paramedic protocol update 2012 westchester regional emergency medical advisory committee westchester...

Paramedic Protocol UpdateParamedic Protocol Update20122012

Westchester Regional Emergency Medical Advisory Committee

Westchester Paramedic Protocol Update 2/12 - Overview1

Update Roll-OutUpdate Roll-Out


Roll-out training materials will be emailed to agencies. Update materials will also be posted on WREMSCO

website. Presentations cover the updated protocols by section:

Adult Medical Pediatric Medical

Agencies are expected to deliver content to affiliated paramedics.

Service Medical Directors should approve a delivery mechanism I.e., classroom session, computer delivery, follow-up quiz, etc…

Agencies must have proof on record that all Paramedics (anyone on roster) have completed ACLS and PALS courses after April 1, 2011April 1, 2011.

DocumentationDocumentation


Agency Medical Director MUST affirm that all affiliated paramedics have received update training from the agency All update affirmations MUST be submitted by

MARCH 31MARCH 31stst

Agencies MUST affirm that ALL rostered paramedics hold ACLS and PALS cards completed after April 1, 2011. Completed ACLS/PALS affirmations MUST be

submitted by MAY 31MAY 31stst

ImplementationImplementation


PROTOCOL CHANGES WILL BE IN EFFECT AS OF:

APRIL 1APRIL 1stst

OverviewOverview


Adult Medical ProtocolsAdult Medical Protocols

Westchester Regional Paramedic Protocol Update 2012


MEDICAL – 4.0:MEDICAL – 4.0:Cardiac Cardiac (General)(General)

New note regarding activating STEMI policy


MEDICAL - 4.1:MEDICAL - 4.1:Acute Coronary Acute Coronary SyndromeSyndrome

Update note regarding BP

Update note regarding type and quantity of ASA

Clarifying time frame for caution related to providing NTG in light of use of ED medications


MEDICAL – 4.3:MEDICAL – 4.3:BradycardiaBradycardia

Update period for repeating Atropine dose

Addition of Note cautioning use of Atropine in the presence of certain heart blocks


MEDICAL – 5.0:MEDICAL – 5.0:Cardiac Arrest – Cardiac Arrest – Non-TraumaticNon-Traumatic

Addition of NEW sub-protocol

Addition of Note regarding unwitnessed arrests

Addition of Note regarding consideration of Magnesium

Removal of Note regarding “Consider Termination of Resuscitation Protocol”


MEDICAL – 5.1:MEDICAL – 5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythm

Addition of consideration of advanced airway control with capnography

Update period for repeating Epinephrine dose

Removal of administration of Lidocaine (only antidysrhythimic is now Amiodarone)

Removal of consideration for Magnesium (moved to Medical – 5.0)


MEDICAL – 5.1:MEDICAL – 5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythmcont’dcont’d

Addition of NOTE to refer to Protocol M-5.3 if return of perfusing rhythm

Removal of NOTE regarding administration of Lidocaine if rhythm converts

Removal of NOTE regarding administration of antidysrhythimic infusions after rhythm conversion (Amiodarone infusion moved to Protocol M-5.3, Lidocaine eliminated)


MEDICAL – 5.2:MEDICAL – 5.2:Cardiac Arrest – Cardiac Arrest – Non-Shockable Non-Shockable RhythmRhythmAddition of consideration of advanced airway control with capnography

Simplified statement re search for reversible causes


Clarified amount of 0.9% NS infusion

Removal of administration of Atropine



MEDICAL – 5.3:MEDICAL – 5.3:Post Cardiac Post Cardiac Arrest CareArrest Care

Ventilation/Oxygenation

Consider Airway Maintain SpO2 Maintain ETCO2 DO NOT

HYPERVENTILATE

Obtain IV/IO access

Adm of Amiodarone drip if used prior to conversion

Contact OLMC for pressors

IV/IO fluid challenges

Notify ER of possible hypothermia therapy

Obtain 12 lead EKGWestchester Paramedic Protocol Update 2/12 - Overview14

MEDICAL – 5.3:MEDICAL – 5.3:Post Cardiac Post Cardiac Arrest Care Arrest Care cont’dcont’d

OLMC Epi and Dopamine infusion orders

NOTE regarding reversible causes

NOTE regarding activation of the Regional STEMI policy if STEMI present


MEDICAL – 5.4:MEDICAL – 5.4:Field Field Termination of Termination of Resuscitation Resuscitation EffortsEfforts

Change of Numbering

Additional note regarding use of capnography to confirm placement of ETT

NEW notation of ETCO2 readings

Removal of notation regarding administration of Atropine


Pediatric Medical ProtocolsPediatric Medical Protocols

Westchester Regional Paramedic Protocol Update 2012


PEDIATRIC – PEDIATRIC – 5.0:5.0:Cardiac Arrest – Cardiac Arrest – Non-TraumaticNon-Traumatic

Update regarding unwitnessed arrests

Update of ventilation rates when advanced airway in place

Addition of NEW sub-protocol


PEDIATRIC – PEDIATRIC – 5.1:5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythm


Removal of administration of Lidocaine (only antidysrhythimic is now Amiodarone)


PEDIATRIC – PEDIATRIC – 5.1:5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythmcont’dcont’d

Addition regarding Joulage settings for second and subsequent defibrillations


Update of administration of 0.9% NS bolus after medication

Removal of NOTE regarding administration of Lidocaine (bolus or drip) if rhythm converts


PEDIATRIC – PEDIATRIC – 5.2:5.2:Cardiac Arrest – Cardiac Arrest – Non-Shockable Non-Shockable RhythmRhythmAddition of consideration of advanced airway control with capnography

Simplified statement re search for reversible causes


Clarified amount of 0.9% NS infusion

Addition of NOTE to refer to Protocol P-5.3 if return of perfusing rhythm


PEDIATRIC – PEDIATRIC – 5.3:5.3:Post Cardiac Post Cardiac Arrest CareArrest Care

Ventilation/Oxygenation

Consider Airway Maintain SpO2 Maintain ETCO2 DO NOT

HYPERVENTILATE

Obtain IV/IO if not already done

IV/IO fluid challenges

Contact OLMC for Epi or Dopamine infusions

Notify ER of possible hypothermia therapy

Obtain 12 lead EKGWestchester Paramedic Protocol Update 2/12 - Overview22

PEDIATRIC – PEDIATRIC – 5.3:5.3:Post Cardiac Post Cardiac Arrest Care Arrest Care cont’dcont’d

OLMC Epi and Dopamine infusion orders

NOTE regarding reversible causes

NOTE regarding activation of the Regional STEMI policy if STEMI present


PEDIATRIC – PEDIATRIC – 10.0:10.0:Neonatal Neonatal ResuscitationResuscitation

Addition of direction to warm, dry and stimulate, clearing airway ONLY if necessary

Update regarding intubation after clearing of airway due to meconium

Addition to monitor SpO2

Update regarding compression-ventilation ratios

Addition of direction to change ratios if arrest is known to be cardiac in origin


RemindersReminders


QUALITY CPR comes first Advanced airway ONLY if BLS procedures are

inadequate – especially for Pediatric patients ETCO2 monitoring (quantitative waveform

capnography) required for ALL intubated patients 12 Lead EKGs are required for ALL non-arresting

or post-arrest cardiac patients Transport of a body to a hospital post Termination

of Resuscitation decision should be: A rare occurance Coordinated with OLMC

QuestionsQuestions


Westchester Regional EMS Office 914-231-1616

Westchester REMSCO Website www.wremsco.org

Thank youThank you


paramedic protocol update 2012 westchester regional emergency medical advisory committee westchester...

Documents

update roll

update training

update materials

update affirmations

bp update note

capnography update period

bradycardia update period

overview8 slide