EMS Protocol of the Week - Anaphylaxis (Adult)

Anaphylaxis is one of the rare protocols where you will actually find medication administration as early as the CFR (FDNY firefighter) level. In this protocol, if CFRs are the first on scene and recognize a patient in anaphylaxis, they will administer epinephrine via auto-injector while awaiting EMS backup. 

BLS will also administer IM epi, either by auto-injector or – in some instances – manually drawn up into a premarked syringe. However, EMTs require OLMC approval to give a second dose, regardless if they themselves gave the first epi or the CFRs did. This highlights the importance of checking with crews which meds were given, and by whom. BLS is also equipped to administer albuterol for any wheezing noted.

ALS providers on scene will do all manner of ALS stuff – advanced airway management if needed, IV fluids, steroids, diphenhydramine, ipratropium, and repeat epi if instructed by OLMC. Any further issues with respiratory or hemodynamic status are referred to appropriate protocols for additional management.

That’s it for this week, but I bet you’re all…itching…to find out what happens for pediatric patients in anaphylaxis? Stay tuned, faithful readers!

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

 Dave

EMS Protocol of the Week - Obstructed Airway (Adult and Pediatric)

Even though they're written out in two separate protocols, the adult and pediatric approaches to the obstructed airway are effectively the same, with the pediatric protocol including considerations for uncuffed endotracheal tubes.

Aside from that, in both instances, CFRs will promote coughing and initiate “airway maneuvers” (think abdominal thrusts, back blows, etc.)

BLS, you’ll notice, will initiate transport, but only after requesting ALS assistance. The reasoning behind this is that if ALS can assist with airway management, great, but if it will take longer for paramedics to arrive than it would to get the patient to the hospital, it may make more sense to just transport to the ED for further management.

If on scene, ALS can perform actual airway interventions, starting with direct laryngoscopy and attempted removal of foreign bodies with Magill forceps. If unsuccessful, they may place an endotracheal tube to maintain the airway, advancing it down the right mainstem bronchus for persistent difficulty with ventilation.

That’s all they got! Maybe someday we’ll see fiber optic bronchoscopes in the backs of ambulances, but until then, you’ll still have something to do when the patient reaches the ED!

www.nycremsco.org or the protocols binder for more!

Dave