MICU Protocols

A mobile intensive care unit, or MICU, is an ambulance designed to transport patients who are in need of critical care and treatment during transport. Protocols are procedures that are designed to identify a course of action to take when a certain event occurs. For MICUs, these protocols provide specific guidance for health care physicians, nurses, paramedics and emergency personnel.

Standing Orders

• According to the regulations issued by the New Jersey Office of Emergency Medical Services, standing order protocols are established to authorize specific treatment in life-saving situations. These protocols anticipate the situation where the medical personnel in the MICU will not have time to communicate with the base station and receive instructions from a physician. By this protocol the medical personnel are authorized to follow exactly the course of treatment for the particular medical emergency as detailed in the standing order.

Radio Failure Protocols

• These protocols anticipate the situation when radio contact between the MICU and the base station, normally a hospital, is lost. Medical personnel are given detailed instructions on a variety of subjects and are authorized to proceed without waiting for radio contact to be re-established. A copy of these protocols must be kept in each licensed vehicle at all times.

Administration

• Many MICU protocols relate to administrative tasks, such as program policy and medical director role. Other examples would be the required equipment list and transport capabilities. The narcotic medication box exchange is the protocol that deals with accountability for controlled substances which are on the required equipment list. A hospital pharmacy maintains responsibility for keeping the box stocked with all required narcotic medicines. It also must reconcile the inventory and account for medications that have been used.

Procedures

• Protocols like those established by Washtenaw County Michigan detail treatment for specific medical procedures. For example, the chest pain protocol details that MICU patients with active chest pain receive nitroglycerin in the specific amounts listed. Adverse effects of nitroglycerin are listed in the protocol. The protocol also covers administration of morphine and lists all of the specific directives relating to treatment of chest pain. Another protocol governs chest tubes. It states that MICU paramedics will monitor and fix any problems with chest tubes already inserted but they will not insert chest tubes. Numerous directives are included explaining how to monitor, adjust and correct any problems with the tubes.