Section 700.00: Memorandum Indicating Change or Clarification ● 1 of 6
Section 700.00: Memorandum Indicating Change or Clarification
Memorandums contained in this section are intended to alter or clarify current Volusia County Prehospital Standing Orders and Treatment Protocols. Each memorandum is appropriately titled, contains a brief description of the content of the change, and identifies the effected section or sections within the document. Dissemination of this information to all appropriate personnel is the responsibility of each agency.
With the addition of these memorandums to the document, the EMS Medical Director strongly encourages the agency to reference the specific memorandum on the affected pages in order to make providers aware of the change while perusing or otherwise referencing the manual.
The next revision of this document will contain these changes or clarifications in the body of the document, thereby eliminating pages in this section with every revision.
Section 700.01: Medication shortage (epinephrine, 1:10,000) ● 2 of 6
Section 700.01: Medication Shortage (epinephrine, 1:10,000)
Description of modification/clarification: Alternative medication based upon unavailability from vendors.
Distribution date: September 17, 2012
Expiration date: Upon availability of medication Approved by: Peter C. Springer, MD, FACEP Effected portion(s) of the document:
Section 200.08 Cardiopulmonary Arrest, Adult
Based upon a reported national shortage of epinephrine, vasopressin is being authorized as a substitution in treatment of adult cardiopulmonary arrest only until such time as epinephrine becomes available.
In the presence of cardiopulmonary arrest in the adult patient (height/length of patient exceeds the color range on the Broselow™ Pediatric Emergency Care tape), paramedics shall administer a single dose of vasopressin, 40 units (U) intravenously or intraosseously. If an agency possesses sufficient quantities of epinephrine (1:1,000), they have the option of diluting the medication (one milligram epinephrine [1:1,000] with nine milliliters of 0.9% sodium chloride) immediately prior to administering the agent in lieu of purchasing vasopressin.
Vasopressin is not authorized in the treatment of pediatric patients. Furthermore, this temporary modification shall not be interpreted to suggest vasopressin is a substitute for epinephrine in other occurrences within Volusia County Prehospital Standing Orders and Treatment Protocols. Please ensure that only limited quantities of vasopressin are ordered as it is the intent to return to conventional epinephrine dosing following the return of product availability.
If an agency exercises the vasopressin alternative, they are responsible for the widest dissemination of the package insert to all paramedics. All questions shall be directed to the EMS Medical Director.
Section 700.02: Alternative medications for unavailable products ● 3 of 6
Section 700.02: Alternative medications for unavailable products
Description of modification/clarification: Alternative medication based upon lack of availability from vendors.
Distribution date: January 31, 2013
Expiration date: Upon availability of medication Approved by: Peter C. Springer, MD, FACEP Effected portion(s) of the document:
Section
See Indications for the alternative medication (below)
Based upon national and ongoing shortage with various pharmaceuticals, the following alternative medication therapies are approved for Volusia County prehospital providers under the indications outlined below.
Primary medication
Alternative
medication Indications for the alternative medication
Epinephrine (1:10,000)
Vasopressin Cardiopulmonary arrest (200.08) in the adult patient (height/length of patient exceeds the color range on the Broselow™ Pediatric Emergency Care tape). Vasopressin is not authorized as a substitute for epinephrine in any other condition.
Single dose of vasopressin, forty (40) units intravenously or intraosseously.
Furosemide (Lasix)
Bumetanide (Bumex)
Pulmonary edema (200.11) and submersion (200.16). Bumetanide is not authorized as a substitute for furosemide in any other condition.
Single dose of bumetanide (Bumex), one (1) milligram intravenously.
Sodium bicarbonate
Calcium chloride Cardiopulmonary arrest (200.08) in the adult patient (height/length of patient exceeds the color range on the Broselow™ Pediatric Emergency Care tape). Calcium chloride is not authorized as a substitute for sodium bicarbonate in any other condition.
Single dose of calcium chloride one (1) gram intravenously or intraosseously.
Section 700.03: Alternative medications for unavailable products (Dextrose) ● 4 of 6
Section 700.03: Alternative medications for unavailable products (Dextrose)
Description of modification/clarification: Alternative medication based upon lack of availability from vendors.
Distribution date: March 7, 2013
Expiration date: Upon availability of medication Approved by: Peter C. Springer, MD, FACEP Effected portion(s) of the document:
Section
See Indications for the alternative medication (below)
Based upon national and ongoing shortage with dextrose, the following alternative is approved for Volusia County prehospital providers under the indications outlined below.
Primary medication
Alternative
medication Indications for the alternative medication
Dextrose (50%) Dextrose (10% in 250 milliliters)
Hypoglycemia in the adult patient (height/length of patient exceeds the color range on the Broselow™ Pediatric Emergency Care tape) under parameters established in protocol.
Infuse 250 milliliters of ten percent dextrose (D10) intravenously or intraosseously.
Section 700.04: Addition of facility under Therapeutic Hypothermia Transport Protocols ● 5 of 6
Section 700.04: Addition of facility under Therapeutic Hypothermia Transport Protocols Description of modification/clarification: Inclusion of Florida Hospital Fish Memorial as a therapeutic hypothermia receiving facility.
Distribution date: September 25, 2013
Expiration date: Upon release of next protocol revision Approved by: Peter C. Springer, MD, FACEP
Effected portion(s) of the document:
Section
100.09 Transport Protocols, Therapeutic Hypothermia
Effective immediately, Florida Hospital Fish Memorial, 1055 Saxon Boulevard, Orange City is a designated receiving facility for patients meeting “code cool” parameters. With the exception of patients with an identified STEMI, patients with return of spontaneous circulation following resuscitative efforts may be transported to Florida Hospital Fish Memorial. If STEMI is identified, the patient shall be transported to a STEMI receiving facility.
Section 700.05: Fluid substitution ● 6 of 6
Section 700.05: Fluid substitution
Description of modification/clarification: Alternative fluid based upon unavailability from vendors.
Distribution date: March 12, 2014
Expiration date: Upon release of next protocol revision Approved by: Peter C. Springer, MD, FACEP
Effected portion(s) of the document:
Section Various
Based upon national and ongoing shortage involving 0.9% sodium chloride, Lactated Ringer’s solution is authorized as a substitute for 0.9% sodium chloride under Volusia County Prehospital Standing Orders and Treatment Protocols.