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Category Archives: Miscellaneous

April 24, 2012 SWORBHP Category: Miscellaneous | Date: 24-Apr-2012

Question: When a hospital is on "consideration" and we are not accepted by this particular hospital due to their CTAS score or related clinical condition and they are to deteriorate while en-route to the next receiving hospital. What liability do we as paramedics wear in these situations?

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Miscellaneous

March 1, 2012 SWORBHP Category: Miscellaneous | Date: 1-Mar-2012

Question: When is the "new" treatment algorithm ALS/BLS for Medical Cardiac Arrest being posted?

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Miscellaneous

February 21, 2012 SWORBHP Category: Miscellaneous | Date: 21-Feb-2012

Question: I’m not comfortable having to make critical decisions in the field, on calls that are few and far between, yet serious in nature. Is SWORBHP doing anything along with MOHLTC to advocate for regular training days to be a part of our regular schedule and duties? I'm all for continuing self-study, however, since so much of our job is practical application, don’t you think it is wise to give your paramedics practical practice? As an aside, in my opinion, insufficient funds is an unacceptable excuse not to. Fire and Police have always had ample training time, and we are just as important to public welfare. So could it be possible for all parties to come together and find the funds necessary? Thank you for creating this site and allowing me to put this issue forward.

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Answer: Well first, thank you for submitting this question. If you are feeling this way, for certain other paramedics within the SWORBHP region feel the same.

Short answer: we completely agree with you. We do think it is wise for more “practical practice” and we wish we had more education time with all the paramedics within the SWORBHP region. In fact, planning for this coming year’s recert day is already well under way and we are looking at implementing a practical “skills review” as part of the day to meet this very need you describe.

In the interim, if a paramedic is not feeling comfortable making critical decisions in the field, what are their options?

First, the educators at SWORBHP and the Medical Directors need to hear from you. Paramedics should not fear deactivation or decertification from the BH if a paramedic highlights that they feel a need for further education. The time has come for this culture of fear to end. This is all about patient safety. What is the worst that is going to happen? We are not your employer; all we can do is educate you until we have exhausted every opportunity. We would much rather hear from you now before a quality assurance investigation uncovers an adverse event.

Depending upon the perceived need and situation, SWORBHP can team you with a Regional Paramedic Educator for scenario/skill review and/or Medical Directors are willing to have paramedics accompany them on emergency department shifts where various clinical situations can be reviewed and discussed in real time.

In some services, service educators/peer mentors are another option if paramedics are still apprehensive about approaching the BH.

If it were up to us, the SWORBHP would prefer to have far greater hours to provide you with “practical practice” as you request. With that said, not every paramedic wants this as you would seem to prefer (and we wish more paramedics felt the same as you!). Some paramedics view this “practical practice” as testing and we all know how paramedics dislike tests!

As much as you don’t want to talk about funding, it is an issue. Paramedics are paid to be educated. Base Hospital Programs are funded to provide only a certain number of hours per year to each paramedic. The Program Manager from SWORBHP and a Medical Director from the Provincial MAC have been lobbying the MOHLTC-EHS and are creating a business case for more training dollars for more class time for paramedics. The scope of practice and sophistication of the Medical Directives have been increasing exponentially for years and we think (like you do) that the time has come for more training hours.

In fairness, we also have a problem when we provide education in a voluntary fashion with little turn out. When SWORBHP provides webinars, rounds or other CE opportunities like on Stroke etc….turn out is poor. Our typical webinar which takes hours and hours to prepare to ensure the information is evidence based and current usually has 40-50 paramedics log in out of the 1300-1400 paramedics within the SWORBHP region.

Bottom line: let us help you. We often don’t know the paramedic in need of further education until it is too late!

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Miscellaneous

February 21, 2012 SWORBHP Category: Miscellaneous | Date: 21-Feb-2012

Question: I was talking to an ACP who informed me a standard of care I had not heard of. He told me that all Obstetrical patients who have a syncopal episode should have a 12 lead done. He also said that 12 lead can be done pretty much on anyone. I was under the impression that 12 leads were to be done on patient's with chest pain. or symptoms consistent with ischemia. From what he was saying I was getting the impression that we should be doing 12 leads on most people to rule out any underlying cardiac conditions.

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Answer: This is a terrific question. Part of the confusion surrounding ECG acquisition is that in the previous set of directives, there was a specific 12 lead Acquisition Protocol which specified when an ECG should be considered.

The indications were:
1. An alert patient experiencing chest pain or other symptoms consistent with that caused by cardiac ischemia OR experiencing his or her typical angina/MI pain.
2. A patient whose 3 or 5 lead ECG shows a rhythm which is difficult to interpret

In the most recent set of directives, there is no longer a dedicated 12-lead ECG protocol, however consideration for 12-lead acquisition (if available) is mentioned in a number of areas including the cardiac ischemia directive.

To be absolutely clear, a 12-lead ECG should be performed where indicated in the new Advanced Patient Care Standards. This would be considered the minimum, and for those searching for a concrete answer as to when to acquire a 12-lead ECG, you can stop reading now because that is as clear as we can get on this topic.

With that said the SWORBHP Medical Council would suggest that the 12-lead ECG provides valuable information to receiving ED physicians and ultimately provides benefit to the patient in a variety of other clinical situations. While we would not advocate acquiring a 12-lead ECG on anyone and everything, we do believe that a more liberal use of the 12-lead ECG is reasonable as long as it can be acquired in a reasonable time frame (not prolonging scene time) and the patient is hemodynamically stable.

We cannot create an exhaustive list of these clinical situations, nor would the SWORBHP Professional Standards cite a paramedic for acquiring or not acquiring a 12-lead as long as the above criteria are met (short scene time and stable patient).

Clinical situations we would consider a 12-lead ECG reasonable in an otherwise stable patient would include (again not an exhaustive list, paramedics should use judgment): suspected OD, tachycardia, bradycardia, suspected block or arrhythmia, syncope (not just pregnant patients), suspected electrolyte disorders (example dialysis patient).

Remember, the 12-lead ECG is a tool, and another “piece of the puzzle”. It should not change a paramedic’s management in isolation if normal or abnormal outside of areas where a STEMI bypass protocol is in place. For example, if a patient does not have chest pain but for some reason a 12-lead is acquired and it is abnormal, this does not mean the patient is having ischemia and requires ASA or NTG. Alternatively, if the patient is having chest pain and the 12-lead is normal, this does not eliminate the possibility that the chest pain is ischemic and if the conditions are met by the Cardiac Ischemia Directive, then ASA and NTG should be considered.

For more information about 12-lead ECG, please see the WEBINAR on 12-Lead ECG which was presented by Dr. Davis and Dr. Lewell in November 2011 here:
http://www.lhsc.on.ca/About_Us/Base_Hospital_Program/Education/Paramedic_Rounds.htm

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Miscellaneous

February 15, 2012 SWORBHP Category: Miscellaneous | Date: 15-Feb-2012

Question: In performing your ABCs on unconscious patients, the BLS has never clarified whether, after checking the airway you should, insert an airway then go to breathing OR go to breathing, insert 2 breaths, then insert an airway. Can you finally put an end to this debate?

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Miscellaneous

February 15, 2012 SWORBHP Category: Miscellaneous | Date: 15-Feb-2012

Question: Can you explain what this part in the consent section means? It seems to give more flexibility to not begin resuscitation based on family members who seem reliable saying that that is what the patient wanted. "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)."

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Miscellaneous

January 31, 2012 SWORBHP Category: Miscellaneous | Date: 31-Jan-2012

Question: Can we please have our standing order pocket booklets? I know I speak for dozens of medics in this regard. We really need them with so many changes in place.

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Miscellaneous

January 19, 2012 SWORBHP Category: Miscellaneous | Date: 19-Jan-2012

Question: What was the rational for all the little tweaks to this years symptom relief protocols? For example, removing 100mcg from the Ventolin protocol?

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Miscellaneous

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