protocol update l.
Skip this Video
Loading SlideShow in 5 Seconds..
Protocol Update PowerPoint Presentation
Download Presentation
Protocol Update

Loading in 2 Seconds...

play fullscreen
1 / 51

Protocol Update - PowerPoint PPT Presentation

  • Uploaded on

Protocol Update Version 6.032 Updated January 20, 2006 Created by Central Mass EMS Corp. (Region II EMS) Visit us! Overview General Changes Specific Protocol Changes New Protocols Appendix Changes

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Protocol Update' - Jims

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
protocol update

Protocol Update

Version 6.032

Updated January 20, 2006

Created by

Central Mass EMS Corp. (Region II EMS)

Visit us!

  • General Changes
  • Specific Protocol Changes
  • New Protocols
  • Appendix Changes
  • Administrative Requirements and Advisories released since last protocol update
  • Conclusion
general changes4
General Changes
  • New Format (redundancy eliminated)
  • Preamble updated (see #13)
  • Generic names for all medications; also bold typed
  • Drug Reference edited to include only those medications on Medications List (see Appendix A)
general changes continued
General Changes, continued
  • Use of nasal Naloxone wherever Naloxone allowed
  • Blood glucose threshold changed in all pertinent protocols from 100 to 70
general changes continued6
General Changes, continued
  • Reference to “Follow AED Protocol” replaced in all pertinent protocols with:

“Use AED according to the standards of the American Heart Association or as otherwise noted in these protocols and other advisories”.

asystole cardiac arrest 1 1
Asystole/Cardiac Arrest (1.1)

Paramedic Standing Orders:

Administer a250cc bolus of IV Normal Saline if warranted

atrial fibrillation 1 2 and atrial flutter 1 3
Atrial Fibrillation (1.2) andAtrial Flutter (1.3)
  • NOTE: For rate control in adult patients currently prescribed a beta-blocker

Paramedic Medical Control:

  • Administer Metoprolol Bolus 2.5mg-5mg slow IV Push over 2 minutes
  • Repeat dosing in 5 minute intervals to a max of 15mg
atrial fibrillation 1 2 and atrial flutter 1 3 continued
Atrial Fibrillation (1.2) andAtrial Flutter (1.3), continued


Do not mix IV Metoprolol with IV Ca blockers

chest pain 1 5
Chest Pain (1.5)
  • Name changed to Acute Coronary Syndrome
  • Paramedic Standing Orders: Morphine dose 2.0-4.0 mg
  • Medical Control: Lidocaine and repeat bolus removed
post resuscitation 1 6
Post Resuscitation (1.6)

Paramedic Standing Orders:

Dopamine 10.0mcg/kg per minute if BP is < 80 systolic after fluid bolus

vtach with pulses 1 11
VTach with Pulses (1.11)
  • Paramedic Standing Orders: Amiodarone 150mg in 10cc normal saline IV over 8-10 minutesadded
  • Medical Control: Amiodarone 150mg-300mg in 10ml Normal Saline IV over 8-10 minutes (changed from 1-2 minutes)
hypothermia 2 4
Hypothermia (2.4)

Paramedic Standing orders:

Thiamine administration removed

nerve agent exposure 2 6
Nerve Agent Exposure (2.6)

First Responders may administer nerve agent antidotes (Mark-1 kits) to fellow authorized public employees

(This change was initially released as an OEMS Advisory on January 18, 2005)

abdominal pain 3 1
Abdominal Pain (3.1)

Medical Control:

Patients with severe pain and a BP > 110 systolic may be considered for pain management under Adult Pain Management Protocol (3.14)

allergic reaction anaphylaxis 3 2 and pediatric anaphylaxis 5 2
Allergic Reaction/Anaphylaxis (3.2) and Pediatric Anaphylaxis(5.2)
  • “NOTE” section deleted referring to authorized EPI course.
  • All EPI training should now be completed within the Initial EMT course.
  • Further “refresher” training of EPI may be done through continuing education.
chf pulmonary edema 3 5
CHF/Pulmonary Edema (3.5)

Paramedic Standing Orders:

Dobutamine infusion deleted

chf pulmonary edema 3 5 and hypertensive emergencies 3 7
CHF/Pulmonary Edema (3.5) and Hypertensive Emergencies (3.7)

Nitrate note changed to:

Do not administer Nitroglycerin if patient (male or female) has taken any medication in the phosphodiesterase-type-5 inhibitor category within the last 48 hours.

obstetrical emergencies 3 8
Obstetrical Emergencies (3.8)
  • Pitocin (Oxytocin) removed
  • Eclamptic Seizures:
    • Lorazepam 2-4mg slow IV Push or IM -OR-
    • Diazepam 5-10mg slow IV Push or IM
seizures 3 9
Seizures (3.9)
  • Paramedic Standing Orders: Lorazepam 2-4mg slow IV Push or IM over 2-3 minutes
  • CAUTION note added: In patients with head injury or hypotension, the use of Diazepam or Lorazepam may be contraindicated
shock hypotension 3 10
Shock/Hypotension (3.10)

Medical Control Options deleted:

  • Second IV of NS/LR
  • Dobutamine Infusion 2-20µg/kg/minute (duplication)
  • Norepinephrine Infusion
acute stroke 3 11
Acute Stroke (3.11)

Edited for consistency with current Stroke POE guidelines

  • Reference to Massachusetts Stroke Scale (MASS)
  • Reference to Thrombolytic Checklist included in Basic Procedures
spinal injury 4 7
Spinal Injury (4.7)

Paramedic Medical Control Option deleted:

  • Methylprednisolone (Solumedrol) IV infusion over 30 minutes
newborn resuscitation 5 1
Newborn Resuscitation (5.1)

“NOTE” section referring to AED use removed from Basic and Intermediate procedures

pediatric seizures 5 7
Pediatric Seizures (5.7)
  • Paramedic Standing Orders:
    • Cardiac Monitor 12 lead ECG-manage dysrhythmias removed
    • Naloxone HCL removed
    • Diazepam 0.25mg/kg IV/IO to max 5-10mg or Rectal Diazepam 0.5mg/kg -OR-
    • Lorazepam 0.05-0.1mg/kg IV/IO (dilute 1:1 NS) or IM to max 2mg
pediatric seizures continued
Pediatric Seizures, continued
  • Medical Control Note:

Reference to seizure activity changed from 30 minutes to 10 minutes

pediatric vfib pulseless vtach 5 12
Pediatric VFib/Pulseless VTach (5.12)

Paramedic Standing Orders: Epinephrine doses reformatted

  • Initial dose: IV/IO: 0.01mg/kg; ET: 0.1mg/kg(1:10,000, 0.1mL/kg)
  • Subsequent doses: same
  • May repeat every 3-5 minutes
  • IV/IO doses up to 0.02mg/kg of 1:10,000 may be effective
adult upper airway obstruction 3 15
Adult Upper Airway Obstruction (3.15)
  • Modeled after Pediatric Upper Airway Obstruction (5.11)
  • Provides guidance for Tracheostomy tube obstruction management in the adult
diabetic emergencies 3 16
Diabetic Emergencies (3.16)
  • Referenced in Altered Mental Status Protocol (3.3)
  • Hypoglycemia threshold changed from 100 to 70
appendix a medication list
Appendix A: Medication List

Additional Nerve Agent Antidotes added to the Optional Medication List

appendix c cessation of resuscitation
Appendix C: Cessation of Resuscitation
  • Refer to AR 5-515 (2/1/05)
  • Current valid DNR
  • Trauma inconsistent with survival
  • Body condition clearly indicates biological death
appendix d rescue airway
Appendix D: Rescue Airway
  • Name changed to Emergent Advanced Airway
  • Paramedic Medical Control Option: Sedative medications may be allowed
appendix d continued
Appendix D, continued
  • If intubation unsuccessful, insert LMA, Combi-Tube, or other approved rescue device
  • “Grading Airway” figuresadded
appendix n inter facility transfers
Appendix N: Inter-facility Transfers

Updated version to be released soon

appendix q mass
Appendix Q: MASS
  • Massachusetts Stroke Scale
    • Facial Droop
    • Arm Weakness
    • Speech Disturbance
Administrative Requirements


OEMS Advisories Review

administrative requirements 2005
Administrative Requirements 2005
  • AR 5-610 Responding to Scenes Involving Minors Refusing Treatment or Transport
    • Refers to minors that have an emergency medical condition (or potential for one)
    • Use reasonable judgment in determining if patient is minor (<18) or emancipated
ars 2005 continued
ARs 2005, continued
  • AR 5-610 (Minors), continued
    • Refusal for <18 must be made by parent or legal guardian
    • Document in detail: findings, actions and reasons
    • Services should also develop policies with own legal counsel to establish guidelines
ars 2005 continued42
ARs 2005, continued
  • AR 5-520 Requirements for Basic & Intermediate EMT Use of Glucose Monitoring
    • Optionalskill for EMT-B and I
    • Requires agreement for medical director oversight
    • Service must provide appropriate training & associated records
ars 2005 continued43
ARs 2005, continued
  • AR 5-520(Glucometer) continued
    • QA/QI program in place that includes yearly training review
    • Glucose results must be documented
    • Blood borne pathogen policies must be adhered to
    • Glucose monitoring device must meet department requirements
ars 2005 continued44
ARs 2005, continued
  • AR 5-520(Glucometer) continued
    • Manufacturer’s instructions for control runs, use, care & cleaning must be followed
    • CLIA (Clinical Laboratories Improvement Amendments) waiver must be obtained
ars 2005 continued45
ARs 2005, continued
  • AR 5-615 Cancellation of ALS
    • Affiliate hospital and/or service medical director must establish written guidelines
    • BLS must complete assessment and treatment according to state protocols
    • Careful documentation by BLS and ALS
ars 2005 continued46
ARs 2005, continued
  • AR 5-620 ALS Transfer of Calls to BLS
    • If patient contact established by ALS, must complete assessment & treatment according to state protocols
    • If ALS intervention initiated, must attend to patient during transport
    • May transfer care to BLS if ALS intervention is not needed or anticipated
    • Documentation of encounter required
ars 2005 continued47
ARs 2005, continued
  • AR 2-360 Dept. Assessment of Info Reported by EMS Personnel per 105 CMR 170.937
    • EMTs/EFRs must file written report with both DPH/OEMS and own service within 5 days of:
      • any conviction of misdemeanor or felony
      • loss or suspension of driver’s license
advisories 2004
Advisories 2004
  • Administration of Medications by Paramedics to Persons Not Being Transported
    • Don’t do it
  • On-Line CPR Training
    • Not valid unless it also includes practical skills evaluation
advisories 2005
Advisories 2005
  • Ventricular Assist Devices:
    • Do not do chest compressions
    • Use in accordance with manufacturer’s instructions
  • AED Use for ages 1-8
    • Adult AED allowed if pediatric AED is not available
advisories 2005 continued
Advisories 2005, continued
  • Paramedic Medical Control Option: Allows bypass of closest facility to transport to PCI (aka: angioplasty) facility for patients with:
      • ST elevation AND
      • Cardiogenic shock or CHF or contraindications to thrombolysis
  • Summary
  • Verbal Assessment
  • Online Resources:
    • Regional Office
    • OEMS