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VVEMS 2009 Protocol Revisions, Recap & Rationale

VVEMS 2009 Protocol Revisions, Recap & Rationale. VVEMS Writing Group Presented by Todd Lang, MD. Thanks to Schelly and Tish for redoing the whole protocol file so we can edit it! Please email us when you notice a typo and the file will be totally clean pretty quickly. Protocols Introduction.

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VVEMS 2009 Protocol Revisions, Recap & Rationale

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  1. VVEMS 2009 Protocol Revisions, Recap & Rationale VVEMS Writing Group Presented by Todd Lang, MD

  2. Thanks to Schelly and Tishfor redoing the whole protocol file so we can edit it!Please email us when you notice a typo and the file will be totally clean pretty quickly.

  3. Protocols Introduction Moved some items to appendices Not a textbook, but full of information More of a philosophical statement on purpose of guidelines Discusses uniquities of VVEMS Reader expected to be familiar with state and national requirements

  4. Refer to our other guidelines Interfacility transport guideline Sedona/VVMC transport guideline Air transport guideline

  5. Patching vs Notification To save time for both parties Name the type of call up front Patch: please listen and give us guidance Notification: patient is stable and we don’t request any orders, please direct us to a bed and be prepared for us We will work with nursing to help them focus attention on Patch calls more tightly

  6. DO NOT MAKE JOKES ON THE PATCH PHONE PLEASE. IT IS RECORDED AS PART OF THE PATIENT’S PERMANENT MEDICAL RECORD AND IS THE SAME AS MAKING JOKES IN THE CHART, WHICH YOU DON’T DO.

  7. EMS Committees • Functioning, dependable EMS Committees • Prehospital Care: Most months. Everyday EMS policy and related matters for the practicing EMS provider and addressing issues at the interface of EMS service and other services. • Steering: Chiefs, EMS leaders, NAH/VVMC leadership. Meets quarterly or PRN • Peer Review: Bimonthly. A forum to analyze and improve care rendered and offer constructive criticism on care and recordkeeping. Generates useful policy/guideline revisions.

  8. Field Blood Draw Has been running smoothly now for some time Initial growing pains seem to have passed Fine tuning the labeling: need to put patient labels over the MFR labels on the tubes Legal blood draws not required unless blood already being drawn for medical care.

  9. Decentralized QA Process Necessary as volume grows Empowers individual agencies Allows focused QA from medical direction and makes more time available for integrative, system-wide data analysis

  10. IO Allowed but not endorsed strongly by local medical direction Consider use early in codes Use after 2 attempts or 90 seconds in critically ill Costly but safe Tibial sites preferred over humeral

  11. Advanced IV Access PICC line access Portacath access Increase number of people who can get treated while decreasing pain and risk to EMS These are the sickest patients and hardest IV starts

  12. Morphine dosing 0.1 mg/kg for adults 0.05 mg/kg for older (over 55) and peds Repeat in 10 min Mirrors our “Protocol M” in ED Effective and safe dose

  13. Tourniquets An option for life threatening bleeding May use proprietary device or bp cuff

  14. Cardiology Rosetta Lido not a treatment for ischemia Iodine and shellfish do not cross react with contrast dye and were removed from pretreatment for dye allergy CCR Amiodarone removed from protocols

  15. Rosettas for EKG transmission NAH/VVMC purchased to help improve MI care in VV Mostly working now Improved technology over fax-based transmission Helps to bypass the ED in STEMI care when possible

  16. SHARE reporting State wide registry which will analyze cardiac arrest and survival Expect great research Nationally recognized program Part of CCR initiative

  17. CCR Early-middle adoption At request of agencies and leaders Hopefully will improve outcomes Unlikely to make things worse

  18. Respiratory CPAP added Methylprednisolone by patch order Furosemide by patch order, dose guideline (double) Continuous nebs for severe bronchospasm

  19. CPAP Lifesaving Safe Strongly endorsed by Medical Direction Costly, but manageable, expense Should decrease need for invasive airways

  20. Trauma Consider RSI for airway burns Minimize airway manipulation unless RSI available for neuro trauma in field Cervical Spine Immobilization program

  21. ALOC/Toxicology Naloxone dose for altered patient is 0.4 mg IV Naloxone dose for unconscious or unstable is 2 mg IV/IM No NG or charcoal in ALOC OD patient Charcoal only if ingestion <60 min Diazepam OK for EMT-I in seizures

  22. What’s Next? CCR success Cardiac Arrest Center/Cooling survivors Fine tuning of C-spine protocol Focused RN training in 09 Continued Medical Director Ride Time Annual Training like this? Participation and Integration of Medical Direction into EMD process

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