# King County Medic One Guidelines/Protocols



## thegreypilgrim (Dec 13, 2010)

Does anyone have access to the KCM1 clinical guidelines/protocols? I can't seem to find them online.


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## NomadicMedic (Dec 13, 2010)

I've got 'em in my "Paramedic Protocol" app for my iphone. 

They're pretty basic... do you need to know anything specific?


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## thegreypilgrim (Dec 13, 2010)

Well, I'd like to be able to look them over. They're not posted online anywhere?


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## NomadicMedic (Dec 13, 2010)

They used to be on the KCEMS page, but they seem to have been removed. Here's the scope of practice and current meds...

http://www.kingcounty.gov/healthservices/health/ems/MedicOne/scope.aspx

Again, it's pretty basic. Follow the (basic) standing orders and then call the doc.


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## MrBrown (Dec 13, 2010)

What are they using the sodium thiosulfate, isoproteronol, noradrenaline and sodium nitrate for?


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## Smash (Dec 13, 2010)

Sodium thiosulfate I presume for cyanide toxicity.
Isoproteronol is back in favour for bradycardia associated with high level blocks.
Norepi is a useful pressor/inotrope; it's nice to add to epi in sick septic patients to add a bit more squeeze.
Sodium thiosulfate I'm not sure, vasoldilation for something, but what exactly I don't know.


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## TransportJockey (Dec 13, 2010)

Sodium Nitrate? That's Salt Petre... I wonder if you meant Nitrite?


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## Shishkabob (Dec 13, 2010)

We has Levophed too.  Our docs apparently love its use in shocky situations.


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## Smash (Dec 13, 2010)

jtpaintball70 said:


> Sodium Nitrate? That's Salt Petre... I wonder if you meant Nitrite?



I presume so too.  I meant to write sodium nitrite at the bottom, repeated thiosulphate for some reason.  It's been a long day...


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## NomadicMedic (Dec 13, 2010)

The sodium nitrite and thiosufate aren't in the current formulary. That web page may be old. I have the updated guidelines on the protocol provider ap. And KCM1 is the only agency around here (that I know of) that carries levophed. 

Everyone is a little different. Fo example, one agency I work for carries Terbutaline. Another carries Anzemet. It's all minor, but it's what the MPD wants.


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## rhan101277 (Dec 13, 2010)

Its impressive that they can do central lines.  I thought that was a sterile procedure.


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## NomadicMedic (Dec 13, 2010)

See the central line/subclavian discussion from a few weeks back. We also can do central lines in one county that I work in. I won't. Too many things that can go wrong and I think an IO is quicker and easier. 

Take it from someone who has worked in king county, albeit as a BLS provider, it's not all that and a bag of chips. It's not a system where I have any interest in working as a medic.


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## mikie (Dec 13, 2010)

n7lxi said:


> They're pretty basic...




[FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]Perform pericardiocentesis[/FONT]
[FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]Perform escharotomy[/FONT]
[FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]Perform episiotomy[/FONT]
Sounds pretty basic to me


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## Shishkabob (Dec 13, 2010)

They really aren't all that advanced, to be honest.

Heck, our flight crews do escharotomies and pericardiocentesis, and we as ground medics were "taught" how to do escharotomies in case we had to and called in to MC.  We don't carry the proper needle for pericardiocentesis on ground trucks, so that's irrelevant to us.  

Heck, an episiotomy isn't really advanced at all.



(Please, no one bring up "Of course the skill isn't hard, it's knowing when to use it" [as if knowing when to use those 3 is difficult either] as that is an overused phrase that holds no purpose in this current context)


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## NomadicMedic (Dec 13, 2010)

Ground medics in my service may perform pericardiocentesis and an episiotomy if indicated. WITHOUT calling the doc.

Again, it's all about where you're from. If you're working in a VERY restrictive system, the KCM1 treatment guidelines may look like manna from heaven. If you're in a relatively progressive service, you look at KCM1 and say, "Meh. Big deal."


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## Shishkabob (Dec 13, 2010)

n7lxi said:


> Again, it's all about where you're from. If you're working in a VERY restrictive system, the KCM1 treatment guidelines may look like manna from heaven. If you're in a relatively progressive service, you look at KCM1 and say, "Meh. Big deal."



I'm part of the "Big deal" crowd.  


Tends to come with the territory of being a rural service.


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## NomadicMedic (Dec 13, 2010)

That's funny to me Linuss. 

I work in several counties that are considered rural, with LONG (+45 minutes) transport times. The protocols there are even more progressive than the ones I follow in the city, with the medics expected to begin working toward the treatment end point while in the truck, not just simply start a line and drive to the nearest hospital. 

You may have seen a past post of mine that talks about one county's STEMI protocol. After a chat with the Doc we are able to begin to aggressively treat STEMI with NTG drips, Heparin, TNKase and Plavix. We have multiple beta blockers. We have very aggressive pain management protocols. We are treated as a vital step in the patient's hospital experience and both the docs and medics enjoy the give and take relationship that we're able to cultivate.

I guess I'm just spoiled. And, from appearances, pretty damn lucky. B)


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## Shishkabob (Dec 13, 2010)

Usalfyre and I can say the same.  Our agency is technically hospital based rural, with my county being 45+ min to the closest legit hospital.  

They make it clear in our academy that we are no longer "Taking patients to the ER, but taking the ER to the patients"


We have, atleast what I consider, very progressive protocols (guidelines).  Like you, we have Heparin and beta blockers for MIs and if we're transporting from an outlying clinic we can do fibrinolytics.  We have no hard limit on our narcotic usage.  RSI, DAI, and they say our patients aren't considered intubated until we also have an OG/NG tube in.


 Heck, in the entire protocol book, 99% of what we have is standing orders.  We're only told to contact med control 4 times:  Physical restraints, antibiotics in septic patients, RSIing someone after 2 doses of 2mcg/kg Fentanyl doesn't control pain, and to find where the closest reattachment surgeon is for amputations.


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## NomadicMedic (Dec 13, 2010)

Linuss, that sounds like a great system. 

I know that as a new medic, I appreciate the fact that we're considered much more than "ambulance drivers" and I really don't take for granted one bit of the freedom I'm given when it comes to treating my patients. 

Now, to get back to the KCM1 stuff, I'm sure if the OP calls the Medic One office, they can get you a copy of the protocols. After all, Oded (the guy that wrote the paramedic protocol app for the iPhone) got em...


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## usalsfyre (Dec 14, 2010)

Linuss said:


> Usalfyre and I can say the same.  Our agency is technically hospital based rural, with my county being 45+ min to the closest legit hospital.
> 
> They make it clear in our academy that we are no longer "Taking patients to the ER, but taking the ER to the patients"
> 
> ...



You mean ya'll don't consider Cozby a legit hospital?


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## usalsfyre (Dec 14, 2010)

n7lxi said:


> Linuss, that sounds like a great system.
> 
> I know that as a new medic, I appreciate the fact that we're considered much more than "ambulance drivers" and I really don't take for granted one bit of the freedom I'm given when it comes to treating my patients.
> 
> Now, to get back to the KCM1 stuff, I'm sure if the OP calls the Medic One office, they can get you a copy of the protocols. After all, Oded (the guy that wrote the paramedic protocol app for the iPhone) got em...



As Linuss mentioned we're very, very lucky to have a medical director that considers us an extension of the ED. Very progressive guidelines, but far more important is the recognition that our paramedics have the clinical acumen to USE THEIR DISCRETION in treating the patient. This has not come without a major commitment in the area of training, we've had more CE in the last year than many have wanted. It's also not without strong oversight, and reeducation as needed.


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## Shishkabob (Dec 14, 2010)

usalsfyre said:


> As Linuss mentioned we're very, very lucky to have a medical director that considers us an extension of the ED. Very progressive guidelines, but far more important is the recognition that our paramedics have the clinical acumen to USE THEIR DISCRETION in treating the patient. This has not come without a major commitment in the area of training, we've had more CE in the last year than many have wanted. It's also not without strong oversight, and reeducation as needed.



And more changes to come in the coming months, too.





usalsfyre said:


> You mean ya'll don't consider Cozby a legit hospital?



I have been warned very greatly against Cozby   They call it the Bermuda triangle of healthcare, with the 'hospital', nursing home and funeral home all adjacent to eachother.  


Mothers, ETMC, Parkland, Baylor and maybe Greenville are the only 'legit' ones I'll ever transport to... rather not have to go back in 3 ours for an IFT.   Barring, of course, a failed airway.


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## Luno (Dec 16, 2010)

thegreypilgrim said:


> Does anyone have access to the KCM1 clinical guidelines/protocols? I can't seem to find them online.



I'm sure that if you called KC Medic One, they'd be happy to give you what they have.  That being said, I'm not sure if it would include current studies.  Also, there might be some differences between the agencies that fall under the KC Medic One umbrella, namely Seattle FD, Bellevue FD, Evergreen Medic One, Shoreline FD, and King County Medic One.  Usually, Seattle FD has the most restrictive protocols.  If there is something that you are looking for in particular, I'm sure there are ways to find it...   But to preempt this, I do not work for medic one.


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## jjesusfreak01 (Dec 16, 2010)

KCM1 Protocols: Unconscious Person

1. Confirm patient is unconscious
2. Perform precordial thump
3. Profit!!!

I may have skipped/added steps there.


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## Luno (Dec 16, 2010)

Uh, I'm pretty sure that there's only one save from a precordial thump in South King County, and I'm relatively certain that they don't bill, so, not sure where you are going with that...


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## kingcountysucks (Dec 22, 2010)

thegreypilgrim said:


> Does anyone have access to the KCM1 clinical guidelines/protocols? I can't seem to find them online.



http://beepdf.com/doc/73671/king_county_medic_one_patient_care_guidelines.html


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