Category Archives: BLS Patient Care Standards

Question: How is the DNR standard in the BLS PCS reconciled with this statement in the ALS PCS: "if a paramedic is aware or is made aware that the person has a prior capable wish with respect to treatment, they must respect that wish (for example, if the person does not wish to be resuscitated)."

Obviously the ideal situation is that the patient has the DNR confirmation form and there are no issues. The issue comes up with regards to verbal DNRs issued by a capable patient or SDM (that are reasonable), or in such cases where the patient has a DNR, living will or other advanced directive that specifies the patients wishes, but no prehospital DNR form. Is this form not redundant provided there is a reasonable indication that the patient does not wish to be resuscitated or have aggressive life sustaining therapies delivered?

How can the BLS PCS DNR standard be reconciled with the ALS PCS regarding honouring a prior capable wish when the provider is made aware of such wish (provided its reasonable)? Especially given that in nearly ever other case, a directive in the ALS PCS over-rides the BLS-PCS. Given that this issue is not nearly as cut and dry in reality, or in any other healthcare setting, as it seems to be made out to be in EMS in this province what is the situation with regards to this? Especially given that end-of-life issues are increasingly common, the issue is not going to disappear. There are many other provinces that use a similar wording or philosophy to that mentioned in the ALS-PCS under consent and capacity.

Question: Recently we were on scene with an unresponsive 65 year old female. This was a witnessed event by a friend. While on route to the nearest ED patient’s condition improved. The patient started to answer questions. At this time the patient found to have left sided deficits. Should we continue to the local ED (5 min transport) or turn around for stroke bypass (50 min transport) After assessment in ED we ended up transporting to Stroke Unit.

Question: Referring to the STEMI by-pass medical directive, is it 60 minutes from patient contact or 60 minutes transport time?

Question: Are we allowed to accept photocopied DNR? I have heard several discrepancies on this question.

Question: At our recent recertification, I posed a question that was answered by a doctor. This was regarding the ability to call a cardiologist if we had a patient with a STEMI who did not have chest pain. Her answer was: “not at this time”. However, in conversation with medics from other classes, this seems to contradict what they have been told. Can you please clarify?
br>Also, are we to continue to understand that once a patient is out of the STEMI protocol (e.g. with vitals) that they continue to be so even if the vitals improve to within proper range?

Question: Upon review of the new Field Trauma Triage Guidelines, colleagues and I noticed that those patients who have sustained penetrating trauma to the head/neck or torso (with or without vital signs) should be transported to the lead trauma hospital providing it's within 30 minutes transport. Our question is why is this not the case for blunt trauma patients (in particular, those patients VSA from blunt trauma)?

Question: I would like to know the actual medical directive and/or guidelines regarding PCP's transporting trach patients with no nurse, doctor or RT escort.

Additionally, what the medical directive is if staff is sending the patient to the ER without their vent, therefore, the paramedic is required to bag the patient via BVM for the duration of transport and until there is transfer of care at the ER?

Is this in the BLS scope of practice?

Question: Although not employed by a service under the SWORBHP, I have been closely following this site and your LINKS newsletter. Thank you for both of these invaluable resources. After reading the most recent question regarding spinal immobilization, I had to share a resource with you that can located here https://m.youtube.com/watch?v=eM4hxuooNN0. This is a lecture by Dr. Ryan Jacobson, a former paramedic who is now medical director of Johnson County EMS in Kansas and Assistant Professor of Emergency Medicine at University of Missouri-Kansas City School of Medicine. If you have already seen it, you are familiar with its informative value. If not, I'm confident that you will find it of value. This link is unplublished and cannot be found via YouTube search.

Something that I have been wondering after viewing the lecture and statistical evidence is as follows. Hypothetically, if the current practice of securing patients to backboards increases morbidity and mortality (particularly penetrating trauma) and that there is greater spinal movement than if secured directly to the stretcher, and that no negative effects have been observed by not securing to a backboard, is it reasonable to consider foregoing the backboard as care superior to the minimum requirement as written in the BLS? Similarly to a "letter of the law" vs. "spirit of the law" question. LBBs have been contraindicated for transport in Queensland, Australia for the past five years among numerous other jurisdictions. I've inquired with my employer but was given the old "We have standards" response.

Thank you for your time and consideration on this topic. I look forward to your reply.

Question: I have been to a few calls where the patient does not have a DNR, but the death is expected and family does not want CPR or other interventions. The family will make statements like "we don't want CPR" or “they wouldn't want CPR", etc. Do we initiate the CPR and Defibrillation protocols until we can get hold of the BHP or do we run the call and transport regardless of family request?

Question: There is some confusion about patients that have a valid DNR, and are very sick requiring transport. It makes sense that many of the ACP skills might not be utilized on these patients, and CPAP would be a PCP skill. There are cases where the family changes their mind on a DNR, and cases where the status is not clear. There are also other cases where a patient may be a trauma and have a valid DNR where they may need a needle decompression, but not necessarily cardiac arrest needing CPR or intubation. Is it OK for ACPs not to attend valid DNR patients?

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