1. Intermediate Protocol Review Intermediate Level

2. Cardiac Arrest—Initial Care NEW PROTOCOL References rhythm based protocols Reinforces BLS – Good CPR – Intubation not required if ventilation adequate – Consider supraglottic airway

3. Post Cardiac Arrest Therapeutic Hypothermia interventions for all levels of care.

4. Pediatric Cardiac Arrest General Approach Intubation is deemphasized Understand Termination Rules

5. Neonatal Resuscitation

6. Trauma: Transport Guidelines

7. Trauma: Aeromedical Utilization Must SIGNIFICANTLY reduce transport time Signs of life!!! Don’t wait for the helicopter <20 mile transport? Entrapment

8. Trauma: Pregnant Patients Adult trauma pt > 20 weeks gestation – Not meeting trauma criteria – ER of their choice – Meeting trauma criteria – Adult trauma center!

9. Trauma: Chest Bilateral needle decompression as standing order for Trauma Code with suspected chest injury.

10. Trauma: Hypoperfusion Differing fluid goals for compressible injury Reflects current ITLS/ATLS guidelines

11. Airway Management Changes: – CPAP for EMT-I – Must be credentialed – Earlier use of supraglottic airways Waveform required for intubated patients Recommended for alternate airways

12. Airway Management Comparison

13. Continuous Positive Airway Pressure Changes – EMT-I allowed* *If credentialed Remember indications and contraindications

14. Diabetic Emergencies NEW PROTOCOL Addresses low and high blood sugar Intermediates use D10 for hypoglycemia

15. Diabetic Emergencies Comparison

16. Pain / Nausea /Sedation A fluid bolus makes almost anyone feel better