2012 Southwest Ohio Pre-hospital Protocols. Academy of Medicine of Cincinnati Protocol Subcommittee Hamilton H. Lempert, MD FACEP, Chairman. Protocol Committee. Gregory Ballman, EMT-P Justin Benoit, MD Mike Bilkasley, EMT-P Troy Bonfield, EMT-P George Bracher, EMT-P
2012 Southwest Ohio Pre-hospital Protocols Academy of Medicine of Cincinnati Protocol Subcommittee Hamilton H. Lempert, MD FACEP, Chairman
Protocol Committee Gregory Ballman, EMT-P Justin Benoit, MD Mike Bilkasley, EMT-P Troy Bonfield, EMT-P George Bracher, EMT-P Thomas Breyer, NREMT-P Dustin Calhoun, MD Steve Coley, NREMT-P Kenneth Crank, NREMT-P David Derbyshire, NREMT-P Tom Dietz, EMT-P Pamela Erpenbeck RN, NREMT-P Baruch Fertel, MD Paul Gallo, EMT-P Bob Herrlinger RN, EMT-P Matt Huff, MD Randal Johann Steve Kelly, EMT-P Donald Locasto, MD Daniel Mack, NREMT-P Jason McMullan, MD Mike Moyer, MS, EMT-P Bob Murray, EMT-P Todd Owens, EMT-P Marilyn Pappas, EMT-P Hamilton Schwartz, MD Joe Stoffolano, NREMT-P Thomas Trimarco, MD Jonathan Van Zile, MD Sarah Winston, MD Thanks to Daniel Storer, MD, Mel Otten, MD and the previous authors of this operating protocol for providing the initial model. AD HOC MEMBERS: Lawrence T. Bennett, Esq. Joel Pranikoff, MD Tom LeMaster, RN, NREMT-P
Goals • Teaching Tool • Quick Reference Guide
Global Changes • Some • Small clarifications • Re-wordings • Put things into a different order
Global Caveats • Addressed in Introduction • IV Access • Lock or bag of saline at KVO • If after 2 attempts at IV consider IO • Administer Oxygen • Apply appropriate device and volume • Obtain 95% Sat • Some may never get there
Global Caveats • Combined Basic EMT and Paramedic EMT Protocols • Improved Communication • Keep protocols up to date • Section Headings for • EMT • Basics • MEDIC • Paramedics • ALL
Scope of Practice • Ohio moving to National Scope of Practice • Exact dates not yet set • Will remove EMT ability to intubate • EMT’s will still be able to use supraglotic aiway like King • EMT’s should practice within their scope of practice regardless of what the protocol says
Administrative Section • Combined Medic and EMT into one • Streamlined wording • No substantive changes • Changed GSH’s and Middletown notification number to be the same as the telemetry line
Cardiac Section • Updated the protocols to address the latest ACLS changes. • Some small re-wording of CPR and AED use • C301 Removed Atropine from Asystole/PEA • Added use of waveform end tidal CO2 if available • C304 Added Adenosine as consideration in stable V-Tach • Made those changes to Appendix H - Quick Sheet
Medical Section • M405 Nausea and Vomiting • Added note saying • Odansetron can increase the QT interval and should be used with caution in patients who are on other medications that can increase the QT interval
Pediatric Section • Updated the Cardiac Pediatric section to agree with most recent changes in PALS • Modified Appendix I – Pediatric Quick sheet to put things where they belong • Modified P607 III.B – Removed incorrect reference and numbered
Tube Use • T706 – Endotracheal Intubation protocol • Added Statement regarding cuffed and uncuffed endotracheal tubes in pediatric patients • Cuffed may be used, but pay close attention to over inflation of the balloon
Taser • T-712 Taser/Conducted Energy Weapon Emergencies • Addresses many issues • Excited Delirium Syndrome – Sudden Death • Other Injuries • Barb Removal • Police usually trained on it, but just in case they want EMS to address removing the barb.
Drug list • Appendix A • Drug List • Added Calcium Gluconate for M411. • Was in last year’s protocol, but left off of the list • It is an optional medication
State Pharmacy Board Request • When you apply for your license please say that • You are following the Southwest Ohio Protocols • You have the same drug list as Reading License number 020309750 • This will decrease the work for the • If you have any additions or deletions to the list please include that as well
Drug LIcense • Hamilton Lempert will send a copy of these protocols to the State • To renew your license you must fill out the application with all appropriate signatures and drug list (App A). • You do not need to send them a copy of the protocols. • Get it in by November 1st.
Site Visit Form • Site Visit form updated • Made into PDF file that can be filled out online • Removed from protocol and placed on Website • Obtain it from Website and e-mail or snail mail it back to Nancy Coomer at Academy of Medicine
Website • Left Ventricular Assist Device reference sheet approved by UC and Christ • Posted on the “Links” page • Once final approval of protocols will post • Full protocol PDF • Individual protocols PDF • Protocols are available for iPhone • See “Links” page
Final Approval • 2012 Protocols posted on Academy of Medicine Website on October 1st. academyofmedicine.org • Open for comments until December 1st • Please find all of our typo’s and mistakes • Send your comments to Dr. Lempert firstname.lastname@example.org • Updated Protocols will be posted on Academy of Medicine website the last week of December for implementation January 1st, 2012.