Category Archives: BLS Patient Care Standards

Question: Our current stroke directive reads that 3.5 hours is the timeline from time of onset to stroke center. The new BLS reads that the time from onset to stroke center is 4.5 hours. Which timeline are we expected to follow as of Dec 11th?

Question: In regards to the BLS version 2.0 - extremity injury, bone/joint, there's a guideline regarding elbow dislocations. It says that if we encounter an elbow dislocation with nerovascular compromise, that we can contact receiving hospital or Base Hospital Physician for advice regarding manipulation or in-line traction. In the new BLS 3.0, this guideline has been left out. Are we still expected to perform the guideline if we ever encounter this, or has this been purposely taken out? Thank you.

Question: When the Ministry of Health's DNR forms are filled out, can the section where the patient's name goes have a sticker from the hospital with the patients name/health card #/DOB, etc. instead of having the name printed or does that make the form invalid. The form specifically states the patient’s name should be printed clearly. I wasn't sure if the ID sticker was something we could accept instead or if that section can only be filled out by hand.

Question: In a setting where you arrive on scene and you are presented with a patient who is unconscious and is hypotensive, the patient has a valid DNR. Can you still administer fluids to this patient or does that fall under the same category as inserting an OPA/NPA and BVM to a patient with a DNR?

Question: For teaching purposes. While assessing a patient, how important is it to determine any and all treatments or interventions provided to the patient by allied agencies, bystanders, self-administration or other medical professionals prior to the arrival of the Paramedics? How important is it to determine an accurate time line of those treatments or interventions? Is oxygen a treatment and/or intervention?

Question: Is PEEP being considered for inclusion into the paramedic scope of practice? I recently had a patient who was in CHF to the point of unconsciousness whom we would have absolutely given CPAP had he been conscious. Although PEEP isn't exactly the same as CPAP, would it not have potentially provided some benefit?

Question: In Elgin county we have been having trouble with our defibs spitting out 'noisy data' warnings on our 12 lead ECG's lately which has prompted conversation with crews about the STEMI protocol. Though the protocol clearly states that LP15 ECG software interpretation meets ***MEETS ST ELEVATION... some crews are saying that due to this issue with noisy data, we are able to interpret the ECG on our own and determine if it meets our criteria based on the >1 mm/or the >2mm ST elevation criteria. Your thoughts? Should we patch the cardiologist? Should we transport to nearest ED due to software not recognizing due to noisy data?

Question: Can you go stroke bypass with the only complaint being a defined onset of confusion?

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.

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