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
 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
 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 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 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
Antiemesis
 Protocol applies to EMT-CC and EMT-P
 Indications:
– For the prevention and treatment of nausea and
vomiting
 Contraindications:
– Know hypersensitivity to medication
Antiemesis
 Protocol uses Ondansetron (Zofran) as the
Antiemetic
 Agencies may use either the generic or
brand name version of this medication
Ondansetron (Zofran)
 Indications:
– Nausea and vomiting
 Contraindications:
– Known hypersensitivity to this, or other,
antiemetic medications (Anzemet, Kytril, Aloxi)
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 (Zofran)
 Side Effects (continued):
– diarrhea or constipation;
– weakness or tired feeling;
– headache;
– dizziness or drowsiness;
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)
Antiemesis
 Steps:
– 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
 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 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
http://www.vidacare.com/P
roducts/index_4_29.html
Bone Injection Gun (BIG®)
 Approved for all
patients regardless of
age or weight
 Approved for use in
the Tibia
 Further information
available at
http://www.waismed.co
m/unique-79.htm
FAST1™
 Approved for use in
adult patients
 Allows for sternal
access
 Futher information
available at
http://www.pyng.com/
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 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 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 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 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 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
 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
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