Accomack County Dept of Public Safety TEMS 13

Accomack County Dept. of Public Safety TEMS 13 th EDITION EMS PROTOCOLS PROVIDER ROLLOUT

AGENDA Changes to Specific Protocols New Medications Retiring Medications Changes to Eastern Shore IV/Drug Boxes

Changes to Specific Protocols Anaphylaxis Bites and Stings Alcohol removed under Marine Life Stings (now Jellyfish or Man-O-War) Bleeding Control Added “Push Pressor” Epinepherine added New Protocol! Bradycardia Midazolam (Versed) dose changed to 2. 5 mg IN/IM/IV/IO

Changes to Specific Protocols Breathing Difficulty Ativan changed to Midazolam (Versed) 1 mg IV for anxiety Pediatric dose of Albuterol changed to 2. 5 mg Magnesium Sulfate added for pediatric patients Carbon Monoxide/Cyanida New Protocol CBRNE/HAZMAT New Protocol

Changes to Specific Protocols Combative Patient Non-Agitated Uncooperative or danger to self/others => Midazolam 2. 5 mg IN/IM, can repeat Uncooperative or danger to self/others => Haldol 2. 5 mg, can rs Agitated IV dosing of medications removed Added 1000 ml bolus for agitated patients Uncooperative/Agitated Dosing Haldol 5 mg/IM w/ repeat dosing Consider using ½ doses in the elderly

Changes to Specific Protocols Crush Syndrome Morphine and Fentanyl Removed (Refer to Pain Management protocol) Cardiac Arrest Lidocaine added as secondary anti-arrhthmicmic Renal Failure/suspected hyperkalemia issues included Magnesium Sulfate and Calcium Chloride added to Pediatric Dosing Dialysis/Renal Failure Cardiac arrest treatments removed, now only refers to patients with a pulse Bleeding shunt removed (Refer to bleeding control protocol)

Changes to Specific Protocols Hyper/Hypoglycemia D 50 and D 25 changed to D 10 with dosing reflected Glucagon dosage reduced for patients less than 5 years of age (0. 5 mg) Left Ventricular Assist Device (LVAD) Preeclampsia New Protocol Seizure medications removed, refer to seizure protocol Overdose Naloxone (Narcan) dose changed to 1 mg IN Magnesium Sulfate removed Pain Management Ketamine 0. 2 mg/kg IV max dose 20 mg IV or 0. 5 mg/kg IN max 25 mg moved into protocol as a primary medication Morphine and Fentanyl moved into notes pages as other medications to consider

Changes to Specific Protocols Rehabilitation Return of Spontaneous Circulation (ROSC) Dosing for Midazolam (Versed) changed to 2. 5 mg IV or 5 mg IN/IM Lorazepam (Ativan) removed Sepsis Dosing for Norepinepherine (Levophed) changed to 2 -12 mcg/min Shock (Non-Traumatic) 12 -lead ECG within 20 minutes of ROSC added Seizures Re-evaluation heart rate increased to 110 bpm Dosing for Norepinepherine (Levophed) changed to 2 -12 mcg/min Spinal Motion Restruction Abnormal neurological exam (PMS) decision point moved up to the 2 nd decision point

Changes to Specific Protocols Stable Tachycardia Magnesium Sulfate added for pediatric patients Traumatic Injury If SBP less than 90 mm. Hg with signs of hypoperfusion, 250 ml NS bolus IV/IO added

Protocols Removed IV Protocol Diving Emergencies Pediatric Cardiac Arrest/Bradycardia/ROSC – incorporated into one protocol for all ages Pediatric Airway/Oxygenation/Ventilation – incorporated into one protocol for all ages Pediatric Allergic Reaction/Anaphylaxis – incorporated into one protocol for all ages Pediatric Burns – incorporated into one protocol for all ages Pediatric Hyper/Hypoglycemia – incorporated into one protocol for all ages Pediatric Nausea/Vomiting – incorporated into one protocol for all ages Pediatric Pain – incorporated into one protocol for all ages Pediatric Seizure – incorporated into one protocol for all ages Pediatric Toxicological Emergencies – incorporated into one protocol for all ages

Reference Pages Added Lifevest IO – including new site for distal femur in pediatric – physician order IV Existing catheter access Stroke Epinephrine Drip

IV/DRUG BOX CHANGES MEDICATIONS ADDED Ketamine Dextrose 10% Epinephrine – push pressor EASTERN SHORE MEDICATIONS TO BE ADDED Ibuprofen PO tablets (IV Box) Acetaminophen tablets (IV Box) Ondansetron (Zofran) – one vial moved Drug Box to IV Box

IV/DRUG BOX CHANGES MEDICATIONS REMOVED Dextrose 50% Lorazepam (Ativan)

IMPLEMENTATION The TEMS Protocols can be implemented at the discretion of the agency’ OMD anytime after April 1, 2020. Our goal is April 15 th. Training Requirements Complete Online Protocol Training (View 3 Presentations) Successfully complete skills assessment (on-shift, in station) Administration will announce official “live date” once all training is completed New medications will be placed in the boxes on April 1 st. NEW MEDICATIONS ARE NOT TO BE USED UNTIL NEW PROTOCOL TRAINING IS COMPLETED!