Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Management of the ventilations of a patient during a prolonged or inter-facility transport of an intubated patient.
Procedure:
a. Knowledge of the operation of the ventilator is crucial for the transporting personnel.
b. All ventilator settings, including respiratory rate, FiO2, mode of ventilation, PEEP, and tidal volumes should be recorded prior to initiating transport. Additionally, the recent trends in oxygen saturation should also be noted.
c. Prior to transport, specific orders regarding any anticipated changes to ventilator settings as well causes for significant alarms should be reviewed and a working knowledge on how to address the situation.
d. Apply all settings to the transport ventilator.
e. Apply ventilator to patient and observe for tolerance, adjust as necessary.
f. Once in the transport unit, switch the O2 source over to the main tank and once again observe patient tolerance of the ventilator and its settings.
g. Assess breath sounds often and frequently and assess the patient’s respiratory status, noting any decrease in oxygen saturation or changes in tidal volumes, peak pressures, etc.
h. If any significant change in patient condition occurs, including vital signs, oxygen saturation, or there is a concern regarding ventilator performance/alarms, remove the ventilator from the endotracheal tube and use the BVM to oxygenate patient with 100% O2. Contract medical control.
i. Noted any changes in ventilator settings or patient condition on the ACR.
Note: Consider the DOPE mnemonic for problems with the ventilator.
D—dislodgement
O—obstruction
P—pneumothorax
E—equipment (including operator) problem
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.