Draft PA statewide protocols

[stcommodore]

The reason behind two providers that has been told to me is that in the OR and other settings the standard is two providers. In the OR, ED, or other clinical setting you will have two or more people if not a line ready to go for the tube and we should be no different with the same drugs in our hands. I would also hope that etomidate is part of a process to getting other drugs apart of RSI. It will take time but hopefully we as a commonwealth can prove that we can meet the standards and provide the care the patients require.

[Spock]

I didn't see the state medical director this weekend so I couldn't ask him about the NSS bolus. I did see a regional medical director and she wasn't aware of an NSS bolus in the protocol so perhaps this was an oversight. As I said, fluid for a stroke patient is probably not advisable unless hypotensive. The majority of stroke patients I have seen are hypertensive.

Live long and prosper.

Spock

[678 Responding]

In NJ, we are required regardless of service to have 2 ALS providers in the ambulance. Its usually up to the specific medical director, but Etomidate has been used for a while here, along with Versed. The state gives them a list of approved medications and lets the Doc decide which drugs he wants for RSI. CPAP has also been received quite nicely here, as your usual CHF patient can benefit much more from this than a tube. Intubation is always a last resort as we all know, so CPAP gives us a less aggressive option.

The issue with Lasix is understandable, well when it comes to poory educated paramedics. We all know medics that hear "fluid in the lungs" but are unable to differentiate between pneumonia or CHF. This is an education problem that can only be changed with more class time.

Since I live about 15 minutes from Philly, I get to communicate a lot with PA medics that also work in NJ. They welcome the new protocols, but are starting to feel like they are turning into NJ where everything has to be called in, rather than being a protocol driven system like PA is. I feel a compromise between the two would be best suited.

[spgmedic]

In regards to the Etomidate. We use RSI in our service. I prefer RSI to Conscious Sedation. Better for the patient.

[stcommodore]

a very wise medic told me that etomidate is our 'baby steps' to RSI. I think this is a huge undertaking to unite an entire commonwealth under one set of protocals. For some its a step back and for others its a leap foward. Hopefully what it means is that someone in Pittsburg, Dillsburg, Warminster and Philly will all be able to receive that same level of care.