1. Paramedic Protocol Update 2012 Westchester Regional Emergency Medical Advisory Committee Westchester Paramedic Protocol Update 2/12 - Overview1

2. Update Roll-Out Westchester Paramedic Protocol Update 2/12 - Overview2  Roll-out training materials will be emailed to agencies.  Update materials will also be posted on WREMSCO website.  Presentations cover the updated protocols by section:  Adult Medical  Pediatric Medical  Agencies are expected to deliver content to affiliated paramedics.  Service Medical Directors should approve a delivery mechanism  I.e., classroom session, computer delivery, follow-up quiz, etc… April 1, 2011  Agencies must have proof on record that all Paramedics (anyone on roster) have completed ACLS and PALS courses after April 1, 2011.

3. Documentation Westchester Paramedic Protocol Update 2/12 - Overview3  Agency Medical Director MUST affirm that all affiliated paramedics have received update training from the agency MARCH 31 st  All update affirmations MUST be submitted by MARCH 31 st  Agencies MUST affirm that ALL rostered paramedics hold ACLS and PALS cards completed after April 1, 2011. MAY 31 st  Completed ACLS/PALS affirmations MUST be submitted by MAY 31 st

4. Implementation Westchester Paramedic Protocol Update 2/12 - Overview4 PROTOCOL CHANGES WILL BE IN EFFECT AS OF: APRIL 1 st

5. Overview Westchester Paramedic Protocol Update 2/12 - Overview5  UPDATES to Adult and Pediatric Medical protocols consistent with the 2010 American Heart Association (AHA) guidelines.  NEW protocols for Post Cardiac Arrest Care  Medical – 5.3: Cardiac (Arrest) - Post Cardiac Arrest Care  Pediatric – 5.3: Cardiac (Arrest) – Post Cardiac Arrest Care  CHANGED numbering for Termination of Resuscitation Protocol  Medical – 5.3  Medical 5.4

6. Adult Medical Protocols Westchester Regional Paramedic Protocol Update 2012 Westchester Paramedic Protocol Update 2/12 - Overview6

7. MEDICAL – 4.0: Cardiac (General)  New note regarding activating STEMI policy Westchester Paramedic Protocol Update 2/12 - Overview7

8. MEDICAL - 4.1: Acute Coronary Syndrome  Update note regarding BP  Update note regarding type and quantity of ASA  Clarifying time frame for caution related to providing NTG in light of use of ED medications Westchester Paramedic Protocol Update 2/12 - Overview8

9. MEDICAL – 4.3: Bradycardia  Update period for repeating Atropine dose  Addition of Note cautioning use of Atropine in the presence of certain heart blocks Westchester Paramedic Protocol Update 2/12 - Overview9

10. MEDICAL – 5.0: Cardiac Arrest – Non-Traumatic  Addition of NEW sub- protocol  Addition of Note regarding unwitnessed arrests  Addition of Note regarding consideration of Magnesium  Removal of Note regarding “Consider Termination of Resuscitation Protocol” Westchester Paramedic Protocol Update 2/12 - Overview10

11. MEDICAL – 5.1: Cardiac Arrest – Shockable Rhythm  Addition of consideration of advanced airway control with capnography  Update period for repeating Epinephrine dose  Removal of administration of Lidocaine (only antidysrhythimic is now Amiodarone)  Removal of consideration for Magnesium (moved to Medical – 5.0) Westchester Paramedic Protocol Update 2/12 - Overview11

12. MEDICAL – 5.1: Cardiac Arrest – Shockable Rhythm cont’d  Addition of NOTE to refer to Protocol M-5.3 if return of perfusing rhythm  Removal of NOTE regarding administration of Lidocaine if rhythm converts  Removal of NOTE regarding administration of antidysrhythimic infusions after rhythm conversion (Amiodarone infusion moved to Protocol M-5.3, Lidocaine eliminated) Westchester Paramedic Protocol Update 2/12 - Overview12

13. MEDICAL – 5.2: Cardiac Arrest – Non-Shockable Rhythm  Addition of consideration of advanced airway control with capnography  Simplified statement re search for reversible causes  Update period for repeating Epinephrine dose  Clarified amount of 0.9% NS infusion  Removal of administration of Atropine  Addition of NOTE to refer to Protocol M-5.3 if return of perfusing rhythm Westchester Paramedic Protocol Update 2/12 - Overview13

14. MEDICAL – 5.3: Post Cardiac Arrest Care  Ventilation/Oxygenation  Consider Airway  Maintain SpO2  Maintain ETCO2  DO NOT HYPERVENTILATE  Obtain IV/IO access  Adm of Amiodarone drip if used prior to conversion  Contact OLMC for pressors  IV/IO fluid challenges  Notify ER of possible hypothermia therapy  Obtain 12 lead EKG Westchester Paramedic Protocol Update 2/12 - Overview14

15. MEDICAL – 5.3: Post Cardiac Arrest Care cont’d  OLMC Epi and Dopamine infusion orders  NOTE regarding reversible causes  NOTE regarding activation of the Regional STEMI policy if STEMI present Westchester Paramedic Protocol Update 2/12 - Overview15

16. MEDICAL – 5.4: Field Termination of Resuscitation Efforts  Change of Numbering  Additional note regarding use of capnography to confirm placement of ETT  NEW notation of ETCO2 readings  Removal of notation regarding administration of Atropine Westchester Paramedic Protocol Update 2/12 - Overview16

17. Pediatric Medical Protocols Westchester Regional Paramedic Protocol Update 2012 Westchester Paramedic Protocol Update 2/12 - Overview17

18. PEDIATRIC – 5.0: Cardiac Arrest – Non-Traumatic  Update regarding unwitnessed arrests  Update of ventilation rates when advanced airway in place  Addition of NEW sub- protocol Westchester Paramedic Protocol Update 2/12 - Overview18

19. PEDIATRIC – 5.1: Cardiac Arrest – Shockable Rhythm  Update period for repeating Epinephrine dose  Removal of administration of Lidocaine (only antidysrhythimic is now Amiodarone) Westchester Paramedic Protocol Update 2/12 - Overview19

20. PEDIATRIC – 5.1: Cardiac Arrest – Shockable Rhythm cont’d  Addition regarding Joulage settings for second and subsequent defibrillations  Addition of NOTE to refer to Protocol M-5.3 if return of perfusing rhythm  Update of administration of 0.9% NS bolus after medication  Removal of NOTE regarding administration of Lidocaine (bolus or drip) if rhythm converts Westchester Paramedic Protocol Update 2/12 - Overview20

21. PEDIATRIC – 5.2: Cardiac Arrest – Non-Shockable Rhythm  Addition of consideration of advanced airway control with capnography  Simplified statement re search for reversible causes  Update period for repeating Epinephrine dose  Clarified amount of 0.9% NS infusion  Addition of NOTE to refer to Protocol P-5.3 if return of perfusing rhythm Westchester Paramedic Protocol Update 2/12 - Overview21

22. PEDIATRIC – 5.3: Post Cardiac Arrest Care  Ventilation/Oxygenation  Consider Airway  Maintain SpO2  Maintain ETCO2  DO NOT HYPERVENTILATE  Obtain IV/IO if not already done  IV/IO fluid challenges  Contact OLMC for Epi or Dopamine infusions  Notify ER of possible hypothermia therapy  Obtain 12 lead EKG Westchester Paramedic Protocol Update 2/12 - Overview22

23. PEDIATRIC – 5.3: Post Cardiac Arrest Care cont’d  OLMC Epi and Dopamine infusion orders  NOTE regarding reversible causes  NOTE regarding activation of the Regional STEMI policy if STEMI present Westchester Paramedic Protocol Update 2/12 - Overview23

24. PEDIATRIC – 10.0: Neonatal Resuscitation  Addition of direction to warm, dry and stimulate, clearing airway ONLY if necessary  Update regarding intubation after clearing of airway due to meconium  Addition to monitor SpO2  Update regarding compression-ventilation ratios  Addition of direction to change ratios if arrest is known to be cardiac in origin Westchester Paramedic Protocol Update 2/12 - Overview24

25. Reminders Westchester Paramedic Protocol Update 2/12 - Overview25  QUALITY CPR comes first  Advanced airway ONLY if BLS procedures are inadequate – especially for Pediatric patients  ETCO2 monitoring (quantitative waveform capnography) required for ALL intubated patients  12 Lead EKGs are required for ALL non-arresting or post-arrest cardiac patients  Transport of a body to a hospital post Termination of Resuscitation decision should be:  A rare occurance  Coordinated with OLMC

26. Questions Westchester Paramedic Protocol Update 2/12 - Overview26  Westchester Regional EMS Office  914-231-1616  Westchester REMSCO Website  www.wremsco.org

27. Thank you Westchester Paramedic Protocol Update 2/12 - Overview27