New Alberta Protocols

[tniuqs]

Update AB Protocols / Guidelines:

Acting Senior Manager, Emergency Health Services has contacted myself, a very professional note and very polite, the release of new EBM protocols to the public (pubic domain website) and implementation of new EBM Protocols is Dec 1st 2010.

Apparently they (AHS) are working some of the "bugs" out like wording and drug dosages as some newer studies will impact.

One of my biggest questions with purely EBM protocols is just what studies and meta studies were evaluated ? Point being that "some" studies as in OPALS are misinformation and were dated before they were released. I can only hope that level headed and peer reviewed are applicable to our very unique Alberta environment.

Another concern is (with the AHS takeover) are we looking to implement 'best practice' or "most cost effective practice" as some of you are aware their just may be a bit of a "crunch" when it comes to budgetary concerns, that said this is government and I would hope that unbiased Medical Directors we appointed to this Health Policy and Service Standards Board.

Question is: Could we be basing practice on studies that were not derived or applicable even in Alberta, as many of the studies (i.e> wong et all) are out of the USA. Limiting practice / protocol without follow-up peer reviewed studies to validate, could be an error in of itself. I have observed in my experience with medicine that things do swing from one end of the spectrum to the other is very short order.

Lastly but not "Leastly" (sp) Look at the implementation of NIPPV ie in EMS refereed to as CPAP (quite obviously from the choice (minimums) and many sub contracted services WILL purchase based on lowest common denominator ie the device the Boussignac mask is folly and to best of my knowledge no "experts" from other regulated health care professionals were consulted like RRT's. Point in fact: a most current and excellent example during the H1N1 pandemic the Federal Government and without consultation from experts purchased en mass the Neuport 50 ventilator and this ventilator did not HAVE the capability to actually ventilate an ARD's type patient, nor were proper in-service provided to the VERY group that would be pressed into service to use them ... Most shamefully we (Canada Health) ignored or somehow forget to consult the other experts in their respective fields of specialty. So my question remains just who was on the development team (it may be a premature contrarian position) but I believe we just could see some "personal bias" or protocols based somewhat on budget restraints, but I hope not.

Side bar: spend ANY time with the Master Contrarian DR. Bryan Bledsoe and one looks at both sides of the coin ... and the edges too ...

When it comes success or failure with the NIPPV / CPAP devices, I have always been of the opinion that the success of this or that device is VERY dependent on the clinician applying that device, my point being that this is very difficult to be "quantified" by any study.

More to follow on this topic .... I must to go to the Airport and pick up a life time friend that I have not seen in 3 years and that drinks rhum.

cheers

[a_shane2_go]

All i know is i got about half way through the new protocols then bam. Restart year II medic school... and everything came to a hault

I actually tried out our CPAP masks to see how invasive it is... not at all. If they can take a NRB they can take CPAP.

They are asking our input in for the air ambulance protocols. What differences we need etc. They are being very responsive to us so far with the AA program. I'm impressed

[rock_shoes]

Yeah, in the Calgary we haven't used antidysrythmics in routine practice for quite some time, I wonder if an argument could be made to remove even Epi from codes, as it doesn't seem to translate to an increase in pts getting out of the hospital alive.

Fair question. I think it would be prudent to first evaluate the effectiveness of induced hypothermia in ROSC patients prior to dumping everything out of the code box.

[HellsBells]

Agreed, I'm not really for dropping Epi from codes, just thinking out loud about what the future may hold.

That said, I recently finished the hands on portion of the new MCP's. We are using a dial-a-flow IV device instead of pumps to control Nitro, amiodarone, epi, and dopamine drips. Its interesting that on the packaging for a dial-a-flow it states "Not to be used for Medication administration."

[rock_shoes]

That said, I recently finished the hands on portion of the new MCP's. We are using a dial-a-flow IV device instead of pumps to control Nitro, amiodarone, epi, and dopamine drips. Its interesting that on the packaging for a dial-a-flow it states "Not to be used for Medication administration."

I have serious reservations with regard to these dial-a-flow devices. I sincerely hope I'm wrong, but I strongly suspect that use of these devices will play a significant role in more than one patient death in care.

All i know is i got about half way through the new protocols then bam. Restart year II medic school... and everything came to a hault

I know how you feel. I'm just starting into my first paramedic practicum so I'll be out on car when the switch is made. I'll spend four rotations using the old Calgary protocols and four rotations using the new AHS protocols. Even better AHS has yet to release copies of the protocols to the schools.

[mobey]

That said, I recently finished the hands on portion of the new MCP's. We are using a dial-a-flow IV device instead of pumps to control Nitro, amiodarone, epi, and dopamine drips. Its interesting that on the packaging for a dial-a-flow it states "Not to be used for Medication administration."

In the words of the AHS Central zone manager "Don't worry, thier on thier way out."

[tniuqs]

Agreed, I'm not really for dropping Epi from codes, just thinking out loud about what the future may hold.

That said, I recently finished the hands on portion of the new MCP's. We are using a dial-a-flow IV device instead of pumps to control Nitro, amiodarone, epi, and dopamine drips. Its interesting that on the packaging for a dial-a-flow it states "Not to be used for Medication administration."

http://www.isrjem.org/Isrjem_June08.CPAP%20Eisenman_Postprod.pdf

cheers

[HellsBells]

Your opinion on the new protocols people? Its my first week back after holidays, so haven't really used any new drugs/equipment yet. However, I see major problems on the horizon with the regressive new on line medical control (OLMC) that we need to contact for certain treatments. Yesterday our crew needed to contact a doctor simply to talk someone into going to the hospital, we had to go through one automated menu, and two different human dispatchers, and one dropped call before a doc even got on the line. With all the waiting it was about ten minutes to connect. Sad.

[thrutheashes]

Your opinion on the new protocols people? Its my first week back after holidays, so haven't really used any new drugs/equipment yet. However, I see major problems on the horizon with the regressive new on line medical control (OLMC) that we need to contact for certain treatments. Yesterday our crew needed to contact a doctor simply to talk someone into going to the hospital, we had to go through one automated menu, and two different human dispatchers, and one dropped call before a doc even got on the line. With all the waiting it was about ten minutes to connect. Sad.

and let me guess......you were reprimanded for being on scene too long?

[HellsBells]

Ha, No actually we had a supervisor on scene. It was a CO call, and he had to bring us a CO monitor and he witnessed first hand the trouble we had both convincing our pts to agree to transport and the difficulty contacting med control. So, we didnt get our hands slapped, it was just a frustrating process.