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

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

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

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