Hi All,
A short note about the most recent updates to the protocols.

If you were to reread one protocol after this update, make it spinal motion restriction. SMR remains a moving target and evolving area of evidence. I’m doing my best to keep things understandable and aligned with best evidence. Please seek clarification from me as needed, as keep the protocol understandable and usable is important to me also.

Small things

Added phone numbers for clinic desk and provider to reference list.

Numerous formatting edits to improve formatting cohesiveness. Thanks Miranda for the close reading!

MUSCULOSKELETAL INJURY:

Added clarifying language to the use of Slishman traction with concurrent injuries:

“Use of Slishman traction device for suspected mid-shaft femur fracture is appropriate if it improves patient comfort or splints patient for transport. Application is not required if pain is increased by application. Avoid use in patients with concurrent distal femoral, knee, lower leg, or hip injury.”

Essentially, the Slishman should only be used in isolated, mid-shaft femur fracture. It can be used concurrently with a pelvic splint, but only if it doesn’t interfere with the pelvic splint.

SPINAL MOTION RESTRICTION:

-Removed recommendation for use of short spine device when immobilizing pediatrics on LSB. Recommend use of vacuum mattress over LSB in pediatrics.

This just makes the protocol simpler to exclude devices you don’t use. Vacuum mattress is recommended in peds because kids are weird shapes and do better with padding.

-Clarified language regarding use of LSB as an extrication tool.

This was hedgy before. After the NAEMSP review article that I went nerdy on in my last education email, I think there’s no need to be hedgy.

-Added language regarding immobilizing the whole spine as well as use of towel roll/vacuum mattress as C-spine securement.

Ditto on the NAEMSP article. Liberalizing what is considered appropriate for cervical spine immobilization.

-Added language regarding head securement and when it can be omitted.

CARDIAC ARREST (ATRAUMATIC):

-Added AHA algorithm graphics for adults and pediatrics.

I got questions from NSP about compression ratios. ECEMS uses 10:1 in adults. I have no idea where they got that. The AHA guidelines are for 30:2 in all adults until an LMA is in place. If anyone is aware of contradictory guidance, send it my way!

Cheers,

Patrick