Adirondack-appalachian regional emergency medical services council, inc

Adirondack-Appalachian Regional Emergency Medical Services Council, Inc.
EMT-B & AEMT-INTERMEDIATE NEBULIZED ALBUTEROL
TREATMENT PROTOCOL
For patients between one and sixty-five years of age, who are experiencing an
exacerbation of their previously diagnosed asthma
NOTE: For patients in severe respiratory distress, call for advanced
life support assistance. Do not delay transport!
1. Assess the airway. 2. Administer high concentration oxygen. NOTE: If patient exhibits signs of imminent respiratory failure, assist breathing 5. Place the patient in the Fowler’s or Semi-Fowler’s position. 6. Assess the following prior to the administration of the first nebulizer treatment: - Vital signs - Patient’s ability to speak in complete sentences - Accessory muscle use - Wheezing - Patient’s assessment of severity (Scale 1-10) NOTE: For patients with a history of angina, myocardial infarction,
arrhythmia, or congestive heart failure, medical control must be
contacted prior to initiating step #7.
7. Administer Albuterol sulfate 0.085%, one unit dose or 3.0 cc via nebulizer, at a flow rate that will deliver the solution over 5-15 minutes. Do not delay transport to 8. Begin transport. 9. If symptoms persist, treatment may be repeated once for a total of two (2) doses. 10. Reassess the patient after each treatment and frequently enroute to the hospital. Upon transfer to an ALS provider or receiving hospital, reassess the patient. (See 11. Document all assessments and treatments (timed) thoroughly on the PCR. NOTE: Medical control must be contacted for any patient covered by
this protocol who refuses medical assistance or transport.
Adirondack-Appalachian Regional Emergency Medical Services Council, Inc.
NOTICE OF INTENT TO PROVIDE
EMT-B NEBULIZED ALBUTEROL
Agency Name ______________________________________________________ Agency Address ____________________________________________________ Town ____________________________ State _______ Zip Code ___________ Non-Emergency Telephone ___________________ Emergency Telephone _______________________ Agency Medical Director _____________________________________________ Medical Director’s Address ___________________________________________
Town __________________________ State _______ Zip Code ____________
Telephone ________________________
Medical Director’s Statement
I, the medical director for the above named EMS agency, have reviewed the intent of the agency to provide nebulized albuterol by EMT-B and AEMT-Inte mediate le personnel, and hereby approve of such intent. As agency medical director, I will be involved in the training of BLS personnel in this protocol and technique, and in the QI process of the agency in regard to this p o procedures, and practices, including continuing medical education for all agency Signed __________________________________, Agency Medical Director Date ___________________

Agency Chief Operating Officer’s Statement
We, the above named EMS agency, hereby notify the AAREMS regional medical advisory
committee that we hereby intend to provide nebulized albuterol by EMT-B and AEMT-
Intermediate level personnel according to AAREMS protocols. We agree to cooperate with the
REMAC in the regional Quality Improvement process and to submit copies of all PCRs and
continuation forms to the appropriate regional office on a monthly basis. We further agree that
we will provide initial training to all EMT-B personnel using the AAREMS training packet and skill
performance sheet, that we will keep training records on all personnel, and that we will provide
yearly re-training on this protocol and technique to all EMT-B and AEMT-Intermediate level
personnel in our agency.
Agency Chief Operating Officer Signature _______________________ Date _________
Adirondack - Appalachian Regional Emergency Medical Services Council Evaluation
Albuterol Administration via Hand-held Nebulizer
EMT-B Name _______________________________________ Date ________________________ Acceptable Unacceptable

Patient Evaluation
Verbalizes patient
evaluation:
________
________
Vital signs & Breath sounds (wheezing)
Ability to speak in complete sentences
Pt’s assessment of severity (scale 1-10)

Indications Verbalizes standing orders & conditions
contacted
________
________

Body Substance Isolation
Verbalizes appropriate body substance isolation
Precautions
precautions
________
________

Preparation
Gathers and assembles appropriate
Equipment;
expiration
________
________
nebulizer
________
________
medication

Attaches
nebulizer
non-humidified
oxygen source and adjusts rate to 6 lpm
(8 lpm if mask is used) Assures mist
________
________

Administration
Explains
procedure
________
________
mouthpiece
patient’s
patient’s
________
________
Instructs patient to inhale deeply and
________
________
Verbalizes that treatment will continue
medicine
nebulizer
________
________

Reevaluation
Verbalizes patient reevaluations:
Breath sounds (wheezing)
Vital signs
Pt’s ability to speak in complete sentence
Pt’s assessment of severity (Scale 1-10)
________
_________
Repeat Treatment
Verbalizes repeat treatment X 1 if patient’s
________
_________
symptoms continue

Documentation
Verbalizes documentation of:
PMH, medications, allergies
All assessment criteria listed above prior
to administration
Albuterol administration including
time, dose, method, who administered
Patient response including all assessment
criteria listed above
Medical control contact information
including time, method, hospital, MD,
order, how and when further orders were
________
________

COMMENTS:
Evaluator’s Signature ___________________________________

Source: http://www.aarems.org/files/Forms/Albuterol%20(BLS)%20Protocol.pdf