SNHD Protocols1.41 - App Store

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.

Version History Updated Field Reference 1.41 Aug 11 Updated Protocols for July 2026 1.40 Jul 31 Protocol Updates for October 2025 1.39 11/10/2025 Field Reference Manual Update 1.38 08/26/2025 Added Needle Thoracostomy under Procedures 1.37 01/20/2025 Protocols updates for January, 2025 1.36 01/09/2025 Added West Henderson Hospital. 1.35 11/26/2024 An update to the Hospital List in Field Reference 1.34 11/13/2024 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 07/19/2024 Updated Field Reference Guide and Maps. 1.32 05/06/2024 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. 1.31 02/18/2024 Protocol updates for June 2023. 1.30 06/26/2023 -Updates for February 2023
-Fixed the CPAP chapter. 1.29 02/27/2023 -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. 1.28 01/28/2023 -Updates to Door Codes 1.27 01/05/2023 Performance update 1.26 10/23/2022 Updates to the Protocols. 1.25 08/28/2022 -Updates to to the Protocols Manual (January, 2022)
-New Hospitals added to the Map List 1.24 03/05/2022 Updated Protocols for July 2021. New Hospitals added to the Map and List. 1.23 08/15/2021 More Door Codes have been added to the Hospital Numbers Chapter in the Field Reference Guide.

New Manual Version Added. 1.22 07/14/2021 New Door Codes for Hospitals in Clark County, NV have been added in the Field Reference Guide. 1.21 07/10/2021 Glasgow Coma Scale has been fixed. Some chapters have been removed. 1.20 04/17/2020 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 1.19 04/15/2020 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 1.18 04/13/2020 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. 1.17 03/02/2020