Capnography Trouble Shooting Videos and Protocol Updates

There are two main things I want to talk about in this column. The first are new teaching videos available on trouble shooting continuous capnography equipment. Medtronic has recently created these videos. They are free and available to everyone. The second topic relevant to North Carolina EMS Providers is the North Carolina College of Emergency Physicians (NCCEP) protocol update, which was released in mid March. The NCCEP document contains all the statewide, standardized protocols, policies, and procedures for North Carolina.


Medtronic has developed videos that provide a method for providers to quickly determine if their continuous capnography equipment is working properly. Medtronic created this video as a result of lessons learned from the North Carolina Statewide Prehospital Airway Quality Program (SPARQ). As part of the SPARQ program the North Carolina Office of EMS Personnel review all Drug Assisted Airways in North Carolina. A lesson learned from this project was that some providers did not understand how to quickly assess their capnography equipment. It seemed that providers needed more education on quickly determining if their equipment was not working properly versus that the endotracheal tube was misplaced.

In order to address this possible knowledge gap, Medtronic has developed online easily accessible videos on how to quickly assess continuous capnography equipment. Any providers who manage airways must be experts in continuous capnography. Not only does a capnography provide important physiologic information, but it is also the only way to continuously verify appropriate endotracheal tube placement.

Below are the links and QR codes to access the videos. There is a video for Physio-Control monitors and another video for Zoll monitors. Please note that the author received no money or other type of payment from Medtronic.

Physio Control:


Updates to the NCCEP document will be released at the North Carolina Association of EMS Administrator’s meeting in March. Updates will address several key areas: scope of practice changes, sepsis and changes to the document to reflect the skill levels.

One of the new scope of practice changes includes the ability for BLS personnel to utilize continuous capnography. Also, advanced EMTs — formerly known as EMT-I’s — can now place intraosseous catheters.

Providers should remember that the North Carolina Medical Board did NOT agree to expand the scope of practice for ketamine. At this time ketamine cannot be used for pain or to sedate the combative patient unless the drug assisted airway protocol is being utilized. All of the protocols will be adjusted to reflect the new skill levels. Specifically EMT-Intermediate will be changed to Advanced EMT. In addition there will be some new protocols added which are still being determined by NCCEP.

One example will be a sepsis protocol. All EMS agencies should keep an eye out for these protocol changes. A notification will take place when the protocols are updated.

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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