Total Response SA Protocol and Procedure Content Change List

Last Revised: June, 2022

The following is a comprehensive list of changes that were made to the Total Response SA database. While some changes are behind the scenes or “under the hood” in nature, most changes were made as a result of direct of feedback from you, our users.
We are thankful to have such a dedicated group of users contributing to the improvement of Total Response.

Updates received are dependent on the type of license(s) you have. e.g.: Full Service versus EMD only, FSD only, etc.

Procedure Updates

New Tourniquet Procedure

Many of you have asked for it, and now we’ve built it!
Built with the direction and guidance of our Medical Director Dr. Patrick Lanzetta.
Like any other procedure, you can launch it manually from the Procedure search feature, or you can assign it as a Hotkey.

Naloxone Procedure

The procedure has been updated to reflect additional delivery methods of Naloxone:
- Narcan Nasal Atomizer
- Narcan Nasal Spray
- EVZIO Auto Injector

Aspirin Advisory Procedure

The defunct verbiage “baby aspirin” has been replaced with “low dose” in all areas where “baby aspirin” was used.
Wording in the first two Primary Questions has been changed to improve the delivery of the question to a caller.

Epi-Pen Procedure

The procedure has been updated to reflect changes in the appearance of epi-pens (adult and child)
Corrected a spelling error on the Epi Pen 10 element

Active Shooter Procedure

You made us aware of a typo.
- Corrected the spelling of “whoes” to “whose” in the Advisory Statement for the Procedure.
Modified wording to various elements and Advisory Statements to align with current DHS and FBI Active Shooter guidelines.

Choking (Adult) Procedure

The advisory statement from the element Heimlich 4 was removed as it was duplicated wording of the element that is next in the sequence of steps.
- Same for Chest Thrust 3
- Same for Abdo Thrust 4
At the direction of our medical director Dr. Lanzetta, we modified the wording of the Heimlich 7 and Abdo Thrust 4 elements to “Is he/she breathing?”
- Formerly they also asked, “Did anything pop out?”
Corrected a spelling error on the Heimlich5 element; “breath” to “breathe.”
Added correct punctuation to the Abdo Thrust 5 element.
Corrected a module link on the Heimlich 6, Abdo Thrust 8, and Chest Thrust 6 elements.

Choking (Child) Procedure

The advisory statement from the element Heimlich 4 was removed as it was duplicated wording of the element that is next in the sequence of steps.
- Same for Abdo Thrust 4
At the direction of Dr. Lanzetta, we modified the wording of the Heimlich 7 element to “Is he/she breathing?”
- Formerly, it also asked, “Did anything pop out?”

Choking (Infant) Procedure

You made us aware of a typo.
- Corrected the spelling of “breath” to “breathe” in the Infant Back Blows 4 element
The advisory statement from the element Back Blows 3 was removed as it was duplicated wording of the element that is next in the sequence of steps.
At the direction of Dr. Lanzetta, we modified the wording of the Infant Back Blows 4 element to “Is the baby breathing?”
- Formerly it also asked, “if anything came out.”
The “Yes” answer in the Infant Chest Thrust 5 element was capitalized to “YES” as it is a link to a CPR procedure.
At the direction of Dr. Lanzetta, the wording in the Chest Thrust 6 element was modified for clarity.

CPR (Adult) Procedure

The Rescue Breaths and Signs of Circulation answer details in the Chest Compression 6 element were changed to lower case as they are not links to procedures.
The “Yes” answer in the Signs of Circulation element was changed to “YES” as it is a link to a procedure.
Capitalized “Normal Breathing” on the Breathing element as it is a link to a procedure
Corrected a wording error in the Advisory Statement on entry to the procedure
Capitalized the Yes in “YES – Immediately Available” answer detail on the Breathing element as it is a link to a procedure
Added a new advisory statement to the Airway element about the dangers of foreign substances

CPR (Child) Procedure

You made us aware of a typo.
- Removed an “s” at the end of “hand” on the Chest Compression 3 element.
Capitalized “Normal Breathing” on the Breathing element as it is a link to a procedure.
Corrected a wording error in the Advisory Statement on entry to the procedure.

Vehicle Description Procedure

You requested a new element asking about license plate state.
- You will now see a new element asking, “What state is the plate registered in?”
There was a space within the answer details of “mini van” and “motor cycle” on the Vehicle Type element. Answer details now read as “minivan” and “motorcycle.”

Recovery Procedure

Clarified wording on the advisory statement on the Head Injury element

System Wide Changes

Based on widespread user feedback, we have removed all instances of the “Acknowledge” button that was required to be selected at certain points of various procedures.
- You will no longer be stopped and required to select the acknowledge button that appeared in the Alert window, but the Advisory Statements will still be present.

Protocol Updates

Abdominal Pain

Fixed two (2) Incident Type triggers in the Chest Pain element on Primary Questions
Removed a duplicate word from the Look Out element on CC

Aircraft Incident

Corrected a typo in the advisory statement on the Location element on Primary Questions

Alarm Sounding

Removed an un-needed branch from Suspicious Activity element on Primary Questions
Corrected a typo in the CO answer detail in the Alarm Activation element
Modified a trigger branch for the Suspicious Activity element on Primary Questions

Allergies-Stings

A new element, called Medicine Taken, was added to the PAI module.
The Treatment element was changed from a free text to a single select with several answer options.
Wording on the Medication element was modified due to the previous element changes.

Animal Bites-Attacks

Corrected the spelling of “salia’s” to “saliva’s” in the Advisory Statement for the protocol
Added a link to Secondary Questions when choosing “Small Laceration
- You will now be automatically sent to Secondary Questions when that answer is selected.

Assault

Added “Face” as an answer option to the Injury element on Primary Questions

Back Pain

Your feedback was that the Breathing element/answer details on Primary Questions should match the Breathing element/answer details on Vital Signs. We agree!
- Both elements are now identical and selected answers will carry over.

Bleeding-Lacerations

You requested that the Hemorrhage element be given an answer option of “Other.”
- That answer detail has been added.

Breathing Problems

Capitalize “Yes” in Choking element answer details as it links to the Choking Procedure.

Burglary

Your feedback was that a default answer was appearing in the When element on Primary Questions without selecting an answer. The default mechanism has been removed.
- You will no longer see a default answer selected on the When element.
Your feedback was that the purposely duplicated law enforcement related questions that were appearing on both Primary Questions and Secondary Questions did not need to be. We agree and have removed them from Secondary Questions.
- You will no longer see the Location or When elements on Secondary Questions.

Carbon Monoxide-Inhalation

Your feedback indicated you wanted the Vital Signs module on this protocol to have the multiple instances feature. This change has been made.

Chest Pain

You wanted the ability to select more than one answer on the Medications element on Primary Questions
- The element has been changed to multi-select and you can now choose multiple answers. (Remember, you must tab off of a multi-select even if you’re on mouse navigation.)
You asked for a new answer detail for the Medications element of Unknown
- Unknown has been added as an answer detail.
You let us know we had another duplicated word of “has has” on the Medical History element on Secondary Questions. It has been corrected.

Childbirth-Obstetrics

Your feedback indicated you wanted the Vital Signs module on this protocol to have the multiple instances feature. This change has been made.
- You can now record Vital Signs for multiple people, especially if the mom has the baby- in which case hopefully you get a stork pin!
Corrected a “sunny day scenario” by adding in a low priority EMS recommendation.

Choking

The No answers in both Breathing elements on Vital Signs and Primary Questions have been changed to NO as they are links to the Choking procedures.
- Any capitalized answer is a link to a procedure.

Convulsions-Seizures

Under the hood change made to two (2) answer details that improve navigation related to previously selected answers.

Diabetic Problems

You requested that an answer option of “Uncertain” be added to the Insulin Today element.
- That answer detail has been added
The module link trigger to the MonitorABCs procedure was fixed to the correct navigation.
You let us know there was confusion over the Sugar element on PAIs.
- You will now see a preceding statement about how the PAI only applies to those with low blood sugar.

Electrical Hazard

You let us know that the Injury element on Primary Questions was incorrectly configured as a multi-select. This has been corrected and is now a single select element.
The module link off of the Injury element on PAIs was not functioning.
- When you select Electrocution PAI answer detail you’ll go where you’re supposed to go.

Electrocution

An under the hood change where an existing Advisory Statement was added to the “Yes” answer on the Electrical Contact element on Primary Questions, you will now see the same advisory statement when selecting Yes as any other answer.

Falls-Back Injury

Added “Unknown” as an answer option to the Injury element on Primary Questions.

Hazardous Materials

The Hazmat3 element was removed from Secondary Questions because it matched similarly to the existing Contact element and had a similar Advisory Statement making it superfluous.

Headache

A bridge was added to the Yes answer on the Numbness element on Primary Questions.
- You will now have the option of being bridged to Stroke-CVA if you choose Yes.

Heart Problems

Added a NOT BREATHING answer branch and Advisory Statement that directs the call-taker to obtain an age and navigate to the appropriate CPR procedure.
- This branch and Advisory Statement are already in place in other protocols.

Larceny-Theft

Corrected a navigation error where users were being brought to the wrong element after choosing an answer on the Weapons Description element on Secondary Questions.
- Now you’ll be brought to the correct element.

Lock Out-Lock in

You let us know that the Injury element on Primary Questions was incorrectly configured as a multi-select
- This has been corrected and is now a single select element
Corrected a navigation error where users were being brought to the wrong element after choosing an answer on the Animal Location element on Secondary Questions.
- Now you’ll be brought to the correct element. (Anyone hear an echo?)

Motor Vehicle Accident

This one is a bit more complicated; there was a matching element on Primary Questions and Secondary Questions that resulted in the answer being carried over. But the elements were worded very differently and asking for different sets of information.
- The element constant has been changed so that the answer no longer carries over
  - A constant is the name or title of any given element.
- Feedback from users indicated the need to add a “No” answer option to the Left Scene element on Secondary Questions. We agreed! Added.

Prowler

You let us know that the No answer on the Burglary element on Primary Questions did not navigate to the next element.
- Fixed!
Updated the default risk weighting on the Burglary element on Primary Questions.

Sick Person

Several under the hood changes made to activity triggers on the Alert and Breathing elements.
Per Dr Lanzetta, we removed age conditions from the Chest Pain element on Primary Questions.

Stab-Gunshot Incident

Navigation was added to the Threats element answer details to go to Suspect Location

Stab-Gunshot Injury

A module link to Vital Signs was added to the answer detail of Chest on the Injury element

Stalking

Updated Risk Weighting associated with the Weapons element on Primary Questions

Stroke-CVA

At the Direction of Dr Lanzetta, a new answer detail of Facial Drooping has been added to the Symptoms element on Primary Questions.

Structure Fire

Feedback from you indicated that having separate 1^st and 2^nd party PAIs on this protocol were not user friendly. Because the protocol defaults to 2^nd party and if you launched the protocol quickly than you didn’t have easy access to the 1^st party PAIs. After conducting an internal review, it was decided to combine the two sets of PAIs.
- You will now see 1^st and 2^nd party PAIs on a single PAI module when launching the Structure Fire protocol. You simply choose the caller party in the first element and Total Response will guide you down the proper sequence of PAIs.
Updated the wording in the advisory statement on the Trapped Advice element.

Suspicious Package-Item

Corrected a wording error in the Advisory Statement on the How element.

Traumatic Injuries

You made us aware that the answer detail of No on the Breathing element on Primary Questions had no triggers for creating a dispatch recommendation.
- This was corrected to match No on the Breathing element on Vital Signs.
You made a request that additional wording should be added to the Bleeding element on Primary Questions.
- Text added > “If the victim has a penetrating object, DO NOT try to remove it!”

Unconscious-Fainting

You made us aware that several answer options on the Multiple episode element on Primary Questions were not moving you to Secondary Questions.
- All relevant answer details will now link you to Secondary Questions
Updated Risk Weighting on the Breathing elements on Vital Signs and Primary Questions

Vehicle Fire

You supplied several vehicle type element answer suggestions, here is what we did for you:
- Removed the answer detail “Coach”
- Removed the answer detail “Station Wagon”
- Added the answer detail “Farming Vehicle”
Changed the Injury element from multi-select to single select