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Protocol sub-committee minutes
Rappahannock EMS Council
Protocol Sub-Committee Minutes
March 12th, 2007
Heather Calhoun, Chris Corbin, Dr. David Garth, Greg Leitz,
Lori Knowles, Mark Shiflett, and Robert Usher.
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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