Clinical Procedures and Guidelines

Clinical Procedures

and Guidelines

Comprehensive edition

2019 ¨C 2022

CLINICAL PROCEDURES AND GUIDELINES 2019-22

i

? St John New Zealand, 2019

Except as provided by the Copyright Act 1994, no part of this publication may be reproduced or stored

in a retrieval system in any form or by any means without the prior written permission of the copyright

owner.

Clinical Procedures and Guidelines - Comprehensive Edition

Issued by: Dr Tony Smith, Medical Director

Issue No: 8

Document No: CDT508

Authorised by: Norma Lane,

Director of Clinical Operations

Issue date:

June 2019

Expiry date:

February 2022

Introduction

These are the Clinical Procedures and Guidelines (CPGs), incorporating standing

orders for use of personnel within the New Zealand emergency ambulance sector.

These CPGs are for the use of St John personnel with current authority to practise,

when providing clinical care to patients on behalf of St John. These CPGs have

been developed by the National Ambulance Sector Clinical Working Group and

are issued to individual clinical personnel by Dr Tony Smith, the Medical Director

for St John.

These CPGs will be reviewed at the end of 2020 and 2021, with updates being

issued at that time if required. These CPGs expire at the end of February 2022

at which time they will be formally updated and reissued. They remain the

intellectual property of the National Ambulance Sector Clinical Working Group

and may be recalled or updated at any time. Any persons other than St John

personnel using these CPGs do so at their own risk. Neither St John nor the

National Ambulance Sector Clinical Working Group will be responsible for any

loss, damage or injury suffered by any person as a result of, or arising out of, the

use of these CPGs by persons other than authorised St John personnel.

National Ambulance Sector Clinical Working Group Members

Pete Collins, Patient Safety Manager, Wellington Free Ambulance

Dr Craig Ellis, Deputy Medical Director, St John

Hannah MacLeod, Clinical Innovation and Learning Manager, St John

Daniel Ohs, Assistant Director of Operations - Clinical Practice, St John

Dr Tony Smith (Chair), Medical Director, St John

Adam Stevenson, Intensive Care Paramedic, Wellington Free Ambulance

Dr Andy Swain, Medical Director, Wellington Free Ambulance

Comments and enquiries

Personnel should send an email to clinical.excellence@.nz. Others

wishing to make formal comments or enquiries should contact Dr Tony Smith at

tony.smith@.nz.

Dr Tony Smith

Medical Director

Dr Ian Civil

Chair of the Clinical

Governance Committee

CLINICAL PROCEDURES AND GUIDELINES 2019-22

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Contents

1: General treatment principles

1.1

3: Cardiac

1

Authority to practise and practice

levels

1

1.2

General principles

4

1.3

Providing treatment that differs

from that authorised in these CPGs

6

1.4

Analgesia

11

1.5

Advance directives and advance

care plans

21

1.6

Patient competency 

23

1.7

Calling the Clinical Desk 

26

1.8

Personnel on the Clinical Desk

providing advice 

27

1.9

Crew resource management

28

1.10 Handover

31

1.11 Informed consent

32

1.12 Initial management of a major

incident

34

1.13 End of life care 

38

1.14 Verification of death 

40

1.15 Oxygen administration

43

1.16 Status codes

47

1.17 Requesting a helicopter 

49

1.18 Treatment and referral decisions 

54

1.19 Vital signs

59

1.20 Documentation

63

1.21 The primary and secondary survey

68

2: Respiratory

70

2.1

Asthma

70

2.2

Chronic obstructive pulmonary

disease (COPD)

78

2.3

Foreign body airway obstruction

85

2.4

Positive end expiratory pressure

(PEEP)

88

2.5

Stridor

90

2.6

Croup

92

iv

CLINICAL PROCEDURES AND GUIDELINES 2019-22

93

3.1

Assessment for myocardial ischaemia93

3.2

Myocardial ischaemia

101

3.3

ST elevation myocardial infarction

(STEMI) 

104

3.4

Fibrinolytic therapy

111

3.5

Inter-hospital transfer of patients

with STEMI

115

3.6

Cardiogenic pulmonary oedema

118

3.7

Determining the level of

cardiovascular compromise

122

3.8

Ventricular tachycardia

124

3.9

Supraventricular tachycardia

127

3.10 Atrial fibrillation or atrial flutter 

131

3.11 Cardioversion checklist

135

3.12 Bradycardia

136

3.13 Cardiogenic shock

140

3.14 Cardiac arrest

143

Cardiac arrest in special situations 152

3.15 Treatment following return of

spontaneous circulation

156

4: Shock and trauma

160

4.1

Shock

160

4.2

Major trauma triage

163

4.3

Anaphylaxis

172

4.4

Burns

175

4.5

Crush injury

178

4.6

Hypovolaemia from uncontrolled

bleeding

181

4.7

Hypovolaemia from controlled

bleeding

187

4.8

Hypovolaemia from fluid loss

191

4.9

Concussion and minor traumatic

brain injury 

192

4.10 Severe traumatic brain injury 

196

4.11 Limb and/or soft tissue injuries 

200

4.12 Patella dislocation 

206

4.13 Shoulder dislocation 

208

4.14 Digit dislocation 

212

4.15 Other dislocations

213

4.16 Spinal cord injury

216

4.17 Cervical spine immobilisation

222

4.18 Tension pneumothorax

230

9: Intubation and ventilation

4.19 Amputation

234

343

4.20 Eye injuries

237

9.1

The principles of intubation and

ventilation 

343

4.21 Wounds

243

9.2

Preparation for RSI checklist

345

9.3

Rapid sequence intubation (RSI)

346

9.4

RSI checklist

350

5: Altered consciousness/metabolic

246

5.1

Agitated delirium

246

9.5

Failed intubation drill

351

5.2

Hyperglycaemia

252

9.6

Post intubation

352

5.3

Hypoglycaemia

254

9.7

Mechanical ventilation

357

5.4

Poisoning from gases

257

5.5

Poisoning from medicines

260

5.6

5.7

5.8

10: Mental Health

361

Poisoning from recreational drugs 264

10.1 Mental health conditions

361

Poisoning from miscellaneous

causes

269

10.2 Assessing mental status

364

Seizures

274

10.3 Attempted and/or threatened

suicide

367

10.4 Non-suicidal self-harm

370

10.5 Psychological wellness

371

6: Infection

280

6.1

Assessing for sepsis 

280

6.2

Sepsis

283

11: Environmental

373

6.3

Meningococcal septicaemia

288

11.1 Drowning

373

6.4

Cellulitis

292

11.2 SCUBA diving emergencies

376

6.5

Chest infection

294

11.3 Hyperthermia

378

6.6

Influenza

296

11.4 Hypothermia

382

6.7

Lower urinary tract infection (UTI)  298

6.8

Sore throat

300

12: Miscellaneous

389

6.9

Infectious disease precautions

302

12.1 Autonomic dysreflexia

389

12.2 Blocked urinary catheter

392

12.3 Epistaxis

394

12.4 Minor allergy 

396

12.5 Nausea and/or vomiting

397

12.6 Stroke

398

12.7 Transient ischaemic attack

403

12.8 Inter-hospital transfer for stroke

clot retrieval (SCR) 

404

408

7: Paediatrics

305

7.1

Special considerations in

young children

7.2

Paediatric equipment and

drug doses

310

Neonatal resuscitation

326

7.3

305

8: Pregnancy

331

8.1

Antepartum haemorrhage

331

12.9 Special considerations in the

elderly 

8.2

Postpartum haemorrhage

334

12.10 Obesity

412

8.3

Pregnancy and birth

338

12.11 Patients with existing vascular

access

415

CLINICAL PROCEDURES AND GUIDELINES 2019-22

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