West Virginia OEMS
Class 3 Inter-Facility Transport
(C3-IFT)
Course
Module 2
Protocols and Operation
Objectives
• Introduction to WVOEMS levels of care provider,
skill, procedure, and medication interventions.
• Description of the classification of drugs and
procedure lists.
• Review of 3000 Series IFT Protocols.
• Scope, Role, and Modes of operation discussion
within the context of Class 3 Inter-Facility
Transport.
• Plan for introduction of the C3-IFT Course.
Drug Classification
Class - 1 - CCT Registered Nurse
Class - 2 - CCT Paramedic
Class - 3 – C3-Inter-Facility Transport (C3-IFT) Paramedic
Class - 4 - Field Paramedic
A - Administer Primarily
B - Re-administer or continue
C - Monitor Drip
Procedure Classification
Class - 1 - CCT Registered Nurse
Class - 2 - CCT Paramedic
Class - 3 – C3-Inter-Facility Transport
(C3-IFT) Paramedic
Class - 4 - Field Paramedic
A – Perform Skill
B – N/A
C - Monitor
9201 IFTA Procedures
• Main protocol used on all transports
• Must be “stable” patient by criteria
• Question of stability in pediatric patient is ultimately determined by MCP
• Class 6 (EMT-B), Class 5 (EMSA-I), and Class 4 (Field Paramedic) also use part of this protocol
• All Class 3 drugs are provided by the sending facility
• Sending physician MUST provide written orders for type and dose of medications to be utilized in transport
9201 IFTA Procedures
• No drugs or procedures above Class 3 may be transported by the C3-IFT Paramedic
• Document all medications and amounts received from sending facility
• All patients must have an accepting physician’s name prior to departing
• All unused medications must be turned over to the receiving nurse, who must sign PCR attesting to the amounts received or wasting of excess medication as appropriate
9201 IFTA Procedures
• In the event that unforeseen or
unanticipated events develop during the
transport the C3-IFT paramedic should
utilize the 4000 series protocols and
contact Medical Command
3101 Volume Expanders
• All components must be infusing prior to
beginning transport
• Only the unit of blood hanging may be
continued. Additional units may not be
started by the C3-IFT paramedic
• Colloids may be re-administered and
titrated by the C3-IFT paramedic
• Infusion rate is set by sending physician
3101 Volume Expanders
• Re-administration and titration of colloids
requires consultation with MCP
• Blood and blood products MUST be
infusing at least 15 minutes prior to leaving
sending facility to assure no allergic
reaction is occurring
3201 Cardiac NTG Drip Protocol
• C3-IFT paramedic may titrate and monitor the drip but may NOT start drip primarily
• Rate and titration as set by sending physician
• Nitroglycerine (NTG) is the only drug utilized in this protocol
• NTG is usually titrated in 5 mcg/min increments
• NOT based on weight of patient
3202 Hypertension NTG Drip
Protocol
• May titrate or monitor at rate set by
sending physician
• Systolic blood pressure parameters as set
by sending physician
• NTG is only drug in this protocol
3203 Anti-arrhythmic Protocol
• Includes three (3) drugs
– Amiodarone (Cordarone)
– Diltiazem (Cardizem)
– Procainamide (Pronestyl)
• These medications are MONITOR ONLY
for the C3-IFT paramedic
• Rate set by sending physician
3204 Vasopressor Protocol
• C3-IFT paramedic may only monitor or
titrate one (1) vasopressor medication
• If more than one is infusing then it is NOT
a Class 3 transport
• Infusion rate is set by sending physician
• Only approved drugs are:
– Dopamine
– Dobutamine
3301 Bronchodilator Protocol
• Additional Class 3 medication for
inhalation is Alupent (metapreterenol)
• Theophylline IV drip is monitor only for the
C3-IFT paramedic
• Rate set by sending physician
3501 Antivenin Protocol
• Only utilized in the rare situation where
antivenin has been started in the sending
facility and must be continued during the
transport to a receiving facility
• Major issue is allergic reaction to antivenin
because it is derived from horse serum
• Monitor only for the C3-IFT paramedic
3602 Antibiotic Protocol
• Any antibiotic MUST be infusing for at
least 15 minutes prior to transport to
assure patient is not experiencing an
allergic reaction
• ONLY ONE (1) antibiotic may be infusing
at the time of transport by the C3-IFT
paramedic
3603 Anticoagulant / Antiplatelet
Protocol
• Monitor only for C3-IFT paramedic
• Rate set by sending physician
• Only three medications approved:
– Heparin
– Aggrastat (Tirofiban)
– Reopro (Abciximab)
3604 Electrolyte / Nutrition Protocol
• Potassium Chloride (KCL)
– MUST be on a pump
– Concentration cannot exceed 40 meq/1000ml
– MUST be given over no less than 2 hours
• Magnesium Sulfate
• Total Parental Nutrition (TPN)
3605 Nausea / Vomiting Protocol
• There are three (3) approved medications
– Phenergan (promethazine)
– Zofran (ondansetron)
– Compazine (prochlorperazine)
• Ordered by sending physician
3606 Neurological Emergency
Medication Protocol
• Monitor only for C3-IFT paramedic
• Rate set by sending physician
• Approved medications are:
– Mannitol
– Solumedrol (continuous steroid infusion)
3607 Proton Pump Inhibitor
Protocol
• May be re-administered, titrated, or
monitored by the C3-IFT paramedic
• As ordered by the sending physician
• Common drugs include:
– Protonix
– Nexium
– Prevacid
3901 Analgesic Protocol
• Approved medications:
– Morphine Sulfate
– Demerol
• Dose ordered by sending physician
• Morphine Sulfate is the ONLY opiate
analgesic that can be monitored as a
continuous IV infusion by the C3-IFT
paramedic
3902 Sedation Protocol
• Administered IV push only by C3-IFT paramedic
• NO continuous IV drip infusions are in the scope of the C3-IFT paramedic
• Dosage ordered by sending physician
• Approved Class 3 medications are:
– Midazolam (Versed)
– Lorazepam (Ativan)
– Diazepam (Valium)
3903 Reversal Agent Protocol
• Used ONLY in situations where medical
personnel have overmedicated patient
• Administration is ONLY by MCP order
• Medication and dose are provided by the
sending physician
• Medications are:
– Naloxone (Narcan)
– Flumazenil (Romazicon)
3904 Paralytic Medication Protocol
• Patient must be intubated and medically
stabilized by sending physician
• MUST have had at least one dose of medication
prior to transport
• C3-IFT paramedic may re-administer by IV push
only
• EMT-B or higher must be in patient compartment
with paramedic for entire transport
• Only Medication is Vecuronium (Norcuron)
Plan for Course
• Final corrections after test course
• Next group of students to use reading
materials (self study) then test
• Practical skills up-date
• Roll out to CCT paramedics and RNs
• Type of Regional Roll out TBD