Summary of EDCEMSA policy/procedure/protocol changes for 2014 :
Formulary
Chest
Pain/ACS
Protocol
Allergic
Reaction
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.
ALOC Protocol 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.
Asthma
Protocol
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
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
Seizure
Protocol 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
COPD Protocol Deleted entire protocol and Replaced with “Bronchospasm” Protocol
IO Procedure 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