Protocol sub-committee minutes

Rappahannock EMS Council
Protocol Sub-Committee Minutes
March 12th, 2007
Members Present: Heather Calhoun, Chris Corbin, Dr. David Garth, Greg Leitz,
Lori Knowles, Mark Shiflett, and Robert Usher.
Members Absent: Dave Morris
Meeting cal ed to order at 1305 hours at the REMS Council Training Center. Protocol review and discussions continued:  Non-Traumatic Chest Pain: Discussion about al owing Intermediates to have Morphine as a standing order. Dr. Garth wil have to talk with the other OMDs. Some ER doctors feel that EMS is overusing Lopressor. Dr. Garth has spoken with cardiologists about it’s use. In the protocol it is highlighted to only use Lopressor when signs are highly suggestive of cardiac involvement. Move obtain 12 lead EKG to the 1st page.  CHF: Lasix dose changed to 0.5 mg/kg for patients not on Lasix at home and 1.0 mg/kg for those already taking the drug. Considering Morphine & Lasix as standing orders for Intermediates. NTG was changed to be  Oral Aspirin for EMT-Basics. The provider wil assist the patient with taking their own Aspirin. 324 mg is the AHA recommended dosage.  Nausea & Vomiting: Zofran wil be standing orders for Intermediates & Paramedics.4-8 mg Zofran for adults. 0.1 mg/kg for pediatrics, repeat one time to a maximum of 4mg. Can be administered IV or IM. Phenergan wil  Fast1 IO: Standing order for Intermediates and Paramedics. Not for anyone less than 8 years old or less than 80 pounds. Wil put a note at the bottom of the protocol to read: Other devices may be considered with  PRN Adaptors protocol is completed and no comments.  Nasal Drugs: Versed/Narcan, looking at Valium. Some forms of Valium are oil based, which wil not absorb as well as the water based. 1 cc is maximum dose for each nair. Dr. Garth wants to review data before any  Fentanyl: Dr. Garth is not approving it.  Medication Assisted Intubation: Etomadate’s dose wil be 0.3 mg/kg. Do  Robert would like Oral Gastric tubes to be placed in al intubated patients.  Pacing: Change the statement that pacing is not recommended in asystole to do not pace asystole. Heather wil email Bil y Yeatman about the hospital supplying the pacing adaptors to make switching a patient from our monitors to the ER’s monitors easier.  Communications: Greg added in a contact sheet. Dr. Garth spoke of a Regional Based Command that is coming to our region. Problem of the triage tech not al owing providers to speak with the physicians for med control. Heather wil email Bil y Yeatman about the problem.  Seizures: The committee would like to keep Versed as a second line drug  Anaphylaxis: Solumedrol or Decodron wil be added- whichever one is  Asthma: Approval to add in Atrovent from Dr. Garth.  CPCP: Chris wil work on a procedures protocol for it.  The Adult Protocol was reviewed with no comments.  Capnography: 30-35 mm mercury for closed head injuries exhibiting signs  Change Combi-Tube to the King Airway. The protocol wil include a note that other Blind Insertion Airway Devices (BIAD) wil be considered with  AutoPulse: Not approved at this time. Dr. Garth wil re-consider it if an agency can prove that their response times are between 2-6 minutes.  Stil looking at who wil type the protocols up once we finish. May 1st, 2007 is our deadline to have the protocols completed and sent to the The next meeting was scheduled for Monday, March 26th, 2007 at 1300 hours at Monday, April 16th, 2007 and Monday, April 30th, 2007 wil be our final meetings. Both wil be from 1300-1500 hours and at the REMS Council Training Center. The last three meetings wil be announced as public town forums for providers to


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