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EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic, EMSI

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Page 1: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS

Don Spaner, MD CCF East Region Medical Director

Scott Wildenheim, Paramedic, EMSI

Page 2: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

OVERVIEW

New Safety FeaturesMedication ConsolidationStandardized TerminologyScope of Practice UpdatesFirst Patient Contact to 12 Lead Parameters AddedCapnography Stressed / Added

Page 3: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

SAFETY - CAUTIONS / STOPS

Cautions Allows us to put warnings

immediately adjacent to medication or procedure to assure key points are remembered

Stops On page reminder to keep

certain actions from occurring without lengthy explanation in key points that will likely be forgotten, missed, or misunderstood.

Page 4: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

GROUPED INTERVENTIONS

Actions / interventions grouped in protocol, reflecting the way it would actually be done in field, rather than individual boxes

Page 5: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CONTACT MED CONTROL

Current Old CONTACT MEDICAL

CONTROL red box confusing, makes it seem like every patient contact required call to Medical Control

Revised Box

Spells out events as they are actually performed

Page 6: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

WHO TO CONTACT?

YOUR MEDICAL CONTROL IS HILLCREST HOSPITAL.

THE PATIENT WANTS TO BE TRANSPORTED TO CCF MAIN AS THEY HAVE A FEVER AND THE LVADPLACED 2 MONTHS AGO, HAS AN INFLAMED TENDER SURGICAL SITE.

YOUR FOLLOW YOUR PROTOCOL, START AN IV AND TRANSPORT.

WHO DO YOU CALL TO GIVE A REPORT?

HILLCREST OR CCF MAIN?

Page 7: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

FIRST PATIENT CONTACT TO 12 LEAD

First patient contact to 12 lead acquisition and transmission interval added where ACS may be causative factor

Affected Protocols ACS CHF Abdominal Pain Respiratory Distress Altered LOC

Stroke

Page 8: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

SCOPE OF PRACTICE CHANGES Effective date 10.16.2013 Mainly affect EMT and AEMT

Page 9: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

VERBIAGE CHANGES

All protocol pages updated to be consistent with Ohio EMS Scope of Practice / OAC

Titles changed throughout protocol to new standards

EMT(Formerly EMT-B)

AEMT(Formerly Intermediate)

Paramedic (Formerly EMT-P)

Page 10: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

EMT SCOPE CHANGES

Intubation for EMT removed Jan 1, 2013

Still only permitted to use advanced supraglottic (King / LMA) airways on pulseless and apneic patients

Page 11: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

EMT SCOPE CHANGES (CONT)

Direct laryngoscopy removed for EMT of FBAO

Page 12: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

EMT SCOPE CHANGES (CONT) NTG, Aerosols still “patient assisted” which

includes online Med Control order

Epi Pen added for protocol use

Page 13: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

EMT SCOPE CHANGES (CONT)

Intranasal Naloxone (Narcan) permitted for all first responders and EMT’s

AEMT / Paramedic allowed to use IM / IV as well

Used to reverse the respiratory effects of narcotics

Page 14: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

NALOXONE (NARCAN) PHARMACOLOGY

Class and Mechanism of Action

Narcotic antagonist Competes for and binds to

narcotic receptors in the brain Reverses respiratory

depression associated with narcotic overdose

Works on narcotics only

Heroin Morphine Fentanyl Dilaudid Codeine Methadone Percocet Demerol Not a complete list

Page 15: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

NALOXONE (NARCAN) PHARMACOLOGY

Contraindications None if patient not breathing

or breathing insufficiently

Precautions May cause withdrawal effects

in opiate dependent patients (Hypertension, tachycardia, N&V, etc)

Indications Altered mental status AND; Patient breathing

insufficiently (Low resp rate high Co2)

Patient not breathing at all (Resp rate 0, no Co2 or waveform)

Page 16: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

NALOXONE (NARCAN) ADMINISTRATION

Push hard push fast to atomize

1ml / per nostril limit Carried 2mg in 2ml Half of the syringe in each

nostril

Page 17: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 18: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CASE: 18 Y/O FEMALE UNRESPONSIVE AT A PARTY

GLUCOSE 80 RESPIRATIONS 6,

SNORING RESPIRATIONS B/P= 90/70 P=120 POX=80 TREATMENT?

Page 19: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CASE:20 Y/0 MALE SLEEPING IN FRONT OF GOODWILL STORE

EASILY AROUSED POX=96% R=14,P=90,B/P 120/80 INTACT AIRWAY KNOWN HEROIN ABUSER TREATMENT?

Page 20: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

AEMT SCOPE CHANGES

Advanced EMT now allowed to INTUBATE APNEIC as well as PULSELESS andAPNEIC patients

Advanced EMT now allowed to use supraglottic airway (King / LMA) on APNEIC as well as PULSELESS andAPNEIC patients

Page 21: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

VAD PROTOCOL Not specific to LVAD (most

common) Encompasses all types,

LVAD, RVAD, BiVAD Emphasis on correct

transport destination (Implantation Center)

Emphasis on keeping power to unit

Emphasis on Contacting specialized VAD team following patient

New Protocol !

Page 22: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 23: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

TRACH PATIENT MANAGEMENT

Verbiage added in Adult Airway and Adult Respiratory Distress in key points regarding managing Trachpatients

Emphasis on suctioning and maintaining open airway

Emphasis on replacing uncuffed Trach tubes with ET tube if ventilation required

Page 24: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 25: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

LUCAS CPR DEVICE

Added at request of departments that utilize the device – not required by protocol

Automated CPR device Use in medical arrest

situation only Patients > 12 years old Contraindications – Trauma

Arrest / Patient will not fit device

Manual CPR must continue while device is being prepared and placed

NEW!

Page 26: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 27: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 28: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 29: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

NEW POLICY

New Department Supplied Equipment

Allows individual departments to purchase devices not specifically outlined in protocol and have their respective Medical Directors authorize its use

Departments required to have written policy on its use

Updated Restocking Policy

CCF updated EMS Medication and Equipment Policy will be added

Page 30: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 31: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

MEDICATION CONSOLIDATIONLORAZEPAM (ATIVAN) Lorazepam (Ativan) replaces 1 - Midazolam (Versed) 2 / 22 - Midazolam (Versed) 5 / 13 - Diazepam (10 / 2) as the Benzodiazepine of choice all protocols

Lorazpam (Ativan) storage 90 days unrefrigerated Till expiration date

refrigerated

Affected Protocols

Adult Airway ACS Adult Bradycardia Adult Narrow Complex Tachycardia Adult Wide Complex Tachycardia Adult Extremity Trauma Adult Seizure Peds Bradycardia Peds Narrow Complex Tachycardia Peds Seizure

OB Emergencies

Page 32: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

MEDICATION CONSOLIDATIONLORAZEPAM (ATIVAN)

Comparison 1 mg Lorazepam (Ativan) =

approx 10 mg Diazepam (Valium)

Half Life 10 Hours

RoutesIntravascular (IV)Intraosseous (IO)Intramuscular (IM)

Intranasal (IN)

Supplied2 mg / 1 ml Carpuject

Page 33: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 34: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CASE: SOLDIER STARTS SEIZING AT COMPUTER TRAINING CENTER

AFTER INITIAL SEIZURE HE IS POSTICTAL.

BS=130 VS:140/90, P=120,R=20 COMPLEX GENERALIZED

SEIZURE REOCCURS. TREATMENT?

Page 35: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

DIALYSIS PATIENT SYMPTOMATIC HYPERTENSION Added to Dialysis / Renal

Patient protocol to remind Paramedics agents are available for specific situations where prehospitalintervention of hypertension may be indicated

Routine management of hypertension is not recommended – for specific situations

Medical Control contact required

Follows similar BP measures found in Stroke / CVA protocol ( SBP 220 or DBP 120 )

Patient is symptomatic pre/post dialysis HTN PT ( dizzy, HA, Diaphoresis, blurred vision)

Labetalol 10 mg IV with Med Control Consult

Labetalol 20 mg IV with Med Control Consult

Page 36: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 37: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

WHAT IS HTN EMERGENCY?

SIGNS OF END ORGAN DAMAGE DUE TO SEVERE ELEVATED B/P.

NEUROLOGIC SYMPTOMS CARDIAC SYMPTOMS RENAL SYMPTOMS ANY PRE HOSPITAL

TREATMENT REQUIRES MEDICAL CONTROL ORDER SOLDIER!

Page 38: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

MEDICATION CONSOLIDATIONDEXTROSE D50 – Adult Only D25 – Peds Only D10 – Neonate, Peds, and

Adults Need to carry for neonates

anyway, can be used in any population

Simplifies administration if department chooses D10

Safer

Affected Protocols

Altered LOC Diabetic Emergencies Peds Altered LOC Peds Asystole / PEA Peds Diabetic Emergencies Peds Head Trauma Peds Seizure Peds Shock Neonatal Resuscitation

Page 39: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

DEXTROSE 10% PHARMACOLOGY Required use in Neonate Can be used in all patient

populations (Adult, Peds, Neo)

Not required use in Peds / Adult – Department Choice

1 Bag 250 ml D10 = 25 Grams Dextrose (Same as 1 AMP D50)

Not as thick, piggyback on already established IV –Hands free – Can Hand Push from syringe

Page 40: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,
Page 41: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

5-2-1 RULE FOR DEXTROSE

D10 MUST BE USED FOR INFANTS UNDER 12 MONTHS OF AGE.

D25 AGE 1-15 D50 ADULT

D10= 5CC/KG D25=2CC/KG D50=1CC/KG

Page 42: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

STANDARDIZED BP TERMINOLOGY

NEW STANDARD TERMINOLGY

IV NORMAL SALINE BOLUSTo Maintain SBP 90 or Radial Pulses

Changed from specifying bolus amount to what is done in practice

Page 43: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CAPNOGRAPHY Added wherever there may be

potential for gross abnormalities in ventilation, perfusion, or metabolism

Already required by AHA for intubation

Added where sedation or multiple doses of respiratory depressants medications are used

Lorazepam (Ativan) for procedural sedation and seziures

Second doses of Morphine or Hydromorphone

Affected Protocols

Adult Medical Adult Trauma Peds Medical Peds Trauma OB Emergencies

Page 44: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

HOSPITAL CAPABILITIES

Updated and enhanced with additional services

Page 45: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

AIRWAY Direct laryngoscopy

removed for EMT Lorazepam replaces

midazolam Apnic oxygenation for

intubation Stops for head injury,

medications down supraglottic airway

Advanced airway use rules as cautions for EMT / AEMT

Page 46: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

ACS First Patient Contact to

EKG timeframe added Stops added for NTG Pathway added for;

Clean 12 lead with suspicion of MI, perform right sided 12 lead

Lorazepam (Ativan) replaces Midazolam / Diazepam for cocaine induced STEMI

Page 47: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CHF First Patient Contact to

EKG timeframe added Stops for NTG, CPAP,

and ResQGARD added Captopril blue boxed,

assuming no stops prevent administration

Lasix remains red boxed per best practices

Cardiogenic shock highlighted (gray box) to remind providers its not “hypotensive CHF”

Page 48: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

ANAPHYLACTIC SHOCK

Stops added for 1:1000 vs: 1:10000 IV, Solu-Medrol, and Albuterol for EMT use

EPI – PEN added in protocol for EMT use

Anaphylactic shock highlighted (gray box) to remind provider that the patient needs IV medications rather than IM

Page 49: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CASE:ANAPHYLAXIS AFTER EATING TRAIL MIX BAR

PATIENT COLLAPSE POX=70% B/P 60/40 P=120 R=30 TREATMENT?

Page 50: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

RESPIRATORY DISTRESS

Albuterol / Atroventyellow boxed with STOP for EMT use without direct Medical Control

First Patient Contact to EKG timeframe added

Stops added in CPAP and Solu-Medrol

Page 51: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

CPAP REMINDERS CPAP DOES NOT

VENTILATE. CPAP IS USED FOR

OXYGENATION AND TO OPEN UP AVEOLI.

COPD AND ASTHMA PATIENTS HAVE DISTENDED AVEOLI AND CPAP MAY CAUSE BAROTRAUMA TO THESE PATIENTS. LAST DITCH USE FOR EXTREME HYPOXIA.

WE DO USE BIPAP FOR THESE PATIENTS

MAJOR USE IN PRE HOSPITAL IS CHF.

CAN’T USE IN HYPOTENSION.

CAN’T USE WITH FACIAL TRAUMA.

CAN’T USE WITH VOMITING OR AIRWAY ISSUES, INCLUDING ALTERED MENTAL STATUS.

CAN’T USE WITH PNTX TILL TREATED.

Page 52: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

STROKE Improved Cincinnati

stroke scale to help catch posterior circulation problems

CincinnatiPlus Added Visual Fields,

Following, and Acuity Labetalol blue boxed

with cautions and stops

First Patient Contact to EKG timeframe added

Page 53: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

ADD FINGER NOSE FINGER FOR CEREBELLAR TESTING.

ADD FIELD OF VISION TESTING AND EXTRA OCCULAR MOVEMENTS TO TEST OCCIPITAL AREA AND BRAINSTEM.

Page 54: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

PSYCH EMERGENCIES

Lorazepam (Ativan) added as sedative in addition to Haloperidol / Diphenhydramine

Page 55: Cleveland Clinic Regional Hospitals EMS · EMS PROTOCOL ROLL-OUT 2014 Cleveland Clinic Regional Hospitals EMS Don Spaner, MD CCF East Region Medical Director Scott Wildenheim, Paramedic,

PEDS HEAD TRAUMA

Capnography targets added to mirror adult head trauma


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