1. 1 2014 ALS PROTOCOL UPDATE Dr. Daniel J. OlssonSusie Surprenant CNYEMS Regional Medical Director CNYEMS Executive Director

2. 2 Overview  CNYEMS-Midstate-North Country Collaborative ALS Protocol Update.  Thirteen of the ALS protocols have been updated to accommodate the new Advanced EMT level.  The following slides contain highlighted sections where the protocols changes and/or additions have occurred.  Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL.  Adult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.  “Secondary advanced airway device “ verbiage changed to “alternative rescue airway device”.

3. Acute Coronary Syndrome  New Medications for AEMT: –Aspirin –Nitroglycerin Paste –Nitroglycerin Spray –Nitroglycerin Tablet 3

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5. Acute Respiratory Distress Asthma or COPD  New Medications for AEMT: –Albuterol Sulfate  New Skill: –CPAP 5

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7. Airway Management  Adult “secondary advanced airway device “ verbiage changed to “alternative rescue airway device”.  Intermediates and AEMTs are only able to utilize alternative rescue airway devices for patients in respiratory or cardiac arrest.  Examples of alternative rescue airway devices: –Combitube –King Airway –LMA 7

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9. Allergic Reaction / Anaphylaxis  New Medications for AEMT: –Albuterol Sulfate –Epinephrine 1:1,000 9

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11. Alerted Mental Status  Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL.  Adult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.  New Medications for AEMT: –Dextrose 50% –Glucagon –Naloxone 11

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13. Asystole and Pulseless Electrical Activity (PEA)  New Medications for AEMT: –Epinephrine 1:10,000 13

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15. Poisoning / Overdose  Adult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.  New Medications for AEMT: –Naloxone 15

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17. Pulmonary Edema  New Medications for AEMT: –Nitroglycerin Paste –Nitroglycerin Spray –Nitroglycerin Tablet  New Skill: –CPAP 17

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19. Seizures  Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL  New Medications for AEMT: –Dextrose 50% –Glucagon 19

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21. V-Fib / Pulseless V-Tach  New Medications for AEMT: –Epinephrine 1:10,000 21

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23. Airway Management - Pediatric  “Secondary advanced airway device“ verbiage changed to “alternative rescue airway device”.  Patients 16 years and older.  Intermediates and AEMTs are only able to utilize alternative rescue airway devices for patients in respiratory or cardiac arrest. 23

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25. Fluid Challenge - Pediatric  Fluid Administration: –Normal Saline bolus 25

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27. IV / IO Therapy - Pediatric  New Skill for AEMT: –Patients 6 years and older: IV or IO access IV or IO access –Patients < 6 years in cardiac arrest: IV or IO access IV or IO access 27

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29. Review of Protocol Changes  Adult Blood Glucose (hypoglycemia) changed to < 60 mg/dL. changed to < 60 mg/dL.  Adult Naloxone dose changed to 0.4 mg IV; IM or IN. 0.4 mg IV; IM or IN.  “Secondary advanced airway device “ verbiage changed to “alternative rescue airway device”. 29

30. 30 New Medications for AEMT Level  Aspirin  Albuterol Sulfate  Dextrose 50%  Epinephrine 1:1,000  Epinephrine 1:10,000  Glucagon  Naloxone  Nitroglycerin Paste  Nitroglycerin Spray  Nitroglycerin Tablet Fluid Administration  Normal Saline bolus

31. 31 New Skills for AEMT Level  Alternative Rescue Airway Device –Patients 16 years and older  CPAP – Adult  Patients 6 years and older: – IV or IO access  Patients < 6 years in cardiac arrest: – IV or IO access

32. 32 Next Steps  AEMT providers will complete an on-line 2014 AEMT Protocol Test.  In order to continue to practice in the Region, an AEMT provider will need to complete the ALS Protocol Update and pass the on-line Protocol Test.  The updated ALS Protocols will go into effective December 8, 2014. into effective December 8, 2014.  All currently certified Intermediates must be certified under the new AEMT Standards by June 30, 2015. AEMT Standards by June 30, 2015.  All Intermediate Protocols will end on June 30, 2015.