Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Support Protocol
Update
2006
Introduction
Developed by the REMAC Protocol
Subcommittee
Derived from the SEMAC ALS Protocol
Template
Distributed to all regional ALS agencies,
Hospitals, County EMS Coordinators for
comment
Approved by the SEMAC/SEMSCO and
REMAC/REMSCO
Format
Modular Format:
Operations
Together, the
Adult Medical seven separate
Adult Trauma sections make up
Special Considerations the Regional ALS
Pediatric Medical Protocol
Pediatric Trauma
Appendix
General Operating Procedures
Table of Contents
Introduction
EMT-Intermediate/Critical Care Program
Clinical Judgment
Interpretation of Protocols
Medical Control
Medical Authority at the Scene
Communications
Communications Failure
Transfer of Care
Patients Who Refuse Care
Initiation and Termination of CPR Including DNR
General Operating Procedures
Table of Contents
Pediatric Definitions
Procedures
Medications
Equipment
Destination Decision
Ambulance Diversion
Inter-Facility Transfers
Protocol Exceptions
Record Keeping
EMS Complaint/Concern Procedures
EMS Disciplinary Procedures
Protocol Changes
Introduction
This manual represents the minimum
standard of care for provision of pre-
hospital advanced levels of care in the
Hudson Valley Region.
The Regional Advanced Life Support
(ALS) system incorporates three different
tiers of ALS care which includes EMT-I,
EMT-CC, and EMT-P levels of personnel
and services.
EMT-I/CC Program
The EMT-Intermediate/EMT-Critical Care
(EMT-I/EMT-CC) program is designed for
use only as an adjunct within an
established EMT-P (Paramedic) system.
Requires an EMT-P (Paramedic) two-
tiered priority response with simultaneous
dispatch
Clinical Judgment:
Guidelines which should be used in
conjunction with good clinical judgment.
In situations where there is no existing
protocol and a clear need for ALS exists,
the ALS provider shall initiate Initial
Advanced Life Support Care, Protocol
ACP-1 and contact Medical Control
Interpretation of Protocols
NYS BLS Protocols must be initiated, in
conjunction with the HVREMSCO
Advanced Life Support Protocols.
ALS personnel will initiate Initial Advanced
Life Support Care, Protocol ACP-1, for
every ALS patient
Interpretation of Protocols
In each protocol, for every standing order and
medical control option, there is indication as to
which level of provider may initiate that order.
EXAMPLE:
1. Airway control procedures
2. If patient is intubated, secondary
confirmation must be performed, at a
minimum, with End-tidal CO2
monitoring and Pulse Oximetry.
Continuous CO2 monitoring is
recommended.
3. Refer to appropriate protocol for further
assessment and treatment.
Interpretation of Protocols
Some protocols are designed to have numbered
standing orders only; other protocols have
numbered standing orders and medical control
options.
Standing orders may be initiated prior to
contacting Medical Control, and MUST be
performed in numerical sequence.
If there is clinical improvement, further standing
orders may be withheld based upon the ALS
Provider’s clinical judgment.
Interpretation of Protocols
Medical control options may not be initiated
until ordered by Medical Control. Medical
Control will sequence medical control options.
Example:
EMT-I’s Stop Here. EMT-CC/P’s Contact Medical Control.
Patients name;
Diagnosed condition of the patient;
Any treatment and any medication administered to the
patient;
Name of physician ordering transfer;
Name of hospital from which the patient is being
transferred;
Name of the physician(s) who is or are willing and
authorized to receive the patient at the new location;
Name of hospital or other facility that is to receive the
patient;
Date and time of transfer
Signature of the physician ordering the transfer.
Inter-Facility Transfers
Pre-hospital emergency personnel must insure that prior to
initiating the patient transfer, they are supplied with written
documentation of at least the following information:
Obtain written medical orders that do not exceed
their level of medical training;
Confirm that the receiving facility has agreed to
accept the patient in transfer;
Are supplied with appropriate copies of the patient’s
medical records, including radiographs;
Are utilizing the appropriate equipment needed to
transfer the patient;
Verify that the patient has been stabilized to the
fullest extent capable by the referring hospital prior
to transfer.
Inter-Facility Transfers
If a patient’s condition becomes critical
during an inter-facility transport
HVREMAC credentialed personnel shall
utilize the ALS protocols in conjunction
with the NYS BLS protocols provided
Medical Control is contacted ASAP
Protocol Exceptions
While acting in a setting which falls beyond the
scope of the Regional ALS Protocols, no ALS
Provider shall be faulted or suffer punitive action
for:
following on‑line Medical Control orders, provided the
orders are within the ALS Provider’s standard of care
and scope of training;
for refusing to follow an order which the provider
believes to increase risk to the patient;
for refusing to perform a procedure which is beyond
the ALS Provider’s scope of training or expertise.
Protocol Exceptions
This section is not intended by the
HVREMAC as a means for field providers
and Medical Control representatives to
circumvent procedures or training
requirements specifically addressed by
the protocols.
Record Keeping
ALS providers must document all ALS
procedures performed on an appropriate
PCR addendum (ex. PCR Continuation
Form or other form approved by the
HVREMSCO to be used in place of a PCR
Continuation Form).
Record Keeping
ALS Providers must complete a PCR (and
when appropriate, a PCR addendum)
immediately following a call, and a
(Physician, Physician’s Assistant, or Nurse
Practitioner, as appropriate) from the
Receiving Hospital ED must also sign the
ALS PCR or PCR addendum.
Record Keeping
In cases where patients are transported to a
hospital not providing the Medical Control for the
transport, the ALS provider will
Document on a PCR addendum the name of the
Medical Control Practitioner and Medical Control
Facility as well as the time of communication and all
Medical Control orders received or denied.
The ALS Provider will have the PCR addendum
signed by the clinical practitioner designated as in
charge of the Receiving Hospital ED.
Record Keeping
All online medical control orders must be
documented on a PCR addendum and must be
authorized by a Medical Control Practitioner
either by verbal authorization to the clinical
practitioner designated as in charge of the
Receiving Hospital ED (when the patient is
transported to a hospital not providing Medical
Control) or by written authorization (when the
patient is transported to the hospital providing
Medical Control).
Record Keeping
The ALS provider MUST NOT leave the
hospital until a completed PCR is
provided to the appropriate hospital
staff 1
1
NYS DOH Policy Statement 02-05
EMS Complaint / Concern
Procedures
Ambulance Diversion
Destination Decision
Protocol Changes
Protocol Format Changes
Considerations Boxes
May preface the clinical steps of the protocol
May also be found within the protocol’s
clinical steps when the Level of Care changes
(Paramedic considerations maybe different
from those of a Critical Care Technician)
May also be found at the end of the protocol’s
clinical steps
Protocol Format Changes
Medical Control Options
Are found at the end of the clinical steps for a
given level of care.
May also be found at the end of the protocol’s
clinical steps
ALS Care Protocol-1
Initial ALS Care
“This protocol is to be implemented in
conjunction with the New York State Basic Life
Support Adult and Pediatric Treatment Protocols
for every patient that the ALS provider
determines to require pre-hospital ALS care.”
Replaces Adult and Pediatric “Routine Medical
Care” Protocol
Incorporates NYS BLS Protocol “General
Approach to Patient Care” as well as ALS
procedures
L S
C O
T O
R O
T P
O R L
PP IC A
S U ED
IF E T-M
L UL
E D D
N C A
VA
A D
What’s New?
Adult Medical Protocols
Lorazepam, Metoprolol, and Promethazine
Hydrochloride were added to the formulary
Overdose and Toxic Exposure separated
into two distinct protocols.
Two new protocols added:
Abdominal Pain
Suspected Stroke
LS
C O
TO
RO
T P
OR A
P P UM
SU RA
FE T- T
LI UL
ED D
C A
A N
D V
A
What’s New?
Adult Trauma
New Protocols include:
Major Trauma
Major Trauma Transport
High Risk Patient
LS
C O
TO
RO S
T P ON
R T I
PO RA
U P DE
S S I
I FE N
L C O
D
E IA L
C
N EC
A
V SP
AD
What’s New
Special Considerations
The following protocols have been moved into
the Special Considerations section:
Rapid Sequence Intubation
Child Birth/Precipitous Delivery
Pain Management/Analgesia
Toxemia of Pregnancy
Neonatal Resuscitation
New Protocols in this section include:
Mark I kit use
Emergency Incident REHAB
LS
C O
TO
R O
T P
R AL
P O IC
P
U -M E D
E S C
F I
LI ATR
ED DI
A NC PE
V
AD
What’s New
Pediatric Medical Protocols
Abdominal Pain has been added as a new
protocol to this section
Toxic Exposure and Overdose were
separated into two distinct protocols
R T
PO
P U
E S
I F L S A
L CO UM
ED O A
N C O T - TR
V A PR IC
A D TRA
D I
PE
What’s New?
Pediatric Trauma Protocols
New Protocols in this section include:
Major Trauma
High Risk Patients
Traumatic/Hypovolemic Shock
Tension Pneumothorax
Head Trauma
Burns
Major Trauma Transport
What’s New?