EMS Protocol of the Week - Respiratory Distress/Failure/Pulmonary Edema (Adult)

Despite the broad-sounding title, the prehospital protocol for respiratory distress/failure and pulmonary edema serves mostly to describe the pulmonary edema aspect of care.  As we’ve seen, there are separate, more specific protocols of obstructed airways and COPD/asthma exacerbations, leaving this protocol to mostly focus on fluid overload.

Of note, this protocol also refers to Appendix P (attached), which describes indications for prehospital CPAP use. Remember that CPAP can be applied at either the BLS or ALS level, which has been of tremendous utility in caring for these patients.

At the ALS level, paramedics will administer nitroglycerin (either via tablet or spray) as indicated. You may receive OLMC calls from them requesting to give a benzodiazepine (for CPAP-related anxiety) or furosemide (to get a jumpstart on diuresis). Approve or deny the request as you choose; just remember to confirm dosages and routes!

That’s it for this week, gang! One more protocol to…take your breath away!

Goodbye!

www.nycremsco.org or the protocol binder for more

Dave

EMS Protocol of the Week - Amputation (Adult and Pediatric)

Another trauma protocol this week, which means relatively low complexity in terms of prehospital interventions. In approaching amputation, the bulk of care can be administered at the CFR level, with BLS and ALS levels of training offering not much more beyond transport. 

The relevance for OLMC comes in understanding questions on hospital destination. Generally, only amputations proximal to the wrist or ankle require transport to a trauma center (which, remember, often means bypassing a closer, non-trauma center ED), but be sure to listen to the EMT or paramedic’s full presentation on the case. Use your discretion in determining what feels appropriate for patient care, but just like with other transportation decisions, remember that your orders (extending the transport time of a unit, adding patient load to a particular hospital, etc.) may impact the community and overarching EMS system at large.

Reach out with any questions, www.nycremsco.org or the protocols binder for more, and I’ll see you next week!

Dave

EMS Protocol of the Week - Suspected Myocardial Infarction (Adult)

Diaphoretic? Clutching your chest? Might just be your excitement for another EMS-PoW, but it might also be a heart attack! Hard to tell, I know, so it’s probably just safer to call 911.

When dealing with a suspected MI, EMS will administer 324mg of aspirin orally, starting at the CFR level. BLS providers will immediately request ALS backup, but importantly, if the nearest ALS unit is farther away than the nearest appropriate hospital, BLS will instead transport the patient for further evaluation. If the patient is already prescribed nitroglycerin, BLS can help the patient to take it (assuming no erectile dysfunction meds have been given in the preceding 72 hours), but they do not have their own to give. 

Once ALS is on scene, they will perform and interpret a 12-lead EKG – this will assist in determining whether it is more appropriate to bring the patient to the nearest hospital or to bypass said hospital for the nearest STEMI/PCI center. En route, they can also administer their own nitroglycerin for persistent chest pain (again, assuming no ED meds, as well as a systolic BP > 100mmHg).

Not a lot for you all to do on the OLMC phone, but keep in mind that the decision for closer hospital vs longer transport to STEMI center is the main reason behind EMS calling for these sorts of cases. Listen closely to the case details, as well as the paramedic’s description of the EKG (if they have not sent it electronically) to help answer that question.

See you all next week for more! www.nycremsco.org or the protocols binder to tide you all over until then!

 Dave