Hawaii EMS protocols,
in your pocket.

• 81 mg
• 162 mg
• ✓ 325 mg
• 500 mg

The June 2025 update to protocol 2-1-b (Chest Pain: Adult) adjusted aspirin dosing from 162 mg to 325 mg for adults without a history of allergic reaction.

• Hospital-Performed Cardiopulmonary Resuscitation
• ✓ High Performance Cardiopulmonary Resuscitation
• Hands-Placed Cardiopulmonary Resuscitation
• High Priority Cardiopulmonary Resuscitation

The Approved Medical Abbreviations section explicitly defines HP-CPR as 'high performance cardiopulmonary resuscitation.' This is a distinct, protocol-recognized term separate from standard CPR, emphasizing the quality and performance standards expected during resuscitation.

• Withhold further NTG because the maximum of two doses has been reached
• ✓ Administer a third dose of NTG 0.4 mg sublingual since BP remains > 100 mmHg
• Contact the base station physician before giving any additional NTG
• Establish IV access before administering a third dose of NTG

Protocol 2-1-b states NTG may be repeated every 5 minutes if BP remains > 100 mmHg systolic, up to three total doses. The patient has only received two doses and still meets the BP threshold, so a third dose is appropriate. Communication for additional orders is only required if pain is unrelieved after all 3 doses.

• Transport to the nearest emergency department and notify them upon arrival.
• ✓ Transport to the nearest PCTA facility and communicate with the receiving physician; transmit EKG if capable.
• Contact the base station physician first and await orders before selecting a destination.
• Transport to The Queen's Medical Center Punchbowl as it is the only approved STEMI destination.

The protocol states that suspected STEMI patients (as indicated by prehospital EKG) are to be transported to the nearest PCTA facility. Physician communication to the receiving facility is required, and the EKG should be transmitted if capabilities are available.

• He does not qualify because bystander CPR was initiated before EMS arrived
• He does not qualify because PEA is a shockable rhythm
• ✓ He meets ALL criteria for Termination of Resuscitation consideration
• He does not qualify because ETCO2 must be above 10 mmHg to terminate

Per the protocol, ALL of the following must be met: ALS resuscitation ≥ 20 minutes in an unshockable rhythm (met — 22 min, PEA is unshockable), no ROSC (met), > 18 years old (met), initial rhythm asystole or PEA confirmed in two leads (met), no defibrillation performed (met), EMS did not witness the arrest (met), airway confirmed by digital waveform capnography (met), and ETCO2 < 10 mmHg despite effective CPR (met — 8 mmHg). All criteria are satisfied.

• Transport immediately to the nearest hospital and notify en route using the phrase 'STEMI Alert'
• ✓ Notify the receiving hospital using the phrase 'STEMI Alert' as soon as possible and transport to the closest appropriate hospital, preferably one with PCI capability
• Administer aspirin first, then notify the receiving hospital using the phrase 'Cardiac Alert'
• Contact the base station physician for orders before notifying the receiving hospital

Per protocol 2-1-b step 3, if significant ST elevations are present, the paramedic must notify the receiving hospital as soon as possible using the specific phrase 'STEMI Alert' and transport to the closest appropriate hospital, preferably one with PCI capability. The notification phrase and preference for PCI-capable facility are key protocol specifics.