Westchester REMAC Proposed Protocols - Revisited

[WAS967 97]

Just an FYI for all Paramedics credentialed under the Westchester REMAC. The treatment protocols have been updated to conform with the 2005 guidelines made by the AHA. These protocols go into effect IMMEDIATELY and all agencies are required to show that their providers have been in-serviced and brought up to speed on the new guidelines. ACLS/PALS are sufficient proof to show that providers are trained in the algorithms, however providers must STILL show proof that they are proficient in the protocols. Basically it's like the Aspirin in services all over again, just on the ALS level this time.

Protocols are available here: http://www.wremsco.org/protocols.htm

Some good changes:

-No longer need to call medical control for permission to give things like Bicarb on codes. They say if you suspect it, treat it.

-Diltiazem is now standing order for rapid A-Fib/A-Flutter. No more having to call for it.

-Emphasis placed on obtaining 12-Lead ECGs.

Some not so good:

-Still need to call medical control for Beta Blocker and Ca-Channel overdoses.

-It took them almost 2 years to get a simple update out to us. At this rate it will be 2010 before the BLS immobilization protocol is released.

[NWFDMedic 58]

You've got to love New York State, only a few years behind the times. It's not all Westchester's fault, getting protocols through SEMAC is apparently not the easiest thing in the world.

I'm surprised that diltiazem is now a standing order without any apparent restrictions. I've had several doctors that would rather evaluate a stable patient in a rapid A-Fib than have them treated in the field. (Unless of course, the fact that it's under "SVT" means that the rate would have to be 150 or greater to give the diltiazem under standing orders.)

The other thing that surprises me is the lack of proofreading. There are a few spelling errors and this one that caught my eye:

"UNSTABLE denotes no signs or symptoms of POOR PERFUSION, including acute altered mental status, ongoing chest pain, hypotension or other signs of shock."

If that's true, apparently I'm unstable right now (my altered mental status is far from acute).

[WAS967 97]

If a Mod could be so kind to merge this post in with this thread: http://www.emtbravo.net/index.php?showtopic=23581 It would be a more cohesive post in the long run and better for future reference. (Kinda makes me wish I had mod status again *cough*SETH*cough* ).

Anyways....

I revisited the proposed Paramedic protocols and spotted a few revisions that were quite noticeable since the open comment period. I'm guessing that everyone who spoke up about the proposed changes (either pro, con, or just plain for proofreading/typo fixing) made a difference. For that, thank you all for you comments. Here are some of the updated changes I've spied:

-Most notable, Etomidate has been moved from a M/C option to standing order. Thank you god.

-Embracing technology with the addition of consideration of CO-oximetry. (Still cost prohibitive for many, but price is slowly coming down).

-Oxytocin moved to standing order in the presence of severe post-partum hemorrhage.

Wishlist:

-Move Glucagon back to standing order for possible Beta Blocker Overdosage/Complications.

-Add ability to sedate for cardioversion on standing order.

I'm still reviewing the draft at this time. Will update as the day goes on.

Edited July 17, 2008 by WAS967
Ask to be merge with a closed topic.

[WAS967 97]

Okay. Food for thought. The special procedures allows use of morphine on standing order for pain management. It says:

"For patients presenting with need for pain management....."

I interpret that to mean someone who is PRESENTLY in pain OR MAY BE in pain. Does that mean we can give it if we anticipate pain (ie, for cardioversion and/or splinting a fracture that is okay now but might be in more pain during movement?). I would say yes. Downisde of course is the fact, that regardless of the interpretation of said protocol, we would still have to contact M/C according to the VT/SVT protocol.

Discuss.

Edited July 17, 2008 by WAS967