EMS Protocol of the Week - Procedural Sedation (Adult and Pediatric)

Couple of VERY cool updates to the prehospital sedation protocol this past year:

1. Medications can now be given for procedural (eg, cardioversion, pacing, CPAP) or advanced airway management (eg, endotracheal tube, supraglotic device) sedation as Standing Order (ie, without prior OLMC approval). For advanced airway management, these patients need to meet very strict inclusion criteria; otherwise, crews will have to call OLMC for authorization as before.
2. IV ketamine has finally entered the arena as a possible Standing Order and/or Medical Control Option, rather than the Discretionary Order we had previously made it out to be as some hush-hush, off-label use.

Note that all these doses are weight-based, with a limit on the maximum dose to be given at a time. Be sure to practice good closed-loop communication when confirming doses (and routes, for that matter; notice how these are all written as IV formulations, which I think appropriately implies that anyone about to get electrocuted or have a tube shoved down their throat should have vascular access).

Also bear in mind that for pre-airway sedation, even though the protocol is only written as a pre-intubation dose and a post-intubation dose, many crews will often ask for a third dose as a “standby” in case more meds are needed. You might hear “I’d like to give 40 of etomidate followed by 5 and 5 of diazepam as needed post-intubation” while on the phone. Use your discretion for how much medication you feel comfortable approving at once, and again, clearly state your orders in a closed-loop fashion to avoid medication errors.

ALSO also:

Paramedics
Do
Not
Carry
Paralytics
Do
Not
Ask
Them
To
Give
Rocuronium
You
Will
Sound
Silly


And that’s it! You are now all incredibly well…versed…in the world of prehospital sedation! www.nycremsco.org and the protocol binder to keep the knowledge train rolling!


Dave