San Diego protocol regarding BP

JPINFV said:
Just curious, do you have a reference. In general, just because a medication was administered prior to transport by a health care facility does not mean that it's automatically a paramedic level call.
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It's not an ALS call... Protocol states that any meds given that are non standard or narcotic, a BLS unit must wait at least 30 mins from time given to transport. The only time it must be upgraded to ALS in San Diego is if the facility refuses to d/c an IV that is anything more than NS, but that rarely if ever happens.

And again, that is San Diego Protocol, not state or NREMT.
 
Ok... Which section of the protocol is the 30 minute rule found in?

Link to San Diego County LEMSA protocol:

http://www.co.san-diego.ca.us/hhsa/programs/phs/documents/EMS-PolicyProtocolManual_2010online.pdf


Also, pg. 331-333 includes the scope of practice for EMTs in San Diego LEMSA, which incldues the following about IVs:

"B. A supervised EMT student or certified EMT may monitor and transport patients with
peripheral lines delivering IV fluids under the following circumstances:

...

The fluid infusing is a glucose solution or isotonic balanced salt solution, including
Ringer's Lactate."

So, you can transport patinets on more than just NS.
 
S-135, "check for prior IV, IM, SC, and non routine PO medication delivery to assure minimum wait period of 30"..."

No wait time is necessary for routine oral/dermal medications or completed aerosol treatments.

and you're right, NS isn't the only IV you can transport, as long as no added meds are added, and the rate is maintainable without having to adjust.
 
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Ah, gotcha. Thanks for the reference.

I bet either hospitals, SNFs, ambulance services, and dialysis clinics either absolutely hate it or routinely ignore it. Dialysis patient had a little extra taken off the top and got a little IV saline? 30 minute wait.

Patient received some anti-nausea medication? 30 minute wait.

Interfacility psychatric patient who was just given some valium? 30 minute wait.

Interhospital transfer of patient who just recieved pain meds? 30 minute wait.

Now, does the ambulance company just have a crew sitting for 30 minutes, or do they cancel and send the next available crew with the possibility of having to repeat this...
 
Normally the facilities are pretty good about it. an IFT from say, ER to another hospital, sometimes is the only snag.

And yes, i've sat in the ER breakroom for 20-30 minutes before transporting.

It doesn't happen often, and yes, some private companies do not enforce it/ignore it.
 
Monkey said:
That IS against county protocol. However most private BLS agencies don't pay attention to it.
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This was a transport to a hospice facility, and the patient was a DNR. The patient needed no monitoring or IV, and since they were a DNR, no medical professional, whether EMT or MD, was going to do anything if the patient went into respiratory arrest. Also, the 15mg barely touched him.

That said, I wouldn't transport a non-DNR patient on heavy narcs with no way to reverse it (we are an IFT company and our BLS units don't carry Naloxone).
 
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Am I reading this right? (From JPINV): San Diego EMS Protocol is over 330 pages long? (I couldn't download it). I think that is crazy, how do you read and remember that much.

I though ours were bad at 70 odd pages full of info: my old area was 70 pages, but most were half page or less.
 
What is wrong with transporting a patient with heavy narcotics on a BLS level? if they stop breathing or the resp effort slows down, bag them.
On an ALS level if I give Narcan, it cancels the effect of the pain meds, and makes it so they feel everything til the Narcan wears off; (If I remember right, it takes about 2 hours for it to wear off). It only takes 10-15 min for the Morphine to wear off so they start breathing again on their own.
 
hahahaha... i'm waiting for us to get a protocol on applying an adhesive bandage, but yeah, it's thick.

San Diego EMS is a VERY conservitive system. It's a "Mother, may I?" system. It's mainly targeted at ALS, but that trickles down to BLS. CYA is the name of the game. :)
 
Maryland's protocol book is over 500 pages. Of course there is a lot more information in that book then protocols. There is a section on drug information, wilderness EMS, pilot programs, inter-facility transport programs, phone numbers, procedures for attempting to implement a new protocol, and many other things.

The protocols themselves are a few hundred pages long, but they are really easy to remember, especially if you already know what you are doing.

Most protocols should be pretty easy to remember if you had a strong education. The hardest thing I have to remember is when I can give a medication without consult. I was a boarder medic in MO/AR and they were VERY different. I'm a boarder medic here in PA/MD and they are somewhat different. Other then that, I've never had problems moving from system to system.

Keep a copy handy, go over it now and again, and you'll be surprised just how much of that 330 pages you actually really do know.
 
johnrsemt said:
Am I reading this right? (From JPINV): San Diego EMS Protocol is over 330 pages long? (I couldn't download it). I think that is crazy, how do you read and remember that much.

I though ours were bad at 70 odd pages full of info: my old area was 70 pages, but most were half page or less.
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It's not just medical protocols. It's protocols and system policies, so it includes unit inventory and county discipline process, and education requirements, and scope of practice, and everything else that's normally separate from the actual treatment protocols.
 
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