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2017 EMS Collaborative Protocols


2017 Collaborative Protocol Rollout

Cooperstown Medical Transport, Inc.


After several years of revisions the 2017 New York State EMS Collaborative Protocols are ready for rollout. I never thought I would see it in my EMS career, but they are almost statewide! The only EMS Regions that have not signed onto the protocols are NYC, Nassau and Suffolk. The advantages to a statewide set of protocols are many. EMTs and Advanced providers will now be able to move from Region to Region and have the same set of protocols.

There has also been collaboration in developing the training curriculum. Below is the Collaborative Protocol Educational Resource Document. Existing Critical Care Technicians and Paramedics will need to individually attest to completing the components of the educational rollout. Your attestation will be taken to the Medical Director, Dr. Donald Doynow, for approval. If you are already credentialed in the AAREMS Region you will not have to take a credentialing exam. New providers to the region will need to take an open book credentialing exam.

There will be a classroom educational component for both ALS and BLS providers. ALS will be in the form of self-study and an eight hour classroom day, and BLS will be in the form of a four hour classroom day. All classes will be from March 14th to March 28th. They will be offered days, evening and weekends. Sign up under Events on EMS eSchedule.

     ALS classroom will include- new ALS and BLS bags, King Airways, T-pod pelvic girdle, Tactical kit, CS Review, passive oxygenation, medications (K Centra, Alteplase,      Ketamine, Decadron and Cardizem for CC), and additional review of "new skills" such as double sequential defibrillation.
     This day will be scheduled for two four hour blocks with an hour lunch in between. Have your self-study attestation sheet complete to be turned in at class.
     Self- Study attestation sheets should be turned in no later than March 30th- as Dr. Doynow will be signing all forms on March 30th.

     BLS classroom will include- new ALS and BLS bags, T-pod pelvic girdle, Patella reduction, End of Life, Massive Bleeding, Eye Irrigation and the Tactical kit.

During the last week in March CMT, will be updating our rig and supply room inventories for the new equipment and medications. The dates for roll over are March 29th and 30th with an additional day of March 31st if needed. It takes lots of manpower and coordination to touch all 18 rigs and supply rooms in two days so if you are scheduled to work please be patient and helpful.

CMT's target date for implementation will be March 31, 2017. If you have not completed the educational components of the protocol update you will be taken off line until complete. We cannot hold back the entire company moving to the new protocols for one or two people who do not meet the rollout requirements.

The "new" smart phone app should be available for both Apple and Android phones March 1, 2017.  BE CAREFUL- do not download the new app until the end of March!

ATTESTATION

CMT 2017 Attestation Form (DOC)
CMT 2017 Attestation Form (PDF)

CMT Employess, please use this form
AAREMS 2017 Attestation Form (DOC)
AAREMS 2017 Attestation Form (PDF)





OVERVIEW

Collaborative Topics
        Topics provided by others in the collaborative include links to ketamine and patella reduction databases for QA reporting
Podcast
        Audio discussion of select topics in a podcast format
Simulation Video
        Video demonstration and discussion of certain topics that are novel, complex, or otherwise occur infrequently
Self-Study
        Much of the protocol document is fairly straightforward but requires careful review to ensure that providers are familiar with the content and facile in navigating the app
        Providers should be given contact information by their region to facilitate the answering of questions that may arise during self-study
Examination
        An exam will be created to be taken "open book" with the primary intent of assuring the providers are proficient with navigating the application and efficiently finding information.


COLLABORATIVE TOPICS

Hudson Mohawk REMO Update
        (While this video presentation was created for the REMO region, it is a nice general overview of the collaborative highlights):

         Overview of 2015 to 2017 Protocols (MP4)

End of life
         Overview of 2015 to 2017 Protocols (PDF)
         Overview of 2015 to 2017 Protocols (PPTX)

Ketamine

         Ketamine Final (MP4)

         QA Reporting (please complete for every ketamine administration throughout the collaborative - not just in the Rochester area):

         Survey

Patella reduction
         Patella Dislocation and Reduction

         QA reporting (Please complete for every patella reduction throughout the collaborative - not just in the Rochester area):

         Survey

Calcium chloride
         Calcium Chloride (PDF)
         Calcium Chloride (PPTX)

Pre-existing vascular devices
         Vascular Devices (PDF)
         Vascular Devices (PPTX)

Transport ventilators
         Transport Ventilators (PDF)
         Transport Ventilators (PPTX)

RSI checklist
         RSI Checklist (PDF)


SIMULATION

The simulation videos are intended to demonstrate patient care scenarios in the context of the NYS collaborative protocols.
Like the rest of medicine, there are different ways of practicing EMS and we encourage providers to watch the videos with a critical eye and think about how they would debrief the scenarios if they were the instructor/supervisor. Separate links for each module are listed so that you can chose which you would like to share with the providers in your region based on your needs.

Special thanks to Laerdal for their assistance with these videos.

Intro
         Intro (MP4)

Double sequential defibrillation
         Double Sequential Defrib (MP4)

Surgical cricothyroidotomy (Bougie assisted)
         Intubation (MP4)

OB field delivery
         Sim Mom (MP4)

Neonatal resuscitation
         Baby Ambulance (MP4)

Informal debrief of neonatal resuscitation (critiques scenario and models informal call review)
         Ambulance Debrief (MP4)

Complications of delivery and normal delivery (including postpartum hemorrhage, shoulder dystocia, breech, etc.)
         OB All Scenes (MP4)

Avulsed tooth
         Tooth (MP4)

Eye irrigation / Morgan Lens
         Eye (MP4)

PerfectCPR for Apple Watch
         CPR Watch App (MP4)

Massive bleeding (with hemostatic wound packing and clot removal)
         Leg Wound (MP4)

Critical patient management with RSI
         Unconscious (MP4)

Formal debrief of critical patient management scenario (critiques scenario and models formal call review sessions)
         Debrief (MP4)


PODCASTS

The podcasts are not "all-encompassing", but focus on particular points of interest.

Providers often have questions about why certain things came out the way they did.

In addition, there are some things that were discussed while we were writing the protocols that would be worth conveying to make sure the effect of the protocols results in the optimum patient care.

The podcasts span two episodes and cover the topics below.

Episode 38 (1 of 2)
         Review Part 1 (MP3)

Episode 39 (2 of 2)
         Review Part 2 (MP3)

         For your reference, the discussion will include particular topics within the following protocols:

Page 5: Patient care responsibilities

Page 6: Medical control agreement
         Regions will determine procedure for protocol deviations

(1-1): General cardiac arrest
         Importance and maintenance of quality compressions

Transport safety issues

Waveform capnography

(1-3): V-fib arrest
         Discuss the precipitate of CaCl2 and NaHCO3

         Dilution of amiodarone bolus

(1-4): ROSC
         Optimize patient condition prior to transport

(1-7): Pediatric arrest
         No need to intubate if ventilating effectively

(2-2): Chest pain
         Discussion of ASA, NTG, and 12-lead

(2-4): Agitated patient
         Difference between agitated patient and excited delirium protocols

Titration of BDZ on standing order

(2-5): Oxygen
         Concept of oxygen as a medication

         Practice of using 15 LPM via NC during RSI

(2-6): Allergic reaction
         Difference in indication for epi based on history of true anaphylaxis

Meaning of "consider" in protocol

(2-13): Chest trauma
         Discuss sucking chest wound

Discuss CC in protocols
         Review indications for chest decompression

(2-15): COPD
         Discuss differences with statewide BLS protocols and what this means for the EMT

(2-19): Heat emergencies
         Use of p.o. fluids

Discussion of water intoxication

(2-23): Hypoglycemia
         Use of p.o. treatment

Discuss D10

(2-26): Musculoskeletal trauma
         Pelvic fx management

(2-32): General pain management
         Approximated weight based dosing

Ketamine effects
         Ketorolac and nitrous cautions

Morphine histamine reaction vs true allergy

Rigid chest syndrome with fentanyl

(2-34): Post intubation management
         Indicated for every intubated patient (not just for RSI providers)

Importance of analgesia (vs. sedation)

DOPE

(2-50): Vascular access
         Lido for conscious IO

Limit unnecessary IVs in children

(4-9): Trauma criteria
         Trauma center level destination based on CDC criteria


SELF-STUDY

The above education does not cover every aspect of these protocols
Provider self-study is necessary to assure familiarity with the document and proficient navigation of the app