The implementation of the RSI protocol is now considered “standing order” for qualified RSI paramedics. As a reminder only approved Department of EMS paramedics that have successfully completed the required RSI training and associated requirements may perform RSI. A copy of the TEMS protocol and some key points to Rocuronium are provided via these attachments: Rocuronium Key Points and Revised RSI Protocols
Key points to consider:
- When performing RSI as a standing order, two RSI medics must be on-scene.
- It takes two (2) RSI medics to say “GO” and only one (1) to say NO when considering the skill as a standing order.
- At all times, if there is any uncertainty and/or question as to whether RSI should be performed or not, contact a physician for consult.
- If two RSI medics are not available on scene, then the RSI medic must contact Medical Control for orders. Calling for orders requires on RSI medic and one paramedic (or intermediate for patients over 14 years of age) capable of intubating the patient.
- Under all circumstances, four (4) providers are still required to be at the patient’s side to implement this skill.
- Standard dosages are provided in protocols for RSI medical in adult patients. Pediatric dosages are still weight based and dose charts are available in the RSI bags to assist you.
- The RSI kits will be stocked with one paralytic (Rocuronium) for both the initial and continuing paralysis and is supplied in 50mg/5ml (for a 10mg/ml concentration) prefilled syringes. For the standard adult dosing two (2) of the 5 ml syringes (50 mg each) will be utilized.
- Etomidate will remain in the multi dose vial as the prefilled syringes remain on backorder for the indefinite future.
- Fentanyl may be utilized as the analgesic of choice for adult patients as outlined in the RSI protocol.
- Be sure to notify dispatch over the radio both at the onset of the RSI procedure and at the conclusion of a successful RSI event.
- Revised RSI pocket books will be coming in the near future.
From the Medical Director, Dr. Stewart Martin:
Patients that receive RSI are clearly some of our most critical patients. RSI medics should be aware that some patients, particularly those experience a problem of a “medical nature” (as opposed to trauma), that undergo RSI can develop rapid cardiovascular collapse and cardiac arrest. Consider carefully whether or not a “medical” patient truly requires RSI or could perhaps benefit from CPAP or other methods of treatment until arrival at a definitive care facility.
Thank you for the excellent care your provide and stay safe!
3/6/2017 Update: If the hospital is out of stock of the prefilled syringes for Rocuronium, they may add vials. The vials in this picture were placed yesterday and appear to be 100mg/10ml so the concentration is the same (10mg/1ml). But please never assume and double check the concentration before administering.