1. Woods Curry, MD, Co-chair Paul Gallo, EMT-P, Co-Chair
2019 ACADEMY OF MEDICINE OF CINCINNATI PROTOCOLS FOR SOUTHWEST OHIO PREHOSPITAL CARE UPDATE
Woods Curry, MD, Co-chair Paul Gallo, EMT-P, Co-Chair

2. All EMS providers shall be responsible to read and review each protocol and policy in its entirety

3. Provides quality improvement standards
introduction
Training is designed to familiarize the EMS provider with the use and content of new and revised protocols
The protocols will continue to evolve as medicine changes and care is reviewed.
Provides quality improvement standards

4. Protocol committee

5. NEW WEBSITE

6. New Protocols

7. A111 Hospital status

8. M419 Sepsis

9. S507 Special trauma situations

10. S507 Special trauma situations

11. Updated Protocols

12. A100 administrative protocol
Key points
Process for compliance was updated.
New site visit form placed in Appendix K.
Any questions – contact Chief Owens or Dr. Locasto

13. A105 determination of death/termination of cpr
Added: MCI statement
Changed: provides clarification to indicate termination en route was for a moving ambulance

14. SB204 cardiac arrest

15. SB204 cardiac arrest ELEMENTS OF HIGH QUALITY CPR
Ensuring chest compressions of adequate rate (110) – Use metronome
Ensuring chest compressions of adequate depth - at least 2 inches
Adequate Recoil- allowing full chest recoil between compressions
Minimize time off the chest to < 10 seconds for compressor changes or defibrillation
Avoid Hyperventilation – 1 breath every 6 seconds
Rotate compressors every 2 minutes or when end tidal CO2 goes down to reduce rescuer fatigue and ensure high quality compressions
Review and provide feedback of all cardiac arrest calls, including all involved in the call, and including all tools available during the call (e.g., monitor data)

16. Cardiac arrest
C300 Ventricular Fibrillation/Tachycardia Adult w/o Pulse C301 Asystole – Pulseless Electrical Activity (PEA) P601 Pediatric Pulseless Cardiac Arrest (V-Fib, V-Tach) P602 Pediatric Pulseless Cardiac Arrest (Asystole, PEA)
Key points
The basics of CPR removed from each protocol (all in SB204)
Updated medication changes

17. Sb211 & sb213 changes
SB211 Guideline for Assessment/Transport of Adult Trauma Patients SB213 Guideline for Assessment/Transport of Geriatric Trauma Patients
Key points
Anticoagulation and evidence of traumatic brain injury.
a. GCS scale < 13 or AVPU scale that does not respond to Pain or Unresponsive
b. Alteration in LOC during examination or thereafter; loss of conscious > 5 min.
c. Failure to localize pain.

18. C303 & c304
Changed: concentration and dilution of Mag Sulfate

19. M400 Acute coronary syndrome
Changed: to do not administer NTG in an inferior MI.

20. M403 Asthma-copd
Added: option for oral Solu-Medrol.

21. M414 Stroke

22. M414 Stroke

23. S501 Head or spinal trauma Updated: EtCO2 information
Updated: reflects current practice of Air Care based on UC Neurotrauma experts.

24. S505 prehospital pain management
Ketamine has been added as a first-line option. Dose for Ketamine is 0.1 mg/kg IV/IO SLOW PUSH over 1 minute or 0.7 mg/kg IM.

25. S506 administration of tranexamic acid (TXA)
changes
Inclusion Criteria
Age – ALL
Protocol
Pediatric < 12 years - loading dose is 15 mg/kg IV (max 1g) given over 10 minutes. The maintenance infusion of 2 mg/kg/hour for at least 8 hours or until bleeding stops.
Pediatric ≥ 12 years - loading dose is 1g IV over 10 minutes. The maintenance infusion 1g over 8hr or until bleeding stops.

26. P605 pediatric stridor

27. P607 pediatric respiratory distress
Pediatric Respiratory Assessment Measure (PRAM) is a validated scoring tool to classify the severity of exacerbations and its response to treatment in children with asthma. PRAM is a 12-point scoring table that capture’s a patient’s asthma severity using a combination of scalene muscle contraction, suprasternal retractions, wheezing, air entry and oxygen saturation.

28. P607 pediatric respiratory distress

29. P607 pediatric respiratory distress

30. T704 spinal motion restriction (smr)
Key points
Formally known as spinal immobilization…UPDATED for consistency with current evidence-based data to Spinal Motion Restriction (SMR).
SMR refers to the practice of maintaining the entire spine in a neutral in-line position (anatomic alignment) and minimizing movement of the spine without the use of a backboard.
Flow chart form.
Applies to ALL ages.
Spinal care will continue to be assessment based and will focus, when indicated, on “restricting spinal motion” instead of the prior philosophy of spinal immobilization.
Moves from the concept of assuming almost every trauma patient has an unstable spine injury, to the reality that very, very few of them do.
In certain situations the backboard will still be used as an extrication device, but plays no significant role in restricting spinal motion. The EMS crew may, at its discretion, remove the board prior to initiating transport.
Research suggests that unnecessary immobilization on a backboard may cause pain, agitation, respiratory compromise and place some patients at increased risk for pressure-related skin breakdown.

31. T704 spinal motion restriction (smr)

32. T704 spinal motion restriction (smr)
Patients with penetrating trauma to the neck should NOT be placed in a cervical collar or other spinal precautions…This has not change from previous protocols

33. T704 spinal motion restriction (smr)
The committee highly recommends that if your EMS agency responds to organized sporting events in your area that you meet with the athletic trainer/medical staff to review their spinal immobilization procedure.

34. Additional changes Added medication monograph for Ketamine.
Medication monographs located in Appendix O.
Updated the medication chart for pediatrics.
Updated the EMS Scope of Practice in Appendix C.
Reference material on website
Quality and Performance Measures
Football Helmet Removal

35. contacts
Woods Curry, MD, Co-Chair Paul Gallo, EMT-P, Co-Chair