Advanced & Primary Care Paramedic Changes to Medical Directives Fall 2005

“The Power of 7” Base Hospital Programs  Cambridge  Grey Bruce  Hamilton  Lambton  London  Niagara  Windsor S outh W est E ducation C ommittee

History ??  In past medical directives varied between Base Hospital Programs.  This year, implementation of standardized protocols approved by the Provincial Medical Advisory Committee (MAC) have been released for all Base Hospitals to follow.

“New Look” General changes include  An introduction which clearly outlines guidelines for:  Use of the protocols and patching to the Base Hospital Physicians  Consent to treatment and capacity assessment  Refusal of treatment  Cardiac monitoring and oxygen administration Not New Here !

“New Look”  Adult and Pediatric protocols are not combined – but will be in the future.  Auxiliary Protocols.  Personal Protective Equipment use for paramedics is clearly outlined within the appropriate directive, specifically nebulized medication administration.

SOB/Respiratory Distress Protocol  The new medical directives indicates that salbutamol administration will not exceed 3 doses…  previously…maximum administration was 2 doses

SOB/Respiratory Distress Protocol Contraindications for nebulization of salbutamol now include:  Patient has a suspected or known fever (> 38.0 C) OR  In the case of a declared outbreak of a severe respiratory illness by the local Medical Officer of Health

SOB/Respiratory Distress Protocol Procedure changes:  Salbutamol should be administered via MDI if available  If MDI not available or the patient not able to use the MDI/spacer properly then administer salbutamol via nebulizer

SOB/Respiratory Distress Protocol Procedure changes: Salbutamol via spacer dose Patients <30 kg = total of 6 puffs Patients > 30 kg = total of 9 puffs Salbutamol via nebulizer Patients < 30kg = 2.5 mg Patients > 30 kg = 5.0 mg  No longer 1.25 mg for pediatric patients

Moderate to Severe Asthma Exacerbation Protocol This protocol can now be applied to patients where nebulized salbutamol is contraindicated and MDI/spacer is unavailable. Indications for application of this protocol has been expanded to include patient presentation of severe agitation, confusion, and cyanosis.

Moderate to Severe Asthma Exacerbation Protocol Epinephrine can be administered either subcutaneously OR intramuscularly

Moderate to Severe Asthma Exacerbation Protocol Procedure changes: Caution!!!  A BHP patch must be attempted prior to a second dose of epinephrine for patients that are < 10 kg or patients with a history of ischemic heart disease.

Anaphylaxis/Allergic Reaction Protocol Epinephrine can be administered either subcutaneously OR intramuscularly Caution!!! A BHP patch must be attempted prior to a second dose of epinephrine for patients that are < 10 kg or patients with a history of ischemic heart disease. Epipen standing orders are now included for Ambulance Services that utilize them !

Suspected Cardiac Ischemia Chest Pain Protocol Contraindications for nitroglycerin administration: Prescription medication for erectile dysfunction within the last 48 hours

Suspected Cardiac Ischemia Chest Pain Protocol ASA can now be administered to patients even if chest pain has resolved on paramedic arrival

Acute Cardiogenic Pulmonary Edema Protocol Contraindications for nitroglycerin administration: Prescription medication for erectile dysfunction within the last 48 hours

Altered LOC- Suspected Hypoglycemia Protocol  Glucagon now can be administered either subcutaneously OR intramuscularly  Blood glucose tests can be done when:  a glucose problem is suspected; either hypoglycemic or hyperglycemic  The patient can receive oral glucose if signs and symptoms consistent with hypoglycemia are present

Altered LOC- Suspected Hypoglycemia Protocol Caution! patients that are on oral hypoglycemics are at a high risk for recurrent episodes of hypoglycemia

Hypotension Changes to hypotension require the paramedic to only fluid bolus a hypotensive patient when a known or suspected causes exists.

IO infusions The age for IO insertion has been increased to 12 years.

Lasix Not part of any standing order for CHF but drug may be used in consultation with a BHP during a patch for management of a severe CHF patient.

Lidocaine Lidocaine for intubation to prevent the spike in ICP requires………

Arrest Protocols

Cardiac Arrest General Protocol Paramedics, where available, should select the lowest energy level available for each shock for patients between the ages of 8 and 12 years.

The End Questions?