Please be sure to request Narcan and naloxone at least two weeks in advance of anticipated need. Our online request form allows us to streamline requests.
Rotating Narcan Stock and Expiration Dates
Please be sure to check your entire inventory of Narcan/naloxone and be sure to use the Narcan/naloxone that is the ‘oldest’, set to expire sooner. The manufacturer has recently announced a shelf-life extension of Narcan 4 mg White Nasal Spray from 24 months to 36 months. When rotating stock, please remember to include the doses of Narcan in your Naloxone Leave-Behind Kits. Please see the manufacturer’s FAQ sheet for more information and don’t hesitate to email us with additional questions. Please note this does NOT influence the IV vials naloxone medication (salmon-colored boxes). Follow the expiration dates on your medication.
Our recommendation remains for first responders to carry a single dose of Narcan in jump kits. If the patient does not respond to the first dose of Narcan and there is a sole responder on scene, ventilating the patient will help to keep them alive until additional resources arrive.
Please email us if you have any questions or concerns.
Interfacility Transfers Protocol (updated February 23, 2022)
This updated protocol aims to ensure interfacility transfers (IFT) comply with current VT law, licensure, and EMS protocols. It is intended to promote efficiency in IFT while maintaining patient safety. Check out the latest updates to interfacility transfer protocols.
Ready, Check, Inject
The Ready, Check, Inject program provides a simple and safe alternative to epinephrine auto-injectors and allows trained emergency medical technicians (EMTs) to withdraw epinephrine from a vial and inject the medication intramuscularly. It was created to address the rising cost of epinephrine auto-injectors and is designed to be an optional alternative to stocking these devices. It is not intended to necessarily take the place of autoinjectors unless cost is prohibiting their use. Epinephrine auto-injectors are still considered the preferred method of medication administration in anaphylaxis.
To administer intramuscular epinephrine at the EMT level, an agency must stock 1 mL vials of 1 mg/1 mL (1:1000) concentration epinephrine and 1 mL syringes with an accompanying 1-inch intramuscular safety needle. Larger volume vials and syringes are not allowed at the EMT level. We recommend separating this specific equipment from other ALS supplies to prevent confusion. Each EMT medication administration kit must also include the Ready Check Inject Safety Card. Its contents are detailed in the Ready Check Inject training document, but it serves as a cross-check reference to prevent medication error. To obtain cards, email the EMS Office with your required amount. Please see the equipment checklist for the complete list of required items.
Ready, Check, Inject Training and Credentialing
EMS agencies must credential their EMT level providers to use the new protocol using a two-step process. Providers will watch a narrated Power Point on CentreLearn (individually or as a class) and then complete an agency-led practical training session overseen by the agency’s or district’s training coordinator. Competency must be confirmed by a licensed provider at the AEMT or Paramedic level using the skill sheet included in the training program. Documentation of training and competency verification should be kept on file by the agency.
Mobile Integrated Healthcare / Community Paramedicine Program
The Vermont Department of Health contracted with All Clear Emergency Management Group in August 2016 to assess the feasibility of a Mobile Integrated Healthcare / Community Paramedicine (MIH-CP) program in Vermont. There were two main components of this project:
1. Conduct a baseline situation analysis of the current state of work being done in community paramedicine, mobile integrated health, and other non-traditional roles for EMS providers.
2. Conduct a gap analysis of program implementation and provide input on how to address the gaps within Vermont.
This report contains the baseline situation analysis, gap analysis, and recommendations for the Vermont Department of Health. View the Mobile Integrated Healthcare / Community Paramedicine Program in Vermont Final Report.
Rapid Sequence Intubation
Rapid Sequence Intubation (RSI) is an advanced airway skill only available to paramedics with additional training, medical direction oversight and participation in an educational and Continuous Quality Improvement (CQI) program approved by the Department of Health.
For more information, contact EMS Medical Director Dr. Dan Wolfson.
Measles Protocol and Drip Rate Charts
Measles Guidance Medical Procedure - There has been an increased number of measles cases and multiple outbreaks in the U.S. These guidelines address precautions that should be taken by EMS personnel when evaluating and transporting persons with suspected measles infection.
Adult Drip Rate Reference - Appendix 3 - It has come to our attention that the doses for nitroglycerine, epinephrine, and norepinephrine in Appendix 3: Adult Drip Rate Reference were incorrectly listed as mg/min. All three of these doses have been corrected to mcg/min.
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 protect sufficiently from harm. Using excessive protective equipment could delay patient care and prevent first responders from performing their duties well.
Fentanyl and Carfentanil Fact Sheet from the Northern New England Poison Center
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 injuries require emergent medical care within minutes 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 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 Vector under EMS in the Warm Zone (VTEMS). Special thanks to Colleen Nesto, Essex Rescue, and Lt. Hugh O'Donnell, Vermont State Police, for their help preparing 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. Therefore, we have updated the Pain Management – Adult 2.17A protocol with more information regarding indications and contraindications for using 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 valuable information on how to use nitrous at your agency. Agencies wishing to use nitrous should train on these materials and get approval from their local District Medical Advisor.
The course, start-up guide, and updated protocol are posted on CentreLearn under the course title: Nitrous Oxide for Pain Management. The protocol will also be updated on our website and protocol app. Special thanks to Sarah Lamb and Richmond Rescue for their help preparing these materials.
Cardiac Epinephrine 1:10,000 (0.1 mg/ml) Shortage
Our office was recently 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.
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 suggest that providers cross-check medication doses with a second provider before administration.
Please remember that you should only use alternative administration instructions if prefilled syringes are unavailable.
Please get in touch with our office if you have any questions regarding the new procedure.
We will continue to monitor this and any other potential medication shortages and will do our best to keep you updated.