STEMI Program (2-6-12)
The MS Health Care Alliance (MHCA) will hold a press conference this Thursday formally announcing creation of the STEMI program/system. This will not have any immediate effect on our medical control plan. Our protocols already support everything being put forward in the STEMI plan.
Drug Shortage Protocol (2-6-12)
We recently distributed a protocol change, which was approved by MDTQA, for the use of alternate drugs if primary drugs are not available. Please make sure that you are familiar with that protocol. Each service will be administering a test to insure that everyone is adequately familiar with the protocol.
Changes in Medical Control (10-13-11)
Due to a reinterpretation of the Mississippi EMS rules and Regulations there will be a change in the way medical direction is handled for interfacility transports:
1. The sending physician is responsible for all patient care while the patient is on the premises of the sending hospital. During that period the paramedic may take orders from the sending physician so long as those orders do not conflict with the protocols, policies or procedures contained within the CMEMSD protocol manual.
2. The sending physician should give orders for management of the patient during transport. Those orders should be followed so long as they do not conflict with the protocols, policies or procedures contained within the CMEMSD protocol manual. Should the sending physician give orders which conflict with protocols, policies or procedures contained within the CMEMSD protocol manual, the paramedic should politely explain that he/she is required to adhere to the protocols, policies and procedures contained within the CMEMSD protocol manual and attempt to reach an agreement with the physician. If that cannot be accomplished, the paramedic should contact his/her administrative supervisor for resolution
3. In the event that the sending physician is no longer present or available at the sending facility the paramedic should proceed according to protocols. If questions should arise regarding stability issues or additional treatments, medical control should be contacted.
4. In the event that the patient is being transferred by a midlevel practitioner (Nurse Practitioner or Physician Assistant) the paramedic should proceed according to protocols. If questions should arise regarding stability issues or additional treatments, medical control should be contacted.
5. In the event that problems arise during transport the paramedic should contact the sending physician if that can be accomplished in a reasonable amount of time. If that is not possible, medical control should be contacted in the normal manner.
6. In the event that a physician requests that a paramedic accept and transport a patient who is unstable or whose medical condition exceeds the treatment capabilities of the paramedic, the paramedic should notify his/her administrative supervisor of the situation. Paramedics are expected to be patient advocates and should not accept any patient where doing so may endanger the patient’s on-going care.
Any conflicts or refusals of transport which occur during an interfacility transport should be documented as soon as possible after the event and a copy sent to the CMEMSD Executive Director within 48 hours.
Protocol Update
Protocol revisions have now been approved by the BEMS and we will begin protocol update sessions in July 2011. Every paramedic employee must have successfully completed a protocol update before any service will be allowed to implement the new protocols.
Statewide Trauma Destination Guidelines
At its last meeting MTAC approved a new statewide trauma destination guideline. It will be implemented by the BEMS over the next several months.
Protocol Updates (February 2011)
Some recent changes in ACLS guidelines and best practices will require an update to our protocols. That will be done over the next month and should be ready for rollout in late March. Continue using the existing protocols until the new version is approved and distributed.
Remember that existing protocols allow bypassing of local hospitals if it is in the best interest of the patient to go directly to a more distant specialty center. That may be the case with STEMI and stroke patients. The paramedic should use good judgment is making those determinations and contact med control for a second opinion if uncertain.
New Counties (February 2011)
MedStat recently announced that it will begin service in Sunflower and Yazoo Counties. The Board voted to admit those counties to the District at its' February meeting. MedStat will begin operations in Sunflower County on March 1st and Yazoo in April.
Critical Care Paramedic (November 2010)
The EMS Advisory Council Rules and Regulations Subcommittee continues to work on developing a Critical Care Paramedic practitioner level for Mississippi. The Attorney General recently ruled that the program cannot be done as an endorsement as planned. Instead it will have to be approved by the legislature as a seperate program. The BEMS is moving forward to prepare a proposal for the legislature. If you have contacts in the legislature please explain the positive impact that adding this new level of provider in Mississippi would have:
1. Allowing hospitals to keep their staff in house instead of having to send them out on ambulance transfers,
2. More knowledgeable paramedics attending patients during critical care interfacility transports, and
3. A new career ladder rung for paramedics who want to move up
4. Participating ambulance services will likely be able to bill higher rates for these transports.
New Service (April 2010)
MedStat recently added a medical helicopter to its fleet. MedStat Air will primarily service the counties in which MedStat ground ambulances operate. The aircraft will be staffed by specially trained RNs and paramedics.
New Protocols
The new protocols were implemented on September first. Thus far they seem to be working well. There are two sets of protocols. Only those services with quantitative capnometry may utilize the set which contains the Drug Assisted Airway Management algorithm.
Med Control Issues
All calls to the medical control phone now go directly to MedCom. This insures that calls are answered quickly and routed to the appropriate physician. I have received several verbal complaints that med control phones are not being answered or that medics are being placed on hold for extended periods. Thus far no one has provided any specifics. If this happens to you please email me ASAP of the date and time so we can make sure this gets fixed.
Actions taken at the last MDTQA and EMS Advisory Council meetings and which are awaiting final approval from the Board of Health:
High visibility safety garments
This is a new group of regulations that addresses a federal regulation regarding the use of high visibility safety garments by anyone working in a road right-of-way. The new regulations would require all EMS vehicles be equipped with safety garments and that providers wear them when working around roadways or other traffic.
Air ambulance medical directors
This is a modification to existing regulations that clarifies location and practice requirements for air ambulance medical directors. Air ambulance medical directors would be required to have a primary practice in Mississippi or at a designated Mississippi trauma center.
Community College dual enrollment
This modification would allow for exceptions to First Responder and EMT-Basic training program admission requirements. The current regulations have age and diploma/GED requirements. The proposed changes would allow high school students that are in a community college dual enrollment program to enter First Responder and/or EMT-Basic training.
Refresher training
This modification would remove the requirement for refresher training. This would allow for use of the National Registry’s recertification by refresher, examination, or flexible and core content methods.
Intraosseous infusions
This modification specifies that paramedics may initiate both pediatric and adult intraosseous infusions.
Routes of medication administration
This modification would allow paramedics to administer medications through National Standard routes
New optional drugs added to drug list:
Fentanyl
Aripiprizole (Abilify)
Olanzapine (Zyprexa)
Competency Verification
There is a new link on the web site entitled Competency Verification. The link leads to a form which must be completed and signed by the Performance Improvement Officer of the ambulance service before the Medical Director will sign the National Registry recertification form. Please don't ask Dr. Carlton or Anderson to sign a National Registry form if this form has not been completed.
Performance Improvement.
A good performance improvement program requires active involvement at all levels of an organization. Managers must expect high quality performance from their paramedics. PCRs should routinely be reviewed by the QA Officer and/or local manager to insure that all paramedics are consistently performing at a high level. Paramedics are expected to keep their knowledge and skills current. This can be accomplished by attending conferences, reading journals, and interacting with other paramedics and paramedic students. Paramedics who fail to maintain currency may have their medical control suspended or revoked.
BEMS Medications. The DOH-BEMS recently approved use of a number of additional medications. That action by BEMS does not change the CMEMSD medical control plan. The CMEMSD policy regarding these newly authorized medications will be:
1. The medications listed as "optional." Medications which are not in the current CMEMSD protocol manual will not be added to the protocols at this time. They may be considered in the upcoming protocol revision. These medications should not be stocked or administered by paramedics in the CMEMSD.
2. Medications listed as "transport only." These medications may be transported by CMEMSD paramedics only under the following circumstances: (a) The ambulance service PI Officer or another qualified person has conducted an education session covering each of the newly authorized medications. Every paramedic employed by the service must attend one of these sessions. (b) Written documentation has been sent to the District Director stating exactly what was covered during the CE session and the names of all attendees. (c) All paramedics must attend the CE session before any paramedics can begin transporting these medications.
New Protocols
New protocols were implemented on September 1, 2009. So far, they seem to be working well.
