EMS Protocol of the Week - Anaphylaxis / Severe Allergic Reaction (Adult and Pediatric)

The prehospital approach to anaphylaxis in NYC is a good refresher of the graduated responsibilities and expectations of EMS providers across levels of training, especially as we are now seeing medication administration at each level:

-          One dose of IM epinephrine may be given at the CFR (firefighter) level

-          A second dose of IM epinephrine may be given at the BLS (EMT) level; EMTs may also administer nebulized ipratropium and albuterol, if needed

-          A third dose of IM epinephrine and additional albuterol nebs may be given at the ALS (paramedic) level; in addition, paramedics may administer steroids, diphenhydramine, and crystalloid fluids

-          OLMC may permit further doses of medications as needed

Remember that these protocols are formatted such that if, for example, a BLS unit is first on scene, EMTs will perform all the necessary actions under the CFR portion of the protocol prior to starting the EMT section. Similarly, paramedics will complete the CFR and EMT sections prior to starting the paramedic section.

Also bear in mind that the threshold between pediatric and adult dosing for IM epinephrine is either age > 9 years or weight > 30kg.

Reach out with questions! www.nycremsco.org and the protocol binder for more!

Dave

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

We're not quite at the point yet where EMS will initiate insulin therapy in the field, so for the time being, the prehospital approach to hyperglycemia mainly involves the recognition oh hyperglycemic emergencies. This means that, in addition to checking for an elevated glucometer reading, EMTs and paramedics will assess for altered mental status, dehydration, or tachypnea (ie, Kussmaul breathing compensating for DKA). ALS units will likely obtain vascular access and start fluid resuscitation on these patients, so be sure to confirm how much crystalloid was given during transport (if any) when calculating your own fluid repletion strategies. From there, the rest is up to you!

Have fun closing the gap! www.nycremsco.org and the protocol binder for more.

Dave

EMS Protocol of the Week - Asthma/COPD/Wheezing (Adult and Pediatric)

I’ll be one of the first to admit that these protocols can be pretty densely packed with text, which is why I always support finding a way to simplify or consolidate protocols without sacrificing medical care. Previously, steps were taken to combine approaches to asthma and COPD into one document, and this year, it’s been taken a step further by having protocols for your wheezy adult and pediatric patients all in one place. You all know how to take care of your asthmatics/puffers/bloaters, but reading through this week’s protocol serves both as a good refresher and as a good example of the graduated responsibilities from CFR, to EMT, to paramedic, depending on who is on the scene.

Give it a skim – it’ll…take your breath away?

I think I might be starting to repeat some of these bits.

www.nycremsco.org or the protocol binder for more.

Dave