Empress testing new "in the field" APE procedure

[Oswegowind 17]

I just learned that Empress EMS is conducting a new test. They are always participating in these things and I think it is great. They are currently running Positive pressure systems (CPAP) to combat APE (acute pulmonary edema)/ CHF. Evidentially, this system can work wonders in the field. As the results are not in, as of yet, I was wondering if any of the Empress medics on this site would share their experiences with the board. Sounds like next gen medicine. Apparently the positive pressure is in lieu of the current available medications, lasix and bumex.

Edited September 11, 2007 by Oswegowind

[trauma74 111]

Many EMS agencies in Europe and across the USA have been using CPAP for a while. I have heard that it works great in the field for a multitude of breathing problems. It is non-invasive which is another good thing.

[fac911 33]

Our ALS unit @ OLM uses CPAP for about a year & a half now great results with it

[Oswegowind 17]

Our ALS unit @ OLM uses CPAP for about a year & a half now great results with it

Is it already in the NYC MAC procedures/orders?

[emtpjimd 1]

Does anyone know which system Empress is going with? I've been using it for some time in Stamford and we use the WhisperFlo system with GREAT results. We also continue o nitrate and diurese our patients, so it's a synergistic effect. In my volley system we are looking at the Boussignac system; it uses just a special mask that attaches to thenipple on the portable regulator or flowmeter. It's easy and non invasive....hope they like it!

[20y2 43]

Is it already in the NYC MAC procedures/orders?

It's been in the protocols for like 2 years.

[trauma74 111]

FAC911,

Can you please post the patient conditions that require the use of CPAP in the field? Thanks.

Doug

[NJMedic 96]

I predict the medics will love it as well as their patients. We have had it over here in NJ for the last five years. Significantly cuts down on the intubations secondary to respiratory failure. We have CHF patients who waited until the last minute before calling 911 because they thought they could work through it and hated being intubated. Now they call early because they know with C-PAP they can be "back to normal" in a few minutes and can avoid being tubed.

[Guest]

I work up in Rochester, and we have had the WhisperFlow for a few years, and have just changed to the Boussignac in the past several months. The big benefit of the Boussignac is that it attaches to the normal regulator nipple and is used at a much lower flow rate. The WhisperFlow is does let you control the PEEP better, but blows through a full D tank in less than 5 minutes and that is not a big help when the only D tank you have with the special adapter goes dead, or the hospital you go to doesn't have a compatible system so the pt goes without. As far as CPAP in general, in my experience most patients get much better, a few get worse (but improve when CPAP is removed), but none stay the same. The next evolution is in field BIPAP so that we can use it for asthma patients.

[Guest EFFP411]

I know that Mobile Life Support Services was supposed to be having a trial run with the cpap system, but i'm unsure if they ever did or not, i will have to ask tomorrow. I know various medics that have used it, and love it though

[Guest]

a little off topic, but i heard empress has been using the "Tablets" (electronic PCR or ACR) for the past few months now. anyone know how thats goin?

i have a few friends who aren't fond of them, cuz they're all pop-up screens, although it does seem like good technology to increase the billing system.

[Guest]

FAC911,

Can you please post the patient conditions that require the use of CPAP in the field? Thanks.

Doug

PROTOCOL APPENDICES

Page E. 35 Regional Emergency Medical Advisory Committee of New York City

Prehospital Treatment Protocols

APPENDIX P

USE OF THE CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE

Scope: In the event of acute congestive heart failure, Paramedics trained and authorized by the service medical director, may utilize Continuous Positive Airway Pressure (CPAP), if available and appropriate.

INCLUSION CRITERIA

1. Be at least 18 years of age

2. Be Alert

3. Be able to maintain an open and patent airway on their own

4. Have a blood pressure of at least 100 mm Hg systolic

5. Have significant respiratory distress, indicated by cyanosis, accessory muscle use or other signs and symptoms.

CONTRAINDICATIONS

1. Less than 18 years of age

2. Need for immediate endotracheal intubation or other methods of airway control

3. Altered Mental Status or unresponsive patients

4. Hemodynamically unstable patients

5. Patients who are unable to control their own airway

6. Trauma, facial burns, impending respiratory or cardiac arrest

7. Known Active unstable angina or acute myocardial infarction

8. Uncooperative patient

9. Pregnancy

10. Known Pneumonia, pneumothorax, anaphylaxis, pulmonary embolism, or aspiration.

11. Gastric Distention

CPAP IS TO BE IMMEDIATELY DISCONTINUED IF:

1. An immediate need for advanced airway control arises

2. The patient becomes hemodynamically unstable

3. The patient cannot tolerate the mask due to pain or discomfort