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Patient Care Protocols (Blue Book) and EMS Update 2007

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Presentation on theme: "Patient Care Protocols (Blue Book) and EMS Update 2007"— Presentation transcript:

1 Patient Care Protocols (Blue Book) and EMS Update 2007
Seattle—King County

2 Introduction Indicates a change or update from the 2005 blue book (NOT necessarily a change or update to current protocols).

3 Alerts & After—Care Instructions
Page 63 EMTs will leave alerts or after—care instructions as indicated for the following patients: High blood pressure High blood sugar Low blood sugar You must document that an alert or after—care instruction was provided and verify the patient's home phone number.

4 Alerts & After—Care Instructions
Page 63 Inclusion Diabetic with sugar ≥ 300 Non diabetic with sugar ≥ 175 Exclusion Paramedic transported patient Nursing home patients Optional Use judgment with trauma patients

5 Alerts & After—Care Instructions
Page 63 Inclusion Any patient with a systolic ≥ 160 mmHg or diastolic ≥ 100 mmHg Exclusion Paramedic transported patient Nursing home patients Optional Use judgment with trauma patients

6 Alerts & After—Care Instructions
Page 63 Inclusion Diabetic on insulin who responds fully to oral glucose and who is stable enough to remain at home Exclusion Paramedic or EMT transported patient

7 Personal Protective Equipment (PPE)
Pages 104—105 Hand washing is the most effective way to prevent transmission of infectious disease. Wash hands: After patient contact Before eating, drinking, smoking, or handling food Before and after using the bathroom After cleaning or checking equipment

8 Gloves and eye protection should be worn for every patient.
PPE, continued Pages 104—105 FULL PPE for possible infectious contacts: Gloves Eye protection (such as glasses, face shields and goggles) Fit-tested masks (such as N95 and N100 masks) Gowns (or suits) Gloves and eye protection should be worn for every patient.

9 Mask patient if possible.
PPE, continued Pages 104—105 Put on PPE before entering the patient area. The sequence for donning PPE is MEGG: Mask Eye protection Gown Gloves Mask patient if possible.

10 Handle equipment as contaminated waste. Decontaminate eye protection.
PPE, continued Pages 104—105 The sequence for doffing PPE is: Gloves Gown—hand washing min 20 sec. Eye protection Mask—hand washing min 20 sec. Handle equipment as contaminated waste. Decontaminate eye protection.

11 Limit patient contacts.
PPE, continued Pages 104—105 Febrile Respiratory Illness Dispatchers will notify units of infectious symptoms or locations. Dispatch info or fever w/ cough or illness or possible infectious disease Full PPE required. Limit patient contacts.

12 PPE, continued After patient contact:
Pages 104—105 After patient contact: Remove PPE –- (approved sequence). Dispose of PPE as contaminated waste. On-scene decontamination: eye protection & equipment w/ germicidal cleaner. Hospital decontamination: eye protection, equipment and apparatus.

13 PPE, continued At station:
Pages 104—105 At station: Decontaminate affected equipment & contacts (kits, BP/steth, radios, clipboards, etc.). Wash hands before leaving apparatus floor.

14 Taser Dart Removal and Care
Pages 126—127 See pages of the Blue Book (PCP) for a detailed description of Taser darts, Taser removal, EMS care and transport policies for all patients.

15 Sick/Not Sick Pages 10—17 All EMTs are now encouraged to incorporate the SICK/NOT SICK approach into patient assessment PCP provides a brief overview of SICK/NOT SICK

16 ALS Indicators Pages 59-60 PCP now has a two-page summary of all ALS Indicators — conditions that require a medic response Specific ALS indicators for some conditions have been changed and are listed under each condition below

17 Cardiac Arrest For initial analyis
Pages 22—23 For initial analyis After delivering one shock, immediately begin 2 minutes of CPR If no shock indicated, immediately begin 2 minutes of CPR After 2 minutes of CPR, reanalyze the rhythm If a shock is indicated, immediately deliver a single shock If no shock is indicated, immediately check pulse. If no pulse, then begin 2 minutes of CPR

18 Anaphylaxis Page 9 BLS Care Any patient who receives an EpiPen (pre– or post—EMS arrival) should be transported and evaluated in a hospital. Mode of transport depends on clinical symptoms and findings.

19 Epinephrine (EpiPen) Page 75 EMTS may deliver epinephrine via an EpiPen injector for ANY case of suspected anaphylaxis (respiratory distress and/or hypotension must be present.

20 EpiPen, continued Seattle EMTs
Page 75 Seattle EMTs Patient (any age) has a history of same and a prescription for epinephrine Patient is less than 18 years of age with no prescription but permission is obtained from parent or legal guardian. This may be written or oral.

21 EpiPen, continued King County EMTs There are no requirements for: Age
Page 75 King County EMTs There are no requirements for: Age Having a prescription Written/oral permission (beyond standard consent)

22 EpiPen, continued Dosages
Page 75 Dosages Adults and children over 30 kg or 66 lbs: EpiPen (0.3 mg) Child under 30 kg or 66 lbs.: EpiPen, Jr. (0.15 mg)

23 Glucometry Blood glucometry is within EMT scope of practice
Pages 26—27 Blood glucometry is within EMT scope of practice EMTs must complete initial training in glucometry before applying this skill (see EMS Online) Optional protocol for individual EMS agencies

24 Pulse Oximetry Pulse oximetry is within the scope of practice for EMTs
Pages 28—29 Pulse oximetry is within the scope of practice for EMTs EMTs must have initial training in pulse oximetry before applying this skill (see EMS Online) Optional to EMS agencies

25 Reportable Exposures Page 30 New section to provide more guidance on bloodborne exposures Definition of reportable exposure General steps to take following an exposure

26 Altered Level of Consciousness
Page 32 New ALS indicators Hypoglycemia with decreased LOC Drug or alcohol related seizures Other Changes Defined time period of 15 minutes or more in postictal period vs. “not regaining consciousness between seizures” Signs and symptoms of shock vs. “hypotension”

27 Asthma New ALS indicator for asthma
Page 35 New ALS indicator for asthma Sustained tachycardia (persistent heart rate of or greater per minute depending on clinical setting)

28 Burns Page 38 New section to give EMTs more guidance on assessment and treatment of burn injuries

29 Chest Discomfort Pages 39—40 ALS Indicators in this section have changed significantly including Use of nitroglycerin Signs and symptoms of shock such as poor skin signs Sustained tachycardia and hypotension ALS Indicators now emphasize Discomfort or unusual sensations for those 40 years old or greater or with a history of heart problems New Special Instructions section has been added that directs EMTs to be aware of atypical findings seen in the elderly, women and diabetics

30 Cold-Related Hypothermia cardiac arrest protocol has been eliminated
Page 44 Hypothermia cardiac arrest protocol has been eliminated Follow standard cardiac protocols for hypothermic cardiac arrest

31 Congestive Heart Failure
Page 46 Added ALS indicator Unable to lie flat

32 Diabetic ALS Indicator added Revised BLS indicator
Page 48 ALS Indicator added Sustained tachycardia Revised BLS indicator Gag reflex intact, as indicated by swallow Check gag reflex by asking patient if he or she can swallow DO NOT check a gag reflex by putting a tongue depresser against the back of the throat

33 Diabetic, continued New variation in BLS care
Page 49 New variation in BLS care If hypoglycemic and patient is unable to swallow, position on side, give oxygen, ventilation and await paramedics Revision of instructions for leaving patient at the scene Patients with hypoglycemia who have responded to oral glucose may be left at scene (see page 27). These patients must have a repeat glucose level documented and after-care instructions must be left with the patient.

34 Drowning (Scuba Diving)
Page 52 Revised BLS care for SCUBA-related injury Position patient flat (supine) to avoid cerebral edema Former treatment “Position patient on left side with head and chest lower than feet to prevent air bubbles from moving to lungs, heart and brain (heart down, head down).”

35 Gynecologic ALS Indicators added
Page 52 ALS Indicators added Sustained tachycardia (persistent heart rate or greater per minute depending on clinical setting) Possible ectopic pregnancy

36 Head and Neck Page 57 Revised care for suspected c-spine injury when wearing a helmet As long as the airway is not affected and remains patent AND the c-spine can be secured in an neutral, in-line position, leave football and motorcycle helmets on All other non-fitted helmets may be removed as soon as possible (e.g., bicycle helmets, skateboard helmets, rollerblade helmets)

37 Heat - Related Page 58 ALS Indicator added Sustained tachycardia

38 Orthopedic New ALS indicators
Pages 65—67 New ALS indicators Open fractures except for hands and feet High index of suspicion based on MOI Contact medics for severe pain Refined realignment of long-bone fractures Long-bone fractures, which occur in the proximal or distal 1/3, that may or may not involve a joint, may be realigned if compromise of distal circulation or nerve function is detected and definitive care is delayed. New BLS care for pelvic fractures - “sheet splinting”

39 Respiratory Page 70 ALS Indicator added Sustained tachycardia

40 Seizures ALS Indicators added Multiple seizures (status seizures)
Page 72 ALS Indicators added Multiple seizures (status seizures) Drug and alcohol associated seizures Defined a time frame for the postictal period of greater than 15 minutes

41 Admin of Meds (Nitro) Page 83 Revised conditions for assisting with nitrogylcerin The patient should not have taken Viagra or Levitra within the past 24 hour or Cialis within the past 48 hours

42 Bag—Valve Mask Page 92 FATS technique is now referred to as the One EMT Technique

43 Dressing and Bandaging
Pages 96—97 Revised BLS Care Cover eviscerated abdominal contents with a large multi-trauma dressing soaked with sterile saline. Then apply an occlusive dressing, if available, to retain heat and moisture. Former PCP directed EMTs to not moisten the dressing.

44 Noxious Stimuli Two approved methods only:
Page 91 Two approved methods only: Firm earlobe pressure (Figure 1) Firm pressure behind earlobe (Figure 2) Figure 1 Figure 2

45 Oxygen Delivery For King County COPD patients (non-Seattle FD)
Page 106 For King County COPD patients (non-Seattle FD) EMTs have the option of using a non-rebreathing mask if a nasal cannual at 4 L/min is inadequate

46 Patient Restraint Change in technique
Pages 113—114 Change in technique One arm secured high above the head and the other low at the patient’s side and both secured to the backboard or stretcher

47 Postural Vital Signs Added contraindication
Pages 115—116 Added contraindication Patient with suspected cardiac chest pain Check vital signs in two positions only: supine or sitting and standing (formerly 3: supine, sitting and standing) Positive findings have been redefined as follows: Increase in pulse of 20/minute or more and/or a 20 mmHg or more drop in systolic BP from supine to standing with associated symptoms OLD: “Decrease in systolic BP of 30 mm/Hg or more from supine to sitting or standing. Systolic BP of less than 90 mm/Hg in sitting or standing position.”

48 Questions EMS Online Guidelines and Standing Orders
Mike Helbock, M.I.C.P., NREMT-P Training Division Manager support: Dr. Mickey Eisenberg Medical Director Ask the Doc:


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