Category Archives: BLS Patient Care Standards

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: Recently, after transporting a stroke bypass patient we were told they could not be treated for the stroke (with thrombolytic) due to the patient's history of warfarin use.

How does this fall under our protocol but outside theirs? If blood thinners (either in conjunction with a specific disease or as a certain dose) are a roadblock to thrombolytic therapy why isn't it listed as a contraindication to the bypass protocol? We did not have time to discuss the rationale behind the statement and have been wondering since if we misinterpreted the statement or if warfarin and similar drugs really do prevent thrombolytic use with CVA's? I know there have been studies linking problems with tPA in patients with warfarin history but didn't know that played an active role in the exclusion criteria at stroke centers now. If this is the case why not change the protocol to eliminate needless transport (especially when transporting from outside of the city/county where the center is located?

Question: Called to a nursing home for 90 year old male. On scene staff state patient has valid DNR but they are unable to produce it. The crew continues to resuscitate patient as per usual. Enroute to receiving facility, CACC advises the crew that family has phoned in and stated that they have the DNR and they do not want the patient resuscitated. The attendant phones the attending BHP and advises him of the situation. The BHP orders EMS to cease resuscitation efforts on patient. Is this right or wrong?

Question: I was on a call recently where I was instructed that all patients from a scene, where there has been a fatality, are CTAS 2. I had never heard of this so I asked our Quality Assurance and they said that all patients from the vehicle which had the fatality in it are CTAS 2. They also told me that Victoria Hospital (LHSC) is thinking about making them all CTAS 1. I asked around and not many people had heard about this. I looked through the original CTAS course module and could not find anything on this. I thought we were supposed to CTAS according to presenting condition. Some of these people are out walking around at the scene with no complaints.

Question: Patient has a FBAO and a valid DNR (ex. nursing home). Resuscitate or not?

1 5 6 7