Videos; ALS Collaborative Protocols; Posts. Advisory 2020-08 Flu Prevention; Advisory 2020-07 Suspension of … If the respirations remain absent, gasping, or become depressed (< 30/min) despite stimulation, if the airway is obstructed, or if the heart rate is < 100/min: Clear the infant’s airway by suctioning the mouth and nose gently with a bulb syringe, and then ventilate the infant at a rate of 40-60 breaths/minute with an appropriate BVM as soon as possible, with a volume just enough to see chest rise. New York American College of Emergency Physicians. Links to the protocol training modalities for currently credentialed TEKs are also available there, as are links to Paramedic, Critical Care and AEMT level credentialing exams for new … KEY POINTS **Lactated Ringers may be substituted for normal saline, if there is a persistent shortage and normal saline is not available. The MLREMS region has previously incorporated many of the changes in the 2019 New York State EMS Collaborative Protocols through the implementation of our local care bundles. However, it will be expected that any deviations from protocol shall be documented and reviewed, according to regional procedure. Consider long-term paralysis with rocuronium or vecuronium, if available, Inadequate response to sedation and pain management may be secondary to insufficient sedation and/or analgesia. The New York State EMS Collaborative Protocols are now available. The patient may be covered and, if allowed by law enforcement, may be moved to an adjacent private location. Follow common sense, apply good clinical judgment, and follow regionally approved policies and procedures, All passengers including patients and EMS personnel should be restrained. Pursuant to the provisions of Public Health Law, the individual having the highest level of prehospital medical certification, and who is responding with authority (duty to act) is responsible for providing and/or directing the emergency medical care and the transportation of a patient. The color-coded format of the protocols allows each EMS professional to easily follow the potential interventions that could be performed by level of certification. (Resources: Prescribed Medication Assistance), If abnormal, refer to the “General: Hypoglycemia - Pediatric” protocol, Midazolam (Versed) 0.1 mg/kg IM or intranasal. The WREMAC will issue new guidance on cardiac arrest management in the near future. Re: NYS BLS and ALS Collaborative Protocols Ladies and Gentlemen, I welcome you all to the innovative New York State Department of Health, Bureau of Emergency Medical Services and Trauma Systems Learning Management System (LMS) Vital Signs Academy . The provision of patient care is a responsibility given to certified individuals who have completed a medical training and evaluation program specified by the NYS Public Health or Education Laws and subject to regional and State regulations or policy. The NYS EMS Collaborative protocol app allows users to make clinical decisions with ease. Consider allergic reaction, airway obstruction, pulmonary edema. As of the date of this memo, the EMS Medical Directors on the WREMAC do not feel our region meets a community crisis standard. These protocols are intended to guide and direct patient care by EMS providers across New York State. The collaborative protocols have been developed to serve all the levels of certification within New York State. Download NYS EMS Collaborative Protocol PC for free at BrowserCam. Hypertension or volume overload can quickly cause pulmonary edema to develop. Pediatric patients with suspected infection who are abnormally hot or cold to touch, and/or have a fever over 100.4° F (38° C), or less than 96.8° F (36° C) and high heart rate (age dependent) and/or high respiratory rate (age dependent) with: Poor perfusion (capillary refill > 3 seconds, decreased peripheral pulses, distal extremity [hands/feet] coolness and dusky color, or age-dependent hypotension), altered mental status (lethargy, irritability), Airway management and give high flow oxygen (non-rebreather as tolerated), Normal saline 20 mL/kg bolus IV (Use normal saline 100 mL bag if patient < 20 kg), Consult medical control if you suspect cardiogenic shock, Do not use normal saline 1000 mL (one liter) bags for pediatric patients unless they weigh ≥ 20 kg, Sepsis / septic shock is a life-threatening condition in children and must be recognized and treated as rapidly as possible, *Blood pressures may be very difficult to obtain in infants - assure the respiratory rate and pulse are measured accurately, Communication with the destination hospital is critical so that they can prepare to treat the child aggressively, Oxygen via non-rebreather mask (NRB) at 15 LPM, Apply a carbon monoxide monitor, if equipped, See also “General: Carbon Monoxide Exposure - Suspected,” protocol, If the patient is in respiratory distress or rales are present and there is no soot in the airway, consider CPAP* 5-10 cm H2O (if the device delivers 100% oxygen), Cardiac monitor with 12-lead ECG, when possible, Hydroxy cobalamin (CyanoKit) 5 grams IV over 15 minutes, Hydroxycobalamin (CyanoKit) 70 mg/kg IV over 15 minutes, Repeat dose hydroxycobalamin (CyanoKit) 5 grams IV over 15 minutes to 2 hours (depending on clinical condition), Hydroxycobalamin (CyanoKit) is not available in all ambulances, and may not be available in all regions. Many processes are not sequential and tasks should be performed as most appropriate for patient care. NYSDOH Protocols Listing. warfarin/Coumadin), Fentanyl should be used if there is concern for potential hemodynamic instability, For ease of administration, if clinically appropriate: consider approximating the dose of fentanyl and administer either 25 or 50 mcg; consider approximating the dose of morphine and administer either 2.5 or 5 mg, Refer to the “General: Nausea and/or Vomiting (>2 y/o) - Pediatric” protocol, if needed, This protocol is intended for the undifferentiated toxic exposure, For a suspected carbon monoxide exposure, see the “General: Carbon Monoxide Exposure - Suspected” protocol, For an opioid overdose, see the “General: Opioid (Narcotic) Overdose” protocol, For an organophosphate exposure, see “General: Organophosphate Exposure” protocol, For smoke inhalation, see “General: Smoke Inhalation/Cyanide Poisoning - Symptomatic” protocol, For altered mental status, see “General: Altered Mental Status” protocol, If suspected WMD nerve agent, refer to the “Resource: Nerve Agent-Suspected” protocol, Refer to the “General: Hypoglycemia - Adult” protocol, as indicated, For contamination of the skin or eyes, refer to the “Trauma: Burns” protocol, Consider a 12-lead ECG, especially if the patient is bradycardic or tachycardic. Select the appropriate mode, if applicable For patients presenting with hot, flushed, and dry skin: Apply cold packs to patient’s neck, groin, and armpits, Keep the patient’s skin wet by applying wet sponges or towels, For adult patients only, consider normal saline 500 cc IV bolus; may repeat up to 2 liters as needed, if there are no signs of pulmonary edema and no concern for water intoxication*, Additional IV fluid hydration or IV fluid hydration in children, Stable patients with normal mental status and no signs of hot, dry skin may only require oral rehydration and cooling, Do not delay transport to treat the patient on the scene; transport is suggested for all patients who present with a heat emergency, *Water intoxication occurs when patients ingest excessive water which causes potentially life-threatening electrolyte abnormalities, Suspect in long distance runners who consume large amounts of water and present with collapse or confusion, Cool the patient, as indicated, and contact medical control before administering any fluid to a patient with suspected water intoxication, Temperature ≥ 2°F (1°C) over baseline, Recipient of a blood / blood product transfusion, Patient has not had a total dose of >650 mg of acetaminophen (either acetaminophen or an acetaminophen containing product) or > 400 mg of ibuprofen within the last 4 hours, Normal saline 500 mL bolus; may repeat once, if lung sounds remain clear (no concerns for pulmonary edema). KVO, 250 mL/hr, open) and total fluid infused should be noted on the PCR, Good clinical judgment will dictate the maximum number of vascular access attempts, Do not delay transport solely to attempt vascular access, If the patient is in EXTREMIS and a lifesaving intervention will be performed, establish access to the device. Designed by a medical team with years of pre-hospital experience, NYS EMS Collaborative protocol app allows users to … If abnormal, refer to the “General: Hypoglycemia - Pediatric” protocol, as indicated, A team approach should be attempted for the safety of the patient and the providers, For adult patients who are extremely combative and are at immediate risk of causing physical harm to emergency responders, the public, and/or themselves. Collaborative agreement. The courses and modules contained within the eLearning Institute, have been created with you, the user, in mind. If any pads, patches, or other medical equipment have been applied, they should be left in place, Notify law enforcement. Be prepared for respiratory arrest, Expiratory wheezing does not always indicate asthma. On this episode, we start right where we left off discussing part two of the historic New York State Collaborative Protocols.The nuances, the evidence, the rational for implementing it and instituting this new set of protocols across 13 out of the 16 regions in New York State. Rocuronium is to be used for paralysis only when succinylcholine is contraindicated. Select the appropriate inspiratory time (It), if applicable Each region will determine which levels will be credentialed to practice within their jurisdiction. Assess pulse and artificial heart function: Consider early consult with TAH coordinator or medical control, Check for severed or kinked TAH driveline (address if possible), Check battery position and power status (replace if possible), Use the backup driver, or hand pump, if available, Assess blood pressure: goal blood pressure is >90 mmHg and <150 mmHg, Perform a secondary assessment and treat per protocol, If unresponsive with a pulse, evaluate for noncardiac etiologies, Assure that patient has both drivers (compressors), hand pump, all batteries, and power cords for transport, Any trained support member should remain with patient, If blood pressure is >150 mmHg administer sublingual nitroglycerin 0.4mg, Repeat sublingual nitroglycerin 0.4mg every 5 minutes if BP>150 mmHg. If a single attempt to replace the uterus fails, cover the exposed uterus with moistened sterile towels, Magnesium 4 grams in 100 mL IV over 20 minutes, Transport to the closest appropriate hospital, if delivery is imminent or occurs on scene, If a patient is unwilling to go to the closest appropriate hospital, consult medical control for assistance in determining an appropriate destination, For the evaluation and resuscitation of babies just delivered. AutoPulse®, LUCAS®, LifeStat®, or other FDA approved device), Cycle of CPR = 30 compressions then 2 breaths (single rescuer) 15 compressions then 2 breaths (if two rescuers available), 5 cycles = 2 minutes (10 cycles = 2 minutes for 2-rescuers), Rotate compressors every two minutes with rhythm checks, as resources allow, Use of level-appropriate airway adjuncts and bag-mask device (BVM), as indicated, with BLS airway management, including suction (as needed), as available, Bag-mask should be connected to supplemental oxygen, if available, Rhythm check or AED “check patient” every two minutes of CPR, Defibrillate as appropriate (Pediatric AED pads preferred for children with weight < 25 kg or age < 8 years, if available.) New York State EMS Collaborative Protocols. Ability to add PEEP or PEEP valve in the minimum range of 5 - 10 cmH2O An FiO2 of 1.0 (100% O2) is a standard start and then should be titrated down to maintain SpO2 ≥ 94% NYS Collaborative Protocol; Prehospital Ultrasound. A copy of the DNR, MOLST, or eMOLST must be attached to the PCR and retained by the agency for all transports from a sending facility to a nursing home, Pressure limit/safety relief at a maximum of 40 cmH2O, Ability to adjust volume to 4-8 mL/kg ideal body weight, Ability to adjust rate in the minimum range of 10-30 breaths/min, Ability to add PEEP or PEEP valve in the minimum range of 5 - 10 cmH, Ability for patient triggered breaths (complete control ventilation is prohibited), Prepare the BVM device for emergent use in case of a ventilator failure, Assure a secondary oxygen source with a minimum of 1000psi in a D tank, Attach a ventilator to appropriate oxygen/air source, Attach a disposable ventilator circuit to ventilator, Attach a gas outlet, pressure transducer, and exhalation valve tubes to corresponding connectors, Select the appropriate mode, if applicable, Select the appropriate respiratory rate (RR). 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