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2013 TransCare Protocol Update

2013 TransCare Protocol Update. Presented by Aaron Taylor TransCare Ambulance Training Group 155-CO. Objectives. Familiarize BLS Personnel with changes to BLS Acts Allowed as well as changes to TransCare BLS Protocols.

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2013 TransCare Protocol Update

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  1. 2013 TransCare Protocol Update Presented by Aaron Taylor TransCare Ambulance Training Group 155-CO

  2. Objectives Familiarize BLS Personnel with changes to BLS Acts Allowed as well as changes to TransCare BLS Protocols. Familiarize ALS Personnel with changes to ALS Acts Allowed as well as changes to TransCare ALS Protocols. Familiarize all personnel with differences between TransCare Protocols and the Garfield County Unified EMS Protocols.

  3. Summary of Changes Zofran ODT for EMT use. Pralidoxime Droperidol Olanzipine Ziprasidone Versed for EMT-I use Vassopressin Bumetinide Thiamine Metaproterinol Dexamethasone Terbutaline Nicardipine Octreotide Procedural Sedation Technology Dependent Patients Foley Catheter Insertion and Maintenance. Updated Backboarding Procedure

  4. Zofran ODT Now allowed for EMT and EMT-IV. Base contact or written orders are required. Dosage = 1 Oral Dissolving Tablet, 4mg. May be repeated in 4 hours with physician approval.

  5. Pralidoxime Pralidoxime is an organophosphate antidote. It is supplied as either an auto-injector or a powder that requires reconstitution. Be prepared to administer very large amounts of this drug. 1200 to 1800mg may be required to control initial symptoms with frequent repeat dosing. In the event of a mass casualty event involving intentional or accidental release of organophosphates, auto-injectors may be distributed to all levels of EMS providers for use.

  6. Droperidol Used as an anti-psychotic when Haldol is ineffective. Also used as an anti-emetic when other drugs such as Zofran are ineffective. May cause prolonged QT Syndrome and other Ventricular Arrhythmias. Continuous EKG Monitoring is required on all patients. Extra-pyramidal effects may be seen in some patients. Allowed for RN’s, Paramedics, and EMT-Is.

  7. Olanzipine Used to treat acute mania in Bi-Polar Disorder and psychosis due to Schizophrenia. Has been noted to increase mortality rate in patients with dementia. Allowed for RNs, Paramedics and EMT-Is. Schedule 4 controlled substance.

  8. Ziprasidone Used to chemically restrain combative patients. Similar to Droperidol in cardiac effects. Continuous EKG monitoring is required for all patients. Extra-pyramidal reactions have occasionally been noted. Allowed for RNs, Paramedics and EMT-Is.

  9. Versed Versed is now allowed for EMT-Intermediates, with physician approval, for all listed indications. These include seizures, behavior control, therapeutic induced hypothermia, electronic cardio-version and during procedural sedation.

  10. Vassopressin Vassopressin may be used by RNs, Paramedics and EMT-Is in the event of cardiac arrest in conjunction with epinephrine. IV or IO push. RNs and Paramedics may use vassopressin as an IV drip (pump controlled) for treatment of hypotension that is not responding to front line treatments. Base consult is required prior to titration.

  11. Bumetanide Can be used by RNs and Paramedics as an alternative to Lasix when treating edema due to heart failure, liver failure or kidney failure. May be ordered for neonatal patients suffering from oliguria.

  12. Thiamine Used by RNs and Paramedics to treat drunk patients suspected of being malnourished. Also used to treat patients suffering from DTs.

  13. Metaproterinol Used by RNs, Paramedics and EMT-Is to treat bronchospasms due to asthma, COPD or anaphylaxis. Multiple concentrations available for nebulization. Ensure dosage prior to administration. Similar side effects to albuterol.

  14. Dexamethasone Used by RNs and Paramedics to treat moderate to severe asthma, COPD, anaphylaxis and croup. May be used IV, IO or IM as well as in an IV Drip (pump controlled)

  15. Terbutiline Used by RNs and Paramedics to treat acute or chronic bronchospasm due to COPD. Particularly useful in older patients where epinephrine is not suitable. Sub-Q or IM Injection.

  16. Nicardipine Calcium Channel Blocker used by RNs and Paramedics to control Acute Hypertensive Crisis. Administered as an IV Drip (pump controlled). Titrate by 2.5mg/hour every 15 minutes to achieve desired BP.

  17. Octreotide Used by RNs and Paramedics to treat Esophageal Varices. Administered as an IV Drip (pump controlled). Often administered in conjunction with Protonix. Sometimes shown to cause cardiac arrhythmias. Continuous EKG monitoring is required.

  18. Procedural Sedation The state now allows Paramedics to perform procedural sedation. The following language was added to the Acts allowed and TransCare Protocols: 13.1 The administration of a combination of benzodiazepines and opiates, for the purpose of pain management, anxiolysis and/or muscle relaxation is permitted. Safeguards shall be taken to maximize patient safety including but not limited to the patient’s ability to: 13.1.1 Independently maintain an open airway and normal breathing pattern, 13.1.2 Maintain normal hemodynamics, and 13.1.3 Respond appropriately to physical stimulation and verbal commands. 13.2 The administration of combination therapy requires appropriate monitoring and care including but not limited to: IV or IO access, continuous waveform capnography, pulse oximetry, ECG monitoring, blood pressure monitoring and administration of supplemental oxygen.

  19. Tech Dependent Patients The state now allows EMS providers to transport patients receiving continuous IV pharmaceuticals that are typically administered at home by the patient or his caregiver. The EMS provider is not allowed to change or discontinue these medications or devices without direct contact with medical control. Due to possible complications, TransCare policy is that, whenever possible, an ALS provider will transport these patients. Only if no ALS provider is available shall a BLS provider be utilized.

  20. Foley Catheter A protocol has been added for the insertion of Foley Catheters for RNs and Paramedics. A protocol has been added for the general maintenance of Foley Catheters by all EMS providers.

  21. Spinal Immobilization Spinal Immobilization has been questioned for the past decade. Current science does not generally back up the need for it on Long Spine Boards. As such, the new protocol limits the occasions when a patient will be backboarded. In Inter-facility transports, backboarding is at the physician’s discretion, but will be very rare.

  22. GarCo Unified EMS Protocols • Vassopressin • Bumetinide • Thiamine • Metaproterinol • Dexamethasone • Terbutaline • Nicardipine • Octreotide There are several additions to the TransCare Protocols that are not included in the GarCo EMS Protocols. They include: Dilaudid Ativan Pralidoxime Droperidol Olanzipine Ziprasidone Foley Catheter

  23. CPAP The state now allows EMTs to maintain and initiate CPAP on patients. Due to the acuity of these patients in the inter-facility discipline, TransCare Medical Control has decided to NOT ALLOW patients requiring CPAP to be transported by BLS personnel. Garfield County Unified EMS Protocols will also not allow BLS personnel to perform this procedure.

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