PROTOCOL CHANGES
SPECIFIC TO NEW YORK STATE

     
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The Latest NYS EMT BLS Protocol Manual is dated July 2011, which contains all intermediate updates and changes up to and including 11/1/11.

The following protocols have been updated and take effect August, 2011:

M-5, M-12, M-13, M-14, T-1, T-2, T-6, T-7, & SC-3.

 

Use the link below to view them.
 

These are the latest NYS EMS Protocol changes sent to this Institution by the NYS DOH,
and that may not have been updated in print or on the NYS EMS Web Page.
These Protocols apply to NYS Certified (A)EMT's ONLY.
This includes Students enrolled in our Courses.

NYS CFRs have their own Protocols.
If you are from another state or region, your protocols will be different.
Check with your local training officer or state EMS office in the state where you are certified.


~ Updated:  November 1, 2011 ~

~ Reviewed & Corrections made on January 29, 2013 ~

All Information comes directly from NYS DOH EMS or SEMAC Documents.

 

This page DOES NOT REFLECT
New York City REMSCO/REMAC BLS Protocols.

Which are Available by CLICKING HERE

 

The above link will also take you to the Policy Statements and SEMAC Advisories page.

The following NYS EMS Protocols have been updated and take effect August 18, 2011: M-5, M-12, M-13, M-14, T-1, T-2, T-6, T-7, and SC-3.

 


All NYS Written Certification Exams will reflect the new protocol changes.

 

22259
People have reviewed these Protocols
since the latest Update

 

 





NYS Protocol:
Suctioning

Adult suctioning is performed "on the way out" for a duration of no more than 15 seconds at a time.

 

Local Protocol
Children ~ No more than 10 seconds.
Infants ~ No more than 5 seconds.

NYS Protocol:
Mast Pants (PASG)

All 3 compartments are inflated at the same time except as contraindicated by an impaled object or pregnancy.
Inflation is to 106 mm/Hg on the gauge OR until "pop-off" valves start to "hiss".
No gauge or valves, NO PANTS.

 

    APPLICATION:
  • Mast Pants ARE NOT REQUIRED to be carried on NYS Ambulances.
  • Consider only in Adult Major Trauma
  • 8 y/o or younger - NO PANTS.
  • Use MUST be REMAC approved
  • Shock Protocol must be followed
  • Obvious Pregnancy - inflate Legs ONLY

     

  • Unstable pelvic fracture only
    B/P MUST be below 90 systolic
  • Severe Shock
    B/P MUST be below 50 systolic
NYS Protocol SC-3:
Childbirth

Suction the infant’s oropharynx only if the airway is obstructed or artificial ventilations are required.

As soon as the infant has delivered, quickly dry the infant and place the infant on a warm towel (if available) in a face-up position with the head lower than the feet. Keep the infant at the level of the mother’s vagina until the cord is cut.

If the infant is breathing spontaneously and crying vigorously and has a pulse greater than 100/min:

Clamp the umbilical cord ONE (1) minute after birth with two clamps, three inches apart, and cut the cord between them.

The first clamp will be 8 – 10 inches from the baby. Place the second clamp 3 inches from the first clamp towards the mother.

Supplemental Oxygen delivery has been downgraded - it's use is limited.

Perform APGAR Score at One Minute and Five Minutes after birth.

Do not delay transport to wait for the placenta to be delivered.

NEONATE RESUSCITATION:

IF AT ANY TIME

If the infant's respirations are absent or depressed (less than30/minute in a newborn):
Rub the infant's lower back gently.
Snap the bottom of the infant's feet with your index fingergently.

If the respirations remain absent or become depressed (less than30/minute in a newborn) despite stimulation, or if cyanosis is present:
Clear the infant's airway by suctioning the mouth and nose gently with a bulb syringe.
Administer normal concentration oxygen (pocket mask, BVM) as soon as possible.

If respirations remain absent or depressed (less than 30/minute in a newborn) despite stimulation, or if cyanosis is present:
Clear the infant’s airway by suctioning the mouth and nose gently with a bulb syringe.

Insert the proper size oral airway gently.

Ventilate the infant without supplemental oxygen at a rate of 40 – 60 /minute with an appropriately sized pocket mask or bag-valve-mask as soon as possible.

Each ventilation given over one second assuring that the chest rises with each ventilation. If patient does not respond within 30 seconds add supplemental oxygen.

Monitor the infant's pulse rate continuously.

If the pulse rate drops below 100 beats per minute at anytime,
assist ventilations at a rate of 40 to 60/minute with supplemental oxygen.
If the pulse rate drops below 60 beats per minute at anytime,
OR does not increase above 60 beats per minute after 30 seconds of assisted ventilations,

add chest compressions to assisted ventilations following AHA/ARC/NSC guidelines.

NYS Protocol:
Assisted Ventilation & Oxygen

If the patient demonstrates inadequate ventilation & the respiratory rate is
less than 10 per minute OR greater than 29 per minute
and the patient is confused, restless, or cyanotic

 

  • VENTILATE w BVM @100% O2:
    ADULT
    - 12 X per minute
    INFANTS & CHILDREN - 20 X per minute

  • If the Pediatric BVM has a "pop-off" valve
    Disable it.

  • Any patient in Respiratory Distress,
    Including COPD gets 100% O2
    via Non-Rebreather, regardless of other conditions
  • EXCEPT
    Unable to tolerate NRB
    Infant & Child ~ "Blow-By" as per Protocol

NYS Protocol:
Hyperventilation in Traumatic Brain Injury

 

    If head injury is suspected,
    the Glasgow Coma Scale (GCS) score is less than 8,
    and active seizures or one or more of the following signs of brain herniation are present
    :

  • Fixed or asymmetric pupils
  • Abnormal flexion or abnormal extension ~ (neurologic posturing)
  • Hypertension and bradycardia ~ (Cushings Reflex)
  • Intermittent apnea ~ (Cheyne-Stokes Respirations)
  • Further decrease in GCS score of 2 or more points ~ (neurologic deterioration)

  • hyperventilate the patient with high concentration oxygen
    at a rate of 20 breaths/min in an adult
    and 25 breaths/min in a child.

  • Disable BVM pop-off valve

  • Do not hyperventilate unless the above criteria are met.

NYS Protocol:
Medications

  • BLS DRUGS
    Use MUST be REMAC approved
  • Epinephrine Auto-Injector (NYS Protocol M-3)
  • Albuterol (SC-4)
  • Activated Charcoal
  • Mark 1 Kits (PS - 03-05) 
  • Aspirin (NYS Protocol M-5 as of 1/2007) 
  • Ipacac (No longer listed in Part 800)

 

 

Adult Cardiac Related Problem (NYS Protocol M-5)
  • If patient has not taken aspirin and has no history of aspirin allergy and no evidence of recent gastrointestinal bleeding,
    administer 325 mg nonenteric chewable
    aspirin.
  • If chest pain is present AND if the patient possesses nitroglycerin prescribed by his/her physician
    AND has a systolic blood pressure of 120mm Hg or
    greater,
    the EMT-B may ASSIST the patient in self-administration of the patient’s prescribed sublingual nitroglycerin tab or sublingual spray
    as indicated on the medicine container.

  •  If chest pain is present and if the patient possesses nitroglycerin prescribed by his/her physician, has a systolic blood pressure of 120mm Hg or greater and the patient has not taken any erectile dysfunction medication in the last 72 hours, the EMT-B may assist the patient in self-administration of the patient’s prescribed sublingual nitroglycerin as indicated on the medicine container.

  • A.  In the absence of standing orders for nitroglycerin,
    contact medical control for authorization to administer the nitroglycerin.

  • B.  Confirm the systolic blood pressure is 120mm Hg or greater.

  • C.  Question patient on last dose administration of nitroglycerin, effects,
    and assure understanding of route and administration.

  • D.  Administer one (1) metered dose of nitroglycerin spray
    OR
    one (1) nitroglycerin tablet under the patient’s tongue without swallowing
    and record the time of the administration.

  • E.  Recheck blood pressure within two (2) minutes of administration
    AND record any changes in the patient’s condition.

  • F. * If the patient continues to have chest pain with a systolic BP above 120mm Hg, the EMT-B may assist in administering up to two (2) additional doses following the above steps in A through E for each single dose administered. Each dose shall be no less than 5 minutes from the last dose given.

NYS Protocol:
  • AED
  • Burns
  • Hypothermia
  • Child Abuse
  • BCLS
  • IV's

    NYS Cardiac Arrest Protocol M-12 & M-13, PLUS AED PROTOCOL M-14

 

  • Monophasic AED ~ Contraindicated in children under the age of 8
  • Bi-Phasic Defibrillator
  • SEMAC Approved (7/2002) Pediatric Bi-phasic Defibrillator use for Children Ages 1 to 8
    MUST be used with Pediatric Pads.
  • Do Not Use Pediatric Pads on Adults. They WILL NOT WORK.
  • IF Pediatric Pads are UNAVAILABLE, Adult pads may be used.
  • DO NOT DELAY BEGINNING COMPRESSIONS TO BEGIN VENTILATIONS – COMPRESSIONS MUST BEGIN AS SOON AS IT IS DETERMINED THE PATIENT DOES NOT HAVE A PULSE

     
  • ALL SHOCKS MUST be delivered
    as per the NYS EMS BLS Cardiac Arrest (Non-Traumatic) Protocol M-14 for Adult and Pediatric Patients
  • Follow the AHA 2010 Guidelines when performing CPR on Adults, Children, and Infants. 

     

    BURNS ~ NYS Burn Protocol
    Second Degree: Cover with a Moist Sterile Dressing
    Third Degree: Cover with a Dry Sterile Dressing
  • Sterile Moist Dressing covered with a Dry Dressing
    is a Regional Protocol.

    Hypothermia

  • Pulse check for a Hypothermic Patient is at least 45 seconds
  • Deep Cold Injury re-warming (Water Bath) NOT to exceed 105F 

    Child Abuse

  • NYS (A)EMT's are now MANDATED REPORTERS
    for (Suspected) Child Abuse (Not CFR's)

    BCLS

  • CPR to be preformed to the 2010 AHA Guideline Standards
  • Protocols will reflect these changes.

    EMT-B's and IV's

     

     

  • SEMAC has determined that it is no longer permissible for a BLS ambulance,
    staffed by EMT-Bs to transport a patient with an IV line in place.

  • This applies to the following situations:
    1. Intravenous lines with fluid.
    2. Intravenous lines with medication.
    3. Central and peripheral vascular access devices with medication.

     

    It is allowable for an EMT-B to transport a patient with a secured saline lock (hep-lock)
    device in place, as long as no fluids or medications are attached to the port.
    However, the EMT-B must insure that the venous access site is secured
    and dressed prior to leaving the health care facility.

  • Trauma Protocols T-6 & T-7 now include The National Trauma Triage Protocol from the CDC for Adult and Pediatric patients.
    Click HERE to download from the CDC.

 
   
 

Creative Commons License
NYS EMS Protocols by NYS EMS is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States License.
Based on a work at TIMER, Inc By the NYS EMS Regional Faculty.