Transcription

StatewideBasic Life SupportAdult and PediatricTreatment Protocols2019 Version 1.0[April 12, 2019]Effective August 1, 2019health.ny.gov/ems

IndexBackground .4Introduction .5Pediatric Definition and Discussion .7Acknowledgements .8General Approach to Prehospital Care .9General Approach to the EMS Call .10General Approach to the Patient . 11General Approach to Transportation .14General Approach to Safety Restraining Devices. 15Extremis/Cardiac Arrest Protocols .16Cardiac Arrest .17Cardiac Arrest – Pediatric .19Foreign Body Obstructed Airway . 21Foreign Body Obstructed Airway – Pediatric .22Respiratory Arrest/Failure .23Respiratory Arrest/Failure – Pediatric.24Obvious Death .25General Adult and Pediatric Medical Protocols . 26AMS: Altered Mental Status . 27AMS: ALTE/BRUE – Pediatric . 28Anaphylaxis. 29Anaphylaxis – Pediatric .30Behavioral Emergencies .32Carbon Monoxide Exposure – Suspected .333Cardiac Related Problem .35Cardiac Related Problem – Pediatric .36Childbirth: Obstetrics .38Childbirth: Newborn/Neonatal Care .40Difficulty Breathing: Asthma/Wheezing.41Difficulty Breathing: Asthma/Wheezing – Pediatric . 43Difficulty Breathing: Stridor – Pediatric .45Environmental – Cold Emergencies .46Environmental – Heat Emergencies .48Opioid (Narcotic) Overdose . 49Version 011619A1

Poisoning .50Seizures . 51Sepsis/Septic Shock .52Sepsis/Septic Shock – Pediatric .53Stroke . 54Technology Assisted Children . 55Total Artificial Heart (TAH) . 57Ventricular Assist Device (VAD) .58Trauma Protocols .60Trauma Patient Destination . 61Amputation .62Avulsed Tooth .63Bleeding/Hemorrhage Control . 64Burns . 66Chest Trauma .68Eye Injuries . 69Musculoskeletal Trauma .70Patella Dislocation.71Suspected Spinal Injuries .72Resources . 74Advance Directives/DNR/MOLST . 75APGAR . 77Automatic Transport Ventilator .78Child Abuse Reporting .80Glasgow Coma Score (GCS) . 81Incident Command .82Needlestick/Infectious Exposure . 83Normal Vital Signs for Infants/Children .84Oxygen Administration .85Pediatric Assessment Triangle .86Prescribed Medication Assistance .87Refusal of Medical Attention . 88Responsibilities of Patient Care.90Transfer of Patient Care .91Version 011619A2

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BackgroundThese protocols are intended to guide and direct patient care by EMS providers across NewYork State. They reflect the current evidence-based practice and consensus of contentexperts. These protocols are not intended to be absolute treatment documents, rather, asprinciples and directives which are sufficiently flexible to accommodate the complexity ofpatient management.No protocol can be written to cover every situation that a provider may encounter, nor areprotocols a substitute for good judgment and experience. Providers are expected to utilizetheir best clinical judgment and deliver care and procedures according to what isreasonable and prudent for specific situations. However, it will be expected that anydeviations from protocol shall be documented and reviewed, according to regionalprocedure.THESE PROTOCOLS ARE NOT A SUBSTITUTEFOR GOOD CLINICAL JUDGEMENTVersion 011619A4

IntroductionThe Statewide Basic Life Support Adult and Pediatric Treatment Protocols reflect thecurrent acceptable standards for basic life support (BLS) delivered by certified firstresponders (CFR), and emergency medical technicians (EMT) in New York State.Advanced life support (ALS) protocols are developed separately and subject to regionalvariation.Advanced providers are also responsible for, and may implement, the standing ordersindicated for BLS care. Protocols are listed for each provider level and STOP lines indicatethe end of standing orders. Generally, BLS interventions should be completed before ALSinterventions.Bullets are used throughout this document. Many processes are not sequential and tasksshould be performed as most appropriate for patient care.Regional protocols and policies may accompany these BLS protocols.The color-coded format of the protocols allows each BLS professional to easily follow thepotential interventions that could be performed by level of certification.CRITERIA Any specific information regarding the protocol in generalCFR AND ALL PROVIDER LEVELS CFR and EMT standing ordersThese are also standing orders for all levels of credential above EMTCFR STOPEMT EMT standing ordersThese are also standing orders for all levels of credential above EMTEMT STOPMEDICAL CONTROL CONSIDERATIONS Medical control may give any order within the scope of practice of the providerOptions listed in this section are common considerations that medical control maychoose to order as the situation warrantsKEY POINTS/CONSIDERATIONS Additional points specific to patients that fall within the protocolThese protocols do not supplant regionally required equipment specifications or theitems required under Public Health Law and RegulationsVersion 011619A5

These protocols should not serve as a demonstration of required equipment ortraining, as regional and agency variations will exist“*if equipped and trained” is noted to indicate interventions that may be performed if anagency or region chooses to implement these variations. These are not required.Version 011619A6

Pediatric Definition and DiscussionThe period of human development from childhood to adulthood is a continuum with thetransition occurring during puberty. Since the completion of this transition is not sharplydemarcated and varies among individuals, it is difficult to set a precise age when childhoodends and adulthood begins. It follows that use of such a definition to determine when apediatric or an adult protocol is to be used is also problematic.The medical control agreement contained within these protocol document states, “providersare expected to utilize their best clinical judgment and deliver care and proceduresaccording to what is reasonable and prudent for specific situations.” The determination ofwhen to utilize an adult or pediatric protocol shall be no different and subject to the sameCQI review that is compulsory with any other aspect of prehospital emergency care.As a general guideline for use with these protocols, the following definition has beenestablished: Pediatric protocols should be considered for patients who have not yet reachedtheir 15th birthdayVersion 011619A7

AcknowledgementsThe State and Regional Emergency Medical Services Councils, State and RegionalEmergency Medical Advisory Committees, State Emergency Medical Services for ChildrenAdvisory Committee, Regional Program Agency staff, and all who contributed to this andprevious versions of these protocols.The BLS Protocols Advisory and Writing Group.NYSDOH Bureau of EMS staff.Special thanks to Robin Snyder-Dailey for the protocol design.Version 011619A8

General Approach to Prehospital CareVersion 011619A9

General Approach to the EMS CallApplies to adult and pediatric patientsCRITERIAThis general approach guidance document is intended to provide a standardized frameworkfor approaching the scene. Follow common sense, apply good clinical judgment, and followregionally approved polices and protocols.CFR AND ALL PROVIDER LEVELSEMTConsider dispatch information while responding: Type of response(emergency/non) Prevailing weather Road conditions Time of day Location of callEMD determinant/mechanismof illness/injuryNumber of anticipated patientsNeed for additional resourcesSurvey the scene – do not approach the scene unless acceptably safe to do so. Stageproximate to the scene until scene is rendered acceptably safe: Environmental hazards Mechanical hazards CBRNE hazards Violence/threat of violence