SNHD Protocols
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About SNHD Protocols
This is the full version of the SNHD Protocols manual for Paramedics/EMT's in the Clark County area. Included in this is the Field Reference Guide, a Map of Hospitals, and a List of Hospitals that provides directions.
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What's New in the Latest Version 1.31
Last updated on Feb 18, 2024
Old Versions
Manual Updates for January, 2024:
1.EMTs can now pursue an EMT-IV endorsement after completing the mandatory training. The agency must agree to 100% chart review, and this skill may only be performed under the supervision of a paramedic or AEMT. The EMT can only perform the skill and is not allowed to be the primary caregiver for the patient.
2. Trauma Field Triage Criteria has been updated to follow the latest guidelines approved by the American College of Surgeons Commitee on Trauma. Instead of Steps, there are now Red and Yellow categories. Catchment for Sunrise and Siena have remained the same. There have been some adjustments made to Mike O’Callaghan catchment.
3. Adult Cardiac Arrest pearls were updated to allow for the use of mechanical CPR devices on pregnant patients if these devices were approved for this use by their manufacturer. CPR is to follow a pit crew approach, with roles assigned prior to arrival whenever possible.
4. Westcare has been removed as a patient destination.
5. MountainView Hospital has been removed as a NIR capable facility.
6. Dopamine has been removed from all protocols, as well as from the EMS formulary.
7. Removal of Push Dose Phenylephrine from the Adult Bradycardia protocol.
8. Addition of Push Dose Epinephrine to the Adult Bradycardia and Pediatric Shock protocols.
9. The dosage of Push Dose Epinephrine was standardized across all adult protocols to 10 mcg IV/IO.
10. The dosage of Push Dose Epinephrine in pediatric protocols standardized to 0.1 mcg/kg IV/IO, max 5 mcg.
11. CPAP procedure protocol name changed to Non-Invasive Positive Pressure Ventilation to allow for the use of both ventilators equipped for Bi-Pap and masks that can be dual utilized for CPAP and Bi-level ventilation.
12. Sodium bicarbonate dosage in Adult Hyperkalemia and Adult Overdose protocols changed to 50 meq IV/IO. Sodium Bicarbonate dosage in Pediatric Overdose protocol changed to 1/meq/kg, max 50 mg. The notation of using 4.2% for neonates was removed from the front of the protocol and added as a pearl. Both adult and pediatric overdose protocols will allow for a repeat dose if the QRS remains wide after treatment.
13. Atropine dosage in Adult Bradycardia changed to 1mg to align with current ACLS standards.
14. Updated Behavioral Emergencies protocol, removing the “excited delirium” language and stressing the avoidance of placing agitated patients in the prone position.
15. Removal of Push Dose Phenylephrine from cardiogenic shock on the Shock protocol. Replaced with Push dose epinephrine.
16. Name of Needle Thoracentesis protocol changed to Needle Decompression, and more detail added to mid-axillary placement directions.
17. Changes in terminology in the Behavioral Emergencies protocol including emphasis on patient positioning while restrained.
1.EMTs can now pursue an EMT-IV endorsement after completing the mandatory training. The agency must agree to 100% chart review, and this skill may only be performed under the supervision of a paramedic or AEMT. The EMT can only perform the skill and is not allowed to be the primary caregiver for the patient.
2. Trauma Field Triage Criteria has been updated to follow the latest guidelines approved by the American College of Surgeons Commitee on Trauma. Instead of Steps, there are now Red and Yellow categories. Catchment for Sunrise and Siena have remained the same. There have been some adjustments made to Mike O’Callaghan catchment.
3. Adult Cardiac Arrest pearls were updated to allow for the use of mechanical CPR devices on pregnant patients if these devices were approved for this use by their manufacturer. CPR is to follow a pit crew approach, with roles assigned prior to arrival whenever possible.
4. Westcare has been removed as a patient destination.
5. MountainView Hospital has been removed as a NIR capable facility.
6. Dopamine has been removed from all protocols, as well as from the EMS formulary.
7. Removal of Push Dose Phenylephrine from the Adult Bradycardia protocol.
8. Addition of Push Dose Epinephrine to the Adult Bradycardia and Pediatric Shock protocols.
9. The dosage of Push Dose Epinephrine was standardized across all adult protocols to 10 mcg IV/IO.
10. The dosage of Push Dose Epinephrine in pediatric protocols standardized to 0.1 mcg/kg IV/IO, max 5 mcg.
11. CPAP procedure protocol name changed to Non-Invasive Positive Pressure Ventilation to allow for the use of both ventilators equipped for Bi-Pap and masks that can be dual utilized for CPAP and Bi-level ventilation.
12. Sodium bicarbonate dosage in Adult Hyperkalemia and Adult Overdose protocols changed to 50 meq IV/IO. Sodium Bicarbonate dosage in Pediatric Overdose protocol changed to 1/meq/kg, max 50 mg. The notation of using 4.2% for neonates was removed from the front of the protocol and added as a pearl. Both adult and pediatric overdose protocols will allow for a repeat dose if the QRS remains wide after treatment.
13. Atropine dosage in Adult Bradycardia changed to 1mg to align with current ACLS standards.
14. Updated Behavioral Emergencies protocol, removing the “excited delirium” language and stressing the avoidance of placing agitated patients in the prone position.
15. Removal of Push Dose Phenylephrine from cardiogenic shock on the Shock protocol. Replaced with Push dose epinephrine.
16. Name of Needle Thoracentesis protocol changed to Needle Decompression, and more detail added to mid-axillary placement directions.
17. Changes in terminology in the Behavioral Emergencies protocol including emphasis on patient positioning while restrained.
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Version History
1.31
Feb 18, 2024
Manual Updates for January, 2024:
1.EMTs can now pursue an EMT-IV endorsement after completing the mandatory training. The agency must agree to 100% chart review, and this skill may only be performed under the supervision of a paramedic or AEMT. The EMT can only perform the skill and is not allowed to be the primary caregiver for the patient.
2. Trauma Field Triage Criteria has been updated to follow the latest guidelines approved by the American College of Surgeons Commitee on Trauma. Instead of Steps, there are now Red and Yellow categories. Catchment for Sunrise and Siena have remained the same. There have been some adjustments made to Mike O’Callaghan catchment.
3. Adult Cardiac Arrest pearls were updated to allow for the use of mechanical CPR devices on pregnant patients if these devices were approved for this use by their manufacturer. CPR is to follow a pit crew approach, with roles assigned prior to arrival whenever possible.
4. Westcare has been removed as a patient destination.
5. MountainView Hospital has been removed as a NIR capable facility.
6. Dopamine has been removed from all protocols, as well as from the EMS formulary.
7. Removal of Push Dose Phenylephrine from the Adult Bradycardia protocol.
8. Addition of Push Dose Epinephrine to the Adult Bradycardia and Pediatric Shock protocols.
9. The dosage of Push Dose Epinephrine was standardized across all adult protocols to 10 mcg IV/IO.
10. The dosage of Push Dose Epinephrine in pediatric protocols standardized to 0.1 mcg/kg IV/IO, max 5 mcg.
11. CPAP procedure protocol name changed to Non-Invasive Positive Pressure Ventilation to allow for the use of both ventilators equipped for Bi-Pap and masks that can be dual utilized for CPAP and Bi-level ventilation.
12. Sodium bicarbonate dosage in Adult Hyperkalemia and Adult Overdose protocols changed to 50 meq IV/IO. Sodium Bicarbonate dosage in Pediatric Overdose protocol changed to 1/meq/kg, max 50 mg. The notation of using 4.2% for neonates was removed from the front of the protocol and added as a pearl. Both adult and pediatric overdose protocols will allow for a repeat dose if the QRS remains wide after treatment.
13. Atropine dosage in Adult Bradycardia changed to 1mg to align with current ACLS standards.
14. Updated Behavioral Emergencies protocol, removing the “excited delirium” language and stressing the avoidance of placing agitated patients in the prone position.
15. Removal of Push Dose Phenylephrine from cardiogenic shock on the Shock protocol. Replaced with Push dose epinephrine.
16. Name of Needle Thoracentesis protocol changed to Needle Decompression, and more detail added to mid-axillary placement directions.
17. Changes in terminology in the Behavioral Emergencies protocol including emphasis on patient positioning while restrained.
1.EMTs can now pursue an EMT-IV endorsement after completing the mandatory training. The agency must agree to 100% chart review, and this skill may only be performed under the supervision of a paramedic or AEMT. The EMT can only perform the skill and is not allowed to be the primary caregiver for the patient.
2. Trauma Field Triage Criteria has been updated to follow the latest guidelines approved by the American College of Surgeons Commitee on Trauma. Instead of Steps, there are now Red and Yellow categories. Catchment for Sunrise and Siena have remained the same. There have been some adjustments made to Mike O’Callaghan catchment.
3. Adult Cardiac Arrest pearls were updated to allow for the use of mechanical CPR devices on pregnant patients if these devices were approved for this use by their manufacturer. CPR is to follow a pit crew approach, with roles assigned prior to arrival whenever possible.
4. Westcare has been removed as a patient destination.
5. MountainView Hospital has been removed as a NIR capable facility.
6. Dopamine has been removed from all protocols, as well as from the EMS formulary.
7. Removal of Push Dose Phenylephrine from the Adult Bradycardia protocol.
8. Addition of Push Dose Epinephrine to the Adult Bradycardia and Pediatric Shock protocols.
9. The dosage of Push Dose Epinephrine was standardized across all adult protocols to 10 mcg IV/IO.
10. The dosage of Push Dose Epinephrine in pediatric protocols standardized to 0.1 mcg/kg IV/IO, max 5 mcg.
11. CPAP procedure protocol name changed to Non-Invasive Positive Pressure Ventilation to allow for the use of both ventilators equipped for Bi-Pap and masks that can be dual utilized for CPAP and Bi-level ventilation.
12. Sodium bicarbonate dosage in Adult Hyperkalemia and Adult Overdose protocols changed to 50 meq IV/IO. Sodium Bicarbonate dosage in Pediatric Overdose protocol changed to 1/meq/kg, max 50 mg. The notation of using 4.2% for neonates was removed from the front of the protocol and added as a pearl. Both adult and pediatric overdose protocols will allow for a repeat dose if the QRS remains wide after treatment.
13. Atropine dosage in Adult Bradycardia changed to 1mg to align with current ACLS standards.
14. Updated Behavioral Emergencies protocol, removing the “excited delirium” language and stressing the avoidance of placing agitated patients in the prone position.
15. Removal of Push Dose Phenylephrine from cardiogenic shock on the Shock protocol. Replaced with Push dose epinephrine.
16. Name of Needle Thoracentesis protocol changed to Needle Decompression, and more detail added to mid-axillary placement directions.
17. Changes in terminology in the Behavioral Emergencies protocol including emphasis on patient positioning while restrained.
1.30
Jun 26, 2023
Protocol updates for June 2023.
1.29
Feb 27, 2023
-Updates for February 2023
-Fixed the CPAP chapter.
-Fixed the CPAP chapter.
1.28
Jan 28, 2023
-Addition of Henderson Hospital as a Stroke Center.
-Addition of Mountain View Hospital as a NIR Capable facility.
-Change in the Chest Pain protocol pearls section regarding suspected aneurysm patients.
-Change in the Behavioral Emergencies protocol pearls regarding taser dart removal.
-Addition of Mountain View Hospital as a NIR Capable facility.
-Change in the Chest Pain protocol pearls section regarding suspected aneurysm patients.
-Change in the Behavioral Emergencies protocol pearls regarding taser dart removal.
1.27
Jan 5, 2023
-Updates to Door Codes
1.26
Oct 23, 2022
Performance update
1.25
Aug 28, 2022
Updates to the Protocols.
1.24
Mar 5, 2022
-Updates to to the Protocols Manual (January, 2022)
-New Hospitals added to the Map List
-New Hospitals added to the Map List
1.23
Aug 15, 2021
Updated Protocols for July 2021. New Hospitals added to the Map and List.
1.22
Jul 14, 2021
More Door Codes have been added to the Hospital Numbers Chapter in the Field Reference Guide.
New Manual Version Added.
New Manual Version Added.
1.21
Jul 10, 2021
New Door Codes for Hospitals in Clark County, NV have been added in the Field Reference Guide.
1.20
Apr 17, 2020
Glasgow Coma Scale has been fixed. Some chapters have been removed.
1.19
Apr 15, 2020
Fixed the Glasgow Coma Scale chapter. Also new are chapters and a tab for responding to COVID-19:
-COVID Protocol and Packet
-Respiratory Distress For Use Only During COVID Response
-MDI Addition to Inventory
-Terbutaline Formulary
-COVID Protocol and Packet
-Respiratory Distress For Use Only During COVID Response
-MDI Addition to Inventory
-Terbutaline Formulary
1.18
Apr 13, 2020
Added chapters and a tab for responding to COVID-19:
-COVID Protocol and Packet
-Respiratory Distress For Use Only During COVID Response
-MDI Addition to Inventory
-Terbutaline Formulary
-COVID Protocol and Packet
-Respiratory Distress For Use Only During COVID Response
-MDI Addition to Inventory
-Terbutaline Formulary
1.17
Mar 2, 2020
New in this Version: Changes in the Protocols:
Adult Protocol Changes:
-Sepsis (Suspected) (MAB 12-4-19) – Added a new protocol providing guidelines for recognition and
treatment of suspected sepsis.
-Termination of Resuscitation (MAB 8-7-2019) – Removed capnography requirement under medical arrest. Now reads “for medical arrest: The Patient remains in persistent asystole or agonal rhythm after twneyt (20 minutes of appropriate Paramedic resuscitation to include:...”
-Transport Destinations (MAB 10-2-2019) – Remote Outpatient Emergency Department Alternate Destination Criteria. Revised line 2 to read “The patient has normal vital signs, unless accepted by the remote outpatient emergency department, telemetry contact is made, and ...”
-Addition of Page D3 – Addition of Telemetry Radio Map.
Adult Protocol Changes:
-Sepsis (Suspected) (MAB 12-4-19) – Added a new protocol providing guidelines for recognition and
treatment of suspected sepsis.
-Termination of Resuscitation (MAB 8-7-2019) – Removed capnography requirement under medical arrest. Now reads “for medical arrest: The Patient remains in persistent asystole or agonal rhythm after twneyt (20 minutes of appropriate Paramedic resuscitation to include:...”
-Transport Destinations (MAB 10-2-2019) – Remote Outpatient Emergency Department Alternate Destination Criteria. Revised line 2 to read “The patient has normal vital signs, unless accepted by the remote outpatient emergency department, telemetry contact is made, and ...”
-Addition of Page D3 – Addition of Telemetry Radio Map.
1.16
Aug 4, 2019
New Hospitals added to Map and List. Updates to the Protocols.
1.15
Sep 26, 2018
This app has been remade with Swift. A map of hospitals has been added. A list of hospitals has been added. Changes can be seen here: http://www.southernnevadahealthdistrict.org/ems/regs-manuals.php
1.14
Jun 4, 2017
-Added AEMT to providers who are able to use IOs for Vascular Access. AEMTs may perform IOs on adults only.
-Added the Vascular Access IO skill to the AEMT Scope of Practice.
-Added the Vascular Access IO skill to the AEMT Scope of Practice.
1.13
Apr 6, 2017
Seizure: D10 dose changed to 25g IV (250ml of 10% solution).
Endotracheal Intubation: Ketamine added to the Endotracheal Intubation procedure as an induction agent. Medication dose is 2.0 mg/kg IV or 4.0 mg/kg IM.
Field Reference: Added Door Number for Henderson Hospital.
Endotracheal Intubation: Ketamine added to the Endotracheal Intubation procedure as an induction agent. Medication dose is 2.0 mg/kg IV or 4.0 mg/kg IM.
Field Reference: Added Door Number for Henderson Hospital.
1.12
Aug 2, 2016
Updated Door Codes
1.11
Jul 5, 2016
Updated the Protocols effective June, 2016. Additions include: Public Intoxication. Therapeutic Hypothermia and Post-Resuscitation Care leads to Target Temperature Management and Post-Resuscitation according to the Table of Contents.
1.10
Nov 12, 2015
New in this Version: Updated the Protocols effective October, 2015. Additions include: Hostile Mass Casualty Incident, First Response Evaluate/Release, First Response Low‐Risk Alpha Evaluate and Release Form
1.9
Aug 17, 2015
-Updated Protocols Effective April 2015
-New Chapter Added: Formulary -> Solu-Cortef
-New Chapter Added: Formulary -> Solu-Cortef
1.8
Feb 13, 2015
Added door codes.
1.7
Dec 4, 2014
Updated To Protocols effective November 4, 2014. Put in the correct phone numbers in the Field Reference.
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SNHD Protocols supports English
