EMS Protocol of the Week - Traumatic Cardiac Arrest (Adult and Pediatric)

For the large number of “medical” cardiac arrest calls we field on the OLMC phone, we rarely (if ever) get calls from crews asking for orders in traumatic cardiac arrest. Why? Well for one, as you can see in this week’s protocol, the only real Medical Control Option available in traumatic cardiac arrest is for additional crystalloid fluid resuscitation, which I think we can all agree is probably not the lifesaving intervention here. But more to the point, as you read through the protocol from the top down, you’ll see how high a priority it is for crews to simply transport the patient, starting at the EMT level. Remember, this is in line with most trauma jobs, which are usually managed by EMTs who can more rapidly bring these patients to a trauma center for definitive care rather than spend extra time securing vascular access or an airway in the street. So don’t be caught off guard if BLS rolls in a traumatic arrest rolls with chest compressions, a BVM and nothing else; the EMTs are doing what they were trained to do!

Look at us, gang, we’ve made it through another year of these emails! I really appreciate you all taking the time to read through these and provide feedback, and I’m glad to hear that it’s helped some of you have more informed interactions with our EMTs and paramedics. But look at me, prattling on…such a bleeding heart.

www.nycremsco.org and the protocol binder for all you go-getters out there!

Dave

EMS Protocol of the Week - Bleeding / Hemorrhage Control (Adult and Pediatric)

It’s important to keep in mind that all the approaches for hemorrhage control described in this week’s protocol should be considered adjuncts to our first line defense against rapid exsanguination: direct pressure. Applying a tourniquet proximally? Keep pressure on that distal bleed. Packing a junctional wound? Maintain constant pressure on top. Placing a pressure dressing? Put some pressure on that pressure! Even the fancy hemostatic dressings (QuikClot, etc) can only help so much without some direct pressure to zhuzh it up.

You guys I’m actually pretty proud of keeping up with the puns at the end of these emails. Even for gross ones like uncontrolled bleeding. But, like…I don’t wanna gush.

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

 Dave

EMS Protocol of the Week - Acute Coronary Syndrome / Suspected Myocardial Infarction / Chest Pain (Adult)

Chest pain: it's our bread and butter in the ED, and it’s similarly a fairly straightforward EMS protocol. Providers at the CFR level can give chewable aspirin, while EMTs can assist with administering a patient’s own, previously prescribed nitro. Paramedics can independently give nitro if appropriate, but crucially, they’ll be the ones to perform and interpret the 12-lead EKG to answer the ever-important question: “STEMI or no STEMI?” Once again I’m attaching the specialty center appendix to show which NYC hospitals are currently equipped to receive STEMIs. For those of us answering the OLMC phone, the most important thing we will often be providing to these jobs is our own interpretation of the EKG (either via an emailed copy or, sometimes, just a verbal report), as well as guidance as to whether or not crews should divert from the nearest hospital to go to a STEMI center, instead.

I hope you all have been appreciating these emails as of late, I really do put a lot of…heart…into them? ha ha you’re all welcome www.nycremsco.org and the protocol binder for more.

Dave