EMS Protocol of the Week - Undifferentiated Shock (Adult)

The new protocol for the adult patient in undifferentiated shock puts a lot of tools in the hands of paramedics. To be clear, the approach changes if there is a clear etiology for the shock, but for the patient who is in shock without a clear reason why, there’s now a protocol to assist! Providers at the BLS level will initiate transport procedures while checking a blood glucose level. ALS providers will obtain vascular access and check an EKG to look for a cardiac cause of the shock, after which they will initiate a 20mL/kg crystalloid bolus. If this doesn’t resolve the shock, paramedics can either administer a repeat bolus or start a vasopressor agent – options include infusions of norepinephrine or dopamine, or push-doses of epinephrine. After choosing an agent, if crews want to switch to a different agent (or give an additional one), OLMC can be used for additional orders. OLMC also has the option of authorizing vasopressin administration as another option.

Check the attached pdf for specifics in dosing, but overall this is a great summary of what’s now available in the paramedic’s toolbox for shock. Protocol binder or www.nycremsco.org for more.

Dave

EMS Protocol of the Week - Vaccine Administration (Adult and Pediatric)

Not really any big takeaways for OLMC this week, just a cool new feature added in light of the last couple years that provides some guidance in allowing EMTs to administer vaccines under the discretion of their medical directors. The attached appendix elaborates on the indications, contraindications, and preparations of the currently permitted vaccines (currently influenza and COVID [Pfizer and Moderna], with the potential for more in the future). Worth a glance for your own awareness and/or a vaccine refresher.

www.nycremsco.org or the protocols binder to tide you all over til next week!

Dave

EMS Protocol of the Week - General Pain Management (Adult and Pediatric)

New year, new protocols! The newest version of the REMAC protocols will be live on the streets in February, and there are plenty of new changes and additions to keep us all on our toes. One of the biggest new features is something that’s been long overdue and in the works for years – let’s kick things off with our new General Pain Management protocol!

A couple years ago, you found orders for the available prehospital pain meds (namely, morphine and fentanyl) scattered across different protocols – they were listed for burns or extremity injuries, and sometimes crews requested them as Discretionary Orders for abdominal pain, or eye pain, et cetera. Boiling everything down to one general pain management protocol brings a lot of simplicity to the process and decreases opportunities for error.

Even more exciting, however, is the fact that this protocol finally introduces some non-opiate analgesic alternatives to the ALS toolbelt! Ketorolac and acetaminophen have entered the arena as Standing Order options for paramedics, with ketamine becoming a Medical Control Option for you all answering the OLMC phone. When discussing these meds over the phone, be sure to review any possible contraindications for these new medications with the crews (as written out in the protocol), and, as always, remember to practice good closed-loop communication to confirm dosage and route for all medications.

And for those of us on the receiving end of these patients, here’s an extra reminder of the importance of verifying prehospital medications to avoid excessively dosing any of these meds.

This is an amazing step forward for the quality of care our crews can provide out in the field, and I’m excited to keep showing you what more to expect this year! Check the protocol binder for more, as well as www.nycremsco.org for the entirety of the 2022 version.

Dave