This document reviews the EMS protocols for the Town of Vernon, focusing on medication administration and procedures. Key points covered include glucose administration for hypoglycemia, use of prescribed inhalers for asthma, CPAP, nitroglycerin and aspirin for chest pain, epinephrine for allergic reactions, oxygen delivery, Diastat and vagus nerve stimulation for seizures, naloxone for overdoses, and tourniquet and wound packing application. The protocols are based on the 2019.5 CT Statewide OEMS guidelines and require either direct medical oversight or operating within standing orders and guidelines set by the state and local medical control.

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