Category Archives: Miscellaneous

Question: Would SWORBHP ever consider putting a system in place for medics to learn the in hospital diagnosis of patients they transported. There are times when we transport patients and never learn what was causing them to present as they did. I think it would be beneficial to learn what the cause of the patient's condition in those instances for our own improvement and growth. I understand it would be unreasonable to do this for every patient but it would not be difficult to set up a flagging system to tag specific interesting calls. A system similar to the follow up after a ROSC may be a model to base it on.

Question: I have a number of questions in regards to the management of obstetrical emergencies and the established standards outlined in the BLS. I know that out of hospital delivery in comparison to other call types is a rare occurrence for Paramedics. So it may be reasonable to deter pre-hospital management of certain situations for definitive care, just based on training, risk and benefit. However, I think it is important for Paramedics to know how to manage these situations when they arise.

For an example, In the BLS standards shoulder dystocia although rare is not specifically outlined. If one does some research or digs back to many college programs where the HELPER mnemonic is touched on we find that suprapubic pressure and the McRoberts maneuver can resolve many of these situations, preventing trauma and harm to the mother and newborn. Although not identified clearly in the BLS both of these interventions are touched on in other areas such as breech delivery and emergency delivery. I wondered the reason why these interventions are not applied specifically to the situation where the shoulders do not deliver and rather the Paramedic is to initiate transport immediately? Secondly, what would MAC's direction be to the Paramedic managing a possible shoulder dystocia? With the potential for fetal hypoxia and stress it seems reasonable to apply these same interventions in this setting.

If we go along the same question of course we aren't performing field episiotomy or controlled clavicle fractures but why can we not assist a shoulder or roll the pt on all fours in this setting? Sure we can and use our judgment but with the legalities of following the standards it may be deemed as a deviation. Can Paramedics really apply the appropriate measures from various parts of the standards to situations like dystocia and still remain legally within their scope?

The only other question this may bring up is how do we hold midwives, who have a higher level of training and knowledge to the BLS Standards?

Question: I am asked to transport a patient to the cath lab. The new onset unstable angina patient (who is bradicardic with a lowest rate of 38 and multiple unifocal pvcs) and is only CP free because of the nitro during patch put on by the ER doctor.

Does leaving the patch on constitute me giving a medication that is out of my skill set? Since she/he is bradicardic (but has a good pressure) do I have to remove it? Do I have the ability/obligation to remove a treatment started by the attending ER physician? Escort required? Other suggestions?

Question: I have been hearing a lot lately of BHPs telling PCP crews to give a drug (such as Epi) on a VSA when they call for a TOR. Even after reiterating that they were a PCP/BLS crew there still seemed to be some confusion. In some cases complicating the situation to the point where the misunderstanding seemed to lead to an order to transport as opposed to granting a TOR. Is there a better way to disseminate the differences to the doctors who may be taking the TOR or BHP patch (such as a card distributed to the doctors or a chart posted at the patch phones outlining what PCP crews can do vs. ACP crews)? I am sure it is as frustrating for the doctor taking the patch as it is for the crew trying to explain why they can't do what is being asked. Maybe something like this could help ease the whole process?

Question: When a patient presents with Subcutaneous Emphysema? Can we give A.S.A.? Patient has taken it before and there are no other contraindications. SubQ is sometimes caused by perforations in the digestive and/or respiratory system, so I'm thinking ASA would be contraindicated - just looking for your thoughts or if there is a precaution.

Question: This question is regarding cardiac arrest documentation expectations. Is it a requirement to document vital signs every 2 minutes or would it be sufficient to document one set with a comment: Patient remained pulseless throughout? As well, CPR charted once, with a similar comment: CPR performed throughout. In my opinion, this would be more efficient and concise.

As well, if in a position where we are transporting a VSA patient, as an ACP I have always performed a rhythm interpretation even while the vehicle is moving. I have never really noticed artifact as an issue, and cannot find any documentation relating to ACP practice stating I must pull over. I have not had any feedback from base hospital regarding this practice, but my supervisor has mentioned some serious concerns.

Thanks again for this forum that helps our practice.

Question: Do we have an idea when the iPhone app for our medical directives will be released. The majority of paramedics I know use iPhones and are anxiously waiting for this new tool. Any idea when?

Question: To what extent am I allowed to take orders from a physician who is riding out with me? Are there any set guidelines to direct us and the physicians in this aspect? A recent resident riding with me said they had no issue with providing the order if it seemed reasonable. Narcan administration was used as an example as something that seemed reasonable. However the resident felt (and I agreed) something like a TOR order warranted a call to a BHP. Discussion of this subject would be appreciated.

Question: I work out of a first response vehicle. If I start an IV to deliver a med such as gravol, and the patient will not require anymore treatment via IV and I am handing the patient over to a crew that is not IV certified what is my responsibility? Do I have to accompany the patient? Or can I lock the IV or can they monitor the IV TKVO?

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