Aspirin Guidelines

1. Aspirin Guidelines New Milford Hospital, Emergency Department

2. Aspirin Policy Policy:EMT-Basics will be allowed to administer aspirin, as per the proceeding protocols, to patients who are experiencing chest pain believed to be cardiac in nature only if all of the following are criteria are met: • 1. The EMT has successfully completed the sponsor hospitals initial training in aspirin administration, and annual recertification. • 2. The service for which the EMT is affiliated and working with has 100% compliance of all members being trained and recertified as stated in (1).

3. Aspirin (Policy cont.) • 3. The EMT is in good standing with sponsor hospital medical oversight, is registered with the New Milford sponsor hospital program and has maintained current State of Connecticut Certification as an EMT or EMT Intermediate. • 4. The EMT and service have AED capabilities, and availability of paramedic intercept service or better. • 5. The EMS service must have the appropriate State of Connecticut Office of Emergency Medical Services (OEMS) MIC application completed, signed by the Medical Director and the EMS Coordinator at New Milford Hospital and accepted by OEMS.

4. Aspirin • QualityAssurance:The treatment provided to, and patient care records (PCRs) of all patients who receive pre-hospital aspirin from EMT-Basics will be reviewed for quality assurance purposes. Most notably to document that the appropriate dose of aspirin, route of administration, timeliness of administration, side effects, known allergies, and timely utilization of paramedic level of care. Deviations will be addressed as protocol violations, and dealt with on a case by case basis.

5. Aspirin Protocol According to the AHA and ECC guidelines immediate administration of aspirin in chest pain that is potentially cardiac in origin has shown reduction in morbidity and mortality.

6. Aspirin • MechanismofAction:Aspirin inhibits platelet aggregation, blocks pain impulses in the CNS, and dilates peripheral vessels. • Onset and Duration:Onset: 15 to 30 minutesDuration: 4 to 6 hours

7. Aspirin • Indications: Chest Pain, suggestive of cardiac ischemia (restriction in blood supply) and/or infarction (blood supply is interrupted).

8. Aspirin Contraindications:Allergy or hypersensitivity to salicylates (aspirin, wintergreen)GI BleedingActive ulcer diseaseHemorrhagic strokeBleeding disordersChildren with cold and flu-like symptoms DrugInteractions:Decreased effects with antacids and steroids. SpecialConsiderations:Pregnancy Category D, not to be used in pregnant women, unless under direct medical oversight.

9. Aspirin • Dosage:Chewable tablets (“Baby Aspirin”) 81mg each for a total dose of 324mg (4 chewtabs).

10. CAS/ Chest Pain Algorhythm of Care:Primary EMT-B CareConsider Paramedic InterceptVital SignsOxygen Aspirin 324 mg PO, 4 chewable tablets.Reevaluate and vital signsProceed to intercept with paramedicContact direct medical oversight (medical control) for any questions, deviations or if patient has taken aspirin prior to EMS arrival (inform of last time and dose)

11. CHEST PAIN/ CAS DO NOT APPLY AED UNLESS PATIENT BECOMES UNRESPONSIVE, APNEIC AND PULSELESS

12. Aspirin/ Chest Pain Documentation:Documentation of aspirin must be done by the EMT-B who administered it. The following must be documented on the PCR, in addition to the normal information and data: Time and dose administered Route of administration EMT administering the ASA Problems or complications (i.e. vomiting) Response, if any, to the treatment Vital signs after administration This data needs to be documented on the paramedic intercept PCR as well as the primary responder.