pain/dyspnea Approximate ambient air temperature Nausea/vomiting Estimate exposure time Headache/mental status Type of environment (inside, outside, Neuro Assessment wet) Treatments/Reassessments Loss of consciousness Report and signature of RN Fluid intake Skin turgor/condition ETOH/Substance abuse Treatments/reassessments Report and signature of RN INHALATION INJURY (TOXIC GAS/SMOKE) POISONING/DRUG INGESTION Type of gas Name of substance Duration of exposure Amount Area of exposure (enclosed room) Route of intake Heated environment How long ago Burns/singing (oral, nasal, facial area) Vomiting since ingestion as appropriate Treatments/reassessments Intentional vs. Unintentional Report given and signature of RN ETOH/substance use Oral mucosa burns if appropriate Treatments/reassessments Report and signature of RN PREGNANCY/OB DELIVERY REFUSALS Separate report required for mother and each Documentation of: delivery Competency Non-Delivery MMSE Abdominal Pain Lack of Trauma Gravida/Para/Abortion Situation Length of gestation/estimated due date Ability to make good decisions Edema (pedal)/BP/Headache/Visual Safety of patient is assured by caretakers, Disturbance family, etc. Vaginal bleeding/discharge if yes, – describe Treatments/reassessments Report given and signature of RN Last time movement Delivery SEIZURES Multiple fetuses OPQRST and SAMPLE as appropriate Mucous plug resented Obvious injures head, tongue) Membranes ruptured if yes, is amniotic Duration and number of events – fluid clear? Incontinence Crowning as appropriate of consciousness (postictal) Treatments/reassessments Report given and signature of RN NEONATE STROKE/CVA/TIA Time of birth OPQRST and SAMPLE as appropriate
pain/dyspnea Nausea/vomiting Headache/mental status Neuro Assessment Treatments/Reassessments Report and signature of RN Approximate ambient air temperature Estimate exposure time Type of environment (inside, outside, wet) Loss of consciousness Fluid intake Skin turgor/condition ETOH/Substance abuse Treatments/reassessments Report and signature of RN INHALATION INJURY (TOXIC GAS/SMOKE) Type of gas Duration of exposure Area of exposure (enclosed room) Heated environment Burns/singing (oral, nasal, facial area) Treatments/reassessments Report given and signature of RN POISONING/DRUG INGESTION Name of substance Amount Route of intake How long ago Vomiting since ingestion as appropriate Intentional vs. Unintentional ETOH/substance use Oral mucosa burns if appropriate Treatments/reassessments Report and signature of RN PREGNANCY/OB DELIVERY Separate report required for mother and each delivery Non-Delivery Abdominal Pain Gravida/Para/Abortion Length of gestation/estimated due date Edema (pedal)/BP/Headache/Visual Disturbance Vaginal bleeding/discharge – if yes, describe Treatments/reassessments Report given and signature of RN Last time movement REFUSALS Documentation of: Competency MMSE Lack of Trauma Situation Ability to make good decisions Safety of patient is assured by caretakers, family, etc. Delivery Multiple fetuses Mucous plug resented Membranes ruptured – if yes, is amniotic fluid clear? Crowning as appropriate SEIZURES OPQRST and SAMPLE as appropriate Obvious injures head, tongue) Duration and number of events Incontinence of consciousness (postictal) Treatments/reassessments Report given and signature of RN NEONATE Time of birth STROKE/CVA/TIA OPQRST and SAMPLE as appropriate
TN_EMS_Protocol_Guidelines_-_Jul2017_Revised11.7.2017.docx