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The Valley Hospital Emergency Services
Standing Orders / Communications Failure Orders
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(h) Post intubation, continuous waveform capnography shall be monitored for the duration of the
patient encounter.
(i) If the patient requires sedation due to bucking or combative behavior, the ALS crewmembers shall
administer Lorazepam 0.1 mg/kg to a maximum dose of 2 mg IV/IO push as long as the systolic
blood pressure is at least 90 mmHg. This may be repeated one time in 15 minutes if the patient
requires additional sedation.
8.41-8.6 Standing orders for pediatric vascular access
(a) The following standing orders for the initiation of pediatric vascular access are authorized in those
cases where an emergent or potentially emergent condition exists and current ALS treatment
protocols require the initiation of IV therapy. In such cases, ALS crewmembers may establish
vascular access at keep vein open (KVO) rate, establish vascular access with a saline port, or
establish intraosseous infusion prior to contacting medical command.
a. ALS crewmembers shall contact medical command as soon as possible after the
establishment of vascular access. Contact with medical command shall not be delayed
by, or as a result of, unsuccessful vascular access in the field.
b. The time of the initiation of vascular access and the time of contact with medical
command shall be recorded on the patient care report.
c. The provider's medical director shall notify the Department as to the solution to be
utilized for vascular access when established under this section.
(b) This standing order may be utilized in conjunction with any other standing order where vascular
access is indicated.
Communications Failure Orders for pediatric vascular access:
(a) Do not delay transport in the event of a patient with difficult vascular access.