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Region VII BLS SMO Revision - PowerPoint PPT Presentation

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Region VII BLS SMO Revision. 2011. 2011 BLS SMO. This presentation will highlight changes in the SMO’s and also cover information that is on the 2011 SMO study booklet. Code 2: Respiratory Distress. Added reference to Failed Adult Airway Code 75 for inadequate breathing.

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2011 bls smo
2011 BLS SMO

This presentation will highlight changes in the SMO’s and also cover information that is on the 2011 SMO study booklet.

code 2 respiratory distress
Code 2: Respiratory Distress
  • Added reference to Failed Adult Airway Code 75 for inadequate breathing.
  • Code 75 – BLS providers now allowed to use King Airway for patients who are not getting good ventilations with BVM alone.
code 3
Code 3
  • The Airway Obstruction code, in the past, referred to infant situations.
  • The pediatric portion (less than one year) was eliminated in this revision and now Code 3 only refers to patients that are over 1 year old.
code 4 cardiac arrest
Code 4 – Cardiac Arrest
  • Codes 6, 9 and 11 now all refer back to this code (Vfib, Vtach, PEA, asystole)
  • BLS treatment for all is the same anyway.
  • Includes suggestion that King Airway be considered.
  • Encourages minimal interruptions of chest compressions per new AHA guidelines.
code 12 suspected cardiac patient
Code 12 – Suspected Cardiac Patient
  • Have added “perform 12 lead EKG and transmit if available” to BLS cardiac SMO.
  • Have added box that includes times 12-lead use should be considered:
    • Chest pain/discomfort/pressure
    • Arm pain
    • Jaw pain
    • Upper back pain
    • Unexplained diaphoresis
    • Vomiting without fever or diarrhea
    • Shortness of breath
    • Dizzy/syncope
    • Epigastric pain
    • Unexplained fall in elderly
    • Weakness/fatigue
    • Bradycardia or tachycardia
bls and 12 leads
BLS and 12-leads
  • BLS providers will not be asked to interpret 12-lead EKG’s.
  • But it will be within their scope of practice to apply electrodes if trained, and transmit the results to the ER.
  • Will make the EMT-B of even greater assistance to their EMT-P partner, and to the ER.
code 13 pulmonary edema due to heart failure
Code 13 – Pulmonary Edema Due to Heart Failure
  • Adds “consider CPAP en route, if available” for patients with a BP > 90.
  • CPAP an exciting new addition to the BLS toolbox for patients with trouble breathing due to pulmonary edema/CHF.
  • Also referred to in Code 30 (Asthma, COPD, Wheezing) with approval of medical control.
trauma codes
Trauma Codes
  • Codes 16 and 21 (trauma and extremity injuries) now allow for use of hemostatic agents by BLS providers.
  • These are powders or chemicals that are applied to wounds to stop bleeding.
  • Your EMS coordinator will have more information on whether your department has purchased hemostatic agents.

Code 21




(ABCs always take priority over the severed part)

  • Control bleeding with direct pressure and elevation
  • For uncontrolled hemorrhage:
    • Consider use of a hemostatic agent
    • Use a tourniquet if needed
      • Note time of placement
      • Apply as close to the injury as possible
      • DO NOT release once applied

NITROUS OXIDE (optional)

  • Wrap part in sterile gauze, sheet or towel.
  • Place part in waterproof bag or container and seal.
  • DO NOT immerse part in any solutions.
  • Place this container in a second one filled
  • with ice, cold water or cold pack.

Transport part to hospital with patient



MORPHINE SULFATE 5-10mg slow IV in 5mg

increments every 5 minutes as necessary for pain.

Reviewed 10/01/11

Effective 05/01/98


code 24 trauma in pregnancy
Code 24 – Trauma in Pregnancy
  • Added F – “Manually displace uterus to the left side during CPR.”
  • Left uterine displacement increases cardiac output by 30% and restores circulation.
intranasal medications
Intranasal Medications
  • Codes 32, 33, 34 and 35 now allow for BLS use of Intranasal Narcan and Glucagon.
  • Fast-acting through the nasal mucosa.
  • Allows for effective BLS treatment of diabetics, drug OD’s, comas of unknown origin and seizures

Code 18




Suspected Deceleration Injuries,

Motor Vehicle Crashes, Falls, etc.


Spine pain/tenderness or

complaint of neck/spine pain



Physical findings suggesting neck and/or back injury



Other painful injury identified

(Distracting Injury)



Decreased or altered level of consciousness



Motor/Sensory Exam

Patient is

  • Calm
  • Cooperative
  • Alert
  • Ambulatory without pain
  • No apparent distress
  • No suspected intoxication
  • Having an acute stress reaction
  • Suspected of being intoxicated
  • Have symptoms of brain injury
  • Acting inappropriately
  • Having difficulty communicating,
  • such as, speaks a foreign language, deaf, etc.

Reliable patient exam


Reviewed 10/01/11

Effective 05/01/98



code 38 suspected stroke
Code 38 – Suspected Stroke
  • “Hypertensive Crisis” code is gone.
  • Replaced with “Suspected Stroke” code.
  • Includes possible use of 12-lead EKG
  • Also includes performance of Cincinnati Stroke Scale and checking of glucose.
code 45 emergency childbirth
Code 45 – Emergency Childbirth
  • Removes “involuntary pushing with contractions” and “contractions less than 2 minutes apart” from criteria to prepare for immediate delivery.
  • Bulging perineum or crowning are most important things to look for… the rest may still allow you transport time.
some other minor changes
Some other minor changes
  • Code 55 and 56, pediatric respiratory distress and arrest, now refer to “back slaps” instead of “back blows”.
  • Code 61, pediatric toxic exposure, now says simply “do not induce vomiting” instead of going into detail about caustic substances.
  • Code 68, Behavioral Emergencies, now reminds you to first “maintain situational awareness and scene safety”.