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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 105
Registered: 07-2003
Posted on Thursday, January 15, 2004 - 10:34 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I'm working on developing a comprehensive set of patient care protocols similar to how many EMS systems in the States do it. This will apply to BTS1 and BTS1+ members. (I define BTS1+ as having the additional skills of BP and O2. They may or may not have BTS2). This will serve as a general guide for the sequence of care provided in specific emergencies. Comments on the format are welcome but keep in mind this is the first rough draft of one protocol.

ALLERGIC REACTION

DEFINITION: This protocol applies to patients presenting with rash, hives, shortness of breath, or other signs and symptoms apparently due to an allergic reaction (e.g. bee or other insect sting, food allergy, medication reaction, or latex). Common food allergens include: nuts, eggs, and shellfish.

TREATMENT:
BTS1:
1. Assess airway and breathing and circulation:
a. Perform basic airway maneuvers, as needed
b. Assist ventilations, as needed
c. Obtain complete vital signs: HR, RR, capillary refill.

2. Remove clothing & jewelry, if there is a possibility of cutting off circulation due to swelling

4. Position patient:
a. If in shock or altered mental status: shock position (elevate patientís feet), if tolerated
b. Otherwise: position of comfort

5. Reassess patient:
a. Unstable patient: HR, RR, capillary refill at least every 5 minutes
b. Stable patient: HR, RR, capillary refill at least every 10 - 15 minutes


6. If patient is wheezing or experiencing shortness of breath or respiratory distress:
a. Assist patient in self-administering their prescribed Epi-pen if they are concious and able to do so. Repeat 1 time in 10 minutes if needed.
b. Administer patientís prescribed Epi-pen for them only if they are unconcious or unable to do so. Repeat 1 time in 10 minutes if needed.

7. Reassess patient as per step 5.

Upon EMS arrival, give report, transfer care, and assist with patient care.
NOTE: Consider direct transport if an appropriate emergency department can be reached significantly sooner than EMS arrival, or if appropriate EMS intercept can be made as per guidelines.

BTS1+:
1. Assess airway and breathing and circulation:
a. Perform basic airway maneuvers, as needed
b. Assist ventilations with BVM device, as needed
c. Suction airway, as needed
d. Obtain complete vital signs: BP, HR, RR, capillary refill

2. Apply supplemental oxygen:
a. NRBM at 15 LPM

3. Remove clothing & jewelry, if there is a possibility of cutting of circulation due to swelling.

4. Position patient:
a. If SBP < 90 or in shock or altered mental status: shock position (elevate patientís feet), if tolerated
b. Otherwise: position of comfort

5. Reassess patient:
a. Unstable patient: BP, HR, RR, capillary refill at least every 5 minutes
b. Stable patient: BP, HR, RR, capillary refill at least every 10 - 15 minutes

6. If patient is wheezing or experiencing shortness of breath or respiratory distress:
a. Assist patient in self-administering their prescribed Epi-pen if they are concious and able to do so. Repeat 1 time in 10 minutes if needed.
b. Administer patientís prescribed Epi-pen for them only if they are unconcious or unable to do so. Repeat 1 time in 10 minutes if needed.

7. Reassess patient as per step 5.

Upon EMS arrival, give report, transfer care, and assist with patient care.
NOTE: Consider direct transport if an appropriate emergency department can be reached significantly sooner than EMS arrival, or if appropriate EMS intercept can be made as per guidelines.


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Tim Gallant
Advanced Member
Username: Tim

Post Number: 31
Registered: 03-2003
Posted on Friday, January 16, 2004 - 01:34 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Quote(Consider direct transport)and(Administer patientís prescribed Epi-pen for them only if they are unconcious or unable to do so. Repeat 1 time in 10 minutes if needed)that's not gonna go over so well.

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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 106
Registered: 07-2003
Posted on Friday, January 16, 2004 - 03:23 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Like I said, this is the first draft of the first protocol.

I was iffy about the direct transport thing but wrote it because SOME Brigades DO transport. Note the "according to guidlines" or whatever it was. They would be VERY strict and VERY restrictive.

And with the Epi, I was told that we can administer Epi to them if they are unable to do so for themselves as long as they consent.

What I'm more looking for is comments about the format of the protocol (is there a better way to do it?) and if you think we need a comprehensive protocol list in the first place. Honestly, mostly what I'm doing is looking at the EMT protocols from the states and very closely following them, changing a few things as needed.
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Mike Rumble, RPN
Senior Member
Username: Mrumble

Post Number: 108
Registered: 11-2002
Posted on Saturday, January 17, 2004 - 09:18 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

There are also Brigades with EpiPens prescribed "For Use By Physician or His/Her Delegate"
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Tim Gallant
Advanced Member
Username: Tim

Post Number: 32
Registered: 03-2003
Posted on Saturday, January 17, 2004 - 10:22 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

What is our protocol right now?Just sfa/MFR protocols?
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 107
Registered: 07-2003
Posted on Sunday, January 18, 2004 - 01:11 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

That's the thing, as far as I know there are no formal written protocols like this. If there are, they aren't easily accesible... I find the format I propose to be easier to use.
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Kevin Morgan
Member
Username: Kmorgan

Post Number: 15
Registered: 02-2003
Posted on Sunday, January 18, 2004 - 04:43 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Alex, before I say anything else I commend the effort and initiative.

However....

I don't think the best thing to do is try to create a protocol for all the things we may encounter. Here's why.

1. It's hard to create a protocol for every situation. It makes it more confusing when they get a case that they have no protocol for. What do I do now? I have no protocol for this.

2. Lot's of protocols make it harder to remember them all - notice most of the stuff there is the basic stuff that would be done for almost every patient? Give them a bunch of sheets of protocols, they have to try to memorize them all.

3. Back to the above, lots of protocls means lots of reading and memorizing... I know my members, while eager to learn, don't want to have a book of protocols to read... Bad enough we have 3 pages of divisional rules/regs.


Rather than memorizing all these sheets of protocols, focus on learning the basics and then go from there. For an MFR or BTS 2, this is where the focus should have been. Learn that assessment (the "MFR CHECKLIST") cold. Once you have that down, build on those basic skills.

Another concern is if we start pushing protocols for every situation it takes away from learning what we are actually doing and why. Try to develop "critical thinking" and go from there.

Good old "first aid by principle" will always rule over pages of protocols - we need some protocols, Oxygen Admin, AED, Nitro protocol, perhaps an epi protocol for those brigades that have it - but do we need them for every situation?

Again I commend the effort and initiative, but that's my 2 cents.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 108
Registered: 07-2003
Posted on Monday, January 19, 2004 - 12:18 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thank you for your comments Kevin and I can certainly see your arguements. However, protocols are guidelines that represent the preferred, prospective approach for a given situation. So in other words protocols are there to show what is usually the best way to do things. It isn't the only way as a protocol can't cover all the variations. By the same token, one can not make protocols for every possible situation. What I am suggesting is that these don't have to be followed to the letter but they can be used as more of a guide for care. Something that can be checked at a glance to see if anything was missed. Protocols would exist for the following (that I can see):

Allergic Reaction
Chest Pain
Diabetic Emergency
OB Emergency
Respiratory Distress
Seizure
Shock
Stroke

They would be summaries of the care that should be provided in most situations.
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Michael Lawrence, RN
Advanced Member
Username: Spud

Post Number: 37
Registered: 10-2002
Posted on Monday, January 19, 2004 - 12:57 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

As far as I see it, our standard first aid textbook already has protocols for everything you have mentioned... why rewrite what is already there?

Just my thoughts,
Michael
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 109
Registered: 07-2003
Posted on Monday, January 19, 2004 - 02:01 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Michael,

I'm looking at making a pocket guide type book with the barebones information. And where in our FA guide does it talk about O2/BP/KED etc? I'm trying to make all-inclusive treatment lists. I don't know about the SJA AMR (or whatever it's called now) books but my RC EFR books don't show things in a protocol style format. I don't have access to the SJA ones however.

Also, I believe I stated it before but I could be wrong, different people remember things in different ways. I know that when I first joined SJA I had a hard time remembering what to do in the 'more serious' things. For example, in my first month of joining we had a patient with a bee sting reaction. I didn't handle it very well but thankfully I wasn't alone. What I then did was a bunch of research. I read every protocol I could find (mostly American EMT-B) and related them to SJA, cutting out the parts that didn't apply to us in my head. Now I find it SO much easier to do the 'major' stuff. Some of it may be experience, yes, but some of it was the protocols. I'm suggesting these because if they worked for me they will work for others. Having it in a shorts, ordered, to the point list helps some people.
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Mike Rumble, RPN
Senior Member
Username: Mrumble

Post Number: 109
Registered: 11-2002
Posted on Monday, January 19, 2004 - 07:57 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Alex, are you attempting to develop these protocols for your own division? Or are you working on a district/province assignment?
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 110
Registered: 07-2003
Posted on Monday, January 19, 2004 - 08:13 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I don't know, whoever wants to use them would be welcome to. I'm doing this on my own initiative, not at the direction of anyone. If district/provincial wanted them they could use them (with appropriate credit given of course) and the same goes for my division. At the very least I'm making them for myself just to see if I can. I'm odd that way I guess ;)

I must be mildly OCD or something... once I get an idea into my head I can't stop thinking about it until I've done it. So at the very least I'm doing this so I can stop thinking about it :-) But who knows, it might turn out as something useful. As an example, I recently got interested in ECG interpretation. Not because it's part of my course for RPN (because it isn't) but just for personal interest. I went on a blitz, reading everything I could find on it and trying to learn as much as I could. I just do those things. Same with SJA when I joined, I went looking for absolutely everything I could find about it.

Does this change things at all? If so, how?
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 195
Registered: 11-2002
Posted on Tuesday, January 20, 2004 - 12:06 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

As long as you're not turning the door knob 3 times every time you open the door, I think you're fine :P

hehe
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Lana H
Intermediate Member
Username: Ldh

Post Number: 27
Registered: 11-2003
Posted on Monday, March 01, 2004 - 10:18 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Speaking of protocols I would like some clarification (or consensus) on the protocols for treating a burn. Perhaps it's just me but I know this is sparking some heated debate in our division has anyone LOOKED at the First Aid for Heat Burns in the FOTS text (Section 9-7). I draw your attention to the middle picture where they are depicting "dumping" what looks like a bucket of water on the casualty and the above description in Section 2 which states to "pour cool water on the area". (FYI same info is in the previous version of FOTS). I have to admit this is new to me - obviously my instructors missed this part - even way back before I became a member - immersion; yes, cover with clean, wet cloth; yes but dumping or pouring water?? My concern is the added injury potential if the burn is more than a superficial or 1st degree. Have I missed something along the way or does this FOTS guideline seem vague enough to be dangerous? I referred back to some older text still recommended for BTS and they do not refer to any treatment other than immersion and moist cloth. Anyone have any input on protocol or official directive that I'm not aware of?
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 229
Registered: 11-2002
Posted on Monday, March 01, 2004 - 12:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I've learned to take those illustrations in our FOTS book with a grain of salt.

Where those drawn or reviewed by our medical panel as well? Cause sometimes, its not exactly what the "words" say.
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Lana H
Intermediate Member
Username: Ldh

Post Number: 28
Registered: 11-2003
Posted on Monday, March 01, 2004 - 12:41 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I hear what you say but it sure puts you in a nasty place when you hear "but it's in the book". I've been "CYA"ing it by using the logical approach. "If the basic premise of F/A is to not inflict any more pain or injury "dumping" water directly onto a burn could 1) break blisters 2) introduce infection to the wound and 3) hurt like h***, I wouldn't want it done to me and I wouldn't do it to someone else if there was any other option". I could find no supporting data anywhere including exam questions and those on the quizzes which really confuses me as to why it's even in the book. I would hesitate to tell someone it's a mistake since, I guess it could be used for a 1st degree burn but it's certainly not the most effective to my mind and of course that would just open you up to the next inevitable question - "is there anything else wrong in the book I should know about?" Arrgh!
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Kevin Morgan
Intermediate Member
Username: Kmorgan

Post Number: 17
Registered: 02-2003
Posted on Monday, March 01, 2004 - 01:37 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Lana and Johnson

Irrigation of minor burns is perfectly all right. Obviously "dumping a bucket" is not an acceptable method. If you choose to irrigate, make sure that it is poured very gently.

From a realistic perspective, you are more likely to irrigate than anything else while you're out on duty. Most of us don't take the kitchen sink, much more likely to have bottles of sterile water while you're out on duty.
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 231
Registered: 11-2002
Posted on Monday, March 01, 2004 - 02:15 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I think we both agree to that.

The discussion was more towards why the picture in the book depicts a bucket of water being dumped on an injured part.
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Lana H
Intermediate Member
Username: Ldh

Post Number: 29
Registered: 11-2003
Posted on Monday, March 01, 2004 - 05:06 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Exactly Johnson! PS Kevin my preferred method is moistening a 4X4 sterile with my handy dandy bottle of water that I carry in my FA kit - much less fuss, muss and easy to maintain cooling since I just keep "dumping" the bottle of water on it as necessary!
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Gordon Siu
Intermediate Member
Username: Erdaemon

Post Number: 24
Registered: 04-2003
Posted on Saturday, March 06, 2004 - 12:05 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Comprehensive protocols, if that's what you trying to "create", will not fit in a field guide.
Even if it fits, it may become dangerous as it promotes the situation:
"Sir/ma'am, hang on! Let me check with my handy-dandy field guide to see what should i do with that squirting wound of yours"
protocols are meant to be studied before your shift.
field guides are there to remind you about tiny details that doesn't warrant memorization.

a few state/county have protocols available as pdf for public to download. (for education purposes, not do it at home)
probably need at least a 3" binder to hold them.
print them out and try if u insist, but don't kill trees just for the fun of it.
the thickness also depends on how much details is written out.

Sometimes it's not what unwritten that makes us clueless, it's what written and not being read that's causing all sorts of problem.
Wondering why educators are concern about that mysterious "reading skills" in the education system?
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john Docherty RRT
Intermediate Member
Username: Jpdocherty

Post Number: 22
Registered: 05-2003
Posted on Friday, May 14, 2004 - 10:51 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Why? Have you ever heared of the Basic Life Support manual (BLS) that the ministry of health has and has used for years, it may save you a lot of time.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 166
Registered: 07-2003
Posted on Saturday, May 15, 2004 - 12:33 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Heard of it, never seen it. Is there an electronic version? I'd love to see it...
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Mike Rumble, RPN
Senior Member
Username: Mrumble

Post Number: 136
Registered: 11-2002
Posted on Saturday, May 15, 2004 - 09:45 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Nope. No electronic version (that I know of). It costs about $100 and can be ordered from Ronen House publishing. IF you have access to a Paramedic student or your local ambulance service you an always ask them to borrow a copy to look over. There may also be a nearby division that has an office copy you could borrow.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 167
Registered: 07-2003
Posted on Saturday, May 15, 2004 - 02:47 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Meh, I'll just wait. If all goes according to plan I start Paramedic in September so I'll get it then.
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john Docherty RRT
Intermediate Member
Username: Jpdocherty

Post Number: 23
Registered: 05-2003
Posted on Sunday, May 16, 2004 - 05:44 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Good luck if you get in, its very competative. Im starting my second year in sept. You will have the oppertunity to buy a copy of the BLS for about $80 or so I cant remember how much I payed. Even if your not a studend you can walk into a college book store and pick one up.

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