- When will the First Responder Protocols be changed to reflect new AHA Guidelines-Cardiac Arrest Protocol #102?
All EMS protocols are being updated to current AHA standards simultaneously. Those revisions should be ready for implementation within the next two months. However, as providers are updated and recertified in the new AHA guidelines, they should begin utilizing the new guidelines for CPR and Defibrillation. Refer to the “AED and AHA guideline update” memo posted on the WVOEMS website.
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Protocol 6403 specifies "consider oral glucose in active seizures." Are we to insert a foreign substance in a patients mouth when they are (or may be) unable to control their airway? Sounds like a bad idea!
The proper administration of glucose gel is buccally (placed between the cheek and gum), not as an oral bolus. If used properly, the potential for aspiration is minimal. This question will be reviewed further.
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For the Death in the Field Protocol: Does the EMT-B have to request ALS and have them on the scene before contacting MEDCOM to discontinue CPR? (Can an EMT-B request to stop CPR without ALS on the scene?)
The answer to this question can be found by reviewing both Death in the Field Protocol 9101 and Cease Efforts Protocol – 9102. Questions 1 and 2 both actually refer to the Cease Effort Protocol 9102. In most routine situations the EMT-B will be calling for ALS back-up after starting CPR and BLS on a patient. Under routine circumstances, most cardiac arrest patients will require ALS intervention before the Cease Efforts protocol is implemented. As outlined in Section A of Protocol 9102, there are certain specific circumstances where an EMT-B may actually contact the Medical Command Physician to cease efforts in patients who have not received ALS. Those specific situations are outlined in Section A (pay special attention to A.2 and A.4). Section B outlines the procedure to follow. Section C outlines the exceptions. EMT-Bs should also be familiar with the Death in the Field Protocol 9101 which outlines situations where it may be inappropriate to start resuscitation. Death in the Field Protocol – 9101 also should be used immediately after use of the Cease Efforts Protocol 9102.
In summary: “Can an EMT-B request to stop CPR without ALS on the scene?”
Answer: Yes, but only in certain specific situations as outlined in the Protocols.
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Can an EMT-B assist an EMT-P with a new Protocol without calling in to MEDCOM? This would be under the direct supervision of a paramedic.
Yes, if the EMT-B and the EMT-P are together at the patients side. If the EMT-B performs any of the skills before the EMT-P arrives at the patient, they are to contact medical command as prescribed in the protocols.
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Is there a list of what status to call in for - such as Status 3, 2, 1, or do they just call in with no status used?
It is the same process for all levels of EMS providers. It is addressed in Protocol 9106.
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Must we use the specific Epi-Pen products or may we use the (cheaper) generics?
Other auto injectors may be okay. Simple syringe and needle combinations are not acceptable. We are researching "generic" auto-injectors.
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For the albuterol treatment, do we have to use the "peace pipe" (as pictured in the video) or can we choose between that and the mask?
Either administration device, mouthpiece or mask, is acceptable.
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Is it mandatory for fire departments who first respond to EMS calls that have EMTs carry Epi-Pen, nitro, albuterol on their vehicle?
At present, it is not mandatory. This is a policy question that will be answered prior to the implementation date of 7/1/07.
If not mandatory, is it okay for fire department to carry on truck?
Yes
Will they have to carry extra insurance for rapid response?
Insurance questions must be posed to the individual agencys insurance carrier.
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Can EMT-Bs use compressed air to deliver albuterol treatments?
No, emergent patients need to have treatments administered utilizing oxygen.
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Everything mentions nitro tablets, but can we use nitro spray?
Yes.
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Are the new drugs/equipment required on BLS units only, or on BLS and ALS units?
All new drugs and equipment are going to be required on BLS (Class B) ambulances by the implementation date. Specifics of the list are not complete at this time.
All items except Epi-Pens are currently required on ALS (Class C) ambulances. If a Class C ambulance is staffed by BLS personnel, then Epi-Pens will need to be on-board and available, same as an AED.
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WVU-Ruby is currently utilizing the NIH Stroke Scale. Will this cause any misunderstandings between the EMT-B and MEDCOM?
The WV EMS System and the Stroke Pilot Project both utilize the Cincinnati Prehospital Stroke Scale for the prehospital evaluation of patients. The NIH Stroke Scale is a more comprehensive scale designed to be utilized in the hospital setting. There should be no misunderstandings based on the EMS use of the CSS.
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Dr Ramsey stated that EMT-Is would have all run sheets go thru the QA process. Does Dr Ramsey feel that EMT-Bs performing the new protocols should have their QA process same as the EMT-I?
EMT-Basics will be contacting medical command to perform almost all “new” skills and procedures, therefore, concurrent QI will be provided for each case. The sheer numbers of EMT-Bs make it impossible for the state or region to review all PCRs. Each agency is encouraged to initiate an in-squad review process for these calls as they deem necessary.
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How many times can an EMT-B take the update exam if they don’t pass?
The written exam was not planned to be used as a “pass/fail” criteria. It was meant to gauge understanding of new material presented as continuing medical education. Any EMT-B who does not attain acceptable performance of the skills or knowledge should receive remedial training as needed. If an EMT-B cannot make at least a 70% on the update exam after three (3) attempts, then the STO and Squad Medical Director should seriously consider what additional assistance and remediation the EMT-B needs. Those criteria are more appropriately determined by squad medical directors and training personnel.
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Where is the answer key for the exam?
It will be provided to STOs.