Itemized List of Changes to ACCESS EMS Providers SWO S for 2014

Itemized list of changes to ACCESS EMS providers SWO’s for 2014

Note: Not all corrections to spelling, grammar, punctuation, or formatting of the information are itemized here. Only specific, new, or fundamental changes to the individual protocols are listed.

General Section:

G-1: Foundations of patient care.

 Removed reference to demand valves in Ventilatory support.

 Removed reference to central lines in Vascular access.

 Change to EKG/Electrical therapy section for monitoring of patients.

G-2: Medical Direction.

 Nothing.

G-3: Hospital Destination Protocol.

 Update out of county approved hospital destinations.

 Change references to ACEMSS to ACCESS.

 Reference to appendix in Trauma Patients section renumbered to new list.

 Suspected ACS/STEMI section reworded for clarity.

G-4: Special Resuscitation Situations.

 Reference to appendix changed due to renumbering.

G-5: Air Medical Response.

 Removed reference to “F3” in radio communication. This channel is no longer programed.

G-6: Pre-hospital Integration of Care Protocol.  Nothing.

G-7: Medical Monitoring of Incident Rehab.

 New Protocol.

G-8: Special Needs Populations.

 New Protocol.

G-9: Patient Definition, Cancel Call Definition, Refusal Procedure.

 New Protocol, not yet released. See 1st quarter update.

Cardiac Section:

C-1: Adult Cardiac and Respiratory Arrest.

 Added Sodium Bicarb information in Calcium Chloride portion of ALS care.

 Added ETCO2 monitoring note at end of document.

 Appendix renumbered in physician pearls.

C-2a/b: Adult Cardiopulmonary Arrest- BLS/ILS Algorithm.

 Combine BLS/ILS algorithm into one document titled C-2a.

C-2b: Adult Cardiopulmonary Arrest- ALS Algorithm.

 Now Adult Cardiopulmonary Arrest- ALS Algorithm. See above.

 Removed reference to BG checks in Box 5, this is included in C-1.

 Amiodarone drip added for ROSC with Amiodarone use during resuscitation.

 Physician Pearl removed.

C-2c: Adult Cardiopulmonary Arrest- ALS Algorithm.

 Deleted, see above.

C-3: General Cardiac Care/ACS.  Change to analgesic dosing for Morphine and Fentanyl per new pain control protocol.

 Changes to NTG in BLS section.

C-4: STEMI Protocol/Flow Chart.

 Removed redundant radio call in reference in BLS care.

 Removed flow chart at end, deemed redundant.

C-5: Adult Wide Complex Tachycardia.

 Manual defib settings for some monitors, otherwise use manufactures recommended settings.

 Corrected reference to new Sedation for Painful Procedures M-15 for sedation prior to cardioversion.

 Removed redundant unstable patient reference at end of document.

C-6: Adult Narrow Complex Tachycardia.

 Manual defib settings for LP/MRx monitors on chart.

 Corrected reference to new Sedation for Painful Procedures M-15 for sedation prior to cardioversion.

 Procainamide removed from protocol.

 Physician PEARL removed.

C-7: Adult Bradycardia.

 Updated sedation and analgesia information.

 Dopamine and Epi drip information now found under the specific drug in the Pharmacology section.

 Rearranged some data for better understanding.

C-8 Congestive Heart Failure/ Pulmonary Edema.

 Initial CPAP setting now at 5 cmH2O.

 Furosemide removed from protocol.  Updated reference to new sedation protocol.

 Analgesia removed.

C-9 Induced Hypothermia.

 Updated Midazolam dosing.

 Removed chilled saline from protocol.

 Again, dopamine and epi drip charts in the specific drug section.

Medical Section:

M-1: General Medical Care.

 Added information to BLS assessment.

 Removed reference to multiple IV lines in ILS section.

 Removed some redundant information in ALS section.

M-2: Adult Reactive Airway Emergencies.

 CPAP starting pressure at 5 cmH2O.

 Reference to Brethine (terbutaline) removed.

M-3: Adult Hypotension and Shock.

 Dopamine and Epi drip data in drug appendix.

 Removed redundant information in BLS section.

 More specific fluid instructions included in ALS section.

M-4: Adult CVA.

 Clarified information in BLS section.

 Bullet points in ALS section changed.

 Removed anticonvulsants, see specific protocol for CVA related complications.

M-5: Adult Seizure Activity.  Dextrose and Glucagon removed from anticonvulsants and given their own section.

 Stroke references at end removed, look for stroke stuff in the CVA protocol.

M-6: Adult Hypoglycemia.

 Simplified information in BLS section.

M-7: Adult Hyperglycemia.

 Removed BLS specific instructions, see Protocol M-1

 Reworded ILS section to mirror Protocol M-1.

 Removed several Physician Pearls.

M-8: Adult Vomiting/Severe Nausea/Vertigo.

 Greatly simplified SWO.

 Removed Benzodiazepines from protocol.

 Emphasis on good neuro exam added to general comments.

M-9: Dehydration and Rehab.

 Removed all notes in ALS section, see issue specific protocol for specific medical/traumatic complaint.

M-10: Adult Allergic Reaction/Anaphylaxis.

 Removed antiemetic and benzodiazepines.

 Removed much unnecessary information from physician’s pearls.

M-11: Adult Pain Control.

 New General sections comments (Important).

 Removed redundant bullet points in BLS Specific Care.

 Change to weight based dosing for analgesia.  Added IN route for Fentanyl.

M-12: Adult Heat Emergencies.

 Removed treatments listed in ALS section, see specific protocol for treatment of specific illness/injury.

M-13: Adult Cold Emergencies.

 Removed microwave instructions from ILS section.

 Removed Lactated Ringers reference from physician’s pearls.

M-14: Behavioral Emergencies and Combative Patients.

 Reordered some information for clarity.

M-15: Sedation for Painful Procedures.

 New Protocol.

OB Section:

OB-1: General OB Care.

 New protocol, see the associated appendix for more information.

OB-2: Obstetrical Emergencies.

 New protocol, see above.

Trauma Section:

T-1: General Trauma Care.

 Changed language for head injured patients in BLS section.

 Occlusive dressings seal on “4” sides in BLS section.

 Anticonvulsant and analgesic drugs removed from ALS section, see appropriate protocol for specific medical/traumatic complaint.

T-2: Orthopedic Injuries.

 Minor wording change in BLS section.

T-3: Burn Trauma.  Changes IV fluid information in ILS section.

T-4: Crush Injuries.

 Much removed from BLS Specific Care, see T-1 for that information.

T-5: General Tourniquet Use.

 No changes.

Toxicology Emergencies:

R-1: Toxicology Emergencies.

 Removed reference to HAZMED.

 Changed reference to seizure activity in ALS section.

R-2: Opiate Overdose.

 Reorganized points in the BLS section.

 Removed some notes from Physicians pearls.

R-3: Hyperdynamic Crisis/Overdose.

 Removed Haldol from protocol for hyperdynamics.

 Removed Benadryl and ACS specific drugs from protocol, treat ACS with the appropriate cardiac protocol.

 Removed arrhythmic and analgesics from protocol, treat with appropriate specific SWO.

 Benzodiazepine doses found in Protocol M-14.

R-4: TCA Overdose.

 Reorganized BLS specific care notes.

 Sodium Bicarb optional infusion removed from ALS section.

 Anticonvulsants, cardioversion, and some antidysrhythmics removed from this SWO, see appropriate specific SWO.

R-5: Organophosphate/Carbamate/Nerve Agent Exposure.  Removed HAZMED reference from BLS.

 Changes to Atropine dosing in ALS section.

R-6: Calcium Channel Blocker/Beta Blocker Overdose.

 Removed BLS and ILS specific instructions, see appropriate SWO’s R-1, M-1, and PM-1.

 Removed some redundant information in ALS bullet points.

 Change to Atropine dosing in ALS section.

 Removed nebulizer information, see appropriate SWO for bronchospasm.

R-7: Sedative Overdose.

 Sedatives removed from sedative overdose protocol. (How odd).

R-8: Cyanide/Hydrogen Sulfide Poisoning.

 Significant changes to ALS portion.

 Medication Hydroxocobalamin previously carried by HAZMED now to be carried by Fire/EMS supervisors.

R-9: Withdrawal Symptoms.

 Removed redundant BLS/ILS information.

 Changed anticonvulsant to anxiolysis.

 Haldol removed from protocol.

 Anti-emetics removed, see appropriate SWO.

R-10: Carbon Monoxide Toxicity.

 Removed some redundant information from BLS/ILS/ALS sections.

Pediatric Cardiac Section:

PC-1: Pediatric Cardiac/Respiratory Arrest.

 Simplified instructions in ILS specific care.  Changed reference to Hypoglycemia protocol to reference the new combined hypo/hyperglycemia pediatric protocol.

PC-1a: Pediatric Cardiac/Respiratory Arrest- BLS.

 Combined PC1a and PC-1b into one renamed PC-1a BLS/ILS algorithm.

PC-1b: Pediatric Cardiac/Respiratory Arrest- ILS.

 See above and below.

PC-1c: Pediatric Cardiac/Respiratory Arrest- ALS.

 Renamed to PC-1b. See above.

 Recently updated, no new changes.

 Appendix reference in physician pearls updated.

PC-2: Pediatric Symptomatic Bradycardia.

 Reordered some BLS specific information.

 Clarified Atropine dosing in ALS Specific care, ETT route removed.

PC-3: Pediatric Tachycardia.

 Significantly revamped for better clarity.

PC-4: Removed.

Pediatric Medical Section:

PM-1: Pediatric General Medical Care.

 Added BG assessment to BLS section.

 ALS specific items removed see appropriate specific SWO.

PM-2: Pediatric Respiratory Emergencies.

 Wheezing/Stridor replaces previous language.  Information in ALS section reordered to provide better clarity.

 Clarification of information in Physicians Pearls.

 Dosing changed for Epinephrine nebulizer.

 Added ECG monitoring requirement for all respiratory emergencies.

PM-3: Pediatric Allergy/Anaphylaxis.

 Removed some redundant information in BLS section.

 Removed sympathomimetics, antihistamines, and corticosteroids. See specific SWO for anaphylaxis related problems.

 Dosing change for Epinephrine nebulizer.

 Increased max dose of Benadryl to 50 mg.

 Removed some information in Physician Pearls.

PM-4: Pediatric Seizures.

 Rearranged some information in the BLS section.

PM-5: Pediatric Hypotension and Shock.

 Simplified pharmacology information.

 Removed redundant information in BLS/ILS sections.

 Removed Physician Pearl.

PM-6: Pediatric Hyper/Hypoglycemia.

 Combined Hypo/hyperglycemia protocol.

 Changed Glucagon dosing.

PM-7: Pediatric Pain Control.

 New General sections comments (Important).

 Removed redundant bullet points in BLS Specific Care.

 Change to weight based dosing for analgesia.

 Added IN route for Fentanyl. PM-8: Pediatric Nausea, Vomiting, Vertigo, and Dehydration.

 Renumbered.

 Very streamlined SWO.

PM-9: Pediatric Toxicological Emergencies.

 Changes to BLS bullet points.

 Changes to Benzo dosing.

 Lidocaine removed from Suspected TCA section.

 NTG removed from Hyperdynamic ingestion.

PM-10: Renumbering, removed.

PM-11: General Newborn Care.

 Removed, redundant.

Appendices: All Appendices renumbered. Several appendices removed as unnecessary.

Appendix 1: Airway Support Procedures.

 Some redundant information removed.

Appendix 2: Intubation Procedures.

 Reorganized some information to improve understanding.

Appendix 3: Medication Assisted Intubation.

 Ketamine information added to protocol.

 Complications section moved to Appendix 2.

 Moved some data to Appendix 2 for better clarification.

Appendix 4: King Airway Procedure.

 No changes. Appendix 5: Cricothyrotomy.

 Previously 2 appendix D-2/3 combined as one.

Appendix 6: CPAP.

 Removed some information in section 2.

Appendix 7: Nebulized Bronchodilator Treatment.

 No changes.

Appendix 8: Needle Thoracotomy Procedure.

 G and Ga combined to one appendix.

Appendix 9: LUCAS.

 No changes.

Appendix 10: Cardiac Monitoring Procedure.

 Clarified some information in special considerations.

Appendix 11: AED Procedure.

 No changes.

Appendix 12: Vagal Maneuver Procedure.

 Few changes to improve clarity.

Appendix 13: Cincinnati Stoke Scale.

 No changes.

Appendix 14: Intraosseous Procedure

 References removed.

Appendix 15: EZ-IO Infusion System.

 Minor changes to information flow.

Appendix 16: Trauma Leveling.  Minor updates.

Appendix 17: Selective Spinal Immobilization.

 Recently updated.

Appendix 18: Tourniquet Policy.

 No changes.

Appendix 19: Patellar Reduction Procedure.

 Removed references.

Appendix 20: Taser Care Supplement.

 Removed some information in other considerations.

Appendix 21: Nasal/Rectal Medication Procedure.

 Minor clarifications only.

Appendix 22: Duodote Procedure.

 Reference change from ACEMSS to ACCESS.

 Needle disposal information removed.

Appendix 23: Childbirth.

 Rewritten for better clarity and organization.

Appendix 24: Safe Haven Guidelines.

 No changes.

Appendix 25: Integration of Care Reporting Guidelines.

 No changes.

Appendix 26: In-field Death/POST/DNR.

 Minor wording changes only.

Appendix 27: SOAP Guidelines.

 Some narrative information added. Appendix 28: Abbreviations.

 No changes.

Drug Guide:

RX Furosemide (Lasix) REMOVED-No longer to be carried.