Advanced Life Support Protocol Update 2006

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Advanced LifeAdvanced Life

Support ProtocolSupport ProtocolUpdateUpdate

20062006


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F ormatF ormat

Modular Format:Modular Format:OperationsOperations

Adult Medical Adult Medical Adult Trauma Adult TraumaSpecial ConsiderationsSpecial ConsiderationsPediatric MedicalPediatric MedicalPediatric TraumaPediatric Trauma

Appendix Appendix

Together, the

seven separatesections make upthe Regional ALSProtocol


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G eneral Operating ProceduresG eneral Operating Procedures

IntroductionIntroductionEMTEMT--Intermediate/Critical Care ProgramIntermediate/Critical Care ProgramClinical JudgmentClinical JudgmentInterpretation of ProtocolsInterpretation of ProtocolsMedical ControlMedical ControlMedical Authority at the SceneMedical Authority at the SceneCommunicationsCommunications

CommunicationsF

ailureCommunicationsF

ailureTransfer of CareTransfer of CarePatients Who Refuse CarePatients Who Refuse CareInitiation and Termination of CPR Including DNRInitiation and Termination of CPR Including DNR

Table of ContentsTable of Contents


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Pediatric DefinitionsPediatric DefinitionsProceduresProceduresMedicationsMedicationsEquipmentEquipmentDestination DecisionDestination DecisionAmbulance DiversionAmbulance DiversionInter Inter- -F acility TransfersF acility Transfers

Protocol ExceptionsProtocol ExceptionsRecord KeepingRecord KeepingEMS Complaint/Concern ProceduresEMS Complaint/Concern ProceduresEMS Disciplinary ProceduresEMS Disciplinary ProceduresProtocol ChangesProtocol Changes

G eneralG eneral Operating ProceduresOperating ProceduresTable of ContentsTable of Contents


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IntroductionIntroduction

This manual represents the minimumThis manual represents the minimumstandard of care for provision of prestandard of care for provision of pre- -hospital advanced levels of care in thehospital advanced levels of care in theHudson Valley Region.Hudson Valley Region.The Regional Advanced Life SupportThe Regional Advanced Life Support(ALS) system incorporates three different(ALS) system incorporates three different

tiers of ALS care which includestiers of ALS care which includesEM

T EM

T--I,I,EM T EM T--CC, and EM T CC, and EM T--P P levels of personnellevels of personneland services.and services.


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EMTEMT--I /CC ProgramI /CC Program

The EMTThe EMT- -Intermediate/EMTIntermediate/EMT- -CriticalCritical CareCare(EMT(EMT--I/EMTI/EMT--CC) program is designedCC) program is designed for for

use only as an adjunct within anuse only as an adjunct within anestablished EMTestablished EMT- -P (Paramedic) system.P (Paramedic) system.Requires an EMTRequires an EMT- -P (Paramedic) twoP (Paramedic) two- -tiered priority responsetiered priority response w ith simultaneousw ith simultaneousdispatchdispatch


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Clinical Judgment:Clinical Judgment:

G uidelines which should be used inG uidelines which should be used inconjunction with good clinical judgment.conjunction with good clinical judgment.

In situations where there isIn situations where there is no existing no existing protocol protocol and a clear need for ALS exists,and a clear need for ALS exists,the ALS provider shall initiate Initialthe ALS provider shall initiate Initial

Advanced Life Support Care, Protocol Advanced Life Support Care, Protocol ACP ACP--1 and1 and contact M edical Control contact M edical Control


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Interpretation of ProtocolsInterpretation of Protocols

NY S BLS Protocols must be initiated,NY S BLS Protocols must be initiated, ininconjunctionconjunction with the HVREMSCOwith the HVREMSCO

Advanced Life Support Protocols. Advanced Life Support Protocols. ALS personnel will initiate Initial Advanced ALS personnel will initiate Initial AdvancedLife Support Care, Protocol ACPLife Support Care, Protocol ACP- -1, for 1, for every ALS patientevery ALS patient


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Interpretation of ProtocolsInterpretation of ProtocolsIn each protocol, for every standing order andIn each protocol, for every standing order andmedical control option, there is indication as tomedical control option, there is indication as towhich 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 aminimum, w ith End-tidal CO2

monitoring and Pulse Oximetry.Continuous CO2 monitoring isrecommended.

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


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Some protocols are designed to have numberedSome protocols are designed to have numberedstanding orders only; other protocols havestanding orders only; other protocols havenumbered standing orders and medical controlnumbered standing orders and medical controloptions.options.Standing orders may be initiated prior toStanding orders may be initiated prior tocontacting Medical Control, andcontacting Medical Control, and MU ST MU ST bebeperformed in numerical sequence.performed in numerical sequence.If there is clinical improvement, further standingIf there is clinical improvement, further standingorders may be withheld based upon the ALSorders may be withheld based upon the ALSProviders clinical judgment.Providers clinical judgment.


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Medical control options may not be initiatedMedical control options may not be initiateduntil ordered by Medical Control. Medicaluntil ordered by Medical Control. MedicalControl will sequence medical control options.Control will sequence medical control options.

Example:Example:

Medical Control options

Diazepam 5-10mg IVPMorphine Sulfate 2-10mg IVPMidazolam 0.5-2mg Slow IVP

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

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


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Additional information pertinent to the protocol Additional information pertinent to the protocolhas been included in separate sections entitledhas been included in separate sections entitledConsiderations.Considerations.

Example:Example:

ConsiderationsConsiderationsPrior to nasotracheal intubation, consider thePrior to nasotracheal intubation, consider theadministration of Phenylephrine HCl 1% N asal Spray. If administration of Phenylephrine HCl 1% N asal Spray. If

utilized, administer 2 sprays in the selected nostril.utilized, administer 2 sprays in the selected nostril.RSI Credentialed Paramedics may refer to MedicationRSI Credentialed Paramedics may refer to MedicationFacilitated/Rapid Sequence Intubation Protocol SCPFacilitated/Rapid Sequence Intubation Protocol SCP- -55as appropriate.as appropriate.


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It is understood that a patients clinicalIt is understood that a patients clinicalpresentation may require more than onepresentation may require more than oneprotocol.protocol.In such cases, the patients most emergentIn such cases, the patients most emergentclinical problem should be treated as the priority.clinical problem should be treated as the priority.Implement the standing orders in the newImplement the standing orders in the newprotocolprotocol w ithout exceeding the maximumw ithout exceeding the maximumrecommended medication dosagesrecommended medication dosages andand contact contact M edical Control M edical Control as indicated.as indicated.


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Medical ControlMedical Control

Standing OrdersStanding OrdersMedical Control OptionsMedical Control Options

Medical Control Practitioner means aMedical Control Practitioner means aHVREMAC credentialedHVREMAC credentialed PhysicianPhysician or or Physicians Assistant Physicians Assistant ..


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Medical Authority at a SceneMedical Authority at a Scene

Only a Medical Control Practitioner mayOnly a Medical Control Practitioner mayrelinquish 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 frommay allow ALS providers to follow orders fromthe physician at a scene, provided suchthe physician at a scene, provided suchorders are included within the Regional ALSorders are included within the Regional ALS

Protocols.Protocols.


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Medical Authority at a SceneMedical Authority at a Scene

Orders given by an on scene physician thatOrders given by an on scene physician thatare not within established HVREMSCOare not within established HVREMSCOprotocols 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 ownThat the on scene physician utilizes his/her owndrugs and equipment.drugs and equipment.That the on scene physician accompanies theThat the on scene physician accompanies thepatient 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 "PhysicianControl will complete and sign the "PhysicianRelease Form" Release Form"


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CommunicationsCommunications

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

The ALS Provider must contact theThe ALS Provider must contact theMedical Control Facility upon completionMedical Control Facility upon completionof standing orders, and whenever there isof standing orders, and whenever there isa patient who requires ALS services, buta patient who requires ALS services, butrefuses treatment or transport.refuses treatment or transport.


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CommunicationsCommunications

W hen patients are transported to aW hen patients are transported to ahospital not providing the Medical Controlhospital not providing the Medical Control

The MC Practitioner providing the order willThe MC Practitioner providing the order willnotify the clinical practitioner in charge of thenotify the clinical practitioner in charge of theReceiving Emergency DepartmentReceiving Emergency Department

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

circumstancescircumstances


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Communication F ailureCommunication F ailure

Complete appropriate standing orders andComplete appropriate standing orders andinitiate transport.initiate transport.

Attempt voice contact with any available Attempt voice contact with any availableRegional MC Facility.Regional MC Facility. After call, advise Medical Control and After call, advise Medical Control anddocument circumstancesdocument circumstances


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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 w ithin the follo w ing provisions: provider w ithin the follo w ing provisions:1. To an equal or higher level of care provider:1. To an equal or higher level of care provider:

W hen transport is by helicopter critical care team.W hen transport is by helicopter critical care team.W hen transport is by another provider/service with the sameW hen transport is by another provider/service with the samelevel of training.level of training.W hen patient is turned over to an appropriate receiving facility.W hen 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:W hen the ALS Provider at the scene recognizes that there isW hen the ALS Provider at the scene recognizes that there isno indication for ALS intervention.no indication for ALS intervention.W hen ALS capabilities are exceeded (ex. MCI) and patient isW hen ALS capabilities are exceeded (ex. MCI) and patient istriaged to other ALS or BLS services.triaged to other ALS or BLS services.W hen a coroner or other appropriate agency takes custody.W hen a coroner or other appropriate agency takes custody.


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Patients Who Refuse CarePatients Who Refuse Care

W hen a patient or legal guardian/proxy W hen a patient or legal guardian/proxy refuses treatment or transport:refuses treatment or transport:

Refer toN

ewY

ork State Department of Refer toN

ewY

ork State Department of Health, Bureau of EMS Basic LifeHealth, Bureau of EMS Basic LifeSupport Protocol SCSupport Protocol SC- -5 Refusing Medical5 Refusing Medical

Aid (RMA); Aid (RMA);Communicate w ith M edical Control if Communicate w ith M edical Control if

ALS is indicated . ALS is indicated .


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Initiation and Termination of CPRInitiation and Termination of CPRincluding 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 facilityFor any patient originating from an Article 28 facility(hospital or nursing facility) when(hospital or nursing facility) when w ritten DNR ordersw ritten DNR orderssigned by a physician are presented signed by a physician are presented ;;For any patient N OT originating from an Article 28For any patient N OT originating from an Article 28Facility (hospital or nursing facility) when a nonFacility (hospital or nursing facility) when a non- -hospitalhospitalDN R order is presented on the standard Department of DN R order is presented on the standard Department of Health form (DOHHealth form (DOH- -3474) or when the standard3474) or when the standardDepartment of Health D N R bracelet is found on theDepartment of Health D N R bracelet is found on thepatients body;patients body;In cases of obvious death such as rigor mortis,In cases of obvious death such as rigor mortis,decomposition, extreme dependant lividity, or mortaldecomposition, extreme dependant lividity, or mortalinjuries such as decapitation.injuries such as decapitation.


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

Effective spontaneous circulationEffective spontaneous circulationhas been restored;has been restored;

Resuscitative efforts have beenResuscitative efforts have beentransferred to another transferred to another appropriately trained individualappropriately trained individualwho 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 Medicalagrees to relinquish MedicalControl to an onControl to an on- -scene physicianscene physicianwho assumes responsibility for who assumes responsibility for the care of the patient;the care of the patient;

A Medical ControlA Medical ControlPractitioner ordersPractitioner orderstermination of CPR (by radio,termination of CPR (by radio,telephone, or other telephone, or other communication means);communication means);Care of the patient isCare 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 C F R, EMT or AEMT isThe C F R, EMT or AEMT is

exhausted and physicallyexhausted and physicallyunable to continueunable to continueresuscitation.resuscitation.


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If the decision is made to terminate CPR, theIf the decision is made to terminate CPR, thepatientpatient must still bemust still be transported if transported if ;;Arrest is in a public placeArrest is in a public placeAn environmental situation not conducive toAn environmental situation not conducive totermination existstermination existsNo police agency or coroner is presentNo police agency or coroner is presentCommunication failure occurredCommunication failure occurredAsystole developed after the arrival of EMSAsystole developed after the arrival of EMSInadequate IV access or airway control was obtainedInadequate IV access or airway control was obtained ..

I f decision is made not to transport, the ALS I f 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.


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Pediatric DefinitionsPediatric Definitions

A pediatric patient is any patient who is less than A pediatric patient is any patient who is less thaneighteen (18) years old.eighteen (18) years old.The term infant refers to pediatric patients lessThe term infant refers to pediatric patients lessthan 1 year old.than 1 year old.The term neonate refers to pediatric patients inThe term neonate refers to pediatric patients inthe 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 beFor the purposes of CPR and AED a child will beconsidered eight (8) years of age or less.considered eight (8) years of age or less.


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ProceduresProcedures

N ew Section (specifies variousN ew Section (specifies variousprocedures)procedures)

Biphasic defibrillation is an acceptable optionBiphasic defibrillation is an acceptable optionif used according to the specific if used according to the specific manufacturers instructions .manufacturers instructions .12 Lead ECG 12 Lead ECG implementationimplementation stronglystrongly

supported by the HVREMACsupported by the HVREMACEM T EM T--I services are required to utilizeI services are required to utilize

Automated E xternal Defibrillators . Automated E xternal Defibrillators .


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Medications/EquipmentMedications/Equipment

Agencies will be required to stock each Agencies will be required to stock each ALS unit ALS unit and maintain stock and maintain stock levelslevelsaccording to the minimum guidelines asaccording to the minimum guidelines asset forth in the medication andset forth in the medication andequipment lists in the appendix.equipment lists in the appendix.


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Inter Inter- -F acility TransfersF acility Transfers

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


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Patients name;Patients name;Diagnosed condition of the patient;Diagnosed condition of the patient;Any treatment and any medication administered to theAny treatment and any medication administered to thepatient;patient;Name of physician ordering transfer;Name of physician ordering transfer;Name of hospital from which the patient is beingName of hospital from which the patient is beingtransferred;transferred;Name of the physician(s) who is or are willing andName of the physician(s) who is or are willing andauthorized 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 theName of hospital or other facility that is to receive thepatient;patient;Date and time of transfer Date and time of transfer Signature of the physician ordering the transfer.Signature of the physician ordering the transfer.

PrePre- -hospital emergency personnel must insure that prior to initiating thehospital 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 thefollowing information:following information:


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Inter Inter- -F acility TransfersF acility TransfersPrePre- -hospital emergency personnel must insure that prior tohospital emergency personnel must insure that prior toinitiating the patient transfer, they are supplied with writteninitiating 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 exceedObtain written medical orders that do not exceedtheir level of medical training;their level of medical training;

Confirm that the receiving facility has agreed toConfirm that the receiving facility has agreed toaccept the patient in transfer;accept the patient in transfer;Are supplied with appropriate copies of the patient sAre supplied with appropriate copies of the patient smedical records, including radiographs;medical records, including radiographs;Are utilizing the appropriate equipment needed toAre utilizing the appropriate equipment needed totransfer the patient;transfer the patient;V erify that the patient has been stabilized to theV erify that the patient has been stabilized to thefullest extent capable by the referring hospital prior fullest extent capable by the referring hospital prior to transfer.to transfer.


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If a patients condition becomes criticalIf a patients condition becomes criticalduring an inter during an inter- -facility transportfacility transportHVREMAC credentialed personnel shallHVREMAC credentialed personnel shallutilize the ALS protocols in conjunctionutilize the ALS protocols in conjunctionwith the NY S BLS protocolswith the NY S BLS protocols provided provided Medical Control is contactedMedical Control is contacted ASAP ASAP


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Protocol ExceptionsProtocol ExceptionsW hile acting in a setting which falls beyond theW hile acting in a setting which falls beyond thescope of the Regional ALS Protocols, no ALSscope of the Regional ALS Protocols, no ALSProvider shall be faulted or suffer punitive actionProvider shall be faulted or suffer punitive action

for:for:following onfollowing on- -line Medical Control orders,line Medical Control orders, provided the provided theorders are w ithin the ALS Providers standard of careorders are w ithin the ALS Providers standard of careand scope of training and 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 beyondfor refusing to perform a procedure which is beyondthe ALS Providers scope of training or expertise.the ALS Providers scope of training or expertise.


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This section is not intended by theThis section is not intended by theHVREMAC as a means for field providersHVREMAC as a means for field providersand Medical Control representatives toand Medical Control representatives tocircumvent procedures or training circumvent procedures or training requirements specifically addressed by requirements specifically addressed by the protocols.the protocols.

Protocol ExceptionsProtocol Exceptions


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Record KeepingRecord Keeping

ALS providers must document ALS providers must document all ALSall ALS procedures procedures performed on an appropriateperformed on an appropriatePCR addendum (ex. PCR ContinuationPCR addendum (ex. PCR ContinuationForm or other form approved by theForm or other form approved by theHVREMSCO to be used in place of a PCRHVREMSCO to be used in place of a PCRContinuation Form).Continuation Form).


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In cases where patients are transported to aIn cases where patients are transported to ahospital not providing the M edical Control hospital not providing the M edical Control for thefor thetransport, the ALS provider willtransport, the ALS provider will

Document on a PCR addendum the name of theDocument on a PCR addendum the name of theMedical Control Practitioner and Medical ControlMedical Control Practitioner and Medical ControlFacility as well as the time of communication and allFacility as well as the time of communication and allMedical Control orders received or denied.Medical Control orders received or denied.

The ALS Provider will have the PCR addendumThe ALS Provider will have the PCR addendumsigned by the clinical practitioner designated as insigned by the clinical practitioner designated as incharge of the Receiving Hospital ED.charge of the Receiving Hospital ED.


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All online medical control orders must be All online medical control orders must bedocumented on a PCR addendum and must bedocumented on a PCR addendum and must beauthorized by a Medical Control Practitioner authorized by a Medical Control Practitioner

either by verbal authorization to the clinicaleither by verbal authorization to the clinicalpractitioner designated as in charge of thepractitioner designated as in charge of theReceiving Hospital ED (Receiving Hospital ED ( w hen the patient isw hen the patient istransported to a hospital not providing M edical transported to a hospital not providing M edical

Control Control ) or by written authorization () or by written authorization ( w hen thew hen the patient is transported to the hospital providing patient is transported to the hospital providing M edical Control M edical Control ).).


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The ALS provider The ALS provider MUST NOTMUST NOT leave theleave thehospital until a completed PCR ishospital until a completed PCR isprovided to the appropriate hospitalprovided to the appropriate hospitalstaff staff 11

1NY S DOH Policy Statement 02-05


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EMS Complaint / ConcernEMS Complaint / ConcernProceduresProcedures

Note:Note: The NY S DOH, Bureau of EMS mandatesThe NY S DOH, Bureau of EMS mandatesspecific incident reporting responsibilities andspecific incident reporting responsibilities andrequirements for all EMS services. Mandatoryrequirements for all EMS services. Mandatoryreporting of incidents must be performed asreporting of incidents must be performed asindicated in:indicated in:

NY State EM S Code, Part 800, Section 21 ( q) 1NY State EM S Code, Part 800, Section 21 ( q) 1 --5 and 5 and Section 21 ( r), Part 80, 80 .136 ( k), NYS DOH, BureauSection 21 ( r), Part 80, 80 .136 ( k), NYS DOH, Bureauof EM S Policy Statement 98 of EM S Policy Statement 98- -11 , and any other NYS11 , and any other NYSDOH Policies and ProceduresDOH Policies and Procedures ..


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EMS Disciplinary ProceduresEMS Disciplinary ProceduresThe E valuation Committee is a subThe E valuation Committee is a sub- -committee of thecommittee of theRegional M edical Advisory Committee ( R EM AC) . TheRegional M edical Advisory Committee ( R EM AC) . The

E valuation Committee consists of seven (7 ) members asE valuation Committee consists of seven (7 ) members asfollow s:follow s:

Chairman of the Evaluation CommitteeChairman of the Evaluation CommitteeChairman of the HVREMACChairman of the HVREMACRegional Medical Director Regional Medical Director Regional Executive Director Regional Executive Director

Regional Quality Improvement Coordinator Regional Quality Improvement Coordinator Two EMS ProvidersTwo EMS ProvidersNo member of the field unit or institution involved in theNo member of the field unit or institution involved in the

complaint shall be appointed to the E valuationcomplaint shall be appointed to the E valuationCommittee . Committee .


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No ChangesNo Changes

Ambulance DiversionAmbulance Diversion

Destination DecisionDestination DecisionProtocol ChangesProtocol Changes


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Protocol Format ChangesProtocol Format Changes

Considerations BoxesConsiderations BoxesMay preface the clinical steps of the protocolMay preface the clinical steps of the protocolMay also be found within the protocolsMay also be found within the protocolsclinical steps when the Level of Care changesclinical steps when the Level of Care changes(Paramedic considerations maybe different(Paramedic considerations maybe differentfrom those of a Critical Care Technician)from those of a Critical Care Technician)

May also be found at the end of the protocolsMay also be found at the end of the protocolsclinical stepsclinical steps


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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 agiven level of care.given level of care.May also be found at the end of the protocolsMay also be found at the end of the protocolsclinical stepsclinical steps


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ALS Care Protocol ALS Care Protocol- -11Initial ALS CareInitial ALS Care

This protocol is to be implemented inThis protocol is to be implemented inconjunction w ith the Ne w York State Basic Lifeconjunction w ith the Ne w York State Basic LifeSupport Adult and Pediatric Treatment ProtocolsSupport Adult and Pediatric Treatment Protocols

for every patient that the ALS provider for every patient that the ALS provider determines to require predetermines to require pre- -hospital ALS care . hospital ALS care .

Replaces Adult and Pediatric Replaces Adult and Pediatric Routine M edical Routine M edical CareCare Protocol ProtocolIncorporates NY S BLS Protocol Incorporates NY S BLS Protocol General General

Approach to Patient Care as w ell as ALS Approach to Patient Care as w ell as ALS procedures procedures


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W hats N ew?W hats N ew? Adult Trauma Adult Trauma

N ew Protocols include:N ew Protocols include:Major TraumaMajor TraumaMajor Trauma TransportMajor Trauma TransportHigh Risk PatientHigh Risk Patient


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W hats N ewW hats N ewSpecial ConsiderationsSpecial Considerations

The following protocols have been moved intoThe following protocols have been moved intothe Special Considerations section:the Special Considerations section:

Rapid Sequence IntubationRapid Sequence Intubation

Child Birth/Precipitous DeliveryChild Birth/Precipitous DeliveryPain Management/AnalgesiaPain Management/AnalgesiaToxemia of PregnancyToxemia of PregnancyN eonatal ResuscitationN eonatal Resuscitation

N ew Protocols in this section include:N ew Protocols in this section include:Mark I kit useMark I kit useEmergency Incident REHABEmergency Incident REHAB


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W hats N ewW hats N ewPediatric Medical ProtocolsPediatric Medical Protocols

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

Toxic Exposure and Overdose wereToxic Exposure and Overdose wereseparated into two distinct protocolsseparated into two distinct protocols


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W hats N ew?W hats N ew?

EachEach of of thethe fivefive clinicalclinical sectionssections of of thetheprotocolsprotocols includesincludes referencereference chartscharts (such(such asasG CSG CS andand BurnBurn Charts)Charts) whichwhich maymay bebe helpfulhelpfultoto ALS ALS providersproviders inin thethe fieldfield..


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Appendices Appendices

Include:Include:Regional Helicopter Utilization G uidelinesRegional Helicopter Utilization G uidelinesRegional Hospital InformationRegional Hospital InformationLocation CodesLocation CodesPhysician Release FormPhysician Release FormEquipment ListEquipment List

Medication ListMedication ListDrug FormularyDrug Formulary


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Formulary ChangesFormulary Changes

Additions to the formulary include: Additions to the formulary include:LorazepamLorazepamMetoprololMetoprololPromethazine HClPromethazine HCl

The following have been removed from theThe following have been removed from theformulary:formulary:

OxytocinOxytocinVerapamilVerapamil

Advanced Life Support Protocol Update 2006

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