Category Archives: Miscellaneous

Question: I've heard the discussion among crews about allowing certain procedures to be performed on patients while still on EMS stretchers and on delay. I've received conflicting responses. I am perfectly fine with 12 lead, blood samples and going to x-ray while patient is with EMS. I'm not comfortable with any medications being given outside my scope of practice while under my care. Some crews say no "hospital" procedures are to be done until the patient is accepted by the ER. My personal opinion is that is possibly delaying patient care and causing more back up delays in the ER. I've received different opinions by our management. I know MAC cannot answer to service direction but what is the direction of MAC to what can or should be allowed to be performed by ER staff while under EMS care.

Question: Are MOOCs eligible for continuing education (CE) points?

Question: If TCP with Zoll E series, what are the steps to be taken when transferring care to the receiving facility? Procedure to switch to their machine?

Question: Why don't Base Hospital Doctors at either Hospital carry a cellphone so when paramedic's call for a physician patch that call goes directly to them instead of being routed to triage and then to the red phone at either hospital? I have had a couple of calls recently where by the time I was speaking to the Doctor we were almost at the hospital when I got the order. I think this would be a tremendous asset for the medics if we could have this option.

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.

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