11

2014 ALS PROTOCOL

UPDATE

Dr. Daniel J. Olsson Susie Surprenant

CNYEMS Regional Medical

Director

CNYEMS Executive Director

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OverviewOverview CNYEMS-Midstate-North Country CNYEMS-Midstate-North Country

Collaborative ALS Protocol Update. Collaborative ALS Protocol Update.

Thirteen of the ALS protocols have been Thirteen of the ALS protocols have been updated to accommodate the new updated to accommodate the new Advanced EMT level. Advanced EMT level.

The following slides contain highlighted The following slides contain highlighted sections where the protocols changes sections where the protocols changes and/or additions have occurred.and/or additions have occurred.

Adult Blood Glucose (hypoglycemia) Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL.changed to < 60 mg/dL.

Adult Naloxone dose changed toAdult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.

““Secondary advanced airway device “ Secondary advanced airway device “ verbiage changed to “alternative rescue verbiage changed to “alternative rescue airway device”airway device”..

Acute Coronary SyndromeAcute Coronary Syndrome

New Medications for AEMT:New Medications for AEMT:– AspirinAspirin– Nitroglycerin PasteNitroglycerin Paste– Nitroglycerin SprayNitroglycerin Spray– Nitroglycerin TabletNitroglycerin Tablet

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Acute Respiratory Distress Acute Respiratory Distress Asthma or COPDAsthma or COPD

New Medications for AEMT:New Medications for AEMT:– Albuterol SulfateAlbuterol Sulfate

New Skill:New Skill:– CPAPCPAP

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Airway ManagementAirway Management

Adult “secondary advanced airway Adult “secondary advanced airway device “ verbiage changed to device “ verbiage changed to “alternative rescue airway device”“alternative rescue airway device”..

Intermediates and AEMTs are only able Intermediates and AEMTs are only able to utilize alternative rescue airway to utilize alternative rescue airway devices for patients in respiratory or devices for patients in respiratory or cardiac arrest. cardiac arrest.

Examples of alternative rescue airway Examples of alternative rescue airway devices:devices:

– CombitubeCombitube– King AirwayKing Airway– LMALMA

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Allergic Reaction / Allergic Reaction / AnaphylaxisAnaphylaxis

New Medications for AEMT:New Medications for AEMT:– Albuterol SulfateAlbuterol Sulfate– Epinephrine 1:1,000Epinephrine 1:1,000

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Alerted Mental StatusAlerted Mental Status

Adult Blood Glucose (hypoglycemia) Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL.changed to < 60 mg/dL.

Adult Naloxone dose changed toAdult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.

New Medications for AEMT:New Medications for AEMT:– Dextrose 50%Dextrose 50%– GlucagonGlucagon– NaloxoneNaloxone

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Asystole and Pulseless Asystole and Pulseless Electrical Activity (PEA)Electrical Activity (PEA)

New Medications for AEMT:New Medications for AEMT:– Epinephrine 1:10,000Epinephrine 1:10,000

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Poisoning / OverdosePoisoning / Overdose

Adult Naloxone dose changed toAdult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.

New Medications for AEMT:New Medications for AEMT:– NaloxoneNaloxone

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Pulmonary EdemaPulmonary Edema

New Medications for AEMT:New Medications for AEMT:– Nitroglycerin PasteNitroglycerin Paste– Nitroglycerin SprayNitroglycerin Spray– Nitroglycerin TabletNitroglycerin Tablet

New Skill:New Skill:– CPAPCPAP

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SeizuresSeizures

Adult Blood Glucose (hypoglycemia) Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL changed to < 60 mg/dL

New Medications for AEMT:New Medications for AEMT:– Dextrose 50%Dextrose 50%– GlucagonGlucagon

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2020

V-Fib / Pulseless V-TachV-Fib / Pulseless V-Tach

New Medications for AEMT:New Medications for AEMT:– Epinephrine 1:10,000Epinephrine 1:10,000

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Airway Management - Airway Management - PediatricPediatric

““Secondary advanced airway device“ Secondary advanced airway device“ verbiage changed to “alternative verbiage changed to “alternative rescue airway device”rescue airway device”..

Patients 16 years and older.Patients 16 years and older.

Intermediates and AEMTs are only Intermediates and AEMTs are only able to utilize alternative rescue able to utilize alternative rescue airway devices for patients in airway devices for patients in respiratory or cardiac arrest. respiratory or cardiac arrest.

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Fluid Challenge - PediatricFluid Challenge - Pediatric

Fluid Administration:Fluid Administration:– Normal Saline bolusNormal Saline bolus

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IV / IO Therapy - PediatricIV / IO Therapy - Pediatric

New Skill for AEMT:New Skill for AEMT:– Patients 6 years and older: Patients 6 years and older:

IV or IO accessIV or IO access– Patients < 6 years in cardiac arrest: Patients < 6 years in cardiac arrest:

IV or IO accessIV or IO access

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Review of Protocol Review of Protocol ChangesChanges

Adult Blood Glucose (hypoglycemia) Adult Blood Glucose (hypoglycemia)

changed to < 60 mg/dL.changed to < 60 mg/dL.

Adult Naloxone dose changed to Adult Naloxone dose changed to

0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.

““Secondary advanced airway device Secondary advanced airway device “ verbiage changed to “alternative “ verbiage changed to “alternative rescue airway device”.rescue airway device”.

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New Medications for New Medications for AEMT LevelAEMT Level

AspirinAspirin Albuterol SulfateAlbuterol Sulfate Dextrose 50%Dextrose 50% Epinephrine 1:1,000Epinephrine 1:1,000 Epinephrine 1:10,000Epinephrine 1:10,000 GlucagonGlucagon NaloxoneNaloxone Nitroglycerin PasteNitroglycerin Paste Nitroglycerin SprayNitroglycerin Spray Nitroglycerin TabletNitroglycerin Tablet

Fluid AdministrationFluid Administration Normal Saline bolus Normal Saline bolus

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New Skills for AEMT LevelNew Skills for AEMT Level

Alternative Rescue Airway DeviceAlternative Rescue Airway Device–Patients 16 years and olderPatients 16 years and older

CPAP – AdultCPAP – Adult

Patients 6 years and older: Patients 6 years and older: – IV or IO accessIV or IO access

Patients < 6 years in cardiac arrest: Patients < 6 years in cardiac arrest:

– IV or IO accessIV or IO access

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Next StepsNext Steps AEMT providers will complete an on-AEMT providers will complete an on-

line 2014 AEMT Protocol Test. line 2014 AEMT Protocol Test.

In order to continue to practice in the In order to continue to practice in the Region, an AEMT provider will need to Region, an AEMT provider will need to complete the ALS Protocol Update and complete the ALS Protocol Update and pass the on-line Protocol Test.pass the on-line Protocol Test.

The updated ALS Protocols will go The updated ALS Protocols will go into effective December 8, 2014. into effective December 8, 2014.

All currently certified Intermediates must All currently certified Intermediates must be certified under the newbe certified under the new

AEMT Standards by June 30, 2015. AEMT Standards by June 30, 2015.

All Intermediate Protocols will end on All Intermediate Protocols will end on June 30, 2015.June 30, 2015.