Microsoft word - behavorialemergencyin-service cvrltr 201
COUNTY OF SUFFOLK
DEPARTMENT OF HEALTH SERVICES JAMES L. TOMARKEN, MD
MSW, MPH, MBA, FRCPC, FACP
All Ambulance and First Response Services in Suffolk County
Chief, Prehospital Medical Operations and
NEW SOP FOR BEHAVIORAL RESTRAINT AND NEW ALS PROTOCOL
FOR BEHAVIORAL EMERGENCIES / AGITATION
The EMS Division is pleased to announce the release of one (1) new Standard Operating Policy (SOP) for CFRs, EMT-Bs, EMT-CCs and EMT-Ps and one (1) new ALS protocol for EMT-CCs and EMT-Ps, each developed to enhance our care of patients exhibiting signs of behavioral emergency and/or agitation, and each designed to provide a greater margin of safety to our EMS providers. Lorazepam (Ativan) is already in our formulary for agencies with a Class 3(c) Controlled Substance Limited Dispensing License and carried by many authorized ALS agencies. One (1) new medication – haloperidol (Haldol) - is being added to our formulary. This IS NOT a controlled substance and may be obtained from your pharmaceutical vendor. If your agency is BLS only, the new medications and protocols don’t apply. Simply download the Behavioral Restraint SOP from the enclosed CD, ensure widespread distribution to your membership, and ensure that your Service Medical Director and Training Officer address the use of restraints through in-service training. Training should be documented, including maintaining attendance sheets and a copy of the slide presentation.
The SOP on the use of soft restraints enhances procedures already taught in NY State DOH curricula, suitable for use by basic and advanced life support providers. The REMAC and SEMAC approved ALS Protocols were developed for use by advanced life support providers to enhance care of agitated patients by medication, which is known to decrease injury potential to patient and provider alike, facilitating humane treatment of persons with mental illness (PMI), and create a safer working environment for EMS personnel. This work is the result of the collaborative efforts of the EMS Division, Suffolk County Police Department, the Division of Community Mental Hygiene Services and other mental health professionals, and the REMAC. Collectively, introduction of this SOP and the clinical protocols enhances are capacity to protect our patients and our providers, while providing care and transport in a compassionate and humane manner. After your members have successfully completed the training program, the agency may elect to purchase the REMAC-approved Posey devices to be stored and used by certified agencies, and begin using the devices on the compliance date, listed on the last page of the letter.
P.O. Box 6100, Hauppauge, NY 11788-0099 (631) 853-5800 Fax (631) 853-8307
For your convenience, and to avoid the time consuming process of bringing providers in for a county in-service, we have developed an ambulance service-level Continuing Medical Education (CME) module to provide focused education & training, which, when properly followed, will lead to EMS System and REMAC authorization. Responsibility for ensuring that all providers are appropriately trained rests with the Ambulance Service Medical Director. The Ambulance Service Medical Director may provide the training. If the Ambulance Service Medical Director is not available, the training may performed by an ALS level Certified Instructor Coordinator (CIC) or Certified Lab Instructor (CLI) from your agency. Alternatively, if no ALS Level CIC or CLI is available, the Ambulance Service Medical Director may designate an ALS provider from the agency that he/she feels comfortable entrusting the responsibility to. We encourage neighboring services to pool resources and train together to maximize the process. For those agencies that are unable to provide Ambulance Service Medical Director or local ALS level CIC or CLI oversight, the EMS Division will assist you in meeting the training requirements.
For your convenience, we have enclosed a CD with all required material, including a PowerPoint presentation and written SOP and protocol. The information is also posted on the website www.suffolkremsco.com under the “Protocols” tab. Documents include:
Drug Fact Sheet for haloperidol (Haldol)
Revised Medication Authorization Form listing haloperidol as an approved medication.
NOTE: Lorazepam (Ativan) is a controlled substance already in protocol for agencies with a Class 3(c) Controlled Substance Limited Dispensing License.
Please follow this step-by-step process for completing this required in-service.
1. Each provider is responsible to review the material on the CD or from the web.
a. BLS Providers are responsible for the Use of Restraint SOP ONLY. b. ALS Providers are responsible for the Use of Restraint SOP AND the level of certification-specific
Behavioral Emergencies/Agitation Protocol.
2. Training Officers, Ambulance Service Medical Directors, and CICs/CLIs should work together to conduct as many
classes as are needed to reach each of your certified providers, completing the enclosed attendance sheets for each training session, including the physician or CIC signature attesting to the training, and FOR ALS PROVIDERS ONLY, completing the appropriate sections of the competency post-test.
BLS ONLY – Medical Non-Core up to 1.5 hours - BLS CICs or CLIs may teach the Use of Restraint SOP to BLS Providers. In order to receive CME credit, each certified EMS provider must receive individual documentation that he/she has successfully completed the in-service and present documentation with CME packages at the appropriate time. Please copy the enclosed CME Documentation Form as needed.
ALS – Medical Non-Core up to 2.5 hours - Advanced level CICs or CLIs may teach both the Use of Restraint SOP AND the ALS Protocols. In order to receive CME credit, each certified EMS provider must receive individual documentation that he/she has successfully completed the in-service and present documentation with CME packages at the appropriate time. Please copy the enclosed CME Documentation Form as needed.
3. ALS AGENCIES: If you have a Class 3(c) Controlled Substance Limited Dispensing License but do not have
lorazepam (Ativan), obtain stock from your supplying hospital.** If you already carry this med, you may purchase haloperidol (Haldol) from your pharmaceutical vendor. ALS AGENCIES that do not have a Class 3(c) Controlled Substance Limited Dispensing License may purchase haloperidol (Haldol) from your pharmaceutical vendor.
4. BLS and ALS AGENCIES: Save a copy of the presentation, attendance sheets, and competency post-test in your
agency’s training files as you are required by NY State regulation to attest to training updates.
5. For ALS AGENCIES ONLY, send sign-in sheets with printed name and signature of all attendees as well as the
printed name and signature of the person(s) conducting the training to the EMS Division. Forms can be sent via fax (853-8307) or scanned as a .pfd file and emailed to email@example.com
Although we are providing the answer key and cannot control access to that key, we are trusting that your efforts to learn the material and document competency is done in a recognized fashion for adult learners as ultimate responsibility for learning the material and adherence to protocol rests with each individual provider. Once we have received and reviewed your submission, we will update the website list created to track this project. Technician names entered onto the website list documents completion and subsequent authorization and providers may begin to use the new SOP and/or protocol. If you experience difficulty in conducting this agency level training, or have any questions regarding the in-service and authorization process, please contact Tom Lateulere at 853-4407 or firstname.lastname@example.org Please begin training as soon as practical, and as often as necessary to ensure that all providers in your agency receive the appropriate training. Implementation date for the BLS Policy and the ALS Protocol is August 1, 2011. ** NOTE: FOR ALS AGENCIES WITH a Class 3(c) Controlled Substance Limited Dispensing License that currently do not have lorazepam (Ativan), this will require an amendment to your Controlled Substances Operational and QI Plans, and amendments must be submitted to the NY State DOH. Contact Karl Klug at 853-8309 or email@example.com for assistance with this work item. cc:
CONFERÊNCIA “New drugs for Chagas disease treatment: From basic science to clinical trials” Julio A. Urbina1 1Venezuelan Institute for Scientific Research Chagas disease, a systemic parasitosis caused by the Kinetoplastid protozoon Trypanosoma cruzi, remains the largest parasitic disease burden in the American continent and is now spreading to non-endemic areas due to intr
Molecular Membrane Biology, September Á/October 2004, 21, 307 Á/313pH modulation of large conductance potassium channel from adrenalchromafﬁn granuleschannel gene CLCN7 leads to a severe osteopetroticphenotype because osteoclasts fail to resorb bone andthey cannot acidify the lacuna . Mitochondrial potassiumchannel has been suggested as a trigger and effectormyocardial ischemic precon