Presentation on theme: "Patient Care Protocols (Blue Book) and EMS Update 2007"— Presentation transcript:
1Patient Care Protocols (Blue Book) and EMS Update 2007 Seattle—King County
2IntroductionIndicates a change or update from the 2005 blue book (NOT necessarily a change or update to current protocols).
3Alerts & After—Care Instructions Page 63EMTs will leave alerts or after—care instructions as indicated for the following patients:High blood pressureHigh blood sugarLow blood sugarYou must document that an alert or after—care instruction was provided and verify the patient's home phone number.
4Alerts & After—Care Instructions Page 63InclusionDiabetic with sugar ≥ 300Non diabetic with sugar ≥ 175ExclusionParamedic transported patientNursing home patientsOptionalUse judgment with trauma patients
5Alerts & After—Care Instructions Page 63InclusionAny patient with a systolic ≥ 160 mmHg or diastolic ≥ 100 mmHgExclusionParamedic transported patientNursing home patientsOptionalUse judgment with trauma patients
6Alerts & After—Care Instructions Page 63InclusionDiabetic on insulin who responds fully to oral glucose and who is stable enough to remain at homeExclusionParamedic or EMT transported patient
7Personal Protective Equipment (PPE) Pages 104—105Hand washing is the most effective way to prevent transmission of infectious disease.Wash hands:After patient contactBefore eating, drinking, smoking, or handling foodBefore and after using the bathroomAfter cleaning or checking equipment
8Gloves and eye protection should be worn for every patient. PPE, continuedPages 104—105FULL PPE for possible infectious contacts:GlovesEye 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.
9Mask patient if possible. PPE, continuedPages 104—105Put on PPE before entering the patient area.The sequence for donning PPE is MEGG:MaskEye protectionGownGlovesMask patient if possible.
10Handle equipment as contaminated waste. Decontaminate eye protection. PPE, continuedPages 104—105The sequence for doffing PPE is:GlovesGown—hand washing min 20 sec.Eye protectionMask—hand washing min 20 sec.Handle equipment as contaminated waste. Decontaminate eye protection.
11Limit patient contacts. PPE, continuedPages 104—105Febrile Respiratory IllnessDispatchers will notify units of infectious symptoms or locations.Dispatch info or fever w/ cough or illness or possible infectious diseaseFull PPE required.Limit patient contacts.
12PPE, continued After patient contact: Pages 104—105After 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.
13PPE, continued At station: Pages 104—105At station:Decontaminate affected equipment & contacts (kits, BP/steth, radios, clipboards, etc.).Wash hands before leaving apparatus floor.
14Taser Dart Removal and Care Pages 126—127See pages of the Blue Book (PCP) for a detailed description of Taser darts, Taser removal, EMS care and transport policies for all patients.
15Sick/Not SickPages 10—17All EMTs are now encouraged to incorporate the SICK/NOT SICK approach into patient assessmentPCP provides a brief overview of SICK/NOT SICK
16ALS IndicatorsPages 59-60PCP now has a two-page summary of all ALS Indicators — conditions that require a medic responseSpecific ALS indicators for some conditions have been changed and are listed under each condition below
17Cardiac Arrest For initial analyis Pages 22—23For initial analyisAfter delivering one shock, immediately begin 2 minutes of CPRIf no shock indicated, immediately begin 2 minutes of CPRAfter 2 minutes of CPR, reanalyze the rhythmIf a shock is indicated, immediately deliver a single shockIf no shock is indicated, immediately check pulse. If no pulse, then begin 2 minutes of CPR
18AnaphylaxisPage 9BLS CareAny 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.
19Epinephrine (EpiPen)Page 75EMTS may deliver epinephrine via an EpiPen injector for ANY case of suspected anaphylaxis (respiratory distress and/or hypotension must be present.
20EpiPen, continued Seattle EMTs Page 75Seattle EMTsPatient (any age) has a history of same and a prescription for epinephrinePatient 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.
21EpiPen, continued King County EMTs There are no requirements for: Age Page 75King County EMTsThere are no requirements for:AgeHaving a prescriptionWritten/oral permission (beyond standard consent)
22EpiPen, continued Dosages Page 75DosagesAdults and children over 30 kg or 66 lbs: EpiPen (0.3 mg)Child under 30 kg or 66 lbs.: EpiPen, Jr. (0.15 mg)
23Glucometry Blood glucometry is within EMT scope of practice Pages 26—27Blood glucometry is within EMT scope of practiceEMTs must complete initial training in glucometry before applying this skill (see EMS Online)Optional protocol for individual EMS agencies
24Pulse Oximetry Pulse oximetry is within the scope of practice for EMTs Pages 28—29Pulse oximetry is within the scope of practice for EMTsEMTs must have initial training in pulse oximetry before applying this skill (see EMS Online)Optional to EMS agencies
25Reportable ExposuresPage 30New section to provide more guidance on bloodborne exposuresDefinition of reportable exposureGeneral steps to take following an exposure
26Altered Level of Consciousness Page 32New ALS indicatorsHypoglycemia with decreased LOCDrug or alcohol related seizuresOther ChangesDefined time period of 15 minutes or more in postictal period vs. “not regaining consciousness between seizures”Signs and symptoms of shock vs. “hypotension”
27Asthma New ALS indicator for asthma Page 35New ALS indicator for asthmaSustained tachycardia (persistent heart rate of or greater per minute depending on clinical setting)
28BurnsPage 38New section to give EMTs more guidance on assessment and treatment of burn injuries
29Chest DiscomfortPages 39—40ALS Indicators in this section have changed significantly includingUse of nitroglycerinSigns and symptoms of shock such as poor skin signsSustained tachycardia and hypotensionALS Indicators now emphasizeDiscomfort or unusual sensations for those 40 years old or greater or with a history of heart problemsNew Special Instructions section has been added that directs EMTs to be aware of atypical findings seen in the elderly, women and diabetics
30Cold-Related Hypothermia cardiac arrest protocol has been eliminated Page 44Hypothermia cardiac arrest protocol has been eliminatedFollow standard cardiac protocols for hypothermic cardiac arrest
31Congestive Heart Failure Page 46Added ALS indicatorUnable to lie flat
32Diabetic ALS Indicator added Revised BLS indicator Page 48ALS Indicator addedSustained tachycardiaRevised BLS indicatorGag reflex intact, as indicated by swallowCheck gag reflex by asking patient if he or she can swallowDO NOT check a gag reflex by putting a tongue depresser against the back of the throat
33Diabetic, continued New variation in BLS care Page 49New variation in BLS careIf hypoglycemic and patient is unable to swallow, position on side, give oxygen, ventilation and await paramedicsRevision of instructions for leaving patient at the scenePatients 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.
34Drowning (Scuba Diving) Page 52Revised BLS care for SCUBA-related injuryPosition patient flat (supine) to avoid cerebral edemaFormer 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).”
35Gynecologic ALS Indicators added Page 52ALS Indicators addedSustained tachycardia (persistent heart rate or greater per minute depending on clinical setting)Possible ectopic pregnancy
36Head and NeckPage 57Revised care for suspected c-spine injury when wearing a helmetAs 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 onAll other non-fitted helmets may be removed as soon as possible (e.g., bicycle helmets, skateboard helmets, rollerblade helmets)
38Orthopedic New ALS indicators Pages 65—67New ALS indicatorsOpen fractures except for hands and feetHigh index of suspicion based on MOIContact medics for severe painRefined realignment of long-bone fracturesLong-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”
40Seizures ALS Indicators added Multiple seizures (status seizures) Page 72ALS Indicators addedMultiple seizures (status seizures)Drug and alcohol associated seizuresDefined a time frame for the postictal period of greater than 15 minutes
41Admin of Meds (Nitro)Page 83Revised conditions for assisting with nitrogylcerinThe patient should not have taken Viagra or Levitra within the past 24 hour or Cialis within the past 48 hours
42Bag—Valve MaskPage 92FATS technique is now referred to as the One EMT Technique
43Dressing and Bandaging Pages 96—97Revised BLS CareCover 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.
45Oxygen Delivery For King County COPD patients (non-Seattle FD) Page 106For 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
46Patient Restraint Change in technique Pages 113—114Change in techniqueOne arm secured high above the head and the other low at the patient’s side and both secured to the backboard or stretcher
47Postural Vital Signs Added contraindication Pages 115—116Added contraindicationPatient with suspected cardiac chest painCheck 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 symptomsOLD: “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.”
48Questions EMS Online Guidelines and Standing Orders Mike Helbock, M.I.C.P., NREMT-P Training Division Managersupport:Dr. Mickey Eisenberg Medical DirectorAsk the Doc: