The concept of referring out to other protocols is again on display this week, this time in support of pediatric respiratory distress/failure/arrest. This protocol starts with heavy emphasis on the CFR portion, given the importance of respiratory status in pediatrics. Note that there is a separate protocol to refer to in the case of suspected airway obstruction, but following from that, CFRs will administer supplemental oxygen and assist with ventilations if necessary. BLS will call for ALS backup while initiating transport (remember, lots of prehospital pediatric critical care in NYC focuses on rapid transport of the patient to a definitive care facility). If ALS is on scene and suspects overdose, they will administer naloxone as per the new Altered Mental Status protocol. They will also perform advanced airway management and needle decompression as indicated. Again, this is ideally all happening while the patient is already en route to the hospital, so the role for OLMC is limited to discussing vascular access in patients who may need it. Finally, the Key Points/Considerations section provides some reference/terminology info to assist in teasing out the degree of illness severity in these patients.
That about wraps it up! Some of these protocols appear a bit thinner now that there are portions that refer to other protocols, so don’t forget to refer to them for more info. You can do so at – you guessed it! – www.nycremsco.org and the protocols binder!
Dave