Updates on EMS Practices

CarolinaFireJournal - By James Winslow
By James Winslow
10/26/2015 -

Here is a quick update on some news related to EMS in North Carolina. First of all, the North Carolina Medical Board working with the North Carolina Office of EMS is setting up an advisory group to give advice to the Medical Board on EMS scope of practice issues. Secondly, the North Carolina Office of EMS has also been reviewing data from pediatric anaphylaxis patients and data from rapid sequence intubations in the state.


The North Carolina Office of EMS and the North Carolina Medical Board want to adjust how the board makes scope of practice changes. There will be an EMS Advisory group that will have five members plus the Medical Director of the Office of EMS as chair. The five members will include representatives of the North Carolina College of Emergency Physicians, the North Carolina Committee of Trauma, the North Carolina Association of EMS Administrators, the North Carolina Chapter of the National Association of EMS Physicians, and one non-affiliated physician. The EMS Advisory Group will help gather stakeholder input and give expert opinions to the Allied Health Subcommittee of the North Carolina Medical Board. It is felt that this process will increase stakeholder involvement and increase the depth of advice given to the medical board.

The North Carolina Office of EMS has been working closely with the EMS Performance Improvement Center at Chapel Hill to analyze care given to patients in North Carolina involving pediatric anaphylaxis and rapid sequence induction. This process is still on going but some important trends have been noted.

Currently pediatric patients in North Carolina who have anaphylaxis are only receiving epinephrine about one third of the time. This is consistent with data that has been reported in other areas of the country. Epinephrine is the only effective treatment for anaphylaxis. This data seems to indicate that better training should be given on recognizing anaphylaxis. There also should be more emphasis on giving epinephrine if anaphylaxis is present.

Important data also appears to be emerging on rapid sequence intubation in North Carolina. The North Carolina Office of EMS has been reviewing data from the EMS PIC and from airway evaluation forms collected by the North Carolina Office of EMS. The following factors appear to be associated with cardiac arrest RSI.

These factors include inability to obtain at least an end tidal carbon dioxide reading of 20 and increasing age. There is increased incidence of cardiac arrest after intubation on patients who are hypoxic, hypotensive or bradycardic before the procedure.

This data points out the need for increased training on interpreting capnography and a need for resuscitation of patients before performing the procedure.

Dr. Winslow graduated from Emergency Medicine residency from UNC-Chapel Hill in 2002 and completed his EMS Fellowship in 2003. He has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the NC Office of EMS in 2011. This document contains all protocol, procedures, and policies for all EMS agencies in North Carolina.
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