Protocol Changes

ffemt8978

Forum Vice-Principal
Community Leader
11,024
1,472
113
Strictly for discussion purposes only (we promise not to tell you medical control director :p ).

What would you change about your current protocols and why if it was up to you?

As for me, I would change two things immediately. First of all, our protocols only allow us to give oxygen at 15 lpm via NRB or 6 lpm via nasal canula. I would change this to allow us to titrate the O2 to maintain sats above 95%, consistent with national guidelines on flow rates for the various masks.

Secondly, our protocols state that we are NOT to board and collar a patient based upon mechanism of injury alone. I would change this to allow c-spine precautions based upon mechanism of injury or medic gut-feeling. Our protocols state that we are not to board and collar a patient if communication is possible and all of the following conditions are met:

1. Patient is CAOx3
2. Patient not under influence of drugs or alcohol
3. Patient has no complaints of neck pain
4. Patient has no complaints of arm or leg numbness
5. External exam reveals non-tenderness
6. NO distracting injury

I had a call a couple of months ago, for a female that had been thrown from a moving vehicle. Upon our arrival, PT was CAOx4, not under the influence, no complaints of neck pain or arm/leg numbness. PT was non-tender, and there were absolutely NO signs of injury what so ever. I mean, her jeans didn't even appear to have scraped on the concrete. Privately, I thought she was just claiming this to get a free ride, especially when she couldn't repeat the details of the incident consistently. I went ahead and placed her on a board and collar based upon mechanism alone, and initiated transport. While in route, I asked all of the routine SAMPLE History questions. The PT stated that she had some surgery a couple of years ago, so I asked her what type of surgery. She replied that she had broken her neck, and had three bones fused together!!! I then called for an ALS rendevous, and they completed the transport. A few days later, I was asked by a member of my department (who was at the call but not there during the transport), why I placed the patient in C-spine precautions and called for ALS when she did not appeared to be injured. I explained her history and added that after learning it, I was very glad that I did what I did (just to cover my own butt).
 

MMiz

I put the M in EMTLife
Community Leader
5,519
401
83
Our protocols allow us to administer O2 via NC or NRB at any rate we choose. Protocols state that we are to backboard any PT that meets ANY of a set of 10 or so criteria (MOI being one), but you better believe almost anyone gets a C-Spine precautions because of lawsuits. I've even seen a person that had a diabetic emergency and fell down to a carpeted floor be c-spined. It's up to the EMT.

Our hospitals want any person we even feel might need to be back-boarded to be back-boarded.

I wish EMT-Basics carried EPI pens, Nitro, and 81 MG Aspirins. In our county we have ALS only a few minutes away, so it's not really a big deal though.

The one issue I have is with RLS (Red Lights and Sirens). Our county is extremely strict with when they may be used. We're only allowed to use it if the call if the patient may lose life or limb. That is up to the dispatcher, and is their call.

If we transport BLS with RLS, that's going to be a write-up or automatical QI review. BLS is to call ALS for an intercept for all ALS calls.

ALS also MUST be dispatched for the following calls:
  • Cardiac Arrest
  • Chest pain
  • drug overdose / poison
  • Anything under AOX3
  • Allergic reaction
  • Difficulty breathing
  • Drowning or near drowning
  • Injury with bleeding (I know)
  • Seizures
  • Diabetic emergencies
  • Child birth
  • Burns
Also, Medical First Responders may not request helicopter intercepts. At least an EMT-B must call it in.

Also, Each BLS unit must have:
  • ET Detection Device
  • KED
  • Broslow Ped Tape
(which is above the standard state-approved minimum)

That's about it
 

rescuecpt

Community Leader Emeritus
2,088
1
0
I want a portable chest x-ray. The ACLS class always says "obtain a portable chest x-ray". :D

I hope you all know I'm KIDDING!!! :lol:
 
OP
OP
ffemt8978

ffemt8978

Forum Vice-Principal
Community Leader
11,024
1,472
113
Originally posted by rescuelt@Jun 27 2004, 04:37 PM
I want a portable chest x-ray. The ACLS class always says "obtain a portable chest x-ray". :D

I hope you all know I'm KIDDING!!! :lol:
Come on down to the airport that I work at. We'll do it for free! :D :lol:


Just kidding. :p
 

rescuecpt

Community Leader Emeritus
2,088
1
0
Sure, I'll drive my patients through the scanner. ;)
 

ResTech

Forum Asst. Chief
888
1
0
Not really protocol change I guess but the following would be nice additions for EMT-B.

- Albuterol
- Combitube
- Blood glucose monitoring
 

MMiz

I put the M in EMTLife
Community Leader
5,519
401
83
Originally posted by ffemt8978+Jun 27 2004, 07:39 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (ffemt8978 @ Jun 27 2004, 07:39 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuelt@Jun 27 2004, 04:37 PM
I want a portable chest x-ray. The ACLS class always says "obtain a portable chest x-ray". :D

I hope you all know I'm KIDDING!!! :lol:
Come on down to the airport that I work at. We'll do it for free! :D :lol:


Just kidding. :p [/b][/quote]
haha, amazing.

"No no, I swear I saw this on TV once. I'm a trained medical professional"
 
OP
OP
ffemt8978

ffemt8978

Forum Vice-Principal
Community Leader
11,024
1,472
113
Originally posted by ResTech@Jun 27 2004, 05:32 PM
Not really protocol change I guess but the following would be nice additions for EMT-B.

- Albuterol
- Combitube
- Blood glucose monitoring
Here in Washington, the EMT-ILS (Intermediate Life Support) is allowed to give nebulizer treatments with albuterol, and all EMT's are allowed to do blood glucose monitoring.
 

SafetyPro2

Forum Safety Officer
772
2
0
OK, here's my list:

Combitube (its in the State protocol, but not our County)
Carry EpiPens (we currently can only assist with a prescribed EpiPen)
Blood glucose check

On the C-spine issue, we can board anyone we want. We're required to for any fall greater than 15 feet and generally always do on any TC where we transport.

On O2, we can give 12-15 LPM by mask or 3-6 by cannula, though we generally use the max.
 

cbdemt

Forum Lieutenant
145
0
0
We have a pretty wide scope of practice as basics already... 12 lead, epi pens, glucose check, albuterol, nitro, asprin. In our new protocols that should be out soon they are also giving us nasal glucagon, nasal narcan(sp?).... and one more that i cant remember. The only other thing that i think we need would be combitube/advanced airway.
 
OP
OP
ffemt8978

ffemt8978

Forum Vice-Principal
Community Leader
11,024
1,472
113
Originally posted by cbdemt@Jul 5 2004, 08:32 AM
they are also giving us nasal glucagon, nasal narcan(sp?).... and one more
Nasal narcan and nasal glucagon....

Where can we get it? How long has it been out? Who makes it? I want it, I want it, and I want it now. B)
 

cbdemt

Forum Lieutenant
145
0
0
ya! it was news to all of us too. As I said though, we have yet to actually see the drugs. The good word came from a lady at our regional EMS office at a continuing ED meeting, I HOPE she wasn’t just yanking our chain! :p
 

citizencain20

Forum Probie
15
0
0
Originally posted by ResTech@Jun 27 2004, 08:32 PM
Not really protocol change I guess but the following would be nice additions for EMT-B.

- Albuterol
- Combitube
- Blood glucose monitoring
Wow, as an EMT-B, I99 in training, and after reading your posts, I am beginning to believe that Wisconsin has some of the most liberal allowences for EMT-B's. We are able to give Albeuteral, Combitube, Glucose, Glucagon (IM), Nitroglycerin, ASA, and Epi. As far as protocal change, just add ET and I would be happy. :D
 
Top