11/17/2023

 

• Multiple updates applied to all guidelines

 

10/17/2022

 

• Multiple spelling, formatting, and punctuation corrections have been made throughout the document.
• Drugs Rocuronium, Levophed, and Metoprolol have been added to the drug formulary.
• Lactated Ringers has been removed from the drug formulary and all guidelines.
• COG 1.6 Discontinuation of Prehospital Resuscitation has been revised to include a new procedure process as well as a new contraindications list. New rhythm criteria for discontinuation has been added. The PEARLS have also been revised.
• COG 1.8 Deceased Person has been revised to include new instructions to not cover the body of a unnatural, questionable, or traumatic death, unless it is a MV A fatality.
• COG 2.15 Cardiac: External Pacing/cardioversion has been created to cover the indications and skill procedure steps for both external packing and synchronized cardioversion.
• COG 2.24 Venous Access: lntraosseus Pediatrics has been revised to now include a Lidocaine 2% dose for patient's responsive to pain.
• COG 2.28 Pain Management: Nitrous Oxide has been revised to now have previous eye surgery within the past 3 months as a contraindication. Line 6 PSI pressure has also been removed.

• COG 3.1 Surgical Airway has been added to the guidelines for only the tactical paramedic team as approved by DHEC and medical control.

• COG 5.2A and 5.2B Adult Airway RSI/MFI has been revised to include a Rocuronium 0.6 mg/kg IV/IO dose. PEARLS has been updated to include Airway confirmation signature from receiving hospital staff.

• COG 6.1 ACS has been revised for BLS units to transmit all 12 lead EKGs for physician interpretation.
• COG 6.2 Adult Bradycardia has been revised to now include obtain 12 lead EKG. The Atropine dose has now increased to 1 mg from 0.5 mg.
• COG 6.3 CHF has been revised to now include Atropine dose of 1 mg. Dopamine has been removed and replaced with Levophed.
• COG 6.4 Narrow Complex Tachycardia has been revised to now include Metoprolol as an alternative to Cardizem.
• COG 7.1 Adult Cardiac Arrest has been revised for EMT’s to initiate BIADs for procedure steps. The PEARLS have been revised to now include a Mag and Lidocaine dose for patient’s in persistent v-fib/v-tach. CPR induced consciousness has now been listed in PEARLS and a Ketamine procedural sedation dose has been added.
• COG 8.1 Abdominal Pain has been revised to include minor changes to abdominal regions.
• COG 8.3.2 Dystonic Reaction has been revised to now include a Versed dose.
• COG 8.8 Medical Hypotension has been revised to now have Dopamine replaced with Levophed under cardiogenic shock. Under non-cardiogenic shock, push dose epi or Levophed has been added. Second line of the PEARLS has been revised to now state push dose epi can be given prior to Levophed infusion in non-cardiac and non-trauma shock.
• COG 8.17 Sepsis has now been revised to include a Rocephin dose of 2 g instead of 1 g. If suspected or reported PCN allergy, crews must still contact medical control for order of Rocephin.
• COG 10.12 and 10.13 Traumatic Arrest has been revised to now include instructions to see COG 1.4 for criteria to withhold resuscitation.
• COG 12.12 R.A.C.E Scale has the word leg extremity changed from arm revised in the third result column.
• Page 155 Rocephin has been revised for 2 g and 100 mL or 50 mL bag is added.
• Page 161 Nitroglycerin has been revised to include contraindication of ED medications taken up to 48 hours.

 

 

4/7/2022

 

• COG 8.18 Stroke/CVA/TIA has been updated to include acute stroke ready hospitals in the guidelines. Prisma Health Hillcrest has been added as a primary stroke center. St. Francis Simpsonville has been added as an acute stroke ready hospital.
• COG 12.6 Hospital Numbers has been updated to include St. Francis Simpsonville.
• COG 12.7 Destination Guidelines has been updated to include St. Francis Simpsonville and Prisma Health Hillcrest.

 

 

02/24/1022

 

• COG 7. I Adult Medical Cardiac Arrest has been revised to now include a max Epinephrine dose with the option to contact medical control for additional doses. This revision has been added in the PEARLS.
• COG I 0.12 Adult Traumatic Cardiac Arrest has been revised to now include a max Epinephrine dose with the option to contact medical control for additional doses. This revision has been added in the PEARLS.
• The Epinephrine drug appendix has been revised to now include a max of four Epinephrine doses with the option to contact medical control for additional doses.

 

 

9/3/2021

 

• The Pediatric age definition has been revised to now state, 1 day to less than age 12 or less than 55 kgs in ages 12-18.
• COG 1.14 has been revised to no longer list out trauma alert criteria. Trauma alert criteria has now been replaced in appendices 12.16.
• COG 1.5 has been revised to state that the POST forms are no longer on state pilot.
• COG 2.18 has been revised and now includes anterior axillary needle decompression site.
• COG 2.23 has been updated to include current IO procedure insertion steps and considerations.
• COG 2.24 has been revised and now includes distal femur for another IO site location.
• Nitrous Oxide is no longer on state pilot and is now listed as an EMT skill procedure.
• COG 7.1 has been revised and now the defined criteria for death has been removed and now states, see COG 1.4 for criteria for death/withholding resuscitation.

• COG 8.15 has been revised to now include a Versed IM dose, if IV is unobtainable.
• COG 9.0 Pediatric Universal Airway has been created.
• Dextrose 10% dose has been increased to 5 mL/kg across all applicable pediatric protocols.
• COG 9.1 has been revised to include a ventilation rate of 20-30 breaths per minute. The defined criteria for death has been removed and now states, see COG 1.4 for criteria for death/withholding resuscitation.
• COG 9.3 has been retitled to Pediatric Post Arrest. Amiodarone drip table has been removed. Oxygenation has been revised to give supplemental oxygen to maintain SPO2 above 94%. ETCO2 target range is now listed as 35-45.
• COG 9.4 has been revised to no longer include a Amiodarone drip dose for wide complex, however now will state consider conscious sedation and synchronized cardioversion.
• COG 9.7 has been revised to include Sickle Cell Disease and less than 60 days old under immunocompromised.
• COG 9.9 has been revised to no longer state if meconium is present, intubate. Also, BVM with room air has been added in place of 100 percent oxygen. The PEARLS has also been revised to consider hypovolemia and pneumothorax if heart rate is persistently less than sixty.
• COG 9.10 has been revised to have Morphine moved up above Fentanyl in the algorithm.
• COG 9.13 has been revised to include abnormal eye movements are the most common sign of seizures in neonates.
• COG 12.6 has been revised to include an FD Medical Control consult number.

 

 

8/21/2021

 

• COG 3.1 Special Team Skill Procedure Surgical Cricothyrotomy has been removed.
• COG 5.2 Adult Airway RSI, has been revised to include Age 12 or greater for indications.
• COG 8.4 Behavioral Emergencies/Chemical Restraint has been revised to include Ketamine back as a medication option. Versed also includes a 5 mg redose.

 

7/01/2021

 

• St. Francis Downtown is moving back to a Primary Stroke Center July 1, 2021.
• Stroke, TIA (R.A.C.E score < 4) transport to GMH, Greer, SFH Downtown, SF Eastside or PMC

 

6/18/2021

 

Behavioral Emergencies: Added repeat dose of Versed IM Removed Ketamine. This is a temporary change until we have a restock order of Ketamine.

 

02.22.2021(Version 1.8)

 

The following revisions have been made to COG version 1.7 that was last updated in August of 2020. This COG version has been reviewed and approved by local medical control. This updated COG version will be effective on February 22nd.

• Dr. Ryan Hoffman has resigned as Assistant Medical Control Director.
• Dr. Kevin Horn has accepted the position of Assistant Medical Control Director.
• COG 1.3 has been revised to include Elderly, Children, and Vulnerable adult abuse reporting.
• COG 2.28 has been revised to include the proper procedural steps for setting up the Nitrox.
• COG 5.1 Universal Airway has been revised.
• COG 5.2 Adult Airway: MFI/RSI, has replaced COG's 5.2 and 5.3 and is now one protocol.
• COG 5.3 is now Post Airway Management. This COG has also been revised.
• COG 5.4 Adult: Failed Airway has now been created.
• COG 8.15 Sedation/Anxiety has been revised to now have a Ketamine max dose of 100 mg. Also, the procedural sedation PEARLS now only states: cardioversion and transcutaneous pacing.
• COG 8.16 Seizures has now been revised to not have max doses listed in last line of PEARLS.
• COG 8.4 has been revised to have Ketamine dose listed as mgs/kgs and the dosing chart has been removed. The upper age restrictions have also been removed for Ketamine and the PEARLS have been revised.
• COG 10.2 Burns has been revised to include further instruction for chemical burns.
• COG 10.3 Chest Injuries has been revised to state that chest seals can be done at the first responder level.
• COG 12.15 Drug list 1 has been revised to no longer include an adult dose of Acetaminophen.
• COG 12.15 Drug list 6 has been revised to include ALS and BLS Epi doses Epi IV dose has also be revised to reflect the dose listed in the guideline.
• COG 12.15 Drug list 7 has been revised to include max doses for Ketamine.
• COG 12.15 Drug list 14 has been revised to list out the Vecuronium dose.

 

08.31.2020

• Version 1.7 Update Release

 

06.12.2020

• Updated COVID PPE
• Updated Terbutaline
• Created new tab "Temporary Polices"
• Medication Cross Check Tab added to menu page

 

06.11.2020

• Changed verbiage in PEARLS of RSI and MFI to read: Airway confirmation signature must be obtained.
• Updated Trauma Activation 1.13 to mirror current guidelines.
• misc. spellings
• removed Trauma Alert Levels, 2 & 3
• Added Telehealth guidelines
• Added Blood Administration guidelines under procedures > treatment

 

06.03.2020_ Updated Stroke/TIA and Hospital Designation to reflect St. Francis Hospital as a Comprehensive Stroke Center that actually went into effect 11/18/2019.

 

03.03.2020_Added Rocephin to Extremity Trauma/Amputation

 

11.5.2019_ Corrected BE Versed Dosage. Removed 2nd dose. Additional doses of Versed or Ketamine have to have online order.