Use of EMS units as transport units

If pt is transported to a facility that is not capable of taking care of the pt, you may be able to use the same squad to transport the pt to another facility

Need to have an accepting doc

May need to send additional personnel with the squad

Hypotension/Shock protocol

Push dose Epi regardless of type of shock - 1 ml of cardiac Epi into 9 mls of NS flush 1 ml q1-2 min For more info - EMCrit Podcast on Push Dose Pressors

No more Dopamine!

Bradycardia: Versed for external pacing

Toxicology

No more activated charcoal

Cyanide: give cyanokit when both decreased level of consciousness and hypotension

Narcan: can give IN, no more than 1mL per nostril per dose

OTC medications: if pt requests OTC med for minor medical concern and they have no signs or symptoms of significant medical condition

Imminent delivery

Viability = 24 wks

Do not suction baby unless respiratory distress

Mom and baby go to SAME hospital whenever possible

Head or spinal trauma: can use hypertonic saline if pupil difference, decreased level of consciousness and evidence of head trauma

TXA: there is now a protocol for adults (only for trauma)

Emphasis on vital signs (SBP < 90, HR > 110) and timing (within 3 hours from injury)

Not for peds

Peds submersion in ice water

If there is ice, the patient has to be transported to CCHMC on Burnet (ECMO availability)

< 30 minutes, no ice on water and no signs of life can be transported to closest ED

Spine immobilization

AMS, intoxication, distraction, midline spine tenderness, neurologic injury à need backboard

Airway Protocol Updates

The term "rescue airway" is gone. Replaced by "supraglottic airway"

No more than 2 intubation attempts…for now

Do not stop compressions if CPR in progress

Hemorrhage control

Tools: tourniquet, wound packing, hemostatic gauze, TXA

Medication Changes

Removed medications: lasix, dopamine

Added medications: TXA, hypertonic, LR, narcan autoinjectors

Termination of resuscitation of trauma: transport if ROSC or may benefit from ED thoracotomy

Bag, manual C spine immobilization, bilateral needle decompression, IV/IO with saline, then put on monitor

PEA > 40 should be transported transport

PEA < 40 or asystole should be pronounced

The 2014 Southwest Ohio EMS Protocols can be found here on tamingthesru.com/hems-and-ems

We will post the 2015 SW Ohio EMS Protocols once they are finalized!