Paramedic Guidelines

We have begun reviewing our guidelines again at our regional EMS Medical Advisory meetings and I am quite excited by early discussions. Among the issues we are looking at are:

1. Revising our seizure guidelines in light of the recent RAMPART study that showed the benefits of IM Midazolam over IV Ativan in patients in status epilepticus.

2. Revising our spinal immobilization guidelines to take into account recent and not so recent literature that suggests immobilizing a patient to a long back board in certain instances may cause more harm than benefit.

3. Revising of CHF guidelines to increase our dosages of nitroglycerine.

4. Addressing our cardiac arrest practices to emphasize working nontraumatic arrests on scene for at least 20 minutes prior to transporting in order to maximize the patient’s chances at resuscitation by limiting interruptions in quality CPR.

It is thrilling to see a group of doctors and paramedics get together, review the medical literature and make changes based on the best interests of their patients.

I will keep you all updated on the committee’s progress.

2 Comments

  • Re #4; Do your protocols include field termination for asystolic arrests after 20 minutes of resuscitation?

  • medicscribe says:

    Yes, we have had that for quite awhile. How this is different is that we will be asking paramedics and EMTs to, in general, work all nontraumatic arrests on scene (Vfib arrest included)rather than rushing to get them to the hospital. We are finding that too many paramedics are moving the patient out to the ambulance to begin resucitation or moving after only a round or two of medicine and that these moves reduce the quality of CPR and likely harm the patient’s outcome. Likewise, too often BLS is in a hurry to load and go with a cardiac arrest patient to meet a paramedic intercept than to concentrate on providing excellent CPR on scene and letting the paramedic come to them. If paramedics are unsuccessful after 20 minutes, then we ask them to either consider beginning transport, consider continuing on scene or consider field termination. We just don’t want them trying to carry a fresh v-fib down 4 flights of stairs until they have given their best shot at resucitation where the patient fell.

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Peter Canning

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  • Comments
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30
    Joseph Eriksen
    The Ideal Medic
    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
    2015-03-24 19:37:25
    Shawn McCormick
    The Ideal Medic
    I totally agree. To me those make great paramedics. I work as a Operation Supervisor and encourage teamwork/backup whenever the situation calls for it. I encourage feedback from a difficult call my crews responded to. 1) they have the chance to recall the events that took place and they may self evaluate the call. 2)…
    2015-03-24 17:14:14
    Sean Fitch
    The Ideal Medic
    Totally agree Peter, For too long I had the same interpretation and like you now, I would by far take your current description.
    2015-03-24 17:05:33
    tom combs - ER doc/author
    The Ideal Medic
    Twenty-five years as an ER doc in level one trauma centers has me in total agreement. I Interestingly what you say regarding paramedics also, in many ways, applies to ER docs. "Tries to learn from each call...puts the patient first." A great post. I salute to your wisdom!
    2015-03-24 17:04:06

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