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Paramedic Protocol UpdateParamedic Protocol Update20122012
Westchester Regional Emergency Medical Advisory Committee
Westchester Paramedic Protocol Update 2/12 - Overview1
Update Roll-OutUpdate Roll-Out
Westchester Paramedic Protocol Update 2/12 - Overview2
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, 2011April 1, 2011.
DocumentationDocumentation
Westchester Paramedic Protocol Update 2/12 - Overview3
Agency Medical Director MUST affirm that all affiliated paramedics have received update training from the agency All update affirmations MUST be submitted by
MARCH 31MARCH 31stst
Agencies MUST affirm that ALL rostered paramedics hold ACLS and PALS cards completed after April 1, 2011. Completed ACLS/PALS affirmations MUST be
submitted by MAY 31MAY 31stst
ImplementationImplementation
Westchester Paramedic Protocol Update 2/12 - Overview4
PROTOCOL CHANGES WILL BE IN EFFECT AS OF:
APRIL 1APRIL 1stst
OverviewOverview
Westchester Paramedic Protocol Update 2/12 - Overview5
Adult Medical ProtocolsAdult Medical Protocols
Westchester Regional Paramedic Protocol Update 2012
Westchester Paramedic Protocol Update 2/12 - Overview6
MEDICAL – 4.0:MEDICAL – 4.0:Cardiac Cardiac (General)(General)
New note regarding activating STEMI policy
Westchester Paramedic Protocol Update 2/12 - Overview7
MEDICAL - 4.1:MEDICAL - 4.1:Acute Coronary Acute Coronary SyndromeSyndrome
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
Westchester Paramedic Protocol Update 2/12 - Overview8
MEDICAL – 4.3:MEDICAL – 4.3:BradycardiaBradycardia
Update period for repeating Atropine dose
Addition of Note cautioning use of Atropine in the presence of certain heart blocks
Westchester Paramedic Protocol Update 2/12 - Overview9
MEDICAL – 5.0:MEDICAL – 5.0:Cardiac Arrest – Cardiac Arrest – Non-TraumaticNon-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”
Westchester Paramedic Protocol Update 2/12 - Overview10
MEDICAL – 5.1:MEDICAL – 5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythm
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)
Westchester Paramedic Protocol Update 2/12 - Overview11
MEDICAL – 5.1:MEDICAL – 5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythmcont’dcont’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)
Westchester Paramedic Protocol Update 2/12 - Overview12
MEDICAL – 5.2:MEDICAL – 5.2:Cardiac Arrest – Cardiac Arrest – Non-Shockable Non-Shockable RhythmRhythmAddition 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
Westchester Paramedic Protocol Update 2/12 - Overview13
MEDICAL – 5.3:MEDICAL – 5.3:Post Cardiac Post Cardiac Arrest CareArrest 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 OLMC for pressors
IV/IO fluid challenges
Notify ER of possible hypothermia therapy
Obtain 12 lead EKGWestchester Paramedic Protocol Update 2/12 - Overview14
MEDICAL – 5.3:MEDICAL – 5.3:Post Cardiac Post Cardiac Arrest Care Arrest Care cont’dcont’d
OLMC Epi and Dopamine infusion orders
NOTE regarding reversible causes
NOTE regarding activation of the Regional STEMI policy if STEMI present
Westchester Paramedic Protocol Update 2/12 - Overview15
MEDICAL – 5.4:MEDICAL – 5.4:Field Field Termination of Termination of Resuscitation Resuscitation EffortsEfforts
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
Westchester Paramedic Protocol Update 2/12 - Overview16
Pediatric Medical ProtocolsPediatric Medical Protocols
Westchester Regional Paramedic Protocol Update 2012
Westchester Paramedic Protocol Update 2/12 - Overview17
PEDIATRIC – PEDIATRIC – 5.0:5.0:Cardiac Arrest – Cardiac Arrest – Non-TraumaticNon-Traumatic
Update regarding unwitnessed arrests
Update of ventilation rates when advanced airway in place
Addition of NEW sub-protocol
Westchester Paramedic Protocol Update 2/12 - Overview18
PEDIATRIC – PEDIATRIC – 5.1:5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythm
Update period for repeating Epinephrine dose
Removal of administration of Lidocaine (only antidysrhythimic is now Amiodarone)
Westchester Paramedic Protocol Update 2/12 - Overview19
PEDIATRIC – PEDIATRIC – 5.1:5.1:Cardiac Arrest – Cardiac Arrest – Shockable Shockable RhythmRhythmcont’dcont’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
Westchester Paramedic Protocol Update 2/12 - Overview20
PEDIATRIC – PEDIATRIC – 5.2:5.2:Cardiac Arrest – Cardiac Arrest – Non-Shockable Non-Shockable RhythmRhythmAddition 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
Westchester Paramedic Protocol Update 2/12 - Overview21
PEDIATRIC – PEDIATRIC – 5.3:5.3:Post Cardiac Post Cardiac Arrest CareArrest 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 12 lead EKGWestchester Paramedic Protocol Update 2/12 - Overview22
PEDIATRIC – PEDIATRIC – 5.3:5.3:Post Cardiac Post Cardiac Arrest Care Arrest Care cont’dcont’d
OLMC Epi and Dopamine infusion orders
NOTE regarding reversible causes
NOTE regarding activation of the Regional STEMI policy if STEMI present
Westchester Paramedic Protocol Update 2/12 - Overview23
PEDIATRIC – PEDIATRIC – 10.0:10.0:Neonatal Neonatal ResuscitationResuscitation
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
Westchester Paramedic Protocol Update 2/12 - Overview24
RemindersReminders
Westchester Paramedic Protocol Update 2/12 - Overview25
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: A rare occurance Coordinated with OLMC
QuestionsQuestions
Westchester Paramedic Protocol Update 2/12 - Overview26
Westchester Regional EMS Office 914-231-1616
Westchester REMSCO Website www.wremsco.org
Thank youThank you
Westchester Paramedic Protocol Update 2/12 - Overview27