advanced & primary care paramedic

Advanced & Primary Care Paramedic

Changes to Medical Directives

Fall 2005

“The Power of 7” Base Hospital Programs

Cambridge Grey Bruce Hamilton Lambton London Niagara Windsor

SouthWestEducationCommittee

History ?? In past medical directives varied

between Base Hospital Programs. This year, implementation of

standardized protocols approved by the Provincial Medical Advisory Committee (MAC) have been released for all Base Hospitals to follow.

“New Look”

General changes includeAn introduction which clearly outlines guidelines for:

Use of the protocols and patching to the Base Hospital PhysiciansConsent to treatment and capacity assessmentRefusal of treatmentCardiac monitoring and oxygen administration

Not New H

ere!

“New Look”

Adult and Pediatric protocols are not combined – but will be in the future.

Auxiliary Protocols.

Personal Protective Equipment use for paramedics is clearly outlined within the appropriate directive, specifically nebulized medication administration.

SOB/Respiratory Distress Protocol

The new medical directives indicates that salbutamol administration will not exceed 3 doses…

previously…maximum administration was 2 doses

SOB/Respiratory Distress Protocol

Contraindications for nebulization of salbutamol now include:

Patient has a suspected or known fever (> 38.0 C)

ORIn the case of a declared outbreak of a severe respiratory illness by the local Medical Officer of Health

SOB/Respiratory Distress Protocol

Procedure changes:

Salbutamol should be administered via MDI ifavailable

If MDI not available or the patient not able to use the MDI/spacer properly then administersalbutamol via nebulizer

SOB/Respiratory DistressProtocol

Procedure changes:

Salbutamol via spacer dosePatients <30 kg = total of 6 puffsPatients > 30 kg = total of 9 puffs

Salbutamol via nebulizerPatients < 30kg = 2.5 mgPatients > 30 kg = 5.0 mg

No longer 1.25 mg for pediatric patients

Moderate to Severe AsthmaExacerbation Protocol

This protocol can now be applied to patients where nebulized salbutamol is contraindicated and MDI/spacer is unavailable.

Indications for application of this protocol has been expanded to include patient presentationof severe agitation, confusion, and cyanosis.

Moderate to Severe AsthmaExacerbation Protocol

Epinephrine can be administered either subcutaneously OR intramuscularly

Moderate to Severe AsthmaExacerbation Protocol

Procedure changes:

Caution!!!

A BHP patch must be attempted prior to a second dose of epinephrine for patients that are < 10 kg or patients with a history of ischemic heart disease.

Anaphylaxis/Allergic Reaction Protocol

Epinephrine can be administered either subcutaneously OR intramuscularly

Caution!!!A BHP patch must be attempted prior to a second dose of epinephrine for patients that are < 10 kg or patients with a history of ischemic heart disease.

Epipen standing orders are now included for Ambulance Services that utilize them!

Suspected Cardiac Ischemia Chest Pain Protocol

Contraindications for nitroglycerin administration:

Prescription medication for erectile dysfunction within the last 48 hours

Suspected Cardiac Ischemia Chest Pain Protocol

ASA can now be administered to patients even if chest pain has resolved on paramedic arrival

Acute Cardiogenic Pulmonary Edema Protocol

Contraindications for nitroglycerin administration:

Prescription medication for erectile dysfunction within the last 48 hours

Altered LOC- Suspected Hypoglycemia Protocol

Glucagon now can be administered either subcutaneously OR intramuscularly

Blood glucose tests can be done when:a glucose problem is suspected; either hypoglycemic or hyperglycemic

The patient can receive oral glucose if signs and symptoms consistent with hypoglycemia are present

Altered LOC- Suspected Hypoglycemia Protocol

Caution! patients that are on oral hypoglycemics are at a high risk for recurrent episodes of hypoglycemia

Hypotension

Changes to hypotension require the paramedic to only fluid bolus a hypotensive patient when a known or suspected causes exists.

IO infusions

The age for IO insertion has been increased to 12 years.

Lasix

Not part of any standing order for CHF but drug may be used in consultation with a BHP during a patch for management of a severe CHF patient.

Lidocaine

Lidocaine for intubation to prevent the spike in ICP requires………

Arrest Protocols

Cardiac Arrest General Protocol

Paramedics, where available, should select the lowest energy

level available for each shock for patients between the ages of

8 and 12 years.

The EndQuestions?