These protocols are not intended to be absolute treatment documents, rather, as principles and directives which are sufficiently flexible to accommodate the complexity of patient management. While these organizations have no specific statutory authority, they were established to provide day to day … Ability to adjust rate in the minimum range of 10-30 breaths/min Gentle nasal suctioning is the primary treatment along with oxygen, particularly in infants. Patient should be instructed to eat a meal if they are refusing transport because simple sugars are quickly metabolized, If the patient’s blood glucose level is below 60 mg/dL and the patient is able to self- administer and swallow on command, administer oral glucose or equivalent, rather than establishing vascular access, if practical, If the patient regains normal responsiveness prior to infusion of the complete dose of dextrose, stop the infusion and record amount infused, Diabetic patients may exhibit signs of hypoglycemia with a blood sugar between 60-80 mg/dL. Avoid tap water storage, if possible, but do not allow the permanent tooth to dry, This protocol authorizes the use of hemostatic dressings, compressive devices, and commercially manufactured tourniquets, These devices are not mandatory for any agency to stock or carry, Junctional tourniquets, wound closure devices, and other hemostatic devices may be used in accordance with manufacturer instructions, if regionally approved, Tactical application of these devices beyond this protocol may be regionally approved. Working to establish Pediatric Emergency Care Coordinators at EMS agencies across New York State. Full cardiopulmonary monitoring should be done by ALS, Transport to hospital should not be delayed in ill pediatric cardiac patients, This protocol is to be used with the “General: ST Elevation MI (STEMI) - CONFIRMED” or “General: Cardiac Related Problem / Chest Pain - Adult” protocols for patients who have signs of hypoperfusion, Acquire and transmit 12-lead ECG, if equipped and regionally approved, Hospital destination may be determined in consultation with medical control, Place patient supine unless dyspnea is present, Notify hospital AS SOON AS POSSIBLE for ST elevation myocardial infarction (STEMI), If UNSTABLE, or in pulmonary edema, norepinephrine 2 mcg/min, titrated to 20 mcg/min if needed after fluid bolus complete to maintain MAP > 65 mmHg or SBP > 100 mmHg, Refer to appropriate dysrhythmia protocols, as needed, Childbirth is a natural phenomenon and the type of delivery cannot be regulated by your level of certification - if an CFR is faced with anything but a normal delivery, please feel comfortable calling medical control for assistance, Support the baby’s head over the perineum with gentle pressure, If the membranes cover the head after it emerges, tear the sac with your fingers or forceps to permit escape of the amniotic fluid, Gently guide the head downward until the shoulde rappears, The other shoulder is delivered by gentle upward traction, The infant’s face should be upward at this point. This Pediatric Emergency Care Coordinator and EMS Pediatric Prepared project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $100,000 with 0% percent financed with nongovernmental … Patients may also have a medical bracelet, necklace, or wallet card with this information, Perform a secondary assessment and treat per appropriate protocol, Assure that patient has the power unit, extra batteries, and backup controller for transport, A trained support member should remain with patient, Unless otherwise directed by medical control, transport patient to a facility capable of managing VAD patients, Apply cardiac monitor and obtain 12-lead ECG. (General: Hyperkalemia, Extremis: Ventricular Fibrillation or Pulseless V. Tachycardia - Adult), Consider time to definitive care when electing to utilize RSI procedure, In some cases, it may be more beneficial to implement BLS airway interventions and call ahead so the receiving hospital can prepare for RSI upon the patient’s arrival, Position the patient on the side if vomiting, Do not put anything in the patient’s mouth when the patient is actively seizing, Utilize an appropriate airway adjunct, if needed, after the seizure has ended, Remove hazards from the patient’s immediate area. Adult: 12-14 breaths/min Is there evidence of internal hemorrhage or signs of shock? The MLREMS region has previously incorporated many of the changes in the 2019 New York State EMS Collaborative Protocols through the implementation of our local care bundles. Is the pulse too fast or too slow to sustain life? The 2017 New York State EMS Collaborative Protocols are posted on the www.midstateems.org web site. (Evaluate for QRS widening or long QT). Transferring or receiving providers will not be responsible for his or her counterpart’s actions, Patients may be transferred to a provider with the same or higher level of certification, Patients may be transferred to a provider with a lower level of certification provided the patient is not anticipated to require higher-level care and the lower level provider has formally accepted the transfer of care, Ensure that all patient information is transferred to the receiving provider, such as chief complaint, past medical history, current history, vital signs, and care given prior to the transfer of care, Assist the receiving provider until they are ready to assume patient care, Be willing to accompany the receiving provider to the hospital, if the patient’s condition warrants or if the receiving provider requests it, as resources allow, Both providers will complete a Patient Care Report (PCR), as appropriate, detailing the care given to the patient while in their care, The receiving provider must briefly document patient care given prior to receiving the patient, Providers within the same agency may utilize the same PCR (as technology and agency/regional/state policy allow), Resolution of any disagreements between transferring and transporting providers, Any disparity between the providers must be resolved by on-line medical control or the provider of higher certification must transport with the patient, In situations involving multiple patients or mass casualty incidents, EMS providers may field-triage patients to care and transportation by EMS providers of lower level of certification as resources allow, A standardized process of transfer of care may be implemented by regional systems, Critical pediatric IV (cardiac arrest/respiratory arrest/diabetic emergency/or similar situation where intervention is critical ONLY), Need to maintain critical IV infusion in pediatric patient (such as Flolan [epoprostenol]) (General: Prescribed Medication Assistance), If IO access is started in a conscious patient, the IO should be instilled with lidocaine (2%) 40 mg (2 mL) for adults, or 1 mg/kg for pediatric patients in the method described by the manufacturer, Access to pre-existing vascular devices standing order is for patients in extremis requiring a lifesaving intervention ONLY. These protocols are effective immediately for all Monroe-Livingston Regional EMS providers upon completion of the required training. The NYS Collaborative Protocols continue to be a great example of cooperation, as dozens of physicians and EMS leaders from across the state combine resources to establish the best evidence-based protocols possible, for our patients. More extensive involvement of urticaria or other signs of allergic reaction should be treated (See: the “General: Anaphylaxis - Adult” protocol), Fentanyl may be repeated after 5 minutes once; maximum total dose of 100 mcg, Vascular access, if indicated. Search for and treat possible contributing factors that EMS can manage according to your level of certification: For cardiac arrest associated with fire, see also “General: Cyanide Poisoning / Smoke Inhalation - Symptomatic” protocol. NYSDOH Protocols Listing. EMS Protocols (Effective on August 1, 2019) Basic Life Support Adult and Pediatric Treatment Protocols (PDF) Collaborative Advanced Life Support Adult and Pediatric Treatment Protocols (PDF) The New York State Statewide Protocols are for all levels of certification. Pursuant to the provisions of Public Health Law, the individual having the highest level of prehospital medical certification, and who is responding with authority (duty to act) is responsible for providing and/or directing the emergency medical care and the transportation of a patient. They know their child best. Too much oxygen may be detrimental and result in worsening circulation, Pediatric patients with a cardiac condition may have sudden arrhythmias that require treatment, including SVT. The NYS EMS Collaborative protocol app allows users to make clinical decisions with ease. Maximum dose 5 mg, Additional Midazolam (Versed) 0.1-0.2 mg/kg IV, IM, or intranasal, Consult medical control, if seizures persist, as soon as possible, Any EMS provider may assist the patient’s family or caregivers with the administration of rectal diazepam (Valium/Diastat), if available (see “Resources: Prescribed Medication Assistance” protocol), This protocol excludes traumatic hypovolemia, cardiogenic, and septic shock, For cardiogenic shock, “General: Cardiogenic Shock - Adult”, For septic shock, “General: Severe Sepsis/Septic Shock”, For trauma, “Trauma: Trauma Associated Shock - Adult”, Administer supplemental oxygen; refer to the “Resource: Oxygen Administration and Airway Management” protocol, Normal saline, to a total of 2 L, if there is no concern for pulmonary edema, Consider norepinephrine 2 mcg/min, titrated to 20 mcg/min, if needed, after the fluid bolus is completed, Consider dexamethasone (Decadron) 10 mg PO, IM, or IV. ventriculoperitoneal or V-P shunt), Internal tube that drains spinal fluid from the brain into the abdomen, Gastrostomy (PEG tube, MIC-KEY® “button”) or J-tube, Feeding tube that goes through the abdominal wall, Bowel connected through abdominal wall for collection of waste in a bag, Connection of the urinary system through the abdominal wall or through the back for collection of urine in a bag, Catheter in urethra to collect urine from the bladder into a bag, ABCs and vital signs including blood pressure, Basic airway management if needed, give high flow oxygen (non-rebreather) if neede, If on ventilator and there are respiratory concerns, disconnect and attempt to ventilate via tracheostomy adapter using BVM, If tracheostomy tube is fully or partially dislodged, remove it, cover tracheostomy stoma with an occlusive dressing, and ventilate via mouth and nose using BVM, Central venous catheters: if catheter is broken or leaking, clamp (pinch off) catheter between patient and site of breakage or leakage, Gastrostomy tube or button, ureterostomy or nephrostomy tube: if tube or button is fully dislodged, cover the site with an occlusive dressing; if partially dislodged, tape in place, Gastrostomy, colostomy, ileostomy, or nephrostomy: if stoma site is bleeding, apply gentle direct pressure with a saline-moistened gauze sponge, Foley catheter: if catheter is dislodged, tape in place, Notify the destination hospital ASAP and state that the patient has special health care needs that requires technological assistance (be specific), Obtain frequent vital signs, including blood pressure. 2015 Spinal Protocol Update. In cases of inadequate ventilation or oxygenation of the intubated patient, consider the DOPE mneumonic: Patients who are being ventilated (with positive pressure) have an increased risk of developing a tension pneumothorax, Cardiac monitor with continuous pulse oximetry and waveform capnography. One set of fully charged batteries provides 8-10 hours of power: If the battery or power is low, the batteries need to be replaced immediately, Assist with the replacement of batteries if directed by patient/caregiver, The most common complication in VAD patients is infection. The specific issues of direction, provision of patient care, and the associated communication among responders must be integrated into each single or unified command structure and assigned to the appropriately trained personnel to carry out. If able to tolerate oral fluid consider one of the following: Acetaminophen 650 mg/20.3 mL PO (2-325 mg/10.15 mL PO unit doses)* o Ibuprofen 400 mg/20 mL PO (4-100 mg/5 mL PO unit doses)*, Additional acetaminophen 325 mg/10.15 mL PO (1 additional-325 mg/10.15 mL PO unit dose), Additional ibuprofen 100 mg/5 mL PO (1 or 2 additional - 100 mg/5 mL PO unit dose). Check a blood glucose level, if equipped. Patients may not have a readily measurable blood pressure, In pulsatile flow VAD patients with a HeartMate 3© centrifugal device, patients may have a palpable pulse (pulse is generally set to 30 BPM) in the setting of a normally functioning device, yet may not have a readily measurable blood pressure, Ascertain, and make note of: pump model, installing institution, and institution VAD coordinator phone number from a tag located on the pocket controller. The color-coded format of the protocols allows each EMS professional to easily follow the potential interventions that could be performed by level of certification. PEEP: 5 cm H2O (increase up to 10 cm H2O as needed to improve oxygenation). If the child is the patient, the seat should be secured onto the stretcher and the child belted in the child safety seat, If the ambulance service does not have an ambulance equipped with child safety seats or restraint, it is recommended that the agency purchase approved child safety seat(s) or restraint(s) for each ambulance. Do not use foil alone, Keep the infant warm and free from drafts. Pressure limit/safety relief at a maximum of 40 cmH2O Obtaining IV access (or an IO, should IV access be unobtainable) and continuing an infusion pump the patient has prescribed may be life-saving, Access of ports may not be done unless the provider has additional training and is equipped, or patient has his or her own access device. This resource is for those adult patients who are suspected of being exposed to an organophosphate or a chemical nerve agent, and are experiencing some or all of following signs/symptoms: MODERATE: SLUDGEM = Salivation-Lacrimation-Urination-Diarrhea-GI Distress-Emesis-Muscle Twitching-Miosis, SEVERE: SLUDGEM + Agitation/Confusion/Seizures/Coma + Respiratory Distress, This is a reference to assist with the implementation of BEMS policy statement 03-05 (“Mark I Kits”) or the updated version in a WMD incident, Contact dispatch to declare an incident; request an appropriate response, Request ALS, if not already present or en route, Contact medical control to request CHEMPACK Program Antidote Kits, Consider requesting an EMS physician to scene, Airway management with high concentration oxygen, If SEVERE signs and symptoms are present, administer three (3) atropine 2 mg auto-injectors and three (3) pralidoxime (2-PAM) auto-injectors in rapid succession (stacked). If abnormal, refer to the “General: Hypoglycemia - Adult” protocol, Midazolam (Versed) 5 mg IV, IM, or intranasal; may repeat x 1 in 5 minutes, Magnesium 4 grams IV over 20 minutes, if patient is pregnant, Additional midazolam (Versed) 2.5-5 mg IV, IM, or intranasal, Seizures secondary to eclampsia in pregnancy occur because of a different mechanism than typical epileptic seizures, Pre-eclampsia is typically described as BP > 140/90 mmHg with severe headache, confusion, and/or hyperreflexia in a pregnant patient, or in one who has given birth within the past month, Protect the patient and EMS crew from injury during the seizure, Patients may become confused and combative after a seizure (in the postictal state), Obtain law enforcement assistance, if needed, Status epilepticus (continuing seizure) is a critical medical emergency. The MLREMS region has previously incorporated many of the changes in the 2019 New York State EMS Collaborative Protocols through the implementation of our local care bundles. This update is required to be completed by all New York State certified EMS providers: The 2015 BLS Protocol update on hemorrhage control and spinal injuries is approved for 3 hours of CME (Preparatory, Trauma, or Other). Emergency incident scenes may be under the control of designated incident commanders who are not emergency medical care providers. Re: NYS BLS and ALS Collaborative Protocols Ladies and Gentlemen, I welcome you all to the innovative New York State Department of Health, Bureau of Emergency Medical Services and Trauma Systems Learning Management System (LMS) Vital Signs Academy . Regional protocols and policies may accompany these protocols. It is intended only for those who are separately equipped and trained. large body build or obesity) precludes accurate assessment, immobilize in position found, Gradually extend the knee while, at the same time, a second provider applies pressure on the patella towards the midline of the knee, When straight, place the entire knee joint in a knee immobilizer or splint, Some increased pain may occur during reduction, If there is severe increased pain or resistance, stop and splint in the position found, Patient usually feel significantly better after reduction, but they still need transport to a hospital for further evaluation and possible treatment, Altered mental status - associated with trauma - for any reason including possible intoxication from alcohol or drugs (GCS<15), Complaint of neck and/or spine pain or tenderness, Weakness, tingling or numbness of the trunk or extremities at any time since the injury, Deformity of the spine not present prior to the incident, Painful distracting injury or circumstances (i.e. No prophylactic IV lines / access may be established using pre-existing vascular devices. decapitation, burned beyond recognition, massive open or penetrating trauma to the head or chest with obvious organ destruction, etc. If the respirations remain absent, gasping, or become depressed (< 30/min) despite stimulation, if the airway is obstructed, or if the heart rate is < 100/min: Clear the infant’s airway by suctioning the mouth and nose gently with a bulb syringe, and then ventilate the infant at a rate of 40-60 breaths/minute with an appropriate BVM as soon as possible, with a volume just enough to see chest rise. 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