Podcast
Questions and Answers
Within the NASEMSO National Model EMS Clinical Guidelines, what necessitates the consideration of intraosseous (IO) access as an alternative when vascular access is explicitly delineated?
Within the NASEMSO National Model EMS Clinical Guidelines, what necessitates the consideration of intraosseous (IO) access as an alternative when vascular access is explicitly delineated?
- Solely in instances of documented patient allergy to intravenous (IV) cannulation materials, preempting any IV attempt.
- When the medical director mandates IO as the primary route for specific medications, irrespective of IV access feasibility.
- Specifically when intravenous (IV) access is unattainable or therapeutically unsuitable for drug administration. (correct)
- When the expertise of the EMS clinician favors IO over IV, based on their individual assessment of patient comfort.
In the context of the NASEMSO National Model EMS Clinical Guidelines, how should EMS systems utilize National EMS Quality Alliance (NEMSQA) Performance Measures?
In the context of the NASEMSO National Model EMS Clinical Guidelines, how should EMS systems utilize National EMS Quality Alliance (NEMSQA) Performance Measures?
- To supplant existing Quality Assurance/Continuous Performance Improvement (QA/CPI) programs with a standardized, nationally dictated protocol.
- As a mandatory checklist to ensure adherence to national benchmarks, disregarding local EMS system variations and resource limitations.
- Exclusively for retrospective audits to ensure compliance with national standards, without integrating them into real-time clinical decision support.
- As a resource integrated into Quality Assurance/Continuous Performance Improvement (QA/CPI) programs to identify areas for enhancement. (correct)
What is the foundational purpose of incorporating National EMS Information System (NEMSIS) Version 3 Labels and Codes within each guideline?
What is the foundational purpose of incorporating National EMS Information System (NEMSIS) Version 3 Labels and Codes within each guideline?
- To ensure compliance with HIPAA regulations by providing a standardized framework for anonymizing patient data across all EMS systems.
- To standardize EMS data collection on a national scale, enabling comprehensive research and advancement of EMS practices. (correct)
- To facilitate billing accuracy by standardizing diagnostic and procedural codes, thereby optimizing revenue cycle management for EMS agencies.
- To mandate uniform documentation practices across all EMS agencies, thereby limiting local adaptation of clinical protocols.
Considering the integrated approach of the NASEMSO National Model EMS Clinical Guidelines, what best describes the intended application of the pediatric-specific guidelines?
Considering the integrated approach of the NASEMSO National Model EMS Clinical Guidelines, what best describes the intended application of the pediatric-specific guidelines?
In what context are brand names of medications referenced within the NASEMSO National Model EMS Clinical Guidelines Version 3.0?
In what context are brand names of medications referenced within the NASEMSO National Model EMS Clinical Guidelines Version 3.0?
How should a medical director most effectively integrate the NASEMSO National Model EMS Clinical Guidelines into their EMS system's operational protocols, maintaining fidelity to both national standards and local needs?
How should a medical director most effectively integrate the NASEMSO National Model EMS Clinical Guidelines into their EMS system's operational protocols, maintaining fidelity to both national standards and local needs?
Considering the stated objectives of the NASEMSO National Model EMS Clinical Guidelines, what is the document's primary focus?
Considering the stated objectives of the NASEMSO National Model EMS Clinical Guidelines, what is the document's primary focus?
In the context of continuous performance improvement (CPI) programs within EMS systems, what role is fulfilled by key performance measures derived from the National EMS Quality Alliance (NEMSQA)?
In the context of continuous performance improvement (CPI) programs within EMS systems, what role is fulfilled by key performance measures derived from the National EMS Quality Alliance (NEMSQA)?
Considering the complex interplay between evidence-based and consensus-based methodologies in the development of NASEMSO Model EMS Clinical Guidelines, what critical evaluation must an EMS medical director undertake to ensure appropriate application within their local jurisdiction, given the non-mandatory nature of these guidelines?
Considering the complex interplay between evidence-based and consensus-based methodologies in the development of NASEMSO Model EMS Clinical Guidelines, what critical evaluation must an EMS medical director undertake to ensure appropriate application within their local jurisdiction, given the non-mandatory nature of these guidelines?
In the context of interjurisdictional EMS operations and the increasing mobility of EMS clinicians across healthcare systems, what is the most nuanced challenge posed by the implementation of varied, locally adapted NASEMSO Model EMS Clinical Guidelines, considering the guidelines' intent to promote uniform practice?
In the context of interjurisdictional EMS operations and the increasing mobility of EMS clinicians across healthcare systems, what is the most nuanced challenge posed by the implementation of varied, locally adapted NASEMSO Model EMS Clinical Guidelines, considering the guidelines' intent to promote uniform practice?
Given that NASEMSO Model EMS Clinical Guidelines are designed to be patient-centric and adaptable regardless of existing resources and capabilities within an EMS system, how should an EMS system with severely limited resources prioritize the implementation of these guidelines to maximize patient outcomes?
Given that NASEMSO Model EMS Clinical Guidelines are designed to be patient-centric and adaptable regardless of existing resources and capabilities within an EMS system, how should an EMS system with severely limited resources prioritize the implementation of these guidelines to maximize patient outcomes?
Considering the interplay between NHTSA's role in convening experts for guideline development and NASEMSO's authorization of its Medical Directors Council in creating unified patient care guidelines, what is the most critical strategic alignment needed to optimize the impact of these collaborative efforts on EMS clinical practice?
Considering the interplay between NHTSA's role in convening experts for guideline development and NASEMSO's authorization of its Medical Directors Council in creating unified patient care guidelines, what is the most critical strategic alignment needed to optimize the impact of these collaborative efforts on EMS clinical practice?
In the context of prehospital STEMI management, what is the most critical timeframe for EMS clinicians to acquire a 12-lead EKG from a patient exhibiting signs and symptoms of Acute Coronary Syndrome (ACS)?
In the context of prehospital STEMI management, what is the most critical timeframe for EMS clinicians to acquire a 12-lead EKG from a patient exhibiting signs and symptoms of Acute Coronary Syndrome (ACS)?
In scenarios where evidence-based guidelines are lacking and consensus-based guidelines are developed utilizing available research, what inherent limitation must EMS medical directors acknowledge when integrating these guidelines into local protocols?
In scenarios where evidence-based guidelines are lacking and consensus-based guidelines are developed utilizing available research, what inherent limitation must EMS medical directors acknowledge when integrating these guidelines into local protocols?
An EMS system is considering implementing a protocol for remote STEMI interpretation. What strategic element is most crucial to ensure the effectiveness and reliability of this protocol?
An EMS system is considering implementing a protocol for remote STEMI interpretation. What strategic element is most crucial to ensure the effectiveness and reliability of this protocol?
Given that the NASEMSO Model EMS Clinical Guidelines are not mandatory and are not meant to determine local scope of practice, what is the most consequential implication for state EMS systems aiming to enhance standardization of patient care?
Given that the NASEMSO Model EMS Clinical Guidelines are not mandatory and are not meant to determine local scope of practice, what is the most consequential implication for state EMS systems aiming to enhance standardization of patient care?
Considering the focus of the NASEMSO Model EMS Clinical Guidelines on patient-centric care, safety of patients and clinicians, and outcomes, what advanced analytical approach should EMS systems employ to evaluate the effectiveness of these guidelines in diverse operational environments?
Considering the focus of the NASEMSO Model EMS Clinical Guidelines on patient-centric care, safety of patients and clinicians, and outcomes, what advanced analytical approach should EMS systems employ to evaluate the effectiveness of these guidelines in diverse operational environments?
Serial EKGs are indicated for symptomatic patients when the initial EKG is non-diagnostic for STEMI. What is the primary rationale behind this approach, considering the dynamic pathophysiology of acute coronary syndromes?
Serial EKGs are indicated for symptomatic patients when the initial EKG is non-diagnostic for STEMI. What is the primary rationale behind this approach, considering the dynamic pathophysiology of acute coronary syndromes?
In light of the statement that the NASEMSO Model EMS Clinical Guidelines should be adapted to align with federal, state, regional, and jurisdictional laws and regulations, what critical due diligence process must an EMS medical director undertake before implementing any guideline adaptation?
In light of the statement that the NASEMSO Model EMS Clinical Guidelines should be adapted to align with federal, state, regional, and jurisdictional laws and regulations, what critical due diligence process must an EMS medical director undertake before implementing any guideline adaptation?
Given the importance of timely access to EKG data at the receiving hospital, what is the most effective strategy for ensuring seamless data transfer in a rural EMS system with limited technological infrastructure?
Given the importance of timely access to EKG data at the receiving hospital, what is the most effective strategy for ensuring seamless data transfer in a rural EMS system with limited technological infrastructure?
A patient with suspected ACS is hypotensive (SBP 85 mmHg). Nitroglycerin is indicated but blood pressure is marginal. Which intervention is most appropriate?
A patient with suspected ACS is hypotensive (SBP 85 mmHg). Nitroglycerin is indicated but blood pressure is marginal. Which intervention is most appropriate?
A patient with confirmed STEMI reports taking tadalafil (Cialis®) daily for pulmonary hypertension. What is the most appropriate course of action regarding nitroglycerin administration?
A patient with confirmed STEMI reports taking tadalafil (Cialis®) daily for pulmonary hypertension. What is the most appropriate course of action regarding nitroglycerin administration?
Which of the following represents the MOST appropriate formulation and dosage of aspirin to administer to a patient with suspected ACS in the prehospital setting, considering optimal platelet inhibition and ease of administration?
Which of the following represents the MOST appropriate formulation and dosage of aspirin to administer to a patient with suspected ACS in the prehospital setting, considering optimal platelet inhibition and ease of administration?
In a tiered EMS system, a Basic EMT (EMT-B) arrives on scene to a patient complaining of chest pain. The EMT-B can administer aspirin according to protocol, but advanced interventions require a Paramedic unit which is en route with an ETA of 15 minutes. What is the MOST critical action for the EMT-B to perform while awaiting the Paramedic unit's arrival, beyond aspirin administration?
In a tiered EMS system, a Basic EMT (EMT-B) arrives on scene to a patient complaining of chest pain. The EMT-B can administer aspirin according to protocol, but advanced interventions require a Paramedic unit which is en route with an ETA of 15 minutes. What is the MOST critical action for the EMT-B to perform while awaiting the Paramedic unit's arrival, beyond aspirin administration?
In the context of rapidly assessing a patient's disability (D) during primary assessment, which neurological finding would necessitate immediate intervention beyond basic airway and circulatory support, assuming other causes have been ruled out?
In the context of rapidly assessing a patient's disability (D) during primary assessment, which neurological finding would necessitate immediate intervention beyond basic airway and circulatory support, assuming other causes have been ruled out?
During the 'Exposure' phase of primary assessment, what specific clinical action demonstrates the MOST comprehensive approach to safeguarding patient well-being while ensuring adequate examination?
During the 'Exposure' phase of primary assessment, what specific clinical action demonstrates the MOST comprehensive approach to safeguarding patient well-being while ensuring adequate examination?
In a patient with suspected acute aortic dissection presenting with altered mental status, hypotension, and diminished peripheral pulses, which element of the secondary survey would be MOST critical to expedite and integrate with ongoing resuscitative efforts, given the potential for rapid decompensation?
In a patient with suspected acute aortic dissection presenting with altered mental status, hypotension, and diminished peripheral pulses, which element of the secondary survey would be MOST critical to expedite and integrate with ongoing resuscitative efforts, given the potential for rapid decompensation?
A patient involved in a high-speed motor vehicle collision is undergoing secondary survey. Palpation of the pelvis reveals marked instability and crepitus. Given this finding, what immediate intervention has the HIGHEST priority in the prehospital setting?
A patient involved in a high-speed motor vehicle collision is undergoing secondary survey. Palpation of the pelvis reveals marked instability and crepitus. Given this finding, what immediate intervention has the HIGHEST priority in the prehospital setting?
During secondary assessment of the head, which finding is MOST indicative of a basilar skull fracture warranting heightened suspicion for potential central nervous system injury?
During secondary assessment of the head, which finding is MOST indicative of a basilar skull fracture warranting heightened suspicion for potential central nervous system injury?
In a patient presenting with acute respiratory distress, asymmetrical chest wall movement with respiration, and absent breath sounds on one side, which aspect of the secondary survey is MOST crucial for guiding immediate management decisions?
In a patient presenting with acute respiratory distress, asymmetrical chest wall movement with respiration, and absent breath sounds on one side, which aspect of the secondary survey is MOST crucial for guiding immediate management decisions?
Following a witnessed cardiac arrest with successful return of spontaneous circulation (ROSC), a patient remains unresponsive. During the 'Disability' assessment, what intervention is MOST crucial to perform, assuming standard airway and circulatory management are already in place?
Following a witnessed cardiac arrest with successful return of spontaneous circulation (ROSC), a patient remains unresponsive. During the 'Disability' assessment, what intervention is MOST crucial to perform, assuming standard airway and circulatory management are already in place?
During the secondary survey of a trauma patient, you note jugular venous distension (JVD) and muffled heart sounds. Which additional finding would MOST strongly suggest cardiac tamponade as the underlying cause, necessitating immediate intervention?
During the secondary survey of a trauma patient, you note jugular venous distension (JVD) and muffled heart sounds. Which additional finding would MOST strongly suggest cardiac tamponade as the underlying cause, necessitating immediate intervention?
In scenarios involving pediatric patients requiring pharmacological intervention, under which specific condition is the weight-based dose permitted to surpass the standard maximum adult dosage?
In scenarios involving pediatric patients requiring pharmacological intervention, under which specific condition is the weight-based dose permitted to surpass the standard maximum adult dosage?
Considering the transport of patients with time-sensitive conditions, what specific temporal threshold, concerning ground transport duration, should automatically trigger consideration for air medical transport, assuming its availability?
Considering the transport of patients with time-sensitive conditions, what specific temporal threshold, concerning ground transport duration, should automatically trigger consideration for air medical transport, assuming its availability?
What is the MOST appropriate initial assessment tool for a pediatric patient upon arrival of EMS personnel?
What is the MOST appropriate initial assessment tool for a pediatric patient upon arrival of EMS personnel?
While the standard upper age limit for defining the pediatric population can vary by jurisdiction, what criterion is MOST commonly applied when differentiating pediatric from adult patients in the context of medication dosing and physiological considerations?
While the standard upper age limit for defining the pediatric population can vary by jurisdiction, what criterion is MOST commonly applied when differentiating pediatric from adult patients in the context of medication dosing and physiological considerations?
In the context of medication administration within the geriatric population, which of the following constitutes the MOST critical consideration regarding potential dosage adjustments?
In the context of medication administration within the geriatric population, which of the following constitutes the MOST critical consideration regarding potential dosage adjustments?
Concerning oxygen administration, what is the recommended target range for oxygen saturation ($SpO_2$) to be achieved in most patients?
Concerning oxygen administration, what is the recommended target range for oxygen saturation ($SpO_2$) to be achieved in most patients?
A 72-year-old patient with a history of severe cirrhosis requires pain management. Considering the patient's co-morbidity, which pharmacological approach would necessitate the MOST judicious dose adjustment and vigilant monitoring?
A 72-year-old patient with a history of severe cirrhosis requires pain management. Considering the patient's co-morbidity, which pharmacological approach would necessitate the MOST judicious dose adjustment and vigilant monitoring?
In the context of determining appropriate medication dosages for elderly patients, what single pre-existing condition should MOST significantly influence dosage adjustments?
In the context of determining appropriate medication dosages for elderly patients, what single pre-existing condition should MOST significantly influence dosage adjustments?
In the context of prehospital emergency care, which of the following scenarios MOST accurately exemplifies the critical importance of obtaining a comprehensive 'Events' component within the SAMPLE history, particularly when managing patients presenting with acute neurological deficits such as stroke?
In the context of prehospital emergency care, which of the following scenarios MOST accurately exemplifies the critical importance of obtaining a comprehensive 'Events' component within the SAMPLE history, particularly when managing patients presenting with acute neurological deficits such as stroke?
Given the complexities of waveform capnography interpretation in the prehospital setting, under which of the following clinical circumstances would the sole reliance on digital capnometry, without waveform analysis, pose the GREATEST risk of misinterpreting the patient's respiratory status and potentially lead to inappropriate interventions?
Given the complexities of waveform capnography interpretation in the prehospital setting, under which of the following clinical circumstances would the sole reliance on digital capnometry, without waveform analysis, pose the GREATEST risk of misinterpreting the patient's respiratory status and potentially lead to inappropriate interventions?
Considering limitations of pulse oximetry in specific patient populations, which of the following clinical scenarios demands the MOST judicious interpretation of SpO2 readings and warrants consideration of alternative methods for assessing oxygenation and ventilation?
Considering limitations of pulse oximetry in specific patient populations, which of the following clinical scenarios demands the MOST judicious interpretation of SpO2 readings and warrants consideration of alternative methods for assessing oxygenation and ventilation?
In the context of intraosseous (IO) access for medication administration, particularly in conscious patients, which of the following statements BEST encapsulates the pathophysiological rationale behind the preemptive administration of lidocaine prior to drug infusion via the IO route?
In the context of intraosseous (IO) access for medication administration, particularly in conscious patients, which of the following statements BEST encapsulates the pathophysiological rationale behind the preemptive administration of lidocaine prior to drug infusion via the IO route?
When managing a patient with a suspected acute coronary syndrome (ACS) in the prehospital setting, which of the following elements of the 'Quality' component of the OPQRST mnemonic is MOST critical in differentiating between ischemic cardiac pain and other potential causes of chest discomfort, thereby guiding appropriate triage and treatment decisions:
When managing a patient with a suspected acute coronary syndrome (ACS) in the prehospital setting, which of the following elements of the 'Quality' component of the OPQRST mnemonic is MOST critical in differentiating between ischemic cardiac pain and other potential causes of chest discomfort, thereby guiding appropriate triage and treatment decisions:
In the management of prehospital patients with suspected hypercarbia associated with hypoventilation, which of the following strategies represents the MOST nuanced approach to oxygen administration, balancing the potential benefits of improved oxygen saturation with the risks of exacerbating respiratory compromise?
In the management of prehospital patients with suspected hypercarbia associated with hypoventilation, which of the following strategies represents the MOST nuanced approach to oxygen administration, balancing the potential benefits of improved oxygen saturation with the risks of exacerbating respiratory compromise?
Within the framework of the National Model EMS Clinical Guidelines, what is the MOST critical rationale for diligently documenting the presence of medical alert tags, portable medical records, and advance directives during the secondary survey of a patient with altered mental status?
Within the framework of the National Model EMS Clinical Guidelines, what is the MOST critical rationale for diligently documenting the presence of medical alert tags, portable medical records, and advance directives during the secondary survey of a patient with altered mental status?
Considering the complexities of prehospital stroke management and the emphasis on obtaining witness accounts in cases of syncope, seizure, altered mental status, or acute stroke, which of the following scenarios underscores the MOST critical aspect of witness interaction TO relay to the Emergency Department (ED) care team?
Considering the complexities of prehospital stroke management and the emphasis on obtaining witness accounts in cases of syncope, seizure, altered mental status, or acute stroke, which of the following scenarios underscores the MOST critical aspect of witness interaction TO relay to the Emergency Department (ED) care team?
Flashcards
NHTSA Recommendation
NHTSA Recommendation
A call for national guidelines to standardize treatment, triage, and transport by EMS professionals.
NASEMSO's Goal
NASEMSO's Goal
A need for standardized clinical guidelines in EMS to ensure consistent patient care across different EMS Systems.
EMS Clinician Value
EMS Clinician Value
The value EMS clinicians bring to patient care.
Benefit of Uniform Guidelines
Benefit of Uniform Guidelines
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Benefit to Medical Directors
Benefit to Medical Directors
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NASEMSO Guidelines Creation
NASEMSO Guidelines Creation
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Consensus-Based Guidelines
Consensus-Based Guidelines
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Guideline Focus
Guideline Focus
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Patient Considerations
Patient Considerations
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IV/IO Access
IV/IO Access
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Generic Medication Names
Generic Medication Names
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NEMSIS
NEMSIS
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QA/CPI Programs
QA/CPI Programs
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NEMSQA
NEMSQA
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EMS Clinical Guidelines
EMS Clinical Guidelines
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OPQRST History
OPQRST History
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SAMPLE History
SAMPLE History
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Allergies (SAMPLE)
Allergies (SAMPLE)
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Medications (SAMPLE)
Medications (SAMPLE)
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Past Medical History (SAMPLE)
Past Medical History (SAMPLE)
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Oxygen Administration
Oxygen Administration
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Patient Monitoring Equipment
Patient Monitoring Equipment
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IO Pain Mitigation
IO Pain Mitigation
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12-Lead EKG
12-Lead EKG
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EKG Timing Goal
EKG Timing Goal
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EKG Interpretation
EKG Interpretation
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STEMI Notification
STEMI Notification
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Serial EKGs
Serial EKGs
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EKG Availability
EKG Availability
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Aspirin Dosage (ACS)
Aspirin Dosage (ACS)
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Nitroglycerin Dosage
Nitroglycerin Dosage
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Pediatric Dose Limit
Pediatric Dose Limit
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Contact Medical Direction
Contact Medical Direction
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Air Medical Transport
Air Medical Transport
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Pediatric Weight Assessment
Pediatric Weight Assessment
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Pediatric Population
Pediatric Population
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Pediatric Assessment Triangle
Pediatric Assessment Triangle
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Geriatric Population
Geriatric Population
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Reduced Dosage Considerations
Reduced Dosage Considerations
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Perfusion Evaluation
Perfusion Evaluation
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Capillary Refill
Capillary Refill
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AVPU
AVPU
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Gross Motor & Sensory Function
Gross Motor & Sensory Function
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Check Blood Glucose (AMS)
Check Blood Glucose (AMS)
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Suspected Stroke
Suspected Stroke
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Secondary Survey Components
Secondary Survey Components
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Jugular Venous Distension (JVD)
Jugular Venous Distension (JVD)
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Study Notes
- This report advocates for the development of evidence-based model prehospital care protocols by a panel of multidisciplinary experts.
- National EMS clinical guidelines are needed to standardize patient care and adapt future practices.
- EMS clinicians offer crucial patient care that extends across boundaries, highlighted during events like the 2019 novel coronavirus pandemic.
- Model EMS clinical guidelines promote uniformity in EMS medicine, fostering consistent practice across healthcare systems and offering a basis for EMS medical director practices.
- NASEMSO, supported by funding from NHTSA and HRSA, collaborates with stakeholder organizations and experts to create unified patient care guidelines.
- Consensus-based guidelines are developed using available research when evidence-based guidelines are lacking.
- The NASEMSO Model EMS Clinical Guidelines serve as a resource for clinical practice, patient and clinician safety, and outcomes, and can be adapted at various levels.
- These guidelines should align with laws and regulations.
- Pediatric, geriatric, and bariatric considerations are integrated throughout the guidelines.
- If IV access is not possible, IO access and drug routing should be considered.
- Generic medication names are used; brand names are listed in Appendix III.
- Accurate data collection is essential for EMS advancement, with NEMSIS playing a key role in unifying EMS data nationally.
- Each guideline is listed by its corresponding NEMSIS Version 3 Label and Code.
- Quality assurance and performance improvement programs are vital for identifying and resolving gaps in EMS systems, with the NEMSQA Performance Measures serving as a resource.
- This edition incorporates many NEMSQA performance measures.
Target Audience
- The guidelines are intended for field EMS clinicians and are designed for easy integration into EMS system operational guidance by medical directors and leaders.
- The document emphasizes patient care and is structured for quick reference, so leaders can easily adapt it.
Universal Care
- Evaluate perfusion by assessing skin color and temperature and capillary refill
- Evaluate patient responsiveness using AVPU (Alert, Verbal, Painful, Unresponsive).
- Assess gross motor and sensory function in all extremities.
- Check blood glucose in patients with altered mental status or suspected stroke; if blood glucose is less than 60 mg/dL, follow the Hypoglycemia Guideline.
- If acute stroke is suspected, follow the Suspected Stroke/Transient Ischemic Attack Guideline.
- Expose patient for examination while ensuring modesty and warmth.
- Assess for urgency of transport.
- Perform a secondary survey, but do not delay transport for critical patients.
- Tailor secondary surveys to patient presentation and chief complaint.
Secondary Survey Considerations
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Pupils
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Ears
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Naso-oropharynx
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Skull and scalp
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Jugular venous distension
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Tracheal position
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Spinal tenderness
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Retractions
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Breath sounds
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Chest wall tenderness, deformity, crepitus, and excursion
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Respiratory pattern, symmetry of chest movement with respiration
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Tenderness or bruising
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Abdominal distension, rebound, or guarding
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Spinal tenderness, crepitus, or step-offs
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Pelvic stability or tenderness
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Pulses
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Edema
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Deformity/crepitus
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Obtain OPQRST history: Onset, Provocation, Quality, Radiation, Severity, Time.
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Obtain SAMPLE history: Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading up to the 911 call.
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Collect details from witnesses for patients experiencing syncope, seizure, altered mental status, or acute stroke and provide to hospital staff
Treatment and Interventions
- Administer oxygen to achieve 94–98% saturation, selecting the appropriate delivery method to address hypercarbia.
- Use pulse oximetry, cardiac rhythm monitoring, waveform capnography or digital capnometry, or carbon monoxide assessment as needed.
- Establish vascular access if indicated.
- Consider using 0.5 mg/kg of lidocaine 0.1 mg/mL (up to 40 mg) for IO use in conscious patients to reduce pain.
- Monitor pain and agitation-sedation scales as needed.
- The maximum pediatric medication dose should not exceed the adult dose, unless specified.
- Contact medical direction when required or necessary.
- Consider air medical transport for time-critical conditions when ground transport exceeds 30 minutes.
Key Considerations
- Use weight-based assessment tools for pediatrics to guide medication and equipment choices.
- Pediatrics are defined as patients weighing up to 40 kg or up to 14 years of age.
- Use the pediatric assessment triangle (appearance, work of breathing, circulation) for initial assessment.
- Geriatric considerations, reduced medication dosages may apply to patients with renal or hepatic disease.
Cardiovascular
- Administer oxygen to achieve 94–98% saturation.
- Acquire a 12-lead EKG within 10 minutes for patients showing signs and symptoms of ACS.
- EKGs can be transmitted for remote interpretation or screened for STEMI.
- Notify the receiving hospital for patients identified as having a STEMI.
- Serial EKGs are encouraged for symptomatic patients with non-diagnostic EKGs.
- All EKGs should be available at the receiving hospital.
- Administer chewable, non-enteric-coated aspirin (162–325 mg).
- Establish IV access.
- Nitroglycerin 0.4 mg sublingual (SL) can be repeated every 3–5 minutes if SBP is greater than 100 mmHg.
- Avoid nitrates if the patient has used a phosphodiesterase inhibitor within 48 hours.
- Examples include sildenafil (Viagra®, Revatio®), vardenafil (Levitra®, Staxyn®), tadalafil (Cialis®, Adcirca®).
- Avoid use in patients receiving intravenous epoprostenol (Flolan®)or treporstenil (Remodulin®).
- Use caution when administering nitroglycerin to patients with marginal blood pressure.
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Description
This document discusses the development of model prehospital care protocols by a panel of multidisciplinary experts. National EMS clinical guidelines are needed to standardize patient care and adapt future practices. NASEMSO develops unified, consensus-based patient care guidelines for EMS clinicians.
