According to a JEMS news report, the Mesa Fire and Medical Department (MFMD) in Arizona has developed a new noninvasive positive pressure ventilation protocol for respiratory distress patients.
Previously, the standard approach for EMS was to place the patient on 100% oxygen via a non-rebreather mask or ventilation via a bag-valve mask for respiratory distress and failure, if needed. In addition, the patient would also receive medication depending on the field diagnosis.
The JEMS news report indicates that depending on agency policy and procedures, providers would either intubate the patient utilizing rapid sequence intubation/medication assisted intubation (RSI/MAI) or wait until the patient was obtunded enough to place a laryngoscope. However, when a patient is intubated, morbidity and mortality is increased, and if this invasive procedure can be prevented, patient outcomes improve and healthcare costs notably decrease.
The go-live date for noninvasive positive pressure ventilation (NPPV) was April 1, as the MFMD observed the need to investigate other treatment protocols for providing aid to patients in respiratory distress. The goal was to decrease the number of patients who would require pre-hospital intubation. However, if they did require intubation, they would be ventilated with a safe and appropriate mechanical ventilator, as noted on the JEMS news report.
Evidence-based medicine supports the implementation of NPVV as a first-line treatment for acute respiratory failure in the pre-hospital setting prior to intubation attempts and invasive ventilation, as indicated on a JEMS news report. The inclusion criteria for this procedure should be based upon patient presentation and provider impression rather than a specific diagnosis.
The JEMS news report indicates that the MFMD providers can quickly recognize patients who benefit from NPPV, using it in conjunction with the medications available to them for respiratory problems. The Ariz-based department states the results of this new development are positive, NPPV is another tool that can help decrease intubation in a select group of patients in respiratory distress or impending respiratory failure with intubation becoming a secondary intervention.