New Hampshire EMS Quick Reference Guide for Hospital Staff

Provided by:

NH Department of Safety Div. of Fire Standards and Training & EMS

NH EMS for Children Program at Dartmouth

Copies of this guide, with or without modification, can only be made with the expressed consent of the NH EMSC Program and NH Division of Fire Standards and Training and EMS. 2011

Adult and child and child Adult Adult only ■

1, Atropine, Pralidoximine,

Diazepam rectal gel rectal Diazepam by auto-injector Epinephrine Nitroglycerin-oral Activated Charcoal - oral Nerve antidote kits ( Mark Glucose - oral oral - Glucose Albuterol metered dose inhalers Aspirin - oral

♦ ■ ■ ♦ ■ May administer: ■ ♦ ■ Assists with self-administration self-administration Assists with medications: of patient’s Duodote) or ■

EMT-Basic (EMT) (EMT) EMT-Basic Medications EMT BASIC BASIC EMT

Adult cardiac arrest only cardiac Adult Adult and and child Adult ■

♠ Stabilize and immobilize signs Vital childbirth Emergency Stroke scale assessment temperature Body stimulator nerve Vagal / management Wound Advanced spinal assessment spinal Advanced Cervical and spinal

■ fractures Other Skills ■ ■ ■ ■ assessment ■ activation care ■ burn Immobilization Immobilization ■ ■ immobilization CPR External Automatic Application of 3- or 4-Lead Application of 12-Lead ECG Oral suctioning Oral via Oxygen administration ventilation Tracheostomy Blood glucose analysis Pulse oximetry oximetry Pulse Bag valve mask ventilation airway Nasopharyngeal Oropharyngeal airway Supraglottic airway Supraglottic Cardiac Management Cardiac Management ■ AED) ( ■ Defibrillator ■ ECG ■ ■ ■ nasal cannula and mask ■ and maintenance Access Vascular ■ Skills Skills Procedures Airway ■ ■ ■ ■ ♠

Duringtransfers only interfacility adult Adult only Adult and child only and shock arrest Adult cardiac ■ ♦ ● ▲ Intravenous pump

Sublingual Sublingual Intraosseous needle Intraosseous Intravenous Inhalation Intramuscular Intranasal Subcutaneous ♦

Medication Administration Administration Medication Routes: ♦ ♦ ● ▲ ♦ ♦ ■

Hydrocortisone (Solu-Cortef) (Solu-Cortef) Hydrocortisone Dextrose Epinephrine Epinephrine Glucagon (Cyanokit) Hydroxocobalamin (Atrovent) Ipratropium bromide (Narcan) Naloxone Nitrobid, Nitroglycerin (Tridil, with Nitrous oxide premixed infusion Crystalloid ♦ ♦ ■ ♦ ♦ ♦ ♦ Nnitrostat) ♦ (Nitronox) oxygen ♦ ■ EMT-Intermediate (Advanced) (Advanced) EMT-Intermediate Medications Can provide all that an medications provide can EMT–Basic plus: Skills Can provide all skills that Cardiac Management an EMT-Basic can provide ♦ Manual defibrillation plus: ♦ Interpretation of 3- or 4-lead ECG (V-Fib/V-Tach, Asystole, PEA) Airway Procedures ■ Capnography ♦ CPAP ● Laryngeal mask airway ♦ Nebulizer Treatment

Vascular Access ♦ Blood draw ● Commercial intraosseous needle

♦ Peripheral venous access - extremities

■Adult and child ♦Adult only ●Adult cardiac and shock only EMT-I (ADVANCED) (ADVANCED) EMT-I Paramedic Medications Can provide all medications ♦ Haloperidol (Haldol) ♦ Prochlorperazine that an EMT–Basic and EMT–I ♦ Heparin (Compazine) (Advanced) can provide plus: ■ Ibuprofen (Motrin) ■ Proparacaine (Alcaine) ∇ Rocuronium (Zemuron) ■ Acetaminophen (Tylenol) ♦ Ketorolac (Toradol) ■ Sodium bicarbonate ■ Adenosine (Adenocard) ■ Levalbuterol (Xopenex) ∇ ■ Amiodarone (Cordarone) ■ Lidocaine Succinylcholine (Anectine) ■ Atropine ■ Lorazepam (Ativan) ■ Tetracaine ♦ Bumetanide (Bumex) ■ Magnesium sulfate ♦ Vasopressin ∇ ■ Calcium Chloride ♦ Methylprednisolone Vecuronium (Norcuron) (Solumedrol) ■ Diazepam (Valium) ♦ Verapamil (Calan) ♦ Metoclopramide (Reglan) ♦ Diltiazem (Cardizem, Medication ♦ Metoprolol (Lopressor) Administration Routes: Dilacor, Tiazac) ■ Diphenhydramine (Benadryl) ■ Midazolam (Versed) ■ Endotracheal ♦ Dolasetron (Anzemet) ■ Morphine ■ Intraosseous ■ Dopamine ■ Norepinephrine (Levophed) ■ Intravenous pump ∇ Etomidate (Amidate) ■ Ondansetron (Zofran) ■ Rectal ■ Fentanyl (Sublimaze) ♦ Oxytocin (Pitocin) ■ Transdermal ♦ Phenylephrine ■ Flumazenil (Romazicon) (Neo-Synephrine) ■Adult and child ♦ Furosemide (Lasix) ■ Pralidoxime (2-Pam, ♦Adult only ∇Additional training required; ■ Granisetron (Kytril) Protopam Chloride) Skill may vary by EMS agency

PARAMEDIC PARAMEDIC

Skill may varySkill mayagency by EMS Adult and child and child Adult Emergent care only Emergent care Adult only ■ training required; ∇Additional ♥ Interpretation of 12-lead ECG Interpretation of 3- or 4-lead ECG cardioversion Synchronized pacing Transcutaneous irrigation Eye Immunization Restraint – pharmacological - Peripheral venous access Intraosseous vein Umbilical draw Blood Central line access ♦ Cardiac Management ■ ■ ■ ■ Other Skills ■ ■ ■ Vascular Access Access Vascular ♥ ■ external jugular ■ ■ ■ Rapid sequence intubation Capnography Capnography in Foreign body removal Endotracheal intubation and intubation Nasotracheal tube Nasogastric tube replacement Tracheal decompression Needle airway mask Laryngeal airway Supraglottic Treatment Nebulizer Skills Skills operation Resuscitation ventilator Can provide an skills that all and EMT-I EMT-Basic can provide(Advanced) plus: Airway Procedures ■ airway ■ obstructed ■ Suctioning ■ ■ stomas ■ through ♦ ■ ■ ■ ■ ∇ Paramedic: Inter-facility Transfers

Paramedic for Inter-facility Transfers (PIFT) Paramedic for Critical Care Transport (CCT) PIFT Paramedics and CCT Paramedics have skills and may provide medications over and above all other levels of providers, particularly during inter-facility transport of critically injured and ill persons. Any medication or blood product ordered and NOTE: A neonatal or pediatric patient may require expertise and initiated in a health care facility or home health care setting equipment provided by a dedicated may be continued during transport staffed by a PIFT or CCT pediatric transport service.

Paramedic. Advanced skills of PIFT Paramedics and CCT Paramedics are listed in Transfer Patient Acuity Levels and Minimum Staffing

Requirements.

All paramedics staffing the transfer of a critically ill patient must be credentialed at a minimum of PIFT level. A small number of patients will have a level of acuity and/or complexity requiring the higher CCT level. If a credentialed CCT Crew is not available, it is acceptable to supplement the PIFT crew with hospital staff qualified to provide the level of care required by the patient. These include critical care or emergency registered nurse, physician assistant, nurse practitioner, physician, or a CCT Paramedic. Two advanced care providers must be in the patient compartment during transport. * ■ ■ ■ 1 PIFTParamedic and1EMT(driver) Stable patientwith MEDIUM riskof ■ ■ ■ ■ ■ 1 EMT-Intermediate and1FirstResponder(driver) Stable patientwith LOW riskof ■ ■ ■ ■ 1 EMT-BasicandFirstResponder(driver) deterioration Stable patientwith virtuallyNOriskof

settings (i.e.nopressure support,PEEP Intubated/ventilated patient care facility Stable patientonventilatordisc Transcutaneous pacing Established feedingtube IV pump non-pharmacological for agents PCA pump No ongoingmeds administ IV crystalloids Saline lockpermitted infusion orsuction) feeding tube(NG,PEG,J-tubenotconnectedto Previously insertedFoleycathete Oxygen forstablepatient permitted No IVinfusions MUST have a deterioration deterioration Transfer Patient Acuity Levels

second provider inthe patient compartment ered oranticipated with non-complex harged tolongterm r, suprapubictube, ≤ 10)*

and MinimumStaffingRequirements ■ ■ ■ ■ ■ ■ ■ provider (hospital-based) CCT Crewor1PIFTParamedic, 1advancedcare of UNSTABLE patientor stablewith HIGHrisk deterioration ■ ■ ■ ■ ■ ■ Paramedic and hospital-based advanced health care provider. to PIFT isin addition compartment. This in patient practitioner

PEEP >10,etc.) complex ventsettings(suchaspressuresupport of practice,andtraining Procedures consistentwith Intubated/ventilated patien Transvenous pacing Balloon pump Invasive monitoring Uncorrected shock Multiple vasoactive medication drips Epidural catheterifs Maintenance ofpreviouslyinitiatedmedications Infusion ofpreviouslyinitiatedbloodproducts Chest tube Advanced airwaymanagement medications, protocols,andlicensure administration consistentwith Medical monitoring, procedures ♦ Non CCT Crews MUST ALSO have respiratory care

♦

ecured, cappedandlabeled and1EMT(driver)

ts withadvancedor provider licensure,scope skillset,approved , andmedication

INTER-FACILITY TRANSFERS Is PaƟent Unstable or Transfer Staffing Stable With High Risk For DeteroraƟon? Requirements YES NO

Is PaƟent Stable CCT with Medium Risk CREW For DeterioraƟon ? YES NO

Is PaƟent Stable PIFT with Low Risk PARAMEDIC For DeterioraƟon ? YES NO

EMT-INTERMEDIATE Is PaƟent Stable With or Virtually No Risk PARAMEDIC For DeterioraƟon ?

YES

EMT-BASIC

With gratitude, we acknowledge the Utah Department of Health and EMSC program for creating the original concept and for granting permission to New Hampshire to modify Utah’s Quick Reference Guide.

This publication was made possible though a grant from the EMS Program, US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Health Bureau. (Project no. H33MC06727 )