Author Archives: SWORBHP

Question: Seeking clarification: Traumatic Cardiac Arrest where TOR does not apply and we are transporting to nearest ER. While en-route, the medical directives currently state we are to transport with CPR and no further treatment. Is it acceptable to intubate if required, IV and epi q 4 min, consideration of bilateral chest needles? Would I require an order to proceed with the chest needles if patient is in PEA.

Same question for hypothermic arrest, is it permissible to intubate, IV access, patch for further orders, i.e. epi?

Question: Is the stipulation that the patient must be VSA upon arrival to qualify for a Trauma TOR is a SWORBHP deviation from the provincial directives? The protocol does not specifically state witnessed or unwitnessed arrest (as does the Medical TOR protocol). After talking to a couple paramedics under another Base Hospital they have informed me that they can Trauma TOR a witnessed traumatic VSA (for example, the patient goes VSA during extrication and meets all other criteria).

Question: When is a patient no longer considered nitro naive? Issue: you have a patient that is suffering chest pain and qualifies for ischemic protocol. You establish a patient IV and give them nitro. The patient accepts the nitro without any adverse reactions and pressure does not fall out of protocol at any time. After your second dose of nitro you check the IV and discover it’s no longer patent and you have to discontinue it. You attempt your second IV and are unsuccessful. Nitro has been decreasing patient's pain but they still have active chest pain. Can we still continue with nitro without an IV as the patient has already been given nitro and not had any reaction?

Question: The DNR confirmation form states the paramedic will not initiate basic or advanced CPR such as, TCP being one of them. From what I understand, until that person suffers cardiac or respiratory arrest, they are fair game for treatment. So, if a patient is in a 3rd degree block at 20bpm and they have a DNR, we are pacing this patient?

Also, what do they mean on the DNR confirmation form about palliative care? They say we are to provide care to alleviate pain/discomfort such as - NTG, ASA, benzodiazepine, epi for anaphylaxis, o2, Morphine etc. Is this merely an FYI on how to treat a pre-code patient? Clearly the patient would have to be alive to administer these drugs. Again it is said that the DNR does not come into play unless the patient codes. Why is this on the form?

Question: This question is in regards to the TOR's and calling BHP. Some paramedic services lack having a spare cell phone while the primary cell phone for a truck is "out for service", missing etc. I have heard of some paramedics using their personal cell phones to call for the mandatory BHP patch for a pronouncement. I have spoken to Police and Crown Officials, and they have both stated that our personal phone can be submitted into evidence at an inquest or other matters, as this was the tool used to make that pronouncement (upon further investigation a paramedics credibility can be challenged as the court can see text messages, pictures, and phone calls placed on the personal phone). If our service fails to provide us with a cell phone for that shift for whatever reason, are we obligated to use our personal phone knowing it could be taking from us in an investigation for an unknown length of time? Would we document "no cell phone available" on the ACR?

Question: I have checked with a SWORBHP Educator and they did confirm that you cannot Medical TOR an OD but you can do Medical TOR on Drowning Hanging and Electrocution. There still seems to be doubt out in the field so I thought I would post so all could see answer

Question: If a DNR only comes into play once the patient has suffered respiratory or cardiac arrest, why do hospitals use DNR as an excuse to downgrade CTAS or justify putting certain patients as a code 7?

Question: When is the "new" treatment algorithm ALS/BLS for Medical Cardiac Arrest being posted?

Question: With respect to the Medical Arrest Protocol, are we still to alternate giving Epi and Amio/Lido on the 2 minute mark since each are to be given Q4 minute? Or can we give them at the same time? What is preferred?

Question: I’m not comfortable having to make critical decisions in the field, on calls that are few and far between, yet serious in nature. Is SWORBHP doing anything along with MOHLTC to advocate for regular training days to be a part of our regular schedule and duties? I'm all for continuing self-study, however, since so much of our job is practical application, don’t you think it is wise to give your paramedics practical practice? As an aside, in my opinion, insufficient funds is an unacceptable excuse not to. Fire and Police have always had ample training time, and we are just as important to public welfare. So could it be possible for all parties to come together and find the funds necessary? Thank you for creating this site and allowing me to put this issue forward.

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