2015 BLS Protocols

1. Town of VernonTown of Vernon
Emergency Medical ServicesEmergency Medical Services

2. BLS PROTOCOLSBLS PROTOCOLS

3. OBJECTIVESOBJECTIVES
 Review E.M.T.’S to current North Central CT EMSReview E.M.T.’S to current North Central CT EMS
Region & ECHN BLS Protocols for which you mayRegion & ECHN BLS Protocols for which you may
render carerender care
 The proper use of medications under supervision of aThe proper use of medications under supervision of a
medical director or on standing ordermedical director or on standing order
 Define “ ON-LINE vs. OFF-LINE” CareDefine “ ON-LINE vs. OFF-LINE” Care
 Understanding of each MedicationUnderstanding of each Medication
 Proper Dosage of each medicationProper Dosage of each medication
 Indications / ContraindicationsIndications / Contraindications

4. These Protocols are Based and follow theThese Protocols are Based and follow the
North Central Connecticut RegionalNorth Central Connecticut Regional
Guidelines and ECHN BLS Protocols. AsGuidelines and ECHN BLS Protocols. As
best as possible each protocol is referenced tobest as possible each protocol is referenced to
the page number that it corresponds to in thethe page number that it corresponds to in the
Regional Guidelines updated version 9/2014Regional Guidelines updated version 9/2014

5. ON-LINEON-LINE
 On-Line Medical Direction: is described as directOn-Line Medical Direction: is described as direct
medical contact with medical control to render care formedical contact with medical control to render care for
a patient.a patient.
 You the care giver must contact Medical Control andYou the care giver must contact Medical Control and
speak to a Doctor to receive permission to administerspeak to a Doctor to receive permission to administer
certain medications prior to administration.certain medications prior to administration.

6. ON-LINEON-LINE
 OFF-LINE: You are operating under a set ofOFF-LINE: You are operating under a set of
guidelines or protocols that have been set byguidelines or protocols that have been set by
your regional or local medical control.your regional or local medical control.
 The medication is given under prior authority ofThe medication is given under prior authority of
the sponsor hospitals Medical Controlthe sponsor hospitals Medical Control
Physician. (Standing Order)Physician. (Standing Order)

7. GlucoseGlucose
 Altered Level ofAltered Level of
ConsciousnessConsciousness
 Page 37 North CentralPage 37 North Central
Regional ProtocolsRegional Protocols

8. Generic Name:Generic Name:
 Oral glucoseOral glucose
Trade Name:Trade Name:
 Glucose, Insta-GlucoseGlucose, Insta-Glucose
Actions:Actions:
 increases blood glucose levelsincreases blood glucose levels

9. IndicationsIndications
 Altered mental statusAltered mental status
 Hx of diabetesHx of diabetes
 Known diabeticKnown diabetic
 Signs & Symptoms of a diabetic EmergencySigns & Symptoms of a diabetic Emergency
 Ability to swallow or gag reflexAbility to swallow or gag reflex
 Blood Glucose level < 80mg/dlBlood Glucose level < 80mg/dl

10. ContraindicationsContraindications
 Unresponsive patientUnresponsive patient
 Patient unable to swallow (no gag reflex)Patient unable to swallow (no gag reflex)

11. Side EffectsSide Effects
 May be aspiratedMay be aspirated
 No other reported side effects when givenNo other reported side effects when given
properlyproperly

12. DosageDosage
 1 tube equals 15 grams of Glucose1 tube equals 15 grams of Glucose
 Second tube requires Medical Control (on-line)Second tube requires Medical Control (on-line)

13. AdministrationAdministration
 Squeeze tube into mouth between cheek andSqueeze tube into mouth between cheek and
gum or under tongue and let absorbgum or under tongue and let absorb
 Reassess after a few minutesReassess after a few minutes
 Document administration, time and resultsDocument administration, time and results

14. Prescribed InhalersPrescribed Inhalers
 Respiratory DistressRespiratory Distress
 Page 30 North CentralPage 30 North Central
Regional GuidelinesRegional Guidelines

15. Generic Name:Generic Name:
 AlbuterolAlbuterol
Trade Names:Trade Names:
 Proventil, VentolinProventil, Ventolin
Actions:Actions:
 relaxes bronchial smooth muscles, relievesrelaxes bronchial smooth muscles, relieves
bronchospasm, reduces airway resistance, bronchialbronchospasm, reduces airway resistance, bronchial
dilationdilation

16. Indications / ContraindicationsIndications / Contraindications
INDICATIONSINDICATIONS
Pt. exhibits signs & symptoms of Resp.Pt. exhibits signs & symptoms of Resp.
DistressDistress
**If this is patients’ first dose it may beIf this is patients’ first dose it may be
administered prior to Med-Con (off-line)administered prior to Med-Con (off-line)
CONTRAINDICATIONSCONTRAINDICATIONS
None for field use
Pre-Caution with Rapid heart ratesPre-Caution with Rapid heart rates
Pre-Caution with pt’s. with HTN or C.P.Pre-Caution with pt’s. with HTN or C.P.

17. Side EffectsSide Effects
 Increased pulse rateIncreased pulse rate
 TremorsTremors
 NervousnessNervousness
 NauseaNausea

18. DosageDosage
 Take 1-2 inhalationsTake 1-2 inhalations
 Maybe repeated after 15 minutesMaybe repeated after 15 minutes**
** Requires Medical ControlRequires Medical Control

19. AdministrationAdministration
 Confirm Shortness of BreathConfirm Shortness of Breath
 Confirm the patient has a prescribed inhalerConfirm the patient has a prescribed inhaler
 Check expiration dateCheck expiration date
 Determine if patient has taken any doses yetDetermine if patient has taken any doses yet
 ** If this is first dose it may be given prior to contactingIf this is first dose it may be given prior to contacting
Med-ControlMed-Control
 Obtain medical control (on-line)Obtain medical control (on-line)
 Shake inhalerShake inhaler
 Have patient exhaleHave patient exhale

20. AdministrationAdministration
 Assist pt. in putting lips around opening ofAssist pt. in putting lips around opening of
inhalerinhaler
 Have PT. depress inhaler as they begin to inhaleHave PT. depress inhaler as they begin to inhale
deeplydeeply
 Have pt. hold breath for as long as comfortablyHave pt. hold breath for as long as comfortably
possible to have medication absorbpossible to have medication absorb
 ReassessReassess
 Document time and dosageDocument time and dosage

21. NitroglycerinNitroglycerin
 Acute CoronaryAcute Coronary
Syndromes (Chest Pain)Syndromes (Chest Pain)
 Page 10 North CentralPage 10 North Central
Regional GuidelinesRegional Guidelines

22. Generic NameGeneric Name
 NitroglycerinNitroglycerin

23. Trade NamesTrade Names
 NitrostatNitrostat
 NitrobidNitrobid
 Nitro sprayNitro spray

24. ActionsActions
 Vascular smooth muscle relaxantVascular smooth muscle relaxant
 Vasodilator which decreases myocardialVasodilator which decreases myocardial
workloadworkload
 Decreases B/PDecreases B/P
 Subsides C.P.Subsides C.P.

25. IndicationsIndications
 Pt. is having C.P. (Angina Pectoris)Pt. is having C.P. (Angina Pectoris)
 The Pt. has prescribed NTG to themThe Pt. has prescribed NTG to them
 Systolic B.P. >100Systolic B.P. >100

26. ContraindicationsContraindications
 Pt. has a B.P. less than <100 mm/hg systolicPt. has a B.P. less than <100 mm/hg systolic
 Pt. has a head injuryPt. has a head injury
 Pt. has taken the maximum number of dosesPt. has taken the maximum number of doses
(3 in 10 minutes) P.T.A.(3 in 10 minutes) P.T.A.
 Use of a erectile dysfunction drug within theUse of a erectile dysfunction drug within the
past 48 hourspast 48 hours

27. DosageDosage
 (1) tablet or (1) sublingual spray(1) tablet or (1) sublingual spray
 Repeated every 3-5 minutes if continued C.P.Repeated every 3-5 minutes if continued C.P.**
 B.P. checks between each dosage > 100mm HgB.P. checks between each dosage > 100mm Hg
 Maximum of 3 dosesMaximum of 3 doses

28. AdministrationAdministration
 Confirm C.P.Confirm C.P.
 Confirm Pt. has prescribed nitroConfirm Pt. has prescribed nitro
 Check expirationCheck expiration
 Determine if pt. has taken any doses and timeDetermine if pt. has taken any doses and time
 Assess B.P.Assess B.P.
 ** If this is Pt’s. first dose of NTG it maybeIf this is Pt’s. first dose of NTG it maybe
given on Standing Ordergiven on Standing Order
 Get Med Control (for subsequent doses)Get Med Control (for subsequent doses)

29. TabletsTablets
 Have pt. raise tongue upHave pt. raise tongue up
 Administer to Pt. under tongueAdminister to Pt. under tongue
 Advise Pt not swallow until the tablet isAdvise Pt not swallow until the tablet is
absorbedabsorbed

30. Nitro SprayNitro Spray
 Ask pt. to raise tongueAsk pt. to raise tongue
 Hand nitro spray to Pt. for self-administration orHand nitro spray to Pt. for self-administration or
spray the medication under Pt’s. tonguespray the medication under Pt’s. tongue
 Advise Pt not to swallow for a few moments forAdvise Pt not to swallow for a few moments for
absorptionabsorption

31.  REASSESSREASSESS
 DOCUMENTDOCUMENT

32. Epinephrine Auto InjectorEpinephrine Auto Injector
 AnaphylaxisAnaphylaxis
 Page 36 North CentralPage 36 North Central
Regional GuidelinesRegional Guidelines

33. Generic NameGeneric Name
 epinephrineepinephrine

34. Trade NameTrade Name
 AdrenalinAdrenalin
 Epi-penEpi-pen
 Epi-pen jr.Epi-pen jr.

35. ActionsActions
 Dilates the bronchiolesDilates the bronchioles
 Constricts blood vesselsConstricts blood vessels
 Increases cardiac output and rateIncreases cardiac output and rate

36. IndicationsIndications
Anaphylaxis, is considered a multisystem response to
an allergen including one or more of the following
signs or symptoms
 Severe Respiratory Distress
 Airway compromise (including wheezing,
swelling of lips/tongue, throat tightness)
 Widespread hives, itching, swelling
 Abdominal pain, nausea, vomiting
 Signs of shock

37. ContraindicationsContraindications
 None if used in life threatening allergic reactionsNone if used in life threatening allergic reactions

38. Side EffectsSide Effects
 An increase in H.R. and B.P.An increase in H.R. and B.P.
 Pale skinPale skin
 DizzinessDizziness
 C.P.C.P.
 HeadacheHeadache
 Nausea, vomitingNausea, vomiting
 Excitability, anxiousnessExcitability, anxiousness

39. DosagesDosages
 Adult: 0.3mg (above 66 lbs.)Adult: 0.3mg (above 66 lbs.)
 Child: 0.15mg (below 66 lbs.)Child: 0.15mg (below 66 lbs.)

40. AdministrationAdministration
 Confirm Allergic ReactionConfirm Allergic Reaction
 Obtain Epi-pen (age Appropriate) fromObtain Epi-pen (age Appropriate) from
AMBULANCESAMBULANCES
 Confirm it is not expired and liquid is clearConfirm it is not expired and liquid is clear
 If patient is having a severe allergic Reaction asIf patient is having a severe allergic Reaction as
defined in indications, Epi may be given ondefined in indications, Epi may be given on
Standing OrderStanding Order
 Contact medical Control if second Epi-pen isContact medical Control if second Epi-pen is
thought to be needed after reassessmentthought to be needed after reassessment

41. AdministrationAdministration
 Remove safety cap from injector to “arm” itRemove safety cap from injector to “arm” it
 Place tip of injector against the lateral side ofPlace tip of injector against the lateral side of
pt’s. thigh between the waist and kneept’s. thigh between the waist and knee
 Push injector firmly against leg until it activatesPush injector firmly against leg until it activates
 Hold injector in place until all medication isHold injector in place until all medication is
injected (approx. 5-10 seconds)injected (approx. 5-10 seconds)
 Remove and dispose of injector as a sharpRemove and dispose of injector as a sharp
 Be careful of exposed needleBe careful of exposed needle

42.  Reassess patients vitalsReassess patients vitals
 DOCUMENTDOCUMENT

43. AspirinAspirin
 Acute CoronaryAcute Coronary
Syndromes (Chest Pain)Syndromes (Chest Pain)
 Page 10 North CentralPage 10 North Central
Regional GuidelinesRegional Guidelines

44. Generic:Generic:
 AspirinAspirin
Trade:Trade:
 Bayer, Ecotrin,Bayer, Ecotrin,

45. ActionsActions
 Inhibits platelet aggregationInhibits platelet aggregation
 Decreases blood clotting timeDecreases blood clotting time
 Slight Analgesic effectsSlight Analgesic effects

46. IndicationsIndications
 Chest pain of cardiac originChest pain of cardiac origin
 Signs & symptoms of C.P.Signs & symptoms of C.P.

47. ContraindicationsContraindications
 Allergies / HypersensitivityAllergies / Hypersensitivity
 G.I. BleedingG.I. Bleeding
 Active ulcer diseaseActive ulcer disease
 Bleeding disordersBleeding disorders
 Hemorrhagic strokeHemorrhagic stroke

48. Side EffectsSide Effects
 Gastric irritationGastric irritation
 Nausea, vomitingNausea, vomiting
 Abd. PainAbd. Pain
 G.I. BleedingG.I. Bleeding

49. DosageDosage
One Dose EqualsOne Dose Equals
 4 chewable baby aspirin (81mg each) = 324 mg4 chewable baby aspirin (81mg each) = 324 mg
 Not repeatedNot repeated

50. AdministrationAdministration
 Evaluate for Hx of C.P. or new onset of C.P.Evaluate for Hx of C.P. or new onset of C.P.
 Hx of C.A.D.Hx of C.A.D.
 Consider Nitro along with AspirinConsider Nitro along with Aspirin
 Obtain vitalsObtain vitals
 S.A.M.P.L.E. & EXAMS.A.M.P.L.E. & EXAM
 Pour (4) tablets into gloved hand and hand to pt. toPour (4) tablets into gloved hand and hand to pt. to
chew tablets or administer to patientchew tablets or administer to patient
 ReassessReassess
 DocumentDocument

51. Oxygen DeliveryOxygen Delivery
 Supplemental oxygen is not needed wSupplemental oxygen is not needed without
evidence of Respiratory Distress if SPO2 >94%evidence of Respiratory Distress if SPO2 >94%
 If SPO2 is <94% oxygen maybe deliveredIf SPO2 is <94% oxygen maybe delivered
 Titrate to 94% or greaterTitrate to 94% or greater

52. INITIAL TRAINING HELD:INITIAL TRAINING HELD:
FEBRUARY & MARCH 2015FEBRUARY & MARCH 2015
WILL BECOME PART OFWILL BECOME PART OF
YEARLY PROTOCOLYEARLY PROTOCOL
REQUIREMENTSREQUIREMENTS
CPAPCPAP

53. INITIAL TRAINING HELD:INITIAL TRAINING HELD:
FEBRUARY & MARCH 2015FEBRUARY & MARCH 2015
WILL BECOME PART OFWILL BECOME PART OF
YEARLY PROTOCOLYEARLY PROTOCOL
REQUIREMENTSREQUIREMENTS
NALOXONENALOXONE

54. If you have any further questions or want moreIf you have any further questions or want more
review please refer to the North Centralreview please refer to the North Central
Regional Guidelines (Version 9/2014) orRegional Guidelines (Version 9/2014) or
contact an EMS Supervisorcontact an EMS Supervisor
ctemscouncils.orgctemscouncils.org