VVEMS Writing Group Presented by Todd Lang, MD.
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Transcript of VVEMS Writing Group Presented by Todd Lang, MD.
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VVEMS Writing GroupPresented by Todd Lang, MD
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Moved some items to appendices Not a textbook, but full of information More of a philosophical statement on
purpose of guidelines Discusses uniquities of VVEMS Reader expected to be familiar with
state and national requirements
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Interfacility transport guideline Sedona/VVMC transport guideline Air transport guideline
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To save time for both parties Name the type of call up front Patch: please listen and give us
guidance Notification: patient is stable and we
don’t request any orders, please direct us to a bed and be prepared for us
We will work with nursing to help them focus attention on Patch calls more tightly
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Functioning, dependable EMS Committees Prehospital Care: Most months. Everyday EMS
policy and related matters for the practicing EMS provider and addressing issues at the interface of EMS service and other services.
Steering: Chiefs, EMS leaders, NAH/VVMC leadership. Meets quarterly or PRN
Peer Review: Bimonthly. A forum to analyze and improve care rendered and offer constructive criticism on care and recordkeeping. Generates useful policy/guideline revisions.
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Has been running smoothly now for some time
Initial growing pains seem to have passed
Fine tuning the labeling: need to put patient labels over the MFR labels on the tubes
Legal blood draws not required unless blood already being drawn for medical care.
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Necessary as volume grows Empowers individual agencies Allows focused QA from medical
direction and makes more time available for integrative, system-wide data analysis
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Allowed but not endorsed strongly by local medical direction
Consider use early in codes Use after 2 attempts or 90 seconds in
critically ill Costly but safe Tibial sites preferred over humeral
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PICC line access Portacath access Increase number of people who can
get treated while decreasing pain and risk to EMS
These are the sickest patients and hardest IV starts
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0.1 mg/kg for adults 0.05 mg/kg for older (over 55) and
peds Repeat in 10 min Mirrors our “Protocol M” in ED Effective and safe dose
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An option for life threatening bleeding
May use proprietary device or bp cuff
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Rosetta Lido not a treatment for ischemia Iodine and shellfish do not cross react
with contrast dye and were removed from pretreatment for dye allergy
CCR Amiodarone removed from protocols
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NAH/VVMC purchased to help improve MI care in VV
Mostly working now Improved technology over fax-based
transmission Helps to bypass the ED in STEMI care
when possible
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State wide registry which will analyze cardiac arrest and survival
Expect great research Nationally recognized program Part of CCR initiative
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Early-middle adoption At request of agencies and leaders Hopefully will improve outcomes Unlikely to make things worse
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CPAP added Methylprednisolone by patch order Furosemide by patch order, dose
guideline (double) Continuous nebs for severe
bronchospasm
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Lifesaving Safe Strongly endorsed by Medical
Direction Costly, but manageable, expense Should decrease need for invasive
airways
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Consider RSI for airway burns Minimize airway manipulation unless
RSI available for neuro trauma in field Cervical Spine Immobilization
program
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Naloxone dose for altered patient is 0.4 mg IV
Naloxone dose for unconscious or unstable is 2 mg IV/IM
No NG or charcoal in ALOC OD patient
Charcoal only if ingestion <60 min Diazepam OK for EMT-I in seizures
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CCR success Cardiac Arrest Center/Cooling
survivors Fine tuning of C-spine protocol Focused RN training in 09 Continued Medical Director Ride Time Annual Training like this? Participation and Integration of
Medical Direction into EMD process