NYS Regional ALS Protocol Consolidation

[x635 4,066]

I heard something today about that local ALS REMSCO's (excluding NYC) are consolidating ALS protocols? Can anyone elaborate?

[x635 4,066]

Anyone? And what does this mean for Westchester REMSCO?

[Goose 188]

I heard something today about that local ALS REMSCO's (excluding NYC) are consolidating ALS protocols? Can anyone elaborate?

I think as of right now they are unofficially called the "NY Collaborative protocols." I first heard rumblings about this over a year ago, but it has since picked up steam close to home. My understanding is that the REMO region (up and around Albany) is probably one of, if not the, leading EMS region in the state when it comes to protocols. From my reading of the collaborative protocols they generally seem far more forward thinking and progressive than what the lower hudson valley providers are use to. In addition, my understanding is that they have a very well established and active protocol committee which not only puts out the document but is constantly reviewing and making revisions as medical technology and trends change.

Anyone? And what does this mean for Westchester REMSCO?

I think that EMS regions in general struggle to find members who are engaged, experienced, and really know what is going on in the field (watch a web casted westchester REMAC meeting and the majority of doctors have little to no understanding about how EMS is administered county wide). That said, i think the general consensus of a number of regions throughout the state is why should we struggle to create protocol and keep up with medicine when REMO does it so well? So, given that, a number of upstate regions as well as hudson valley has adopted the REMO protocols rather than developing their own. I know westchester had been looking into it and the general opinions seemed to be positive with some minor concerns regarding inter-facility transports and maybe EMT Intermediates (i could be mistaken about the EMT-Is).

Don't quote me on any of this - i've just deduced it from a few years as a paramedic and trying to keep up with what the REMAC (after all they govern what i can and can't do) is up to. Hope that helps.

[sympathomedic 383]

Empress has begun giving these protocols out via CD. We were told they would be in effect 1/1/14, and that prior to that there would be some kind of test, ranging from take-home to for-real, but they were not sure yet. I guess when one region bows out, THEY can't make the decision, and the new, larger region has not taken over yet, so THEY can't say either.

So far I barely looked, but the ones they gave out seem pretty cool, and well assembled. We were told we (Empress) would get to keep RSI, which is pretty important.

Either way, the IV bags will drip, the drugs will flow and sick folks will be stabilized and transferred. That's what we do.

[v85 212]

Does this only effect operational protocols or administrative ones too?

For example, upstate, there are agencies which are part-time ALS, meaning when a paramedic is working, the agency operates ALS, when the paramedic goes off duty the agency reverts to BLS. This is currently disallowed in HVREMSCO, and I think Westchester as well.

Would this protocol be changing?

[50-65 205]

I could never figure out why there are different treatment protocols from region to region. If one were standing on the regional border and had a heart attack, treatments could depend on which way he fell. Just never made sense to me.

[INIT915 1,119]

I heard something today about that local ALS REMSCO's (excluding NYC) are consolidating ALS protocols? Can anyone elaborate?

If that's true, and I hope it is, it's long overdue.

[STAT213 332]

Up here in NH, we have statewide protocols, and are in the process of moving towards regional multi-state protocols.

[WAS967 97]

The so called consolidated protocols were voted on and approved at a recent REMAC meeting with the exception of the interfacility transfer protocol which I believe WREMSCO will make their own addendum for. It is HOPED that they go into effect the first of the year, but if history is any indication, it will probably take longer. Frankly, I look forward to it. Think about this - you can be an ALS provider anywhere from the border of NYC to the border of Canada and have the same protocols. Some things are a little wonky and make you go "huh?" but others make a lot of sense. IF it moves us forward, then it's a good thing in my book. NJ has had a statewide protocol for ALS for years. Go figure they actually did something right ahead of us.

Edited October 3, 2013 by WAS967

[WAS967 97]

Here's a link to the "collaborative protocols" including a training module that should be used for it's roll out. Dunno if that's what we'll use down here or if they will make their own or similar. That remains to be seen.

http://www.remo-ems.com/emergency-medical-services/protocols/

Here's a video someone did relating to the transition from the HVREMAC protocols to the new consolidated protocols. I have yet to see the documents he shows in the video posted anywhere publically that I can find however. If someone has a source, please share.

http://www.emsseo.com/2013/07/hudson-valley-ems-protocols-webinar-review/

[Hudson61 11]

Here is a question.

Under the new colaberative protocals, being MACed here in Hudson Valley, now if I want to work say in Plattsburgh (cause I like cold weather) do I have to redo the MAC test??? after all in theory it is now all the same protocol. Right?

[gpeifer 89]

If you are a Critical Care Techncian in NYS (will Westchester be pushed into having them?) then the new protocols suit you well. Paramedics should take a hard, close look, compare them to the old protocols, and then come to a conclusion. You will be calling a doctor many, many, more times than you have in the past. ACLS? Dont bother...they dont follow the algorythms. They are great for the "I'm barely a medic" providers that live in the protocol book and cannot make an educated patient care decision on their own. Just my two cents.....

[Jybehofd 85]

yes and now if your a trained EMT you can take a patient on a vent. WTF

[newsbuff 286]

yes and now if your a trained EMT you can take a patient on a vent. WTF

But in order to handle a patient with a vent, you might have to deep suction (not a basic skill, granted it's self explanatory) and have to monitor O2 saturation (which NYS has no basic protocol for). So are there protocols for this stuff now? Did I miss the memo?

[Jybehofd 85]

yes but deep suctioning is never mention in the protocols unless I over looked it. and majority of the BLS units have PSO2 now with rainbow probs to they can get the CO leves. check the new collaborative protocols that are coming to Westchester February 15th

http://www.remo-ems.com/images/uploads/pdfs/2011-10-08_Comprehensive_Protocols2.pdf

Page 76

EMT

• Oxygen therapy via non-rebreather mask (NRB) 10-15 lpm, or nasal cannula (NC) 2-6 lpm,

to maintain oxygen saturation > 95%

• Oxygen therapy using bag valve mask (BVM) 15-25 lpm

• Nasopharyngeal airways (NPA)

• Oropharyngeal airways (OPA)

• BVM assisted ventilation

• Portable automated transport ventilators, if trained (ATV)

[newsbuff 286]

yes but deep suctioning is never mention in the protocols unless I over looked it. and majority of the BLS units have PSO2 now with rainbow probs to they can get the CO leves.

Having worked numerous vent jobs, deep suction is almost a necessity. And most, if not all commercial transport agencies do not have SpO2 for BLS, because it's not an 800 requirement. Guess they are going to have to spend some money. IMHO, Vent stuff is specialty care, and should not be pushed off on EMT's and medics. Edited January 26, 2014 by newsbuff

[Jybehofd 85]

hey i didn't write it but its their. EMTs can do it I just wonder if any will get "trained" to do it. I personally like doing vent jobs its more control for a critical patient typically when the patient is on a vent long term and used to a specific vent its a little more of a pain sometimes to match exactly. Well the real question is what are the transfer protocols going to look like. there is no mention of using a vent for inter facility transport or being allowed to.

[newsbuff 286]

hey i didn't write it but its their. EMTs can do it I just wonder if any will get "trained" to do it. I personally like doing vent jobs its more control for a critical patient typically when the patient is on a vent long term and used to a specific vent its a little more of a pain sometimes to match exactly. Well the real question is what are the transfer protocols going to look like. there is no mention of using a vent for inter facility transport or being allowed to.

I'm not going after you! Sorry if it came out that way.