AI

Question 1

What are the patient transport standards for CTAS 1 and 2 patients?

Answer 1

Move the patient to the stretcher using the most appropriate lift or carry, and transport the patient to and from the ambulance on the stretcher.

Question 2

What are the patient transport standards for CTAS 3-5 patients?

Answer 2

Transport the patient to and from the ambulance using the appropriate lift, carry, or ambulatory assistance with respect to the situation, the patient’s clinical condition, or for patient comfort.

Question 3

Who is allowed to operate the ambulance?

Answer 3

PCPs and ACPs.

EMR’s may operate smaller, motorized vehicles at the authorization of their supervisor.

Question 4

What should the medic do if a patient with capacity refuses treatment or transport?

Answer 4

• Make reasonable efforts to inform the patient or SDM that treatment and/or transport are recommended and explain the possible consequences of refusal. * Confirm that the patient or SDM has capacity utilizing the Aid to Capacity Assessment. * Advise the patient or SDM to call 911 again if further concerns arise. * Obtain signatures and complete additional documentation requirements as per the Ontario Documentation Standards.

The patient or SDM can refuse to sign the Refusal of Service section of the Patient Call Report, as there is no obligation on the patient or SDM to sign the Patient Call Report. Should this occur, the paramedic shall document the patient’s or SDM’s refusal and reason for failing to provide a signature.

Question 5

When should the medic carry out emergency treatment for an incapable patient without consent?

Answer 5

• The patient does not have capacity.
• The patient is apparently experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm.
• The delay required to obtain a consent or refusal on the patient’s behalf will prolong the suffering that the patient is apparently experiencing or will put the patient at risk of sustaining serious bodily harm.

Question 6

When should the medic carry out emergency treatment for a capable patient without consent?

Answer 6

• The patient is apparently experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm.
• The communication required in order for the patient to give or refuse consent cannot take place because of a language barrier or because the patient has a disability that prevents the communication from taking place.
• Steps that are reasonable in the circumstances have been taken to find a practical means of enabling the communication to take place, but no such means has been found.
• The delay required to find a practical means of enabling the communication to take place will prolong the suffering that the patient is apparently experiencing or will put the person at risk of sustaining serious bodily harm.
• There is no reason to believe that the patient does not want the treatment.

Question 7

What is the normal range for maintaining a patient’s oxygen saturation?

Answer 7

92-96%

Question 8

When should high concentration oxygen be continuously administered to a patient?

Answer 8

• Confirmed or suspected carbon monoxide or cyanide toxicity or noxious gas exposure
• Upper airway burns
• Scuba-diving related disorders
• Ongoing cardiopulmonary arrest
• Complete airway obstruction
• Sickle cell anemia with suspected vaso-occlusive crisis

Question 9

When should high concentration oxygen be administered to patients if pulse oximetry equipment is not functioning?

Answer 9

• Patients specified in paragraph 2
• Those with critical findings like age-specific hypotension, respiratory distress, cyanosis, altered level of consciousness, abnormal pregnancy or labor

Question 10

What is the target oxygen saturation range for patients with chronic obstructive pulmonary disease (COPD)?

Answer 10

88-92%

Question 11

What is the recommended oxygen flow rate for COPD patients with altered mental status or major trauma?

Answer 11

Two liters per minute above the patient’s home oxygen levels

Question 12

How often should the vital signs be reassessed for COPD patients?

Answer 12

Approximately every 10 minutes

Question 13

What should be done if a COPD patient’s status deteriorates or they indicate feeling worse?

Answer 13

Increase oxygen by increments of two liters per minute above starting level approximately every two to three minutes

Question 14

What should paramedics be prepared to do for COPD patients?

Answer 14

Ventilate

Question 15

What does “Regionally Designated Equivalent Hospital” mean?

Answer 15

An appropriately resourced hospital facility as defined by the Regional Trauma Network of Critical Care Services Ontario and included in a local PPS

Question 16

What does ‘Transport Time’ refer to?

Answer 16

The time from scene departure to time of arrival at destination.

Question 17

What is the purpose of the General Directive?

Answer 17

To provide guidance for field triage of patients injured by a traumatic mechanism or who show evidence of trauma.

Question 18

What criteria should the medic assess to determine if a patient needs transportation to a Lead Trauma Hospital (LTH) or regionally designated equivalent hospital?

Answer 18

• Patient does not follow commands
• Systolic blood pressure <90 mmHg
• Respiratory rate <10 or ≥30 breaths per minute or need for ventilatory support <20 in an infant aged <1 year

Question 19

List the anatomical criteria for assessing a patient’s need for transportation to an LTH or regionally designated equivalent hospital.

Answer 19

• Any penetrating injuries to head, neck, torso and extremities proximal to elbow or knee
• Chest wall instability or deformity (e.g. flail chest)
• Two or more proximal long-bone fractures
• Crushed, de-gloved, mangled or pulseless extremity
• Amputation proximal to wrist or ankle
• Pelvic fractures
• Open or depressed skull fracture
• Paralysis

Question 20

What should the medic do if unable to secure the patient’s airway or survival to the LTH or regionally designated equivalent hospital is unlikely?

Answer 20

Transport the patient to the closest emergency department despite other criteria.

Question 21

Under which circumstances should the patient be transported directly to an LTH or regionally designated equivalent hospital?

Answer 21

• Penetrating trauma to the torso or head/neck
• Vital signs absent yet not subject to Trauma Termination of Resuscitation (TOR)
• Land transport to the LTH or regionally designated equivalent hospital is estimated to be <30 minutes

Question 22

List the criteria to determine if the patient may require other support services at the LTH or regionally designated equivalent hospital as a result of his/her traumatic mechanism of injury.

Answer 22

• Falls:
  
  • Adults: falls ≥6 meters
  • Children (age <15): falls ≥3 meters or two to three times the height of the child
• High Risk Auto Crash:
  
  • Intrusion ≥0.3 meters occupant site; ≥0.5 meters any site, including the roof
  • Ejection (partial or complete) from automobile
  • Death in the same passenger compartment
  • Vehicle telemetry data consistent with high risk injury (if available)
  • Pedestrian or bicyclist thrown, run over or struck with significant impact (≥30 km/hr) by an automobile
  • Motorcycle crash ≥30 km/hr

Question 23

What special criteria should be considered in conjunction with the physiological, anatomical, and mechanism of injury criteria?

Answer 23

• Age:
  
  • Risk of injury/death increases after age 55
  • SBP <110 may represent shock after age 65
• Anticoagulation and bleeding disorders
• Burns with trauma mechanism: triage to LTH
• Pregnancy ≥20 weeks

Question 24

What is the maximum transport time allowed when determining the need for patient transport to an LTH or regionally designated equivalent hospital?

Answer 24

30 minutes, which may be amended to up to 60 minutes as per an ambulance service PPS but may not exceed 60 minutes.

Question 25

Where do canaPHEM medics transport patients?

Answer 25

They do not transport to hospitals or medical clinics.

Question 26

What are the operational criteria for requesting an on-scene air ambulance response?

Answer 26

* The land ambulance is estimated to require more than 30 minutes to reach the scene and the air ambulance can reach the scene quicker. * The land ambulance is estimated to require more than 30 minutes to travel from the scene to the closest appropriate hospital * And the air ambulance helicopter can reach the scene and transport the patient to the closest appropriate hospital quicker than the land ambulance. * The estimated response for both land and air is estimated to be greater than 30 minutes, but approximately equal, and the patient needs care which cannot be provided by the responding land ambulance. * There are multiple patients who meet the clinical criteria and the local land ambulance resources are already being fully utilized.

Question 27

What are the clinical criteria for requesting an on-scene air ambulance response?

Answer 27

* Patients meeting the criteria listed in the Field Trauma Triage Standard. * Patients meeting one or more of the medical criteria including shock, acute stroke with a clearly determined time of onset, altered level of consciousness, acute respiratory failure or distress, suspected STEMI or potentially lethal dysrhythmia, resuscitation from respiratory or cardiac arrest, status epilepticus, unstable airway or partial airway obstruction. * Patients meeting one or more of the obstetrical criteria including active labour with abnormal presentation, multiple gestation and active labour, umbilical cord prolapse, significant vaginal bleeding.

Question 28

What are the steps to assess if an on-scene air ambulance helicopter is appropriate?

Answer 28

1. Determine the perceived severity of the reported injuries and without confirmation that the clinical criteria have been met, or 2. Establish if the patient cannot reasonably be reached by land ambulance (e.g. sites without road access such as islands; geographically isolated places, etc.)

Question 29

What steps should be followed when requesting an on-scene air ambulance helicopter response?

Answer 29

1. Provide the ACO with the information set out in operational and clinical criteria above. In order for the ACO to determine if an air ambulance response and transport will be quicker than land ambulance, the paramedic will provide the ACO with the estimated time to prepare the patient for transport, identify separately any time required for patient extrication, provide the estimated land ambulance driving time to the closest appropriate hospital and any additional information as required. 2. The paramedics shall not delay patient transport by waiting for the air ambulance helicopter, unless the air ambulance helicopter can be seen on its final approach to the scene. If the air ambulance helicopter is en route but not on final approach to the scene, and the land paramedics have the patient in his/her ambulance, then the land ambulance will proceed to the closest local hospital with an emergency department. The air ambulance helicopter will proceed to that local hospital and, if appropriate, assist hospital personnel prepare the patient for rapid evacuation. 3. While en route to the local hospital, paramedics may rendezvous with the air ambulance helicopter if, i. the air ambulance helicopter is able to land along the direct route of the land ambulance; and ii. it would result in a significant reduction in transport time to the most appropriate hospital.

Question 30

What should be done if the call's circumstances and patient(s) fail to meet the criteria for an on-scene air ambulance helicopter response?

Answer 30

Contact the CACC/ACS and advise that an on-scene air ambulance helicopter response is not required and provide an explanation.

Question 31

What are the guidelines for air ambulance helicopter landing site safety and coordination?

Answer 31

The medic shall follow the guidelines set out by the Ornge Aviation Safety Department, which can be found on Ornge's "Aircraft Safety" website at: [https://www.ornge.ca/aircraft-safety](https://www.ornge.ca/aircraft-safety).

Question 32

What are the other uses of air ambulance helicopters?

Answer 32

* Air ambulance helicopters are not permitted to respond to night calls which require a landing at a site other than night licensed airports, helipads or night approved remote landing sites. * Air ambulance helicopters are not permitted to conduct search and rescue calls. * In cases where a land ambulance can reach the patient(s) and an on-scene response by air ambulance helicopter is appropriate, the ACO will assign a land ambulance and continue the land response until the flight crew requests that the land ambulance be cancelled. * In cases where a land ambulance arrives on-scene prior to the air ambulance helicopter, paramedics shall inform the CACC/ACS as clinical events occur.