1. Effective November 2013

2. FORMAT Different layout with different protocol names based on the OEMS state contract. There are numbers listed beside the protocol titles in the Table of Contents. This is for the VPHIB system.  General – Green  Airway- Blue  Cardiac Arrest- Pink  Environmental – Yellow  Injury- Red (Trauma)  Medical – Orange  OB/GYN – Purple  Exposure – Lime Green The Adult and Pediatric protocols are no longer different sections.

3. FORMAT All of the sections are in the same Microsoft Visio program, even the medication index. The committee hopes you enjoy the new look of the medication index and that it is easier to read and follow.

4. EXAMPLE OF MEDICATION INDEX

5. GENERAL Section This section includes protocols such as:  Behavioral/Patient Restraint  Epistaxis (Nose Bleed)  Fever  Indwelling Medical Device/Equipment  IV/IO Access  Pain Control  Spinal Immobilization/Clearance  Universal Patient Care/Initial Patient Contact

6. AIRWAY Section Protocols included:  Airway (Adult)  Airway (Pediatric)  Airway- Failed  Airway- Obstruction (Adult)  Airway – Obstruction (Pediatric)

7. CARDIAC ARREST Section These are only Cardiac Arrest protocols and do not include other Cardiac related protocols (found in the Medial section) Protocols included:  Cardiac Arrest (Adult)  Cardiac Arrest (Pediatric)  Cardiac Arrest – Asystole/PEA (Adult)  Cardiac Arrest – Asystole/PEA (Pediatric)  Cardiac Arrest – Post resuscitation Care (Adult)  Cardiac Arrest – Post resuscitation Care (Pediatric)  Cardiac Arrest – Ventricular Fibrillation/Ventricular Tachycardia (Adult)  Cardiac Arrest – Ventricular Fibrillation/Ventricular Tachycardia (Pediatric)

8. OTHER Section Other sections include:  Environmental  Injury (Trauma)  Medical  OB/GYN  Exposure

9. BLS Changes BLS Changes to include:  Tylenol to Adult and Pediatric patients for Fever protocol.  Adult will receive 1000 mg (2- 500 mg tablets)  Pediatric – follow the dosage chart given. If the patient weighs greater than >45kg, administer adult dose. The Tylenol must be administered using a 5ml syringe for the Pediatric patients (No needles). Afrin to Adult and Pediatric patients for nose bleeds. Diphenhydramine (Benadryl) 50mg PO for Adult Allergic Reactions.

10. BLS Changes CPAP has been added to the Adult protocol for Pulmonary Edema and Respiratory Distress. Spinal Immobilization/Clearance. There is education to help providers learn this new process.

11. ALS Changes Administration of the following Drugs:  Afrin to Adult and Pediatric patients for nose bleeds.  Tylenol to Adult and Pediatric patients for Fever protocol.  Adult will receive 1000 mg (2- 500 mg tablets)  Pediatric- follow the dosage chart given. If the patient weighs greater than >45kg, administer adult dose. The Tylenol must be administered using a 5ml syringe for the Pediatric patients (No needles).  Prednisone for Adults in the Respiratory Distress protocol.  Enalpril in Pulmonary Edema/CHF protocol.  Dobutamine in the Pulmonary Edema/CHF protocol (for Cardiogenic Shock).

12. ALS Changes  Sodium Bicarbonate and Calcium Chloride:  Special Consideration for dialysis patients: If suspected hyperkalemia. Administer CALICUM CHLORIDE 1g IV/IO OVER 15 MINUTES (avoid if patient is on digitalis) then Administer SODIUM BICARBONATE 50mEq IV/IO  Addition of Magnesium Sulfate (4g over 15 minutes) to ROSC while administering cold fluids.  Administration of Benadryl while giving Morphine.  Administration of Zofran while giving Morphine.