Region VII BLS SMO Revision

1. Region VII BLS SMO Revision 2011

2. 2011 BLS SMO This presentation will highlight changes in the SMO’s and also cover information that is on the 2011 SMO study booklet.

3. Code 2: Respiratory Distress • Added reference to Failed Adult Airway Code 75 for inadequate breathing. • Code 75 – BLS providers now allowed to use King Airway for patients who are not getting good ventilations with BVM alone.

5. Code 3 • The Airway Obstruction code, in the past, referred to infant situations. • The pediatric portion (less than one year) was eliminated in this revision and now Code 3 only refers to patients that are over 1 year old.

6. Code 4 – Cardiac Arrest • Codes 6, 9 and 11 now all refer back to this code (Vfib, Vtach, PEA, asystole) • BLS treatment for all is the same anyway. • Includes suggestion that King Airway be considered. • Encourages minimal interruptions of chest compressions per new AHA guidelines.

8. Code 12 – Suspected Cardiac Patient • Have added “perform 12 lead EKG and transmit if available” to BLS cardiac SMO. • Have added box that includes times 12-lead use should be considered: • Chest pain/discomfort/pressure • Arm pain • Jaw pain • Upper back pain • Unexplained diaphoresis • Vomiting without fever or diarrhea • Shortness of breath • Dizzy/syncope • Epigastric pain • Unexplained fall in elderly • Weakness/fatigue • Bradycardia or tachycardia

9. BLS and 12-leads • BLS providers will not be asked to interpret 12-lead EKG’s. • But it will be within their scope of practice to apply electrodes if trained, and transmit the results to the ER. • Will make the EMT-B of even greater assistance to their EMT-P partner, and to the ER.

11. Code 13 – Pulmonary Edema Due to Heart Failure • Adds “consider CPAP en route, if available” for patients with a BP > 90. • CPAP an exciting new addition to the BLS toolbox for patients with trouble breathing due to pulmonary edema/CHF. • Also referred to in Code 30 (Asthma, COPD, Wheezing) with approval of medical control.

14. Trauma Codes • Codes 16 and 21 (trauma and extremity injuries) now allow for use of hemostatic agents by BLS providers. • These are powders or chemicals that are applied to wounds to stop bleeding. • Your EMS coordinator will have more information on whether your department has purchased hemostatic agents.

15. Code 21 ISOLATED EXTREMITY INJURY AND/OR AMPUTATED AND AVULSED PARTS INITIAL TRAUMA CARE (ABCs always take priority over the severed part) • Control bleeding with direct pressure and elevation • For uncontrolled hemorrhage: • Consider use of a hemostatic agent • Use a tourniquet if needed • Note time of placement • Apply as close to the injury as possible • DO NOT release once applied NITROUS OXIDE (optional) • Wrap part in sterile gauze, sheet or towel. • Place part in waterproof bag or container and seal. • DO NOT immerse part in any solutions. • Place this container in a second one filled • with ice, cold water or cold pack. Transport part to hospital with patient TRANSPORT NOTE TO PREHOSPITAL PROVIDER: MORPHINE SULFATE 5-10mg slow IV in 5mg increments every 5 minutes as necessary for pain. Reviewed 10/01/11 Effective 05/01/98 ALS

16. Code 24 – Trauma in Pregnancy • Added F – “Manually displace uterus to the left side during CPR.” • Left uterine displacement increases cardiac output by 30% and restores circulation.

17. Intranasal Medications • Codes 32, 33, 34 and 35 now allow for BLS use of Intranasal Narcan and Glucagon. • Fast-acting through the nasal mucosa. • Allows for effective BLS treatment of diabetics, drug OD’s, comas of unknown origin and seizures

19. Code 18 SUSPECTED SPINAL CORD INJURY SPINAL IMMOBILIZATION Mechanism: Suspected Deceleration Injuries, Motor Vehicle Crashes, Falls, etc. Yes Spine pain/tenderness or complaint of neck/spine pain No Yes Physical findings suggesting neck and/or back injury No Yes Other painful injury identified (Distracting Injury) No Yes Decreased or altered level of consciousness No Abnormal? Motor/Sensory Exam Patient is • Calm • Cooperative • Alert • Ambulatory without pain • No apparent distress • No suspected intoxication • Having an acute stress reaction • Suspected of being intoxicated • Have symptoms of brain injury • Acting inappropriately • Having difficulty communicating, • such as, speaks a foreign language, deaf, etc. Reliable patient exam IMMOBILIZE Reviewed 10/01/11 Effective 05/01/98 ALS NO IMMOBILIZATION NEEDED

20. Code 38 – Suspected Stroke • “Hypertensive Crisis” code is gone. • Replaced with “Suspected Stroke” code. • Includes possible use of 12-lead EKG • Also includes performance of Cincinnati Stroke Scale and checking of glucose.

22. Code 45 – Emergency Childbirth • Removes “involuntary pushing with contractions” and “contractions less than 2 minutes apart” from criteria to prepare for immediate delivery. • Bulging perineum or crowning are most important things to look for… the rest may still allow you transport time.

23. Some other minor changes • Code 55 and 56, pediatric respiratory distress and arrest, now refer to “back slaps” instead of “back blows”. • Code 61, pediatric toxic exposure, now says simply “do not induce vomiting” instead of going into detail about caustic substances. • Code 68, Behavioral Emergencies, now reminds you to first “maintain situational awareness and scene safety”.

24. The End!