cnyems 2008 protocol additions phase 1 n.
Skip this Video
Loading SlideShow in 5 Seconds..
CNYEMS 2008 Protocol Additions Phase 1 PowerPoint Presentation
Download Presentation
CNYEMS 2008 Protocol Additions Phase 1

Loading in 2 Seconds...

play fullscreen
1 / 25

CNYEMS 2008 Protocol Additions Phase 1 - PowerPoint PPT Presentation

  • Uploaded on

CNYEMS 2008 Protocol Additions Phase 1. Medical Director, Daniel Olsson, DO Executive Director, Susie Surprenant Central New York EMS 50 Presidential Plaza Jefferson Tower, Suite LL1 Syracuse, New York 13202. Purpose.

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 'CNYEMS 2008 Protocol Additions Phase 1' - barth

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
cnyems 2008 protocol additions phase 1

CNYEMS 2008 Protocol Additions Phase 1

Medical Director, Daniel Olsson, DO

Executive Director, Susie Surprenant

Central New York EMS

50 Presidential Plaza

Jefferson Tower, Suite LL1

Syracuse, New York 13202

  • The purpose of the lesson is to familiarize Advanced Life Support (ALS) providers with the following new CNYEMS protocols:
  • Severe Pain Management
  • Antiemesis
  • Adult Intraosseous Access
severe pain management
Severe Pain Management
  • Protocol will allow EMT-CC and Paramedics to administer Morphine as a Standing Order for the following indications:
    • Patients with pain secondary to:
      • Severe burns without hemodynamic compromise
      • Suspected extremity fractures or dislocations with severe pain
severe pain management1
Severe Pain Management
  • Contraindications (for standing order):
    • Painful conditions not listed under “indications (for standing order)”
    • Altered mental status
    • Hypoventilation
    • Hypotension
    • Significant non-extremity traumatic injuries
    • Known hypersensitivity to medication
severe pain management2
Severe Pain Management
  • Steps:
    • Routine Medical Care
    • Assess patient eligibility
    • If patient is eligible for standing order
      • Morphine 4mg IV
      • Dose may be repeated once after 5 minutes as needed (standing order)
      • Additional Morphine 4mg IV every 5 minutes as needed up to 20mg (requires Medical Control order)
    • If patient is ineligible for standing order a

Medical Control order must be obtained

for all doses

  • Protocol applies to EMT-CC and EMT-P
  • Indications:
    • For the prevention and treatment of nausea and vomiting
  • Contraindications:
    • Know hypersensitivity to medication
  • Protocol uses Ondansetron (Zofran) as the Antiemetic
  • Agencies may use either the generic or brand name version of this medication
ondansetron zofran
Ondansetron (Zofran)
  • Indications:
    • Nausea and vomiting
  • Contraindications:
    • Known hypersensitivity to this, or other, antiemetic medications (Anzemet, Kytril, Aloxi)
ondansetron zofran1
Ondansetron (Zofran)
  • Side Effects:
    • blurred vision or temporary blindness;
    • fever;
    • slow heart rate, trouble breathing;
    • anxiety, agitation, shivering;
    • feeling light-headed, fainting; or
    • urinating less than usual or not at all
ondansetron zofran2
Ondansetron (Zofran)
  • Side Effects (continued):
    • diarrhea or constipation;
    • weakness or tired feeling;
    • headache;
    • dizziness or drowsiness;
ondansetron zofran3
Ondansetron (Zofran)
  • Use Zofran with caution in patients taking the following medications:
    • phenytoin (Dilantin), phenobarbital (Luminal);
    • carbamazepine (Carbatrol, Tegretol);
    • tramadol (Ultram); or
    • rifampin (Rifadin, Rimactane, Rifater)

Routine Medical/Trauma Care

Ondansetron (Zofran) 0.1mg/kg up to 4mg IV

Repeat once after 2 minutes as needed

Additional dose per Medical Control Order

adult intraosseous access
Adult Intraosseous Access
  • Protocol allows for the use of Adult IO devices to obtain vascular access
  • Written generically so that agencies may choose which device to use
  • Device may be used in any FDA approved access site
adult intraosseous access1
Adult Intraosseous Access
  • Devices currently available include:
    • EZ IO®
    • Bone Injection Gun (BIG®)
    • FAST1TM
ez io
  • Approved for use in patients weighing 3kg or more
  • Allows access in both the Proximal Humerus and Proximal Tibia
  • Further information available at
bone injection gun big
Bone Injection Gun (BIG®)
  • Approved for all patients regardless of age or weight
  • Approved for use in the Tibia
  • Further information available at
  • Approved for use in adult patients
  • Allows for sternal access
  • Futher information available at
adult intraosseous access2
Adult Intraosseous Access
  • Indications:
    • Patients who require IV access and a peripheral IV cannot be established in 2 attempts or 90 seconds and in patients who exhibit 1 or more of the following:
      • An altered mental status (GCS of 8 or less)
      • Hemodynamic instability (Systolic BP <90)
      • Patients requiring sedation/paralysis for airway management
adult intraosseous access3
Adult Intraosseous Access
  • The Adult IO is Optional Equipment for the CNYEMS Region.
  • Agencies that elect to carry this equipment must provider didactic and skill instruction on the device per manufacturer’s guidelines.
  • This instruction must be completed

prior to the device being used in the field.

adult intraosseous access4
Adult Intraosseous Access
  • IO may be considered prior to peripheral IV attempts in the following situations:
    • Cardiac arrest
    • Evidence of profound hypovolemia with alteration in mental status
adult intraosseous access5
Adult Intraosseous Access
  • Contraindications:
    • Evidence of fracture in bone of insertion site
    • Known previous orthopedic procedures/hardware in bone of insertion site
    • Known pre-existing medical condition such as tumor near insertion site or sternotomy
    • Infection or vascular compromise at

insertion site

    • Inability to locate landmarks
adult intraosseous access6
Adult Intraosseous Access
  • Steps:
    • Routine Medical Care
    • Prepare equipment, to include: IO driver, IO needle of appropriate size, Alcohol swab, IV and/or extension set, 10 ml syringe, Tape, Pressure bag, Sharps container
    • Locate and cleanse FDA approved insertion site
    • Stabilize and insert the IO needle set
    • Remove driver while stabilizing

catheter hub

adult intraosseous access7
Adult Intraosseous Access
  • Steps (Continued):
    • Remove stylet and secure in a sharps container
    • Confirm proper placement
    • Consider Lidocaine 20-50 mg IO slow in conscious patient
    • Flush catheter rapidly with 10 ml of normal saline
    • Place pressure bag and inflate; Begin infusion
    • Dress site and secure tubing
    • Continue to monitor patient and infusion site
protocol additions
Protocol Additions
  • All ALS providers must successfully complete the quiz in order to maintain their ALS privileges in Central New York. You will be directed from the next slide to take the test.
  • Inserts for the protocol books will be provided to agencies.
  • Click on the link for the three protocols.
    • New ALS Protocols
  • Protocols go into effect February 1, 2008.
protocol additions test
Protocol Additions Test

Click appropriate link below to take test – you will be directed to login to your CNYEMS account in an Internet

browser. Login and proceed from there with the test. (You may have to close the presentation).

Protocol AdditionsTest