2020 Protocols

1. Town of Vernon
Emergency Medical Services

2. EMS PROTOCOLS

3. OBJECTIVES
 Review EMS Providers to CT Statewide OEMS
Protocols
 The proper use of medications under supervision of a
medical director or on standing order
 Understanding of each Medication
 Proper Dosage of each medication
 Indications / Contraindications

4. This presentation is based and follow the
CT STATEWIDE OEMS PROTOCOLS
Version 2019.5

5. ON-LINE ( Direct Medical Oversight)
 On-Line Medical Direction: is described as Direct
Medical Oversight (DMO) to render care for a patient.
 You the caregiver must contact Medical Control
(Direct Medical Oversight) and speak to a Doctor to
receive permission to administer / re-administer certain
medications prior to administration

6. OFF-LINE
 OFF-LINE: You are operating under a set of
guidelines or protocols that have been set by the
Statewide and / or local medical control.
 The medication / procedure is done under prior
authority of the sponsor hospitals Medical
Control Physician. (Standing Order)

7. Routine Patient Care 1.0
 Provides care and direction to follow for every
call
 Includes… Scene Size Up / Safety / Patient
Approach /ABC / Disability assessment /
Transport decision

8. EMR 1.1
 Reviews Scope of Practice for EMR’s
 Scope of Practice & Skills for ALL levels in
Appendix

9. Glucose (Hypoglycemia) 2.12 A/P
 Obtain FSBS (if able)
 If <70 Admin glucose
15Gms Oral Glucose
 Stop pump if Hypo and
cannot ingest Glucose
 May give more than one
glucose if remaining <70

10. Actions:
 increases blood glucose levels

11. Indications
 Altered mental status
 Hx of diabetes
 Known diabetic
 Blood Glucose level < 70mg/dl
 Signs & Symptoms of a diabetic Emergency
 Ability to swallow or gag reflex

12. Contraindications
 Unresponsive patient
 Patient unable to swallow (no gag reflex)

13. Side Effects
 May be aspirated
 No other reported side effects when given
properly

14. Dosage
 1 tube equals 15 grams of Glucose

15. Administration
 EMT’s
 Squeeze tube into mouth between cheek and
gum or under tongue and let absorb
 Reassess after 3-5 minutes
 Repeat Blood Glucose level
 If <70 mg/dl
 Repeat Glucose Administration
 Document administration, time and results

16. Administration
 ? Other possibilities (TIA / CVA)
 ? Opiate Overdose
 ? ETOH

17. Prescribed Inhalers
(Asthma) 2.5 A/P
CPAP 5.2

18. Inhaler Actions:
 relaxes bronchial smooth muscles, relieves
bronchospasm, reduces airway resistance, bronchial
dilation

19. Indications / Contraindications
INDICATIONS
Pt. exhibits signs & symptoms of Resp.
Distress
Non Adequate Breathing / Pulse Ox <94%
CONTRAINDICATIONS
Allergic
Pre-Caution with Rapid heart rates, HTN, C.P.

20. Side Effects
 Increased pulse rate
 Tremors
 Nervousness
 Nausea

21. Dosage
 Admin 4-6 Puffs
 Repeat every 5 minutes as needed
 MDI: Albuterol, Albuterol/Ipratropium
Bromide (DuoNeb)

22. Administration
 Confirm Shortness of Breath
 Confirm the patient has a prescribed inhaler
 Check expiration date
 Shake inhaler
 Have patient exhale

23. Administration
 Assist pt. if necessary
 Have PT. depress inhaler as they begin to inhale
deeply
 Have pt. hold breath for as long as comfortably
possible to have medication absorb
 Reassess
 Document time and dosage

24. CPAP

25. Continuous Positive Air Pressure
 Asthma patients who do not respond to MDI’s
 CHF Patients
 COPD Patients
 Pneumonia Patients
 MAX pressure of 10cm H2O

26. Acute Coronary Syndrome 3.0

27. Nitroglycerin / Aspirin
Nitroglycerin
 Confirm Pt’s own
 Expiration
 Admin 1 tablet or Spray
every 3-5 minutes until pain
subsides
 B.P. stays > 100 mmHg
 Total of 3 doses
Aspirin
 No Aspirin within 24 hours
 Able to swallow
 Admin (4) 81Mg baby aspirin
 Given once / not repeated

28. Nitro Actions
 Vascular smooth muscle relaxant
 Vasodilator which decreases myocardial
workload
 Decreases B/P
 Subsides C.P.

29. Nitro Indications
 Pt. is having C.P. cardiac in nature
 The Pt. has prescribed NTG to them
 Systolic B.P. >100

30. Nitro Contraindications
 Pt. has a SB.P. less than <100 mm/hg systolic
 Pt. has a head injury
 Use of a erectile dysfunction drug within the
past 48 hours (Viagra, Cialis,Levitra,
Staxyn,Revatio)

31. Nitro Dosage
 (1) tablet 0.4mg or (1) sublingual spray 1/150 gr.
 Repeated q5 minutes if continued C.P.
 B.P. checks between each dosage
 SB/P > 100mm Hg
 Repeat q5 minutes until symptom free or
maximum of 3 doses given

32. Nitro Administration
 Confirm C.P.
 Confirm prescribed nitro to Pt.
 Check expiration
 Determine if pt. has taken any doses and time
 Assess B.P.
 Determine usage of a Erectile medication within
48 hours
 All three NTG may now be given q5 if indicated
and necessary

33. Nitro Tablets
 Have pt. raise tongue up
 Administer to Pt. under tongue
 Advise Pt not swallow, allow tablet to absorb
under tongue

34. Nitro Spray
 Ask pt. to raise tongue
 Hand nitro spray to Pt. for self-administration
or spray the medication under Pt’s. tongue
 Advise Pt not to swallow for a few moments for
absorption

35. Aspirin Admin
 (4) 81mg tablets for total of 324mg (on
ambulances)
 Not expired
 Hand to patient they can self administer (if able)

36. Administration
 Evaluate for Hx of C.P. or new onset of C.P.
 Hx of C.A.D.
 Consider Nitro along with Aspirin
 Obtain vitals
 S.A.M.P.L.E. & EXAM
 Pour (4) tablets into gloved hand and hand to pt. to
chew tablets or administer to patient
 Reassess
 Document

37. Actions
 Inhibits platelet aggregation
 Decreases blood clotting time
 Slight Analgesic effects

38. Aspirin Contra
 Allergy's to ASA or NSAIDs
 Active GI Bleed

39. Side Effects
 Gastric irritation
 Nausea, vomiting
 Abd. Pain
 G.I. Bleeding

40. Allergic Reactions 2.3A / P
 Anaphylaxis
 EMR / EMT

41. Actions
 Dilates the bronchioles
 Constricts blood vessels
 Increases cardiac output and rate

42. Indications
Hypotension or respiratory compromise with known allergen exposure
OR:
Acute onset of symptoms and 2 or more of the following:
o Respiratory compromise (dyspnea, wheeze, stridor)
o Angioedema or facial/lip/tongue swelling
o Widespread hives, itching, swelling
o Persistent gastrointestinal involvement (vomiting, diarrhea, abdominal
pain)
o Altered mental status, syncope, cyanosis, delayed capillary refill, or
decreased level of consciousness associated with known/suspected
allergenic exposure
o Signs of shock

43. Contraindications
 Allergic

44. Side Effects
 An increase in H.R. and B.P.
 Pale skin
 Dizziness
 C.P.
 Headache
 Nausea, vomiting
 Excitability, anxiousness

45. Dosages
 Adult: 0.3mg (above 55 lbs.)
 Child: 0.15mg (below 55 lbs.)

46. Administration
 Confirm Allergic Reaction
 Use Direct Inject Epi From Ambulances
 Confirm it is not expired and liquid is clear
 Additional Dosing contact DMO

47. Oxygen Delivery
 Indicated in any condition with increased
Cardiac work load, respiratory distress or illness
or injury resulting in altered ventilation or
perfusion
 Supplemental oxygen is not needed without
evidence of the above or if SPO2 is <94%
(<90% for COPD Pt’s)
 If SPO2 is <94% oxygen maybe delivered
 Titrate to 94% or greater

48. Oxygen
 1-4 liters = Nasal Cannula
 6-15 liters = NRB
 15 liters or greater = BVM

49. Seizures 2.21 A/P
Diastat (Rectal Gel)
 Assist Family / Caregiver in
Administration
 Administered Rectally
Vagus Nerve Stimulation
 May assist family / Caregiver
 May administer VNS Magnet
 Pass Magnet closely over area
 Repeat q3-5 minutes if
unsuccessful
 Total of 3 times

50. Diastat Gel
 Diazepam (Valium)
 Seizure Control
 Administer as instructed (Family/ Caregiver)

51. Vagus Nerve Stimulator
 As stated stimulates Vagus Nerve
 Slows / Stops Seizures
 Activated by a magnet
 Implanted device similar to a pacemaker usually
upper left chest area
 Family or EMS may assist with magnet (Pt
should have magnet)

52. Naloxone (Narcan)
Poisoning / Overdose 2.20 A/P

53. Naloxone
 Suspected Opioid overdose with respiratory
depression
 Ineffective Respirations = <6 minute

54. Thinking Points
 “Addicts take opiates and other sedatives
specifically to induce a pleasant stupor. If they’re
lethargic and hard to arouse, but still breathing
EFFECTIVLY, it’s not an overdose.
“It’s a dose.”
 Naloxone is for depressed respirations, not
depressed mental status.
 Opiate use alone (without depressed
respirations) does not merit the use of naloxone.

55. Administration
 EMR / EMT
 Airway management Priority
 4mg IN
 Single nostril
 If inadequate response repeat 3-5 minutes
 Any additional doses contact DMO

56. Tourniquets 6.17 Pg. 152

57. Application
 Used to control a life threatening hemorrhage
on a injured extremity
 Used when bleeding cannot be controlled by
other means
Direct pressure
Pressure dressing
Tourniquet

58. Even if its not bleeding consider
a tourniquet in this scenario

59. Application
 2-3 inches above the wound
 Watch for other sites of bleeding
 above the wound
 Multiple bleeding sites
 proximal application
 May have to use two

60. Application
 Should be tight enough to stop bleeding
 The tourniquet should never be placed
 Joint (knee or elbow)
 Over an impaled object
 Extremity should be exposed
 Document application time
 Write on patient!

61. Application
 A prehospital tourniquet should not be
removed by EMS personnel without
authorization from their EMS Sponsor
Hospital/Medical Direction
 If application exceeds six hours, removal should
only be done by the physician providing
definitive care

62. Wound Packing
 EMR / EMT
 Used for severe hemorrhage in extremities or
central core where a Tourniquet cannot be
placed
 Find point of bleeding
 Apply direct pressure
 Use Gauze or Hemostatic treated Gauze to stop
bleeding

63. Wound Packing
 Hemostatic Gauze works within 3-5 minutes
 Fill all spaces
 Pack wound tightly
 Wrap with Pressure bandage

64. Questions
 Quiz

65. If you have any further questions or want more
information please refer to the Statewide
OEMS Protocols
Contact an EMS Supervisor
ctemscouncils.org