2013 Southwest Ohio pre hospital Protocol Update

2016 Southwest Ohio Pre Hospital Protocol UpdateAcademy of Medicine of Cincinnati Protocol Subcommittee

Hamilton Lempert, MD FACEP CEDC Chairman

Protocol Committee

Hamilton Lempert, MD FACEP CEDC ChairmanMary Ahlers, RN, CPC, NRPJustin Benoit, MDLarry Bennett, EsqMike Bilkasley, EMT-P, L.O., L.PedMike Bohanske, MDTodd Burwinkel EMT-PDustin J. Calhoun, MDSteve Coley NREMT-PKenneth Crank, NREMT-P Dave Derbyshire, NREMT-PTom Dietz, NREMT-PJeff Durr, EMT-PPamela Erpenbeck RN, NREMT-P Paul Gallo, EMT-PRyan Gerecht, MDMarilyn Goin EMT-PNicole Harger, PharmDRandall Johann, FP-C, EMT-PRandall Johann, FP-C, EMT-PAndy Kalb, EMT-P

Dave Kemper EMT-PAshley Larrimore, MDDaniel Mack, NREMT-PJason McMullan, MDMike Moyer, PhD, MS, EMT-PWill Mueller, EMT-PBob Murray, EMT-PMel Otten, MDTodd Owens, EMT-P Russ PollackJoel Pranikoff, MDRos PwalkLauren Riney, DOHamilton Schwartz, MDEmily Sterrett, MDMike Steuerwald, MDJoe Stoffolano, NREMT-PEd Von Lehmden, NREMT-PScott Williams, NREMT-P

IntroductionA few small grammatical changesMagnesium to Magnesium SulfateAdded to introduction not to give medications that a patient is allergic to

AdministrativeNew Protocol for Infectious Disease A110Approach to patient with SARS, MERS, Swine Flu, Ebola, etc.Updated A106 to be in agreement to ORCDefined valid DNRRemoved need to call medical controlA107Mercy Fairfield fax number updated

Symptom BasedTrauma Triage ChangesPhysiologic CriteriaModified Needs intubation to Need for ventilatory supportRespiratory rate less than 20 in infants less than 1 year oldAdded pulse greater than 90 in GeriatricAdded to signs of shockTachycardia, bradycardia, hypotensionAnatomic CriteriaAdded Open skull fractureMechanism ChangesAdded Vehicle telemetry data consistent with high risk injury

Trauma TriagePer the state submersion injuries, strangulation and asphyxia should go to trauma centerBurnsFull thickness or partial thickness greater than ten percent total body surface area, or other significant burns involving the face, feet, hands, genitalia, or airway. 1st degree burns are not calculated in TBSA. Mechanism of injury does not make a trauma patient but needs to be considered

Push Dose EPI1 ml of 1:10,000 epi cardiac epiMix with 9 ml of Normal SalineAdminister 1 ml every 1-2 minutes as neededTakes the place of Dopamine

CardiacC308 Traumatic Cardiac Arrest Added need to control bleeding per T710

MedicalM400 ACSAdded some other Erectile Dysfunction meds and Pulmonary Hypertension drugsAdded Nitro alternative to M400 ACS and M404 CHF 1.Nitroglycerin 0.4 mg sublingual every 3-5 minutes to a max of 3 doses only if SBP remains greater than 100 2.Topical nitroglycerin (Nitropaste) may be used in lieu of sublingual nitroglycerin. Apply 1 inch of nitropaste to the anterior chest wall one time. Added to remove the nitropaste if the patient become symptomatic with feeling faint, lightheaded, dizzy or hypotensive.

MedicalM404 CHF Nitro use more complex1.For patients with mild symptoms (eg. HR < 100, SBP 100-150, RR 94%) Administer LOW DOSE nitroglycerin 0.4 mg sublingual every 3-5 minutes to a max of 3 doses 2.For patients with moderate to severe symptoms (eg. HR >100, SBP >150mmHg, RR >25, accessory muscle use, retractions, fatigue, O2 sats