My Courses Medstar OCMCA Protocol Training 2024 Section 7: Procedures

Section 7: Procedures (Length: 21:44)

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Section 7 Procedure Protocols - 2024 OCMCA Protocol Implementation.

  • 7.1 12 Lead EKG Protocol
    • Procedure
      • Added the ability to do repeat 12 leads for long transports.
  • 7.2 Child Abuse and Neglect
    • Our current protocol has been made into two protocols. One for children and one for adults (7.4 Vulnerable Adult Abuse, Neglect, or Exploitation).
  • 7.3 Crime Scene Management
    • Added a reference to the Sexual Assault Treatment Protocol.
  • 7.4 Vulnerable Adult Abuse, Neglect, or Exploitation
    • Formerly all included in the old Abuse and Neglect Protocol.
  • 7.5 CPAP
    • No longer allows for the use of BiPAP. The OCMCA is currently working on an optional BiPAP protocol for emergent use.
    • Contraindications
      • Added a pediatric blood pressure threshold.
    • Procedure
      • Added values for titrating the CPAP pressure
      • Allows for administration of medications, including brief removal for sublingual medication administration.
    • Discontinue CPAP Therapy section
      • Added a list of potential reasons CPAP may be discontinued post radio.
    • Special Notes section
      • A reminder to monitor patients on CPAP with a decrease LOC closely.
  • 7.6 Dead on Scene and Termination of Resuscitation
    • A purpose was added
    • Dead on Scene Criteria
      • Submersion water temperature changes as listed in protocol 2.8 Drowning and Submersion Injury.
      • Reference to MI-POST
    • Exceptions to the Dead on Scene Criteria
      • Added transport of witnessed arrest in a pregnant patient. Contact medical control as soon as possible.
  • 7.7 Do Not Resuscitate
    • Reference to MI-POST
  • 7.8 Electrical Therapy
    • Added a list of precautions to electrical therapy
    • AED
      • Do not apply on a patient with an LVAD.
      • Reminded to minimize interruptions.
      • Recommends anterior/posterior placement on all patients.
      • Clearly defines the word “shock” used in the remainder of the protocol.
    • Manual Defibrillation
      • Removal of precautions that would have been redundant due to the addition of the overall precautions list.
  • 7.9 Airway Maintenance
    • The protocol is currently under review by the OCMCA.
    • The protocol has been drastically shortened and simplified.
  • 7.10 Helmet Removal
    • No changes
  • 7.12 Oxygen Administration
    • NRB range adjusted from 8-12 to 8-15lpm
  • 7.13 Pain Management
    • For pediatric patients utilize the MIMEDIC Cards o Ketamine is back post radio
      • Review ketamine dosing for pain
    • Slight language change to opioid section
      • Review administration
  • 7.14 Patient Assessment
    • Added a reference at the end to the Crashing Patients Protocols
  • 7.15 Documentation and Patient Care Records
    • An ePCR must be generated any time the EMS agency arrives on scene.
  • 7.15.1 Patient Care Record and Electronic Documentation and EMS Information System Addendum
    • This is an Oakland County specific protocol.
      • Please note the requirement to have your completed ePCRs to the emergency room is still two hours. There has been no change.
  • 7.16 Patient Restraint – This protocol is currently under review by the OCMCA.
  • 7.17 Patient Procedural Sedation
    • The purpose was changed to just encompass procedures.
    • A note was added to remind providers ketamine is not indicated in this protocol.
  • 7.18 Pleural Decompression
    • Added a reference to Traumatic Arrest.
    • Midclavicular line is preferred for patients less than 14 years old.
  • 7.19 Patient Refusal o Terminology change from “competent” to “capable”
    • Added a definition of “minor” o Reminded the EMS provider that “Inability to obtain a signature does not preclude completion of documentation of a refusal.
    • Requires documentation that supports the clinical judgement that the patient was capable to refuse transport or specific treatment.
  • 7.20 Spinal Precautions
    • Added a line at the end reminding EMS providers to monitor the venous return of pregnant patients.
  • 7.21 Blood Glucose Testing
    • New protocol review
  • 7.22 Tourniquet Application
    • Reference to the Pain Management Protocol
    • Added ability to apply a second tourniquet to a limb if necessary.
  • 7.23 Venous Access and IV Fluid Therapy
    • Indications
      • Removal of status epilepticus.
    • Contraindications
      • Added burns over peripheral sites, Added infection over peripheral sites.
    • Solutions
      • Use NS or LR, use NS for dilution.
    • Flow Rates
      • Added specific adult and pediatric dosing.
      • Added dosing to KVO unless otherwise specified in protocol.
    • Procedure for IO
      • For cardiac arrest the preferred site is the proximal humerous.
  • 7.24 End-Tidal CO2 Monitoring
    • Capnography via nasal cannula is mandatory during certain medication administrations per applicable protocol as it is also a valuable assessment tool in critically ill patients.
    • Qualitative CO2 monitoring is acceptable for EMT and MFR usage.
    • Capnography MUST be used on all critically ill patient and for ROSC patients in ALS/LALS units.
  • 7.25 MI-POST
    • New protocol review
  • 7.26 Interfacility High Flow Nasal Cannula
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