2006 Protocol UpdateCentral New York EMS50 Presidential PlazaJefferson Tower, Suite LL1Syracuse, New York 13202Click mouse anywhere on slide to continue.

OverviewFormat ReadjustmentsAdult Protocol ChangesPediatric Protocol ChangesSpecial Protocols and ChartsReview

Format ChangesIndexEasier to read and quickly locate protocolsPages Laminated for durability and longevitySection tabsIndicate the protocol section on the side of the pageSections are no longer designated at the top of the page

Format ChangesFontsThough it may still seem small, font size has been maximized without compromising the size of the bookClinical judgment boxesProtocol sections that require clinical judgment are:black with white letters

Format ChangesCardiac Protocol TitlesTitles are based on subject and the word cardiac has been removed from the titlesAsystoleBradycardia, SymptomaticCardiogenic ShockChest PainPEATachycardia, UnstableTachycardia, StableV-Fib / Pulseless V-Tach

Adult Protocol ChangesPain Non-Cardiac (page 29)

Routine Medical or Trauma Care

Nubain 10 mg IVORMorphine up to 5 mg IVMay repeat every 5 min. up to 20 mgMajor PainAcetaminophen PO 15 mg/kg (maximum dose 1000mg) if patient can tolerate oral medicationAssess with Visual Analog Pain Scale (page 71) or equivalent

Minor PainEMT-CC/EMT-P* For pain of 6 and below via the Visual Analog Pain Scale (page 71) consider treatment via the Minor Pain pathway only, and care may be transferred to BLS.

Adult Protocol ChangesPain Non-CardiacAgencies will carry 325 mg and/or 500 mg tablets of acetaminophen and potable water.While available under standing order and not technically a controlled substance, the storage, use, distribution and record-keeping shall be the same for nalbuphine (Nubain) as is currently utilized for ALL controlled substances.

Adult Protocol ChangesFacilitated Intubation (page 5)Etomidate 0.3 mg/kgEtomidate 20 mg IV over 30 to 60 secondsRepeat Etomidate dose after 1-2 minutes if desired effect is not achievedAfter successful intubationConsider Diazepam 5.0 mg or Versed 2.0 mg for continued sedation*

To reverse effects of diazepam (Valium ) or midazolam (Versed ) due to complications arising from unsuccessful intubation (for example: hypotension or inability to maintain an airway) flumazenil (Romazicon ) 0.2 mg IV may be given.

Adult Protocol ChangesAllergic Reaction/Anaphylaxis (page 10)Systolic BP

Adult Protocol ChangesPulmonary Edema (page 13)

Furosemide 80 mg IV over 1 min.May repeat or increase initial doseNitroglycerin 0.4 mg SLMay repeat every 5 min. x 2Morphine 2 mg IVMay repeat every 5 min. up to 10 mgNitroglycerin 0.4 mg SLMay repeat every 5 min. x 2Furosemide 40 mg IV over 1 min.Morphine up to 5 mg IV for adultsMay repeat every 5 min. up to 10 mgFurosemide 80 mg IV over 1 min.If patient does not improve

Adult Protocol ChangesMorphine initial dose change to range, still requires orders for all providersUp to 5 mg for adultsPulmonary Edema (page 13)Chest Pain (page 17)

Pediatric Protocol ChangesAll pediatric protocols:Use of Broselow Tape for adjunct sizes and drug dosages is required.

Pediatric Protocol ChangesAcute Respiratory DistressAtrovent 500 mcg in 2.5 milliliters normal saline

Albuterol (2.5 mg in 3 ml NS) andAtrovent (500 micrograms in 2.5ml NS)Administer via nebulizer*

Wheezing or history ofAsthma or BronchiolitisAlbuterol 2.5 mg in 3 ml via nebulizerorEpi 1:1000 0.01 mg/kg SC to a total of 0.3 mgMay repeat in 20 min.

Pediatric Protocol ChangesSeizures (page 52)Added Maximum Total Doses of Diazepam and VersedDiazepam 0.1 mg/kg IVMay repeat X 1Maximum total Dose5 mg

ORDiazepam 0.5 mg/kg PR*May repeat X 1Maximum total Dose10 mg

ORVersed 0.07 mg/kg IMMay repeat X 1Maximum total Dose 5 mg

Special ProtocolsTrauma Triage Criteria added (page 64)

Major trauma is present if the mechanism of injury or patients physical findings meet any one of the following criteria:Mechanism of Injury- Death in the same passenger compartment- Fall >20 feet- Vehicle-pedestrian collision- Patient ejected from the vehicle- Vehicle collision >20 mph resulting in 12 inches of deformity to the vehicle- Vehicle rollover- Motorcycle crash- Vehicle vs. bicycle collision >5 mphPhysical Findings-Pulse 120/min-Systolic blood pressure of 90 mmHg or less- Respiratory rate 28/min- Glasgow Coma Scale

Special Protocols12 Lead EKG (page 65)CriteriaFrequencyConsiderations for suspected MIReminders

V14th intercostal space @ R sternum edgeV24th intercostal space @ L sternum edgeV3Between V2 & V4 V45th intercostal space, midclavicular line V5Level with V4, L anterior axillary line V6Level with V5, L mid axillary line

ChartsVisual Analog Pain Scale (page 71)This scale is designed to be used as a tool to subjectively determine pain level. Refer to the Pain Non-Cardiac protocol (page 29)

ReviewProvider-friendlier formatAdult protocol changes to:Pain Non-Cardiac Facilitated IntubationAllergic Reaction/AnaphylaxisPulmonary EdemaChest Pain

ReviewPediatric Protocol changes to:Acute Respiratory DistressSpecial Protocol Additions:Trauma Triage Criteria12 Lead EKGCharts Additions:Visual Analog Pain Scale

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