Protocols

Protocol 100: Medication Administration

1. FIRST, DO NO HARM:   Medication errors are the most common AVOIDABLE error that causes patients direct harm.  When in doubt, contact ON DUTY MEDICAL CONTROL for any questions concerning dosage.

2.  VERIFY “5 RIGHTS”:

               - right patient

           - right drug

           - right dose

           - right route (IV, IO, IM, SC, etc)

           - right time (including rate of administration)

3.  DOCUMENTATION: document accurately all medications administered, any reaction to medication, repeat vital signs after administration, and any adverse events.

4. MEDICATION ERRORS: Any error in medication administration should be documented and reported immediately through the CQI process to the Medical Director / Liaison for review.  The goal of CQI review is to determine and minimize systemic contributions to causality of errors, not to take punitive action.

5.  PEDIATRICS:  Errors in pediatric medication dosing occur more often due to poor estimates of weight or infrequent use of pediatric doses.  Every effort must be made to obtain accurate weight estimates, accurate calculation of dose, and appropriate monitoring of patient response.  When in doubt, contact MEDICAL CONTROL for verification of dosage.  Standardized tools to determine dosing in critical situations, such as a ‘pedi-wheel’ or Broslow tape, are encouraged.

               *****When calculating pediatric doses, NEVER ROUND UP*****

Protocol 101:  IV Fluid Administration

SCOPE:  AEMT, Paramedic

MECHANISM OF ACTION: Isotonic crystalloids provide volume replacement to maintain blood pressure and perfusion.  The mechanism in trauma is far more complex, as aggressive fluid replacement often worsens blood loss and hypothermia.

INDICATIONS:  dehydration, syncope, sepsis, medication administration, right-sided myocardial infarction, undifferentiated cardiac arrest

CONTRAINDICATIONS: While small amounts of fluid may be used, large volume fluid administration should be avoided in acute CHF, major trauma, or dialysis patients.  Hyperkalemia is a relative contraindication for Lactated Ringers (LR), as there is a small amount of potassium in LR.  If there are signs of hyperkalemia on EKG, LR should not be used.

PRINCIPLES OF ADMINISTRATION:

1.       LR is the preferred volume replacement fluid for most situations. This is especially true for trauma and sepsis.

2.       Normal Saline, 0.9% NaCl, should be limited to use for mixing and administration of medications.

3.       In major trauma, limit fluid resuscitation to those indications noted in trauma protocols.

4.       Doses of fluids are specific to the medical/trauma indication, and the specific protocol should be referenced for amounts of fluid administration.

5.       D10% use is addressed specifically under dextrose protocol and hypoglycemia.

6.       D5%W may be utilized and transported by both AEMT and Paramedics under this protocol.

7.       This protocol applies to all 911 and Interfacility Transfers for both AEMT and Paramedics.

CONSIDERATIONS:

-         If supply chain limitations prohibit the use of LR, normal saline may be substituted until such time that LR is available.

-         This protocol is specific to 911 calls, as interfacility transports may require patient-specific orders from the sending provider.