2011 Southwest Ohio Pre-hospital Protocols

1. 2011 Southwest Ohio Pre-hospital Protocols Academy of Medicine of Cincinnati Protocol Subcommittee Hamilton H. Lempert, MD FACEP, Chairman

2. Protocol Committee Greg Ballman, EMT-P Bob Baioni, EMT-P Mike Bilkasley, EMT-P Troy Bonfield, EMT-P Thomas Breyer, NREMT-P Steve Coley Lindsey Collett, EMT-P Kenneth Crank, NREMT-P Tim Delgado

3. Goals Teaching Tool Quick Reference Guide

4. Global Change Combined Basic EMT and Paramedic EMT Protocols Improved Communication Keep protocols up to date Section Headings for EMT Basics MEDIC Paramedics ALL

5. Global Changes Many, Many Small clarifications Re-wordings Creating new order of things

6. Global change New Section called “Symptom Based” abbreviated “SB” Guideline for care based on symptom and not disease Collected many common steps from disease protocol Obtain Vital Signs Transport Patient Etc…

7. SB200 Clinical Practice Standards Should be followed on every patient Discusses definitions Who is a patient Initial Assessment Initial Treatment steps Transport Communication Refusal Documentation

8. Other SB Protocols SB201 Altered Level of Consciousness SB202 Respiratory Distress SB203 Chest Pain SB204 Cardiac Arrest SB210 to SB214 Trauma Triage Does not cover every situation Use good judgment Recommend going over each one

9. Global Caveats IV Access Lock or bag of saline at KVO If after 2 attempts at IV consider IO Administer Oxygen Apply appropriate device and volume Obtain 95% Sat Some may never get there

10. Global Caveats Inclusion Criteria Replaced Historical Findings and Physical Findings Differential Diagnosis Preplaced Exclusion Criteria

11. Administrative Section Changed from 200 numbers to 100 numbers SB now 200 numbers Added intubation as an automatic QA item for MEDICS Was already there for EMT’s Added BLS and State Certification needed for all Basics Removed A104 – Covered in Trauma Triage Removed A106 – Pediatric Determination of Death Incorporated into Adult Determination of Death A105

12. Cardiac Section C300 V-Fib Added some clarifications Planning on re-doing Cardiac Section in 2012 After new American Heart Association updates ASA changed from 325 to 324

13. Medical Section M400 Acute Coronary Syndrome Added a few clarifications regarding Erectile Dysfunction Drugs Pushed IV Access earlier Added Medical Control Call for Nitro treatment for Inferior Wall MI

14. Medical Section M401 Cardiogenic Shock Added Dopamine Drip Chart M403 Asthma Added Solumedrol IV as alternate steroid to Prednisone PO Re-Worded “Do not give” Epinephrine in patients over 40 years old or with Cardiac Artery Disease to “Caution should be used”

15. Medical Section M405 Poisoning Removed M405 Now Nausea and Vomiting Added Oral Zofran M414 and M413 switched so Hyperthermia and Hypothermia could be next to one another M416 Nothing by Mouth moved to SB200

16. Medical Section M411 Toxicological Emergencies Huge new protocol For any age Covers External, Inhaled and Ingested Poisons Covers Specific Toxins: Tylenol, Alcohol, Aspirin, Beta Blockers Calcium Channel Blockers, Cocaine, Amphetamines, PCP Digoxin, Cyanide, Dextormethorphan, Dystonic reactions Narcotic, Organophosphates, Tricyclic antidepressant Cyano Kit

17. Surgical Section Moved Trauma Triage to SB Section Moved S511 Pediatric Head Injury to P613 Moved S512 Pediatric Hemorrhagic Shock to P614

18. Pediatric Section P608 Altered Level of Consciousness deleted and incorporated into SB201 New P608 Hypo/Hyperglycemia P612 Nothing by Mouth Deleted and incorporated into SB200 P613 Pain Management renumbered to P612

19. Invasive Procedure Section T703 Central Access Device Added to attempt IO T705 Airway Protocol Added that King Airway is acceptable even though some problems with certification

20. Appendix section Renumbered the Appendixes Appendix A Added Oral Zofran Cyano Kit Solumedrol Appendix B Substitutions Added a list of acceptable substitutions if supplies run short Appendix D Chemical Agent now for all Ages

21. Appendix Section Appendix L Blood Collection by EMS Providers Senate Bill 58 Rules still under development List of recommendations for Medical Director and Department Leadership to come up with agreement with local Police Agency.

22. Drug LIcense Hamilton Lempert will send a copy of these protocols to the State To renew your license you must fill out the application with all appropriate signatures and drug list (App A). You do not need to send them a copy of the protocols. Get it in by November 1st.

23. Final Approval 2010 Protocols posted on Academy of Medicine Website on October 1st. academyofmedicine.org Open for comments until December 1st Please find all of our typo’s and mistakes Send your comments to Dr. Lempert hlempert9@gmail.com Updated Protocols will be posted on Academy of Medicine website the last week of December for implementation January 1st, 2011.