Paramedic Protocol Update
2012
Westchester Regional Emergency Medical Advisory Committee
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Westchester Paramedic Protocol Update 2/12 - Overview
Update 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, 2011.

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Westchester Paramedic Protocol Update 2/12 - Overview
Documentation
Agency Medical Director MUST affirm that all affiliated
paramedics have received update training from the agency


All update affirmations MUST be submitted by
MARCH 31st
Agencies MUST affirm that ALL rostered paramedics hold
ACLS and PALS cards completed after April 1, 2011.


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Completed ACLS/PALS affirmations MUST be submitted by
MAY 31st
Westchester Paramedic Protocol Update 2/12 - Overview
Implementation
PROTOCOL CHANGES WILL
BE IN EFFECT AS OF:
APRIL
4
st
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Westchester Paramedic Protocol Update 2/12 - Overview
Overview

UPDATES to Adult and Pediatric Medical protocols
consistent with the 2010 American Heart Association (AHA)
guidelines.

NEW protocols for Post Cardiac Arrest Care
 Medical – 5.3: Cardiac (Arrest) - Post Cardiac Arrest Care
 Pediatric – 5.3: Cardiac (Arrest) – Post Cardiac Arrest Care

CHANGED numbering for Termination of Resuscitation
Protocol
 Medical – 5.3  Medical 5.4
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Westchester Paramedic Protocol Update 2/12 - Overview
Adult Medical Protocols
Westchester Regional Paramedic Protocol Update 2012
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 4.0:
Cardiac (General)
New
note regarding
activating STEMI policy
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL - 4.1:
Acute Coronary
Syndrome
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
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 4.3:
Bradycardia
Update
period for
repeating Atropine dose
Addition
of Note
cautioning use of Atropine
in the presence of certain
heart blocks
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 5.0:
Cardiac Arrest –
Non-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”
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 5.1:
Cardiac Arrest –
Shockable Rhythm
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)
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 5.1:
Cardiac Arrest –
Shockable Rhythm
cont’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)
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 5.2:
Cardiac Arrest –
Non-Shockable
Rhythm
Addition
of consideration
of advanced airway control
with capnography
Simplified
statement re
search for reversible causes
Update
period for
repeating Epinephrine dose
Clarified
amount of 0.9%
NS infusion
Removal
of administration
of Atropine
Addition
of NOTE to
refer to Protocol M-5.3 if
return of perfusing rhythm
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 5.3:
Post Cardiac Arrest
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
IV/IO
OLMC for pressors
fluid challenges
Notify
ER of possible
hypothermia therapy
Obtain
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Westchester Paramedic Protocol Update 2/12 - Overview
12 lead EKG
MEDICAL – 5.3:
Post Cardiac Arrest
Care cont’d
OLMC
Epi and Dopamine
infusion orders
NOTE
regarding
reversible causes
NOTE
regarding activation
of the Regional STEMI
policy if STEMI present
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Westchester Paramedic Protocol Update 2/12 - Overview
MEDICAL – 5.4:
Field Termination
of Resuscitation
Efforts
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
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Westchester Paramedic Protocol Update 2/12 - Overview
Pediatric Medical Protocols
Westchester Regional Paramedic Protocol Update 2012
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Westchester Paramedic Protocol Update 2/12 - Overview
PEDIATRIC – 5.0:
Cardiac Arrest –
Non-Traumatic
Update
regarding
unwitnessed arrests
Update
of ventilation rates
when advanced airway in
place
Addition
protocol
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Westchester Paramedic Protocol Update 2/12 - Overview
of NEW sub-
PEDIATRIC – 5.1:
Cardiac Arrest –
Shockable Rhythm
Update
period for
repeating Epinephrine dose
Removal
of administration
of Lidocaine (only
antidysrhythimic is now
Amiodarone)
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Westchester Paramedic Protocol Update 2/12 - Overview
PEDIATRIC – 5.1:
Cardiac Arrest –
Shockable Rhythm
cont’d
Addition
regarding Joulage
settings for second and
subsequent defibrillations
Addition
of NOTE to
refer to Protocol M-5.3 if
return of perfusing rhythm
Update
of administration
of 0.9% NS bolus after
medication
Removal
of NOTE
regarding administration of
Lidocaine (bolus or drip) if
rhythm converts
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Westchester Paramedic Protocol Update 2/12 - Overview
PEDIATRIC – 5.2:
Cardiac Arrest –
Non-Shockable
Rhythm
Addition
of consideration
of advanced airway control
with capnography
Simplified
statement re
search for reversible causes
Update
period for
repeating Epinephrine dose
Clarified
amount of 0.9%
NS infusion
Addition
of NOTE to
refer to Protocol P-5.3 if
return of perfusing rhythm
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Westchester Paramedic Protocol Update 2/12 - Overview
PEDIATRIC – 5.3:
Post Cardiac Arrest
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
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Westchester Paramedic Protocol Update 2/12 - Overview
12 lead EKG
PEDIATRIC – 5.3:
Post Cardiac Arrest
Care cont’d
OLMC
Epi and Dopamine
infusion orders
NOTE
regarding
reversible causes
NOTE
regarding activation
of the Regional STEMI
policy if STEMI present
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Westchester Paramedic Protocol Update 2/12 - Overview
PEDIATRIC – 10.0:
Neonatal
Resuscitation
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
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Westchester Paramedic Protocol Update 2/12 - Overview
Reminders





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:


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A rare occurance
Coordinated with OLMC
Westchester Paramedic Protocol Update 2/12 - Overview
Questions

Westchester Regional EMS Office


914-231-1616
Westchester REMSCO Website

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www.wremsco.org
Westchester Paramedic Protocol Update 2/12 - Overview
Thank you
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Westchester Paramedic Protocol Update 2/12 - Overview