EMS Protocol of the Week - Drowning/Decompression Illness (Adult and Pediatric)

It’s summertime! Which means it’s hot out! Which means people are going swimming! Which means people are drowning!

Not a ton unexpected out of the protocol for drowning and decompression illness. ABCs again, with a reminder for spinal precautions as needed. The protocol refers out to the previously discussed section on Cold Emergencies for suspected hypothermia and reminds providers to initiate CPR on pulseless hypothermic patients. For suspected decompression illness, EMTs will place the patient left side down in case of air emboli. Most importantly, they are instructed to transport the patient and any companion divers to the nearest appropriate hospital (in this case, one with hyperbarics). The attached appendix is a list of facilities with specialty care capabilities, including hyperbarics.

That’s it! ABCs, protect the spine, know where to look up the closest dive tank, and you’re not dead til you’re warm and dead!

See you all next week! www.nycremsco.org and the protocol binder for more.

 Dave

EMS Protocol of the Week - Weapons of Mass Destruction Nerve Agent Exposure (Adult and Pediatric)

Timed up perfectly to coincide with our annual hazmat days is the REMAC’s WMD protocol, specifically with regards to weaponized nerve agents (think sarin gas). Obviously, incidents such as these, should they occur, would trigger all sorts of MCI operations, but the point of this protocol specifically is to highlight how the use of antidotes (in this case, DuoDote – the atropine/pralidoxime combo autoinjector) is operationalized. In these cases, one of the FDNY EMS medical directors would issue a Class Order instructing agencies to start utilizing this specialized intervention, an order which may wind up disseminated to OLMC facilities like ours to further disseminate to EMS crews. Use this protocol as a reference tool in the specific dosing of DuoDotes; note that there are separate tables for initial treatment, subsequent management, and pediatrics specifically. Also note that these tables all fall under a CFR header, meaning CFRs, EMTs, and paramedics can all administer these autoinjectors.

Of course, this protocol will hopefully never need to be utilized, but having these sort of strategies set ahead of time goes a long way in disaster preparedness and protection of life in what is hopefully a never-event.

Thanks for reading! www.nycremsco.org and the protocol binder for more!

Dave

EMS Protocol of the Week - Abdominal Injuries and Chest Injuries (Adult and Pediatric)

Last week, we talked about what EMS does for someone whose belly hurts. This week, we get to talk about what EMS does for someone whose belly hurts because they got stabbed! 

Once again we find ourselves discussing trauma protocols, which comes with the requisite reminder that the majority of prehospital trauma care comes at the BLS level, since the name of the game is generally rapid transport to the hospital. For abdominal injuries, after addressing ABCs there’s little more involved aside from special considerations for evisceration injuries (tldr – don’t shove bowel back inside, just cover it with moist gauze). For chest injuries, the protocol addresses dressing (and, if needed, “burping” the dressing for) sucking chest wounds. There is also reference to Appendix O, which describes how to perform a needle decompression in cases of tension pneumothorax. 

Not a lot of OLMC-specific stuff in either of these protocols, but now you have something to refer to the next time an EMT calls the phone asking for help! www.nycremsco.org or the protocol binder if you want to brush up even more. 

Dave