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The Valley Hospital Mobile ICU
Standing Orders / Communications Failure Orders
6
(e) Orotracheal and nasotracheal intubation are both considered appropriate management options.
(f) ALS personnel will be permitted only two intubation attempts per person. If the intubation attempts
are unsuccessful, a supraglottic airway should be utilized.
(g) If insertion supraglottic airway does not result in adequate ventilation, ALS crewmembers shall
ventilate the patient with a bag valve mask and basic airway adjuncts.
(h) In the rare case that the ALS crewmembers are presented with a patient who cannot be intubated
and where ventilation with a BVM and basic adjuncts or a supraglottic airway device have failed
(also known as the “Can’t Intubate, Can’t Ventilate” scenario), the ALS crewmembers shall
establish an airway using the approved Cricothyrotomy kit.
(i) Post intubation, continuous waveform capnography shall be monitored for the duration of the
patient encounter.
(j)
If the patient requires sedation due to bucking or combative behavior, the ALS crewmembers shall
administer Lorazepam 2mg IV/IO push as long as the systolic blood pressure is at least
100mmHg. This may be repeated one time in 15 minutes if the patient requires additional
sedation.
8:41-7.4 Standing orders for Vascular Access
(a) The following standing orders for the initiation of vascular access are authorized in those cases
where an emergent or potentially emergent condition exists and current ALS treatment protocols
require the initiation of vascular access. In such cases, ALS crewmembers may establish
vascular access at “keep vein open” (KVO) rate or with a saline port prior to contacting medical
command.
i). If IO access is achieved on a conscious patient, ALS may administer 40mg of Lidocaine
prior to fluid infusion
ii). If IV/IO access is not available or unsuccessful the patient’s Established Vascular Access
Device (EVAD) may be accessed if one of the following emergent conditions is present:
1. Cardiac Arrest
2. Unstable patient with systolic blood pressure less than 90 mmHg with signs of
shock (chest pain, cardiac arrhythmia, altered mental status, significant dyspnea,
anaphylaxis)
iii). EVAD is defined as an established central venous catheters and/or subcutaneous
indwelling catheters
(b) 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.