Author Archives: SWORBHP

Question: I have a few questions about some of the omissions from these protocols that were in the old protocols. The first one is in the event chest pain resolves and re-occurs it is treated as a new episode and nitro protocol repeated. This isn't stated in the new protocol so if this were to occur can we repeat although it isn't stated? The other question is regarding the medical arrest protocol. No provision is made in regards to on scene ROSC and re-arresting patient in ambulance. The old protocol says we can pull over and analyze once then continue to receiving facility. With nothing in the new protocol do we follow the same format? Thank you.

Question: As far as the TOR mandatory patch point goes: if we are able to relay to the BHP that we would like to transport as opposed to terminating (e.g. public place, family insists we do so etc.) then why not allow the discretion of the paramedic to dictate whether to spend the time actually doing the patch? Since the physician is relying on us to paint a picture of the scene and if the BHP will accept our interpretation of the events unfolding and most likely state to transport anyway, patching to get permission to initiate transport seems to be more of a delay than a benefit.

Question: I don't agree with the transport consideration in case study #1 of the Acute Stroke Protocol that states the patient is excluded from transport to a Designated Stroke Centre due to not being able to determine onset of symptoms: male, age 58, found unconscious on the floor at 0800 by a friend, when he came to pick him up for work.

Shouldn't we consider it likely the symptom onset was < 3.5hrs especially in this case where it would be safe to assume symptom onset probably occurred after patient got up to get ready for work and that he probably does not get up three and a half hours prior to getting picked up at 0800.

Further, it's more likely his GCS would be worse than 10 had he been down much longer. Bottom line, shouldn't we be erring on the side of caution for these patients and give them the benefit of the doubt that symptom onset might be < 3.5hrs given the evidence at hand? Or even with less evidence? As an aside, is the time going to be extended as i believe some doctors think it should?

Question: The old protocol for Gravol stated it may be given for severe nausea or vomiting. The new one also says we may give it for nausea or vomiting. It does not say severe anymore. My question is do we have to give it to everyone who says they have nausea even if it's minor?

Question: In the ALS patient care standards it states that a Supraglottic Airway (King) is indicated when "Need for ventilatory assistance OR airway control AND Other airway management is inadequate or ineffective"

In the "un-controlled" world of EMS would it not be more effective to use a King over an oral airway after the first round of CPR is complete? The King allows for movement from the floor to stretcher with no worry about "losing" your airway. It also doesn't fall out as an oral airway will in the difficult situations/extrications we face in the field. The fear of gastric distention is also completely alleviated, making the King more effective. It would also allow for constant compressions, which is the best treatment for cardiac arrest patients in pre-hospital settings according to the Heart & Stroke. I have had many discussions with other paramedics and they seem to think that you can't use the King at all if you have an oral airway that is giving adequate control. So my question is, if you use the King on VSA patients, is it acceptable even if the oral airway will work (just not as adequately or effectively in my opinion)?

Question: With respect to the Medical TOR, can we leave a deceased patient with family members after the TOR has been granted? It does not state in our medical directive who we can leave the body with (I always presumed it would Police, a family doctor, Coroner, Supervisor, Nurse at Nursing Home / patient’s home, etc.). In the Deceased Patient Standards it does state under responsible person / unexpected death chart... family members would be acceptable. I would imagine it would depend on the situation at the scene and family members state of mind. If you and your partner are at the scene of a medical TOR and another call comes in down the street for a code 4 - VSA for example, can both crew members leave the scene and have family take over care of the body? I know you could do a first response with one crew member, but again, two would be optimal. If you were a Supervisor on scene taking over care for your crew, could you leave the pt in the care of family and do a first response? You are on scene with a patient who has met the Obvious Death Criteria, can you leave the patient with family members or do we wait for Police, Supervisor etc. to attend the scene?

Just wanting clarification on who would be the 'responsible person'. If a Paramedic felt that family would meet the criteria for 'responsible person', could we have family take over custody of the deceased person for Medical TOR or Obvious Death Criteria providing scene was safe, family coping well, no suspicious events at scene, etc.?

Question: If we are on a call and suspect child abuse or neglect may be taking place what would be the best way to contact child services? Also could we run into confidentiality problems? An example would be if we are called to a residence for a woman with abdo pains. After assessing the scene we notice an infant sitting next to drug paraphernalia.

Question: I had a question in regards to why do we need to establish an IV in a patient with suspected pulmonary edema? If they fit this protocol, they will most likely have crackles, and therefore if we happen to bottom out their pressure with nitro sprays, we will not be able to bolus due to the patient having crackles. Thanks in advance.

Question: This question was addressed at the end of January but I'm still unclear on the answer. In our protocol is discusses DKA and the patch point for pts from 2 to 12 for obvious reasons to me. It does not discuss any patient greater than 12. In the past if pt was DKA and showing signs of dehydration we could do a 10ml/kg bolus, then it was changed so that we had to patch for this bolus.

The previous question was weather or not we were doing boluses for adults and it was not addressed. There is no talk of it in our latest protocols. Can we go ahead and bolus an adult in DKA who is showing signs of dehydration without a patch or even with a patch?

Question: I was having a debate with another paramedic about the proper order of procedure in the following situation: You are en-route to the hospital, in the back of the ambulance alone with your patient, and they go VSA. You check for pulse and respirations and confirm VSA, update your partner, and ask them to pull over and help. While they are pulling over and moving to the back of the ambulance should you: a) begin chest compressions; or b) immediately apply defib pads and analyze?

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