EMS Protocol of the Week - Introduction

Happy New Year, Maimo fam! Hope everyone is tan, hydrated, and getting settled into their new MMC roles. After a bit of a summer break, we’re back with your regular EMS Protocol of the Week emails! These are meant to serve as a longitudinal guide/reference as you start experiencing the new, mysterious, dare I say invigorating world of On-Line Medical Control (OLMC).

Each week, we will review another protocol highlighting the roles and responsibilities of EMS field providers and OLMC physicians in NYC; these protocols are designed by physicians and are a good review of core EM concepts, but they are also intended to help guide you on how to best advise EMTs and paramedics that call us looking for assistance.

This first email for the year will reinforce some OLMC basics, starting with how to read the protocols (found here, at www.nycremsco.org, and the protocols binder next to the phone [you know, the one you always pick up by mistake]). Take a look at the attached pdf for a refresher on protocol formatting, but here are the big points:

1.       Each protocol is divided into dedicated sections for CFR (firefighters), BLS (EMTs), and ALS (paramedics).

2.       Each protocol reads top to bottom, in sequential order, but each section builds on the section before it (remember, “Good ALS care starts with good BLS care”). CFRs will stop at the end of their section, EMTs will cover everything between the CFR section and the BLS section, and paramedics will cover everything from the CFR, BLS, and ALS sections.

3.       Standing Orders (SO) describe everything explicity written in each of these sections that EMS providers are expected to do by default.Medical Control Options (MCOs) are found at the end of each protocol and describe what providers (usually paramedics) can do after calling OLMC for physician approval; the most common example of this would be paramedics requesting to give calcium chloride and sodium bicarbonate during a cardiac arrest.

a.       Discretionary Orders (DO) are those that you, as the OLMC physician, are requesting the providers to perform but are not explicitly written in the protocols as either SO or MCO. The order must be for something that the crew already carries and is trained in using; an example of this might be having our paramedics use fentanyl for intubation, because they use it in another protocol (General Pain Management), and it’s not currently listed as a sedation option for airway management. On the flip side, you cannot ask the crew to give propofol as a Discretionary Order, as this is not a medication that they carry or know how to use. Discretionary Orders highlight the importance of having a general understanding of what EMTs and paramedics can do and how their ambulances are stocked.

4.       While we use 18 as the age cutoff for whether or not a patient is a minor, for the purposes of these protocols, the NYC REMAC defines pediatric patients as up to 15 years of age.

Look this over a few times and please reach out with any questions; we’ll be putting it all into practice next week as we review our first protocol!

Dave