Summary of EDCEMSA policy/procedure

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Summary of EDCEMSA policy/procedure/protocol changes for 2014

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Policy

Procedure

Protocol

Formulary

Changes

Chest

Pain/ACS

Protocol

Allergic

Reaction

Protocol

ALOC Protocol

Asthma

Protocol

Added:

Acetaminophen

Ibuprofen

EPIPEN/EPIPEN JR

Note on each expanded scope EMT medication

Changed:

Epinephrine in bronchospasm protocol reflected

Added nebulized epinephrine information

Neosynephrine- epistaxis added to indications

Dextrose- Changed adult indication from bs of 80 to 60

Updated pedi reference cards

Removed peanut allergy caution from atrovent

Added:

ASA for BLS providers

ASA was moved from “ALS Treatment” section to “BLS Treatment” section. Don’t forget that paramedics must start with the BLS stuff and then move on to the ALS stuff.

Added:

 Expanded Scope EMT Section. Including OTC PO Benadryl and

EpiPen/EpiPen JR

Changed:

Streamlined protocol to flow better

Allowed breathing treatments prior to epinephrine for

 bronchospasm

Added nebulized epinephrine for patients with airway stridor. This should be administered concurrently with IM epinephrine.

Changed:

 Blood glucose parameters (D50 indication) for adults from 80 mm/dL to 60 mm/dL and added the word “symptomatic” in front of hypoglycemia.

Deleted entire protocol and Replaced with new “Bronchospasm”

Protocol which combines all types of conditions resulting in bronchoconstriction.

Summary of EDCEMSA policy/procedure/protocol changes for 2014

:

Bronchospasm

Protocol

This new protocol replaces both the

COPD and Asthma protocols and combines them into one.

Features:

Verbiage in adult and pedi BLS sections to slow ventilatory rate for severe asthma patients to 6-8 VPM

Expanded Scope EMT Section allowing CPAP and EpiPen for

(EpiPen only in severe asthma)

Nebulized epinephrine for stridor (croup, respiratory burns,

 anaphylaxis, laryngeal edema)

IM epinephrine for patients in extremis in all bronchospasm conditions, including COPD.

Use with caution in older patients

Pulseless Arrest

Protocol

Last minute change (did not go through PAC or MAC because of time limitations) but was approved by Dr. Brazzel

 Joule settings for Physio-Control® Biphasic are now: 200J (Increase to 300J, then 360J for each subsequent shock)

General

Trauma

Protocol

Seizure

Protocol

COPD Protocol

IO Procedure

Added:

 Traumatic arrest treatment guidelines which includes large fluid boluses and bilateral needle chest decompression. It is assumed that any traumatic arrest (that is worked up) would be decompressed to rule out tension pneumothorax

Changed:

Blood glucose parameters (D50 indication) for adults from 80 mm/dL to

60 mm/dL

Added:

Acetaminophen and/or Ibuprofen for febrile seizure patients

Stroke Protocol Removed:

The word “Ischemic” for CVA specific patient assessment criteria

(all suspected stroke patients should be assessed in this manner)

Confusing verbiage regarding transport destination. (All ERs that serve as closest receiving facilities for El Dorado County are stroke capable.)

 Eliminated verbiage regarding “thrombolytic candidates” in protocol procedure section – all stroke patients should receive rapid transport to the closest ER

Deleted entire protocol and Replaced with “Bronchospasm” Protocol

Changed:

 Eliminated the “two IV attempts” requirement for IO placement. If

 you feel that an IO would be more appropriate than attempting peripheral IV access, it is your decision…

Moved 1 st

site for EZ-IO to proximal humerus

 B.I.G. IO procedure was not changed

Watch the video at this link to gain a better knowledge of the humeral placement site: http://www.youtube.com/watch?v=Wu-KVibUGNM

Summary of EDCEMSA policy/procedure/protocol changes for 2014

:

NTI Procedure Changed:

Epi 1:100,000 with lidocaine has been removed from the procedure

Neosynephrine is now the approved pretreatment vasoconstrictor

VAD procedure Changed:

 Policy has been reformatted

EMS

Documentation

Policies

Hospice DNR

Policy

ALS Unit

Inventories

Student Intern

Application

Combined into one Document:

 ePCR added

Abbreviations updated

Many updates in documentation requirements

Significant changes in CCT requirements. CCT RNs will be writing

 the PCR. Ambulance crew to assist with times, mileage, and crew info

Document replaces all previous documentation section policies

*CCT PCRs are currently being developed and should be available by the end of August 2014. Until then Medics should follow the procedure for

Non-contracted MICNs (on page 5 of the document).

New policy

 Allows medics to transport dying patients to facilities other than hospitals, including private residences, convalescent facilities, hospice facilities, etc.

There is now a Hospice DNR form that is specific to the needs of

Hospice patients

The most important feature of this policy is the Hospice phone number (West Slope only) which you can call at any time to ask for assistance

The hospice DNR is also specific to West Slope patients only. East

Slope medics can call the Base Station for assistance if needed

Changed:

 N202/CPAP Adapter (pigtail) made optional on all units

Buretrol Sets made optional on ALS Engines

Fentanyl minimum inventory reduced to 300/100/100

MS minimum reduced to 24/8/8

Neosynephrine is now required on all units

Nose clips (for epistaxis) are now required. Dr. Brazzel feels they offer a better shot at stopping epistaxis because there is constant pressure on the bleed

New addition

 This application is now required for any individual wishing to intern

 in EDC

It provides accountability and sets minimum training standards

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