EMS Update 2015 Protocol Revisions

Transcription

1 EMS Update 2015 Protocol Revisions

2 Introduction The following policies are scheduled for release on February 12, All EMS providers are individually responsible for reviewing and knowing all policy and protocol. Although not explicitly stated, all of the following protocol have undergone formatting and grammatical changes. All changes to content are categorized by the corresponding section within the protocol (i.e. BLS Care, ALS Care, Special Considerations, Base Hospital Contact)

3 Policy 700-A04: Altered Mental Status BLS and ALS Care Consideration of Causes was removed from BLS Care and moved to ALS Care with the addition of suspected CNS infection and/or sepsis. Routine Medical Care removed from ALS Care Blood Glucose Table removed from protocol Special Considerations The statement All providers shall document history, medications, and any neurological deficits was added.

4 Policy 700-A08: Suspected Cardiac Ischemia BLS and ALS Care Addition of the requirement to transmit 12-Lead ECGs from the field if it indicates STEMI. Clarification made for NTG administration: Administer Nitroglycerin 0.4 mg SL/TM every 3-5 minutes to a max of 5 doses, as long as pain persists, and if SBP is above 100 mmhg. Addition of Zofran administration: If the patient displays signs and/or symptoms of nausea/vomiting, administer Zofran 4mg ODT/IV/IM. Zofran may be given alongside morphine to reduce the potential for nausea. Special Considerations Addition of STEMI indicator table.

5 Policy 700-A11: Respiratory Distress BLS and ALS Care Consideration of Causes added. Obtain Baseline SpO2 added. Anticipation of Advanced Airway added. Clarification on the sequence of drug administration (i.e. If NTG does not alleviate pain or is contraindicated, then administer Morphine; If, after all other interventions, the patient remains hypotensive, Dopamine: 5 20 mcg/kg/min IV drip.) Special Considerations Item C: Do not use epinephrine excessively, as it tends to thicken secretions, deplete glycogen stores, and increase apprehension is removed from the protocol.

6 Policy 700-A15: Poisoning and Overdose BLS and ALS Care The base hospital section of this protocol was completely removed. Drug administration that was previously allowed only with base hospital contact has been revised and placed in ALS care. Some verbiage has changes in these situations. These situations include: Tricyclic Antidepressant Overdose: sodium bicarbonate Organophosphates / Cholinergics / Pesticides: atropine and Duo- dote injectors. Major Tranquilizers / Neuroleptics: diphenhydramine Calcium Channel Blockers: glucagon and calcium chloride Beta Blockers: Glucagon

7 Policies 700-A06: Burns, 700-A19: Smoke Inhalation, 700-A22: Crush Injury, 700-M02: Pleural Decompression, and 700-P04: Pediatric Burns These policies have minor changes to them which include grammatical corrections and format changes.

8 Policy 700-M09: 12 Lead Electrocardiogram Indications Section Addition of indicator: Symptoms indicating cardiogenic shock. Addition of Item III.B: ECG s can and should be used with a number of Santa Clara Prehospital Care Policy, such as: A04: Altered Mental Status A08: Suspected Cardiac Ischemia A11: Respiratory Distress a. Suspect acute cardiogenic pulmonary edema A22: Crush Injury Addition of Item III.C: Treatment under these policies should proceed in conjunction with the application of the 12-lead ECG. Procedure Addition of Item IV.B: ECG Criteria for STEMI Alerts

9 Policy 700-M12: Continuous Positive Airway Pressure Purpose Section Section added to protocol that describes the goals of CPAP and the signs and symptoms of failure to improve after CPAP. Indications Section Indications are revised to separate patients experiencing CHF related SOB and other SOB etiologies. CPAP is an approved procedure for comfort care measures. Contraindications Section The term vomiting is replaced with Patients that have an increased risk of aspiration. Equipment Section Current content is replaced by Santa Clara County approved CPAP delivery system. Procedure Section Addition: If there is no improvement in v/s or mentation within five (5) minutes, consider the need for an advanced airway and discontinue CPAP.