EMS Protocol of the Week - General Trauma Care (Adult and Pediatric)

We’ll get more into specific trauma protocols throughout the year, but the protocol in place for general trauma care serves mostly to give the most basic level of approaches to supporting a patient and their ABCs during the initial scene encounter. It serves as a good refresher/reminder of some potentially more emergent injury patterns and what the first interventions should be.

The attached appendix also describes the criteria used in determining whether or not a patient should be brought to a trauma center or general ED. Keep in mind that, while there is some overlap, this is not for EMS to use in determining whether something is a Level 1, Level 2, or Level 3 trauma; it only helps guide them on transportation destination (ie, trauma center or not). The level of activation is done at the hospital level.

Hope that all makes sense! Reach out with questions, www.nycremsco.org and the protocol binder for more.

Dave

EMS Protocol of the Week - Excited Delirium (Adult and Pediatric)

Ever wonder why the occasional crew would look to give a whopping 10mg IM midazolam to the curmudgeonly, 50-pound grandma?

Historically, the only protocol that has allowed for sedative medications to be given to facilitate transport has been that for excited delirium, which by definition is supposed to be the hypermetabolic state in which the patient that is presenting an acute risk to self or others; there has not been a protocol for the simply agitated, uncooperative patient. That is still the case now, but in instances of dangerously aggressive geriatrics and pediatrics, there is now a greater shift to weight-base dosing when administering these meds. This has been an overarching change to many of the updated protocols this year, and it means that while the young, large, violent adult may still get the appropriate 10mg IM midazolam by Standing Order, the old, tiny, violent nana might only get 5mg, or less. Time will tell, but hopefully this leads to fewer instances of oversedation, without a large increase in OLMC calls requesting additional meds.

Happy sedating! www.nycremsco.org and the protocol binder for more.

Dave

EMS Protocol of the Week - Poisoning (Adult and Pediatric)

Previously combined with the protocol for overdoses, the prehospital approach to various types of poisoning is now given its own space to shine in the 2022 edition. First and foremost in terms of importance, as in all prehospital encounters, is for crews to ensure scene safety so as not to put themselves at further risk. From there, special considerations are given regarding decontamination of different potential exposures, from ingestion, to inhalation, to animal envenomation. Read through the attachment for specifics, as it serves as a good refresher of initial steps in management. Otherwise, this protocol contains the other basic tenets that you would expect – support ABCs, and transport to an appropriate facility (including Venomous Bite Centers as needed – check last week’s email to see where they are in the city!). 

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

Dave