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Paramedic Protocol Update 2009

Paramedic Protocol Update 2009 Westchester Regional Emergency Medical Services Council Introduction Westchester Regional Paramedic Protocol Update 2009 Introduction New Format indicating STADING ORDERS, MEDICAL CONTROL OPTIONS, and NOTATIONS.

JasminFlorian
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Paramedic Protocol Update 2009

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  1. Paramedic Protocol Update2009 Westchester Regional Emergency Medical Services Council Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  2. Introduction Westchester Regional Paramedic Protocol Update 2009 Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  3. Introduction • New Format indicating STADING ORDERS, MEDICAL CONTROL OPTIONS, and NOTATIONS. • Each protocol initiates with M1.0-Routine Medical Care or T1.0-Routine Trauma Care. • To be carried out in conjunction with appropriate policies, procedures, and advisories. • Separate Interfacility Transport Protocols under development Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  4. Introduction • New Standard Operating Procedures for Advanced airway Management, Tension Pneumothorax, and Intravenous Access • Endotracheal drug administration has been removed from all protocols • Pediatric protocols now in separate pediatric section • 14 years or youngerfor pediatric patient Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  5. Introduction • In Communications section, "The paramedic must contact the Medical Control Facility upon completion of standing orders" has been removed. Also, the requirement of notification and submission of on scene times of 20 minutes or more has been removed. • In Record Keeping section, NYSDOH approved alternative patient care documentation instrument added. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  6. Introduction • In Conflict Resolution section, cases to be brought to the attention of the service medical director and regional medical director. • In DNR Orders section, clarification of when a DNR may be honored: • For any patient originating from an Article 28 facility (hospital or nursing facility) when written DNR orders from a physician are presented; • For any patient NOT originating from an Article 28 Facility (hospital or skilled nursing facility), ONLY when a physician-signed New York State Department of Health (NYS DOH) non-hospital DNR order (DOH-3474) is presented, or an approved NYS DOH DNR bracelet is found on the patient’s body. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  7. Standard Operating Procedures Westchester Regional Paramedic Protocol Update 2009 Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  8. Standard Operating Procedures • Three new procedures: • Advanced Airway Management • Tension Pneumothorax • Intravenous Access Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  9. Advanced Airway Management Includes: • Endotracheal Intubation (ETT) • Laryngeal Mask Airway (LMA) • Multi-lumen Airway (i.e. Combitube) • Foreign Body Airway Removal via direct Laryngoscopy • Needle Cricothyrotomy • Tracheal Suctioning (including meconium aspiration) • Gastric Decompression • Needle Decompression • Rapid Sequence Intubation (RSI)* *May only be performed by with approval of WREMAC Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  10. Advanced Airway Management Must document PRIMARY confirmation of ETT placement using: • Quantitative Methods • Digital end-tidal CO2 detectors • Wave form capnography • Qualitative Methods • Colormetric end-tidal CO2 detectors Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  11. Advanced Airway Management • Document secondary confirmation using accepted clinical parameters per ACLS guidelines. • Continuous Waveform Capnography must be monitored if medication is used to facilitate intubation. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  12. Tension Pneumothorax Evidence of respiratory/cardiovascular compromise and two of the following: - Absent/decreased breath sounds on affected side- Tracheal deviation- Subcutaneous emphysema Pleural decompression is indicated using a large bore over the needle catheter or other REMAC approved device. Procedure may be repeated if signs and symptoms recur. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  13. Intravenous Access IV KVO of NS or IV lock unless fluid challenge is required. • IV NS with large bore (18ga or larger) catheter for patients requiring rapid volume replacement. • Peripheral veins (not external jugular) should be used as primary access site. • IO may be used only if other sites are not accessible. • IO med administration is preferred over ETT if no IV. • Blood drawing as indicated. Before med administration. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  14. Future SOPs Additional SOPs will be added as needed Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  15. Trauma Protocols Westchester Regional Paramedic Protocol Update 2009 Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  16. Routine Trauma Care T1.0 Replaces old trauma protocols Consolidated: Routine Medical Care, airway, transport consideration, fluid resuscitation for shock, analgesics for pain management, and CPR/rapid transport for Traumatic arrest. Added: Directs provider to Airway Management Protocols, Trauma Transport Algorithm, and Pain Management Protocol. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  17. Trauma Report Appendix 2.3 Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  18. Special Protocols Westchester Regional Paramedic Protocol Update 2009 Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  19. Pain Management S1.0 Replaces old protocols 31 and 31a Changed: For patients presenting with need for pain management (a) with a SBP greater than 110 mmHg: MORPHINE 0.1 mg/kg IV or IO (maximum 5 mg) (b); For continued pain, repeat once (maximum total dose 10 mg) Contact Medical Control Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  20. Pain Management S1.0 Replaces old protocols 31 and 31a Added: Notes a & b. a. Pain management is CONTRAINDICATED for patients presenting with (including but not limited to): Altered Mental Status, Moderate or Severe Head Trauma, Overdoses, or Hypotension b. If HYPOVENTILATION develops: in the ADULT PATIENT, administer NALOXONE up to 2 mg IV, IO or IN. in the PEDIATRIC PATIENT, administer NALOXONE 0.1 mg/kg IV, IM, IO or IN Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  21. Rapid Sequence Intubation S2.0 Replaces old protocol S-1 Added: Note b. Once medication is used to facilitate intubation, whether or not it is successful, the patient’s respiratory effort MUST be monitored with CONTINUOUS WAVEFORM CAPNOGRAPHY. Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  22. Nerve Agent Antidotes S3.0 Replaces old protocol S-2 Added: Commercially available DuoDoteTM auto-injectors, or the previously manufactured Mark I kits, may be possessed / used by a paramedic only under the following conditions… Changed: Directs provider to Adult Administration Protocol (S3.1) and Pediatric Administration Protocol (S3.2) (Continued on Next Slide) Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  23. Nerve Agent Antidote-Adult S3.1 Changed: Standing Orders now: MILD - 1 MARK I KIT /1 DUODOTETM KIT or ATROPINE 2 mg IV, IM or IO every 5 minutes until secretions resolve / PRALIDOXIME 1 g IV, IM or IO over 10 minutes MODERATE - 2 MARK I KITS / 2 DUODOTETM KITS or ATROPINE 4 mg IV, IM or IO every 5 minutes until secretions resolve / PRALIDOXIME 2 g IV, IM or IO over 10 minutes SEVERE - 3 MARK I KITS /3 DUODOTETM KITS or ATROPINE 6 mg IV, IM or IO every 5 minutes until secretions resolve / PRALIDOXIME 2 g IV, IM or IO over 10 minutes (Continued on Next Slide) Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  24. Nerve Agent Antidote-Pediatric S3.2 Changed: Standing Orders now: MODERATE - 2 MARK I KITS / 2 DUODOTE KITS or ATROPINE 0.02 mg/kg IV, IM or IO every 5 minutes until secretions resolve / PRALIDOXIME 40 mg/kg IV, IM or IO over 10 minutes SEVERE- 3 MARK I KITS /3 DUODOTE KITS or ATROPINE 0.04 mg IV, IM or IO every 5 minutes until secretions resolve / PRALIDOXIME 40 mg/kg IV, IM or IO over 10 minutes If the patient is presenting with MILD exposure symptoms, CONTACT MEDICAL CONTROL. 1 MARK I KIT /1 DUODOTE KIT or ATROPINE 0.02 mg/kg IV, IM or IO every 5 minutes until secretions resolve / PRALIDOXIME 40 mg/kg IV, IM or IO over 10 minutes Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

  25. Questions • WREMSCO Office • 914-231-1616 Westchester Paramedic Protocol Update 5/09 - Intro/SOPs/Trauma/Special

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