400: Weapons of Mass Destruction Nerve Agent Exposure Protocol - ANS-Authorization for the use of the nerve agent antidote kit comes only from the FDNY office of medical affairs through a class order issued by FDNY dashama medical director who is on scene or as related by an FDNY OMA medical direct...
400: Weapons of Mass Destruction Nerve Agent Exposure Protocol - ANS-
Authorization for the use of the nerve agent antidote kit comes only from the FDNY
office of medical affairs through a class order issued by FDNY dashama medical
director who is on scene or as related by an FDNY OMA medical director through online
medical control or through FDNY emergency medical dispatch.
Note: the issuance of any class order shall be conveyed to all regional medical control
facilities for relate two units in the field.
Treatment within the hot and warm zones may be performed only by appropriately
trained personnel wearing appropriate chemical protective clothing as determined by
the FDNY incident commander.
•Red Tag may be treated simultaneously with decontamination.
•Yellow/Orange Tag will be treated as soon as possible following decontamination.
•Green Tag (asymptomatic) will be decontaminated and receive close observation.
Note: nerve agent kit contains one each: 2 milligram atropine autoinjector and 600
milligram 2-pam auto injector.
For a red tag patient with severe respiratory distress, agitation sludgem 3 auto-injector
kits will be used for a total of 6 milligrams monitor every 5 minutes.
For a yellow tag patient with respiratory distress, sludgem 2 autoinjector kits will be
used for a total of 4 milligrams monitor every 10 minutes.
Green tag patients who are asymptomatic receive no auto injector kits monitor every 15
minutes.
Note: Do not give more than 3 auto-injector kits to any patient.
Record on the triage take the number of atropine and auto-injector kits used.
A symptomatic patients do not require treatment.
Monitor every 15 minutes.
In the setting of a nerve agent exposure, all symptomatic children aged 0-8 shall be
assigned a red tag. For pediatric red tags less than 1 years old use 1 pediatric atropine
autoinjector (0.5 milligrams) no antidote kit and monitor every 3 minutes. Atropi
, 401: Respiratory Distress / Failure - ANS-Note: All patients who are in respiratory arrest
must have ventilatory assistance unless a valid New York State prehospital DNR order
and / or MOLST is present to the crew.
1. Monitor the airway.
2. If an obstructed airway is suspected, see protocol #402
3. Administer oxygen.
4. For patients over 1 year of age who are experiencing exacerbation of asthma or
wheezing, see protocol #407
5. Do not permit physical activity.
6. Request advanced life support assistance.
7. Monitor breathing for adequacy. Note: monitor breathing continuously. Be alert for
signs of hypoxia and / or increasing respiratory distress.
8. Place the patient in a Fowler's, semi Fowler's position, or in a position of comfort.
9. Transport.
10. For the patient with signs of ongoing hypoxia, inability to adequately protect their
airway, and / or exhibiting signs of inadequate respiration, assisted ventilation may be
required. This should be done utilizing one of the following methods:
A- pocket mask with supplemental oxygen set at 10-15 liters/minute
B- bag valve mask and reservoir with flow set at 10 - 15 liters per minute.
Note: do not use a demand valve resuscitator due to the possibility of causing severe,
life-threatening complications.
11. Transport.
402: Obstructed Airway - ANS-1. If the patient is conscious and can breathe, cough,
speak, or cry: A. Encourage coughing.
2. If the patient is unconscious or cannot breathe, cough, speak, or cry: A. Perform
obstructed airway clearing maneuvers. B. Request advanced life support assistance.
3. Transport.
4. Continue obstructed airway maneuvers in route to the hospital until the foreign body
is dislodged. NOTE: the patient must be taken to the hospital for evaluation even if the
airway is cleared.
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