Fentanyl and Carfentanil Exposures in First Responders
The risk of significant opioid exposure is minimal for first responders who encounter fentanyl, carfentanil or other fentanyl analogs in the field. The evidence suggests that limited precautions, such as nitrile gloves, provide sufficient protection from harm. Use of excessive protective equipment could delay patient care and prevent first responders from performing their duties well.
EMS in the Warm Zone
Active shooter and mass casualty incidents are becoming more common in our society and can happen in any community large or small. The historical practice of EMS staging until the scene is “safe” may no longer be operational best practice. Clearing a scene can take hours, yet certain types of injuries require emergent medical care within minutes in order to save lives. Research has shown that such “point-of-wound” care is essential for treating victims of massive hemorrhage, airway compromise, and tension pneumothorax. By entering the “warm zone”, EMS providers may perform these time-critical interventions to save lives. We have just published the "Vermont Active Threat Best Practice Guide", which offers guidelines to help agencies who choose to coordinate with local law enforcement to perform these interventions as safely as possible. You will find a training course and PDF of the guidelines posted on CentreLearn under the course title: EMS in the Warm Zone: Active Threat Best Practice Guide. Special thanks to Colleen Nesto – Essex Rescue, and Lt. Hugh O’Donnell – VSP, for help in preparation of these materials. Thank you for your service and be safe.
Nitrous oxide for acute pain control
Given the current state of the opiate epidemic, many Vermont EMS agencies have expressed an interest in using nitrous as an alternative to opiate use for pain control. We have updated the Pain Management – Adult 2.17A protocol with more information regarding indications and contraindications for the use of nitrous oxide for acute pain control. In addition, we have posted a training course on CentreLearn and an accompanying Nitrous Start Up Guide document that provides useful information for how to use nitrous at your agency. Agencies wishing to use nitrous should train on these materials and get approval from the local District Medical Advisor. The course, start up guide, and updated protocol are posted on CentreLearn under the course title: Nitrous Oxide for Pain Managment. The protocol will also be updated to our website and protocol app. Special thanks to Sarah Lamb and Richmond Rescue for help in preparation of these materials.
Cardiac Epinephrine 1:10,000 (0.1 mg/mL) SHORTAGE
Our office has recently been notified about a potential shortage of prefilled epinephrine syringes (1:10,000 “cardiac epinephrine). Although the scope of the shortage is still a bit unclear, it appears that the prefilled syringe dosing will be in short supply at least through the summer months. To address this issue, Dr. Wolfson has created alternative dosing/administration instructions to enable the use of 1:1,000 epinephrine for those previously authorized by protocol to administer the drug. Those instructions are attached.
Our office has recently been notified about a potential shortage of prefilled epinephrine syringes (1:10,000 “cardiac epinephrine). Although the scope of the shortage is still a bit unclear, it appears that the prefilled syringe dosing will be in short supply at least through the summer months. To address this issue, Dr. Wolfson has created alternative dosing/administration instructions to enable the use of 1:1,000 epinephrine for those previously authorized by protocol to administer the drug. Those instructions are attached. We have done our best to provide a simple and easy solution to work around this shortage. However, as with any change from standard practice, a new procedure requires familiarization and practice to minimize the possibility of error. We would further suggest that providers cross check any medication dose with a second provider before administration.
Please remember that the alternative administration instructions should only be used if prefilled syringes are not available.
If there are any questions regarding the new procedure, please feel free to contact our office.
We will continue to monitor this and any other potential medication shortages and will do our best to keep you updated.
Upcoming Trainings and Conferences
The Team Two scenario-based curriculum focuses on collaboration between law enforcement, dispatchers and mobile mental health crisis teams in the field. This course will offer practical tips and discuss warrants, emergency department issues, and screening/assessment difficulties. Completion of ACT 80 training (Interacting with Persons with a Mental Illness) is a pre-requisite for law enforcement officers. This one-day course will be offered five times in the coming months:
EMS EMPLOYMENT OPPORTUNITIES