18-Feb-2015 | SWORBHP Ask MAC

Date Archives: 18-Feb-2015

February 18, 2015 SWORBHP Category: Acute Cardiogenic Pulmonary Edema, CPAP | Date: 18-Feb-2015

Question: I have been talking with my paramedic colleagues and I am wondering about the role of CPAP and aspiration. My understanding of the Medical Directive is that CPAP is not indicated for pneumonia or aspiration but rather severe SOB from either COPD or pulmonary edema. Can you please clarify the role of CPAP for respiratory distress patients with either pneumonia or aspiration as the underlying precipitating factor for their SOB?

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February 18, 2015 SWORBHP Category: Moderate to Severe Pain | Date: 18-Feb-2015

Question: When administering Ketorolac, is it required that the medication is diluted prior to administration?

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Moderate to Severe Pain

February 18, 2015 SWORBHP Category: Cardiogenic Shock | Date: 18-Feb-2015

Question: As an Advanced Care Paramedic, can I administer dopamine IO?

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Cardiogenic Shock

February 18, 2015 SWORBHP Category: Adult Analgesia, Moderate to Severe Pain | Date: 18-Feb-2015

Question: My question relates to analgesia that I can provide patients as an ACP. If I have a patient that meets the indications and conditions for Morphine or Fentanyl under the ACP Core Pain Medical Directive, and if the patient’s discomfort is improving with the administration of the above narcotic analgesic, is it a requirement that I must proceed to administer Ketorolac?

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February 18, 2015 SWORBHP Category: Medical Cardiac Arrest | Date: 18-Feb-2015

Question: When managing a cardiac arrest as a PCP and following the Medical Cardiac Arrest Medical Directive, if the patient does not qualify for a TOR (shock delivered, ROSC obtained at some point etc.), why is it required to patch to the BHP (Mandatory Provincial Patch Point) for authorization to transport when it is clear that transport is the only option?

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Medical Cardiac Arrest

February 18, 2015 SWORBHP Category: Miscellaneous | Date: 18-Feb-2015

Question: There has been a great deal written lately about the use of the long spine board (LSB) and its use in prehospital care. Many jurisdictions have eliminated or curtailed the use of the LSB due to the lack of clinical evidence supporting its benefit and the growing evidence that it actually increases morbidity and mortality in many types of patients. When is MAC going to examine this issue and hopefully revise the Standards to reflect the current knowledge base?

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Answer:

Thanks for your excellent question. You have summarized very well the current debate with the use of the long backboard when transporting trauma patients in the pre-hospital environment.

You are absolutely correct that there is a paucity of high quality data indicating that long backboards prevent secondary spinal cord injury or are effective in achieving rigid spinal immobilization.

Further, there is evidence that the use of long backboards is not a benign therapy: skin breakdown, patient agitation, and respiratory compromise are among but a few of the adverse events that are associated with this equipment.

We are very much aware of the movement away from the routine use of the long backboard across EMS agencies internationally as well as the various position statements from organizations.

The SWORBHP Medical Council supports the National Association of EMS Physicians Position Statement with regards to the use of the long backboard. A link to this can be found here:

http://naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf

At this time in Ontario however, paramedics are required to follow the Basic Life Support Patient Care Standards (BLS-PCS) with regards to spinal immobilization. In section III, page 35 this document states that when spinal cord injury is obvious, suspect or cannot be ruled out, paramedics are required to immobilize the cervical spine with a rigid collar and further immobilize the thoraco-lumbar spine, pelvis and legs using a long backboard.

As a reminder, spinal immobilization is not a controlled medical act requiring delegation. Therefore, the use of the long backboard as well as the other standards listed within the BLS-PCS are not under the direct oversight of the OBHG MAC. Rather, the BLS-PCS are the responsibility of the Ontario Association of Paramedic Chiefs (OAPC) as well as the MOHLTC. The OBHG MAC is however involved in an advisory capacity.

As of today, the entire BLS-PCS is under review with a new version anticipated to be released by the MOHLTC within this calendar year. This work has been underway for over 3 years. To answer your specific question, the SWORBHP Medical Council as well as the OBHG MAC endorses the incorporation of the NAEMSP Position Statement into the BLS-PCS so that paramedics in Ontario can follow best practice recommendations with regards to the use of the long backboard.

Thanks again for your question and for your insights to the changing practice of trauma patient care.

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Miscellaneous