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Wichita-Sedgwick County EMS System Medical Protocols

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Wichita-Sedgwick County EMS System Medical Protocols Wichita‐Sedgwick County EMS System Medical Protocols Reviewed and Approved by the Medical Society of Sedgwick County Published July 2012 Updated October 1, 2014 Thanks . to the Provider Advisory Council for their engaged participation in this task . which took way longer than anyone thought it would, especially me. to other EMS systems and medical directors who shared their protocols, especially Dr. Jeff Beeson and Medstar, Fort Worth, Texas Dr. Paul Hinchey and Austin-Travis County Office of the Medical Director, Texas Dr. Joe Holley and Memphis Fire Department, Tennessee Dr. Lester Richardson and Johnson County MedACT, Kansas Dr. Allen Yee and Chesterfield Fire Department, Virginia Albemarle County Fire Rescue, Charlottesville, Virginia . to all the EMSS providers who gave thoughtful and constructive input into creating these protocols. to the Medical Society of Sedgwick County Physicians Advisory Council and Board of Directors for their review of and input to these protocols as well as their ongoing strong support of WSC EMSS agencies, providers, and providing the highest level of emergency care to our patients. INTRODUCTION Wichita‐Sedgwick County EMS System Protocols Effective 7‐1‐2012 This edition of the Wichita-Sedgwick County EMS System protocols represents a significant change in format and approach. Please take the time to read the introductory materials as they are important to provide context and set the stage for the protocols themselves. Authority: This document represents medical care protocols, approved by the Medical Society of Sedgwick County in accordance with Kansas statutes. Wichita-Sedgwick County EMS System (WSC EMSS) providers will operate in accordance with these protocols under the medical oversight of the EMS System Medical Director. EMS providers act under the delegated practice of the medical advisor. All medical practice within WSC EMSS is performed at the discretion of the Medical Director or her designee. All providers operating under these protocols must have current certification in the state of Kansas. Advanced Life Support (ALS) Providers with SCEMS must be in good standing, and ALS Providers in first response agencies must be currently fully credentialed in order to utilize these guidelines to their level of certification. These protocols are for use by all Basic Life Support providers to their level of current certification. Both Advanced EMT and Paramedic are considered ALS providers with scope of practice as specified. Scope of the Protocols: Every effort has been made to include guidance for treatment of the majority of emergencies, however due to the nature and scope of EMS, it cannot be comprehensive. These protocols should be considered procedural rules, and thus the decision to diverge from the protocols must be carefully weighed to assure that the benefit outweighs the risk. You may need to consult the Medical Director or online medical command for guidance in these cases. If you feel protocol deviation is necessary, you should make every effort to do so in conjunction with the EMS Ops Captain, and/or EMSS Medical Director, and/or on line medical command. If this is not practical during the call itself, you should report protocol divergence to the EMS Ops and Education/QI Captain (and the Fire Medical Training Officer if applicable) and Medical Director as soon as possible. General Philosophy: Overall, the protocols are designed in many ways for increased patient safety and increased consistency. The protocols provide job aids and decision support tools to limit the opportunity for medication administration errors, to support quality and complete documentation, and overall to promote quality patient care. The goal is to provide procedural rules that support quality patient care and delineating what is acceptable practice. There are significantly fewer individual protocols than in the most recent (2009) version of the protocols. These protocols are specifically written to allow a stepwise, assessment- based approach to patient management which addresses the vast majority of emergent complaints you will encounter. They are also written to provide you greater latitude to exercise your clinical judgment when appropriate, but are dependent on the EMS provider INTRODUCTION Wichita‐Sedgwick County EMS System Protocols Effective 7‐1‐2012 adopting a critical thinking approach to each patient encounter. Every patient intervention should be based on an assessment that supports the patient’s need for it, and its effect evaluated by reassessment following the intervention. Patient care documentation should reflect both these assessment findings and the decision-making process that led to the intervention (or decision not to intervene). Keep in mind that just because a protocol exists for a specific problem does not necessarily mean that an individual patient will benefit from application of that protocol. It is important to note that these protocols will be a living document, rather than a static one. Providers’ input is welcomed at all times as we implement and use these guidelines. Although a huge amount of time (and input) went in to creating this document, some things may be confusing or misleading initially and need to be reformatted or reworded. Updates should be expected fairly frequently. These will keep our protocols current, user- friendly, and in keeping with best practices, current research, and current thinking on out-of- hospital care. Quarterly meetings with the Medical Society of Sedgwick County PAC will allow timely updating of protocols in an ongoing fashion rather than complete intermittent overhaul. Because of the dynamic nature of the protocols going forward, this will be the last edition of the protocols that will be provided by WSC EMSS in printed format. Updates will be distributed to WSC EMSS agencies through electronic mechanisms and the most current version of each protocol will be available on the WSC EMSS Moodle website (www.wscomd.net). Individual agencies will be responsible for determining the best way to distribute protocols and updates to their providers. EMSS is also planning to make the protocols available in App format for Droid and iPhone at no cost to the provider. Updates will be posted to the App just as they will to Moodle, so the App will be current as well. If you have a smartphone, you will have that option, and should also strongly consider utilizing other electronic support information such as current drug information and interaction information (i.e. Epocrates), drip calculation software, and other available information to improve medication administration accuracy and patient safety. I hope these protocols provide the basis for moving our system forward and provide you greater capacity to both act as the healthcare professionals you are, but also to provide excellent, current, safe care to patients in Wichita and Sedgwick County. PROTOCOL STRUCTURE OVERVIEW Wichita-Sedgwick County EMS System v1.1 7-1-13 Effective 7-1-2012 General Approach: Every intervention should be preceded and supported by an appropriate assessment. This document and every patient encounter should start with use of the GENERAL ASSESSMENT Protocol, either adult or pediatric. Additional detail on information to include in these assessments and in your documentation can be found in the ASSESSMENT Procedure. Based on your findings there, you will bridge to specific protocols. You may only need the interventions provided for in the GENERAL ASSESSMENT Protocol for a significant number of patients. This structure helps eliminate some of the repetitiveness of the previous format, particularly with regard to basic assessment and care measures that should be provided for nearly every patient (i.e. vital signs, airway assessment and oxygen if indicated). You will notice that the pediatric assessment does not include blood pressure, since that is notoriously inaccurate, and decision-making is actually based on heart rate and perfusion status, not blood pressure. The GENERAL and TRAUMA ASSESSMENT Protocols incorporate a structured assessment plan that allows you the flexibility to perform specific skills and apply monitoring equipment as dictated by your assessment, rather than having to go to a specific protocol to do so. The ASSESSMENT Procedure also includes cues to assist you in your patient care documentation record with appropriate (but not all- encompassing) pertinent positives and negatives. Based on your findings from these ASSESSMENTS, you can then move to the appropriate specific protocols, if needed, to continue care of specific problems. As previously noted, not every eventuality is included in the protocols, and if you feel you have a special case, you always have the option of discussing your assessment and proposed plan with the Medical Director or with online medical command at the receiving facility for potential orders. Each protocol makes the following assumptions: 1. Patient has been asked and IS NOT allergic to any medication / medication class being given. 2. Intravenous (IV) and Intraosseous (IO) administration are considered to be equivalent and thus IO is not separately noted. See VASCULAR ACCESS Procedure for further specifics. 3. All equipment appropriate to the type of call and prearrival information will be taken to the patient at the time of initial contact for appropriate and efficient assessment, treatment and transport. PROTOCOL STRUCTURE OVERVIEW Wichita-Sedgwick County EMS System v1.1 7-1-13 Effective 7-1-2012 Each protocol is formatted as a flowchart. Many protocols apply to both adult and pediatric patients, some are only for adult or only for pediatrics. Effort has been made to be consistent throughout the protocols. For example, pediatric is considered age birth-8 year old, adult hypotension is SBP < 90 mmHg; adult tachycardia is P > 110, hypoxia is pulse ox < 94%. Whenever possible, medication doses are consistent throughout the protocols (magnesium sulfate starts with 2 grams IV), and are given as a specific dose rather than a dose range. All medication names in the protocols are generic, and providers should refer to them by these names at all times to avoid confusion and potential medication errors.
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