VVEMS Writing GroupPresented by Todd Lang, MD

Moved some items to appendices Not a textbook, but full of information More of a philosophical statement on

purpose of guidelines Discusses uniquities of VVEMS Reader expected to be familiar with

state and national requirements

Interfacility transport guideline Sedona/VVMC transport guideline Air transport guideline

To save time for both parties Name the type of call up front Patch: please listen and give us

guidance Notification: patient is stable and we

don’t request any orders, please direct us to a bed and be prepared for us

We will work with nursing to help them focus attention on Patch calls more tightly

Functioning, dependable EMS Committees Prehospital Care: Most months. Everyday EMS

policy and related matters for the practicing EMS provider and addressing issues at the interface of EMS service and other services.

Steering: Chiefs, EMS leaders, NAH/VVMC leadership. Meets quarterly or PRN

Peer Review: Bimonthly. A forum to analyze and improve care rendered and offer constructive criticism on care and recordkeeping. Generates useful policy/guideline revisions.

Has been running smoothly now for some time

Initial growing pains seem to have passed

Fine tuning the labeling: need to put patient labels over the MFR labels on the tubes

Legal blood draws not required unless blood already being drawn for medical care.

Necessary as volume grows Empowers individual agencies Allows focused QA from medical

direction and makes more time available for integrative, system-wide data analysis

Allowed but not endorsed strongly by local medical direction

Consider use early in codes Use after 2 attempts or 90 seconds in

critically ill Costly but safe Tibial sites preferred over humeral

PICC line access Portacath access Increase number of people who can

get treated while decreasing pain and risk to EMS

These are the sickest patients and hardest IV starts

0.1 mg/kg for adults 0.05 mg/kg for older (over 55) and

peds Repeat in 10 min Mirrors our “Protocol M” in ED Effective and safe dose

An option for life threatening bleeding

May use proprietary device or bp cuff

Rosetta Lido not a treatment for ischemia Iodine and shellfish do not cross react

with contrast dye and were removed from pretreatment for dye allergy

CCR Amiodarone removed from protocols

NAH/VVMC purchased to help improve MI care in VV

Mostly working now Improved technology over fax-based

transmission Helps to bypass the ED in STEMI care

when possible

State wide registry which will analyze cardiac arrest and survival

Expect great research Nationally recognized program Part of CCR initiative

Early-middle adoption At request of agencies and leaders Hopefully will improve outcomes Unlikely to make things worse

CPAP added Methylprednisolone by patch order Furosemide by patch order, dose

guideline (double) Continuous nebs for severe

bronchospasm

Lifesaving Safe Strongly endorsed by Medical

Direction Costly, but manageable, expense Should decrease need for invasive

airways

Consider RSI for airway burns Minimize airway manipulation unless

RSI available for neuro trauma in field Cervical Spine Immobilization

program

Naloxone dose for altered patient is 0.4 mg IV

Naloxone dose for unconscious or unstable is 2 mg IV/IM

No NG or charcoal in ALOC OD patient

Charcoal only if ingestion <60 min Diazepam OK for EMT-I in seizures

CCR success Cardiac Arrest Center/Cooling

survivors Fine tuning of C-spine protocol Focused RN training in 09 Continued Medical Director Ride Time Annual Training like this? Participation and Integration of

Medical Direction into EMD process