4-5 PEDIATRIC NEAR DROWNING

EMR - Emergency Medical Responder

1. Establish patient responsiveness.
2. If cervical spine trauma suspected, and trained to do so, manually stabilize the spine.
3. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
4. Open the airway via chin lift or modified jaw thrust.
5. Suction as necessary
6. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
7. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
8. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
9. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
10. Assess circulation and perfusion.
11. Control obvious sites of hemorrhage with direct pressure or a pressure dressing.
12. Splint any obvious sites of extremity deformity.
13. Call for ALS intercept  

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Continue manual stabilization while placing a rigid cervical collar. Immobilize the patient on a long backboard or similar device.
2. Check blood glucose and if less than 60 mg/dL, refer to pediatric hypoglycemia protocol.
3. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed).
4. Initiate transport and Contact MEDICAL CONTROL to request ALS intercept.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Consider need for vascular access and administer NS at a TKO rate. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6, and signs of poor perfusion are present, request ALS intercept and initiate transport.
2. Initiate transport and Contact MEDICAL CONTROL to discuss need for ALS intercept and for further fluid orders, if indicated.

Intermediate - Perform/Confirm All Above Interventions

1. Evaluate need for advanced airway management and ventilatory support.
2. Assess rhythm on the monitor and treat per appropriate protocol.
3. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement. Scene time should not be delayed for IV placement.
4. Initiate transport and Contact MEDICAL CONTROL for further orders.

Paramedic - Perform/Confirm All Above Interventions