Advanced Life Suppor..

Advanced Life Advanced Life Support Protocol Support Protocol

UpdateUpdate

20062006

IntroductionIntroduction

Developed by the REMAC Protocol Developed by the REMAC Protocol SubcommitteeSubcommitteeDerived from the SEMAC ALS Protocol Derived from the SEMAC ALS Protocol TemplateTemplateDistributed to all regional ALS agencies, Distributed to all regional ALS agencies, Hospitals, County EMS Coordinators for Hospitals, County EMS Coordinators for commentcommentApproved by the SEMAC/SEMSCO and Approved by the SEMAC/SEMSCO and REMAC/REMSCOREMAC/REMSCO

FormatFormat

Modular Format:Modular Format: OperationsOperations Adult MedicalAdult Medical Adult TraumaAdult Trauma Special ConsiderationsSpecial Considerations Pediatric MedicalPediatric Medical Pediatric TraumaPediatric Trauma AppendixAppendix

Together, the seven separate sections make up the Regional ALS Protocol

General Operating ProceduresGeneral Operating Procedures

Introduction Introduction EMT-Intermediate/Critical Care Program EMT-Intermediate/Critical Care Program Clinical Judgment Clinical Judgment Interpretation of Protocols Interpretation of Protocols Medical Control Medical Control Medical Authority at the Scene Medical Authority at the Scene Communications Communications Communications Failure Communications Failure Transfer of Care Transfer of Care Patients Who Refuse Care Patients Who Refuse Care Initiation and Termination of CPR Including DNR Initiation and Termination of CPR Including DNR

Table of ContentsTable of Contents

Pediatric Definitions Pediatric Definitions Procedures Procedures Medications Medications Equipment Equipment Destination Decision Destination Decision Ambulance Diversion Ambulance Diversion Inter-Facility Transfers Inter-Facility Transfers Protocol Exceptions Protocol Exceptions Record Keeping Record Keeping EMS Complaint/Concern Procedures EMS Complaint/Concern Procedures EMS Disciplinary Procedures EMS Disciplinary Procedures Protocol Changes Protocol Changes

GeneralGeneral Operating Procedures Operating ProceduresTable of ContentsTable of Contents

IntroductionIntroduction

This manual represents the minimum This manual represents the minimum standard of care for provision of pre-standard of care for provision of pre-hospital advanced levels of care in the hospital advanced levels of care in the Hudson Valley Region.Hudson Valley Region.The Regional Advanced Life Support The Regional Advanced Life Support (ALS) system incorporates three different (ALS) system incorporates three different tiers of ALS care which includes tiers of ALS care which includes EMT-I, EMT-I, EMT-CC, and EMT-PEMT-CC, and EMT-P levels of personnel levels of personnel and services. and services.

EMT-I/CC ProgramEMT-I/CC Program

The EMT-Intermediate/EMT-CriticalThe EMT-Intermediate/EMT-Critical Care Care (EMT-I/EMT-CC) program is designed(EMT-I/EMT-CC) program is designed for for use only as an adjunct within anuse only as an adjunct within an established EMT-P (Paramedic) system. established EMT-P (Paramedic) system.

Requires an EMT-P (Paramedic) two-Requires an EMT-P (Paramedic) two-tiered priority response tiered priority response with simultaneous with simultaneous dispatch dispatch

Clinical Judgment:Clinical Judgment:

Guidelines which should be used in Guidelines which should be used in conjunction with good clinical judgment. conjunction with good clinical judgment.

In situations where there is In situations where there is no existing no existing protocolprotocol and a clear need for ALS exists, and a clear need for ALS exists, the ALS provider shall initiate Initial the ALS provider shall initiate Initial Advanced Life Support Care, Protocol Advanced Life Support Care, Protocol ACP-1 and ACP-1 and contact Medical Controlcontact Medical Control

Interpretation of ProtocolsInterpretation of Protocols

NYS BLS Protocols must be initiated, NYS BLS Protocols must be initiated, in in conjunctionconjunction with the HVREMSCO with the HVREMSCO Advanced Life Support Protocols. Advanced Life Support Protocols.

ALS personnel will initiate Initial Advanced ALS personnel will initiate Initial Advanced Life Support Care, Protocol ACP-1, for Life Support Care, Protocol ACP-1, for every ALS patient every ALS patient

Interpretation of ProtocolsInterpretation of ProtocolsIn each protocol, for every standing order and In each protocol, for every standing order and medical control option, there is indication as to medical control option, there is indication as to which level of provider may initiate that order.which level of provider may initiate that order.

EXAMPLE:EXAMPLE:

1. Airway control procedures2. If patient is intubated, secondary

confirmation must be performed, at a minimum, with End-tidal CO2 monitoring and Pulse Oximetry. Continuous CO2 monitoring is recommended.

3. Refer to appropriate protocol for further assessment and treatment.


Some protocols are designed to have numbered Some protocols are designed to have numbered standing orders only; other protocols have standing orders only; other protocols have numbered standing orders and medical control numbered standing orders and medical control options. options.

Standing orders may be initiated prior to Standing orders may be initiated prior to contacting Medical Control, and contacting Medical Control, and MUSTMUST be be performed in numerical sequence. performed in numerical sequence.

If there is clinical improvement, further standing If there is clinical improvement, further standing orders may be withheld based upon the ALS orders may be withheld based upon the ALS Provider’s clinical judgment. Provider’s clinical judgment.


Medical control options may not be initiated Medical control options may not be initiated until ordered by Medical Control. Medical until ordered by Medical Control. Medical Control will sequence medical control options.Control will sequence medical control options.

Example:Example:

Medical Control options

Diazepam 5-10mg IVPMorphine Sulfate 2-10mg IVP

Midazolam 0.5-2mg Slow IVP

Lidocaine 1.0-1.5mg/kg slow IVP (as appropriate for increased intracranial pressure)

EMT-I’s Stop Here. EMT-CC/P’s Contact Medical Control.


Additional information pertinent to the protocol Additional information pertinent to the protocol has been included in separate sections entitled has been included in separate sections entitled “Considerations”.“Considerations”.

Example:Example:

ConsiderationsConsiderations

Prior to nasotracheal intubation, consider the Prior to nasotracheal intubation, consider the administration of Phenylephrine HCl 1% Nasal Spray. If administration of Phenylephrine HCl 1% Nasal Spray. If utilized, administer 2 sprays in the selected nostril.utilized, administer 2 sprays in the selected nostril.

RSI Credentialed Paramedics may refer to Medication RSI Credentialed Paramedics may refer to Medication Facilitated/Rapid Sequence Intubation Protocol SCP-5 Facilitated/Rapid Sequence Intubation Protocol SCP-5 as appropriate.as appropriate.


It is understood that a patient’s clinical It is understood that a patient’s clinical presentation may require more than one presentation may require more than one protocol. protocol.

In such cases, the patient’s most emergent In such cases, the patient’s most emergent clinical problem should be treated as the priority. clinical problem should be treated as the priority.

Implement the standing orders in the new Implement the standing orders in the new protocol protocol without exceeding the maximum without exceeding the maximum recommended medication dosagesrecommended medication dosages and and contact contact Medical ControlMedical Control as indicated. as indicated.

Medical ControlMedical Control

Standing OrdersStanding Orders

Medical Control OptionsMedical Control Options

““Medical Control Practitioner” means a Medical Control Practitioner” means a HVREMAC credentialed HVREMAC credentialed PhysicianPhysician or or Physician’s AssistantPhysician’s Assistant..

Medical Authority at a SceneMedical Authority at a Scene

Only a Medical Control Practitioner may Only a Medical Control Practitioner may relinquish Medical Control, relinquish Medical Control, and only to an identified physician at a scene. and only to an identified physician at a scene. may allow ALS providers to follow orders from may allow ALS providers to follow orders from

the physician at a scene, provided such the physician at a scene, provided such orders are included within the Regional ALS orders are included within the Regional ALS Protocols. Protocols.

Medical Authority at a SceneMedical Authority at a Scene

Orders given by an on scene physician that Orders given by an on scene physician that are not within established HVREMSCO are not within established HVREMSCO protocols require:protocols require:

That the on scene physician implements the order.That the on scene physician implements the order. That the on scene physician utilizes his/her own That the on scene physician utilizes his/her own

drugs and equipment.drugs and equipment. That the on scene physician accompanies the That the on scene physician accompanies the

patient to hospital.patient to hospital.

The on scene physician who accepts Medical The on scene physician who accepts Medical Control will complete and sign the "Physician Control will complete and sign the "Physician

Release Form"Release Form"

CommunicationsCommunications

ALS Providers may contact Medical ALS Providers may contact Medical Control at any time. Control at any time.

The ALS Provider must contact the The ALS Provider must contact the Medical Control Facility upon completion Medical Control Facility upon completion of standing orders, and whenever there is of standing orders, and whenever there is a patient who requires ALS services, but a patient who requires ALS services, but refuses treatment or transport. refuses treatment or transport.

CommunicationsCommunications

When patients are transported to a When patients are transported to a hospital not providing the Medical Controlhospital not providing the Medical Control The MC Practitioner providing the order will The MC Practitioner providing the order will

notify the clinical practitioner in charge of the notify the clinical practitioner in charge of the Receiving Emergency Department Receiving Emergency Department

If on scene >20 min. document If on scene >20 min. document circumstances circumstances

Communication FailureCommunication Failure

Complete appropriate standing orders and Complete appropriate standing orders and initiate transport. initiate transport.

Attempt voice contact with any available Attempt voice contact with any available Regional MC Facility. Regional MC Facility.

After call, advise Medical Control and After call, advise Medical Control and document circumstancesdocument circumstances

Transfer of CareTransfer of Care

ALS Providers may transfer care of a patient to another ALS Providers may transfer care of a patient to another provider within the following provisions:provider within the following provisions:

1. To an equal or higher level of care provider:1. To an equal or higher level of care provider: When transport is by helicopter critical care team.When transport is by helicopter critical care team. When transport is by another provider/service with the same When transport is by another provider/service with the same

level of training.level of training. When patient is turned over to an appropriate receiving facility.When patient is turned over to an appropriate receiving facility.

2. To an equal or lower level of care provider:2. To an equal or lower level of care provider: When the ALS Provider at the scene recognizes that there is When the ALS Provider at the scene recognizes that there is

no indication for ALS intervention.no indication for ALS intervention. When ALS capabilities are exceeded (ex. MCI) and patient is When ALS capabilities are exceeded (ex. MCI) and patient is

triaged to other ALS or BLS services.triaged to other ALS or BLS services. When a coroner or other appropriate agency takes custody.When a coroner or other appropriate agency takes custody.

Patients Who Refuse CarePatients Who Refuse Care

When a patient or legal guardian/proxy When a patient or legal guardian/proxy refuses treatment or transport:refuses treatment or transport:

Refer to New York State Department of Refer to New York State Department of Health, Bureau of EMS Basic Life Health, Bureau of EMS Basic Life Support Protocol SC-5 “Refusing Medical Support Protocol SC-5 “Refusing Medical Aid (RMA)”;Aid (RMA)”;

Communicate with Medical Control if Communicate with Medical Control if ALS is indicated.ALS is indicated.

Initiation and Termination of CPR Initiation and Termination of CPR including Do Not Resuscitate (DNR)including Do Not Resuscitate (DNR)

The only exceptions to initiating CPR are:The only exceptions to initiating CPR are:For any patient originating from an Article 28 facility For any patient originating from an Article 28 facility (hospital or nursing facility) when (hospital or nursing facility) when written DNR orders written DNR orders signed by a physician are presentedsigned by a physician are presented;;For any patient NOT originating from an Article 28 For any patient NOT originating from an Article 28 Facility (hospital or nursing facility) when a non-hospital Facility (hospital or nursing facility) when a non-hospital DNR order is presented on the standard Department of DNR order is presented on the standard Department of Health form (DOH-3474) or when the standard Health form (DOH-3474) or when the standard Department of Health DNR bracelet is found on the Department of Health DNR bracelet is found on the patient’s body;patient’s body;In cases of obvious death such as rigor mortis, In cases of obvious death such as rigor mortis, decomposition, extreme dependant lividity, or mortal decomposition, extreme dependant lividity, or mortal injuries such as decapitation.injuries such as decapitation.


Once CPR is initiated by a CFR, EMT or AEMT it must be continued Once CPR is initiated by a CFR, EMT or AEMT it must be continued until one of the following occurs:until one of the following occurs:

•Effective spontaneous circulation Effective spontaneous circulation has been restored;has been restored;•Resuscitative efforts have been Resuscitative efforts have been transferred to another transferred to another appropriately trained individual appropriately trained individual who continues CPR and other who continues CPR and other basic life support measures;basic life support measures;•A Medical Control Practitioner A Medical Control Practitioner agrees to relinquish Medical agrees to relinquish Medical Control to an on-scene physician Control to an on-scene physician who assumes responsibility for who assumes responsibility for the care of the patient;the care of the patient;

•A Medical Control A Medical Control Practitioner orders Practitioner orders termination of CPR (by radio, termination of CPR (by radio, telephone, or other telephone, or other communication means);communication means);•Care of the patient is Care of the patient is transferred to hospital staff transferred to hospital staff assigned responsibilities for assigned responsibilities for emergency care;emergency care;•A valid DNR is presented;A valid DNR is presented;•The CFR, EMT or AEMT is The CFR, EMT or AEMT is exhausted and physically exhausted and physically unable to continue unable to continue resuscitation.resuscitation.


If the decision is made to terminate CPR, the If the decision is made to terminate CPR, the patientpatient must still be must still be transported if transported if;;

Arrest is in a public placeArrest is in a public place An environmental situation not conducive to An environmental situation not conducive to

termination existstermination exists No police agency or coroner is presentNo police agency or coroner is present Communication failure occurredCommunication failure occurred Asystole developed after the arrival of EMSAsystole developed after the arrival of EMS Inadequate IV access or airway control was obtainedInadequate IV access or airway control was obtained..

If decision is made not to transport, the ALS If decision is made not to transport, the ALS provider will leave all tubes and lines in provider will leave all tubes and lines in

place.place.

Pediatric DefinitionsPediatric Definitions

A pediatric patient is any patient who is less than A pediatric patient is any patient who is less than eighteen (18) years old.eighteen (18) years old.

The term “infant” refers to pediatric patients less The term “infant” refers to pediatric patients less than 1 year old.than 1 year old.

The term “neonate” refers to pediatric patients in The term “neonate” refers to pediatric patients in the first minutes to hours immediately after birth.the first minutes to hours immediately after birth.

For the purposes of CPR and AED a child will be For the purposes of CPR and AED a child will be considered eight (8) years of age or less.considered eight (8) years of age or less.

ProceduresProcedures

New Section (specifies various New Section (specifies various procedures)procedures) Biphasic defibrillation is an acceptable option Biphasic defibrillation is an acceptable option

if used according to the specific if used according to the specific manufacturer’s instructions.manufacturer’s instructions.

12 Lead ECG 12 Lead ECG implementationimplementation strongly strongly supported by the HVREMAC supported by the HVREMAC

EMT-I services are required to utilize EMT-I services are required to utilize Automated External Defibrillators.Automated External Defibrillators.

Medications/EquipmentMedications/Equipment

Agencies will be required to stock each Agencies will be required to stock each ALS unit ALS unit and maintain stockand maintain stock levels levels according to the minimum guidelines as according to the minimum guidelines as set forth in the medication and set forth in the medication and equipment lists in the appendix.equipment lists in the appendix.

Inter-Facility TransfersInter-Facility Transfers

Patient care is the direct responsibility of Patient care is the direct responsibility of the referring hospital and physician for all the referring hospital and physician for all inter-facility transfer of patients. inter-facility transfer of patients.


Patients name;Patients name; Diagnosed condition of the patient;Diagnosed condition of the patient; Any treatment and any medication administered to the Any treatment and any medication administered to the

patient;patient; Name of physician ordering transfer;Name of physician ordering transfer; Name of hospital from which the patient is being Name of hospital from which the patient is being

transferred;transferred; Name of the physician(s) who is or are willing and Name of the physician(s) who is or are willing and

authorized to receive the patient at the new location;authorized to receive the patient at the new location; Name of hospital or other facility that is to receive the Name of hospital or other facility that is to receive the

patient;patient; Date and time of transferDate and time of transfer Signature of the physician ordering the transfer.Signature of the physician ordering the transfer.

Pre-hospital emergency personnel must insure that prior to initiating the Pre-hospital emergency personnel must insure that prior to initiating the patient transfer, they are supplied with written documentation of at least the patient transfer, they are supplied with written documentation of at least the

following information:following information:

Inter-Facility TransfersInter-Facility TransfersPre-hospital emergency personnel must insure that prior to Pre-hospital emergency personnel must insure that prior to

initiating the patient transfer, they are supplied with written initiating the patient transfer, they are supplied with written documentation of at least the following information:documentation of at least the following information:

Obtain written medical orders that do not exceed Obtain written medical orders that do not exceed their level of medical training;their level of medical training;Confirm that the receiving facility has agreed to Confirm that the receiving facility has agreed to accept the patient in transfer;accept the patient in transfer;Are supplied with appropriate copies of the patient’s Are supplied with appropriate copies of the patient’s medical records, including radiographs;medical records, including radiographs;Are utilizing the appropriate equipment needed to Are utilizing the appropriate equipment needed to transfer the patient;transfer the patient;Verify that the patient has been stabilized to the Verify that the patient has been stabilized to the fullest extent capable by the referring hospital prior fullest extent capable by the referring hospital prior to transfer.to transfer.


If a patient’s condition becomes critical If a patient’s condition becomes critical during an inter-facility transport during an inter-facility transport HVREMAC credentialed personnel shall HVREMAC credentialed personnel shall utilize the ALS protocols in conjunction utilize the ALS protocols in conjunction with the NYS BLS protocols with the NYS BLS protocols provided provided Medical Control is contacted Medical Control is contacted ASAPASAP

Protocol ExceptionsProtocol Exceptions

While acting in a setting which falls beyond the While acting in a setting which falls beyond the scope of the Regional ALS Protocols, no ALS scope of the Regional ALS Protocols, no ALS Provider shall be faulted or suffer punitive action Provider shall be faulted or suffer punitive action for:for: following on‑line Medical Control orders, following on‑line Medical Control orders, provided the provided the

orders are within the ALS Provider’s standard of care orders are within the ALS Provider’s standard of care and scope of trainingand scope of training; ;

for refusing to follow an order which the provider for refusing to follow an order which the provider believes to increase risk to the patient; believes to increase risk to the patient;

for refusing to perform a procedure which is beyond for refusing to perform a procedure which is beyond the ALS Provider’s scope of training or expertise.the ALS Provider’s scope of training or expertise.

This section is not intended by the This section is not intended by the HVREMAC as a means for field providers HVREMAC as a means for field providers and Medical Control representatives to and Medical Control representatives to circumvent procedures or training circumvent procedures or training requirements specifically addressed by requirements specifically addressed by the protocols.the protocols.

Protocol ExceptionsProtocol Exceptions

Record KeepingRecord Keeping

ALS providers must document ALS providers must document all ALS all ALS proceduresprocedures performed on an appropriate performed on an appropriate PCR addendum (ex. PCR Continuation PCR addendum (ex. PCR Continuation Form or other form approved by the Form or other form approved by the HVREMSCO to be used in place of a PCR HVREMSCO to be used in place of a PCR Continuation Form).Continuation Form).


ALS Providers must complete a PCR (and ALS Providers must complete a PCR (and when appropriate, a PCR addendum) when appropriate, a PCR addendum) immediately following a call, and a immediately following a call, and a (Physician, Physician’s Assistant, or Nurse (Physician, Physician’s Assistant, or Nurse Practitioner, as appropriate) from the Practitioner, as appropriate) from the Receiving Hospital ED Receiving Hospital ED must also sign the must also sign the ALS PCR or PCR addendumALS PCR or PCR addendum..


In cases where patients are transported to a In cases where patients are transported to a hospital not providing the Medical Controlhospital not providing the Medical Control for the for the transport, the ALS provider willtransport, the ALS provider will Document on a PCR addendum the name of the Document on a PCR addendum the name of the

Medical Control Practitioner and Medical Control Medical Control Practitioner and Medical Control Facility as well as the time of communication and all Facility as well as the time of communication and all Medical Control orders received or denied. Medical Control orders received or denied.

The ALS Provider will have the PCR addendum The ALS Provider will have the PCR addendum signed by the clinical practitioner designated as in signed by the clinical practitioner designated as in charge of the Receiving Hospital ED.charge of the Receiving Hospital ED.


All online medical control orders must be All online medical control orders must be documented on a PCR addendum and must be documented on a PCR addendum and must be authorized by a Medical Control Practitioner authorized by a Medical Control Practitioner either by verbal authorization to the clinical either by verbal authorization to the clinical practitioner designated as in charge of the practitioner designated as in charge of the Receiving Hospital ED (Receiving Hospital ED (when the patient is when the patient is transported to a hospital not providing Medical transported to a hospital not providing Medical ControlControl) or by written authorization () or by written authorization (when the when the patient is transported to the hospital providing patient is transported to the hospital providing Medical ControlMedical Control).).


The ALS provider The ALS provider MUST NOTMUST NOT leave the leave the hospital until a completed PCR is hospital until a completed PCR is provided to the appropriate hospital provided to the appropriate hospital staffstaff 11

1NYS DOH Policy Statement 02-05

EMS Complaint / Concern EMS Complaint / Concern ProceduresProcedures

Note:Note: The NYS DOH, Bureau of EMS mandates The NYS DOH, Bureau of EMS mandates specific incident reporting responsibilities and specific incident reporting responsibilities and requirements for all EMS services. Mandatory requirements for all EMS services. Mandatory reporting of incidents must be performed as reporting of incidents must be performed as indicated in:indicated in: NY State EMS Code, Part 800, Section 21(q) 1-5 and NY State EMS Code, Part 800, Section 21(q) 1-5 and

Section 21(r), Part 80, 80.136 (k), NYS DOH, Bureau Section 21(r), Part 80, 80.136 (k), NYS DOH, Bureau of EMS Policy Statement 98-11, and any other NYS of EMS Policy Statement 98-11, and any other NYS DOH Policies and ProceduresDOH Policies and Procedures. .

EMS Disciplinary ProceduresEMS Disciplinary Procedures

The Evaluation Committee is a sub‑committee of the The Evaluation Committee is a sub‑committee of the Regional Medical Advisory Committee (REMAC). The Regional Medical Advisory Committee (REMAC). The

Evaluation Committee consists of seven (7) members as Evaluation Committee consists of seven (7) members as follows:follows:

Chairman of the Evaluation CommitteeChairman of the Evaluation CommitteeChairman of the HVREMACChairman of the HVREMACRegional Medical DirectorRegional Medical DirectorRegional Executive DirectorRegional Executive DirectorRegional Quality Improvement CoordinatorRegional Quality Improvement CoordinatorTwo EMS ProvidersTwo EMS ProvidersNo member of the field unit or institution involved in the No member of the field unit or institution involved in the

complaint shall be appointed to the Evaluation complaint shall be appointed to the Evaluation Committee. Committee.

No ChangesNo Changes

Ambulance DiversionAmbulance Diversion

Destination DecisionDestination Decision

Protocol ChangesProtocol Changes

Protocol Format ChangesProtocol Format Changes

Considerations BoxesConsiderations Boxes May preface the clinical steps of the protocolMay preface the clinical steps of the protocol May also be found within the protocol’s May also be found within the protocol’s

clinical steps when the Level of Care changes clinical steps when the Level of Care changes (Paramedic considerations maybe different (Paramedic considerations maybe different from those of a Critical Care Technician)from those of a Critical Care Technician)

May also be found at the end of the protocol’s May also be found at the end of the protocol’s clinical stepsclinical steps

Protocol Format ChangesProtocol Format Changes

Medical Control OptionsMedical Control Options Are found at the end of the clinical steps for a Are found at the end of the clinical steps for a

given level of care. given level of care. May also be found at the end of the protocol’s May also be found at the end of the protocol’s

clinical stepsclinical steps

ALS Care Protocol-1ALS Care Protocol-1Initial ALS CareInitial ALS Care

““This protocol is to be implemented in This protocol is to be implemented in conjunction with the New York State Basic Life conjunction with the New York State Basic Life Support Adult and Pediatric Treatment Protocols Support Adult and Pediatric Treatment Protocols for every patient that the ALS provider for every patient that the ALS provider determines to require pre-hospital ALS care.”determines to require pre-hospital ALS care.”

Replaces Adult and Pediatric “Replaces Adult and Pediatric “Routine Medical Routine Medical CareCare” Protocol” Protocol

Incorporates NYS BLS Protocol “Incorporates NYS BLS Protocol “General General Approach to Patient Care” as well as ALS Approach to Patient Care” as well as ALS procedures procedures

ADVANCED LIFE SUPPORT PROTOCOLS

ADULT-MEDICAL

What’s New?What’s New?Adult Medical ProtocolsAdult Medical Protocols

Lorazepam, Metoprolol, and Promethazine Lorazepam, Metoprolol, and Promethazine Hydrochloride were added to the formulary Hydrochloride were added to the formulary

Overdose and Toxic Exposure separated Overdose and Toxic Exposure separated into two distinct protocols.into two distinct protocols.

Two new protocols added:Two new protocols added: Abdominal PainAbdominal Pain Suspected StrokeSuspected Stroke


ADULT-TRAUMA

What’s New?What’s New?Adult TraumaAdult Trauma

New Protocols include:New Protocols include: Major TraumaMajor Trauma Major Trauma TransportMajor Trauma Transport High Risk Patient High Risk Patient


SPECIAL CONSIDERATIONS

What’s New What’s New Special ConsiderationsSpecial Considerations

The following protocols have been moved into The following protocols have been moved into the Special Considerations section:the Special Considerations section: Rapid Sequence IntubationRapid Sequence Intubation Child Birth/Precipitous DeliveryChild Birth/Precipitous Delivery Pain Management/AnalgesiaPain Management/Analgesia Toxemia of PregnancyToxemia of Pregnancy Neonatal ResuscitationNeonatal Resuscitation

New Protocols in this section include:New Protocols in this section include: Mark I kit useMark I kit use Emergency Incident REHABEmergency Incident REHAB


PEDIATRIC-MEDICAL

What’s NewWhat’s NewPediatric Medical ProtocolsPediatric Medical Protocols

Abdominal Pain has been added as a new Abdominal Pain has been added as a new protocol to this sectionprotocol to this section

Toxic Exposure and Overdose were Toxic Exposure and Overdose were separated into two distinct protocolsseparated into two distinct protocols

ADVANCED LIFE SUPPORT

PROTOCOLS

PEDIATRIC-TRAUMA

What’s New?What’s New?Pediatric Trauma ProtocolsPediatric Trauma Protocols

New Protocols in this section include:New Protocols in this section include: Major TraumaMajor Trauma High Risk PatientsHigh Risk Patients Traumatic/Hypovolemic ShockTraumatic/Hypovolemic Shock Tension PneumothoraxTension Pneumothorax Head TraumaHead Trauma BurnsBurns Major Trauma TransportMajor Trauma Transport

What’s New?What’s New?

Each of the five clinical sections of the Each of the five clinical sections of the protocols includes reference charts (such as protocols includes reference charts (such as GCS and Burn Charts) which may be helpful GCS and Burn Charts) which may be helpful to ALS providers in the field. to ALS providers in the field.


APPENDIX

AppendicesAppendices

Include:Include: Regional Helicopter Utilization GuidelinesRegional Helicopter Utilization Guidelines Regional Hospital InformationRegional Hospital Information Location CodesLocation Codes Physician Release FormPhysician Release Form Equipment ListEquipment List Medication ListMedication List Drug FormularyDrug Formulary

Formulary ChangesFormulary Changes

Additions to the formulary include:Additions to the formulary include: LorazepamLorazepam MetoprololMetoprolol Promethazine HClPromethazine HCl

The following have been removed from the The following have been removed from the formulary:formulary: OxytocinOxytocin VerapamilVerapamil

Advanced Life Suppor..

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