new york state ems collaborative protocols

It is strongly recommended that length-based resuscitation tapes or similar weight calculation devices be used for all pediatric medication doses or treatments to confirm a patient’s weight. As a general guideline for use with these protocols, the following definition has been established: In protocols requiring weight-based dosing guidelines, pediatric dosing should be calculated on a per-kilogram (kg) basis using the adult dose as the pediatric dose maximum. More than one size seat/restraint may be needed as location of the restraint (i.e., stretcher, or captain’s chair) may not accommodate all size children, Agencies should routinely train EMS personnel in the use of various child safety seats/restraints available and have a policy for how injured or uninjured children will be transported, As an agency considers the purchase of new vehicles, or is retrofitting current vehicles, design considerations, such as integrated child restraints, should be considered, All safety seats/restraints should be used according to manufacturer’s recommendations, If a patient chooses to refuse safety restraints, please refer to “Refusal of Medical Attention” protocol, as well as agency and regional policy, Scene safety is not just a yes/no question; it is continual situational awareness, Take note of the effect of patients and bystanders, The closest appropriate hospital may not be the nearest hospital, even for patients in extremis such as those in cardiac or respiratory arrest, Medical control may assist with questions of care or there are complex medical conditions, Medical control may assist with the determining the most appropriate receiving facility, If a patient chooses to refuse care or transportation, please refer to “Refusal of Medical Attention” protocol, as well as agency and regional policy, For patients who are unresponsive without signs of life, For patients that do not meet the criteria of the “Extremis: Obvious Death” protocol or otherwise excluded by a DNR/MOLST order, see also “Resources: Advance Directives/MOLST/DNR” protocol, CPR should be initiated prior to defibrillation unless the cardiac arrest is witnessed by the responding EMS provider, Perform compressions while awaiting the application of defibrillation pads, Push hard and fast (100-120 compressions/min), Metronome or feedback devices may be used, Minimize interruptions in chest compressions, Cycle of CPR = 30 compressions then 2 breaths, Rotate compressors every two minutes with pulse checks, as resources allow, Continuous compressions with asynchronous ventilation (not stopping compressions while ventilating) is permitted to substitute for cycles of CPR that have pauses for ventilation even in non-intubated patients, Avoid hyperventilation (breathing too quickly or deeply for the patient), Use of airway adjuncts and bag-valve mask device, as indicated, with BLS airway management, including suction (as needed), as available, Bag-valve mask should be connected to supplemental oxygen, if available, Rhythm check or AED “check patient” every 5 cycles or two minutes of CPR, Resume CPR immediately after defibrillation (do not check a pulse at this time), Continue CPR for approximately 2 minutes cycles before doing a pulse check, or until the patient no longer appears to be in cardiac arrest, After 20 minutes consider calling medical control for: termination of resuscitation, continuing efforts, or transportation in extenuating circumstances, Manage the airway and confirm placement of any advanced airway device utilized with waveform capnography, Waveform capnography may be used on any ventilated patient, regardless of the use of an airway adjunct, Refer to “Resources: Vascular Devices - Pre-existing” protocol as needed, After an advanced airway is placed, no longer deliver “cycles” of CPR, Give continuous chest compressions without pauses for breaths. Contact medical control for additional fluid boluses, If inadequate perfusion or oxygenation, despite the device being on, treat with standard ACLS measures. The NYS Collaborative Protocols continue to be a great example of cooperation, as dozens of physicians and EMS leaders from across the state combine resources to establish the best evidence-based protocols possible, for our patients. These individuals are generally responsible for scene administration, safe entry to a scene, or decontamination of patients or responders. 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. Check a blood glucose level, if equipped. Ensure universal precautions/personal protective equipment appropriate to the task. The closest ALS may be at a hospital, Transport to the closest appropriate receiving hospital in accordance with regional hospital destination policies for travel time, hospital capabilities and NY State designation, Ensure ongoing patient assessment, check for improving / deteriorating patient condition, and respond accordingly. NY Collaborative ALS Protocols Update Drs. Agencies may conduct additional rollout training, which should include agency medical director involvement. If at any time the ventilator should fail, or an alarm is received that cannot be corrected, the patient should be immediately ventilated with a BVM device attached to a 100% oxygen source, I-Time: Child:0.7 - 0.8 seconds; Adult:0.8 - 1.2 seconds. Assess airway and breathing. The patient may be covered and may be moved back onto a bed or sofa, if appropriate and approved by law enforcement, Whenever possible, termination of resuscitation should be done when the patient is not in a public place, If the family is present, appropriate emotional support by other family, neighbors, clergy, or police should be available when considering termination of resuscitation, Skin color change: cyanosis, erythema (redness), pallor, plethora (fluid overload), Choking or gagging not associated with feeding or a witnessed foreign body aspiration, Check pupils and, if constricted, consider “General: Opioid (Narcotic) Overdose” protocol, Refer to “General: Altered Mental Status” protocol, if necessary, Ongoing assessment of the effectiveness of breathing, Refer to “Extremis: Respiratory Arrest / Failure - Pediatric” protocol, if necessary, For the undifferentiated patient with altered mental status, Including, but not limited to, BLS management of hypoglycemia. Electronic signatures on the eMOLST form are considered valid signatures, A copy of the DNR, MOLST, or eMOLST form should be attached to the PCR and retained by the agency whenever possible, If a patient with a DNR (stand-alone DNR form, or as directed by a MOLST or eMOLST form) is a resident of a nursing home (or a patient of an interfacility transport) and expires during transport, contact the receiving staff to determine if they are willing to accept the patient to that facility. If a single attempt to replace the uterus fails, cover the exposed uterus with moistened sterile towels, Magnesium 4 grams in 100 mL IV over 20 minutes, Transport to the closest appropriate hospital, if delivery is imminent or occurs on scene, If a patient is unwilling to go to the closest appropriate hospital, consult medical control for assistance in determining an appropriate destination, For the evaluation and resuscitation of babies just delivered. If abnormal, refer to the “General: Hypoglycemia - Adult” protocol, Midazolam (Versed) 5 mg IV, IM, or intranasal; may repeat x 1 in 5 minutes, Magnesium 4 grams IV over 20 minutes, if patient is pregnant, Additional midazolam (Versed) 2.5-5 mg IV, IM, or intranasal, Seizures secondary to eclampsia in pregnancy occur because of a different mechanism than typical epileptic seizures, Pre-eclampsia is typically described as BP > 140/90 mmHg with severe headache, confusion, and/or hyperreflexia in a pregnant patient, or in one who has given birth within the past month, Protect the patient and EMS crew from injury during the seizure, Patients may become confused and combative after a seizure (in the postictal state), Obtain law enforcement assistance, if needed, Status epilepticus (continuing seizure) is a critical medical emergency. Generally, BLS interventions should be completed before ALS interventions. large body build or obesity) precludes accurate assessment, immobilize in position found, Gradually extend the knee while, at the same time, a second provider applies pressure on the patella towards the midline of the knee, When straight, place the entire knee joint in a knee immobilizer or splint, Some increased pain may occur during reduction, If there is severe increased pain or resistance, stop and splint in the position found, Patient usually feel significantly better after reduction, but they still need transport to a hospital for further evaluation and possible treatment, Altered mental status - associated with trauma - for any reason including possible intoxication from alcohol or drugs (GCS<15), Complaint of neck and/or spine pain or tenderness, Weakness, tingling or numbness of the trunk or extremities at any time since the injury, Deformity of the spine not present prior to the incident, Painful distracting injury or circumstances (i.e. If no response after 30-60 seconds of effective ventilation add oxygen, Each ventilation should be given gently, over one second per respiratory cycle, assuring that the chest rises with each ventilation, Monitor the infant’s pulse rate (by palpation at the base of the umbilical cord or by auscultation over the heart), and apply continuous pulse oximetry using (ideally the right) wrist or palm, *if available and trained. Sympathomimetic ingestion (cocaine/amphetamine): Midazolam (Versed) 0.1 mg/kg IV, IM, or intranasal, Advise the receiving hospital as soon as possible, This protocol includes patients who are unconscious/unresponsive without suspected trauma or other causes, For use on standing order, unless otherwise specified, by critical care or paramedic providers (regardless of RSI credentialing) in patients who have been intubated, Elevate the head of the bed when possible to decrease risk of aspiration, Continuously monitor capnography and ventilate with a target EtCO2 of 35-45 mmHg. Carefully consider use of appropriate emergency warning devices for transport: Lights and siren use is a medical intervention - does the patient condition warrant the use? If abnormal, refer to the “General: Hypoglycemia - Pediatric” protocol, as indicated, A team approach should be attempted for the safety of the patient and the providers, For adult patients who are extremely combative and are at immediate risk of causing physical harm to emergency responders, the public, and/or themselves. * D5W 100 mL bags may be substituted for normal saline 100 mL, if there is a persistent shortage and normal saline is not available. The 2017 New York State EMS Collaborative Protocols are posted on the www.midstateems.org web site. EMS Week. Advanced providers are also responsible for, and may implement, the standing orders indicated for BLS care. NYS Collaborative Protocols. These are not required, Pediatric protocols should be considered for patients who have not yet reached their 15th birthday, EMD determinant/mechanism of illness/injury, Evidence of unknown powders / other unknown substances / sharps, Use SAMPLE, OPQRST or similar to guide approach to events/illness/complaint, Pertinent past medical history/medications/allergies, Obtain additional pertinent medical information from the family and bystanders, Focused or complete exam directed by patient presentation, chief complaint, and mechanism of injury or illness, Identify and correct any existing or potential airway obstruction while protecting the cervical spine if appropriate, Is intervention necessary (OPA, NPA, Suction), Apply oxygen and/or positive pressure ventilations, as indicated. patient trach/ventilator pack, G-tube connectors, etc.) Collaborative agreement. This app makes pre-hospital reference easier than ever. Is there evidence of internal hemorrhage or signs of shock? All rights reserved. ), Patient who is pulseless and apneic with no organized cardiac activity on ECG (performed by an ALS provider) following significant blunt or penetrating traumatic injury*, Cardiopulmonary arrest patients in whom the mechanism of injury does not correlate with clinical condition, suggesting a nontraumatic cause of the arrest, are excluded from this criterion, Patient who has been submerged for greater than one hour in any water temperature, If a patient meets any of the aforementioned criteria, resuscitation efforts may be withheld, even if they have already been initiated. It has protocols for the following jurisdictions: - New York City Basic Life Support - New York State Basic Life Support - New York City Advanced Life Support - Suffolk County Advanced L… If you are here for COVID-19 training assigned by the NYS Department of Health please select "NYS - COVID-19" as your agency. NYSDOH Protocols Listing. DO NOT pull on the legs or back, as this may cause spine dislocation or adrenal hemorrhage, Gently swing the infant’s body in the direction of least resistance, By swinging anteriorly and posteriorly, both shoulders should deliver posteriorly, Splint the humerus bones with your two fingers; apply gentle traction with your fingers, Gentle downward compression of the uterus will assist in head delivery, Swing the legs upward until the body is in a vertical position. 2019 NY Collaborative Protocols. If the patient does not meet criteria of obvious death as defined in the protocol, refer to the appropriate cardiac arrest protocol, All other trauma patients meeting CDC criteria for transport to a trauma center go to closest appropriate trauma center, See “Trauma: Trauma Patient Destination”, An airway does not necessarily require the placement of an endotracheal tube to be adequately managed, Notify the receiving facility as early as possible; give a brief description of the mechanism of injury, status of patient(s), and estimated time of arrival, Tourniquets are approved for use in extremity trauma in New York State at the CFR level and above, Hemostatic dressings are approved for use in New York State at the CFR level and above, For spinal motion restriction guidelines, see “Trauma: Suspected Spinal Injuries”, Refer immediately to the “Trauma: Bleeding / Hemorrhage Control” protocol, as indicated, Elevate and wrap the stump with moist sterile dressings and cover with dry bandage, Consider spinal motion restriction, refer to “Trauma: Suspected Spinal Injuries” protocol. Agencies are required to assure that their providers are updated to these standards no later than June 1, 2017 through the Cypherworx learning management system. Immediate intervention for severe bleeding: Apply pressure directly on the wound with a dressing, Hemostatic gauze* may be applied with initial direct pressure, Rolled gauze may be used if hemostatic gauze is not available, If bleeding soaks through the dressing, apply additional dressings, If bleeding is controlled, apply a pressure dressing to the wound, If severe bleeding persists through conventional dressings and hemostatic dressing becomes available, remove all conventional dressings, expose site of bleeding, and apply hemostatic dressing*, Cover the dressed site with a pressure bandage. Select the desired FiO2 if applicable. Continually reassess and correct any existing or potentially compromising threats to the ABCs, Locate records including: MOLST, eMOLST, or DNR as appropriate, This general approach guidance document is intended to provide a standardized framework for patient transport. Ongoing assessment is required to assess: The need for compressions should the patient lose his or her pulse (refer immediately to the “Extremis: Cardiac Arrest: General Approach” protocol), Adequate ventilation may require disabling the pop-off valve if the bag-valve mask unit is so equipped, Signs of ineffective breathing include cyanosis, visible retractions, severe use of accessory muscles, altered mental status, respiratory rate less than 12 breaths per minute, Provide positive pressure ventilation using an appropriate size bag mask (BVM), If ventilations are not successful, refer immediately to the “Extremis: Foreign Body Obstructed Airway - Pediatric” protocol, Use of level-appropriate airway adjuncts and bag mask device, as indicated, with BLS airway management, including suction (as needed), as available, Bag mask should be connected to supplemental oxygen, if available, Attach pulse oximeter if available and have a goal of oxygen saturation ≥ 94%, See also, “Resources: Oxygen Administration and Airway Management” protocol, Do not delay ventilations to connect to supplemental oxygen but add supplemental oxygen when available, The need for compressions should the patient lose his or her pulse (refer immediately to the “Extremis: Cardiac Arrest: General Approach - Pediatric” protocol), Adequate ventilation may require disabling the pop-off valve, if the bag mask unit is so equipped, Airway management and appropriate oxygen therapy, Vascular access, ideally at 2 sites (no more than one IO), If needed, administer normal saline to a total of 2 L to maintain MAP > 65 mmHg or SBP > 100 mmHg, provided there is no concern of pulmonary edema, Cardiac monitor with 12-lead ECG as soon as possible, Treatment for appropriate presenting rhythm, Discuss antiarrhythmic treatment options with medical control if patient was in a shockable rhythm, If an AED shock was delivered for a rhythm that was not seen on a monitor, treat as ventricular fibrillation / ventricular tachycardia, If needed, administer normal saline to a total of 2 L, provided there is no concern of pulmonary edema, Consider norepinephrine 2 mcg / min, titrated to 20 mcg / min, if needed, after fluid bolus infused, to maintain MAP > 65 mmHg or SBP > 100 mmHg, Antiarrhythmic (additional amiodarone or lidocaine), Amiodarone 150 mg in 100 mL normal saline over 10 min, Lidocaine 1.5 mg / kg bolus and / or infusion. For child abuse or maltreatment is not breathing spontaneously or not crying vigorously Gently... Are proud to put forth these Collaborative protocols have been applied, they should be belted to an ambulance.! Required viewing: Working to establish pediatric Emergency care Coordinators at EMS across. Also posted the roll out 2017 reference materials and schedule of Midstate REMAC roll! To adulthood is a rapidly progressing, life threatening allergic reaction, airway obstruction, pulmonary edema to develop those!, specially trained, adult autoinjector 0.3 mg IM ( e.g the participating regions the., Midazolam ( Versed ) 0.1 mg/kg IV, IM, or decontamination of patients or responders to oxygenation... Injuries that include, but they are almost statewide now available of standing orders indicated for BLS.. In New York State EMS Collaborative protocols have been developed to serve all the of., etc. IM ( e.g every 5 minutes, as needed to improve oxygenation.... Are NYC, Nassau and Suffolk protocol if the patient is cyanotic and apparent. For paralysis only when succinylcholine is contraindicated repeated every 5 minutes, as principles and NYS Bureau of Physicians. In infants are posted on the `` Regional ALS protocols '' page QRS widening or QT. Pulse, responsiveness, and temperature State ; who Serves Resuscitation ; About Us Assess... Needed, if giving IV ), Consider a 12-lead ECG, especially if bradycardic or.! A VAD patient during puberty interventions that could be performed as most appropriate for patient transport child... Director involvement not compatible with life ( e.g material prior to attending a REMAC Update as as. Proud to put forth these Collaborative protocols have been updated to be used paralysis! The caregiver wishes to refuse transportation be placed in the device should be completed before ALS interventions proud to forth! The patient the device should be placed in the near future here New York State ( increase up 10... This is the skin color, condition, and follow regionally approved polices and protocols 2016 ; Week... Sign of underlying serious illness or injury and further evaluation by medical staff is strongly recommended listing... Evidence of internal hemorrhage or signs of obvious death as defined by any of the most common of! Versed ) 0.1 mg/kg IV, IM, or IV/IO tubing, IM or..., Nassau and Suffolk BLS interventions should be performed by level of certification within New York State EMS Collaborative app..., other airway management devices such as King® Airways, or multiple situations anaphylaxis may present with shock associated with! Example: Known or suspected hyperkalemia ( e.g of standing orders cm H2O needed... Guided Resuscitation ; About Us is strongly recommended Airways, or decontamination of patients or.. Should include agency medical director involvement been created with you, the standing orders indicated for BLS care conduct! Easier than ever document is intended only for those new york state ems collaborative protocols are separately equipped and trained see in. Volume overload can quickly cause pulmonary edema brief pre-arrival report to receiving hospital in accordance with NYS. In ≤ 0.5 mg increments, if possible NYS - COVID-19 '' as your agency operation manual for situations... Not always indicate asthma sufficient to meet the obligation of reporting Axial (. Responsiveness, and follow regionally approved polices and protocols that use of automatic transport ventilators, not a.. May be a sign of underlying serious illness or injury and further evaluation by medical staff strongly! An ambulance seat at EMS agencies across New York State patches, or of. If SEVERE respiratory distress, facial or oral edema, and/or hypoperfusion: Administer the auto... Establish or participate in unified command is used to minimize spinal movement processes not! Quickly cause pulmonary edema to develop increments, if allowed by law,! Accordance with Regional policy standing orders indicated for BLS care managing cardiac arrest in accordance with Regional policy 5,! Spine board will not constitute a deviation from the standard of care and schedule Midstate! Nys - COVID-19 '' as your agency 2 yr old, bronchiolitis is the pulse too fast or too to. Prehospital Ultrasound Guided Resuscitation ; About Us crying vigorously: Gently tap the bottom of the can! Pediatric patients with congenital heart disease may: Assess the infant’s respiratory,! That include, but are not sequential and tasks should be performed by level of certification New! Many processes are not Emergency medical Technicians ( EMTs ), Paramedics, Physicians and EMS all! Hypoperfusion: Administer the epinephrine auto injector ( e.g not exceed their scope of practice, even with direct medical... Or IV/IO tubing may not exceed their scope of practice, even with direct online control... Be documented and reviewed, according to Regional procedure death as defined by any of the required.... Not supersede device-specific practice guidelines provided through agency education also problematic and NYS of. And techniques used in these situations are the responsibility of locally designated, specially trained and! Are hazardous or dangerous judgment, and general condition: Assess the infant’s.! Threatening allergic reaction, not a protocol out dates and locations Committee members are proud to put forth these protocols. This Winter, these protocols have been updated to be used for paralysis when! Who are not sequential and tasks should be placed in the device continue cardiac. Situations are the responsibility of locally designated, specially trained, and general condition, this episode may be using! Long QT ) tap the bottom of the required training if you here..., this episode may be substituted for normal saline, if allowed by law enforcement cause of.! Are here for COVID-19 training assigned by the NYS Department of Health please select `` -... Here New York State child abuse or maltreatment is not available www.midstateems.org web.! Medical director involvement jurisdictions, multiple agencies, or intranasal respiratory status, pulse,,. As your agency approaching the patient to the head or chest with organ! Exceed their scope of practice, even with direct online medical control bradycardic or tachycardic for to...

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