Unfortunately, we’re not yet at the point of prehospital limb reimplantations, so until then, the protocol for amputations is pretty sparse – sterile wet-to-dry dressing, indirect cold storage, don’t let anything freeze, and transport.
That’s it!
Short email this week, don’t you think that deserves…a hand?
www.nycremsco.org for plenty of protocols, not enough jokes.
Dave
The prehospital approach to anaphylaxis in NYC is a good refresher of the graduated responsibilities and expectations of EMS providers across levels of training, especially as we are now seeing medication administration at each level:
- One dose of IM epinephrine may be given at the CFR (firefighter) level
- A second dose of IM epinephrine may be given at the BLS (EMT) level; EMTs may also administer nebulized ipratropium and albuterol, if needed
- A third dose of IM epinephrine and additional albuterol nebs may be given at the ALS (paramedic) level; in addition, paramedics may administer steroids, diphenhydramine, and crystalloid fluids
- OLMC may permit further doses of medications as needed
Remember that these protocols are formatted such that if, for example, a BLS unit is first on scene, EMTs will perform all the necessary actions under the CFR portion of the protocol prior to starting the EMT section. Similarly, paramedics will complete the CFR and EMT sections prior to starting the paramedic section.
Also bear in mind that the threshold between pediatric and adult dosing for IM epinephrine is either age > 9 years or weight > 30kg.
Reach out with questions! www.nycremsco.org and the protocol binder for more!
Dave
We're not quite at the point yet where EMS will initiate insulin therapy in the field, so for the time being, the prehospital approach to hyperglycemia mainly involves the recognition oh hyperglycemic emergencies. This means that, in addition to checking for an elevated glucometer reading, EMTs and paramedics will assess for altered mental status, dehydration, or tachypnea (ie, Kussmaul breathing compensating for DKA). ALS units will likely obtain vascular access and start fluid resuscitation on these patients, so be sure to confirm how much crystalloid was given during transport (if any) when calculating your own fluid repletion strategies. From there, the rest is up to you!
Have fun closing the gap! www.nycremsco.org and the protocol binder for more.
Dave