Cleveland Clinic Regional Hospitals EMS Protocol DRAFT Release Notes. Global Changes
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1 Cleveland Clinic Regional Hospitals EMS Protocol 2014 DRAFT Release Notes Global Changes Added cautions and stops with selected high risk medications / procedures on protocol tree page for safety Individual treatments / procedures grouped in logical chunks as they would likely be performed in the field. Grouping of typical multiple simultaneous actions. Contact Med Control and Transport boxes on every page replaced with one box TRANSPORT to appropriate facility CONTACT receiving facility CONSULT Medical Direction where indicated Standardized target BP terminology Maintain SBP 90 or radial pulses Color coding grids updated to new ODPS nomenclature EMT AEMT PARAMEDIC 2-4 Airway Adult Protocols Lorazepam (Ativan) Added, Midazolam (Versed) Removed Clarification on sedation use pre / post airway placement Apneic oxygenation during airway procedure added Direct laryngoscopy for obstructed airway changed to green / AEMT per ODPS Scope of Practice change Aug 2013 Tracheostomy patient management added 2-6 Obstructed Airway Direct laryngoscopy for obstructed airway changed to green / AEMT per ODPS Scope of Practice change Aug 2013
2 2-8 Respiratory Distress Bronchdiliators changed to yellow (BLS) WITH DIRECT MEDICAL CONTROL note per ODPS Scope of Practice Tracheostomy patient management added 2-10 Congestive Heart Failure Captopril (Capoten) blue boxed, with stops Lasix remains red boxed, with cautions and stops Grey highlight added to cardiogenic shock column 3-4 Anaphylactic Shock Terbutaline (Brethine) removed Grey highlight added to anaphylatic shock column EPI-PEN changed to EMT administration on protocol per ODPS Scope of Practice change Aug 2013 Bronchdiliators changed to yellow (BLS) WITH DIRECT MEDICAL CONTROL note per ODPS Scope of Practice
3 3-5 Hypovolemic, Neurogenic, Cardiogenic, and Septic Shock 4-2 ACS Right side EKG added for patients with clean left EKG but still good story for MI with second dose of analgesics Midazolam and Diazepam removed from cocaine induced ACS, replaced with Lorazepam (Ativan) Hydromorphone (Dilaudid) added as analgesic option for ACS 4-4 Bradycardia Midazolam (Versed), Diazepam (Valium) removed Replaced with Lorazepam (Ativan) 4-6 Narrow Complex Tachycardia Second Adenocard (Adenosine) 12 mg removed following ACLS recommendations Midazolam (Versed), Diazepam (Valium) removed Replaced with Lorazepam (Ativan) 4-8 Wide-Complex Tachycardia Midazolam (Versed), Diazepam (Valium) removed Replaced with Lorazepam (Ativan) Amiodarone (Cordarone) blue boxed, with stops / cautions / requirements
4 4-12 Asystole PEA Field termination requirements listed on protocol tree page 4-14 V-FIB / V-TACH 4-16 Post-Resuscitation Care 4-18 Induced Hypothermia Midazolam (Versed) removed Replaced with Lorazepam (Ativan) 5-2 Abdominal Pain with second dose of analgesics 5-6 Altered LOC Dextrose 10% added
5 5-8 Behavioral Psych Emergencies Lorazepam (Ativan) added 5-10 Diabetic emergencies Dextrose 10% added 5-12 Renal Patients 5-18 Hyperthermia 5-20 Hypothermia 5-22 Seizures Midazolam (Versed), Diazepam (Valium) removed Replaced with Lorazepam (Ativan) 5-24 Severe Pain with second dose of analgesics
6 5-26 Stroke Labetalol (Tandate) blue boxed with cautions and stops Added visual fields / posterior circulation evaluation to Cincinnati stroke scale (Cincinnati Plus) 5-28 Toxic ingestion / Exposure / Overdose 5-30 Toxic Ingestion Cyanide 5-32 Toxic Ingestion CO CO levels added to protocol tree page 6-6 Abdominal Trauma 6-8 Burns Added Parkland formula on tree page 6-10 Chest Trauma
7 6-12 Drowning 6-14 Extremity Trauma Midazolam (Versed) removed Replaced with Lorazepam (Ativan) 6-20 Multiple Trauma 6-22 Trauma Arrest 7-2 Pediatric Airway Pediatric Protocols Direct laryngoscopy for obstructed airway changed to green / AEMT per ODPS Scope of Practice change Aug Pediatric Obstructed Airway Direct laryngoscopy for obstructed airway changed to green / AEMT per ODPS Scope of Practice change Aug Pediatric Respiratory Distress Bronchdiliators changed to yellow (BLS) WITH DIRECT MEDICAL CONTROL note per ODPS Scope of Practice
8 8-2 Pediatric Shock Bronchdiliators changed to yellow (BLS) WITH DIRECT MEDICAL CONTROL note per ODPS Scope of Practice Removed 2 amps max for D25% Capnography added 9-2 Pediatric Bradycardia Capnography added 9-4 Pediatric Narrow Complex Capnography added 9-6 Pediatric Asystole PEA Removed 2 amps max for D25% 9-10 Neonatal Resuscitation 10-2 Pediatric Altered LOC Removed 2 amps max for D25%
9 10-6 Pediatric Diabetic Emergencies Removed 2 amps max for D25% 10-8 Pediatric Hyperthermia Pediatric Hypothermia Pediatric Seizure Midazolam (Versed), Diazepam (Valium) removed Replaced with Lorazepam (Ativan) Pediatric Severe Pain Management Capnography added for second administration of analgesics Pediatric Toxic Ingestion 11-6 Pediatric Abdominal Trauma
10 11-8 Pediatric Burns Parkland Burn Formula Added Pediatric Chest Trauma Pediatric Drowning Pediatric Head Trauma Capnography ventilation points added consistent with adult protocol Pediatric Multiple Trauma Pediatric Trauma Arrest
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