Outline of August 2011 NYC REMAC Protocol Changes

See REMAC Advisories 2011-02,2011-03,2011-04 at www.nycremsco.org

General Opretating Procedures


  • CPR: clarifies that REMAC follows AHA except as specified

  • Advanced Airway Management: adds section making use of ETI and alternative airways equal except in non-cardiac arrest situations, limiting ETI to 2 total attempts

  • Definition of Unstable Dysrhythmias: removes chest pain, SOB, possible MI from definition

CFR Protocols


  • 300 WMD, 301 Resp Destress/Failure, 320 Traumatic Arrest, 328 Burn: updated to match BLS protocols

  • 304 Non-Traumatic Chest Paint: removes blood pressure assessment and assistance of patient with NTG administration


BLS Protocols


  • 403 Non-Traumatic arrest: mandates AED availability & use; moves transport order to step 8

  • 407 Wheezing: removes wheezing from list of assessment criteria; mandates OLMC contact for epinephrine to patients over 33 years-old

  • 410 Anaphylaxis: mandates OLMC contact for patients over 33 years-old

  • 413 Seizures: removes list of signs/symptoms

  • 414 Poisoning of Drug OD remonves OLMC contact, information list, & order for dilution

  • 426 Soft Tissue Injuries: adds tourniquet option

  • 430 EDP: removes GCS from assessment


ALS Protocols

** "ETI" changed to "Advanced Airway Management"

  • 500-A Smoke Inhalation**: changes dopamine administration to Standing Order

  • 500-B Cyanided Exposure**: removes note on indications; changes dopamine admin to Standing Order

  • 501 Resp Arrest: protocol deleted

  • 503 Non-Traumatic Arrest: limits switching from AED to ALS monitor only at the end of CPR cycle

  • 503-B PEA/Asystole**: removes atropine

  • 504-A Suspected MI: moves aspirin to step 1; makes total doses of NTG unlimited under Standing Orders; removes morphine & Medical Control Options

  • 504-B Cardiogenic Shock: moves fluid bolus and dopamine to Standing Orders

  • 505-A, B & C Dysrhythmias: adds note: if defibrillator's maximum joules setting is less than 360, use equivalent cardioversion energies

  • 506 APE: makes total doses of NTG unlimited under Standing Orders

  • 507 Asthma & 508 COPD: makes total doses of albuterol unlimited under Standing Orders; mandates mixing of albuterol & ipratropium, limited to 3 doses

  • 510 Anaphylaxis: changes methylprednisolone and dexamethasone to Standing Orders

  • 515 Non-Cardiogenic Shock & 520 Traumatic Arrest: removes repeat of fluids under Medical Control Options

  • 521 Head Injuries**: clarifies indication for advanced airway management & moves it to step 2

  • 528 Burns & 529 Pain Management: adds fentanyl to Medical Control Options

  • 531 Severe Nausea/Vomiting: new protocol

  • 543 Neonate Resussitation: removes meconium aspiration; moved IV/IO access, epi and fluid bolus administration to Standing orders; removes Medical Control Options

  • 550 Peds Resp Arrest: adds note referring to Peds AMS protocol; changes naloxone to weight-base dosing with titration; removes ET administration of naloxone

  • 551 Peds Obstructed Airway: clarifies procedure with cuffed ET tube

  • 553 Peds Non-Traumatic Arrest**: increases joules settings

  • 559 Peds Traumatic Arrest**

Appendices


  • Appendix B Patient Assessment: clarifies transport decision; removes CUPS

  • Appendix D AED Guidelines: appendix deleted

  • Appendix I Hospital Listing: adds pediatric ages

  • Appendix T Use of Tourniquets: appendix added

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