Town of Vernon Town of Vernon Emergency Medical ServicesEmergency Medical Services

BLS PROTOCOLSBLS PROTOCOLS

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

EMS Region & ECHN BLS Protocols for 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 7/2015version 7/2015

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 of OFF-LINE: You are operating under a set of

guidelines or protocols that have been set guidelines or protocols that have been set by your regional or local medical control. by your regional or local medical 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 Blood Glucose level < 70mg/dlBlood Glucose level < 70mg/dl Signs & Symptoms of a diabetic Signs & Symptoms of a diabetic

EmergencyEmergency Ability to swallow or gag reflexAbility to swallow or gag reflex

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

AdministrationAdministration Squeeze tube into mouth between Squeeze tube into mouth between

cheek and gum or under tongue and let cheek and gum or under tongue and let absorbabsorb

Reassess after 3-5 minutes Reassess after 3-5 minutes Repeat Blood Glucose level Repeat Blood Glucose level If <70 mg/dlIf <70 mg/dl Repeat Glucose AdministrationRepeat Glucose Administration Document administration, time and Document administration, time and

resultsresults

AdministrationAdministration MAXIMUM of 2 doses before MAXIMUM of 2 doses before

contacting Medical Control If still contacting Medical Control If still not returned to baseline or not returned to baseline or >70mg/dl>70mg/dl

? Other possibilities? Other possibilities ? Opiate Overdose? Opiate Overdose ? ETOH? ETOH

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 rates, Pre-Caution with Rapid heart rates, HTN, C.P., HTN, C.P.,

Side EffectsSide Effects Increased pulse rateIncreased pulse rate TremorsTremors NervousnessNervousness NauseaNausea

DosageDosage Take 1 or 2 inhalationsTake 1 or 2 inhalations

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 yetDetermine if patient has taken any doses yet * * 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 opening Assist pt. in putting lips around opening

of inhalerof inhaler Have PT. depress inhaler as they begin Have PT. depress inhaler as they begin

to inhale deeplyto inhale deeply Have pt. hold breath for as long as Have pt. hold breath for as long as

comfortably possible to have medication comfortably possible to have medication absorbabsorb

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. cardiac in naturePt. is having C.P. cardiac in nature 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 0.4mg or (1) sublingual (1) tablet 0.4mg or (1) sublingual

spray 1/150 gr.spray 1/150 gr. Repeated q5 minutes if continued Repeated q5 minutes if continued

C.P.C.P. B.P. checks between each dosage B.P. checks between each dosage SB/P > 100mm Hg SB/P > 100mm Hg Repeat q5 minutes until symptom Repeat q5 minutes until symptom

free or maximum of 3 doses givenfree or maximum of 3 doses given

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

and timeand time Assess B.P. Assess B.P. Determine usage of a Erectile Determine usage of a Erectile

medication within 48 hoursmedication within 48 hours All three NTG may now be given q5 if All three NTG may now be given q5 if

indicated and necessaryindicated and necessary

TabletsTablets Have pt. raise tongue upHave pt. raise tongue up Administer to Pt. under tongueAdminister to Pt. under tongue Advise Pt not swallow, allow tablet Advise Pt not swallow, allow tablet

to absorb under tongueto absorb under tongue

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

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

IndicationsIndicationsHypotension or respiratory compromise with known Hypotension or respiratory compromise with known

allergen exposure allergen exposure OR:OR:

Acute onset of symptoms and Acute onset of symptoms and 2 or more 2 or more of the following: of the following: o o Respiratory compromise (dyspnea, wheeze, stridor) Respiratory compromise (dyspnea, wheeze, stridor) o Angioedema or facial/lip/tongue swelling o Angioedema or facial/lip/tongue swelling o Widespread hives, itching, swelling o Widespread hives, itching, swelling o Persistent gastrointestinal involvement (vomiting, o Persistent gastrointestinal involvement (vomiting, diarrhea, abdominal pain) diarrhea, abdominal pain) o Altered mental status, syncope, cyanosis, delayed o Altered mental status, syncope, cyanosis, delayed capillary refill, or decreased level of consciousness capillary refill, or decreased level of consciousness associated with known/suspected allergenic exposure associated with known/suspected allergenic exposure o Signs of shock o 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

May repeat once after 5 minutes if May repeat once after 5 minutes if indicatedindicated

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 is Hold injector in place until all medication is

injected (approx. 5-10 seconds)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: Aspirin (usually Baby)Aspirin (usually Baby)

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

DosageDosageOne 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

without evidence of Respiratory without evidence of Respiratory Distress if SPO2 >94%Distress if SPO2 >94%

If SPO2 is <94% oxygen maybe deliveredIf SPO2 is <94% oxygen maybe delivered Titrate to 94% or greaterTitrate to 94% or greater

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 7/2015) Guidelines (Version 7/2015)

Contact an EMS Supervisor or Contact an EMS Supervisor or ECHN EMS Coordinator Nancy ECHN EMS Coordinator Nancy

BrunetBrunet

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