EMS Protocol of the Week - Bleeding / Hemorrhage Control (Adult and Pediatric)

It’s important to keep in mind that all the approaches for hemorrhage control described in this week’s protocol should be considered adjuncts to our first line defense against rapid exsanguination: direct pressure. Applying a tourniquet proximally? Keep pressure on that distal bleed. Packing a junctional wound? Maintain constant pressure on top. Placing a pressure dressing? Put some pressure on that pressure! Even the fancy hemostatic dressings (QuikClot, etc) can only help so much without some direct pressure to zhuzh it up.

You guys I’m actually pretty proud of keeping up with the puns at the end of these emails. Even for gross ones like uncontrolled bleeding. But, like…I don’t wanna gush.

www.nycremsco.org or the protocol binder for more.

 Dave

EMS Protocol of the Week - Acute Coronary Syndrome / Suspected Myocardial Infarction / Chest Pain (Adult)

Chest pain: it's our bread and butter in the ED, and it’s similarly a fairly straightforward EMS protocol. Providers at the CFR level can give chewable aspirin, while EMTs can assist with administering a patient’s own, previously prescribed nitro. Paramedics can independently give nitro if appropriate, but crucially, they’ll be the ones to perform and interpret the 12-lead EKG to answer the ever-important question: “STEMI or no STEMI?” Once again I’m attaching the specialty center appendix to show which NYC hospitals are currently equipped to receive STEMIs. For those of us answering the OLMC phone, the most important thing we will often be providing to these jobs is our own interpretation of the EKG (either via an emailed copy or, sometimes, just a verbal report), as well as guidance as to whether or not crews should divert from the nearest hospital to go to a STEMI center, instead.

I hope you all have been appreciating these emails as of late, I really do put a lot of…heart…into them? ha ha you’re all welcome www.nycremsco.org and the protocol binder for more.

Dave

EMS Protocol of the Week - Head, Neck, and Spine Injuries (Adult and Pediatric)

Surprise, another trauma protocol that focuses on ABCs and BLS-level care!

Of course, any paramedics that happen upon a trauma job that requires airway control or vascular access is expected to do so, but the bulk of the protocol on head/neck/spine injuries boils down to how EMTs can best support these patients for transport. The big takeaway is familiarizing yourself with the criteria crews will use in determining spinal precautions, c-spine stabilization, and rigid collar application. As you can see, the criteria mostly line up with those that we would use in the ED, with “any other provider concern…” adding some extra wiggle room to allow for provider gestalt. Keep that in mind as you receive these patients, as they may be eligible for c-collar clearance after an initial evaluation, rather than several CTs and an MRI later.

Let’s hear it for protocols! And for our EMTs and paramedics, who put their…necks out?...on a daily basis? Anyone? Bueller?

www.nycremsco.org and the protocol binder for more.

 Dave