BLS Section 1 AI Flashcards
What is the primary responsibility of a paramedic?
Conserve life, alleviate pain and suffering, and promote health
This represents the fundamental duty of paramedics in their practice.
What should a paramedic protect and maintain regarding the patient?
Patient’s safety, dignity, and privacy
These elements are crucial for ethical patient care.
Care provided by a paramedic should be based on what principle?
Human need with respect for human dignity
This emphasizes the importance of treating patients with respect.
What qualities should a paramedic demonstrate towards patients and their families?
Empathy and compassion
These qualities enhance the patient care experience.
Until when should a paramedic provide patient care?
Until it is no longer required or another qualified health care professional has accepted responsibility
This ensures continuity of care.
What values should a paramedic discharge their duties with?
Honesty, diligence, efficiency, and integrity
These values are essential for maintaining trust in the profession.
How should a paramedic conduct themselves to gain public respect?
Conduct and present oneself in a manner that encourages respect
Professional demeanor is key to public perception.
What is important for a paramedic to establish with colleagues and the public?
Good working relationships
Collaboration is vital for effective healthcare delivery.
What responsibility does a paramedic have regarding personal and professional development?
Assume responsibility including quality assurance initiatives
This includes reporting patient safety incidents.
A paramedic should maintain familiarity with what aspects of their profession?
Current applicable legislation and practice
Staying updated is crucial for legal and effective practice.
What should a paramedic do if they observe incompetent or unethical conduct?
Report it to the ambulance service operator and/or base hospital
This is essential for maintaining professional standards.
What should a paramedic not do regarding their level of certification?
Practice beyond his/her level of certification
What is a paramedic’s obligation towards persons requiring services?
Refuse or neglect to serve persons requiring services that are part of the normal performance of his/her duties
What is prohibited regarding documentation by a paramedic?
Falsify documentation of any kind
What must a paramedic not misrepresent?
Qualifications or credentials
What type of behavior is a paramedic prohibited from exhibiting?
Threaten or use violent behaviour
What is a paramedic not allowed to take or possess?
Drugs from the ambulance service without authorization
What is considered Confidential Information?
Identifying information about an individual, personal health information, and non-public information obtained through one’s position as a paramedic
What should a paramedic do if unsure about disclosing Confidential Information?
Refrain from disclosing the Confidential Information and consult with the ambulance service operator
What type of contact is prohibited between a paramedic and a patient?
Any form of inappropriate sexual contact, relations or impropriety
What type of conduct is a paramedic expected to avoid?
Any other conduct unbecoming of a paramedic
Fill in the blank: A paramedic must not _______ to serve persons requiring services.
Refuse or neglect
True or False: A paramedic can disclose Confidential Information at their discretion.
False
What should a paramedic do upon receipt of a call?
Confirm call information with the CACC/ACS
CACC: Central Ambulance Communications Centre, ACS: Ambulance Communication System
What are the driving protocols a paramedic must adhere to while operating an ambulance?
Use an appropriate route and speed, adhere to approved driving and occupant restraint policies, operate ambulance emergency warning systems responsibly
These protocols ensure the safety of the paramedic and others on the road.
What must a paramedic assess upon arrival at the scene?
The environment and identify routes of access and egress
This ensures safe entry and exit for both the paramedic and the patient.
What is the first action a paramedic should take regarding safety at the call environment?
Ensure the call environment is safe with no danger to self or others
What should a paramedic do if there is danger or uncertainty regarding safety?
Request assistance from allied emergency services and maintain communication with CACC/ACS
What equipment must a paramedic bring to the point of initial patient contact?
Equipment required to establish baseline vital signs and perform defibrillation
How should a paramedic determine any additional equipment needed for a call?
Use call and scene information to identify additional equipment likely required
What should a paramedic do if there is more than one patient?
Make requests to CACC/ACS for additional resources or assistance
What type of equipment must paramedics utilize according to the Patient Care and Transportation Standards?
Personal protective equipment (PPE)
What should a paramedic do upon introducing themselves to a patient?
Obtain consent for patient care as per the Health Care Consent Act, 1996 (Ontario)
What communication techniques should a paramedic employ?
Proper, effective communication techniques to establish patient trust
How should a paramedic protect the patient during care?
Protect the patient from hazards and exposure to adverse environmental conditions
What should be referenced for scene responses involving hazardous materials?
Transport Canada Emergency Response Guidebook
What must a paramedic ensure regarding the use and disposal of equipment?
Safe use and disposal of equipment (e.g. sharps)
What hygiene practice must a paramedic perform?
Hand hygiene as per the Patient Care and Transportation Standards
What should the paramedic assume about the patient’s condition?
The existence of serious, potentially life-, limb- and/or function-threatening conditions.
What types of observations should a paramedic make at the scene?
Scene observations relevant to the patient’s status.
What is the first step in identifying a patient?
Determine the patient’s name, sex, age (or approximate), and weight (or approximate).
What vital signs should be established if immediate intervention is not required?
Baseline vital signs, which include:
* heart rate
* respiration rate
* blood pressure (BP)
* Pulse oximetry (SpO2)
* Glasgow Coma Scale (GCS)
* pupils
* skin colour and condition.
What should be assessed during the primary survey?
Airway patency, breathing, circulation, and level of consciousness.
What actions should a paramedic take upon identifying life-threatening concerns?
Perform critical interventions as per the Patient Management Standard.
What is included in the history of present illness or incident?
Treatment prior to arrival.
True or False: A paramedic should always establish baseline vital signs.
False.
What should a paramedic do if the patient is febrile or experiencing hyperthermia?
Obtain the patient’s temperature.
What should be done if a critical intervention is provided during a call?
Reassess the patient’s airway patency, breathing, circulation, level of consciousness, and consider further assessment or management.
What types of calls typically warrant a cardiac monitor?
Types of calls include:
* All vital signs absent (VSA) patients
* Unconscious or altered level of consciousness
* Collapse or syncope
* Suspected cardiac ischemia
* Moderate to severe shortness of breath
* Cerebrovascular accident (CVA)
* Overdose
* Major or multi-system trauma
* Electrocution
* Submersion injury
* Hypothermia, heat exhaustion or heat illness
* Abnormal vital signs as per the ALS PCS
* If requested by sending facility staff.
What is the purpose of the secondary survey?
To assess patient status or as required by the Standards.
How often should vital signs be reassessed?
Every 30 minutes at a minimum, and more frequently as required.
Fill in the blank: A paramedic should seek _______ for medical information.
[medical information tags]
What should a paramedic do if the patient exhibits signs of cardiovascular, respiratory, or neurological compromise?
Auscultate the patient’s lungs for air entry and adventitious sounds.
What should a paramedic do if the patient is vital signs absent (VSA) and meets ‘obvious death’ criteria?
Follow the procedures outlined within the Deceased Patient Standard
This refers to the specific criteria and protocols for handling deceased patients.
What is required if a patient has a MOH Do Not Resuscitate (DNR) Confirmation Form?
Refer to the Do Not Resuscitate (DNR) Standard
This standard outlines the procedures to follow for patients with DNR orders.
What are the critical interventions a paramedic must perform to establish/improve and maintain airway patency, ventilation, and circulation?
- Protect C-spine if indicated
- Initiate CPR as per guidelines
- Clear airway obstructions
- Ventilate or assist ventilations
- Control trauma-related external hemorrhage
Each of these interventions is guided by specific standards.
What standard should be followed for performing CPR?
Current Heart and Stroke Foundation of Canada Guidelines and Cardiac Arrest Standards
These guidelines provide the necessary steps and considerations for performing CPR.
What should be done to clear airway obstructions?
Follow the Airway Obstruction Standard, focusing on suctioning as necessary
This includes managing saliva, blood, and vomit.
What standard should be followed for administering oxygen therapy?
Oxygen Therapy Standard
This standard outlines how to properly administer oxygen in emergency situations.
What conditions should be managed if they threaten life, limb, or function?
Management as outlined in other sections of the Standards and the ALS PCS
ALS PCS refers to Advanced Life Support Patient Care Standards.
What are the key positions to support in patient management?
- C-spine alignment
- Airway patency
- Breathing
- Venous return and perfusion
- Extremity injury
- Patient comfort
Proper positioning can significantly impact patient outcomes.
What should be done if the patient is stable?
Initiate management on-scene for non-critical conditions
This allows for addressing less urgent medical needs while maintaining care.
What must be done continually during patient management?
Monitor the patient and provide assessment and management as required
Continuous monitoring is essential for assessing changes in patient condition.
What should a paramedic give a patient if indicated by the Standards or ALS PCS?
Give the patient nothing by mouth
This is to avoid complications, especially in critical situations.
What is the importance of maintaining a comfortable temperature for the patient?
To ensure patient comfort or as required by the Standards
Temperature regulation can be vital in patient care.
What does CTAS stand for in the context of patient transport?
Canadian Triage and Acuity Scale
CTAS is used to prioritize patient care based on the severity of their condition.
What is the first step a paramedic must take according to the Patient Transport Standard?
Determine CTAS level (CTAS Depart Scene) as per Prehospital CTAS Paramedic Guide.
What should a paramedic do if confirmation or direction cannot be obtained from an ACO?
Transport to the closest or most appropriate hospital capable of providing the medical care apparently required by the patient.
What must a paramedic collect and transport for review by receiving facility staff?
All relevant patient medications, record of medications, and any other relevant identification and medical records.
In inter-facility transfers, when should a medically-responsible escort be requested?
When the patient’s current care requirements exceed the paramedic’s level of certification.
List the information and/or transfer documents to obtain for inter-facility transfers.
- Name of sending physician
- Verbal and/or written treatment orders from the sending physician
- Transfer paper (e.g., case summary, lab work, x-rays, list of personal effects)
- Name(s) of facility staff and list of equipment accompanying the patient
- Name of receiving facility and receiving physician
How should CTAS 1 and 2 patients be moved to the stretcher?
Using the most appropriate lift or carry.
What is the transport protocol for CTAS 1 and 2 patients to and from the ambulance?
Transport the patient to and from the ambulance on the stretcher.
What method should be used to transport CTAS 3-5 patients to and from the ambulance?
Using the appropriate lift, carry, or ambulatory assistance based on the situation, patient’s clinical condition, or for patient comfort.
During inter-facility transfers, how should the patient be transported to and from the ambulance?
On the stretcher.
What must be ensured regarding the patient, stretcher, equipment, and occupants inside the ambulance?
They must be secured inside the ambulance.
What is expected of the paramedic during transport?
Attend to the patient at all times.
What support should a paramedic provide in the patient compartment?
Support to an escort or team if the patient is under the care of a medical escort or transfer team.
What should be done if the patient deteriorates during transport?
Transport to the closest or most appropriate hospital and notify CACC/ACS of any destination change.
What conditions must be maintained in the patient compartment during transport?
Temperature and lighting conditions which are comfortable for the patient.
What must a paramedic do if a patient refuses treatment and/or transport?
Make reasonable efforts to inform the patient or SDM that treatment and/or transport are recommended and explain the possible consequences of such refusal
SDM stands for Substitute Decision Maker.
How should a paramedic confirm the patient’s capacity?
Utilizing the Aid to Capacity Assessment as per the Ambulance Call Report Completion Manual.
What should a paramedic advise the patient or SDM to do if further concerns arise?
Advise the patient or SDM to call 911 again.
What documentation must a paramedic complete when a patient or SDM refuses treatment?
Obtain signatures and complete additional documentation requirements as per the Ontario Documentation Standards and the Ambulance Call Report Completion Manual.
True or False: A patient or SDM is obligated to sign the Refusal of Service section of the Ambulance Call Report.
False.
What actions should a paramedic take if a patient does not have capacity and requires emergency treatment?
Carry out emergency treatment and transport if the patient is experiencing severe suffering or is at risk of sustaining serious bodily harm.
What must be documented when a paramedic carries out emergency treatment for an incapable patient?
Document the circumstances that led to the decision.
Under what conditions can a paramedic provide emergency treatment to a capable patient without consent?
If the patient is experiencing severe suffering, communication cannot take place due to a barrier, reasonable steps to enable communication have failed, delay would prolong suffering, and there is no reason to believe the patient does not want treatment.
What should a paramedic document when treating a capable patient without consent?
Document the circumstances that led to the decision.
What is the requirement for reporting while en route to the receiving facility for CTAS 1 and CTAS 2 patients?
Transmit a report that includes unit number identification, patient age, patient sex, CTAS level, chief complaint, pertinent history, pertinent assessment findings, pertinent management and response to management, abnormal vital signs, and estimated time of arrival
CTAS stands for Canadian Triage and Acuity Scale, which helps prioritize patient care based on urgency.
What must be included in the report for CTAS 1 and CTAS 2 patients?
- Unit number identification
- Patient age
- Patient sex
- CTAS level
- Chief complaint
- Pertinent history
- Pertinent assessment findings
- Pertinent management and response to management
- Abnormal vital signs
- Estimated time of arrival
These elements ensure comprehensive communication of patient status and needs.
What must the paramedic confirm after transmitting the report?
That the receiving facility or ACO has acknowledged the report
ACO refers to Advanced Care Options, which may include various facilities or services.
What action should be taken if a patient’s CTAS changes to a higher acuity?
Provide additional reports
This ensures that the receiving facility is updated on the patient’s changing medical condition.
What should paramedics recognize regarding regulated health professionals?
The training and qualifications of the regulated health professional
Examples include physician, nurse, midwife, respiratory therapist.
What is the first step a paramedic must take when involved with a regulated health professional?
Determine the nature of the request for ambulance services.
What confirmation must paramedics obtain from the regulated health professional?
That the regulated health professional is a registered member of his/her College within Ontario and that the patient is under his/her care.
To what extent should paramedics assist regulated health professionals?
Only to the level in which the paramedic is authorized.
What must paramedics document on the Ambulance Call Report?
The name of the regulated health professional, type of regulated health professional, and any care provided by the regulated health professional.
What should a paramedic do upon arrival at the receiving facility?
Liaise with receiving facility staff to determine the patient’s destination within the receiving facility.
What is a key action for paramedics while awaiting acceptance from receiving facility staff?
Attend to the patient.
What information should be included in the verbal report to receiving facility staff?
Patient name, age, sex, CTAS, chief complaint, concise history, pertinent assessment findings, management performed, vital signs, reason for transfer.
What should paramedics provide in addition to the verbal report?
A copy of any clinically relevant associated biometric data collected.
If there is a prolonged delay in accepting the patient, what should paramedics do?
Advise CACC/ACS and receiving facility, seek further assistance from ambulance service operator, request to contact sending physician or family physician.
What is the procedure for transferring the patient to the receiving facility?
Transfer the patient from the stretcher where applicable.
What items should be transferred to the receiving facility along with the patient?
Patient medications, record of medications, relevant identification, medical records, and other belongings.
When is the Transfer of Care considered complete?
Upon completion of all specified paragraphs and when the patient is no longer dependent on ambulance service resources.
What should paramedics do with transfer documentation?
Transfer documentation to the receiving facility as per the Ontario Ambulance Service Documentation Standards.
What must the paramedic complete as per the Ontario Ambulance Documentation Standards?
Documentation as per the Ontario Ambulance Documentation Standards and the Ambulance Call Report Completion Manual
This includes documenting clinical responses to treatment and procedures performed.
What instances must be documented on the Ambulance Call Report?
All instances of threatened violence
This ensures proper reporting and accountability in emergency situations.
What should be documented for inter-facility transfers?
Pertinent patient history and care information, receipt of transfer papers, name(s) of escort and transport team members, and list of equipment accompanying the patient
These documents are essential for continuity of care.
How should a paramedic utilize patient care equipment?
Utilize all equipment as trained by the ambulance service operator and base hospital, and as per manufacturer specifications
This ensures the safety and efficacy of the equipment used.
What is the target oxygen saturation for patients receiving oxygen therapy?
Maintain oxygen saturation between 92-96%, unless specified otherwise
This is measured by SpO2.
When should a paramedic continuously administer high concentration oxygen?
For patients with confirmed or suspected carbon monoxide or cyanide toxicity, upper airway burns, scuba-diving disorders, ongoing cardiopulmonary arrest, complete airway obstruction, and sickle cell anemia with suspected vaso-occlusive crisis
High concentration oxygen is critical in these life-threatening situations.
What should a paramedic do if pulse oximetry equipment is not functioning?
Administer high concentration oxygen to specified patients and those with critical findings
Critical findings include age-specific hypotension and altered level of consciousness.
What is the oxygen saturation target for patients with COPD experiencing increased dyspnea?
Titrate oxygen to achieve an oxygen saturation between 88-92%
Adjustments may be made based on the patient’s home oxygen levels.
What is defined as ‘Regionally Designated Equivalent Hospital’?
An appropriately resourced hospital facility as defined by the Regional Trauma Network of Critical Care Services Ontario
This designation ensures that patients receive appropriate trauma care.
What is the maximum estimated transport time to a Lead Trauma Hospital for direct transport?
<30 minutes
This guideline is crucial for timely trauma care.
What physiological criteria must a paramedic assess in trauma patients?
Patient does not follow commands, systolic blood pressure <90mmHg, respiratory rate <10 or ≥30 breaths per minute
These criteria help determine the severity of the patient’s condition.
What anatomical injuries warrant direct transport to a Lead Trauma Hospital?
Penetrating injuries to head, neck, torso, chest wall instability, two or more proximal long-bone fractures, crushed extremity, amputation proximal to wrist/ankle, pelvic fractures, open skull fractures, paralysis
These criteria are crucial in identifying severe trauma cases.
What mechanism of injury criteria may indicate the need for transport to a Lead Trauma Hospital?
Falls ≥6 metres for adults, falls ≥3 metres for children, high risk auto crash, pedestrian or bicyclist struck with significant impact, motorcycle crash ≥30 km/hr
These factors are important for assessing trauma risks.
What special criteria should be considered for trauma patients?
Age over 55, SBP <110 after age 65, anticoagulation and bleeding disorders, burns with trauma mechanism, pregnancy ≥20 weeks
These criteria help identify patients at higher risk for complications.
What is the maximum transport time that may be extended to for ambulance service PPS?
Up to 60 minutes
This extension may only be applied under specific circumstances.
What are the operational criteria for requesting an on-scene air ambulance response?
At least one of the following:
* Land ambulance requires more than 30 minutes to reach the scene
* Land ambulance requires more than 30 minutes to transport from the scene to the closest hospital
* Both land and air response times are greater than 30 minutes, but patient needs care not provided by land ambulance
* Multiple patients meet clinical criteria and land ambulance resources are fully utilized
These criteria ensure that air ambulances are utilized effectively in time-sensitive situations.
What clinical criteria must a patient meet for an air ambulance response?
One or more of the following:
* Patients meeting Field Trauma Triage Standard
* Medical conditions such as shock, acute stroke, altered consciousness, acute respiratory failure, and unstable airway
* Obstetrical conditions like active labor with abnormal presentation and significant vaginal bleeding
These criteria help assess the urgency and appropriateness of air ambulance transport.
True or False: An air ambulance can respond to night calls at any location.
False
Air ambulance helicopters are restricted from responding to night calls unless landing at night licensed airports, helipads, or approved remote sites.
What should paramedics do if the air ambulance response criteria are not met?
Contact the CACC/ACS to advise that an on-scene air ambulance response is not required
This helps manage resources efficiently and prevents unnecessary air ambulance deployment.
What is spinal motion restriction (SMR) and when should it be considered?
SMR should be considered for any patient with potential spine or spinal cord injury based on mechanism of injury, such as:
* Trauma with neck or back pain
* Sports accidents
* Diving incidents
* Explosions
* Falls
* Electrocution
* Penetrating trauma
SMR is a critical protocol to minimize further injury to the spine.
List any three risk criteria that may indicate the need for spinal motion restriction.
- Neck or back pain
- Neurologic signs or symptoms
- High-energy mechanism of injury
Identifying these criteria helps in assessing the need for spinal protection.
Fill in the blank: If a patient meets the criteria for SMR but does not meet any risk criteria, do not apply _______.
SMR
This protocol helps to avoid unnecessary immobilization.
What should paramedics do if a patient has penetrating trauma to the head, neck, or torso?
Determine if the patient exhibits all of the following:
* No spine tenderness
* No neurologic signs or symptoms
* No altered level of consciousness
* No evidence of drug or alcohol intoxication
* No distracting painful injury
* No anatomic deformity of the spine
If all criteria are met, SMR is not applied.
True or False: Using SMR means the paramedic has cleared the spine for blunt trauma patients.
False
SMR is to manage the patient to minimize spinal movement, not to ‘clear’ the spine.
What documentation should paramedics provide regarding neurologic status in relation to SMR?
Document the neurologic status before and after SMR on the Ambulance Call Report
This ensures a record of the patient’s condition and the effects of SMR.
What are spinal boards primarily used for?
Extrication/patient lifting devices
They should be removed from patients as soon as it is safe to do so.
When can a spinal board remain in place during transport?
If deemed safer/more comfortable for the patient with short transport times (<30 min)
Consideration should be given to patient comfort and clinical condition.
What should be done for patients with suspected pelvic fractures?
Secured on a spinal board or adjustable break-away stretcher as per the Blunt/Penetrating Injury Standard
What positions can a patient with SMR be placed in?
Semi-sitting or supine position
Depends on patient comfort and clinical condition.
What should be applied to an unresponsive or uncooperative patient?
Manual C-spine immobilization until appropriate SMR has been applied
When should cervical collars be placed on a patient?
Prior to movement, if possible
What is allowed for patients in an MVC with isolated neck or back pain?
Self-extricate using a stand, turn, and pivot onto the stretcher
Patients should be coached to maintain neutral spinal alignment.
What should be assessed for patients who had a spinal board applied by a first responder?
Assessment for SMR as per the Standard
Can SMR be modified for patients undergoing inter-facility transfers?
Yes, in consultation with the sending physician
What should be done for markedly agitated or combative patients?
Apply SMR to the best of ability and secure the patient to the stretcher with straps
What does DNR stand for?
Do Not Resuscitate
What is the definition of Cardiopulmonary Resuscitation (CPR)?
Immediate application of life-saving measures to a person who has suffered sudden respiratory or cardiorespiratory arrest
Measures include chest compression, defibrillation, artificial ventilation, and more.
What does a Valid MOH DNR Confirmation Form require?
Completion with specific patient and treatment information
Must include patient name, conditions met, and signatures of healthcare professionals.
What must be checked on the DNR Confirmation Form regarding treatment plans?
A current plan of treatment reflecting the patient’s wishes or a physician’s opinion that CPR will not benefit the patient
What information must be included on the DNR Confirmation Form?
- Patient’s full name
- Checked condition box
- Professional designation of signer
- Printed name of signer
- Signature of signer
- Date signed
True or False: A DNR Confirmation Form can be a copy of a fully completed original.
True
What must a paramedic do upon obtaining a Valid MOH DNR Confirmation Form?
SHALL NOT initiate CPR on the patient in respiratory or cardiorespiratory arrest for at least three minutes.
Under what conditions should a paramedic initiate CPR on a patient with a Valid MOH DNR Confirmation Form?
When the patient appears capable and expresses a wish to be resuscitated, or if the request is vague, incomplete, or ambiguous.
What is the paramedic required to provide to the patient according to their clinical condition?
Patient management necessary to provide comfort or alleviate pain.
What should a paramedic do once it is determined that death has occurred?
Advise the CACC/ACS and follow the Deceased Patient Standard.
Define ‘Deceased Patient’.
A patient who is obviously dead, subject of a medical certificate of death, without vital signs with a DNR Confirmation Form, or subject to a TOR or Withhold Resuscitation Order.
What does ‘Expected Death’ mean?
A death that was imminently anticipated, generally due to a progressive end stage terminal illness.
What are gross signs of death that indicate a patient is ‘Obviously Dead’?
- Decapitation
- Transection
- Visible decomposition
- Absence of vital signs with grossly charred body
- Open head or torso wound
- Gross rigor mortis
- Dependent lividity
What is a ‘Termination of Resuscitation (TOR) Order’?
An order given by a Base Hospital Physician to stop resuscitation measures.
What is the role of a ‘Responsible Person’ in the context of a Deceased Patient?
An adult capable of remaining with the Deceased Patient and assuming responsibility.
What should a paramedic do in cases of unexpected death?
- Advise CACC/ACS of the death
- Remain at the scene until the coroner arrives
- Depart if police are present and have secured the scene
What is the protocol for expected death notifications?
- Advise CACC/ACS of the death
- Request a Responsible Person to notify the primary care practitioner or Palliative Care Team
- Document the circumstances of the death if requested by the coroner
What specific considerations should a paramedic take for pediatric patients?
- Aware of pediatric anatomy and physiology problems
- Respiratory arrest is the primary cause of cardiac arrest
- Recognize normal vital signs
- Assess for various specific signs
Fill in the blank: A paramedic shall conduct a full secondary survey from _______.
[toe-to-head]
True or False: Pediatric patients can present with atypical signs and symptoms.
True
What should be assessed in infant patients?
Fontanelles.
What is meant by ‘Child in need of protection’?
A child who is or who appears to be suffering from abuse and/or neglect
Defined under the Child and Family Services Act (Ontario), Section 72.
What does ‘Duty to report’ entail?
The requirement to promptly report any reasonable suspicion that a child is or may be in need of protection directly to a Children’s Aid Society (CAS).
What are ‘Reasonable grounds’?
Information that an average person, using normal and honest judgement, would need in order to decide to report.
List two actions a paramedic must take if they have reasonable grounds to believe a child is in need of protection.
- Ensure the patient is not left alone
- Request police assistance at the scene when risk of imminent harm is believed.
What are some pediatric problems noteworthy for specific attention?
- Submersion injury
- All burns
- Accidental ingestions/poisoning
- Other types of in-home injuries, e.g. falls.
What scene observations may prompt consideration that a patient is a child in need of protection?
- Household/siblings dirty, unkempt, and/or in disarray
- Evidence of violence, e.g. overturned or broken furniture
- Animal/pet abuse
- Evidence of substance abuse, e.g. empty liquor bottles, drug paraphernalia.
What physical signs may indicate that a patient is a child in need of protection?
- Gross or multiple deformities incompatible with incident history
- Multiple new and/or old bruises
- Distinctive marks or burns, e.g. belt, hand imprint, cigarette burns
- Bruises in unusual areas
- Burns in unusual areas
- Signs of long-standing physical neglect
- Signs of malnutrition
- Signs of ‘shaking’ syndrome.
Fill in the blank: A paramedic should obtain as clear a history of the incident as possible, with no display of personal _______.
[curiosity]
What should a paramedic do if there is a prolonged, unexplained delay in seeking treatment?
Consider if the patient may be a child in need of protection.
What should a paramedic’s response be towards parents or caregivers during an investigation?
Make no accusations; make no comments about suspicions in front of the parents or bystanders.
What is the consequence of failing to report a suspicion under the Child and Family Services Act (Ontario)?
It is an offence under that Act.
What should paramedics assume about geriatric patients’ capabilities?
All geriatric patients are capable of normal hearing, sight, speech, mobility, and mental function unless information is provided to the contrary.
List two considerations when assessing a geriatric patient’s living accommodations.
- Living situation
- Ability to perform activities of daily living.
What forms of elder abuse should paramedics be aware of?
- Financial abuse
- Psychological abuse
- Physical abuse
- Sexual abuse
- Neglect.
What action should be taken if elder abuse is suspected?
- Offer to contact police if not on-scene
- Alert receiving facility staff.
What should a paramedic consider when dealing with a patient with an emotional disturbance?
- Underlying organic disorders
- Personal safety
- Serious intent of suicide or self-harm
- Appropriate documentation for transport
Includes assessing if the patient has ideation or intent of self-harm.
Under what conditions can a paramedic transport a patient without consent according to the Mental Health Act (Ontario)?
- Subject of an application for assessment signed by a physician (Form 1)
- Subject of an order for examination signed by a Justice of the Peace (Form 2)
- Person taken into custody by a police officer
- Patient detained under a certificate of involuntary admission (Form 3) or renewal (Form 4)
This list is not exhaustive; refer to the Mental Health Act for further details.
What precautions should be taken when transporting a violent or potentially violent patient?
- Request police assistance
- Wait for police if there is ongoing violence
- Elicit information from others at the scene
- Be alert for signs of impending violence
Personal safety must be prioritized.
What is the maximum flow rate for maintaining IV patency in a patient under 12 years of age?
15 mL/hr of any isotonic crystalloid solution.
What should a paramedic do if they encounter a patient with an embedded Electronic Control Device (ECD) probe?
Consider leaving the probe(s) in place for transport if embedded in sensitive areas.
Fill in the blank: A paramedic shall not transport a patient in the _______ position.
prone
What must be documented on the Ambulance Call Report if a patient is restrained?
- That the patient was restrained
- Description of the patient’s behavior
- Description of the means of restraint
- Who ordered the restraint
- Position of the patient during restraint
- Clinical response to restraint
This documentation is crucial for legal and medical records.
What is the protocol for notifying police in unusual or suspicious situations?
Paramedics shall notify police in cases involving sudden death, violence, or accidents involving emergency vehicles.
How should a paramedic manage an IV line during transport?
- Monitor and maintain IV at the prescribed rate
- Change the IV bag as required
- Discontinue IV flow if dislodged and remove catheter
- Confirm condition of catheter if removed.
What considerations should be made when initiating full body restraint of a patient?
- Organize the team
- Prepare equipment in advance
- Inform the patient of the procedure
- Immobilize limbs and head in one coordinated effort
- Position the patient appropriately
This helps ensure the safety of both the patient and the paramedics.
What should paramedics do in cases of suspected foul play?
Leave the scene undisturbed and preserve evidence.
What is the maximum flow rate for potassium chloride (KCl) administration to patients aged 18 years or older?
10 mEq in a 250 mL bag.
True or False: Paramedics should proceed with transport if a police officer has handcuffed a patient without police present in the patient compartment.
False
What conditions warrant immediate transport for a CTAS 1 patient?
- Prehospital Paramedic CTAS Guide
- Bypass protocols
- Obstetrical emergencies
Examples include eclampsia, limb presentation, and umbilical cord prolapse.
What should be done if a patient is spitting during transport?
Consider using a surgical mask on the patient.
What should be confirmed before transport regarding the IV line?
- Physician’s IV order
- IV solution and flow rate
- Condition of IV site
- Amount of fluid remaining in the bag
This ensures safe and effective patient care during transport.
What should not be discarded after a call completion?
Linen/clothes
Must check with the receiving facility or investigating officer before discarding.
What special precautions should be taken in cases of hanging?
Observe the position of the rope around the neck and cut only if it cannot be slipped off
The knot should be preserved when cutting the rope.
What is the first action a paramedic should take when dealing with a reported sexual assault?
Ensure the patient is not left alone
This is crucial for the safety and support of the patient.
If the patient of a sexual assault is a child, what standard should be followed?
Child in Need of Protection Standard
This ensures appropriate measures are taken for children’s safety.
What should a paramedic offer if police are not on-scene during a sexual assault incident?
Offer to contact police
This assists in ensuring the incident is reported and investigated.
What should a patient be advised not to do until an examination is conducted after a sexual assault?
Wash, urinate, or defecate
This is important to preserve evidence.
What should be done with stretcher linen and materials in contact with a sexual assault patient upon police request?
Bag them and leave with the attending police officer
This preserves evidence for the investigation.
What is the standard for research trials in patient care practices?
MOH may approve research trials with different patient care practices
These must follow certain conditions and regulations.
What conditions must be met for a paramedic to treat a patient in accordance with a research trial?
- MOH approval of practices
- REB approval
- Support from Ontario Base Hospital Group Medical Advisory Committee
Each condition ensures ethical and legal compliance.
What must a paramedic obtain from a patient before participating in a research trial?
Appropriate patient consent
This is necessary for ethical treatment and participation.
What must a paramedic provide in accordance with the approved research trial?
Care in accordance with the approved research trial
Ensures compliance with the trial’s regulations.
What does PHIPA stand for?
Personal Health Information Protection Act
It includes provisions related to personal health information.
True or False: A paramedic can change patient care practices without any approval.
False
Patient care practices must be approved by MOH and relevant committees.
