Protocol Changes for the July 2024 Protocol Manual Update:
1. Removal of both the Adult and Pediatric Drowning Protocols
2. Correction of an omission in catchment for Yellow Mechanism of Injury in the Trauma Field
Triage Criteria Protocol. Language for St Rose Siena catchment should include “the city of
Henderson in its entirety.”
3. Added the following language to the Heat Stroke column of both the Adult and Pediatric Heat-
Related Illness protocols, “Continue cold water immersion if initiated.” Added the following pearl to both protocols, “Cold water immersion (CWI) is the preferred method of active cooling. Some providers such as certified athletic trainers (ATCs) and event medical personnel are prepared to initiate CWI prior to EMS arrival. If cold water immersion was initiated due to documented hyperthermia, these patients should not be removed from CWI prior to their rectal temperature reaching 102.2F (39C) or mental status returning to baseline unless it is required to manage other emergent issues such as airway.”
4. Increased dose of Atropine to 1mg in the Adult Bradycardia protocol, and added the language “q 3-5 min, total max dose 3 mg.”. Addition of pearls discussing symptomatic bradycardia and possible causes.
5. Addition of language to Pediatric Cardiac Arrest Protocol , “Early ventilation is recommended” . Added language in pearls: “Once an advanced airway is in place, compressions should be continuous with ventilations every three seconds.”
6. Multiple changes to the Needle Decompression protocol, including changing the name to Needle Thoracostomy and changing the primary insertion site to the mid-axillary site.
7. Multiple changes to the Behavioral Emergency protocol, including the introduction of the IMC- Rass scale to rate the agitation levels of patients.
1.33 19/07/2024 
