EMS Protocol of the Week - Emergency Childbirth

Baby’s on the way, everyone panic!

Procedures for imminent delivery can largely take place at the CFR level, with further instructions at the BLS and ALS levels for abnormal presentations, such as breech babies or prolapsed cords. Otherwise, this protocol does a great job at giving a stepwise approach to assisting mom and baby through the delivery process. Honestly, I often refer to it myself as a refresher of the process.

Hopefully, having this protocol as a reference helps the vast majority of EMS crews get through an uneventful delivery. But what if baby is not doing alright? We’ll cover that next week, in…

Wait for it…

Our FINAL protocol!

(sort of)

www.nycremsco.org or the protocol binder for a sneak peak.

 Dave

EMS Protocol of the Week - Obstetric Emergencies

The EMS protocol for obstetric emergencies basically goes down one of two paths – is baby coming out or not? If so, it’s all about positioning and referring to the protocol for emergency childbirth (stay tuned!) But if not, the focus shifts to hemorrhage/shock management and close monitoring with a high index of suspicion for maternal hypertension and pre-eclampsia/eclampsia. If an ALS unit is taking care of the patient, this is where they will call OLMC requesting to give IV magnesium, generally as a 2-4g IV infusion. But again, like with any other order, make sure you confirm dosing with clear, closed-loop communication!

The rest of the game is about transport, at this point. That is, right up until baby comes a’knockin! What do our crews do then? We’ll find out next week! Unless you’re all about those spoilers, in which case you’ve got www.nycremsco.org and the protocol binder for more.

Dave

EMS Protocol of the Week - Smoke Inhalation (Adult and Pediatric) and Cyanide Exposure (Adult and Pediatric)

The NYC prehospital approaches to smoke inhalation and cyanide exposure are nearly identical, so it’s worth knocking them both out at once. Both protocols start with ABCs and burn management, and both then focus on the administration of cyanide toxicity kits for post-exposure patients who are symptomatic. You can refer to the PDFs directly for advice on dosing and administration considerations (remember: hydroxocobalaminBEFORE sodium thiosulfate to avoid medication inactivation!). Otherwise, note that prior to administering the cyanide toxicity kit is the ONLY instance in these protocols where paramedics are trained and ordered to draw blood (for pre-medication cyanide levels). 

The key difference in the protocol for cyanide exposure is the early recognition of a possible MCI scenario, which would require a Class Order for widespread medication orders that would then be dispatched through our OLMC line. We touched on this months ago with the WMD protocol and the use of nerve agent antidotes.

Scary stuff, but always better to be aware ahead of time! Want to get even MORE ahead? Check out www.nycremsco.org or the protocol binder to stay on top of it all!

Dave