Suction Mouth FIRST, Then Nose

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 nosegently with a bulb syringe.
Administer high concentration oxygen as soon as possible.
If respirations remain absent or depressed (less than 30/minute in a newborn) despite stimulation and oxygen:
Insert the proper size oral airway gently.
Ventilate the infant with high concentration oxygen at a rate of 40 to 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.

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.

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

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.

• 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 nonenteric chewable aspirin (160 to 325 mg).

• 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
  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.

NYS 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.
• IF Pediatric Pads are UNAVAILABLE, Adult pads may be used.
• ALL SHOCKS MUST be delivered
  as per the NYS EMS BLS Cardiac Arrest (Non-Traumatic) Protocol M-14 for Adult and Pediatric Patients

   

  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 30 to 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 2005 AHA Guideline Standards
  

  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 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.