EMS protocols

[peterb]

For the EMS folks here: My state(NH) has just issued the 2013 edition of our statewide EMS protocols, and I'd be interested in any comments you might have. Download here: http://www.nhoodle.nh.gov/irc/wp-content/uploads/2013/01/2013-NH-Patient-Care-Protocols-1.2.pdf

New this edition are the extended-care protocols for wilderness care or extended transports.

[TGS]

Peter,

We just moved to the national standard last year, but still don't have AEMTs like you guys. I noticed in the standing orders for EMT in 3.2, it mentioned advanced airways. I'm guessing this means supraglottics such as kings and combitubes, but I thought those were AEMT interventions. What's the deal? Can you use supraglottic airways if you are trained in them, even as an EMT? Also, given our interest in shooting, I browsed through the section 4 but didn't see any specifics about penetrating trauma, and interventions such as wound packing or hemostatic agents. What's the deal on those for you guys?

Overall, looks like what I expected: you guys have a lot more interventions at the EMT level than we do. NJ EMTs are pretty restricted compared to other states. We don't carry aspirin, and we're only allowed to assist with its administration (meaning the pt must have some they want to take, we can't just give it to them). We don't administer activated charcoal either....the word I got is because we're so close to hospitals here (I have 4-5 within 15 minutes of my house depending on traffic) that the risk of the pt aspirating is more dangerous than the poison being further digested given the short transport time. Given the national standard, I was trained on CPAP, but we don't actually use it as it's not in our protocols.

It's funny that we're so restricted as EMTs, because our Paramedics are on the opposite end of the spectrum and are great. Not any sort of "NJ uber alles menschen" bullshit, but simply from the way our system is structured with ALS being a chaser crew, so they only ever perform ALS interventions. Lot easier to get your proficiency up to speed when your job naturally has you tubing patients all the time, as opposed to across the river in PA where it might be 6 months between tubing an actual patient. The result is an extremely high 1st try success rate compared to many states for these perishable skills.

[peterb]

I didn't see anything specific on penetrating trauma or wound packing -- that's something I'd like more training on. Tourniquets are approved, commercial tourniquets preferred.

Hemostatics: "Hemostatic bandages must be of a non-exothermic type that can be washed off with 0.9% NaCl (normal saline)." Seems reasonable.

We can use Kings and Combis as EMTs, but not LMAs.

[TGS]

Hemostatics: "Hemostatic bandages must be of a non-exothermic type that can be washed off with 0.9% NaCl (normal saline)." Seems reasonable.

So, hmm....does that mean Quick Clot combat gauze (kaolin) is a no-go since it needs to be pulled out of the wound, whereas Celox (chitosan) actually dissolves when saturated for long enough?


We can use Kings and Combis as EMTs, but not LMAs.

I'm jealous! Either by personal experience, anecdote, or hard data, are the supraglottic airways improving pt outcomes compared to NPAs and OPAs? Have you used them and how difficult are they to use successfully? Is there any increased risk if the pt aspirates, compared to an OPA?