Greater Miami Valley EMS Council

#GMVEMSC: GMVEMSC Research Committee Meeting 8/20 - CANCELLED

**Please Note**

The GMVEMSC Research Committee meeting that was scheduled for today at 12:00 p.m. at GDAHA has been cancelled.

Thanks!

Sandy Lehrter

Office Manager/Executive Assistant

Greater Dayton Area Hospital Association

Greater Miami Valley EMS Council

p: 937.424.2374 | m: 937.307.6553

w: https://gdaha.org e: slehrter@gdaha.org

a: 241 Taylor St. Suite 130 Dayton, OH 45402

#GMVEMSC: FW: Looking for Some Great Controllers and Evaluators - MCI Exercises

Thanks to everyone who responded to our exercise invitation. I have room for only one more RTF crew, and one more EMS crew. However, we also need controller/evaluators, simulation cell workers, and moulage artists for the exercise, and those personnel receive the same con ed credits at other exercise participants. See below for how to sign up.

A major full scale exercise is coming up for our region on Sunday, August 25th, and we need evaluators, simulation cell personnel, moulage artists, and role-players (victims)! GDAHA, MMRS, and Kettering Health Network are sponsoring the “Dawn of a New Day” mass casualty incident (MCI) exercise involving terrorism, an active shooter incident, and an IED.

Locations will include Soin Medical Center, Greene Memorial Hospital, and the Wright-Patt Credit Union building on Pentagon Blvd., Beavercreek. Exercise play will begin at 1:00 PM on Sunday, August 25th, and evaluators will need to arrive by Noon. To sign up as an Evaluator or Simulation Center worker for the Soin/Greene exercise, click here:

· Soin Controller/Evaluator Sign-up: https://www.surveymonkey.com/r/18EContrEval

The exercise will end at approximately 3:30 PM.
Moulage artists should simply email me.
If you have someone who would like to sign up as a victim, the link for that is https://www.surveymonkey.com/r/18EDawnVic

David

David N. Gerstner

MMRS/RMRS/EP Coordinator

Department of Fire I City of Dayton

300 N. Main St. I Dayton, Ohio 45402

Office 937.333.4551 I Fax 937.333.4561 I www.daytonohio.gov

24/7 Pager: 937-227-8705 or E-mail 9372278705@archwireless.net

Cell 937.776.4410
david.gerstner@daytonohio.gov I http://DaytonMMRS.org

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#GMVEMSC Training: FW: AMIODARONE SHORTAGE JITSO

Per Dr. Marriott, GMVEMSC Medical Director and Chair, Region 3 RPAB:

Due to a nationwide shortage of Amiodarone, some GMVEMSC drug bags MAY NOT contain Amiodarone now or in the future. In those circumstances ONLY, this JITSO is to be followed authorizing use of Lidocaine as below. Lidocaine infusions will not be utilized. As always, if there are concerns, contact Medical Control.

CARDIAC ARREST: V-FIB or PULSELESS V-TACH

· If in arrest, initiate quality CPR and proceed to first defibrillation as soon as possible.

· First Defib:

A 360 J for monophasic or use manufacturer’s recommendations for biphasic.

R 2 J/kg or biphasic equivalent.

· CPR for 1-2 minutes

· Repeat cycles of CPR - shock - drug

· Second Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

R 4 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

R Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· CPR for 1-2 minutes

· Third Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

R 6 J/kg or biphasic equivalent.

· Amiodarone:

A 300 mg, IV or IO

R 5 mg/kg IV or IO (max first dose 300 mg)

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***

· Lidocaine:

A 150 mg, IV/IO

· 1.0 mg/kg IV/IO (Max first dose 100 mg)

· CPR for 1-2 minutes

· Fourth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· 8 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· Continue CPR and repeat treatment as indicated

· Fifth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· 8 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· Continue CPR and repeat treatment as indicated

· Sixth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· Fifth and successive defibrillations will be at 10 J/kg or biphasic equivalent

· Repeat Amiodarone, IV or IO after approximately10 minutes:

A 150 mg IV or IO

R 5 mg/kg, (max second dose 150 mg)

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE ***

· Repeat Lidocaine, IV/IO after 10 minutes:

A 75 mg, IV/IO

R 1.0 mg/kg, (Max second dose 100 mg)

· {12-lead EKG}

· Consider treatable causes.

A If patient converts with ROSC from a ventricular arrhythmia and no anti-arrhythmic has been given, then administer Amiodarone 150 mg in 250 ml NS, IV over 10 minutes using 60 drop/ml tubing.

TACHYCARDIA: ADULT ONLY

A Obtain {12-lead EKG}.

Stable:

A Narrow Complex - Regular

o Vagal maneuvers

o Adenosine 6 mg rapid IVP

§ If patient has history of Paroxysmal Supraventricular Tachycardia (PSVT) and advises it takes 12 mg of Adenosine, then skip the 6 mg dose.

o May repeat Adenosine 12 mg rapid IVP x 2.

A Wide Complex – Regular or Irregular

o Amiodarone 150 mg in 250 cc NS, IV over 10 minutes using 60 drop tubing wide open with 18 gauge needle.

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***

o Lidocaine 150 mg IV/IO

Unstable:

An unstable patient is defined as a patient who is hypotensive or unconscious when the hypotension or altered mental status is thought to be due to the patient’s tachycardia. Do not cardiovert patients without hemodynamic changes or patients whose hemodynamic changes have other apparent causes (e.g., blood loss).

A Consider Midazolam 2 mg slow IV prior to cardioversion.

A Cardioversion: 100, 200, 300, 360 J for monophasic or biphasic equivalent

NOTE: The current Pediatric Tachycardia Protocol does NOT include Amiodarone OR Lidocaine and is unaffected by this JITSO.

David N. Gerstner, President

Greater Miami Valley EMS Council

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#GMVEMSC: FW: AMIODARONE SHORTAGE JITSO

Per Dr. Marriott, GMVEMSC Medical Director and Chair, Region 3 RPAB:

CARDIAC ARREST: V-FIB or PULSELESS V-TACH

· If in arrest, initiate quality CPR and proceed to first defibrillation as soon as possible.

· First Defib:

A 360 J for monophasic or use manufacturer’s recommendations for biphasic.

R 2 J/kg or biphasic equivalent.

· CPR for 1-2 minutes

· Repeat cycles of CPR - shock - drug

· Second Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

R 4 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

R Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· CPR for 1-2 minutes

· Third Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

R 6 J/kg or biphasic equivalent.

· Amiodarone:

A 300 mg, IV or IO

R 5 mg/kg IV or IO (max first dose 300 mg)

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***

· Lidocaine:

A 150 mg, IV/IO

· 1.0 mg/kg IV/IO (Max first dose 100 mg)

· CPR for 1-2 minutes

· Fourth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· 8 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· Continue CPR and repeat treatment as indicated

· Fifth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· 8 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· Continue CPR and repeat treatment as indicated

· Sixth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· Fifth and successive defibrillations will be at 10 J/kg or biphasic equivalent

· Repeat Amiodarone, IV or IO after approximately10 minutes:

A 150 mg IV or IO

R 5 mg/kg, (max second dose 150 mg)

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE ***

· Repeat Lidocaine, IV/IO after 10 minutes:

A 75 mg, IV/IO

R 1.0 mg/kg, (Max second dose 100 mg)

· {12-lead EKG}

· Consider treatable causes.

A If patient converts with ROSC from a ventricular arrhythmia and no anti-arrhythmic has been given, then administer Amiodarone 150 mg in 250 ml NS, IV over 10 minutes using 60 drop/ml tubing.

TACHYCARDIA: ADULT ONLY

A Obtain {12-lead EKG}.

Stable:

A Narrow Complex - Regular

o Vagal maneuvers

o Adenosine 6 mg rapid IVP

§ If patient has history of Paroxysmal Supraventricular Tachycardia (PSVT) and advises it takes 12 mg of Adenosine, then skip the 6 mg dose.

o May repeat Adenosine 12 mg rapid IVP x 2.

A Wide Complex – Regular or Irregular

o Amiodarone 150 mg in 250 cc NS, IV over 10 minutes using 60 drop tubing wide open with 18 gauge needle.

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***

o Lidocaine 150 mg IV/IO

Unstable:

An unstable patient is defined as a patient who is hypotensive or unconscious when the hypotension or altered mental status is thought to be due to the patient’s tachycardia. Do not cardiovert patients without hemodynamic changes or patients whose hemodynamic changes have other apparent causes (e.g., blood loss).

A Consider Midazolam 2 mg slow IV prior to cardioversion.

A Cardioversion: 100, 200, 300, 360 J for monophasic or biphasic equivalent

NOTE: The current Pediatric Tachycardia Protocol does NOT include Amiodarone OR Lidocaine and is unaffected by this JITSO.

David N. Gerstner, President

Greater Miami Valley EMS Council

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#GMVEMSC Protocol: FW: AMIODARONE SHORTAGE JITSO

Per Dr. Marriott, GMVEMSC Medical Director and Chair, Region 3 RPAB:

CARDIAC ARREST: V-FIB or PULSELESS V-TACH

· If in arrest, initiate quality CPR and proceed to first defibrillation as soon as possible.

· First Defib:

A 360 J for monophasic or use manufacturer’s recommendations for biphasic.

R 2 J/kg or biphasic equivalent.

· CPR for 1-2 minutes

· Repeat cycles of CPR - shock - drug

· Second Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

R 4 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

R Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· CPR for 1-2 minutes

· Third Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

R 6 J/kg or biphasic equivalent.

· Amiodarone:

A 300 mg, IV or IO

R 5 mg/kg IV or IO (max first dose 300 mg)

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***

· Lidocaine:

A 150 mg, IV/IO

· 1.0 mg/kg IV/IO (Max first dose 100 mg)

· CPR for 1-2 minutes

· Fourth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· 8 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· Continue CPR and repeat treatment as indicated

· Fifth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· 8 J/kg or biphasic equivalent.

A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.

· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.

· Continue CPR and repeat treatment as indicated

· Sixth Defib:

A 360 for monophasic or use manufacturer’s recommendations for biphasic.

· Fifth and successive defibrillations will be at 10 J/kg or biphasic equivalent

· Repeat Amiodarone, IV or IO after approximately10 minutes:

A 150 mg IV or IO

R 5 mg/kg, (max second dose 150 mg)

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE ***

· Repeat Lidocaine, IV/IO after 10 minutes:

A 75 mg, IV/IO

R 1.0 mg/kg, (Max second dose 100 mg)

· {12-lead EKG}

· Consider treatable causes.

A If patient converts with ROSC from a ventricular arrhythmia and no anti-arrhythmic has been given, then administer Amiodarone 150 mg in 250 ml NS, IV over 10 minutes using 60 drop/ml tubing.

TACHYCARDIA: ADULT ONLY

A Obtain {12-lead EKG}.

Stable:

A Narrow Complex - Regular

o Vagal maneuvers

o Adenosine 6 mg rapid IVP

§ If patient has history of Paroxysmal Supraventricular Tachycardia (PSVT) and advises it takes 12 mg of Adenosine, then skip the 6 mg dose.

o May repeat Adenosine 12 mg rapid IVP x 2.

A Wide Complex – Regular or Irregular

o Amiodarone 150 mg in 250 cc NS, IV over 10 minutes using 60 drop tubing wide open with 18 gauge needle.

***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***

o Lidocaine 150 mg IV/IO

Unstable:

An unstable patient is defined as a patient who is hypotensive or unconscious when the hypotension or altered mental status is thought to be due to the patient’s tachycardia. Do not cardiovert patients without hemodynamic changes or patients whose hemodynamic changes have other apparent causes (e.g., blood loss).

A Consider Midazolam 2 mg slow IV prior to cardioversion.

A Cardioversion: 100, 200, 300, 360 J for monophasic or biphasic equivalent

NOTE: The current Pediatric Tachycardia Protocol does NOT include Amiodarone OR Lidocaine and is unaffected by this JITSO.

David N. Gerstner, President

Greater Miami Valley EMS Council

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