Managing EMS Special Operations Protocols

Answer

Managing EMS Special Operations Protocols

Benditt and Adkisson (2013) note that special operations refer to recognized functional procedures that all emergency medical service staff like paramedics as well as Emergency Medical Technicians (EMTs) must adhere to for patient transportation, treatment, and delivery. This paper will, therefore, discus about managing EMS special operations protocols.

Special operations technicians play the role of maintaining mass casualty reaction where and when patients require care services and where multiple requirements may be faced. They equally maintain a care facility’s fleet of utility that are employed during and/or special events (Kessler et al., 2010). Special operations medics work with federal, state, and local law enforcement organizations/agencies to provide pre-hospital emergency medical care when undertaking specialized law administration operations (Benditt & Adkisson, 2013). Paramedics role playing within this distinct pre-hospital setting encounter a number of challenges and problems that cannot be resolved by using standard medical procedures. They are, therefore, trained to be prepared to respond to and deal with inadequate resources, higher incidence of penetrating harms, and delayed transport. EMS staff are essential during the provision of pre-hospital abrupt medical care. EMS protocols are procedures developed by state, local, and national medical institutions and authorities. These protocols are annually reviewed and revised in accordance with necessity. EMS protocols’ purpose is to standardized or normalize medical procedures for all EMS and therefore offer the highest and greatest level of healthcare for patients (Anderson et al., 2016). They equally provide a structure to assist EMTs in making decisions when operating within crisis settings (Benditt & Adkisson, 2013).

EMS protocols for paramedics include a number directions. Foremost, getting a patient’s medical past record is secondary to the patient’s treatment and any life-threating challenge should be assessed as well as treated ahead of acquiring medical past record and other patient data/information. Trauma and distress prompted cardiac arrest is not to be addressed or treated by using standard cardiac arrest procedures. Trauma patients ought to be transported quickly with apt cardiopulmonary resuscitation (CPR) protocols, and cervical spine immobilization, external haemorrhage, and other signposted protocols tried en route to a care facility (Bledsoe et al., 2012). Paramedics ought only to try two IV insertion in sick people with no conditions that are life-threatening who need such treatment. Any extra IV insertion trials must be ratified by medical control as well as other higher authorities. Additionally, patient transport along with other required treatments receive first priority and ought not to be delayed for several trials at endotracheal intubation (Fischer & Choo, 2010). When obtaining online medical or care direction, paramedics must repeat verbally all orders obtained before they implement or initiate them (Dovgalyuk et al., 2007). Any patient experiencing chest pain, irregular pulse, unstable blood pressure, a past record of cardiac dysfunction, or dyspnea ought to be placed upon a cardiac monitor (Kessler et al., 2010).  If a patient’s condition does not conform to standard procedure, a paramedic ought to always contact care/medical control for directions and instructions (Gill et al., 2006).

The goal of patient care is that EMS officers should facilitate apt initial assessment as well as management of EMS patient in addition to linking to suitable procedures as dictated by the outcomes in the Universal Care guideline (Bass et al., 2015). To achieve this, there are several procedures that they need to observe and things they need to do. To begin with, the need to conduct a patient management evaluation for patients. Such an assessment should begin by evaluating a scene safety, which should entail an assessment for hazards to EMS personnel, patient, bystanders, determination of the number of patients, definition of mechanism of harm, requisition for extra resources if required and weigh the paybacks of waiting for extra resources against speedy transport to decisive care, and consideration pronouncement of mass fatality incident if required. Appropriate personal protective equipment (PPE) should be used when handling patients and paramedics should wear high-visibility, retro-reflective apparels when deemed appropriate (Bass et al., 2015). A primary surveys should be carried on every patient. A primary survey entails a patient’s airway assessment for patency and open the airway. For a patient who is unable to sustain airway patency—open airway, which can be realized by chin lifting and head tilting, jaw thrusting, suction, and employment of the suitable airway management devices and adjuncts (Dovgalyuk et al., 2007). For patients with tracheostomies or laryngectomies, remove all clothing or objects that may hinder the opening of these devices, keep the flow of recommended oxygen, as well as reposition the neck and/or head (Anderson et al., 2016). Also, for a patient with laryngectomy, obstructed airway, or tracheostomy, paramedics are advised to use the airway management guideline.

Another assessment should be for breathing. Paramedics are to evaluate rate, breath sounds, accessory muscle use, retractions, patient positioning, administer oxygen as appropriate with a target of achieving 94-98% saturation for most acutely ill patients, and in case a patient not breathing (Apnoea ), use Airway Management guideline (Kessler et al., 2010).  For circulation assessment, paramedics should control any serious or major external bleeding, assess pulse, assess perfusion by evaluating temperature and skin colour, and assess capillary replenishment (Bledsoe et al., 2012). For disability, they should evaluate patient responsiveness: AVPU scale (Alert, Verbal, Pain, Unresponsive), evaluate gross motor and sensory function in all extremities, check blood glucose in patients with altered mental status, if acute stroke suspected then use Suspected Stroke/Transient Ischemic Attack guideline, expose the patient as appropriate to complaint, be considerate of the patient’s modesty, and keep the patient warm (O’Driscoll et al., 2008).

After conducting primary surveys, secondary surveys should be performed. Carrying out of a secondary assessment ought not to deter transport in life-threatening patients. Secondary surveys ought to be customized to chief complaint and patient presentation (Anderson et al., 2016). Secondary surveys entail an assessment of the following components of a human body: head, extremities, neck and neurologic. Another survey under the secondary surveys is to obtain a patient’s baseline vital signs. A patient’s neurologic status evaluation entails instituting a reference point and then trending any kind of change in the patient’s neurologic status (Thomas et al., 2014).

Patients with respiratory or cardiac complaints should be subjected to pulse oximetry, 12-led ECG out to be obtained early from the patient with suspected cardiac or cardiac complaints, incessant cardiac monitoring should be done, if available, and digital capnometry or waveform capnography, should be taken into consideration since it is essential for patients who need invasive airway administration (Anderson et al., 2016). For patients with altered psychological status, check blood glucose, consider digital capnometry and waveform capnography (Thomas et al., 2014). Worth noting is that stable patients ought to have a minimum of two sets of appropriate vital signs. In fact, one set ought to be taken just before arrival at admitting care facility (Gill et al., 2006) and critical patients ought to have relevant vital signs regularly checked (O’Driscoll et al., 2008).

There are several interventions that can be run on a patient. Do admin oxygen as suitable with an aim of attaining 94-98% saturation. Place suitable monitoring paraphernalia as dictated by evaluation – which may include: cardiac rhythm observation, incessant pulse oximetry, carbon monoxide evaluation, and digital capnometry or waveform capnography (Thomas et al., 2014). Additionally, institute vascular access if specified or in the sick who are at danger for clinical worsening. If Intraosseous infusion (IO) is to be employed for a cognizant patient, consider the employment of .5 mg/kg of lidocaine, 0.1mg/mL with a relaxed push via IO needle to a 40 mg maximum to alleviate or moderate pain from IO treatment administration (Bass et al., 2015). Also, observation of pain scale if suitable and carrying out re-evaluate or re-examine of the patient.

Further, paramedics are also to take into consideration patient safety measures. Some of the universal patient safety considerations are that routine employment of sirens and lights is not acceptable and even when sirens and lights are being used, always restrict speeds to safe levels for the emergency vehicle that is being driven and road status upon which it is being used (Bass et al., 2015). Also, they should be cognizant of patient rights and legal issues since they pertain to as well as impact patient healthcare (for instance, patients with operations requirements or children with special health care requirements) (Bledsoe et al., 2012). They need to be cognizant of potential requirement to amend/modify management depending upon comorbidities and patient age and that the uppermost weight-based dose of treatment given to a paediatric patient ought not to surpass the uppermost adult dose except for where particularly stated within a patient’s care guideline (Fischer & Choo, 2010). Direct medical mistake ought to be contacted when instructed or as required and also to think about air medical transport, if accessible, for patients who have time-critical status where road transport time is above 45 minutes.

In general, the management of EMS special operations is an intricate process, involving several facets. Paramedics need to understand the protocols covering right from their preparation for emergencies to assessing patients to treating them, and considerations for the patient’s safety.