Category Archives: Miscellaneous

Question: Can ACPs use xylometazoline nasal spray to aid in the treatment of epistaxis? It seems to be the go to start to treatment in the Emergency Department, why not get started prehospital?

Question: As per the ALS PCS, why is there a deliberate gap between normotension and hypotension?

Question: The new BLS that will be introduced in December 11, 2017 mentions that treatment and transport refusal would require the completion of the refusal of service. The question is whether it is required to be completed for any refusal of treatment or just treatment with possible negative outcome to patient example refusing collar vs. Dimenhydrinate or any analgesic?

Question: Why are all the directives based upon an urban setting assumption given that there are very rural areas in which paramedics work in besides big cities? Further to this, one could suggest that certain advanced skills are more appropriate if not life saving the further from a hospital. Has there ever been any consideration to consider such advanced care skills such as midazolam for seizures, needle thoracostomy, peds IO and even cricothyrotomy to name a few. Why are these not even considered in areas with transport times exceeding well over 1-2hrs. These are skills that overall can make a significant difference in patient outcomes especially when no other care is available. To add, these are not skills that can be deemed to be well learned for even experienced ACP's as actual prevalence even in an urban setting is very low. Thus, the number needed learn position can be put forth ACP's anymore than PCP's but the difference in distance to more advanced care certainly can.

Question: One frustration or perhaps lack of knowing is why the Medical Directives differ so much from province to province even for PCPs. Does "evidence based medicine" stop at provincial borders or is it that interpretation and application of such depends more on who, as well as financial politics and liabilities more than evidence based medicine and timely patient care? I can provide examples but I do not think it is specifically necessary-helpful per say in answering the primary question. Look forward to your response.

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: I've heard of crews being asked to transfer patients between facilities with indwelling tubes and lines that are not within their scope, and they don't have suitable escorts. I had a colleague asked to transport a patient with a chest tube, without an RN escort, to which they refused, but recently saw a crew transporting a patient with a nasal epistax in-situ. I know these have the potential to migrate and cause airway obstruction so didn't think we should move these without a hospital escort. Could the Base Hospital provide some direction so that it is clearer to paramedics as to what they should do in these cases?

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: If you work in 2 services under the same base hospital and you are certified and work in one as an ACP, but one service is now only PCP, can you perform any ACP skills if you feel necessary while working in the PCP service? (for example, cardioversion or pacing, epi in arrests?)

Question: Any news or updates regarding the progress of a new BLS version?

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