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2019 REMSA Policies and Procedure Overview

2019 REMSA Policies and Procedure Overview. Overall Policy Changes Misty Plumley, Senior EMS Specialist. Objectives. Identify and review policy changes for 2019 Discuss CQI Review findings via Case Review Review High Performance CPR objectives

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2019 REMSA Policies and Procedure Overview

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  1. 2019 REMSA Policies and Procedure Overview Overall Policy Changes Misty Plumley, Senior EMS Specialist

  2. Objectives • Identify and review policy changes for 2019 • Discuss CQI Review findings via Case Review • Review High Performance CPR objectives • Review education regarding needed performance standards.

  3. Policy Changes – Section 1000 EMS Personnel REMSA 2019 Policy and Procedure Manual Overview

  4. REMSA 1102 • EMT Training: • Application of training requirements for naloxone, epinephrine • Training must be completed by first recertification after July 1, 2019 • EMT applications updated in LMS • Upcoming: Integration of glucometer in Fall 2019

  5. REMSA 1104 • - No current changes for 2019 • Law enforcement partners continue to evaluate programs for use/deployment of naloxone.

  6. REMSA 1201 • Fee Schedule • Fee Schedule is under review and discussions for change occurring with stakeholder groups, anticipated changes after July 2019.

  7. REMSA 1202 • EMT Certification • Application changes for post July 1, 2019. • Clarification of verbiage to align with CA EMSA verbiage for National Registry completion. • Title 22 CCR Chapter references updated. • Applicants are required to save their materials for application in case of audit.

  8. REMSA 1202 Additional Changes • Added verbiage to be consistent with CA EMSA: • - EMT applicants must have completed their NR exam within 2 years of application • Change from skills exam was valid for 1 year from cognitive test successful completion.

  9. REMSA 1203 • EMT Recertification • Changes consistent with requirements for training that apply after July 1, 2019. • Title 22 CCR Chapter references updated.

  10. REMSA 1204 • New Policy for 2019- EMT Reinstatement • - Policy adds clarifying language for applicants who are applying for recertification with an EMT certificate that has expired • Consistent with CA EMSA processes and verbiage for paramedics. • EMT applicants are required to maintain copies of their application documents and uploads for a period of 4 years in case of audit. • Title 22 CCR reference sections updated.

  11. REMSA 1204* (renumbered to 1205) • EMT Certification by Challenge • With the addition of REMSA 1204 EMT Reinstatement, EMT Certification by Challenge has become REMSA 1205. • Title 22 CCR Chapter references updated.

  12. REMSA 1205* (Renumbered to 1206) • Certificate Review Process • With the addition of REMSA 1204 EMT Reinstatement, Certificate Review Process has become REMSA 1206.

  13. REMSA 1206* (Renumbered to 1207) • Paramedic Accreditation • With the addition of REMSA 1204 EMT Reinstatement, Paramedic Accreditation has become REMSA 1207.

  14. REMSA 1207* (Renumbered to 1208) Paramedic Reverification • With the addition of REMSA 1204 EMT Reinstatement, Paramedic Reverification has become REMSA 1208.

  15. REMSA 1208* (Renumbered to 1209) • MICN Authorization • With the addition of REMSA 1204 EMT Reinstatement, MICN Authorization has become REMSA 1209.

  16. REMSA 1209* (renumbered to 1210) • MICN Reauthorization • With the addition of REMSA 1204 EMT Reinstatement, MICN Reauthorization has become REMSA 1210. • Changes made to reflect new reauthorization requirements: • Ability to utilized either ALS SCV or pre-authorized ALS Ride out time for reauthorization. • Clarification of EMS CE requirements with less than 24 months initial authorization.

  17. Remsa 1210* changes continued • Clarification of EMS CE requirements with less than 24 months initial authorization.

  18. REMSA 1210* (Renumbered to 1211) • MICN Challenge • With the addition of REMSA 1204 EMT Reinstatement, MICN Challenge has become REMSA 1211.

  19. REMSA 1301 • EMS Continuing Education • No Current Changes Proposed for 2019

  20. REMSA 1302 • Skills Competency Verification • Changes to the ALS SCV process to update the form for childbirth/neonatal resuscitation. • All new ALS SCV courses should utilize the updated ALS SCV form, and childbirth & neonatal resuscitation be integrated into pediatric simulation or pediatric resuscitation classes offered by REMSA providers. • REMSA requires that all paramedics have completed the updated ALS SCV process no later than April 1, 2020.

  21. REMSA 1303 • Continuing Education Provider • No Current Changes Proposed for 2019

  22. Policy Changes – Section 2000 Communications REMSA 2019 Policy and Procedure Manual Overview

  23. REMSA 2101 Emergency Medical Dispatch • Changes to EMD cards and LEMSA controlled items occurring as needed. No current policy changes proposed.

  24. REMSA 2201 • Radio Communications Standard • Radio frequency programming will be updated as needed. No policy changes currently proposed.

  25. Policy Changes – Section 3000 Prehospital Services REMSA 2019 Policy and Procedure Manual Overview

  26. REMSA 3203 New policy addition

  27. REMSA 3301 • Drug and Equipment List • Trial study for Ketamine ended, Ketamine approved for Local Optional Scope of Practice (LOSOP), ketamine added.

  28. REMSA 3302 • Controlled Substances • Trial study for Ketamine ended, Ketamine approved for Local Optional Scope of Practice (LOSOP), ketamine verbiage clarified.

  29. Remsa 3309 • Intranasal Naloxone Use by Public Safety Personnel • No Current Changes Proposed for 2019

  30. Policy Changes – Section 4000 Treatment Protocols REMSA 2019 Policy and Procedure Manual Overview

  31. REMSA 4101 • Introduction to Treatment Protocols • No Proposed Changes for 4101 for 2019 • Implications for agencies applying for waiver of AHA training.

  32. REMSA 4102 • Universal Patient Protocol • 12 lead ECG, perform when clinically indicated, when the paramedic is present

  33. REMSA 4103 • Calculation Chart • Narcan Dosing Changes • Ketamine Doses Added

  34. REMSA 4103 • Push Dose Epinephrine (0.01 mg/mL) added:

  35. REMSA 4203 • Do Not Attempt Resuscitation • Added verbiage to further utilize patient’s response to therapy as a guide for withdrawal of resuscitation. • Clarification of BLS Criteria to determine death

  36. REMSA 4203 2019 Protocol 2018 Protocol

  37. REMSA 4203 • Withdrawal of resuscitative efforts: • Driven by patient’s response to therapeutic interventions. • Lack of response to treatment could be an strong indicator of futility of arrest. • Resuscitation of patients should occur on scene • Environmental and safety implications must be addressed • Focus less on specific numbers as decision making points • High Performance CPR should be priority after scene management • Utilize criteria to discontinue, not attempt or withdraw resuscitative efforts as clinically indicated.

  38. REMSA 4204 • Ambulance Patient Offload Delay • No Current Changes Proposed for 2019 • Continued emphasis remains on triaging patients to appropriate care areas • Limiting non-essential ALS treatments • Strategy remains: When ED’s are heavily impacted, patients meeting specific BLS criteria can be placed in triage/waiting room

  39. REMSA 4302 • Traumatic Injuries • Addition of Ketamine for pain control • Ketamine is now LOSOP, currently pediatric administration of ketamine is not indicated. • Ketamine can be used for multi-system trauma • Ketamine has no SBP criterion • Ketamine cannot be combined with other controlled substances without a BHPO.

  40. REMSA 4303 • Burns • Addition of Ketamine for pain control • Ketamine is now LOSOP, currently pediatric administration of ketamine is not indicated. • Ketamine can be used for multi-system trauma • Ketamine has no SBP criterion • Ketamine cannot be combined with other controlled substances without a BHPO.

  41. REMSA 4401 • Shock Unrelated to Trauma • Addition of push-dose epinephrine for management of hypotension associated with shock unrelated to trauma. • Standing order for adult and pediatric patients, with specific SBP endpoints • Used in conjunction with fluid bolus administration • Creation of 0.01 mg/mL of epinephrine by further dilution of 0.1 mg/mL epinephrine.

  42. REMSA 4402 • Point of clarification: orders for nitrates in the inferior wall MI can be obtained from any BH. 12 Lead ECG performance standard also updated.

  43. REMSA 4404 • Symptomatic Tachycardia with Pulses • No Current Changes Proposed for 2019

  44. REMSA 4405 • Symptomatic Bradycardia with Pulses • No Current Changes Proposed for 2019

  45. REMSA 4406 • Cardiac Arrest • Continued emphasis on High Performance CPR (HP CPR) • Clinical data reinforces BLS strategies for resuscitation are of paramount importance and have the most impact! • High performance CPR:

  46. REMSA 4503 • Suspected Stroke • No Current Changes proposed. • Policy verbiage adaptation may be needed with CA EMSA Stroke Regulations are final.

  47. REMSA 4504 • Nausea/Vomiting • No Current Changes Proposed for 2019

  48. REMSA 4601 • Allergies/Anaphylaxis • No Current Changes Proposed for 2019

  49. REMSA 4602 • Overdose Adverse Reaction: • Clarification of pediatric naloxone dosing to not exceed adult doses.

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