The Incident Command System (ICS) does not define who is in charge, but rather defines an operational framework to manage many types of emergency situations. Obtaining IV access (or an IO, should IV access be unobtainable) and continuing an infusion pump the patient has prescribed may be life-saving, Access of ports may not be done unless the provider has additional training and is equipped, or patient has his or her own access device. No protocol can be written to cover every situation that a provider may encounter, nor are protocols a substitute for good judgment and experience. Ability to add PEEP or PEEP valve in the minimum range of 5 - 10 cmH2O NYSDOH Protocols Listing. Assess airway and breathing. These protocols are intended to guide and direct patient care by EMS providers across New York State. The MLREMS region has previously incorporated many of the changes in the 2019 New York State EMS Collaborative Protocols through the implementation of our local care bundles. Use EtCO2 detection and pulse oximetry to evaluate the effectiveness of the ventilation technique and to verify artificial airway patency and position For symptomatic patients with organophosphate poisoning: Atropine 2 mg (per dose) IV, every 3-5 minutes until secretions dry in adults, Atropine 1 mg IV every 3-5 minutes, until secretions dry, For adult seizures see, “General: Seizures - Adult” protocol, For pediatric seizures see, “General: Seizures - Pediatric” protocol, If suspected WMD, refer to the “Resource: Nerve Agent - Suspected” protocol, For severe exposure or multiple patients, the atropine supply may quickly be exhausted. * D5W 100 mL bags may be substituted for normal saline 100 mL, if there is a persistent shortage and normal saline is not available. Patient care takes place in many settings, some of which are hazardous or dangerous. Consider early medical control consultation as patients with a VAD often have dysrhythmias, Consider norepinephrine 2 mcg/min titrated to 20 mcg/min, if needed, after the fluid bolus is complete to maintain MAP > 65 mmHg or SBP >100 mmHg, Community patients with VADs are typically entirely mobile and independent, Trained support members include family and caregivers who have extensive knowledge of the device, its function, and its battery units. Observe airborne and/or droplet precautions in appropriate patients, such as those with suspected pertussis (whooping cough), Refer immediately to the “General: Anaphylaxis - Pediatric” protocol, if indicated, Consider high concentration, humidified, blow-by oxygen delivered by tubing or face mask held about 3-5 inches from face (as tolerated), Facilitate transportation, ongoing assessment, pulse oximeter, and supportive care, If the patient is unconscious and mechanical obstruction is suspected, attempt to remove the object with Magill Forceps, If SEVERE respiratory distress (severe stridor especially with drooling), epinephrine (1:1,000/1mg/mL) 3 mg via nebulizer or racemic epinephrine (2.25%) 0.5 mL in 3 mL of normal saline via nebulizer, Dexamethasone (Decadron) 10 mg PO or IM for patients ≥ 2 years old (may give the IV formulation orally, if tolerated), Dexamethasone (Decadron) 0.6 mg/kg up to 10 mg PO, IM, or IV, Epinephrine (1:1,000/1 mg/mL) 3 mg, via nebulizer for CC or additional doses for CC or paramedic, If the patient has stridor (inspiratory), it is often an upper airway problem (physiologic or mechanical obstruction), Viral croup should be considered in children presenting with absent or low grade fever, barking cough, stridor, and/or sternal retractions, Epiglottitis should be considered in children with a high fever, muffled voice, tripod position, and/or drooling, A vaccination history should be obtained because unvaccinated children are at higher risk of epiglottitis, Agitating a child with croup or epiglottitis could cause a complete airway obstruction, Limit interventions that may cause unnecessary agitation in a child with stridor such as assessment of blood pressure in a child who can still breathe, cough, cry, or speak, For patients presenting with localized cold injury or hypothermia, Remove the patient from the cold environment, Protect areas from pressure, trauma, and friction, Handle patient carefully to prevent cardiac dysrhythmias, Gently remove wet clothing and dry the patient, If oxygen is required, provide warm, humidified oxygen, if available, Place heat packs, if available, in the patient’s groin area, lateral chest, and neck, Wrap the patient in dry blankets and maintain a warm environment, Especially for infants and young pediatric patients, cover the head with a cap or towel to decrease heat loss. Vitals should be frequently assessed during transport to avoid unnecessary prehospital overhydration, Consider potential causes of hypoperfusion: anaphylaxis, toxic ingestions, cardiac rhythm disturbances, myocardial infarction, sepsis, ectopic pregnancy, ruptured abdominal aortic aneurysm, adrenal crisis, or others, Temperature > 100.4° F (38° C), if available, White blood count > 12,000 cells/mm3or < 4,000 cells/mm3 or > 10% bands, if available, Airway management and high flow oxygen (non-rebreather as tolerated), If the patient has altered mental status, refer to the “General: Altered Mental Status” protocol, Attempt to maintain normal body temperature, Advise the destination hospital that the patient has signs of sepsis/septic shock, Obtain vital signs, including blood pressure, frequently, Notify the destination hospital of potential septic shock patient with a verbal report prior to your arrival, Cardiac monitor and continuous pulse oximetry, Patients in septic shock may require boluses of up to 3-4 L (or 30cc/kg) prior to initiating vasopressors, provided there are no contraindications to doing so, such as renal failure or pulmonary edema, Consider norepinephrine 2 mcg/min, titrated to 20 mcg/min, if needed, after the fluid bolus is completed to maintain MAP > 65 mmHg or SBP >100 mmHg, Focus on rapid identification, IV hydration, and early notification of concern for potential septic shock patient to destination facility, Concern for any new or worsening infection includes reported fever, shaking chills, diaphoresis, new cough, difficult or less than usual urination, unexplained or newly altered mental status, flushed skin, pallor, new rash, or mottling, Vitals should be frequently assessed during transport to avoid prehospital over- hydration, For patients with hypoperfusion because of trauma, bleeding, vomiting, diarrhea, or sepsis. The specific issues of direction, provision of patient care, and the associated communication among responders must be integrated into each single or unified command structure and assigned to the appropriately trained personnel to carry out. Attach a ventilator to appropriate oxygen/air source Mode: A/C or SIMV, Pressure Support: 5 - 10 cmH2O, if in SIMV (if available), Volume Control: Tidal volume (Vt) 6 - 8 mL/kg ideal body weight (maintain plateau pressure [Pplat]< 30 cm H2O or PIP < 35 cm H2O), Rate: Child ‎NY EMS Protocols aims to encapsulate our last four apps into one easy to use app for EMS Providers in New York. Patients who have the medical decision-making capacity (ability to understand the nature and consequences of their medical care decision) and wish to refuse care/transport may do so after the provider has: The evaluation of any patient refusing medical treatment or transport should include the following: Medical decision-making capacity determination - As defined below. 2019 ALS Collaborative Comparison Document. Emergency Medical Technicians (EMTs), Paramedics, Physicians and EMS Officers all work within an Emergency Medical Services System. Long spine boards do not have a role in transporting patients between facilities, Position the patient in a supine position, if possible (e.g. Re: NYS BLS and ALS Collaborative Protocols Ladies and Gentlemen, I welcome you all to the innovative New York State Department of Health, Bureau of Emergency Medical Services and Trauma Systems Learning Management System (LMS) Vital Signs Academy . Be prepared for respiratory arrest, Expiratory wheezing does not always indicate asthma. wremac collaborative protocol formulary All Midstate Providers should review both the protocols and the reference material prior to attending a REMAC Update. new york state bls protocols. Do not use abdominal thrusts/Heimlich maneuvers, Perform level-appropriate airway maneuvers, Agitating a child with a partial airway obstruction could cause a complete airway obstruction, Limit interventions that may cause unnecessary agitation such as assessment of blood pressure in a child who can still breathe, cough, cry, or speak. Any request for service that requires evaluation and transport of a patient with a Total Artificial Heart. Regional protocols and policies may accompany these protocols. If you suspect the symptoms are hypoglycemia-induced, titrate dextrose 10 % using 5 grams (50 mL) aliquots for treatment and diagnosis, For pediatric patients with known or suspected hypoglycemia, Refer to “Extremis: Respiratory Arrest/Failure - Pediatric,” protocol if necessary, If unable to obtain adequate results with oral glucose consider glucagon 0.5 mg IM if < 20 kg, otherwise, 1 mg IM*, if needed, IV access, and dextrose 10% 5 mL/kg IV via syringe (, If vascular access is limited: glucagon 0.5 mg IM if < 20 kg, otherwise, 1 mg IM*, If the patient’s parent or guardian wishes to refuse medical care for the patient, and you have administered any medications, including oral glucose, regional procedure may require consultation with medical control prior to completing the refusal, *Preschool aged children and infants may have limited response to glucagon, Normal saline 500 mL IV bolus; may repeat once, if lung sounds remain clear, Consider a 12-lead ECG and cardiac monitor, Ondansetron (Zofran) 4 mg ODT/PO, IV, or IM, may repeat x 1 in 10 minutes, Diphenhydramine (Benadryl) 25 mg IV or IM for motion sickness, This protocol is intended for the prevention and treatment of nausea and/or vomiting, Ondansetron (Zofran) 2 mg IM or 4 mg ODT/PO, This protocol does not apply to patients under the age of two years, A single dose of ondansetron (Zofran) may be given to the pediatric patient prior to seeking medical consultation, Refer to the “General: Hypoglycemia - Adult” or “General: Hypoglycemia - Pediatric” protocol, as indicated, Determine what and how much was taken, along with the time, if possible, In the pediatric patient, administer naloxone (Narcan®) 1 mg** intranasal; 1⁄2 mg per nostril, may repeat once in 5 minutes, if no significant improvement occurs, Titrate naloxone (Narcan) to max 2 mg per dose IV, IM, or intranasal, ONLY if hypoventilation or respiratory arrest. KVO, 250 mL/hr, open) and total fluid infused should be noted on the PCR, Good clinical judgment will dictate the maximum number of vascular access attempts, Do not delay transport solely to attempt vascular access, If the patient is in EXTREMIS and a lifesaving intervention will be performed, establish access to the device. New York State Collaborative EMS Protocols Over the course of the last three years, a group of physicians created a memorandum of understanding between regions and created a set of protocols that have been adopted by every EMS region north of the Bronx. If you are here for COVID-19 training assigned by the NYS Department of Health please select "NYS - COVID-19" as your agency. INITIATING MECHANICAL VOLUME VENTILATION A long spine board is one of multiple modalities that can be used to minimize spinal movement. An immediate oral report shall be made to: NYS Child Abuse and Maltreatment Register: This is a hotline number for mandated reporters only, not the public, All oral reports must be followed up with a written report within 48 hours, using form. Child: 16-20 breaths/min Administer continual analgesia and, if necessary, sedation: Fentanyl 100 mcg IV once, and then 50 mcg IV every 5 minutes, as needed, Midazolam (Versed) up to 5mg IV every 10 minutes, as needed, May substitute ketamine* up to 100 mg every 5 minutes, as needed, Consider vecuronium up to 10 mg every 30 minutes, as needed, if necessary for patient or crew safety, Paralytics are not substitutes for adequate sedation and pain management, Use of paralytics requires ongoing sedation and pain management, Continuously monitor ETT placement, including effectiveness of oxygenation and ventilation, Consider placement of an orogastric (OG) tube, if equipped and regionally approved, Refer to “Resource: Automatic Transport Ventilator,” as indicated, Additional sedation and/or pain management. Adult autoinjector 0.3 mg IM ( e.g now available alone, Keep the infant is breathing! 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