Introduction to Standing Medical Orders
Standing Medical Orders (SMOs) serve as the foundation for pre-hospital emergency care in Region 1. These evidence-based protocols are designed to guide EMTs and paramedics in providing consistent, high-quality care to patients before they reach definitive care at a hospital. This study guide outlines the essential components of Region 1's SMOs that every EMT must understand and apply in the field.
Assessment and Patient Management
The initial patient assessment forms the basis for all subsequent interventions. Region 1 SMOs emphasize a systematic approach to patient evaluation.
Primary Assessment
- Scene safety assessment upon arrival
- General impression of patient
- Level of consciousness assessment
- Airway, breathing, circulation evaluation
- Rapid assessment of life threats
- Baseline vital signs and SAMPLE history
Secondary Assessment
- Focused physical examination based on chief complaint
- Additional vital signs as indicated
- Assessment of medical history and medications
- Allergy assessment
- Last oral intake determination
- Events leading to current presentation
Important Note
All assessments must be documented completely, including times when vital signs are obtained and interventions are performed. Reassessments should occur at regular intervals and after any interventions.
Airway Management Protocols
Proper airway management is critical for patient survival. Region 1 SMOs address various airway scenarios that EMTs may encounter.
Basic Airway Management
- Proper positioning of the patient
- Head tilt-chin lift or jaw thrust maneuver as appropriate
- Use of oropharyngeal and nasopharyngeal airways
- Suctioning techniques
- Bag-valve-mask ventilation with supplemental oxygen
Advanced Airway Management
- Endotracheal intubation criteria and procedures
- Capnography confirmation of tube placement
- Securing the airway device
- Alternative airway devices when intubation is not possible
Cardiac Care Protocols
Cardiac emergencies account for a significant portion of EMS calls. Region 1 SMOs provide specific guidance for common cardiac presentations.
Cardiac Arrest
- Immediate high-quality CPR initiation
- Proper application of AED
- Defibrilitation protocols for shockable rhythms
- Medication administration per protocols
- Post-resuscitation care considerations
Acute Coronary Syndromes
- Assessment of chest pain characteristics
- 12-lead ECG acquisition when available
- Aspirin administration protocols
- Nitroglycerin use criteria and contraindications
- Transport decision factors
| Medication | Indication | Contraindication |
|---|---|---|
| Aspirin | Acute coronary syndrome | Allergy, active bleeding |
| Nitroglycerin | Chest pain with suspected cardiac origin | BP < 90 mmHg, recent phosphodiesterase inhibitor use |
| Albuterol | Respiratory distress with wheezing | Tachycardia > 140, severe hypotension |
Respiratory Emergency Protocols
Respiratory emergencies require prompt assessment and intervention. Region 1 SMOs outline specific approaches for common respiratory presentations.
Asthma/COPD
- Assessment of respiratory distress severity
- Auscultation findings interpretation
- Bronchodilator administration protocols
- IPratropium bromide use criteria
- Consideration of CPAP for appropriate patients
Upper Airway Obstruction
- Recognition of partial versus complete obstruction
- Abdominal thrusts technique for conscious patients
- Finger sweep considerations
- Management of unconscious patients with airway obstruction
Trauma Care Protocols
Trauma patients require systematic assessment and rapid intervention. Region 1 SMOs emphasize the importance of identifying life-threatening injuries.
Primary Trauma Survey
- Airway assessment with cervical spine protection
- Breathing evaluation and intervention
- Circulation assessment with hemorrhage control
- Disability assessment
- Complete exposure and environmental control
Cervical Spine Protection
- Indications for spinal immobilization
- Proper collar sizing and application
- Immobilization techniques
- Special considerations for pediatric patients
Hemorrhage Control
- Direct pressure application
- Tourniquet application criteria
- Hemostatic agent use
- Positioning to control bleeding
OB/GYN Emergency Protocols
Region 1 SMOs provide specific guidance for pregnancy-related emergencies.
Obstetrical Emergencies
- Assessment of pregnancy viability
- Management of pre-eclampsia/eclampsia
- Vaginal bleeding assessment
- Positioning considerations for pregnant patients
Emergency Childbirth
- Assessment of imminent delivery
- Preparation for delivery
- Management of normal delivery
- Breech presentation recognition
- Post-delivery care of mother and infant
Pediatric Considerations
Children are not simply small adults and require special considerations in emergency care. Region 1 SMOs address age-specific needs.
Age-Specific Assessment
- Developmental considerations
- Age-appropriate communication techniques
- Normal vital sign ranges by age
- Special equipment considerations
Medication Dosing
- Weight-based calculations
- Length-based resuscitation tapes
- Equipment sizing based on age/weight
- Special pediatric protocols for common conditions
Pediatric Assessment Triangle
Remember the pediatric assessment triangle: Appearance, Work of Breathing, and Circulation to Skin. This provides a quick initial impression of the severity of a child's condition.
Medication Administration Guidelines
Safe medication administration is a core competency for EMTs. Region 1 SMOs provide specific guidelines for all medications.
Medication Safety
- Five rights of medication administration
- Proper documentation of medication administration
- Verification of medication prior to administration
- Monitoring for adverse reactions
Controlled Substances
- Proper documentation requirements
- Storage and security protocols
- Waste reporting procedures
- Count verification procedures
Documentation Requirements
Complete and accurate documentation is essential for patient care continuity. Region 1 SMOs specify required elements for patient care reports.
Essential Documentation Elements
- Patient identification information
- Chief complaint and history of present illness
- Complete assessment findings
- All interventions performed with times
- Patient response to interventions
- Transport destination and personnel notified
- EMS provider signatures and certification numbers
Communication with Medical Direction
Effective communication with medical control is essential for optimal patient care. Region 1 SMOs provide guidelines for when and how to contact medical direction.
Required Medical Direction Contact
- Situations outside SMO parameters
- Request for additional interventions beyond scope
- Patient refusal of transport after assessment
- End-of-life situations
- Mass casualty incidents
Effective Communication Technique
- Use of standard communication format
- Clear and concise reporting
- Avoidance of medical jargon when appropriate
- Wait for acknowledgment from medical direction
- Repeat back all orders received
Review and Application
Thorough understanding and regular review of Region 1 Standing Medical Orders is essential for all practicing EMTs. These protocols are updated regularly, and EMTs must maintain current knowledge of all revisions. Application of these protocols in the field requires critical thinking within the established guidelines to provide optimal patient care.
