Town of Vernon Town of Vernon Emergency Medical ServicesEmergency Medical Services

BLS PROTOCOLSBLS PROTOCOLS

OBJECTIVESOBJECTIVES Review E.M.T.’S to current North Central Review E.M.T.’S to current North Central

CT EMS Region & ECHN BLS Protocols for CT EMS Region & ECHN BLS Protocols for which you may render carewhich you may render care

The proper use of medications under The proper use of medications under supervision of a supervision of a medical director or on medical director or on standing orderstanding order

Define “ ON-LINE vs. OFF-LINE” CareDefine “ ON-LINE vs. OFF-LINE” Care Understanding of each MedicationUnderstanding of each Medication Proper Dosage of each medicationProper Dosage of each medication Indications / ContraindicationsIndications / Contraindications

These Protocols are Based and These Protocols are Based and follow the North Central follow the North Central

Connecticut Regional Guidelines Connecticut Regional Guidelines and ECHN BLS Protocols. As best and ECHN BLS Protocols. As best

as possible each protocol is as possible each protocol is referenced to the page number referenced to the page number

that it corresponds to in the that it corresponds to in the Regional Guidelines updated Regional Guidelines updated

version 9/2014version 9/2014

ON-LINEON-LINE

On-Line Medical Direction: is described as On-Line Medical Direction: is described as direct medical contact with medical direct medical contact with medical control to render care for a patient.control to render care for a patient.

You the care giver must contact Medical You the care giver must contact Medical Control and speak to a Doctor to receive Control and speak to a Doctor to receive permission to administer certain permission to administer certain medications prior to administration. medications prior to administration.

ON-LINE ON-LINE

OFF-LINE: You are operating under a set OFF-LINE: You are operating under a set of guidelines or protocols that have been of guidelines or protocols that have been set by your regional or local medical set by your regional or local medical control. control.

The medication is given under prior The medication is given under prior authority of the sponsor hospitals Medical authority of the sponsor hospitals Medical Control Physician. (Standing Order)Control Physician. (Standing Order)

GlucoseGlucose

Altered Level of Altered Level of ConsciousnessConsciousness

Page 37 North Central Page 37 North Central Regional ProtocolsRegional Protocols

Generic Name: Generic Name: Oral glucoseOral glucose

Trade Name: Trade Name: Glucose, Insta-GlucoseGlucose, Insta-Glucose

Actions: Actions: increases blood glucose levelsincreases blood glucose levels

IndicationsIndications

Altered mental statusAltered mental status Hx of diabetesHx of diabetes Known diabetic Known diabetic Signs & Symptoms of a diabetic Signs & Symptoms of a diabetic

EmergencyEmergency Ability to swallow or gag reflexAbility to swallow or gag reflex Blood Glucose level < 80mg/dlBlood Glucose level < 80mg/dl

ContraindicationsContraindications

Unresponsive patientUnresponsive patient Patient unable to swallow (no gag Patient unable to swallow (no gag

reflex)reflex)

Side EffectsSide Effects

May be aspiratedMay be aspirated No other reported side effects when No other reported side effects when

given properlygiven properly

DosageDosage

1 tube equals 15 grams of Glucose1 tube equals 15 grams of Glucose Second tube requires Medical Second tube requires Medical

Control (on-line)Control (on-line)

AdministrationAdministration

Squeeze tube into mouth between Squeeze tube into mouth between cheek and gum or under tongue and cheek and gum or under tongue and let absorblet absorb

Reassess after a few minutes Reassess after a few minutes Document administration, time and Document administration, time and

resultsresults

Prescribed InhalersPrescribed Inhalers

Respiratory Respiratory DistressDistress

Page 30 North Central Page 30 North Central Regional GuidelinesRegional Guidelines

Generic Name: Generic Name: AlbuterolAlbuterol

Trade Names:Trade Names: Proventil, VentolinProventil, Ventolin

Actions:Actions: relaxes bronchial smooth muscles, relaxes bronchial smooth muscles,

relieves bronchospasm, reduces airway relieves bronchospasm, reduces airway resistance, bronchial dilationresistance, bronchial dilation

Indications / Indications / ContraindicationsContraindications

INDICATIONSINDICATIONSPt. exhibits signs & symptoms of Pt. exhibits signs & symptoms of

Resp. DistressResp. Distress**If this is patients’ first dose it may If this is patients’ first dose it may be administered prior to Med-Con be administered prior to Med-Con

(off-line)(off-line)

CONTRAINDICATIONSCONTRAINDICATIONSNone for field use

Pre-Caution with Rapid heart ratesPre-Caution with Rapid heart ratesPre-Caution with pt’s. with HTN or Pre-Caution with pt’s. with HTN or

C.P.C.P.

Side EffectsSide Effects

Increased pulse rateIncreased pulse rate TremorsTremors NervousnessNervousness NauseaNausea

DosageDosage

Take 1-2 inhalationsTake 1-2 inhalations Maybe repeated after 15 minutesMaybe repeated after 15 minutes**

* * Requires Medical ControlRequires Medical Control

AdministrationAdministration Confirm Shortness of BreathConfirm Shortness of Breath Confirm the patient has a prescribed inhalerConfirm the patient has a prescribed inhaler Check expiration dateCheck expiration date Determine if patient has taken any doses Determine if patient has taken any doses

yetyet * * If this is first dose it may be given prior to If this is first dose it may be given prior to

contacting Med-Controlcontacting Med-Control Obtain medical control (on-line)Obtain medical control (on-line) Shake inhalerShake inhaler Have patient exhaleHave patient exhale

AdministrationAdministration

Assist pt. in putting lips around Assist pt. in putting lips around opening of inhaleropening of inhaler

Have PT. depress inhaler as they Have PT. depress inhaler as they begin to inhale deeplybegin to inhale deeply

Have pt. hold breath for as long as Have pt. hold breath for as long as comfortably possible to have comfortably possible to have medication absorbmedication absorb

ReassessReassess Document time and dosageDocument time and dosage

NitroglycerinNitroglycerin

Acute Coronary Acute Coronary Syndromes (Chest Syndromes (Chest Pain)Pain)

Page 10 North Page 10 North Central Regional Central Regional GuidelinesGuidelines

Generic NameGeneric Name

NitroglycerinNitroglycerin

Trade NamesTrade Names

NitrostatNitrostat NitrobidNitrobid Nitro sprayNitro spray

ActionsActions

Vascular smooth muscle relaxantVascular smooth muscle relaxant Vasodilator which decreases Vasodilator which decreases

myocardial workloadmyocardial workload Decreases B/PDecreases B/P Subsides C.P.Subsides C.P.

IndicationsIndications

Pt. is having C.P. (Angina Pectoris)Pt. is having C.P. (Angina Pectoris) The Pt. has prescribed NTG to themThe Pt. has prescribed NTG to them Systolic B.P. >100Systolic B.P. >100

ContraindicationsContraindications

Pt. has a B.P. less than <100 mm/hg Pt. has a B.P. less than <100 mm/hg systolicsystolic

Pt. has a head injuryPt. has a head injury Pt. has taken the maximum number Pt. has taken the maximum number

of doses (3 in 10 minutes) P.T.A. of doses (3 in 10 minutes) P.T.A. Use of a erectile dysfunction drug Use of a erectile dysfunction drug

within the past 48 hourswithin the past 48 hours

DosageDosage

(1) tablet or (1) sublingual spray (1) tablet or (1) sublingual spray Repeated every 3-5 minutes if Repeated every 3-5 minutes if

continued C.P.continued C.P.** B.P. checks between each dosage > B.P. checks between each dosage >

100mm Hg100mm Hg Maximum of 3 dosesMaximum of 3 doses

AdministrationAdministration Confirm C.P. Confirm C.P. Confirm Pt. has prescribed nitroConfirm Pt. has prescribed nitro Check expirationCheck expiration Determine if pt. has taken any doses and Determine if pt. has taken any doses and

timetime Assess B.P.Assess B.P. ** If this is Pt’s. first dose of NTG it If this is Pt’s. first dose of NTG it

maybe given on Standing Ordermaybe given on Standing Order Get Med Control (for subsequent doses)Get Med Control (for subsequent doses)

TabletsTablets

Have pt. raise tongue upHave pt. raise tongue up Administer to Pt. under tongueAdminister to Pt. under tongue Advise Pt not swallow until the Advise Pt not swallow until the

tablet is absorbedtablet is absorbed

Nitro SprayNitro Spray

Ask pt. to raise tongue Ask pt. to raise tongue Hand nitro spray to Pt. for self-Hand nitro spray to Pt. for self-

administration or spray the administration or spray the medication under Pt’s. tonguemedication under Pt’s. tongue

Advise Pt not to swallow for a few Advise Pt not to swallow for a few moments for absorptionmoments for absorption

REASSESSREASSESS

DOCUMENT DOCUMENT

Epinephrine Auto Epinephrine Auto InjectorInjector

AnaphylaxisAnaphylaxis Page 36 North Page 36 North

Central Regional Central Regional GuidelinesGuidelines

Generic NameGeneric Name

epinephrineepinephrine

Trade NameTrade Name

AdrenalinAdrenalin Epi-penEpi-pen Epi-pen jr.Epi-pen jr.

ActionsActions

Dilates the bronchiolesDilates the bronchioles Constricts blood vesselsConstricts blood vessels Increases cardiac output and rateIncreases cardiac output and rate

IndicationsIndicationsAnaphylaxis, is considered a multisystem response to an allergen including one or more of the following signs or symptoms

Severe Respiratory Distress Airway compromise (including wheezing, swelling of lips/tongue,

throat tightness) Widespread hives, itching, swelling Abdominal pain, nausea, vomiting

Signs of shock

ContraindicationsContraindications

None if used in life threatening None if used in life threatening allergic reactions allergic reactions

Side EffectsSide Effects

An increase in H.R. and B.P.An increase in H.R. and B.P. Pale skinPale skin DizzinessDizziness C.P.C.P. HeadacheHeadache Nausea, vomitingNausea, vomiting Excitability, anxiousnessExcitability, anxiousness

DosagesDosages

Adult: 0.3mg (above 66 lbs.)Adult: 0.3mg (above 66 lbs.) Child: 0.15mg (below 66 lbs.)Child: 0.15mg (below 66 lbs.)

AdministrationAdministration Confirm Allergic ReactionConfirm Allergic Reaction Obtain Epi-pen (age Appropriate) from Obtain Epi-pen (age Appropriate) from

AMBULANCESAMBULANCES Confirm it is not expired and liquid is Confirm it is not expired and liquid is

clearclear If patient is having a severe allergic If patient is having a severe allergic

Reaction as defined in indications, Epi Reaction as defined in indications, Epi may be given on Standing Ordermay be given on Standing Order

Contact medical Control if second Epi-pen Contact medical Control if second Epi-pen is thought to be needed after is thought to be needed after reassessmentreassessment

AdministrationAdministration

Remove safety cap from injector to “arm” itRemove safety cap from injector to “arm” it Place tip of injector against the lateral side Place tip of injector against the lateral side

of pt’s. thigh between the waist and kneeof pt’s. thigh between the waist and knee Push injector firmly against leg until it Push injector firmly against leg until it

activatesactivates Hold injector in place until all medication Hold injector in place until all medication

is injected (approx. 5-10 seconds)is injected (approx. 5-10 seconds) Remove and dispose of injector as a sharpRemove and dispose of injector as a sharp Be careful of exposed needleBe careful of exposed needle

Reassess patients vitals Reassess patients vitals DOCUMENT DOCUMENT

AspirinAspirin

Acute Coronary Acute Coronary Syndromes (Chest Syndromes (Chest Pain)Pain)

Page 10 North Page 10 North Central Regional Central Regional GuidelinesGuidelines

Generic: Generic: AspirinAspirin

Trade: Trade: Bayer, Ecotrin, Bayer, Ecotrin,

ActionsActions

Inhibits platelet aggregationInhibits platelet aggregation Decreases blood clotting timeDecreases blood clotting time Slight Analgesic effectsSlight Analgesic effects

IndicationsIndications

Chest pain of cardiac originChest pain of cardiac origin Signs & symptoms of C.P.Signs & symptoms of C.P.

ContraindicationsContraindications

Allergies / HypersensitivityAllergies / Hypersensitivity G.I. BleedingG.I. Bleeding Active ulcer diseaseActive ulcer disease Bleeding disordersBleeding disorders Hemorrhagic strokeHemorrhagic stroke

Side EffectsSide Effects

Gastric irritationGastric irritation Nausea, vomitingNausea, vomiting Abd. PainAbd. Pain G.I. BleedingG.I. Bleeding

DosageDosage

One Dose EqualsOne Dose Equals 4 chewable baby aspirin (81mg 4 chewable baby aspirin (81mg

each) = 324 mgeach) = 324 mg Not repeatedNot repeated

AdministrationAdministration

Evaluate for Hx of C.P. or new onset of C.P.Evaluate for Hx of C.P. or new onset of C.P. Hx of C.A.D.Hx of C.A.D. Consider Nitro along with AspirinConsider Nitro along with Aspirin Obtain vitalsObtain vitals S.A.M.P.L.E. & EXAMS.A.M.P.L.E. & EXAM Pour (4) tablets into gloved hand and hand Pour (4) tablets into gloved hand and hand

to pt. to chew tablets or administer to to pt. to chew tablets or administer to patientpatient

ReassessReassess DocumentDocument

Oxygen DeliveryOxygen Delivery

Supplemental oxygen is not needed Supplemental oxygen is not needed wwithout evidence of Respiratory evidence of Respiratory Distress if SPO2 >94%Distress if SPO2 >94%

If SPO2 is <94% oxygen maybe If SPO2 is <94% oxygen maybe delivereddelivered

Titrate to 94% or greaterTitrate to 94% or greater

INITIAL TRAINING HELD: INITIAL TRAINING HELD: FEBRUARY & MARCH FEBRUARY & MARCH 2015 WILL BECOME 2015 WILL BECOME

PART OF YEARLY PART OF YEARLY PROTOCOL PROTOCOL

REQUIREMENTS REQUIREMENTS

CPAPCPAP

INITIAL TRAINING HELD: INITIAL TRAINING HELD: FEBRUARY & MARCH FEBRUARY & MARCH 2015 WILL BECOME 2015 WILL BECOME

PART OF YEARLY PART OF YEARLY PROTOCOL PROTOCOL

REQUIREMENTSREQUIREMENTS

NALOXONENALOXONE

If you have any further questions If you have any further questions or want more review please refer or want more review please refer

to the North Central Regional to the North Central Regional Guidelines (Version 9/2014) or Guidelines (Version 9/2014) or

contact an EMS Supervisor contact an EMS Supervisor

ctemscouncils.orgctemscouncils.org