protocol update alabama ems protocols emt-intermediate edition 5 june, 2010 update 1

PROTOCOL UPDATEPROTOCOL UPDATEALABAMA EMS PROTOCOLSALABAMA EMS PROTOCOLS

EMT-INTERMEDIATEEMT-INTERMEDIATE

EDITION 5 EDITION 5

JUNE, 2010 UPDATE JUNE, 2010 UPDATE

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PROTOCOL UPDATEPROTOCOL UPDATE

• IF YOU IDENTIFY MISTAKES IN THE IF YOU IDENTIFY MISTAKES IN THE PROTOCOLS OR IF YOU HAVE PROTOCOLS OR IF YOU HAVE SUGGESTIONS FOR PROTOCOL SUGGESTIONS FOR PROTOCOL CHANGES EMAIL: CHANGES EMAIL: [email protected]@adph.state.al.us

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PURPOSE OF PROTOCOLS PURPOSE OF PROTOCOLS

• IMPROVE PATIENT CAREIMPROVE PATIENT CARE

• PROVIDE OFF-LINE MEDICAL PROVIDE OFF-LINE MEDICAL DIRECTION DIRECTION

• REPRESENT STANDARD OF CARE REPRESENT STANDARD OF CARE

• PROVIDE QI STANDARDS PROVIDE QI STANDARDS

• PROVIDE EDUCATION STANDARDS PROVIDE EDUCATION STANDARDS

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TITLE PAGE & TABLE OF TITLE PAGE & TABLE OF CONTENTSCONTENTS

• TABLE OF CONTENTS UPDATED WITH TABLE OF CONTENTS UPDATED WITH CHANGESCHANGES– Added two new Patient Care ProtocolsAdded two new Patient Care Protocols

• 4.25 Respiratory Illness/Influenza4.25 Respiratory Illness/Influenza• 4.26 Respiratory Illness – Mass Casualty Emergency4.26 Respiratory Illness – Mass Casualty Emergency• Renumbered:Renumbered:

– 4.27 Seizures4.27 Seizures– 4.28 Shock4.28 Shock– 4.29 Stroke4.29 Stroke– 4.30 Suspected Spinal Injury4.30 Suspected Spinal Injury– 4.31 Syncope4.31 Syncope– 4.32 Vaginal Bleeding4.32 Vaginal Bleeding– 4.33 Vomiting and Nausea4.33 Vomiting and Nausea

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SECTION 4SECTION 4

TREATMENT PROTOCOLSTREATMENT PROTOCOLS

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CARDIAC ARREST CARDIAC ARREST 4.84.8

• Under “Physical Assessment, Part B” Under “Physical Assessment, Part B” changed “closed chest massage” to “chest changed “closed chest massage” to “chest compressions” to reflect current compressions” to reflect current terminologyterminology

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CARDIAC SYMPTOMS/ACUTE CARDIAC SYMPTOMS/ACUTE CORONARY SYNDROME 4.10CORONARY SYNDROME 4.10

• Added wording to stress that women, diabetics, Added wording to stress that women, diabetics, and all adult medical patients over the age of 50 and all adult medical patients over the age of 50 years have an increased risk of coronary artery years have an increased risk of coronary artery disease.disease.

• Also stressed that all adult patients complaining Also stressed that all adult patients complaining of epigastric pain should have an ECG performedof epigastric pain should have an ECG performed

• Noted that all ALS Ambulance services must have Noted that all ALS Ambulance services must have the capability to perform 12-lead ECGs on the capability to perform 12-lead ECGs on patients by June of 2013patients by June of 2013

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4.25 Respiratory 4.25 Respiratory Illness/InfluenzaIllness/Influenza

This is a new protocol for routine use during a flu This is a new protocol for routine use during a flu epidemicepidemic

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1. 1. Follow General Patient Care Protocol 4.1Follow General Patient Care Protocol 4.12. 2. Signs and Symptoms of InfluenzaSigns and Symptoms of Influenza::

a.a. Rapid onset of symptomsRapid onset of symptoms

b.b. Difficulty breathing with exertionDifficulty breathing with exertion

c.c. Doctor has already diagnosed influenzaDoctor has already diagnosed influenza

d.d. CoughCough

e.e. FeverFever

f.f. Shaking ChillsShaking Chills

g.g. Pleuritic chest painPleuritic chest pain

h.h. Sore throat (no difficulty breathing or swallowing)Sore throat (no difficulty breathing or swallowing)

i.i. Nasal congestionNasal congestion

j.j. Runny noseRunny nose

k.k. Muscle achesMuscle aches

l.l. HeadacheHeadache99


3. 3. Be sure you are using appropriate standard Be sure you are using appropriate standard precautionsprecautionsA. If Dispatch advises of the potential for acute febrile A. If Dispatch advises of the potential for acute febrile

respiratory illness symptoms on scene, you should don respiratory illness symptoms on scene, you should don PPE for suspected cases of influenza prior to entering the PPE for suspected cases of influenza prior to entering the scene. This includes disposable N-95 mask, eye scene. This includes disposable N-95 mask, eye protection (shield or goggles), and disposable non-sterile protection (shield or goggles), and disposable non-sterile gloves.gloves.

B. If Dispatch has not identified individuals with symptoms B. If Dispatch has not identified individuals with symptoms of acute febrile respiratory illness symptoms on scene, of acute febrile respiratory illness symptoms on scene, you should stay more than 6 feet away from the patient you should stay more than 6 feet away from the patient and bystanders with symptoms and exercise appropriate and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing routine respiratory droplet precautions while assessing all patients for suspected cases of influenza. If patient all patients for suspected cases of influenza. If patient has signs or symptoms of influenza, you should don the has signs or symptoms of influenza, you should don the PPE described above before coming in close contact with PPE described above before coming in close contact with the patient.the patient.

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4. 4. All EMS personnel engaged in aerosol generating All EMS personnel engaged in aerosol generating activities (e.g. endotracheal intubation, bag-mask activities (e.g. endotracheal intubation, bag-mask ventilation, or CPAP [use expiratory filter]) should ventilation, or CPAP [use expiratory filter]) should wear the PPE described in 3.a.wear the PPE described in 3.a.

5. 5. All patients with acute febrile respiratory illness All patients with acute febrile respiratory illness should wear a surgical mask, if tolerated by the should wear a surgical mask, if tolerated by the patient.patient.

6. 6. Encourage good patient compartment vehicle Encourage good patient compartment vehicle airflow/ventilation (turn on exhaust fan) to reduce airflow/ventilation (turn on exhaust fan) to reduce the concentration of aerosol accumulation when the concentration of aerosol accumulation when possible.possible.

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TRANSPORT OF PATIENTS TOTRANSPORT OF PATIENTS TOHEALTHCARE FACILITIESHEALTHCARE FACILITIES• When transporting a patient with symptoms of When transporting a patient with symptoms of

acute febrile respiratory illness, you should notify acute febrile respiratory illness, you should notify the receiving healthcare facility so that the receiving healthcare facility so that appropriate infection control precautions may be appropriate infection control precautions may be taken prior to patient arrival. Patients with febrile taken prior to patient arrival. Patients with febrile respiratory illness should wear a surgical mask, if respiratory illness should wear a surgical mask, if tolerated. tolerated.

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INTERFACILITY TRANSPORTINTERFACILITY TRANSPORT• EMS personnel involved in the transfer of patients with EMS personnel involved in the transfer of patients with confirmed influenza or suspected infectious respiratory confirmed influenza or suspected infectious respiratory illness should use standard droplet and contact precautions illness should use standard droplet and contact precautions for all patient care activities. This should include wearing for all patient care activities. This should include wearing disposable N-95 mask, eye protection [shield or goggles], disposable N-95 mask, eye protection [shield or goggles], disposable non-sterile gloves and gown. If the transported disposable non-sterile gloves and gown. If the transported patient can tolerate a surgical mask, its use can help to patient can tolerate a surgical mask, its use can help to minimize the spread of infectious droplets in the patient minimize the spread of infectious droplets in the patient care compartment. Encourage good patient compartment care compartment. Encourage good patient compartment vehicle airflow/ventilation (turn on exhaust fan) to reduce vehicle airflow/ventilation (turn on exhaust fan) to reduce the concentration of aerosol accumulation when possible. the concentration of aerosol accumulation when possible. Any nonessential equipment that can be removed from the Any nonessential equipment that can be removed from the patient compartment of the ambulance before transport will patient compartment of the ambulance before transport will hasten the time needed to disinfect and return to service.hasten the time needed to disinfect and return to service.

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CLEANING VEHICLE AFTER TRANSPORTING CLEANING VEHICLE AFTER TRANSPORTING AN INFLUENZA PATIENTAN INFLUENZA PATIENT• After the patient has been removed and prior to cleaning, the air After the patient has been removed and prior to cleaning, the air

within the vehicle may be exhausted by opening the doors and within the vehicle may be exhausted by opening the doors and windows of the vehicle while the ventilation system is running. windows of the vehicle while the ventilation system is running. This should be done outdoors and away from pedestrian traffic. This should be done outdoors and away from pedestrian traffic. Routine cleaning methods should be employed throughout the Routine cleaning methods should be employed throughout the vehicle and on non-disposable equipment.vehicle and on non-disposable equipment.

• Routine cleaning with soap or detergent and water to remove Routine cleaning with soap or detergent and water to remove soil and organic matter, followed by the proper use of soil and organic matter, followed by the proper use of disinfectants, are the basic components of effective disinfectants, are the basic components of effective environmental management of influenza. Reducing the number environmental management of influenza. Reducing the number of influenza virus particles on a surface through these steps can of influenza virus particles on a surface through these steps can reduce the chance of hand transfer of virus particles. Influenza reduce the chance of hand transfer of virus particles. Influenza viruses are susceptible to inactivation by a number of chemical viruses are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial disinfectants readily available from consumer and commercial sources.sources.

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4.26 RespiratoryIllness/Influenza MASS CASUALTY EMERGENCY

NEW PROTOCOLNot for Routine Use


MASS CASUALTY EMERGENCYMASS CASUALTY EMERGENCY• This protocol is designed to be implemented only when This protocol is designed to be implemented only when

there is a significant respiratory disease that has impacted there is a significant respiratory disease that has impacted the health care system to the extent that hospital beds are the health care system to the extent that hospital beds are full, few or no ventilators are available for new patients with full, few or no ventilators are available for new patients with respiratory failure, the EMS/Dispatch work force is respiratory failure, the EMS/Dispatch work force is significantly depleted due to absenteeism, and the calls for significantly depleted due to absenteeism, and the calls for EMS support overwhelm resources to manage all calls. EMS support overwhelm resources to manage all calls. When the Governor proclaims a state of emergency, the When the Governor proclaims a state of emergency, the Alabama Public Health Department (ADPH) Office of EMS & Alabama Public Health Department (ADPH) Office of EMS & Trauma (OEMS&T) will activate this protocol to provide Trauma (OEMS&T) will activate this protocol to provide authorization for the adjustment in the prehospital standard authorization for the adjustment in the prehospital standard of care. Depending upon the Governor’s proclamation, of care. Depending upon the Governor’s proclamation, ADPH OEMS&T may activate this protocol statewide or on a ADPH OEMS&T may activate this protocol statewide or on a regional or local basis.regional or local basis.

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MASS CASUALTY EMERGENCYMASS CASUALTY EMERGENCY1.1. Follow General Patient Care Protocol 4.1.Follow General Patient Care Protocol 4.1.

2.2. Signs and Symptoms of InfluenzaSigns and Symptoms of Influenza• Rapid onset of symptomsRapid onset of symptoms

• Difficulty breathing with exertionDifficulty breathing with exertion

• Doctor has already diagnosed influenzaDoctor has already diagnosed influenza

• CoughCough

• FeverFever

• Shaking ChillsShaking Chills

• Pleuritic chest painPleuritic chest pain

• Sore throat (no difficulty breathing or swallowing)Sore throat (no difficulty breathing or swallowing)

• Nasal congestionNasal congestion

• Runny noseRunny nose

• Muscle achesMuscle aches

• HeadacheHeadache1717

4.26 Respiratory 4.26 Respiratory Illness/InfluenzaIllness/Influenza MASS CASUALTY EMERGENCY MASS CASUALTY EMERGENCY 3. 3. Be sure you are using appropriate standard Be sure you are using appropriate standard precautionsprecautionsA. If Dispatch advises of the potential for acute febrile A. If Dispatch advises of the potential for acute febrile

respiratory illness symptoms on scene, you should don PPE respiratory illness symptoms on scene, you should don PPE for suspected cases of influenza prior to entering the scene. for suspected cases of influenza prior to entering the scene. This includes disposable N-95 mask, eye protection (shield This includes disposable N-95 mask, eye protection (shield or goggles), and disposable non-sterile gloves.or goggles), and disposable non-sterile gloves.

B. If Dispatch has not identified individuals with symptoms of B. If Dispatch has not identified individuals with symptoms of acute febrile respiratory illness symptoms on scene, you acute febrile respiratory illness symptoms on scene, you should stay more than 6 feet away from the patient and should stay more than 6 feet away from the patient and bystanders with symptoms and exercise appropriate routine bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients respiratory droplet precautions while assessing all patients for suspected cases of influenza. If patient has signs or for suspected cases of influenza. If patient has signs or symptoms of influenza, you should don the PPE described symptoms of influenza, you should don the PPE described above before coming in close contact with the patient.above before coming in close contact with the patient.

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4.26 Respiratory 4.26 Respiratory Illness/InfluenzaIllness/Influenza MASS CASUALTY EMERGENCY MASS CASUALTY EMERGENCY 4. 4. If patient has critical vital signs, immediately If patient has critical vital signs, immediately transport to Emergency Departmenttransport to Emergency Department

a.a. Critical Vital Signs: AdultCritical Vital Signs: AdultIf present, immediately transport to an If present, immediately transport to an Emergency DepartmentEmergency Department• Pulse: equal or greater than 130 beats per minutePulse: equal or greater than 130 beats per minute

• Respiratory Rate: equal or greater than 30 breaths per minuteRespiratory Rate: equal or greater than 30 breaths per minute

• Systolic Blood Pressure: Less than 90 mm/HgSystolic Blood Pressure: Less than 90 mm/Hg

• Pulse Oximeter: Less than 92 on room airPulse Oximeter: Less than 92 on room air

• Temperature: FebrileTemperature: Febrile

• Level of Consciousness: Responds only to Pain or is UnresponsiveLevel of Consciousness: Responds only to Pain or is Unresponsive

• Lung sounds: Rales or WheezingLung sounds: Rales or Wheezing

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2020

Capillary refill: > 2 seconds > 2 seconds > 2 seconds

Resp. rate: <30 or >45 or increased work of breathing

<20 or >45or increased work of breathing

<15 or >45or increased work of breathing

Systolic Blood pressure < 60 mmHg < 70 mmHg Under age 10< 70 + (2 X age in years)

Pulse Oximeter < 92 on room air < 92 on room air < 92 on room air

Temperature Febrile Febrile Febrile

Level of Consciousness responds only to pain or is unresponsive

responds only to pain or is unresponsive

responds only to pain or is unresponsive

Lung sounds Rales or Wheezing Rales or Wheezing Rales or Wheezing

Critical Vital Signs: Pediatric: If present, immediately transport to Emergency

Department

Vital Signs Neonates Infants Children

4.26 Respiratory 4.26 Respiratory Illness/InfluenzaIllness/Influenza MASS CASUALTY EMERGENCY MASS CASUALTY EMERGENCY 5. 5. If patient has normal vital signs, then If patient has normal vital signs, then evaluate for signs and symptoms of influenza.evaluate for signs and symptoms of influenza.

a. a. “Normal” Vital Signs: Adult with respiratory “Normal” Vital Signs: Adult with respiratory illnessillness• Pulse: Less than 130 beats per minutePulse: Less than 130 beats per minute

• Respiratory Rate: Less than 30 breaths per minuteRespiratory Rate: Less than 30 breaths per minute

• Systolic Blood Pressure: equal or greater than 91 mmHgSystolic Blood Pressure: equal or greater than 91 mmHg

• Pulse Oximeter equal or greater than 92Pulse Oximeter equal or greater than 92

• Temperature: Afebrile Temperature: Afebrile

• Level of Consciousness: Alert or responds to verbal stimuliLevel of Consciousness: Alert or responds to verbal stimuli

• Lung sounds: ClearLung sounds: Clear

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Capillary refill: < 2 seconds < 2 seconds < 2 seconds

Unlabored breathing or resp. rate:

30-45 20-45 15-45

Systolic Blood pressure > 60 mmHg > 70 mmHg Under age 10> 70 + (2 X age in years)

Pulse Oximeter > 92 > 92 > 92

Temperature Afebrile Afebrile Afebrile

Level of Consciousness Alert or responds to verbal stimuli

Alert or responds to verbal stimuli

Alert

Lung sounds Clear Clear Clear

b. “Normal” Vital Signs Pediatric Patient with Respiratory Illness

Vital Signs Neonates Infants Children

4.26 Respiratory 4.26 Respiratory Illness/InfluenzaIllness/Influenza MASS CASUALTY EMERGENCY MASS CASUALTY EMERGENCY 6. If patient has three (3) or more signs or symptoms of influenza, 6. If patient has three (3) or more signs or symptoms of influenza, transport patient to alternate care facility (if available).transport patient to alternate care facility (if available).

7. If patient has two (2) or fewer signs or symptoms of influenza, 7. If patient has two (2) or fewer signs or symptoms of influenza, call On-line Medical Direction (OLMD) to determine if patient call On-line Medical Direction (OLMD) to determine if patient may be left on-scene, self quarantine, and refer to nurse/public may be left on-scene, self quarantine, and refer to nurse/public health hotline (insert phone number here) for further health hotline (insert phone number here) for further assistance.assistance.

8. Endotracheal intubation should not be performed on any 8. Endotracheal intubation should not be performed on any patient except by direct order of the OLMD physician (Cat. B). patient except by direct order of the OLMD physician (Cat. B).

9. Because of the danger of EMS personnel becoming infected, 9. Because of the danger of EMS personnel becoming infected, aerosol-generating procedures such as advanced airway aerosol-generating procedures such as advanced airway procedures and use of bag-mask should not be performed on procedures and use of bag-mask should not be performed on patients with acute febrile respiratory illness except by direct patients with acute febrile respiratory illness except by direct order of the OLMD physician (Cat. B). CPAP with expiratory filter order of the OLMD physician (Cat. B). CPAP with expiratory filter is still Category A. is still Category A.

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4.26 Respiratory 4.26 Respiratory Illness/InfluenzaIllness/Influenza MASS CASUALTY EMERGENCY MASS CASUALTY EMERGENCY

10.If OLMD orders advanced airway procedures or use of bag-10.If OLMD orders advanced airway procedures or use of bag-mask on a patient with acute febrile respiratory illness, EMS mask on a patient with acute febrile respiratory illness, EMS personnel must be in PPE as described in 2.a above. personnel must be in PPE as described in 2.a above.

11.All patients with acute febrile respiratory illness should 11.All patients with acute febrile respiratory illness should wear a surgical mask, if tolerated by the patient.wear a surgical mask, if tolerated by the patient.

12.Encourage good patient compartment vehicle 12.Encourage good patient compartment vehicle airflow/ventilation (turn on exhaust fan) to reduce the airflow/ventilation (turn on exhaust fan) to reduce the concentration of aerosol accumulation when possible.concentration of aerosol accumulation when possible.

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4.26 Respiratory 4.26 Respiratory Illness/InfluenzaIllness/Influenza MASS CASUALTY MASS CASUALTY

EMERGENCY EMERGENCY TRANSPORT OF PATIENTS TOTRANSPORT OF PATIENTS TO

HEALTHCARE FACILITIESHEALTHCARE FACILITIES• When transporting a patient with symptoms of When transporting a patient with symptoms of

acute febrile respiratory illness, you should notify acute febrile respiratory illness, you should notify the receiving healthcare facility so that the receiving healthcare facility so that appropriate infection control precautions may be appropriate infection control precautions may be taken prior to patient arrival. Patients with febrile taken prior to patient arrival. Patients with febrile respiratory illness should wear a surgical mask, if respiratory illness should wear a surgical mask, if tolerated. tolerated.

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EMERGENCY EMERGENCY INTERFACILITY TRANSPORTINTERFACILITY TRANSPORT

• EMS personnel involved in the transfer of patients with EMS personnel involved in the transfer of patients with confirmed influenza or suspected infectious respiratory confirmed influenza or suspected infectious respiratory illness should use standard droplet and contact precautions illness should use standard droplet and contact precautions for all patient care activities. This should include wearing for all patient care activities. This should include wearing disposable N-95 mask, eye protection [shield or goggles], disposable N-95 mask, eye protection [shield or goggles], disposable non-sterile gloves and gown. If the transported disposable non-sterile gloves and gown. If the transported patient can tolerate a surgical mask, its use can help to patient can tolerate a surgical mask, its use can help to minimize the spread of infectious droplets in the patient minimize the spread of infectious droplets in the patient care compartment. Encourage good patient compartment care compartment. Encourage good patient compartment vehicle airflow/ventilation (turn on exhaust fan) to reduce vehicle airflow/ventilation (turn on exhaust fan) to reduce the concentration of aerosol accumulation when possible. the concentration of aerosol accumulation when possible. Any nonessential equipment that can be removed from the Any nonessential equipment that can be removed from the patient compartment of the ambulance before transport will patient compartment of the ambulance before transport will hasten the time needed to disinfect and return to service.hasten the time needed to disinfect and return to service.

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EMERGENCY EMERGENCY CLEANING VEHICLE AFTER TRANSPORTING CLEANING VEHICLE AFTER TRANSPORTING

AN INFLUENZA PATIENTAN INFLUENZA PATIENT• After the patient has been removed and prior to cleaning, the air After the patient has been removed and prior to cleaning, the air

within the vehicle may be exhausted by opening the doors and within the vehicle may be exhausted by opening the doors and windows of the vehicle while the ventilation system is running. windows of the vehicle while the ventilation system is running. This should be done outdoors and away from pedestrian traffic. This should be done outdoors and away from pedestrian traffic. Routine cleaning methods should be employed throughout the Routine cleaning methods should be employed throughout the vehicle and on non-disposable equipment.vehicle and on non-disposable equipment.

• Routine cleaning with soap or detergent and water to remove Routine cleaning with soap or detergent and water to remove soil and organic matter, followed by the proper use of soil and organic matter, followed by the proper use of disinfectants, are the basic components of effective disinfectants, are the basic components of effective environmental management of influenza. Reducing the number environmental management of influenza. Reducing the number of influenza virus particles on a surface through these steps can of influenza virus particles on a surface through these steps can reduce the chance of hand transfer of virus particles. Influenza reduce the chance of hand transfer of virus particles. Influenza viruses are susceptible to inactivation by a number of chemical viruses are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial disinfectants readily available from consumer and commercial sources.sources.

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STROKE 4.29STROKE 4.29

• Added that the EMS personnel should attempt to Added that the EMS personnel should attempt to bring a knowledgeable friend or family member with bring a knowledgeable friend or family member with the stroke patientthe stroke patient

• Added that if the patient with stroke symptoms has Added that if the patient with stroke symptoms has no signs of CHF, they should receive a 500cc IV no signs of CHF, they should receive a 500cc IV bolus of Normal Salinebolus of Normal Saline

• Added under SPECIAL PRECAUTIONS: Many patients Added under SPECIAL PRECAUTIONS: Many patients with stroke are taking diuretics and are volume with stroke are taking diuretics and are volume depleted. Administer one bolus of IV fluid as noted depleted. Administer one bolus of IV fluid as noted above, unless there are obvious signs of acute heart above, unless there are obvious signs of acute heart failure. This may improve cerebral circulation.failure. This may improve cerebral circulation.

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4.33 VOMITING AND 4.33 VOMITING AND NAUSEANAUSEA

• Changed name to Vomiting and Changed name to Vomiting and NauseaNausea

• Under “Specific Information Needed” Under “Specific Information Needed” added:added:B. Is the patient nauseated?B. Is the patient nauseated?

C. If vomiting, is the cause known?C. If vomiting, is the cause known?

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SECTION 6SECTION 6

PROCEDURESPROCEDURES

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ENDOTRACHEAL INTUBATION ENDOTRACHEAL INTUBATION 6.56.5

• Under “PROCEDURE” added:Under “PROCEDURE” added:7. Monitor tube placement with qualitative 7. Monitor tube placement with qualitative

CO2 detector or preferably a CO2 detector or preferably a quantitative waveform CO2 monitor quantitative waveform CO2 monitor (Use of one or the other is (Use of one or the other is MANDATORY). After June 2013 the MANDATORY). After June 2013 the waveform capnography will be required.waveform capnography will be required.

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ENDOTRACHEAL INTUBATION ENDOTRACHEAL INTUBATION 6.56.5

• Under “NOTES” added:Under “NOTES” added:6. BY June 2013 all ALS services must 6. BY June 2013 all ALS services must

have the ability to monitor patients with have the ability to monitor patients with waveform capnographywaveform capnography

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SECTION 8SECTION 8

ADMINISTRATIVE PROTOCOLSADMINISTRATIVE PROTOCOLS

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SECTION 9SECTION 9

ACCEPTABLE EMS EQUIPMENT ACCEPTABLE EMS EQUIPMENT AND DEVICESAND DEVICES

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BLIND INSERTION AIRWAY BLIND INSERTION AIRWAY DEVICES 9.1DEVICES 9.1

• Noted that the King Airway may be Noted that the King Airway may be used if the service medical director used if the service medical director approvesapproves

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ALERT! BEFORE USING NEW ALERT! BEFORE USING NEW PRTOTOCOLS:PRTOTOCOLS:• EACH SERVICE MUST NOTIFY AND PROVIDE YOUR EACH SERVICE MUST NOTIFY AND PROVIDE YOUR

SERVICE OFF-LINE MEDICAL DIRECTOR A COPY OF SERVICE OFF-LINE MEDICAL DIRECTOR A COPY OF THE 5THE 5THTH EDITION PROTOCOLS (June 2010 edition) EDITION PROTOCOLS (June 2010 edition) AND A COPY OF THIS UPDATE PRESENTATIONAND A COPY OF THIS UPDATE PRESENTATION– It is OK for the medical director to download the material It is OK for the medical director to download the material

insteadinstead

• EACH SERVICE MUST BE SURE THE ON-LINE EACH SERVICE MUST BE SURE THE ON-LINE MEDICAL DIRECTORS AT YOUR MEDICAL DIRECTION MEDICAL DIRECTORS AT YOUR MEDICAL DIRECTION HOSPITALS ARE AWARE THAT THE PROTOCOLS HOSPITALS ARE AWARE THAT THE PROTOCOLS HAVE BEEN UPDATED AND WHERE TO GET THE HAVE BEEN UPDATED AND WHERE TO GET THE MATERIALMATERIAL– The service is not responsible for furnishing copies of the The service is not responsible for furnishing copies of the

protocols or update slide presentationprotocols or update slide presentation

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NEW PROTOCOLS CAN BE NEW PROTOCOLS CAN BE USEDUSED• WHEN EVERYONE IN A SERVICE HAS BEEN WHEN EVERYONE IN A SERVICE HAS BEEN

UPDATEDUPDATED– TURNED ON SERVICE BY SERVICE NOT TURNED ON SERVICE BY SERVICE NOT

INDIVIDUAL BY INDIVIDUALINDIVIDUAL BY INDIVIDUAL– TURN IN ROSTER TO REGIONAL EMS AGENCY TURN IN ROSTER TO REGIONAL EMS AGENCY

NOT TO OFFICE OF EMS & TRAUMANOT TO OFFICE OF EMS & TRAUMA• Also acknowledge that you have updated your off-line Also acknowledge that you have updated your off-line

medical director and provided copy of protocolsmedical director and provided copy of protocols– REGIONAL EMS AGENCY WILL NOTIFY YOU REGIONAL EMS AGENCY WILL NOTIFY YOU

WHEN YOU CAN START USING NEW WHEN YOU CAN START USING NEW PROTOCOLSPROTOCOLS

– EVERY SERVICE MUST BE UPDATED BY EVERY SERVICE MUST BE UPDATED BY OCTOBER 1OCTOBER 1STST, 2010, 2010

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QUESTIONS?QUESTIONS?

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protocol update alabama ems protocols emt-intermediate edition 5 june, 2010 update 1

Documents

patient arrival

patient care activities

adult patients

symptoms of influenza

new patient care protocols

general patient care

adult medical patients

transfer of patients