Author Archives: SWORBHP

TOTW: Rolling TOR-Paramedic Responsibility for Contacting the Coroner

TOTW: Rolling TOR – Paramedic Responsibility for Contacting the Coroner
Posted on: January 2, 2023

Should you encounter a scenario in which you patch for and receive orders for a “Rolling TOR”, per the BLS-PCS, it is the paramedic’s responsibility to advise CACC to contact the coroner. Although the true pronouncement and time of death will be determined at the hospital by the receiving ER physician, in these rare situations, the coroner also should be notified via the paramedic contacting the CACC.

Under the Deceased Patient Standard: “If termination of resuscitation occurs in the ambulance en route to a health care facility, advise CACC/ACS to contact the coroner, and continue to the destination unless otherwise directed by CACC/ACS”.

  • Was this Helpful?
  • Yes   No

Under clinical considerations medical cardiac arrest, plan for extrication and transport after 3 analyses. For Pediatric arrest would we do 3 analyses and go or complete 3 on scene and 4th before departing in ambulance?

When would it be appropriate to treat a non-epileptic (or commonly called pseudo-seizure) with midazolam?

My question is in regards to when an IV certified medic is working with a non-certified medic. If the certified medic establishes IV access and has a lock in place, but doesn’t give any fluids or medications can the non-certified medic still continue to attend the call? Or does the certified one become the attending. Specific example would be a Code Stroke where we established IV access prior to leaving scene, but it was originally the non-certified medics call.

The ALS PCS shows specific suction settings (based on age) for tracheostomy and ETT but what about for oropharyngeal suctioning? We’ve all been taught the values in school but I can’t for the life of me find a specific and reputable reference.

Should Ibuprofen be withheld for patients suffering possible Crohns, colitis and IBS flare ups?

Should we consider cocaine induced chest pain as ischemic and be treating with ASA and NTG? Example: 20 year old male patient midsternal chest tightness. Admits to using cocaine and the symptoms occurring after that. I guess my question is, is the cocaine causing ischemia which causes the chest pain?

I recently attended a CVA/TIA related call; it had been the first CVA related call I had been to since having a 4-year hiatus out of the trucks. Since being out the trucks the CVA consult/bypass protocol has been implemented. I'm having a difficult time understanding the point of the consult. If the Paramedic on scene is able to identify CVA symptoms accurately/appropriately, why are we delaying transport to discuss with a physician, who is not on scene, if we should transport to the appropriate stroke facility? It was explained to me that Paramedics weren't correctly identifying CVAs pre-hospital. If that's the case, those that aren't recognizing a CVA aren't performing a consult because they didn't recognize the CVA in the first place. If I can identify a CVA correctly, announce a code stroke to dispatch, and have the stroke team ready on our arrival, how can there be any benefit to calling someone who knows nothing about the incident other than what I tell them? What is the difference between a doctor incorrectly identifying the CVA over the phone versus the Paramedic incorrectly identifying the CVA on scene other than the 15 minutes saved not trying to call for a consult? There also seems to be some significant discrepancies as to the onset of symptoms time frame between different receiving hospitals and physicians. Our destination guidelines clearly state within 6 hrs of onset of symptoms; however, recently a fellow medic advised me that it was 8 hrs but our guidelines have not yet been changed to reflect this, and a physician told me the window is 12 hrs. Any clarification/suggestions/info would be greatly appreciated. Thank you so much!

What is the rule for stroke bypass when symptoms resolve on scene? It doesn’t specify for this scenario in the directive, and only says “continue to bypass if symptoms resolve on transport”. In this case our patients had stroke symptoms for 1-2 minutes that quickly resolved and he no longer had any symptoms. What is the most appropriate hospital in this scenario?

I have a question in regards to the hypoglycemia directive. We were dispatched to a patient who suffered a fall, with history of diabetes. Upon assessment the patient was GCS 15, answering questions appropriately and oriented to person, place, time and event, however the patient was unable to move their limbs, and had loss of sensation in portions of the arms, torso, and legs, as well as a depressed skull fracture. The patient was hypovolemic and hypoglycemic at 3.2, stating he has not been eating or drinking fluids all day. Due to a complaint of back pain and paralysis, the a c-dollar was applied and scoop was used to extricate. Because the patient was secured to the stretcher supine, treating with oral gel was not an option, and transport was a priority. Some of the symptoms exhibited by the patient are concurrent with typical signs of hypoglycemia. In this situation where the patient is NOT altered, but hypoglycemic, with sufficient suspicion to suspect that low blood sugar may be causing some of the symptoms, would it be reasonable to treat the patient with IV dextrose? How do we proceed in situations where patients may be hypoglycemic, are not altered (GCS less than 15) but are unable to tolerate oral glucose or carbs? I can see this being the case for traumas.

1 2 3 75