Introduction:

Optimal prehospital emergency medical care results from a combination of careful essential prehospital emergency medical services (EMS) patient triage, assessment and management, followed by appropriate medical direction consultations when required. EMS protocols are recognized as a written instructional procedure that all EMS health care professionals, such as paramedics and emergency medical technicians (EMTs) must follow and adhere to during the provision of pre hospital medical care.

The current Civil Defence and Ambulance Authority (CDAA) Emergency Medical Service Protocol - Version 6 update (2024-2027) is issued and endorsed by its ambulance service system medical directors. It encompasses its system pre hospital health care provider’s scope of emergency medical care for each pre hospital discipline with their designated scope of practice. This protocol embraces the use of evidence based medical practice along with essential practical and scientific pearls. The current version is based on the official National Model EMS Clinical Guidelines issued and maintained by the National Association of State EMS Officials (NASEMSO) in United State of America which officially authorized CDAA ambulance service to refer to as part of its clinical governance settings.

The Directorate General of Ambulance medical directors has attempted to ensure that all information in these protocol is accurate and in accordance with the best medical evidence available and relevant professional guidelines as commonly practiced at the time of publication. It is the responsibility of each provider to ensure he/she is familiar with the contents of this document pertinent to their level of training and scope of practice.

Thank you for your hard work and dedication.

Protocol Implementation

These protocol is written for the EMS Scope of Practice Model levels (EMT, AEMT and Paramedic). When has completed training on these protocol, they may begin to use these new protocol.

Protocol Labeling

Protocol that are labeled 

• - #.EMT or #.AEMT or #.Paramedic indicate the adult and pediatric versions of that protocol when appropriate. If no designation is listed and it is not obvious (such as newborn resuscitation), the protocol applies to both adult and pediatric patients.
• labeled #.MD it's indicates the Medical Director.
• Color  Important Information.

Standing Orders Are Cumulative

Standing orders are those orders that may be carried out by an EMS provider without the need for on-line Medical Direction. However, EMS providers at any level of training are encouraged to contact on-line Medical Direction in cases where they believe treatment beyond standing orders is warranted, cases where there is uncertainty regarding treatment or in cases involving medicolegal or jurisdictional issues.

The standing orders for Advanced Medical Technician (AEMT)/Paramedics inherently include the standing orders of the lower levels. The sequence of standing orders as they appear in these protocol is not necessarily the order in which they might be executed by a provider.

Calling for Advanced Life Support 

In case the Ambulance station works with an EMT and in any case where an AEMT or Paramedic can provide interventions beyond those of an EMT, the protocol indicates, “Call for AEMT/paramedic intercept, if available.” When the protocol says call for Paramedic intercept, it means consider obtaining an intercept based on the clinical situation and availability. The intent of this statement is to indicate those clinical situations where a paramedic can provide assessment and interventions beyond those of an EMT. The protocol indicates which clinical situations should receive that level of care. 

Calling for Advanced Life Support

In case the Ambulance station worked with EMT and in any case where an AEMT or Paramedic can provide interventions beyond those of an EMT, the protocol indicates, “Call for AEMT/paramedic intercept, if available.” When the protocol says call for Paramedic intercept, it means consider obtaining an intercept based upon the clinical situation and availability. The intent of this statement is to indicate those clinical situations where a paramedic can provide assessment and interventions beyond those of an EMT. The protocol indicate which clinical situations should receive that level of care.

Continuous Quality Improvement

Quality improvement permeates every aspect of our lives… we strive for a better outcome with each decision. The CDAA EMS Protocol are no different. With each edition, we endeavor to make them better than they were before, knowing that we will improve and refine them in the future as evidence, experience and technology dictate. The Director General of Ambulance wish to thank the entire EMS personals for their involvement in updating the EMS Protocol. The continued quality of this document comes from your thoughtful suggestions and feedback.

The CDAA would like to thank the members of the protocol workgroup, who made an outstanding contribution to the development of these protocol.