King County Medic One Guidelines/Protocols

thegreypilgrim

thegreypilgrim

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Does anyone have access to the KCM1 clinical guidelines/protocols? I can't seem to find them online.
 
I've got 'em in my "Paramedic Protocol" app for my iphone.

They're pretty basic... do you need to know anything specific?
 
Well, I'd like to be able to look them over. They're not posted online anywhere?
 
What are they using the sodium thiosulfate, isoproteronol, noradrenaline and sodium nitrate for?
 
Sodium thiosulfate I presume for cyanide toxicity.
Isoproteronol is back in favour for bradycardia associated with high level blocks.
Norepi is a useful pressor/inotrope; it's nice to add to epi in sick septic patients to add a bit more squeeze.
Sodium thiosulfate I'm not sure, vasoldilation for something, but what exactly I don't know.
 
Sodium Nitrate? That's Salt Petre... I wonder if you meant Nitrite?
 
We has Levophed too. Our docs apparently love its use in shocky situations.
 
jtpaintball70 said:
Sodium Nitrate? That's Salt Petre... I wonder if you meant Nitrite?
Click to expand...

I presume so too. I meant to write sodium nitrite at the bottom, repeated thiosulphate for some reason. It's been a long day...
 
The sodium nitrite and thiosufate aren't in the current formulary. That web page may be old. I have the updated guidelines on the protocol provider ap. And KCM1 is the only agency around here (that I know of) that carries levophed.

Everyone is a little different. Fo example, one agency I work for carries Terbutaline. Another carries Anzemet. It's all minor, but it's what the MPD wants. :)
 
Its impressive that they can do central lines. I thought that was a sterile procedure.
 
See the central line/subclavian discussion from a few weeks back. We also can do central lines in one county that I work in. I won't. Too many things that can go wrong and I think an IO is quicker and easier.

Take it from someone who has worked in king county, albeit as a BLS provider, it's not all that and a bag of chips. It's not a system where I have any interest in working as a medic.
 
n7lxi said:
They're pretty basic...
Click to expand...

  • [FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]Perform pericardiocentesis[/FONT]
  • [FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]Perform escharotomy[/FONT]
  • [FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]Perform episiotomy[/FONT]
Sounds pretty basic to me :P
 
They really aren't all that advanced, to be honest.

Heck, our flight crews do escharotomies and pericardiocentesis, and we as ground medics were "taught" how to do escharotomies in case we had to and called in to MC. We don't carry the proper needle for pericardiocentesis on ground trucks, so that's irrelevant to us.

Heck, an episiotomy isn't really advanced at all.



(Please, no one bring up "Of course the skill isn't hard, it's knowing when to use it" [as if knowing when to use those 3 is difficult either] as that is an overused phrase that holds no purpose in this current context)
 
Ground medics in my service may perform pericardiocentesis and an episiotomy if indicated. WITHOUT calling the doc.

Again, it's all about where you're from. If you're working in a VERY restrictive system, the KCM1 treatment guidelines may look like manna from heaven. If you're in a relatively progressive service, you look at KCM1 and say, "Meh. Big deal."
 
n7lxi said:
Again, it's all about where you're from. If you're working in a VERY restrictive system, the KCM1 treatment guidelines may look like manna from heaven. If you're in a relatively progressive service, you look at KCM1 and say, "Meh. Big deal."
Click to expand...

I'm part of the "Big deal" crowd. :P


Tends to come with the territory of being a rural service.
 
That's funny to me Linuss.

I work in several counties that are considered rural, with LONG (+45 minutes) transport times. The protocols there are even more progressive than the ones I follow in the city, with the medics expected to begin working toward the treatment end point while in the truck, not just simply start a line and drive to the nearest hospital.

You may have seen a past post of mine that talks about one county's STEMI protocol. After a chat with the Doc we are able to begin to aggressively treat STEMI with NTG drips, Heparin, TNKase and Plavix. We have multiple beta blockers. We have very aggressive pain management protocols. We are treated as a vital step in the patient's hospital experience and both the docs and medics enjoy the give and take relationship that we're able to cultivate.

I guess I'm just spoiled. And, from appearances, pretty damn lucky. B)
 
Usalfyre and I can say the same. Our agency is technically hospital based rural, with my county being 45+ min to the closest legit hospital.

They make it clear in our academy that we are no longer "Taking patients to the ER, but taking the ER to the patients"


We have, atleast what I consider, very progressive protocols (guidelines). Like you, we have Heparin and beta blockers for MIs and if we're transporting from an outlying clinic we can do fibrinolytics. We have no hard limit on our narcotic usage. RSI, DAI, and they say our patients aren't considered intubated until we also have an OG/NG tube in.


Heck, in the entire protocol book, 99% of what we have is standing orders. We're only told to contact med control 4 times: Physical restraints, antibiotics in septic patients, RSIing someone after 2 doses of 2mcg/kg Fentanyl doesn't control pain, and to find where the closest reattachment surgeon is for amputations.
 
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Linuss, that sounds like a great system.

I know that as a new medic, I appreciate the fact that we're considered much more than "ambulance drivers" and I really don't take for granted one bit of the freedom I'm given when it comes to treating my patients.

Now, to get back to the KCM1 stuff, I'm sure if the OP calls the Medic One office, they can get you a copy of the protocols. After all, Oded (the guy that wrote the paramedic protocol app for the iPhone) got em...
 
Linuss said:
Usalfyre and I can say the same. Our agency is technically hospital based rural, with my county being 45+ min to the closest legit hospital.

They make it clear in our academy that we are no longer "Taking patients to the ER, but taking the ER to the patients"


We have, atleast what I consider, very progressive protocols (guidelines). Like you, we have Heparin and beta blockers for MIs and if we're transporting from an outlying clinic we can do fibrinolytics. We have no hard limit on our narcotic usage. RSI, DAI, and they say our patients aren't considered intubated until we also have an OG/NG tube in.


Heck, in the entire protocol book, 99% of what we have is standing orders. We're only told to contact med control 4 times: Physical restraints, antibiotics in septic patients, RSIing someone after 2 doses of 2mcg/kg Fentanyl doesn't control pain, and to find where the closest reattachment surgeon is for amputations.
Click to expand...

You mean ya'll don't consider Cozby a legit hospital? :P
 
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