We use to update our regional paramedic guidelines every two years, but we have taken a new approach where we hope to update every six months, provided we have good evidence behind our changes.
North Central CT EMS Regional Patient Care Guidelines
July 2013 Treatment Changes Summary
The following changes to the North Central EMS paramedic and BLS treatment guidelines go into effect July 1, 2013.
1. STEMI ALERT
Details uniform STEMI Alert procedure, emphasizing early notification with MD control contact. “If 12-lead is diagnostic for STEMI and paramedic believes patient is having STEMI, contact CMED for STEMI Alert with Medical Control patch, and transmit ECG if possible.” Standardizes procedure among all PCI hospitals in region.
2. 12-Lead ECGs
Emphasizes 12-lead on first contact, doing serial 12-leads on ACS patients. “In patients with suspected Acute Coronary Syndrome, a 12-lead ECG should ideally be done on first patient contact, during transport and on arrival at the ED.”
3. Nontraumatic Cardiac Arrest Scene Care and Transportation
Emphasizes on-scene resuscitation and quality compressions. “Patients should receive at least 20 minutes of resuscitative efforts on scene prior to considering movement. If a patient remains in asystole after twenty minutes of paramedic effort, termination of resuscitation guidelines should be considered.”
4. Acute Pulmonary Edema
Increased NTG dose from 0.4 mg SL to 0.4-0.8 mg SL. “If SBP >100 mmHg, Nitroglycerine 0.4-0.8 mg SL. Repeat q 3 – 5 minutes prn.
Based on research that shows Versed IM stops seizures quicker than initiating an IV and giving Ativan, establishes Versed as the priority option in a seizing patient without an established IV. Increases doses of Versed and Ativan. “Versed 10 mg IM if patient >39 kg. Versed 5 mg IM if patient <39 kg. Versed can be repeated q 5 minutes to a max total standing order dose of 20 mg if the patient is still seizing. Or if IV already established Ativan 4 mg IV >39 kg. Ativan 2 mg IV if patient <39 kg>13 kg. Can be repeated q 5 minutes to a max total standing order dose of 8 mg if patient still seizing.
6. Behavioral Emergencies
Replaces Ativan with Versed as first option to sedate violent patient. Adds option of Zyprexa.
7. Angulated Fractures
Paramedics may straighten severely angulated fractures if the distal extremity has signs of decreased perfusion. Premedication with sedation or analgesia should be strongly considered. EMRs, EMTs and AEMTs should splint angulated fractures in position found. In unusual circumstances or extremely prolonged transport times, EMRs, EMTs and AEMTs may contact medical control for authorization to straighten severely angulated fractures if the distal extremity has signs of decreased perfusion.
8. Spinal Immobilization (Effective April 26, 2013)
Long backboards are no longer required for spinal immobilization of ambulatory patients. “Long backboards will no longer be utilized for spinal immobilization of ambulatory patients. Patients who are ambulatory at the scene, but who require cervical immobilization based on our regional spinal immobilization guidelines, will be placed in the position of comfort, limiting movement of the neck during the process. This change in procedure is the first step toward eventually using long boards only when needed to facilitate extrication, and not during transport.”
Dextrose 10% up to 25 Gm IV if blood glucose level is low, may repeat one dose if clinically indicated. D10 is the preferred solution for hypoglycemic emergency. D10 can be given either as an open drip or drawn up in a large syringe and given as IV pushes. If D10 unavailable, D25 or D50 may be used. Blood glucose level for treatment changed from <80 to <70.
Future Regional Directions
We hope to take on cardiac arrest during the next six month period, to incorporate the latest research and also get away from the one size fits all approach.
On the state level, we are awaiting on the approval of a Spinal Motion Restriction guideline to further our movement away from the use of long boards for anything but patient extrication and movement. We are also awaiting final approval of CPAP for BLS (conditioned on approval of the service’s medical director).