1. VVEMS Writing Group Presented by Todd Lang, MD

3.  Moved some items to appendices  Not a textbook, but full of information  More of a philosophical statement on purpose of guidelines  Discusses uniquities of VVEMS  Reader expected to be familiar with state and national requirements

4.  Interfacility transport guideline  Sedona/VVMC transport guideline  Air transport guideline

5.  To save time for both parties  Name the type of call up front  Patch: please listen and give us guidance  Notification: patient is stable and we don’t request any orders, please direct us to a bed and be prepared for us  We will work with nursing to help them focus attention on Patch calls more tightly

7.  Functioning, dependable EMS Committees  Prehospital Care: Most months. Everyday EMS policy and related matters for the practicing EMS provider and addressing issues at the interface of EMS service and other services.  Steering: Chiefs, EMS leaders, NAH/VVMC leadership. Meets quarterly or PRN  Peer Review: Bimonthly. A forum to analyze and improve care rendered and offer constructive criticism on care and recordkeeping. Generates useful policy/guideline revisions.

8.  Has been running smoothly now for some time  Initial growing pains seem to have passed  Fine tuning the labeling: need to put patient labels over the MFR labels on the tubes  Legal blood draws not required unless blood already being drawn for medical care.

9.  Necessary as volume grows  Empowers individual agencies  Allows focused QA from medical direction and makes more time available for integrative, system-wide data analysis

10.  Allowed but not endorsed strongly by local medical direction  Consider use early in codes  Use after 2 attempts or 90 seconds in critically ill  Costly but safe  Tibial sites preferred over humeral

11.  PICC line access  Portacath access  Increase number of people who can get treated while decreasing pain and risk to EMS  These are the sickest patients and hardest IV starts

12.  0.1 mg/kg for adults  0.05 mg/kg for older (over 55) and peds  Repeat in 10 min  Mirrors our “Protocol M” in ED  Effective and safe dose

13.  An option for life threatening bleeding  May use proprietary device or bp cuff

14.  Rosetta  Lido not a treatment for ischemia  Iodine and shellfish do not cross react with contrast dye and were removed from pretreatment for dye allergy  CCR  Amiodarone removed from protocols

15.  NAH/VVMC purchased to help improve MI care in VV  Mostly working now  Improved technology over fax-based transmission  Helps to bypass the ED in STEMI care when possible

16.  State wide registry which will analyze cardiac arrest and survival  Expect great research  Nationally recognized program  Part of CCR initiative

17.  Early-middle adoption  At request of agencies and leaders  Hopefully will improve outcomes  Unlikely to make things worse

18.  CPAP added  Methylprednisolone by patch order  Furosemide by patch order, dose guideline (double)  Continuous nebs for severe bronchospasm

19.  Lifesaving  Safe  Strongly endorsed by Medical Direction  Costly, but manageable, expense  Should decrease need for invasive airways

20.  Consider RSI for airway burns  Minimize airway manipulation unless RSI available for neuro trauma in field  Cervical Spine Immobilization program

21.  Naloxone dose for altered patient is 0.4 mg IV  Naloxone dose for unconscious or unstable is 2 mg IV/IM  No NG or charcoal in ALOC OD patient  Charcoal only if ingestion <60 min  Diazepam OK for EMT-I in seizures

22.  CCR success  Cardiac Arrest Center/Cooling survivors  Fine tuning of C-spine protocol  Focused RN training in 09  Continued Medical Director Ride Time  Annual Training like this?  Participation and Integration of Medical Direction into EMD process