2019 ACADEMY OF MEDICINE OF CINCINNATI PROTOCOLS FOR SOUTHWEST OHIO PREHOSPITAL CARE UPDATE Woods Curry MD Cochair Paul Gallo EMTP CoChair All EMS providers shall be responsible to read and review each protocol and policy in its entirety ID: 765847
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2019 ACADEMY OF MEDICINE OF CINCINNATI PROTOCOLS FOR SOUTHWEST OHIO PREHOSPITAL CARE UPDATE Woods Curry, MD, Co-chair Paul Gallo, EMT-P, Co-Chair
All EMS providers shall be responsible to read and review each protocol and policy in its entirety
introduction Training is designed to familiarize the EMS provider with the use and content of new and revised protocols The protocols will continue to evolve as medicine changes and care is reviewed . Provides quality improvement standards
Protocol committee
NEW WEBSITE
New Protocols
A111 Hospital status
M419 Sepsis
S507 Special trauma situations
S507 Special trauma situations
Updated Protocols
A100 administrative protocol Key points Process for compliance was updated. New site visit form placed in Appendix K. Any questions – contact Chief Owens or Dr. Locasto
A105 determination of death/termination of cpr Added: MCI statement Changed : provides clarification to indicate termination en route was for a moving ambulance
SB204 cardiac arrest
SB204 cardiac arrest ELEMENTS OF HIGH QUALITY CPR Ensuring chest compressions of adequate rate (110) – Use metronome Ensuring chest compressions of adequate depth - at least 2 inches Adequate Recoil- allowing full chest recoil between compressions Minimize time off the chest to < 10 seconds for compressor changes or defibrillation Avoid Hyperventilation – 1 breath every 6 seconds Rotate compressors every 2 minutes or when end tidal CO2 goes down to reduce rescuer fatigue and ensure high quality compressions Review and provide feedback of all cardiac arrest calls, including all involved in the call, and including all tools available during the call (e.g., monitor data)
Cardiac arrest C300 Ventricular Fibrillation/Tachycardia Adult w/o PulseC301 Asystole – Pulseless Electrical Activity (PEA) P601 Pediatric Pulseless Cardiac Arrest (V-Fib, V-Tach) P602 Pediatric Pulseless Cardiac Arrest (Asystole, PEA) Key points The basics of CPR removed from each protocol (all in SB204) Updated medication changes
Sb211 & sb213 changesSB211 Guideline for Assessment/Transport of Adult Trauma Patients SB213 Guideline for Assessment/Transport of Geriatric Trauma Patients Key points Anticoagulation and evidence of traumatic brain injury. a. GCS scale < 13 or AVPU scale that does not respond to Pain or Unresponsive b. Alteration in LOC during examination or thereafter; loss of conscious > 5 min. c. Failure to localize pain.
C303 & c304 Changed: concentration and dilution of Mag Sulfate
M400 Acute coronary syndrome Changed: to do not administer NTG in an inferior MI.
M403 Asthma-copd Added: option for oral Solu -Medrol.
M414 Stroke
M414 Stroke
S501 Head or spinal trauma Updated: reflects current practice of Air Care based on UC Neurotrauma experts. Updated: EtCO2 information
S505 prehospital pain management
S506 administration of tranexamic acid (TXA) changes Inclusion Criteria Age – ALL Protocol Pediatric < 12 years - loading dose is 15 mg/kg IV (max 1g) given over 10 minutes. The maintenance infusion of 2 mg/kg/hour for at least 8 hours or until bleeding stops. Pediatric ≥ 12 years - loading dose is 1g IV over 10 minutes. The maintenance infusion 1g over 8hr or until bleeding stops.
P605 pediatric stridor
P607 pediatric respiratory distress
P607 pediatric respiratory distress
P607 pediatric respiratory distress
T704 spinal motion restriction (smr) Key points Formally known as spinal immobilization… UPDATED for consistency with current evidence-based data to Spinal Motion Restriction (SMR). SMR refers to the practice of maintaining the entire spine in a neutral in-line position (anatomic alignment) and minimizing movement of the spine without the use of a backboard. Flow chart form. Applies to ALL ages.
T704 spinal motion restriction (smr)
T704 spinal motion restriction (smr)
T704 spinal motion restriction (smr)
Additional changes Added medication monograph for Ketamine. Medication monographs located in Appendix O. Updated the medication chart for pediatrics. Updated the EMS Scope of Practice in Appendix C. Reference material on website Quality and Performance Measures Football Helmet Removal
contactsWoods Curry, MD, Co-Chaircurrybs@ucmail.uc.edu Paul Gallo, EMT-P, Co-Chair pgallo@readingohio.org