO-M-030", "SO-M-080", "SO-P-120", "SO-P-070" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "midazolam (versed) seizure control and indication-specific sedation, with distinct adult and pediatric limits.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used in active/recurrent seizures and specific pacing, airway, and behavioral-emergency pathways.", "A seizure dose does not authorize all sedation uses. Select the condition order and its blood-pressure, repeat-dose, and base-contact rules." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Active seizure — preferred", "10 mg IM once, before attempting new IV/IO access." ], [ "Seizure — alternative", "5 mg IV/IN/IO if IM cannot be delivered or IV/IO already exists; may repeat once after about 3 minutes for ongoing/recurrent activity." ], [ "Pacing distress", "When systolic BP is above 90: up to 5 mg IV slowly titrated. If IV cannot be obtained, 5 mg IN divided between nostrils; may repeat once after about 3 minutes." ], [ "Toxic delirium interfering with loading", "SO-M-030: 5 mg IV, repeat once in 5 minutes if no improvement; OR 10 mg IM/IN once. For patients older than 65, consider 5 mg IM/IN, repeat once in 5 minutes if needed." ], [ "Specified airway sedation — I-15 / SO-M-080", "5 mg IV/IO/IM once for the listed jaw-tone/airway-placement or pre-existing tube-tolerance indication when systolic BP is above 90. Follow the complete airway order." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "Seizure SO-P-075: 0.2 mg/kg IM once, maximum 10 mg. Alternative when IM cannot be given or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg; repeat once after 3 minutes for continued/recurrent seizures.", "Base contact is required for all pediatric seizure patients, whether transported or not; pediatric-capable base preferred.", "SO-P-070 toxic delirium interfering with loading: contact base (pediatric-capable preferred) for a possible 0.2 mg/kg IM/IN one-time order, maximum 10 mg. This is not an independent pediatric standing-order sedation dose.", "SO-P-120 pre-existing, correctly positioned ETT that is poorly tolerated: with systolic BP above 80, consider 0.1 mg/kg IV/IO/IM once, maximum 5 mg. Base contact is required. Reassess BP; if it falls below 80, give 20 mL/kg saline, maximum 250 mL, and reassess. Monitor oxygenation/ventilation and do not extubate after sedation under this pathway.", "I-20 marks pediatric cardioversion sedation as base-order treatment; use that specific order rather than another indication’s regimen." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Ongoing seizure — preferred IM route", "id": "pediatric-weight-1", "items": [ "Source: SO-P-075. Dose rule: 0.2 mg/kg; route: IM once.", "0.2 mg/kg IM once; maximum 10 mg. The IM first-line regimen is distinct from the lower alternate-route dose.", "Base contact is required for every pediatric seizure patient, including non-transported patients. Monitor ventilation and prepare BVM support.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IM once", "Volume at 5 mg/mL" ], "rows": [ [ "3 kg", "0.6 mg", "0.12 mL" ], [ "4 kg", "0.8 mg", "0.16 mL" ], [ "5 kg", "1 mg", "0.2 mL" ], [ "6 kg", "1.2 mg", "0.24 mL" ], [ "8 kg", "1.6 mg", "0.32 mL" ], [ "10 kg", "2 mg", "0.4 mL" ], [ "12 kg", "2.4 mg", "0.48 mL" ], [ "15 kg", "3 mg", "0.6 mL" ], [ "20 kg", "4 mg", "0.8 mL" ], [ "25 kg", "5 mg", "1 mL" ], [ "30 kg", "6 mg", "1.2 mL" ], [ "35 kg", "7 mg", "1.4 mL" ], [ "40 kg", "8 mg", "1.6 mL" ], [ "45 kg", "9 mg", "1.8 mL" ], [ "50 kg", "10 mg", "2 mL" ], [ "60 kg", "10 mg", "2 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Ongoing seizure — alternate IN/IV/IO", "id": "pediatric-weight-2", "items": [ "Source: SO-P-075. Dose rule: 0.1 mg/kg; route: IN/IV/IO.", "When IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO; maximum 5 mg per dose. May repeat once after 3 minutes for continued or recurrent seizure.", "Base contact is required for all pediatric seizure patients. This is not the 0.2 mg/kg IM first-line dose.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IN/IV/IO", "Volume at 5 mg/mL" ], "rows": [ [ "3 kg", "0.3 mg", "0.06 mL" ], [ "4 kg", "0.4 mg", "0.08 mL" ], [ "5 kg", "0.5 mg", "0.1 mL" ], [ "6 kg", "0.6 mg", "0.12 mL" ], [ "8 kg", "0.8 mg", "0.16 mL" ], [ "10 kg", "1 mg", "0.2 mL" ], [ "12 kg", "1.2 mg", "0.24 mL" ], [ "15 kg", "1.5 mg", "0.3 mL" ], [ "20 kg", "2 mg", "0.4 mL" ], [ "25 kg", "2.5 mg", "0.5 mL" ], [ "30 kg", "3 mg", "0.6 mL" ], [ "35 kg", "3.5 mg", "0.7 mL" ], [ "40 kg", "4 mg", "0.8 mL" ], [ "45 kg", "4.5 mg", "0.9 mL" ], [ "50 kg", "5 mg", "1 mL" ], [ "60 kg", "5 mg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Toxic delirium interfering with loading", "id": "pediatric-weight-3", "items": [ "Source: SO-P-070. Dose rule: 0.2 mg/kg; route: IM/IN once.", "Possible base-ordered dose: 0.2 mg/kg IM/IN once, maximum 10 mg, for the specific toxic-delirium/loading indication.", "Base contact and direction are required; a calculated dose does not create independent standing-order sedation authority.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IM/IN once", "Volume at 5 mg/mL" ], "rows": [ [ "3 kg", "0.6 mg", "0.12 mL" ], [ "4 kg", "0.8 mg", "0.16 mL" ], [ "5 kg", "1 mg", "0.2 mL" ], [ "6 kg", "1.2 mg", "0.24 mL" ], [ "8 kg", "1.6 mg", "0.32 mL" ], [ "10 kg", "2 mg", "0.4 mL" ], [ "12 kg", "2.4 mg", "0.48 mL" ], [ "15 kg", "3 mg", "0.6 mL" ], [ "20 kg", "4 mg", "0.8 mL" ], [ "25 kg", "5 mg", "1 mL" ], [ "30 kg", "6 mg", "1.2 mL" ], [ "35 kg", "7 mg", "1.4 mL" ], [ "40 kg", "8 mg", "1.6 mL" ], [ "45 kg", "9 mg", "1.8 mL" ], [ "50 kg", "10 mg", "2 mL" ], [ "60 kg", "10 mg", "2 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight table — Poorly tolerated pre-existing ETT", "id": "pediatric-weight-4", "items": [ "Source: SO-P-120. Dose rule: 0.1 mg/kg; route: IV/IO/IM once.", "For a correctly positioned, pre-existing ETT that is poorly tolerated and systolic BP above 80: 0.1 mg/kg IV/IO/IM once; maximum 5 mg.", "Base contact is required. Monitor oxygenation, ventilation, and BP; follow SO-P-120 for hypotension and do not extubate after sedation under this pathway.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO/IM once", "Volume at 5 mg/mL" ], "rows": [ [ "3 kg", "0.3 mg", "0.06 mL" ], [ "4 kg", "0.4 mg", "0.08 mL" ], [ "5 kg", "0.5 mg", "0.1 mL" ], [ "6 kg", "0.6 mg", "0.12 mL" ], [ "8 kg", "0.8 mg", "0.16 mL" ], [ "10 kg", "1 mg", "0.2 mL" ], [ "12 kg", "1.2 mg", "0.24 mL" ], [ "15 kg", "1.5 mg", "0.3 mL" ], [ "20 kg", "2 mg", "0.4 mL" ], [ "25 kg", "2.5 mg", "0.5 mL" ], [ "30 kg", "3 mg", "0.6 mL" ], [ "35 kg", "3.5 mg", "0.7 mL" ], [ "40 kg", "4 mg", "0.8 mL" ], [ "45 kg", "4.5 mg", "0.9 mL" ], [ "50 kg", "5 mg", "1 mL" ], [ "60 kg", "5 mg", "1 mL" ] ] }, "generatedPediatric": true }, { "heading": "Pediatric weight bands — cardioversion sedation", "id": "pediatric-cardioversion", "items": [ "I-20 pages 1–10: base hospital order required for cardioversion sedation; the chart lists IN/IV/IM and 5 mg/mL. Confirm the specific order and timing.", "Published band doses below are distinct from seizure and toxic-delirium regimens. Do not extrapolate outside the bands." ], "table": { "headers": [ "I-20 weight band", "Base-ordered dose", "Concentration" ], "rows": [ [ "3–5 kg", "0.4 mg", "5 mg/mL" ], [ "6–7 kg", "0.6 mg", "5 mg/mL" ], [ "8–9 kg", "0.8 mg", "5 mg/mL" ], [ "10–11 kg", "1 mg", "5 mg/mL" ], [ "12–14 kg", "1.2 mg", "5 mg/mL" ], [ "15–18 kg", "1.5 mg", "5 mg/mL" ], [ "19–23 kg", "2 mg", "5 mg/mL" ], [ "24–29 kg", "2.5 mg", "5 mg/mL" ], [ "30–36 kg", "3.5 mg", "5 mg/mL" ], [ "37–49 kg", "4.5 mg", "5 mg/mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Stock is 5 mg/mL; verify route, dose, indication, previous doses, and timing.", "Monitor oxygenation and ventilation. Seizure orders direct BVM assistance when ETCO₂ is 50 mmHg or more.", "I-15 and the full behavioral order differ in some repeat-dose details; this page uses the indication-specific SO-M-030 wording. For airway sedation, open the linked SO-M-080 / SO-P-120 rather than reusing another row." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Be ready to assist ventilation and protect the airway if respiratory depression occurs.", "Adult seizure: contact base if activity continues for 5 minutes after the first IM dose or second IV/IN/IO dose (10 mg total by any route)." ], "related": [ "seizures", "pediatric-seizures", "bradycardia" ], "sourcePage": 3, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/midazolam/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=3", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-040", "title": "Seizure / Convulsions - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf", "checked": "2026-09-16" }, { "code": "SO-P-075", "title": "Seizure / Convulsion - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf", "checked": "2026-09-16" }, { "code": "SO-C-020", "title": "Symptomatic Bradycardia - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-C-20%20Bradycardia.pdf", "checked": "2026-09-16" }, { "code": "SO-M-030", "title": "Psychiatric / Behavioral Emergencies", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-030%20Behavioral%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-M-080", "title": "Sedation for Endotracheal or LMA Intubation - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-M-80%20Sedation%20for%20ETT%20or%20LMA.pdf", "checked": "2026-09-16" }, { "code": "SO-P-120", "title": "Pre-Existing Endotracheal Intubation Requiring Sedation - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-120%20Peds%20sedate%20existing%20ETT.pdf", "checked": "2026-09-16" }, { "code": "SO-P-070", "title": "Psychiatric / Behavioral Emergencies - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/SO-P-070%20Peds%20Behavioral%2004-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/midazolam.md" }, { "slug": "morphine", "title": "Morphine sulfate", "description": "Adult formulation-dependent doses and pediatric weight-based analgesia.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-015", "SO-T-005", "SO-E-005", "SO-P-015", "SO-P-095" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "morphine sulfate adult formulation-dependent doses and pediatric weight-based analgesia.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Opioid analgesia for appropriate injury/burn pain and IV treatment of suspected cardiac pain after nitroglycerin fails or cannot be given.", "I-15 retains different adult doses for the 4 mg carpuject and 10 mg/mL vial presentations." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Pain — IV/IM", "4 mg from the 4 mg carpuject, or 5 mg with the 10 mg/mL vial. May repeat once after about 3 minutes for persistent pain." ], [ "Cardiac pain", "Use the IV route under SO-C-015 after 3 nitroglycerin doses fail or nitroglycerin cannot be administered." ], [ "IO in crush/burn injury", "Only if already established for other treatment: 4 mg or 5 mg according to the preparation, with one repeat after 3 minutes as specified in I-15." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-015 severe injury pain: 0.1 mg/kg IV/IM, maximum 5 mg per dose. May repeat once after 3 minutes; total maximum 10 mg.", "Contact base for children age 2 or younger under SO-P-015. Check the pediatric condition order before using an IO route." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Severe injury pain", "id": "pediatric-weight-1", "items": [ "Source: SO-P-015. Dose rule: 0.1 mg/kg; route: IV/IM.", "0.1 mg/kg IV/IM, maximum 5 mg per dose. May repeat once after 3 minutes; total maximum 10 mg.", "Base contact is required for age 2 or younger. Match the product concentration and route: the I-20 examples distinguish IV carpuject products from the 10 mg/mL IM preparation.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IV/IM", "Volume at 1 mg/mL — IV", "Volume at 4 mg/mL — IV", "Volume at 10 mg/mL — IM" ], "rows": [ [ "3 kg", "0.3 mg", "0.3 mL", "0.075 mL", "0.03 mL" ], [ "4 kg", "0.4 mg", "0.4 mL", "0.1 mL", "0.04 mL" ], [ "5 kg", "0.5 mg", "0.5 mL", "0.125 mL", "0.05 mL" ], [ "6 kg", "0.6 mg", "0.6 mL", "0.15 mL", "0.06 mL" ], [ "8 kg", "0.8 mg", "0.8 mL", "0.2 mL", "0.08 mL" ], [ "10 kg", "1 mg", "1 mL", "0.25 mL", "0.1 mL" ], [ "12 kg", "1.2 mg", "1.2 mL", "0.3 mL", "0.12 mL" ], [ "15 kg", "1.5 mg", "1.5 mL", "0.375 mL", "0.15 mL" ], [ "20 kg", "2 mg", "2 mL", "0.5 mL", "0.2 mL" ], [ "25 kg", "2.5 mg", "2.5 mL", "0.625 mL", "0.25 mL" ], [ "30 kg", "3 mg", "3 mL", "0.75 mL", "0.3 mL" ], [ "35 kg", "3.5 mg", "3.5 mL", "0.875 mL", "0.35 mL" ], [ "40 kg", "4 mg", "4 mL", "1 mL", "0.4 mL" ], [ "45 kg", "4.5 mg", "4.5 mL", "1.125 mL", "0.45 mL" ], [ "50 kg", "5 mg", "5 mL", "1.25 mL", "0.5 mL" ], [ "60 kg", "5 mg", "5 mL", "1.25 mL", "0.5 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Confirm the concentration on the actual vial/syringe and record total milligrams.", "Reassess pain, respiratory effort, mental status, and blood pressure. Document dose times and response; maintain readiness for airway support." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Withhold if systolic BP is below 90 or falls below 90; adult injury/burn orders require BP above 90 before giving analgesia.", "Morphine is stocked in different concentrations. A matching milligram dose can require a very different volume." ], "related": [ "fentanyl", "trauma", "burns" ], "sourcePage": 3, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/morphine/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=3", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "checked": "2026-09-16" }, { "code": "SO-T-005", "title": "General Injury and Trauma - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-E-005", "title": "Burn (Thermal, Electrical, Chemical) - Adult", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-P-015", "title": "General Injury and Trauma - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-P-095", "title": "Burn (Thermal, Electrical, Chemical) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-95%20Burn%204-2024_0.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/morphine.md" }, { "slug": "mouthwash", "title": "Mouthwash preparations", "description": "Oral-care products listed in the fire-service OTC supply program.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "mouthwash preparations oral-care products listed in the fire-service otc supply program.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/mouthwash/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/mouthwash.md" }, { "slug": "naloxone", "title": "Naloxone (Narcan)", "description": "Restore ventilation in suspected opioid toxicity; distinguish ALS routes from the BLS nasal-product pathway.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-050", "SO-P-085", "SO-B-002", "325.00" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "naloxone (narcan) restore ventilation in suspected opioid toxicity; distinguish als routes from the bls nasal-product pathway.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "The ALS overdose pathway treats suspected opioid toxicity with respiratory depression, approximately 12 breaths/min or fewer.", "Support ventilation with BVM and suction as needed while treating the suspected cause." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "ALS IV", "0.4–1 mg IV; repeat every 3 minutes as needed to maintain adequate breathing." ], [ "ALS IM / IN solution", "0.8, 1, or 2 mg IM/IN; repeat every 3 minutes as needed." ], [ "Preloaded nasal product", "I-15 directs the preloaded dose, repeating every 3 minutes as needed. Inventory 325.00 lists 4 mg/0.1 mL and optional 8 mg/0.1 mL products; verify the actual device and agency protocol." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-085: 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose; repeat every 3 minutes as needed. It separately lists a preloaded 4 mg/0.1 mL nasal spray.", "Use the condition order’s maximum and the correct concentration; do not assume all prefilled or intranasal products have the same dose." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Suspected opioid toxicity with respiratory depression", "id": "pediatric-weight-1", "items": [ "Source: SO-P-085. Dose rule: 0.1 mg/kg; route: IN/IM/IV.", "0.1 mg/kg IN/IM/IV, maximum 1 mg per dose; may repeat every 3 minutes as needed. Ventilation support comes first.", "The separate 4 mg/0.1 mL preloaded nasal spray is a fixed single-spray product. Do not use the syringe volumes below for that device.", "I-20 lists a rounded 0.8 mg dose for some 0.4 mg/mL product bands; these examples instead calculate the SO-P-085 0.1 mg/kg regimen with its 1 mg cap. Confirm the actual product and applicable order.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.", "Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice." ], "table": { "headers": [ "Exact weight", "Dose — IN/IM/IV", "Volume at 1 mg/mL", "Volume at 0.8 mg/2 mL = 0.4 mg/mL" ], "rows": [ [ "3 kg", "0.3 mg", "0.3 mL", "0.75 mL" ], [ "4 kg", "0.4 mg", "0.4 mL", "1 mL" ], [ "5 kg", "0.5 mg", "0.5 mL", "1.25 mL" ], [ "6 kg", "0.6 mg", "0.6 mL", "1.5 mL" ], [ "8 kg", "0.8 mg", "0.8 mL", "2 mL" ], [ "10 kg", "1 mg", "1 mL", "2.5 mL" ], [ "12 kg", "1 mg", "1 mL", "2.5 mL" ], [ "15 kg", "1 mg", "1 mL", "2.5 mL" ], [ "20 kg", "1 mg", "1 mL", "2.5 mL" ], [ "25 kg", "1 mg", "1 mL", "2.5 mL" ], [ "30 kg", "1 mg", "1 mL", "2.5 mL" ], [ "35 kg", "1 mg", "1 mL", "2.5 mL" ], [ "40 kg", "1 mg", "1 mL", "2.5 mL" ], [ "45 kg", "1 mg", "1 mL", "2.5 mL" ], [ "50 kg", "1 mg", "1 mL", "2.5 mL" ], [ "60 kg", "1 mg", "1 mL", "2.5 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "For a nasal device, confirm product strength and follow that device’s instructions. For drawn-up solutions, verify mg/mL before selecting volume.", "Document respiratory response, repeated doses, and prior bystander administration; prepare transport and further ALS care." ] } ], "cautionTitle": "Check before giving", "cautions": [ "SO-B-002 is a separate BLS pathway for stocked equipment, including a 4 mg preloaded spray and a 2 mg atomizer method. Do not transfer ALS repeat-dose rules into the BLS instructions.", "Anticipate vomiting, agitation, and withdrawal after reversal. Continue airway and respiratory reassessment." ], "related": [ "bls-naloxone", "poisoning", "altered-mental-status" ], "sourcePage": 4, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/naloxone/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=4", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "checked": "2026-09-16" }, { "code": "SO-P-085", "title": "Substance Overdose / Poisoning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-B-002", "title": "Naloxone Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf", "checked": "2026-09-16" }, { "code": "325.00", "title": "Advanced Life Support (ALS) Provider Unit Minimum Inventory", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/325.00%20ALS%20Minimum%20Equip%2010-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/naloxone.md" }, { "slug": "narrow-complex-tachycardia", "title": "Regular narrow-complex tachycardia", "description": "Distinguish a compensatory fast rate from the adenosine or urgent-cardioversion pathway.", "category": "Cardiac", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-C-025", "sourceCodes": [ "SO-C-025" ], "version": "See linked source for document revision and implementation dates.", "keywords": "regular narrow-complex tachycardia distinguish a compensatory fast rate from the adenosine or urgent-cardioversion pathway.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Confirm the rhythm & assess perfusion", "items": [ "This adult order applies to a regular rhythm above 100/min with QRS width below 0.12 seconds. Record a rhythm strip.", "Assess BP, consciousness, chest symptoms, oxygenation, and evidence of hypovolemia. Provide oxygen for SpO₂ below 95% as described by the source." ] }, { "heading": "Address suspected volume depletion", "items": [ "For suspected hypovolemia with clear lungs/no CHF, give 250 mL normal saline, repeating up to 1 L to maintain perfusion.", "Reassess lung sounds; stop fluid infusion if rales develop. This assessment applies to both the 100–150 range and the faster-rate pathway." ] }, { "heading": "Rate at least 150: choose the branch", "items": [ "With mild chest discomfort, lightheadedness, or diaphoresis: attempt Valsalva. If the regular narrow-complex rhythm persists, give adenosine 12 mg rapid IV; may repeat once after 3 minutes.", "With cardiac chest discomfort, altered mental status, or systolic BP below 90: synchronized cardioversion at 100 J initially, then once at maximum energy if needed, or use the manufacturer’s recommended settings." ] }, { "heading": "Reassess & transport", "items": [ "Document conversion or persistent rhythm and reassess BP, consciousness, chest symptoms, and perfusion. Provide ALS escort to the nearest ERC or contact base as needed.", "A regular rate near 150 may represent flutter and may not respond to adenosine. The source warns that an unstable patient may require immediate cardioversion without premedication; if synchronization fails, unsynchronized treatment may be needed." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Do not administer adenosine to a wide, irregular rhythm.", "A regular narrow rhythm does not by itself prove a primary arrhythmia; assess suspected hypovolemia and stability first." ], "related": [ "adenosine", "normal-saline" ], "url": "https://www.ocmedic.com/guides/narrow-complex-tachycardia/", "sources": [ { "code": "SO-C-025", "title": "Narrow Complex QRS Complex Tachycardia", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/34670.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-C-025", "title": "Narrow Complex QRS Complex Tachycardia", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/34670.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/narrow-complex-tachycardia.md" }, { "slug": "nausea-vomiting", "title": "Nausea, vomiting & dehydration", "description": "Manage airway risk, assess perfusion, and use the adult or pediatric antiemetic pathway.", "category": "Medical", "population": "Adult & pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-060", "sourceCodes": [ "SO-M-060", "SO-P-090" ], "version": "See linked source for document revision and implementation dates.", "keywords": "nausea, vomiting & dehydration manage airway risk, assess perfusion, and use the adult or pediatric antiemetic pathway.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Assess before treating symptoms", "items": [ "Evaluate airway protection, vomiting, perfusion, and signs of dehydration. Keep suction available and maintain the airway.", "An altered level of consciousness or severe poor perfusion should prompt the applicable broader condition order rather than an antiemetic-only approach." ] }, { "heading": "Adult / adolescent", "items": [ "For dehydration or poor perfusion with clear lungs/no CHF, give 250 mL saline boluses up to 1 L as needed for perfusion.", "For continued nausea/vomiting when pregnancy is not known or suspected: ondansetron 8 mg ODT, or 4 mg IV. The IV dose may repeat once after about 3 minutes for continued/recurrent symptoms.", "Transport to an appropriate ERC, with ALS escort when medication or fluids were needed." ] }, { "heading": "Pediatric — SO-P-090", "items": [ "For dehydration/poor perfusion, give 20 mL/kg saline IV/IO, maximum 250 mL per bolus, and contact base (pediatric-capable preferred). May repeat twice for 3 total boluses.", "Age 4 and older: one 4 mg ondansetron ODT as tolerated. The source does not give an ODT regimen below age 4 or routine pediatric IV ondansetron.", "If altered/unresponsive, check glucose and follow the source’s hypoglycemia treatment, including the limited IO dextrose exception." ] }, { "heading": "Reassess & handoff", "items": [ "Reassess airway protection, vomiting frequency, mental status, vital signs, and response to fluid or medication. Document dose times and total fluid.", "Pediatric vomiting can accompany diabetic ketoacidosis with marked hyperglycemia; assess the underlying cause and perfusion, not just symptom relief." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Adult ondansetron orders exclude known or suspected pregnancy.", "Use the pediatric age restriction and fluid maximums explicitly; do not scale the adult ODT regimen by weight." ], "related": [ "ondansetron", "normal-saline", "dextrose" ], "url": "https://www.ocmedic.com/guides/nausea-vomiting/", "sources": [ { "code": "SO-M-060", "title": "Nausea / Vomiting", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12040.pdf", "checked": "2026-09-16" }, { "code": "SO-P-090", "title": "Nausea / Vomiting - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-060", "title": "Nausea / Vomiting", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12040.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/nausea-vomiting.md" }, { "slug": "neosporin", "title": "Neosporin ointment", "description": "The topical OTC ointment product listed in the fire-service source.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "neosporin ointment the topical otc ointment product listed in the fire-service source.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/neosporin/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/neosporin.md" }, { "slug": "nitroglycerin", "title": "Nitroglycerin", "description": "Sublingual adult cardiac/pulmonary-edema treatment and separately authorized transport infusions.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-015", "SO-M-035", "PR-225" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "nitroglycerin sublingual adult cardiac/pulmonary-edema treatment and separately authorized transport infusions.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Use the chest-pain or respiratory-distress standing order that matches the presentation. Their blood-pressure boundaries differ.", "The available SL forms include 0.4 mg tablets, powder packets, and metered sprays." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Cardiac chest pain — SO-C-015", "0.4 mg SL when systolic BP is above 100; repeat about every 3 minutes for discomfort, up to 3 EMS doses while BP stays above 100. Patient self-doses before EMS are not counted in those 3 doses." ], [ "Suspected CHF/pulmonary edema — SO-M-035", "0.4 mg SL when systolic BP is at least 100; may repeat twice if it remains at least 100. At systolic BP at least 150, use 0.8 mg SL and may repeat twice while it stays at least 150; reduce to 0.4 mg if BP falls below 150 but remains above 100." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "No routine pediatric field nitroglycerin regimen is listed in I-20. Do not extrapolate the adult SL rows to children.", "Any pre-existing transport infusion requires the applicable transport authorization and sending-facility orders; it is not a pediatric field initiation dose." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "No routine pediatric field regimen is supplied by the cited OCEMS sources; do not scale an adult dose by weight." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Check the formulation: one 0.4 mg dose is not the same as the 0.8 mg pulmonary-edema dose.", "PR-225 governs a pre-existing IFT nitroglycerin infusion; use the prescribed pump rate and its monitoring/stop criteria, not these SL doses." ] }, { "heading": "Interfacility infusion — PR-225", "items": [ "Verify secure access, a working pump, the sending RN/physician’s prescribed rate, and any prior BP problem. Maintain that prescribed infusion rate.", "Monitor rhythm and vital signs continuously. If systolic BP falls below 90 or obvious poor perfusion develops, stop the infusion and transport to the nearest appropriate ERC.", "Document the rate, monitoring, patient condition, and any stop time/reason at handoff. This continuation pathway is distinct from the SL standing-order doses." ] } ], "cautionTitle": "Check before giving", "cautions": [ "SO-C-015 says not to give if sildenafil, vardenafil, or tadalafil was taken within the preceding 24 hours.", "Recheck BP before repeat doses. I-15 and the condition orders use different boundary wording; this page identifies each condition order explicitly." ], "related": [ "chest-pain", "respiratory-distress" ], "sourcePage": 4, "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/nitroglycerin/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=4", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "checked": "2026-09-16" }, { "code": "SO-M-035", "title": "Respiratory Distress", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "PR-225", "title": "Monitoring Nitroglycerin Infusion during Interfacility Transports", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/49722.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/nitroglycerin.md" }, { "slug": "normal-saline", "title": "Normal saline (0.9% sodium chloride)", "description": "Fluid resuscitation, pediatric bolus limits, and nebulized saline are different uses.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-055", "SO-T-005", "SO-P-080", "SO-P-035", "PR-205" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "normal saline (0.9% sodium chloride) fluid resuscitation, pediatric bolus limits, and nebulized saline are different uses.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used in multiple poor-perfusion/hypovolemia pathways and as a diluent or flush where a procedure specifies it.", "Do not apply a universal fluid limit to every condition: hemorrhage/TBI, sepsis, cardiac, and pediatric pathways have different instructions." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "Common medical resuscitation pattern", "250 mL IV boluses, reassessing between doses, up to 1 L in the relevant medical standing order. Observe any clear-lung/no-CHF condition." ], [ "Traumatic hemorrhage / TBI", "SO-T-005 gives separate ongoing-infusion and BP targets. Use that condition-specific pathway rather than assuming a universal 1 L ceiling." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "Many pediatric orders specify 20 mL/kg IV/IO, maximum 250 mL per bolus, and base contact; up to 3 total boluses under the applicable standing order.", "SO-P-080: if pressure does not improve after the first bolus, continue indicated fluid resuscitation and request a pediatric push-dose epinephrine order.", "Croup-like barking cough in SO-P-035: 3 mL normal saline by continuous nebulization as tolerated. This is an inhalation dose, not a fluid-resuscitation dose." ], "id": "pediatric" }, { "heading": "Pediatric weight table — Poor perfusion / hypotension bolus", "id": "pediatric-weight-1", "items": [ "Source: SO-P-080. Dose rule: 20 mL/kg; route: IV/IO.", "20 mL/kg IV/IO, maximum 250 mL per bolus. SO-P-080 permits two repeats for three total boluses, with reassessment.", "Make base contact. If BP does not improve after the first bolus, request the pediatric push-dose epinephrine order while continuing indicated fluid resuscitation.", "This table is for the SO-P-080 shock bolus. Other indications have their own limits; PR-205 directs no fluid bolus when cardiogenic shock presents with pulmonary edema.", "Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes." ], "table": { "headers": [ "Exact weight", "Dose — IV/IO" ], "rows": [ [ "3 kg", "60 mL" ], [ "4 kg", "80 mL" ], [ "5 kg", "100 mL" ], [ "6 kg", "120 mL" ], [ "8 kg", "160 mL" ], [ "10 kg", "200 mL" ], [ "12 kg", "240 mL" ], [ "15 kg", "250 mL" ], [ "20 kg", "250 mL" ], [ "25 kg", "250 mL" ], [ "30 kg", "250 mL" ], [ "35 kg", "250 mL" ], [ "40 kg", "250 mL" ], [ "45 kg", "250 mL" ], [ "50 kg", "250 mL" ], [ "60 kg", "250 mL" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Verify IV versus preservative-free nebulizer product and the intended route.", "Record each bolus volume, cumulative volume, BP, respiratory findings, and response. Use the specific pediatric order for maximums and repeat count." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Reassess lung sounds and perfusion before more fluid. Avoid transferring sepsis fluid instructions into cardiogenic pulmonary edema.", "PR-205 directs immediate base contact without fluids for pediatric cardiogenic shock with pulmonary edema." ], "related": [ "sepsis", "trauma", "pediatric-respiratory-distress" ], "sourcePage": 5, "pediatricDoseType": "weight-based", "url": "https://www.ocmedic.com/guides/normal-saline/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-055", "title": "Suspected Sepsis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf", "checked": "2026-09-16" }, { "code": "SO-T-005", "title": "General Injury and Trauma - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-P-080", "title": "Shock (Symptomatic Hypotension) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-P-035", "title": "Acute Respiratory Distress - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "PR-205", "title": "Preparation and Dosing of Push Dose Epinephrine - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/normal-saline.md" }, { "slug": "ondansetron", "title": "Ondansetron (Zofran)", "description": "Adult oral/IV treatment and the pediatric age-4-and-older ODT pathway.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-M-060", "SO-P-090" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "ondansetron (zofran) adult oral/iv treatment and the pediatric age-4-and-older odt pathway.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "For ongoing nausea/vomiting in the applicable condition order. Treat associated airway risk and dehydration as well as symptoms.", "The oral dissolving tablet and IV preparation have different dosing instructions." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "ODT", "8 mg (two 4 mg tablets) dissolved orally, once, when pregnancy is not known or suspected." ], [ "IV", "4 mg IV; may repeat 4 mg once after approximately 3 minutes for continued/recurrent symptoms, when pregnancy is not known or suspected." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-P-090: children age 4 and older may receive one 4 mg ODT tablet dissolved orally, as tolerated.", "The cited pediatric nausea standing order does not provide routine IV dosing or an ODT dose below age 4. Do not infer a weight-scaled adult regimen." ], "id": "pediatric" }, { "heading": "Pediatric dose by age / weight", "id": "pediatric-dose-rules", "items": [ "SO-P-090 applies to ongoing nausea/vomiting. Age, not weight, determines eligibility for this fixed dose." ], "table": { "headers": [ "Age / weight", "Pediatric dose", "Route / limit" ], "rows": [ [ "Younger than 4; any weight", "No dose in this pediatric standing order", "Do not extrapolate from an adult IV dose" ], [ "Age 4 and older; any eligible pediatric weight", "4 mg", "One ODT tablet dissolved orally as tolerated" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Stock includes 4 mg ODT and 4 mg/2 mL IV preparations. Verify the product and route.", "Keep suction available when needed. Reassess vomiting, airway protection, perfusion, and treatment response; follow the applicable fluid pathway." ] } ], "cautionTitle": "Check before giving", "cautions": [ "The adult standing order excludes known or suspected pregnancy.", "Do not let symptom control replace assessment of dehydration, poor perfusion, or an altered level of consciousness." ], "related": [ "nausea-vomiting" ], "sourcePage": 5, "pediatricDoseType": "fixed-or-conditional", "url": "https://www.ocmedic.com/guides/ondansetron/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-M-060", "title": "Nausea / Vomiting", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12040.pdf", "checked": "2026-09-16" }, { "code": "SO-P-090", "title": "Nausea / Vomiting - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/ondansetron.md" }, { "slug": "oral-glucose", "title": "Oral glucose", "description": "Adult and pediatric use depends on a safe swallow, intact airway reflexes, and the matching product.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "SO-B-003", "SO-M-020", "SO-P-065" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "oral glucose adult and pediatric use depends on a safe swallow, intact airway reflexes, and the matching product.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used for hypoglycemia when the patient can safely take an oral preparation.", "ALS and BLS source thresholds differ slightly; choose the applicable standing order rather than treating every glucose-related document as identical." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "ALS hypoglycemia", "I-15 lists glucose at or below 60 mg/dL, or 61–80 with symptoms. Give an oral product as tolerated only if airway reflexes are intact." ], [ "BLS gel / paste", "SO-B-003: small portions between cheek and gum on each side, until the tube is empty." ], [ "BLS solution / tablets", "Small amounts of solution until the product is given, or two chewable tablets per SO-B-003." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "Pediatric condition orders permit oral glucose only when tolerated and airway reflexes are intact; use their glucose threshold.", "SO-B-003 specifies one tablet for children younger than 12 instead of the two-tablet amount. It does not specify grams per tablet; use the exact product, not an invented gram conversion." ], "id": "pediatric" }, { "heading": "Pediatric dose by age / weight", "id": "pediatric-dose-rules", "items": [ "SO-B-003 tablet pathway: the patient must tolerate oral administration and have intact airway reflexes. Tablet strength is not supplied by that source; verify the actual product." ], "table": { "headers": [ "Age / weight", "Dose basis", "Amount" ], "rows": [ [ "Child younger than 12; any weight", "Fixed tablet count", "1 tablet; do not invent a gram dose" ], [ "Age 12 or older; any weight", "Use the applicable SO-B-003 product instructions", "See the oral-glucose source and adult/adolescent section" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Confirm the medication is intended for oral administration. Concentrations and package sizes vary.", "BLS: ensure ALS is responding/present; reassess mental status and vital signs at 5 minutes and every 5 minutes until ALS arrival. Record product and amount." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Do not administer to an unresponsive patient, a patient who cannot swallow, or one without a gag reflex.", "Monitor for gagging, choking, drooling, or uncontrolled coughing and support the airway as needed." ], "related": [ "bls-oral-glucose", "dextrose", "glucagon" ], "sourcePage": 2, "pediatricDoseType": "fixed-or-conditional", "url": "https://www.ocmedic.com/guides/oral-glucose/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "checked": "2026-09-16" }, { "code": "SO-B-003", "title": "Glucose Oral Administration", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/69066.pdf", "checked": "2026-09-16" }, { "code": "SO-M-020", "title": "Altered Mental Status", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf", "checked": "2026-09-16" }, { "code": "SO-P-065", "title": "Altered Mental Status - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/oral-glucose.md" }, { "slug": "oxygen", "title": "Oxygen", "description": "Adult and pediatric oxygen delivery, ventilation support, and condition-specific exceptions.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "SO-M-035", "SO-P-035", "SO-E-005", "SO-P-040" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "oxygen adult and pediatric oxygen delivery, ventilation support, and condition-specific exceptions.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "Used for hypoxia and in selected smoke/CO exposure, resuscitation, and diving-related pathways.", "SpO₂ alone cannot assess ventilation; use respiratory effort and available capnography alongside oximetry." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "General I-15 oxygen therapy", "High-flow mask (preferred; I-15 lists 10 L/min) or nasal cannula at 6 L/min, as tolerated, for suspected hypoxia/SpO₂ below 95% and specified exposure indications." ], [ "COPD respiratory distress — SO-M-035", "The initial NC option is 2 L/min. Do not withhold oxygen in severe hypoxia/distress; prepare to assist ventilation." ], [ "Chronic home oxygen", "I-15 lists maintenance of the home flow rate; acute distress still requires assessment and treatment under its standing order." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "Pediatric respiratory orders use high-flow mask or nasal cannula/direct blow-by at 6 L/min as tolerated when SpO₂ is below 95%.", "Support inadequate ventilation with BVM as indicated. The adult COPD-specific 2 L/min wording is not a pediatric default." ], "id": "pediatric" }, { "heading": "Pediatric dose by age / weight", "id": "pediatric-dose-rules", "items": [ "SO-P-035 uses oxygen according to respiratory status and oxygen saturation, not an mg/kg formula. Assist inadequate ventilation with BVM." ], "table": { "headers": [ "Weight", "Treatment trigger", "Delivery" ], "rows": [ [ "Any pediatric weight", "Room-air SpO₂ below 95% under the respiratory order", "High-flow mask or nasal cannula/direct blow-by at 6 L/min, as tolerated" ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Select the device and flow specified for the condition and reassess tolerance, work of breathing, oxygenation, and ventilation.", "For cardiac arrest, use the resuscitation airway/ventilation pathway. For CPAP, check age, contraindications, pressure, and monitoring separately." ] } ], "cautionTitle": "Check before giving", "cautions": [ "A normal or high pulse-oximeter reading may be misleading with smoke/carbon-monoxide exposure.", "Do not mistake oxygen delivery for correction of apnea or inadequate ventilation." ], "related": [ "respiratory-distress", "pediatric-respiratory-distress", "burns", "cpap" ], "sourcePage": 5, "pediatricDoseType": "fixed-or-conditional", "url": "https://www.ocmedic.com/guides/oxygen/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5", "checked": "2026-09-16" }, { "code": "SO-M-035", "title": "Respiratory Distress", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-P-035", "title": "Acute Respiratory Distress - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-E-005", "title": "Burn (Thermal, Electrical, Chemical) - Adult", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/oxygen.md" }, { "slug": "pediatric-altered-mental-status", "title": "Pediatric altered mental status", "description": "Protect ventilation, assess perfusion, check glucose, and treat the identified cause.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-065", "sourceCodes": [ "SO-P-065" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric altered mental status Protect ventilation, assess perfusion, check glucose, and treat the identified cause. SO-P-065", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Initial assessment", "items": [ "Protect the airway and assist ventilation with BVM when needed. Monitor rhythm and document a strip.", "Check SpO₂; below 95% on room air, provide high-flow mask oxygen or nasal cannula/direct blow-by as tolerated. Obtain history, medication access, onset, and a measured or appropriately estimated weight." ] }, { "heading": "Poor perfusion", "items": [ "For poor perfusion or systolic BP below 80, establish IV/IO and give normal saline 20 mL/kg, maximum 250 mL, with base contact.", "May repeat twice for three total boluses. Reassess BP, lung sounds, skin signs, and mental status rather than giving repeats automatically." ] }, { "heading": "Hypoglycemia", "items": [ "Measure and document glucose. Below 60 mg/dL, use oral glucose only if tolerated with intact airway reflexes, or D10 5 mL/kg IV, maximum 250 mL.", "If IV cannot be established, glucagon is 0.5 mg IM. IO dextrose under this order requires unconsciousness, glucose below 60, inability to obtain IV, and no response to IM glucagon." ] }, { "heading": "Suspected opioid toxicity & transport", "items": [ "For suspected narcotic toxicity with respiratory rate at or below 12/min, support ventilation and give naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg, every 3 minutes as needed. The source separately lists the preloaded 4 mg/0.1 mL nasal spray.", "Reassess and document response to every treatment. Provide ALS escort to an appropriate ERC; contact base as needed, with a pediatric-capable base preferred." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Do not give oral glucose to a child who cannot protect the airway.", "Use the glucose threshold in this condition order; the seizure order has different threshold wording." ], "related": [ "dextrose", "glucagon", "naloxone", "normal-saline", "pediatric-assessment" ], "url": "https://www.ocmedic.com/guides/pediatric-altered-mental-status/", "sources": [ { "code": "SO-P-065", "title": "Altered Mental Status - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-065", "title": "Altered Mental Status - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-altered-mental-status.md" }, { "slug": "pediatric-anaphylaxis", "title": "Pediatric allergic reaction & anaphylaxis", "description": "Use weight-based epinephrine first for anaphylaxis, then treat airway, breathing, and perfusion.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-060", "sourceCodes": [ "SO-P-060" ], "version": "See linked source for document revision and implementation dates.", "keywords": "pediatric allergic reaction & anaphylaxis use weight-based epinephrine first for anaphylaxis, then treat airway, breathing, and perfusion.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Classify the reaction", "items": [ "Stable rash/urticaria alone has a different branch from angioedema or systemic anaphylaxis; SpO₂ below 95% moves the patient to the anaphylaxis branch.", "Anaphylaxis findings include hypotension, wheeze, hypoxia, stridor, intraoral swelling, GI symptoms, or impending obstruction.", "For isolated facial/cervical angioedema, the source lists one 0.01 mg/kg IM epinephrine dose (maximum 0.5 mg), held if an auto-injector was already given, plus oxygen and diphenhydramine as specified." ] }, { "heading": "First-line anaphylaxis care", "items": [ "Give epinephrine 0.01 mg/kg IM of 1 mg/mL into the lateral thigh; maximum 0.5 mg. Count prior auto-injector treatment as the first dose.", "Provide oxygen as tolerated. For hypotension, give normal saline 20 mL/kg IV/IO, maximum 250 mL per bolus, and contact base; may repeat twice for 3 total boluses.", "For wheeze or room-air hypoxia below 95%, give continuous albuterol 5 mg/6 mL as tolerated." ] }, { "heading": "Persistent symptoms after about 5 minutes", "items": [ "With continued hypotension, respiratory distress, or impending obstruction, a second dose may be 0.01 mg/kg IM of 1 mg/mL, maximum 0.5 mg; OR 0.01 mg/kg IV/IO of 0.1 mg/mL, maximum 0.3 mg.", "After initial epinephrine, give diphenhydramine 1 mg/kg IM/IV/IO once, maximum 50 mg, unless already taken before EMS arrival." ] }, { "heading": "Contact & transport", "items": [ "Contact base (pediatric-capable preferred) and provide ALS escort to the designated pediatric-capable or other ERC.", "Reassess airway, respiratory effort, perfusion, and response repeatedly. Even a resolving reaction after self-administered epinephrine needs ALS evaluation and transport as described by the source." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "The IM and IV/IO epinephrine solutions have different concentrations and maximum doses.", "Document prearrival epinephrine and diphenhydramine to avoid treating those doses as if they never occurred." ], "related": [ "epinephrine", "diphenhydramine", "albuterol", "normal-saline" ], "url": "https://www.ocmedic.com/guides/pediatric-anaphylaxis/", "sources": [ { "code": "SO-P-060", "title": "Allergic Reaction / Anaphylaxis - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-060", "title": "Allergic Reaction / Anaphylaxis - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-anaphylaxis.md" }, { "slug": "pediatric-assessment", "title": "Pediatric assessment triangle", "description": "Use appearance, breathing, and skin circulation for a rapid first impression.", "category": "Assessment", "population": "Pediatric", "scope": "Assessment", "section": "procedures", "sourceCode": "PR-001", "version": "Revised August 19, 2019 · Implemented April 1, 2020", "keywords": "pat child infant ticls tone interaction consolability gaze cry breathing circulation", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "1. Appearance", "items": [ "Tone: observe movement and posture.", "Interaction: look for alertness and engagement with people or surroundings.", "Consolability: assess response to a caregiver.", "Look/gaze: observe eye contact and tracking.", "Speech/cry: listen to the strength and character of the voice or cry." ] }, { "heading": "2. Work of breathing", "items": [ "Observe breathing effort and listen for abnormal respiratory sounds." ] }, { "heading": "3. Circulation to skin", "items": [ "Observe skin color for pallor, mottling, or cyanosis." ] }, { "heading": "Turn the impression into a focused assessment", "items": [ "Use the triangle as a rapid visual/auditory impression, then assess airway, ventilation, perfusion, and mental status. It does not supply a stand-alone diagnosis or treatment order.", "When documenting depressed consciousness, use the age-appropriate GCS components; PR-002 has separate scoring for age 2 and younger." ] }, { "heading": "Find the next pathway", "items": [ "For respiratory distress, use SO-P-035 and reassess the response to oxygen, airway support, and the specific treatment. For altered mental status, SO-P-065 includes a glucose check and treatment of poor perfusion.", "310.00 identifies pediatric respiratory distress and circulatory compromise as base-contact triggers, with a pediatric-capable base preferred. A reassuring momentary appearance does not cancel the source’s BRUE contact criteria." ] } ], "cautionTitle": "First impression", "cautions": [ "Use visual and auditory observations. The triangle is particularly useful in children younger than 5.", "Continue assessment and use the applicable pediatric standing order for treatment." ], "related": [ "pediatric-respiratory-distress", "pediatric-seizures", "gcs", "base-contact" ], "sourceCodes": [ "PR-001", "PR-002", "SO-P-035", "SO-P-065", "310.00" ], "kind": "clinical", "url": "https://www.ocmedic.com/guides/pediatric-assessment/", "sources": [ { "code": "PR-001", "title": "Pediatric Assessment Triangle", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12401.pdf", "checked": "2026-09-16" }, { "code": "PR-002", "title": "Glasgow Coma Scale (Score)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/PR-02%20GCS%20%28Score%29%2011-2023.pdf", "checked": "2026-09-16" }, { "code": "SO-P-035", "title": "Acute Respiratory Distress - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "SO-P-065", "title": "Altered Mental Status - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf", "checked": "2026-09-16" }, { "code": "310.00", "title": "9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "PR-001", "title": "Pediatric Assessment Triangle", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12401.pdf", "version": "Revised August 19, 2019 · Implemented April 1, 2020", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-assessment.md" }, { "slug": "pediatric-bradycardia", "title": "Pediatric bradycardia", "description": "Correct oxygenation and ventilation first; escalate persistent bradycardia with poor perfusion.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-045", "sourceCodes": [ "SO-P-045", "PR-110" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric bradycardia Correct oxygenation and ventilation first; escalate persistent bradycardia with poor perfusion. SO-P-045", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Assess perfusion", "items": [ "Look for altered mental status, hypotension, weak perfusion, or shock. Ensure the airway is open and rule out obstruction.", "Assist breathing when needed with oxygen and BVM. Monitor rhythm, pulse, BP, and oxygen saturation; preserve a rhythm strip." ] }, { "heading": "Heart rate below 60 with continued poor perfusion", "items": [ "If heart rate remains below 60/min despite oxygenation and ventilation, begin CPR and obtain IV/IO access.", "Give epinephrine 0.01 mg/kg IV/IO using 0.1 mg/mL (0.1 mL/kg); may repeat every 3–5 minutes. Make base contact, pediatric-capable preferred.", "If base contact cannot be established, the order lists atropine 0.02 mg/kg IV/IO for persistent symptomatic bradycardia, increased vagal tone, or primary AV block: minimum 0.1 mg, maximum 0.5 mg per dose; may repeat once." ] }, { "heading": "Further support", "items": [ "Continued poor perfusion may require base-ordered transcutaneous pacing. Use the appropriate pediatric pads/placement under PR-110.", "For suspected hypovolemia or dehydration, normal saline is 20 mL/kg IV/IO, maximum 250 mL per bolus; may repeat twice for three total boluses. Identify causes such as hypoxia, hypothermia, or medication effects." ] }, { "heading": "If perfusion is adequate", "items": [ "Support ABCs and monitor closely. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.", "Obtain a 12-lead and assess the cause. Contact base for destination and ALS escort. Document the response to ventilation before and after each intervention." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Base contact is required. Atropine does not replace oxygenation and ventilation.", "The minimum 0.1 mg and maximum 0.5 mg apply to the bradycardia indication; organophosphate poisoning has a separate atropine regimen." ], "related": [ "atropine", "epinephrine", "normal-saline", "pediatric-cardiac-arrest" ], "url": "https://www.ocmedic.com/guides/pediatric-bradycardia/", "sources": [ { "code": "SO-P-045", "title": "Bradycardia - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf", "checked": "2026-09-16" }, { "code": "PR-110", "title": "Transcutaneous Pacing (TCP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/PR-110%20TCP%204-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-045", "title": "Bradycardia - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-bradycardia.md" }, { "slug": "pediatric-burns", "title": "Pediatric burns", "description": "Assess inhalation injury, treat pain and poor perfusion, and coordinate the burn destination.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-095", "sourceCodes": [ "SO-P-095" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric burns Assess inhalation injury, treat pain and poor perfusion, and coordinate the burn destination. SO-P-095", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "First actions", "items": [ "For enclosed-space burns or smoke exposure, provide high-flow oxygen as tolerated. Pulse oximetry can be misleading with carbon monoxide exposure.", "Cool a burn that remains symptomatic. For wheeze or suspected smoke inhalation, the source lists albuterol 5 mg in 6 mL by continuous nebulization as tolerated." ] }, { "heading": "Pain and circulation", "items": [ "For pain with systolic BP above 80: morphine 0.1 mg/kg IV/IM (maximum 5 mg), OR fentanyl 2 mcg/kg IN/IV/IM (maximum 50 mcg). Each may repeat once after 3 minutes, with total limits of 10 mg morphine or 100 mcg fentanyl.", "Base contact is required at age 2 or younger. Avoid medication injections and IV/IO placement through burned skin.", "For BP at or below 80 or signs of shock, use non-burned access and saline 20 mL/kg IV/IO, maximum 250 mL, with base contact. May repeat twice for three total boluses." ] }, { "heading": "Burn-center criteria", "items": [ "Contact base, pediatric-capable preferred, for suspected inhalation injury, electrical/lightning injury, or chemical burns.", "Other triggers include face/hands/feet/genitalia/perineum involvement, circumferential burns, complicating disease, second-degree burns above 10% TBSA, or any third-degree burn." ] }, { "heading": "Chemical and electrical injuries", "items": [ "Brush off residual dry chemical before irrigation. Use copious continuous water/saline when appropriate, but identify water-reactive chemicals before applying fluids.", "Small electrical skin wounds can conceal deep injury. Follow the source’s high-voltage ALS escort and rhythm-monitoring guidance. Report mechanism, TBSA/depth, airway findings, pain treatment, and fluid response." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "A normal SpO₂ does not exclude carbon monoxide toxicity.", "Do not give fluids blindly to water-reactive chemicals; scene/exposure identification matters." ], "related": [ "fentanyl", "morphine", "normal-saline", "albuterol", "hydroxocobalamin" ], "url": "https://www.ocmedic.com/guides/pediatric-burns/", "sources": [ { "code": "SO-P-095", "title": "Burn (Thermal, Electrical, Chemical) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-95%20Burn%204-2024_0.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-095", "title": "Burn (Thermal, Electrical, Chemical) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-95%20Burn%204-2024_0.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-burns.md" }, { "slug": "pediatric-cardiac-arrest", "title": "Pediatric cardiac arrest", "description": "Follow the pediatric shockable and non-shockable pathways, with weight-based medication and early base contact.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-040", "sourceCodes": [ "SO-P-040" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric cardiac arrest Follow the pediatric shockable and non-shockable pathways, with weight-based medication and early base contact. SO-P-040", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Start resuscitation", "items": [ "Begin or continue high-quality CPR and support ventilation with high-flow oxygen by BVM. Obtain the rhythm and defibrillator without unnecessary interruption.", "Make base contact as soon as possible; a pediatric-capable base is preferred. Establish IV/IO access while maintaining compressions." ] }, { "heading": "VF / pulseless VT", "items": [ "Initial defibrillation: 2 J/kg biphasic, or the source-allowed programmed/manufacturer setting. Continue CPR for about 2 minutes.", "For persistent VF/pulseless VT, use 4 J/kg at the subsequent shock steps. Continue CPR between rhythm assessments and shocks.", "For continued VF/pulseless VT, epinephrine is 0.01 mg/kg IV/IO using 0.1 mg/mL, repeated approximately every 3 minutes.", "For persistent shockable arrest, amiodarone is 5 mg/kg IV/IO, with source-listed repeat doses at 5 and 10 minutes and a stated maximum of 450 mg. Alternative: lidocaine 1 mg/kg IV/IO, maximum 100 mg, once. Follow the full sequence and account for prior doses." ] }, { "heading": "PEA / asystole", "items": [ "Continue CPR and ventilation, establish IV/IO, and give epinephrine 0.01 mg/kg of 0.1 mg/mL IV/IO approximately every 3–5 minutes.", "Look for reversible causes, including hypoxia, hypovolemia, glucose/electrolyte abnormalities, hypothermia, acidosis, tension pneumothorax, tamponade, toxins, or thrombosis.", "For a diabetic patient with suspected hypoglycemia, the arrest order lists D10 5 mL/kg IV/IO, maximum 250 mL. If VF/pulseless VT appears during this branch, follow its 4 J/kg transition step." ] }, { "heading": "ROSC or continuing arrest", "items": [ "After a pulse returns, continue oxygenation and ventilation and correct hypoxia or hypovolemia. Contact base for destination and ALS transport. If base cannot be reached, the source directs transport to the nearest ERC.", "For continuing arrest, request further resuscitation orders and destination direction from base. Report weight, rhythm changes, shocks, medication totals/times, ETCO₂ when available, and any ROSC." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Do not use adult medication doses or adult fixed-energy shocks for a child.", "The current pediatric arrest order does not include routine sodium bicarbonate; an I-20 preparation row alone does not establish an indication." ], "related": [ "epinephrine", "amiodarone", "lidocaine", "pediatric-bradycardia", "dextrose" ], "url": "https://www.ocmedic.com/guides/pediatric-cardiac-arrest/", "sources": [ { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-cardiac-arrest.md" }, { "slug": "pediatric-drowning", "title": "Pediatric non-fatal drowning", "description": "Prioritize ventilation, reassess for deterioration, and obtain the required pediatric destination direction.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-100", "sourceCodes": [ "SO-P-100" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric non-fatal drowning Prioritize ventilation, reassess for deterioration, and obtain the required pediatric destination direction. SO-P-100", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Initial care", "items": [ "Confirm the airway is clear and patent. Use spinal motion restriction for a diving or ocean shore-break mechanism.", "For room-air SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated. Assess ventilatory effort, mental status, perfusion, and temperature." ] }, { "heading": "Respiratory or cardiac compromise", "items": [ "Treat cardiopulmonary arrest using SO-P-040. Monitor and document the rhythm.", "For bradycardia, assist ventilation with high-flow oxygen by BVM. Do not let a monitor task delay ventilation." ] }, { "heading": "Wheezing", "items": [ "If wheezing is present and ventilatory effort is adequate, give albuterol 5 mg in 6 mL by continuous nebulization as tolerated.", "Stop nebulization if the child continually coughs or resists treatment. Reassess air movement and effort; nebulization does not replace assisted ventilation." ] }, { "heading": "Contact and transport", "items": [ "Base contact is required, with a pediatric-capable base preferred. SO-P-100 directs base designation to CHOC, or the nearest appropriate ERC when CHOC transport time exceeds 20 minutes.", "Provide ALS escort. Report the event/mechanism, submersion history if known, airway and ventilation support, response to treatment, and any associated trauma." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Use the pediatric destination rule and obtain base direction.", "Do not apply the adult drowning CPAP step automatically to a child." ], "related": [ "albuterol", "oxygen", "pediatric-cardiac-arrest", "pediatric-bradycardia" ], "url": "https://www.ocmedic.com/guides/pediatric-drowning/", "sources": [ { "code": "SO-P-100", "title": "Non-Fatal Drowning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-100%20Drowning%20pes.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-100", "title": "Non-Fatal Drowning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-100%20Drowning%20pes.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-drowning.md" }, { "slug": "pediatric-nausea-vomiting", "title": "Pediatric nausea / vomiting", "description": "Treat dehydration, protect the airway, and use ondansetron only within its age-specific pediatric order.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-090", "sourceCodes": [ "SO-P-090" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric nausea / vomiting Treat dehydration, protect the airway, and use ondansetron only within its age-specific pediatric order. SO-P-090", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Assess severity", "items": [ "Assess hydration, perfusion, mental status, abdominal symptoms, duration, and ability to tolerate intake. Repeated vomiting can produce hypovolemia.", "Maintain the airway and suction when needed. Consider an underlying illness rather than treating the symptom alone." ] }, { "heading": "Fluid resuscitation", "items": [ "If dehydration or poor perfusion is present, establish IV/IO and give saline 20 mL/kg, maximum 250 mL per bolus, with base contact.", "A pediatric-capable base is preferred. May repeat twice for three total boluses; reassess circulation and respiratory status between boluses." ] }, { "heading": "Antiemetic & glucose", "items": [ "For ongoing nausea/vomiting in a child age 4 or older, give one 4 mg ondansetron ODT tablet to dissolve orally as tolerated. This is a fixed dose, not mg/kg.", "If altered or unresponsive, check glucose. Below 60 mg/dL, follow the source options: oral glucose only with intact airway reflexes, D10 5 mL/kg IV (maximum 250 mL), or glucagon 0.5 mg IM if IV cannot be established. IO dextrose requires the listed additional criteria." ] }, { "heading": "Reassessment & handoff", "items": [ "Reassess vomiting, airway protection, hydration, mental status, glucose response, and treatment tolerance. Marked hyperglycemia with vomiting may indicate DKA; follow the full source rather than assuming gastroenteritis.", "Provide ALS transport to the nearest appropriate ERC and contact base as needed. Document age, weight, fluid totals, medication, and response." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "SO-P-090 does not supply an ondansetron dose below age 4 or a routine pediatric IV regimen.", "Use oral medication only when the child can safely tolerate it." ], "related": [ "ondansetron", "normal-saline", "dextrose", "glucagon", "pediatric-shock" ], "url": "https://www.ocmedic.com/guides/pediatric-nausea-vomiting/", "sources": [ { "code": "SO-P-090", "title": "Nausea / Vomiting - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-090", "title": "Nausea / Vomiting - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-nausea-vomiting.md" }, { "slug": "pediatric-poisoning", "title": "Pediatric overdose / poisoning", "description": "Support breathing, identify the exposure, and use the toxin-specific pediatric pathway.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-085", "sourceCodes": [ "SO-P-085", "PR-130" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric overdose / poisoning Support breathing, identify the exposure, and use the toxin-specific pediatric pathway. SO-P-085", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Airway, glucose & exposure", "items": [ "Assist ventilation with BVM and suction as needed. Determine the likely substance, dose, time, route, and any co-exposures; bring useful packaging when safe.", "Check glucose. At 60 mg/dL or less, oral glucose requires intact airway reflexes; D10 is 5 mL/kg IV, maximum 250 mL, or glucagon 0.5 mg IM when IV is unavailable. The IO dextrose exception has additional criteria." ] }, { "heading": "Opioids or stimulants", "items": [ "For suspected opioid toxicity with respiratory rate at or below 12/min: naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose, every 3 minutes as needed. The 4 mg/0.1 mL preloaded nasal spray is a separate fixed product.", "For stimulant toxicity, continuously assess ventilation and SpO₂. Sudden hypoventilation, desaturation, or apnea requires BVM and oxygen. The source lists saline 20 mL/kg IV/IO, maximum 250 mL, with up to three total boluses; assess for hyperthermia and begin cooling when indicated." ] }, { "heading": "Other named exposures", "items": [ "Extrapyramidal reaction: diphenhydramine 1 mg/kg IM/IV once, maximum 50 mg.", "Organophosphate/chemical-agent poisoning: atropine 0.02 mg/kg IV, repeat once as needed; alternate IM dose 0.1 mg/kg, repeat after 5 minutes as needed, maximum single dose 2 mg.", "For suspected CO or cyanide exposure, provide high-flow oxygen. PR-130 adds base-ordered hydroxocobalamin for its cyanide indications; do not treat every exposure as cyanide poisoning." ] }, { "heading": "Reassess & transport", "items": [ "SO-P-085 permits its listed medications by IO; preserve the separate dextrose exception and indication-specific directions.", "All suspected pediatric overdose/poisoning victims receive ALS escort to the nearest appropriate ERC. Report airway support, serial ventilation findings, exposure details, and all medication totals." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Naloxone should not delay ventilation. Monitor for recurrent respiratory depression.", "Atropine doses for poisoning differ from bradycardia doses." ], "related": [ "naloxone", "atropine", "diphenhydramine", "hydroxocobalamin", "dextrose" ], "url": "https://www.ocmedic.com/guides/pediatric-poisoning/", "sources": [ { "code": "SO-P-085", "title": "Substance Overdose / Poisoning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf", "checked": "2026-09-16" }, { "code": "PR-130", "title": "Hydroxocobalamin for Cyanide Toxicity", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-085", "title": "Substance Overdose / Poisoning - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-poisoning.md" }, { "slug": "pediatric-respiratory-distress", "title": "Pediatric respiratory distress", "description": "Distinguish wheeze, croup-like cough, anaphylaxis, and poor perfusion.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-035", "sourceCodes": [ "SO-P-035", "PR-120", "SO-P-060", "310.00", "I-20" ], "version": "See linked source for document revision and implementation dates.", "keywords": "pediatric respiratory distress distinguish wheeze, croup-like cough, anaphylaxis, and poor perfusion.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "First assessment", "items": [ "Assess appearance, work of breathing, and circulation, then support the airway and ventilation as needed.", "When SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.", "Check for an allergic trigger, upper-airway obstruction, wheeze, barking cough, and poor perfusion." ] }, { "heading": "Wheeze or anaphylaxis", "items": [ "For suspected asthma with wheeze: albuterol 5 mg in 6 mL by continuous nebulization as tolerated. If there is no improvement, consider a base-order request for IM epinephrine.", "For possible anaphylaxis with upper-airway obstruction or respiratory distress: epinephrine 0.01 mg/kg IM of the 1 mg/mL preparation, maximum 0.5 mg, and the fuller SO-P-060 pathway.", "CPAP requires an appropriate mask and the separate PR-120 criteria; the current procedure applies from age 8, with pediatric pressure no higher than 5 cm H₂O." ] }, { "heading": "Croup-like cough & perfusion", "items": [ "For recurrent barking-type cough, the source lists 3 mL normal saline by continuous nebulization as tolerated.", "With poor perfusion, obtain IV/IO and give 20 mL/kg saline, maximum 250 mL, with base contact. May repeat twice for 3 total boluses." ] }, { "heading": "Reassess & escalate", "items": [ "Use ALS escort to the nearest appropriate ERC. Contact base, pediatric-capable preferred, if there is no response or status worsens.", "310.00 also includes pediatric respiratory distress as a base-contact trigger. Record the child’s weight, respiratory findings, treatment, and response.", "The I-20 newborn band lists a different albuterol amount from the general respiratory-order wording. Reconcile neonatal dosing with base rather than silently substituting a chart row." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "IM asthma epinephrine requires the base-order pathway; anaphylaxis has its own standing-order criteria.", "Do not use pediatric CPAP below age 8 or above the pediatric pressure limit." ], "related": [ "albuterol", "epinephrine", "normal-saline", "cpap", "pediatric-assessment" ], "url": "https://www.ocmedic.com/guides/pediatric-respiratory-distress/", "sources": [ { "code": "SO-P-035", "title": "Acute Respiratory Distress - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "PR-120", "title": "Continuous Positive Airway Pressure (CPAP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-P-060", "title": "Allergic Reaction / Anaphylaxis - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf", "checked": "2026-09-16" }, { "code": "310.00", "title": "9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-035", "title": "Acute Respiratory Distress - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-respiratory-distress.md" }, { "slug": "pediatric-seizures", "title": "Pediatric seizure / convulsions", "description": "Use weight-based seizure treatment, monitor ventilation, and contact base for every patient.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-075", "sourceCodes": [ "SO-P-075" ], "version": "See linked source for document revision and implementation dates.", "keywords": "pediatric seizure / convulsions use weight-based seizure treatment, monitor ventilation, and contact base for every patient.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Recognize the emergency", "items": [ "Treat ongoing seizure activity or repeated episodes without recovery of consciousness. Turn to the side, protect the airway, and suction when possible.", "Status epilepticus includes a seizure longer than 5 minutes or repeated seizures without recovery. Subclinical activity can present with abnormal vital signs, gaze deviation, or a clenched jaw." ] }, { "heading": "Midazolam by weight", "items": [ "Preferred: 0.2 mg/kg IM once, maximum 10 mg.", "If IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg. Repeat once after 3 minutes for continuing or recurrent seizures.", "Keep the preferred one-dose IM pathway distinct from the lower-dose alternate-route repeat pathway." ] }, { "heading": "Oxygenation, ventilation & glucose", "items": [ "Monitor SpO₂ and available waveform capnography. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.", "Assist with BVM when ETCO₂ is at least 50 mmHg.", "Check glucose: treat at or below 60 mg/dL, or use field impression at 60–80 when hypoglycemia is suspected. D10 is 5 mL/kg IV (maximum 250 mL); glucagon 0.5 mg IM if IV cannot be established. The IO dextrose exception requires unconsciousness, glucose below 60, no IV, and no response to glucagon." ] }, { "heading": "Required contact & handoff", "items": [ "Make base contact for every transported and non-transported pediatric seizure patient; pediatric-capable base preferred. Provide ALS escort to the nearest appropriate ERC.", "Report weight, seizure duration/pattern, recovery or persistent altered state, glucose, medication route/dose/time, and respiratory response." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Base contact is required even if the seizure stops or the patient is not transported.", "Support ventilation and airway protection after medication; do not rely on cessation of visible motor activity alone." ], "related": [ "midazolam", "dextrose", "glucagon", "gcs", "pediatric-assessment" ], "url": "https://www.ocmedic.com/guides/pediatric-seizures/", "sources": [ { "code": "SO-P-075", "title": "Seizure / Convulsion - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-075", "title": "Seizure / Convulsion - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-seizures.md" }, { "slug": "pediatric-shock", "title": "Pediatric shock / hypotension", "description": "Reassess after each weight-based fluid bolus and obtain base direction for pediatric push-dose epinephrine.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-080", "sourceCodes": [ "SO-P-080", "PR-205" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric shock / hypotension Reassess after each weight-based fluid bolus and obtain base direction for pediatric push-dose epinephrine. SO-P-080", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Recognize and monitor", "items": [ "Assess mental status, pulses, skin signs, BP, respiratory effort, and possible hemorrhage, dehydration, infection, or cardiac disease. Monitor and document the rhythm.", "For room-air SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated. Use the pediatric bradycardia pathway when indicated." ] }, { "heading": "Initial resuscitation", "items": [ "Establish IV; if unresponsive and peripheral IV cannot be obtained, consider IO. Give normal saline 20 mL/kg IV/IO, maximum 250 mL per bolus, and make base contact.", "The order allows two repeats for three total boluses. Reassess BP and perfusion after each bolus. If BP fails to improve after the first bolus, continue indicated fluids and request a base order for pediatric push-dose epinephrine." ] }, { "heading": "Pediatric push-dose epinephrine", "items": [ "PR-205 requires base contact and an order before administration. Its dose is 1 mcg/kg IV/IO of the 10 mcg/mL mixture, maximum 10 mcg (1 mL), repeatable every 3 minutes as ordered.", "If cardiogenic shock presents with pulmonary edema, PR-205 directs base contact without giving a fluid bolus. Exclusions include uncorrected hypovolemic shock and suspected stimulant intoxication." ] }, { "heading": "Glucose & transport", "items": [ "At glucose 60 mg/dL or less, use oral glucose if tolerated with intact airway reflexes, D10 5 mL/kg IV (maximum 250 mL), or glucagon 0.5 mg IM when IV is unavailable. Respect the source-specific IO dextrose conditions.", "Provide ALS escort and report the suspected cause, weight, cumulative fluids, BP response, glucose, medication dose/concentration, and base orders." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Pediatric push-dose epinephrine still requires a base order; the adult PR-230 authorization change does not apply.", "Do not automatically give fluid to a child with cardiogenic shock and pulmonary edema." ], "related": [ "normal-saline", "epinephrine", "dextrose", "pediatric-bradycardia" ], "url": "https://www.ocmedic.com/guides/pediatric-shock/", "sources": [ { "code": "SO-P-080", "title": "Shock (Symptomatic Hypotension) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf", "checked": "2026-09-16" }, { "code": "PR-205", "title": "Preparation and Dosing of Push Dose Epinephrine - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-080", "title": "Shock (Symptomatic Hypotension) - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-05/SO-P-80%20Shock%205-2025.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-shock.md" }, { "slug": "pediatric-temperature-emergencies", "title": "Pediatric heat illness / hypothermia", "description": "Separate cooling from warming pathways and recognize when altered mental status or arrest changes the response.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-105", "sourceCodes": [ "SO-P-105" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric heat illness / hypothermia Separate cooling from warming pathways and recognize when altered mental status or arrest changes the response. SO-P-105", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Mild or moderate heat illness", "items": [ "Move to shade or a cooler area with airflow. Use a fan when available and passive cooling such as cool wet towels or cold packs as tolerated.", "Encourage water or a balanced, non-caffeinated salt drink only when oral intake can be safely tolerated. Reassess mental status and perfusion for progression." ] }, { "heading": "Severe hyperthermia", "items": [ "Confusion/unconsciousness, hot dry skin, or hypotension activates the severe pathway. Contact base early for destination, pediatric-capable preferred. Provide the source’s high-flow oxygen support.", "For hypotension or poor perfusion, saline is 20 mL/kg IV/IO, maximum 250 mL, with base contact; may repeat twice for three total boluses.", "Use available active/passive cooling, including cold packs at the axillae, posterior neck, and groin with airflow. The source directs ALS escort for all pediatric hyperthermia patients." ] }, { "heading": "Hypothermia with a pulse", "items": [ "Remove wet clothing, conserve heat, and begin available warming. Monitor and document the rhythm.", "Expect a slow rate and weak pulse; SO-P-105 directs against trying to reverse hypothermic bradycardia in the field. Transport immediately to the nearest ERC." ] }, { "heading": "Apparent arrest", "items": [ "Check for a pulse for 30–45 seconds before starting CPR. If arrested, use the pediatric arrest pathway; assist ventilation without hyperventilating and continue warming.", "Do not pronounce in the field under this pathway. Contact base and provide ALS transport to the nearest appropriate ERC. Report exposure, warming/cooling measures, perfusion, rhythm, and fluids." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Keep hypothermic bradycardia distinct from the ordinary pediatric bradycardia algorithm.", "Severe heat illness requires prompt cooling and transport; do not wait for a precise temperature to recognize the listed clinical triggers." ], "related": [ "normal-saline", "pediatric-shock", "pediatric-cardiac-arrest" ], "url": "https://www.ocmedic.com/guides/pediatric-temperature-emergencies/", "sources": [ { "code": "SO-P-105", "title": "Thermal Disorders - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-105%20Hyper-hypothermia.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-105", "title": "Thermal Disorders - Pediatric", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-105%20Hyper-hypothermia.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-temperature-emergencies.md" }, { "slug": "pediatric-trauma", "title": "Pediatric injury / trauma", "description": "Control hemorrhage, reassess perfusion, and keep pediatric analgesia and head-injury targets distinct.", "category": "Pediatric", "population": "Pediatric", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-P-015", "sourceCodes": [ "SO-P-015" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Pediatric injury / trauma Control hemorrhage, reassess perfusion, and keep pediatric analgesia and head-injury targets distinct. SO-P-015", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Bleeding control", "items": [ "Apply direct pressure. If controlled, secure a pressure dressing. For persistent bleeding, consider a hemostatic dressing with direct pressure.", "For uncontrolled extremity bleeding despite these measures, apply a tourniquet under the relevant procedure. Begin transport promptly when hypotension or serious injury is present." ] }, { "heading": "Perfusion and triage", "items": [ "For hypotension, establish IV/IO and give saline 20 mL/kg, maximum 250 mL per bolus, with base contact. The hemorrhage pathway allows two repeats for three total boluses.", "Base contact is required for hypotensive hemorrhage and patients meeting trauma-triage criteria; a pediatric-capable base is preferred." ] }, { "heading": "Pain and isolated injury", "items": [ "For severe pain in the listed eye, extremity, or impaled-object pathways: morphine 0.1 mg/kg IV/IM, maximum 5 mg, OR fentanyl 2 mcg/kg IN/IV/IM, maximum 50 mcg. May repeat once after 3 minutes; total limits 10 mg morphine or 100 mcg fentanyl.", "Base contact is required at age 2 or younger. Splint as appropriate, document distal pulse/sensation, and protect an injured eye without globe pressure. Do not remove face/neck impaled objects unless breathing is compromised." ] }, { "heading": "Suspected TBI", "items": [ "Continuously monitor SpO₂ and ETCO₂. The source targets SpO₂ above 90% and ETCO₂ 35–45 mmHg where possible, with airway repositioning/BVM escalation when oxygen alone is insufficient.", "Recheck systolic BP every 5 minutes. TBI targets are above 70 + 2 × age for ages 0–9 and above 90 for age 10 and older; use the TBI-specific fluid and repeat instructions in the source. Assess GCS, using pediatric GCS at age 2 or younger.", "Transport to a trauma center, preferably a Level 1 or 2 pediatric trauma center when possible under source/destination direction." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "The TBI section has different fluid-repeat wording from the hemorrhage section; do not merge them into a single universal rule.", "Confirm the source pathway and account for all prior analgesic doses." ], "related": [ "tourniquet", "fentanyl", "morphine", "normal-saline", "gcs" ], "url": "https://www.ocmedic.com/guides/pediatric-trauma/", "sources": [ { "code": "SO-P-015", "title": "General Injury and Trauma - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-P-015", "title": "General Injury and Trauma - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/pediatric-trauma.md" }, { "slug": "poison-oak-products", "title": "Poison oak / sumac products", "description": "OTC poison oak and sumac product-category guidance under SO-F-02.", "category": "Fire-service OTC", "kind": "medication", "medicationGroup": "Fire-service OTC", "population": "Adult & pediatric scope", "scope": "FS-ARN", "section": "medications", "sourceCode": "SO-F-02", "sourceCodes": [ "SO-F-02" ], "version": "See linked source for document dates and scope restrictions.", "keywords": "poison oak / sumac products zanfel, tecnu/tenu, oakaway, and equivalent otc product-category guidance.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Adult / adolescent", "items": [ "SO-F-02 permits an authorized Fire Service RN to maintain this listed OTC product/category while functioning in the fire-service role. It is made available to firefighting personnel without a known allergy to the product.", "The source directs use for the indications and at the doses on the actual container. It does not publish a universal EMS dose for this product. Eligible personnel obtain the medication from its container without assistance." ], "id": "adult" }, { "heading": "Pediatric", "items": [ "SO-F-02 is an adult/adolescent fire-service personnel program, not a pediatric 9-1-1 standing order. No pediatric dose or administration authority is established by this source.", "Do not convert a package’s consumer pediatric directions into OCEMS field authority. Use an applicable pediatric standing order or medical direction for a child requiring care." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "SO-F-02 supplies no pediatric 9-1-1 dosing or administration authority. This page does not add consumer pediatric doses." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Use, monitoring & documentation", "items": [ "Identify the exact product, active ingredients, strength, and label before use; products in a named OTC category can have different formulations.", "Follow the product’s labeled indications, exclusions, dose, and interval within the authorized program. The absence of an EMS numerical dose here is intentional: SO-F-02 delegates those details to the product label." ] } ], "cautionTitle": "Scope & authority", "cautions": [ "FS-ARN scope only; this listing is not a general ALS/BLS administration order.", "SO-F-02 supplies no pediatric field regimen." ], "related": [], "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/poison-oak-products/", "sources": [ { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-F-02", "title": "Over the Counter (OTC) Medications", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/60122.pdf", "version": "See linked source for document dates and scope restrictions.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/poison-oak-products.md" }, { "slug": "poisoning", "title": "Overdose & poisoning", "description": "Support ventilation first, then identify the opioid, stimulant, cholinergic, or smoke-exposure pathway.", "category": "Medical", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-050", "sourceCodes": [ "SO-M-050" ], "version": "See linked source for document revision and implementation dates.", "keywords": "overdose & poisoning support ventilation first, then identify the opioid, stimulant, cholinergic, or smoke-exposure pathway.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Initial support", "items": [ "Assist ventilation with BVM and suction as needed. Give oxygen for room-air SpO₂ below 95% using the source’s mask or cannula options.", "Check glucose and treat qualifying hypoglycemia with the source’s oral glucose, D10, or glucagon pathway. For systolic BP below 90 with clear lungs, give 250 mL saline boluses up to 1 L.", "The detailed poisoning order has condition-specific access and treatment exceptions; do not treat this overview as an exposure-specific toxicology protocol." ] }, { "heading": "Suspected opioid toxicity", "items": [ "With respiratory depression at 12/min or fewer, give naloxone 0.8, 1, or 2 mg IN/IM, or 0.4–1 mg IV. Repeat every 3 minutes as needed to maintain breathing; the source also lists a 4 mg preloaded nasal spray.", "Continue respiratory support and reassess after every dose." ] }, { "heading": "Stimulant or organophosphate exposure", "items": [ "For stimulant toxicity, monitor breathing, oxygenation, temperature, and perfusion. Cool when hyperthermia is suspected and use the relevant seizure/sedation instructions with airway readiness.", "For suspected organophosphate toxicity, SO-M-050 lists atropine 2 mg IV or IM, repeating once as needed. Bronchospasm, seizures, and DuoDote use have additional source-specific pathways." ] }, { "heading": "Smoke, cyanide & dystonic reactions", "items": [ "Suspected CO toxicity requires high-flow oxygen. For suspected cyanide toxicity, including concerning plastic/hydrocarbon smoke, hydroxocobalamin 5 g IV/IO over 15 minutes requires a base order.", "For an extrapyramidal/dystonic reaction, diphenhydramine 50 mg IM/IV once is listed.", "Provide ALS escort to the nearest ERC or contact base as needed; communicate exposure details, treatment, and response." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Protect rescuers from exposure and use the exposure-specific source.", "Do not mistake successful opioid reversal for resolution of all toxicologic risk. Pediatric poisoning uses different doses and SO-P-085." ], "related": [ "naloxone", "atropine", "duodote", "hydroxocobalamin", "midazolam", "diphenhydramine" ], "url": "https://www.ocmedic.com/guides/poisoning/", "sources": [ { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-050", "title": "Substance Overdose / Poisoning - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/poisoning.md" }, { "slug": "respiratory-distress", "title": "Respiratory distress", "description": "Use the wheeze, suspected CHF, or stridor pathway and reassess ventilation.", "category": "Respiratory", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-035", "sourceCodes": [ "SO-M-035", "PR-120", "SO-C-015" ], "version": "See linked source for document revision and implementation dates.", "keywords": "respiratory distress use the wheeze, suspected chf, or stridor pathway and reassess ventilation.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Immediate assessment & support", "items": [ "Assess respiratory effort, lung sounds, oxygenation, perfusion, and mental status. Monitor cardiac rhythm.", "If SpO₂ is below 95%, provide high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. The COPD branch lists 2 L/min by cannula initially, but explicitly says not to withhold oxygen in severe hypoxia/distress.", "Prepare to assist ventilation when breathing is inadequate; do not rely on a saturation reading alone in severe COPD distress." ] }, { "heading": "Wheeze / suspected bronchospasm", "items": [ "Give albuterol 5 mg in 6 mL continuously by nebulizer, as tolerated.", "If there is no improvement, consider base contact for an IM epinephrine order. CPAP may be used when its separate criteria are met and no contraindication is present." ] }, { "heading": "Basilar rales, labored breathing & suspected CHF", "items": [ "For the source’s CHF pattern (including RR above 20): if systolic BP is at least 100, give nitroglycerin 0.4 mg SL, repeating twice while BP stays at least 100.", "At systolic BP at least 150, the dose is 0.8 mg SL, repeating twice while BP stays at least 150. Reduce to 0.4 mg if pressure falls below 150 but remains above 100. Consider CPAP.", "Obtain a 12-lead; suspected acute MI requires base contact for CVRC destination. Check nitroglycerin medication exclusions." ] }, { "heading": "Stridor, reassessment & destination", "items": [ "For stridor, position comfortably and provide ALS transport; if allergy is suspected, use the anaphylaxis order.", "Contact base for further stabilization orders, and provide ALS escort to an appropriate ERC. Recheck work of breathing, air movement, oxygenation, BP, and response throughout." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "CPAP is not appropriate for every patient in respiratory distress; review its airway, BP, trauma, and age exclusions.", "Differentiate suspected fluid-overloaded CHF from volume depletion before applying another condition’s fluid pathway." ], "related": [ "cpap", "albuterol", "nitroglycerin", "oxygen", "anaphylaxis" ], "url": "https://www.ocmedic.com/guides/respiratory-distress/", "sources": [ { "code": "SO-M-035", "title": "Respiratory Distress", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf", "checked": "2026-09-16" }, { "code": "PR-120", "title": "Continuous Positive Airway Pressure (CPAP)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-015", "title": "Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-035", "title": "Respiratory Distress", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/respiratory-distress.md" }, { "slug": "seizures", "title": "Seizure / convulsions", "description": "Treat active or recurrent seizures, monitor ventilation, and check for hypoglycemia.", "category": "Neurologic", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-040", "sourceCodes": [ "SO-M-040" ], "version": "See linked source for document revision and implementation dates.", "keywords": "seizure / convulsions treat active or recurrent seizures, monitor ventilation, and check for hypoglycemia.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "When this treatment pathway applies", "items": [ "Use for an ongoing seizure or repeated seizure activity without return of consciousness. Turn the patient to the side, protect the airway, and suction when necessary.", "Give the preferred IM medication before spending time establishing new vascular access." ] }, { "heading": "Midazolam", "items": [ "Preferred: 10 mg IM once.", "If IM cannot be delivered, or IV/IO access is already present: 5 mg IV/IN/IO. May repeat once about 3 minutes later for continued or recurrent seizure activity.", "Contact base if seizure continues for 5 minutes after the first IM dose or second IV/IN/IO dose (a total of 10 mg by any route)." ] }, { "heading": "Monitor oxygenation, ventilation & glucose", "items": [ "Use SpO₂ and waveform capnography when available. For room-air SpO₂ below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated, watching for aspiration.", "If ETCO₂ is at least 50 mmHg, assist ventilation with BVM.", "Check glucose: treat at or below 60 mg/dL; the source also permits treatment at 60–80 when hypoglycemia is suspected. Use D10 up to 250 mL IV titrated to response, or glucagon 1 mg IM without IV access. Oral glucose requires consciousness and intact airway reflexes." ] }, { "heading": "Reassess & transport", "items": [ "Reassess seizure activity, airway protection, ventilation, oxygenation, and mental status after treatment. Document dose/route/timing and glucose.", "Provide ALS transport to the nearest ERC, with base contact as indicated. The IO dextrose exception requires unconsciousness, glucose below 60, failed IV access, and no response to IM glucagon." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "The preferred 10 mg IM regimen is a one-time dose; do not automatically repeat it.", "Anticonvulsant treatment can be followed by respiratory depression. Maintain airway and ventilation support." ], "related": [ "midazolam", "dextrose", "glucagon", "pediatric-seizures" ], "url": "https://www.ocmedic.com/guides/seizures/", "sources": [ { "code": "SO-M-040", "title": "Seizure / Convulsions - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-040", "title": "Seizure / Convulsions - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/seizures.md" }, { "slug": "sepsis", "title": "Suspected sepsis", "description": "Recognize suspected sepsis, support perfusion, and know when to contact base.", "category": "Medical", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "sourceCode": "SO-M-055", "version": "Revised July 30, 2024 · Implemented October 1, 2024", "keywords": "infection septic shock fever hypotension fluids", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "1. Check the criteria", "items": [ "Suspected or known infection, plus at least TWO findings:", "GCS below 13; systolic BP below 100 mmHg; respiratory rate above 22/min; or reported/measured temperature above 100.4°F (38°C) or below 97°F (36°C)." ] }, { "heading": "2. Start care", "numbered": true, "items": [ "Monitor cardiac rhythm and oxygen saturation. If SpO₂ is below 95%, give high-flow oxygen by mask or nasal cannula at 6 L/min, as tolerated.", "Establish IV access. If systolic BP is below 100 and lungs are clear without CHF, give 250 mL normal saline.", "Repeat only while lungs remain clear, up to 1 L, to improve perfusion.", "Provide ALS transport to the nearest emergency receiving center. Notify the receiving team early of suspected sepsis." ] }, { "heading": "3. Escalation after fluids", "items": [ "For eligible shock under PR-230, use epinephrine diluted to 10 mcg/mL: 1 mL (10 mcg) IV/IO every 3 minutes, titrated to systolic BP above 90. Use the linked medication guide for preparation and the complete PR-230 exclusions.", "Do not treat hemorrhage/dehydration with push-dose epinephrine before volume replacement. PR-230 also excludes a perfusing non-shock state and suspected stimulant intoxication." ] }, { "heading": "4. Reassessment & handoff", "items": [ "Reassess pressure, perfusion, respiratory status, and lung sounds after each intervention. Stop repeating the clear-lung fluid pathway if congestion develops.", "Communicate the suspected infection, qualifying findings, BP trend, fluid amount, treatment response, and early sepsis concern to the receiving team." ] } ], "cautionTitle": "Escalation & the April 2026 update", "cautions": [ "SO-M-055 still describes contacting base for persistent systolic BP below 90 after 1 L, or CHF developing before 1 L with BP still below 90. The newer PR-230, implemented April 2026, explicitly removes the adult push-dose epinephrine base-contact/order requirement. Other required contact and destination rules still apply.", "Fluid overload is a concern with CHF or renal disease. Absence of fever does not exclude infection, especially in older or immunosuppressed patients." ], "related": [ "epinephrine", "normal-saline", "base-contact", "gcs" ], "sourceCodes": [ "SO-M-055", "PR-230" ], "kind": "clinical", "url": "https://www.ocmedic.com/guides/sepsis/", "sources": [ { "code": "SO-M-055", "title": "Suspected Sepsis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf", "checked": "2026-09-16" }, { "code": "PR-230", "title": "Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-055", "title": "Suspected Sepsis", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf", "version": "Revised July 30, 2024 · Implemented October 1, 2024", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/sepsis.md" }, { "slug": "shock", "title": "Adult shock / hypotension", "description": "Identify poor perfusion, reassess fluid response, and recognize the cardiogenic branch.", "category": "Medical", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-M-045", "sourceCodes": [ "SO-M-045", "PR-230" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Adult shock / hypotension Identify poor perfusion, reassess fluid response, and recognize the cardiogenic branch. SO-M-045", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Assess the patient", "items": [ "Look for systolic BP at or below 90 with poor skin signs, altered mental status, tachycardia, or weak pulses. Search for hemorrhage, dehydration, infection, or a cardiac cause.", "Monitor and document rhythm. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. Obtain IV; consider IO for an unresponsive patient when peripheral IV cannot be established." ] }, { "heading": "Clear lungs with poor perfusion", "items": [ "When lungs are clear and there is no evidence of CHF, give normal saline 250 mL and reassess. Repeat as indicated to a maximum 1 L to support perfusion.", "Contact base if hypotension does not respond. Track the cumulative amount and watch for newly developing rales." ] }, { "heading": "Rales or suspected acute MI", "items": [ "If rales suggest cardiogenic shock, contact base for further orders. Do not continue the clear-lung fluid pathway without reassessment.", "Obtain a 12-lead for suspected acute MI/STEMI and contact base for CVRC destination. PR-230 governs current adult push-dose epinephrine preparation/eligibility; its April 2026 change does not cancel other contact requirements." ] }, { "heading": "Transport and handoff", "items": [ "Provide rapid ALS transport with treatment en route when possible, to the nearest ERC or base-directed destination.", "Report the suspected cause, BP/perfusion trends, lung findings, oxygenation, glucose when relevant, total fluids, and response. Consider sepsis even when an early set of vital signs is less dramatic." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Reassess before every fluid repeat; pulmonary edema changes the pathway.", "Use the pediatric shock guide for children rather than adult 250 mL increments." ], "related": [ "normal-saline", "epinephrine", "sepsis", "chest-pain", "pediatric-shock" ], "url": "https://www.ocmedic.com/guides/shock/", "sources": [ { "code": "SO-M-045", "title": "Shock (Symptomatic Hypotension)", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12038.pdf", "checked": "2026-09-16" }, { "code": "PR-230", "title": "Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-045", "title": "Shock (Symptomatic Hypotension)", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12038.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/shock.md" }, { "slug": "sodium-bicarbonate", "title": "Sodium bicarbonate", "description": "Indication-specific adult treatment and pediatric source-chart guidance.", "category": "Field medications", "kind": "medication", "medicationGroup": "Field medications", "population": "Adult & pediatric guidance", "scope": "ALS", "section": "medications", "sourceCode": "I-15", "sourceCodes": [ "I-15", "I-20", "SO-C-010", "SO-P-040", "SO-T-020" ], "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "keywords": "sodium bicarbonate indication-specific adult treatment and pediatric source-chart guidance.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Use in OCEMS", "items": [ "I-15 lists major-muscle crush injury lasting more than 1 hour and cardiac arrest after 10 minutes of arrest management.", "Use the applicable resuscitation/crush order; this is not a routine medication for every arrest or every acidosis." ] }, { "heading": "Adult / adolescent", "table": { "headers": [ "Indication / route", "Dose & limits" ], "rows": [ [ "I-15 listed indications", "One 50 mL prefilled syringe IV or IO. Inventory includes 8.4% (1 mEq/mL) and 7.5% (44.6 mEq/50 mL) preparations, which do not contain identical mEq totals." ] ] }, "id": "adult" }, { "heading": "Pediatric", "items": [ "I-20 contains a sodium-bicarbonate row with IV/IO dose and volume by weight band; the smallest-weight entries include a 1:1 saline dilution note.", "The current SO-P-040 arrest pathway does not list routine bicarbonate. A chart entry alone does not establish an indication or authority: confirm the relevant pediatric order/base direction and exact concentration before use." ], "id": "pediatric" }, { "heading": "Pediatric dosing availability", "id": "pediatric-dose-rules", "items": [ "I-20 has preparation rows, but SO-P-040 does not authorize routine pediatric arrest bicarbonate. A separate applicable indication/order is needed; no routine pediatric dose is recommended here." ], "table": { "headers": [ "Weight", "OCEMS pediatric dose" ], "rows": [ [ "Any weight", "No general pediatric dose under the cited source; follow the applicable order / medical direction." ] ] }, "generatedPediatric": true }, { "heading": "Preparation & reassessment", "items": [ "Reconcile the requested dose with the actual concentration and any dilution instruction.", "Document indication, formulation, dose/volume, route, and response. Continue the underlying resuscitation or crush-injury pathway." ] } ], "cautionTitle": "Check before giving", "cautions": [ "Confirm whether the preparation is 7.5% or 8.4%, and distinguish milliliters from mEq.", "I-15 specifies IO use when the patient is unconscious and IV access cannot be established." ], "related": [], "sourcePage": 5, "pediatricDoseType": "not-established", "url": "https://www.ocmedic.com/guides/sodium-bicarbonate/", "sources": [ { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5", "checked": "2026-09-16" }, { "code": "I-20", "title": "Pediatric Medication Volume Dose by Weight", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "checked": "2026-09-16" }, { "code": "SO-C-010", "title": "Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf", "checked": "2026-09-16" }, { "code": "SO-P-040", "title": "Cardiopulmonary Arrest - Pediatric", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf", "checked": "2026-09-16" }, { "code": "SO-T-020", "title": "Crush Injury - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-T-20%20Crush%20injury%20adult.pdf", "checked": "2026-09-16" } ], "source": { "code": "I-15", "title": "Adult / Adolescent Standing Order Drug Guide", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "version": "I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/sodium-bicarbonate.md" }, { "slug": "stroke", "title": "Stroke: recognition, treatment & routing", "description": "Capture last known well, check stroke-triage findings, treat reversible problems, and coordinate destination.", "category": "Neurologic", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "sourceCode": "SO-M-025", "version": "Revised July 18, 2023 · Final implementation April 1, 2024", "keywords": "cva neuro hemorrhage unilateral weakness facial droop last known well", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Check the ischemic-stroke pathway", "items": [ "All three: usual neurologic baseline within the past 24 hours; appropriate response to voice/visual cues or spontaneous eye opening; and new one-sided arm drift/paralysis, facial droop, or unequal grip." ] }, { "heading": "Check for possible intracranial bleeding", "items": [ "Sudden, severe headache within 24 hours plus repeated vomiting, neurologic deficit, altered mental status, or diastolic BP above 100.", "If altered mental status prevents obtaining a history: unexplained repeated vomiting, neurologic deficit, diastolic BP above 100, or paramedic judgment of acute bleeding may meet criteria." ] }, { "heading": "Immediate checks & routing", "numbered": true, "items": [ "Record last known well. Obtain a witness phone number when possible.", "Contact base for patients meeting stroke-triage criteria and prepare for stroke-team activation.", "Monitor rhythm and document a strip. If room-air SpO₂ is below 95%, give high-flow oxygen by mask or nasal cannula at 6 L/min as tolerated.", "Avoid oral food or fluids; the source permits dissolving ondansetron.", "If criteria are not met, provide ALS transport to the nearest emergency receiving center." ] }, { "heading": "Glucose & nausea treatment", "items": [ "Check blood glucose. SO-M-025 uses a value below 60 mg/dL: D10 250 mL IV, or glucagon 1 mg IM if IV access cannot be obtained.", "The IO dextrose exception is limited to an unconscious patient with glucose below 60, no IV access, and no response to IM glucagon.", "For nausea/vomiting when pregnancy is neither known nor suspected: ondansetron 8 mg ODT or 4 mg IV. The IV dose may be repeated after about 3 minutes if symptoms persist." ] }, { "heading": "Handoff essentials", "items": [ "Document when the patient was last at their usual neurologic baseline, not just when the deficit was discovered. Obtain a witness callback number when possible.", "Report the observed deficit, glucose and response to treatment, level of consciousness, headache/vomiting findings, and BP. Coordinate the stroke destination through base." ] } ], "cautionTitle": "Protect the airway & preserve the history", "cautions": [ "No oral food or fluid; the source specifically permits dissolving ondansetron.", "Avoid IO/external-jugular access in a potential stroke-neurology destination patient because thrombolysis may create difficult-to-control bleeding. The source’s narrow IO dextrose exception is stated below." ], "related": [ "dextrose", "glucagon", "ondansetron", "base-contact", "gcs" ], "kind": "clinical", "sourceCodes": [ "SO-M-025" ], "url": "https://www.ocmedic.com/guides/stroke/", "sources": [ { "code": "SO-M-025", "title": "Suspected Acute Stroke or Intracranial Hemorrhage (Stroke Triage Criteria)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-M-025%20Stroke%2010-2023.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-M-025", "title": "Suspected Acute Stroke or Intracranial Hemorrhage (Stroke Triage Criteria)", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-M-025%20Stroke%2010-2023.pdf", "version": "Revised July 18, 2023 · Final implementation April 1, 2024", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/stroke.md" }, { "slug": "tourniquet", "title": "Tourniquet: uncontrolled extremity bleeding", "description": "Apply an approved tourniquet, keep it visible, and communicate the placement time.", "category": "BLS", "population": "Adult & pediatric", "scope": "BLS / ALS", "section": "procedures", "kind": "clinical", "sourceCode": "B-010", "sourceCodes": [ "B-010" ], "version": "See linked source for document revision and implementation dates.", "keywords": "tourniquet: uncontrolled extremity bleeding apply an approved tourniquet, keep it visible, and communicate the placement time.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "When to use it", "items": [ "B-010 indicates a tourniquet for upper- or lower-extremity hemorrhage that cannot be controlled with direct pressure or a pressure dressing.", "Use appropriate blood-exposure PPE and an approved device. Inspect the injury and assess distal circulation, motor function, and sensation." ] }, { "heading": "Place & tighten", "items": [ "Apply proximal to the wound, usually 2–4 inches above it under this source. Avoid placing over a joint, angulated/open fracture, or the stab/gunshot wound itself.", "Tighten to the pressure needed to stop bleeding. Cover the wound with an appropriate sterile dressing or bandage.", "Leave the tourniquet visible; do not cover it with the wound dressing." ] }, { "heading": "Reassess", "items": [ "Reassess distal circulation, motor function, and sensation and the effectiveness of bleeding control. Record vital signs and the application time.", "An ALS response is required when a tourniquet is placed. Continue the applicable trauma assessment and destination pathway." ] }, { "heading": "Handoff", "items": [ "Tell the receiving team where the device is and exactly when it was applied; make that information visible in the report and documentation.", "Use the amputation standing order for care of an amputated part. This page describes the B-010 tourniquet procedure, not every trauma-management task." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "The device must remain visible during transport and handoff.", "Placement requires an ALS-level response under B-010." ], "related": [ "trauma", "normal-saline" ], "url": "https://www.ocmedic.com/guides/tourniquet/", "sources": [ { "code": "B-010", "title": "Tourniquets: Indications and Procedure", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12429.pdf", "checked": "2026-09-16" } ], "source": { "code": "B-010", "title": "Tourniquets: Indications and Procedure", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12429.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/tourniquet.md" }, { "slug": "trauma", "title": "Trauma: bleeding, limb injury & TBI", "description": "Control hemorrhage, protect perfusion and ventilation, and recognize destination needs.", "category": "Trauma", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-T-005", "sourceCodes": [ "SO-T-005", "B-010", "PR-075" ], "version": "See linked source for document revision and implementation dates.", "keywords": "trauma: bleeding, limb injury & tbi control hemorrhage, protect perfusion and ventilation, and recognize destination needs.", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Bleeding control & transport", "items": [ "Start direct pressure. If bleeding continues, consider an approved hemostatic dressing; use a tourniquet for uncontrolled extremity hemorrhage under B-010.", "Do not delay transport to establish IV access. For hypotension, the adult order starts with 250 mL saline and permits continued infusion to support perfusion.", "Base contact is required for trauma-triage criteria, hypotension, or saline needed for stabilization." ] }, { "heading": "Limb injuries & impaled objects", "items": [ "Splint/immobilize fractures and document distal pulses and sensation. Cold packs over a splint may improve comfort.", "Stabilize impaled objects when possible. Do not remove face/neck objects unless ventilation is compromised; avoid delays to extrication/transport.", "For qualifying pain with systolic BP above 90, source options include morphine 5 mg (or 4 mg carpuject) IV/IM, fentanyl 50 mcg IV/IM, or fentanyl 100 mcg IN, each with one repeat after 3 minutes as specified." ] }, { "heading": "Suspected traumatic brain injury", "items": [ "Monitor SpO₂ continuously and escalate oxygen/airway/ventilation support to maintain saturation above 90%. Use continuous ETCO₂ and target 35–45 mmHg when possible, especially during assisted ventilation.", "Check systolic BP every 5 minutes. Below 100, give 250 mL saline and continue infusion toward BP above 100; for age 65 and older, use the source’s below-110 trigger and above-110 target.", "At GCS 8 or below, establish an airway by the most appropriate available means. Transport to a trauma center." ] }, { "heading": "Handoff", "items": [ "Report mechanism, hemorrhage control, tourniquet time, neurologic findings, oxygenation/ETCO₂, BP trends, and treatment response.", "Use the complete SO-T-005 for eye injury, airbag exposure, pregnancy-positioning, and other branches beyond this focused guide." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "A fluid threshold for general medical hypotension is not the same as the TBI threshold.", "Trauma-center designation and high hemorrhage risk are ketorolac exclusions in PR-075." ], "related": [ "tourniquet", "gcs", "fentanyl", "morphine", "normal-saline" ], "url": "https://www.ocmedic.com/guides/trauma/", "sources": [ { "code": "SO-T-005", "title": "General Injury and Trauma - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf", "checked": "2026-09-16" }, { "code": "B-010", "title": "Tourniquets: Indications and Procedure", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/12429.pdf", "checked": "2026-09-16" }, { "code": "PR-075", "title": "Ketorolac for Patient Analgesia", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-05/PR-75%20ketorolac%205-2025.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-T-005", "title": "General Injury and Trauma - Adult / Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf", "version": "See linked source for document revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/trauma.md" }, { "slug": "wide-complex-tachycardia", "title": "Wide-complex tachycardia with a pulse", "description": "Separate stable transport from unstable synchronized cardioversion and medication steps.", "category": "Cardiac", "population": "Adult / adolescent", "scope": "ALS", "section": "standing-orders", "kind": "clinical", "sourceCode": "SO-C-040", "sourceCodes": [ "SO-C-040" ], "version": "See the linked OCEMS source for revision and implementation dates.", "keywords": "Wide-complex tachycardia with a pulse Separate stable transport from unstable synchronized cardioversion and medication steps. SO-C-040", "status": "published", "updated": "2026-09-16", "sections": [ { "heading": "Assess and document", "items": [ "Confirm a pulse, monitor rhythm, and obtain a rhythm strip or 12-lead. Assess BP, mental status, chest symptoms, and perfusion.", "If an implanted defibrillator fires at least twice in 15 minutes, contact base for possible CVRC destination. For SpO₂ below 95%, provide oxygen as directed by the source." ] }, { "heading": "Stable patient", "items": [ "The stable branch describes systolic BP above 90, appropriate mental status, and minimal chest discomfort. Monitor serial vital signs and provide ALS escort to the nearest ERC.", "The treatment guideline favors transport without cardioversion or pharmacologic treatment for stable wide-complex tachycardia. Continue looking for deterioration." ] }, { "heading": "Unstable patient", "items": [ "Systolic BP at or below 90, altered consciousness, chest pain, or poor perfusion activates the unstable branch. Synchronized cardioversion starts at 100 J biphasic or the manufacturer-recommended setting; do not delay for IV access if deteriorating.", "If unsuccessful, give amiodarone 150 mg slow IV/IO OR lidocaine 1 mg/kg IV/IO. After 2–3 minutes of infusion, persistent unstable tachycardia leads to synchronized full-output/manufacturer-setting cardioversion.", "If persistent, repeat amiodarone 150 mg slow IV/IO OR lidocaine 0.5 mg/kg IV/IO, followed after 2–3 minutes by the next synchronized cardioversion step if needed." ] }, { "heading": "Reassess and transport", "items": [ "Reassess pulse, rhythm, BP, consciousness, and perfusion after every intervention. Amiodarone can cause hypotension, especially if administered too rapidly.", "Provide ALS escort to the nearest ERC or contact base as needed. If the pulse is lost, switch immediately to the arrest pathway." ] } ], "cautionTitle": "Key cautions & base contact", "cautions": [ "Use synchronized cardioversion for the pulsed pathway and confirm synchronization before each shock.", "Do not substitute the 300 mg arrest amiodarone dose for this 150 mg slow-infusion pathway." ], "related": [ "amiodarone", "lidocaine", "adult-cardiac-arrest", "chest-pain" ], "url": "https://www.ocmedic.com/guides/wide-complex-tachycardia/", "sources": [ { "code": "SO-C-040", "title": "Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf", "checked": "2026-09-16" } ], "source": { "code": "SO-C-040", "title": "Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf", "version": "See the linked OCEMS source for revision and implementation dates.", "checked": "2026-09-16" }, "notice": "Independent summary; does not replace the complete policy, current system notices, or clinical judgment.", "markdown": "https://www.ocmedic.com/guides/wide-complex-tachycardia.md" } ] }