West Virginia OEMS

Class 3 Inter-Facility Transport

(C3-IFT)

Course

Module 2

Protocols and Operation

Objectives

• Introduction to WVOEMS levels of care provider,

skill, procedure, and medication interventions.

• Description of the classification of drugs and

procedure lists.

• Review of 3000 Series IFT Protocols.

• Scope, Role, and Modes of operation discussion

within the context of Class 3 Inter-Facility

Transport.

• Plan for introduction of the C3-IFT Course.

Drug Classification

Class - 1 - CCT Registered Nurse

Class - 2 - CCT Paramedic

Class - 3 – C3-Inter-Facility Transport (C3-IFT) Paramedic

Class - 4 - Field Paramedic

A - Administer Primarily

B - Re-administer or continue

C - Monitor Drip

Procedure Classification

Class - 1 - CCT Registered Nurse

Class - 2 - CCT Paramedic

Class - 3 – C3-Inter-Facility Transport

(C3-IFT) Paramedic

Class - 4 - Field Paramedic

A – Perform Skill

B – N/A

C - Monitor

PROTOCOL REVIEW

9201 IFTA Procedures

• Main protocol used on all transports

• Must be “stable” patient by criteria

• Question of stability in pediatric patient is ultimately determined by MCP

• Class 6 (EMT-B), Class 5 (EMSA-I), and Class 4 (Field Paramedic) also use part of this protocol

• All Class 3 drugs are provided by the sending facility

• Sending physician MUST provide written orders for type and dose of medications to be utilized in transport

9201 IFTA Procedures

• No drugs or procedures above Class 3 may be transported by the C3-IFT Paramedic

• Document all medications and amounts received from sending facility

• All patients must have an accepting physician’s name prior to departing

• All unused medications must be turned over to the receiving nurse, who must sign PCR attesting to the amounts received or wasting of excess medication as appropriate

9201 IFTA Procedures

• In the event that unforeseen or

unanticipated events develop during the

transport the C3-IFT paramedic should

utilize the 4000 series protocols and

contact Medical Command

3101 Volume Expanders

• All components must be infusing prior to

beginning transport

• Only the unit of blood hanging may be

continued. Additional units may not be

started by the C3-IFT paramedic

• Colloids may be re-administered and

titrated by the C3-IFT paramedic

• Infusion rate is set by sending physician

3101 Volume Expanders

• Re-administration and titration of colloids

requires consultation with MCP

• Blood and blood products MUST be

infusing at least 15 minutes prior to leaving

sending facility to assure no allergic

reaction is occurring

3201 Cardiac NTG Drip Protocol

• C3-IFT paramedic may titrate and monitor the drip but may NOT start drip primarily

• Rate and titration as set by sending physician

• Nitroglycerine (NTG) is the only drug utilized in this protocol

• NTG is usually titrated in 5 mcg/min increments

• NOT based on weight of patient

3202 Hypertension NTG Drip

Protocol

• May titrate or monitor at rate set by

sending physician

• Systolic blood pressure parameters as set

by sending physician

• NTG is only drug in this protocol

3203 Anti-arrhythmic Protocol

• Includes three (3) drugs

– Amiodarone (Cordarone)

– Diltiazem (Cardizem)

– Procainamide (Pronestyl)

• These medications are MONITOR ONLY

for the C3-IFT paramedic

• Rate set by sending physician

3204 Vasopressor Protocol

• C3-IFT paramedic may only monitor or

titrate one (1) vasopressor medication

• If more than one is infusing then it is NOT

a Class 3 transport

• Infusion rate is set by sending physician

• Only approved drugs are:

– Dopamine

– Dobutamine

3301 Bronchodilator Protocol

• Additional Class 3 medication for

inhalation is Alupent (metapreterenol)

• Theophylline IV drip is monitor only for the

C3-IFT paramedic

• Rate set by sending physician

3501 Antivenin Protocol

• Only utilized in the rare situation where

antivenin has been started in the sending

facility and must be continued during the

transport to a receiving facility

• Major issue is allergic reaction to antivenin

because it is derived from horse serum

• Monitor only for the C3-IFT paramedic

3602 Antibiotic Protocol

• Any antibiotic MUST be infusing for at

least 15 minutes prior to transport to

assure patient is not experiencing an

allergic reaction

• ONLY ONE (1) antibiotic may be infusing

at the time of transport by the C3-IFT

paramedic

3603 Anticoagulant / Antiplatelet

Protocol

• Monitor only for C3-IFT paramedic

• Rate set by sending physician

• Only three medications approved:

– Heparin

– Aggrastat (Tirofiban)

– Reopro (Abciximab)

3604 Electrolyte / Nutrition Protocol

• Potassium Chloride (KCL)

– MUST be on a pump

– Concentration cannot exceed 40 meq/1000ml

– MUST be given over no less than 2 hours

• Magnesium Sulfate

• Total Parental Nutrition (TPN)

3605 Nausea / Vomiting Protocol

• There are three (3) approved medications

– Phenergan (promethazine)

– Zofran (ondansetron)

– Compazine (prochlorperazine)

• Ordered by sending physician

3606 Neurological Emergency

Medication Protocol

• Monitor only for C3-IFT paramedic

• Rate set by sending physician

• Approved medications are:

– Mannitol

– Solumedrol (continuous steroid infusion)

3607 Proton Pump Inhibitor

Protocol

• May be re-administered, titrated, or

monitored by the C3-IFT paramedic

• As ordered by the sending physician

• Common drugs include:

– Protonix

– Nexium

– Prevacid

3901 Analgesic Protocol

• Approved medications:

– Morphine Sulfate

– Demerol

• Dose ordered by sending physician

• Morphine Sulfate is the ONLY opiate

analgesic that can be monitored as a

continuous IV infusion by the C3-IFT

paramedic

3902 Sedation Protocol

• Administered IV push only by C3-IFT paramedic

• NO continuous IV drip infusions are in the scope of the C3-IFT paramedic

• Dosage ordered by sending physician

• Approved Class 3 medications are:

– Midazolam (Versed)

– Lorazepam (Ativan)

– Diazepam (Valium)

3903 Reversal Agent Protocol

• Used ONLY in situations where medical

personnel have overmedicated patient

• Administration is ONLY by MCP order

• Medication and dose are provided by the

sending physician

• Medications are:

– Naloxone (Narcan)

– Flumazenil (Romazicon)

3904 Paralytic Medication Protocol

• Patient must be intubated and medically

stabilized by sending physician

• MUST have had at least one dose of medication

prior to transport

• C3-IFT paramedic may re-administer by IV push

only

• EMT-B or higher must be in patient compartment

with paramedic for entire transport

• Only Medication is Vecuronium (Norcuron)

Plan for Course

• Final corrections after test course

• Next group of students to use reading

materials (self study) then test

• Practical skills up-date

• Roll out to CCT paramedics and RNs

• Type of Regional Roll out TBD

Review / Questions