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PRIMARY CARE PARAMEDIC 2021/22 > EMER 107 > Flashcards

EMER 107 Flashcards

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1
Q

what is a paramedic

A

self-regulated health care professional with the skills and knowledge to respond to and treat the sick and injured out-of-hospital

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2
Q

what is patient care centred on

A

prevention, preservation of life, promoting better health and preventing the deterioration of our patient’s condition

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3
Q

1700 BCE Babylon

A

medical care professional would go into homes

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4
Q

Code of Hammurabi

A

“protocols and reimbursements for medical care including punishment for malpractice”

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5
Q

Hammurabi

A

the king who invented rule by law

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6
Q

1790’s (Napoleon’s time)

A

sending medical care to the patient was no longer done; care was now provided in the field

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7
Q

Jean Larrey

A

physician who developed ‘ambulances volantes’ (flying ambulances)

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8
Q

1950’s during the Korean War

A

discovered that bringing pre hospital services closer to field increased the survival rate

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9
Q

Mobile Army Surgical Hospitals (MASH units)

A

were helicopters; helped thousands of solders and civilians

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10
Q

Late 1950’s early 1960’s: Mobile Intensive Care Units (MICUs)

A

staffed by specifically trained physicians

Spread to North America and these physicians become short staffed

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11
Q

1965 (united states)

A

The National Academy of Sciences and the National Research Council released a paper which outlined 10 critical points to establish a functioning system

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12
Q

1966

A

National Highway Safety Act was enacted as a result of 1965 paper
It included the US Department of Transportation (US DOT)

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13
Q

US DOT

A

created to help development of basic and advanced life support programs

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14
Q

1971

A

First EMT textbook in USA published by American Academy of Orthopaedic Surgeons (AAOS)
Titled “Emergency Care and Transportation of the Sick and Injured”

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15
Q

1968

A

Basic training standards were developed

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16
Q

1969

A

Dr. Eugene Nagel (Miami, Florida) began training Miami firefighters with advanced medical skills

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17
Q

Dr. Nagel

A

father of paramedicine in the USA
developed first system that enabled firefighters to transmit a patients ECG to physicians and receive radio instructions from physicians regarding how to proceed

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18
Q

1977

A

first National Standard Curriculum for paramedics was developed by the US DOT
Curriculum was based on work of Dr. Nancy Caroline

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19
Q

1832 Toronto

A

first organized ambulance service in Toronto

Mainly transported victims of cholera outbreak (acute diarrheal illness)

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20
Q

1946 Saskatchewan

A

One of the first Canadian Air Ambulance programs

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21
Q

1974 British Columbia

A

organized ambulance service was created

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22
Q

1984

A

The Canada Health Act was passed

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23
Q

The Canada Health Act

A

Canada’s legislation that funds health care insurance using public funds

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24
Q

5 principles of The Canada Health Act

A 
Public administration 
Accessibility 
Comprehensiveness 
Universality 
Portability
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25
Q

Early 1990’s

A

paramedic training programs included in the Canadian Medical Association’s accreditation process

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26
Q

1984

A

Paramedic Association of Canada was formed

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27
Q

Paramedic Association of Canada (PAC)

A

formerly known as Canadian Society of Ambulance Personnel

Canada’s organization representing prehospital practitioners
Represents over 20 000 practitioners

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28
Q

2001

A

National Occupational Competency Profiles (NOCPs)

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29
Q

National Occupational Competency Profiles (NOCPs)

A

issued by PAC

First document to describe core competencies paramedics are required to practice in Canada

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30
Q

2006

A

review process for update of the NOCP began

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31
Q

2011

A

updated version of NOCP

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32
Q

2002

A

The Paramedic Chiefs of Canada (PCC)

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33
Q

The Paramedic Chiefs of Canada (PCC) function

A

incorporated as a national forum for info gathering, policy development and coordinated action by the leadership of Canada’s paramedic systems

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34
Q

2007

A

PCC paper “The Future of EMS in Canada: Defining the New Road Ahead

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35
Q

6 key strategic directions defined by PCC paper “The Future of EMS in Canada: Defining the New Road Ahead

A

Clear core identity: clearly define who and what EMS is
Stable funding: ensure consistent availability of community resources required for EMS services
Systematic development: EMS system must be open to change and accountable for performance in a complex changing environment
Personnel development: Ems must ensure education/training staff are robust to allow personal and professional paramedic growth
As well as highest quality of prehospital care; embracing all new technologies
Leadership support: leaders must have specific knowledge and skills to operate EMS system at maximum performance
Mobilized health care: EMS must change and evolve with health care in Canada
There are paramedic in the world that have evolved to provide definitive primary care outside of traditional clinical venues

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36
Q

what does NOCPs outline

A

each levels scope of practice
Document identifies competencies that must be met to practice in Canada
Helped standardize minimum education requirements across country

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37
Q

dispatcher

A

Key role in an emergency call;
must receive and enter all info;
interpret the info;
relay the info to resources

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38
Q

The Emergency Medical Responder

A

not certified in all provinces/territories
EMR also called first responder: trained in CPR and/or first aid
Often works as part of fire service or other community based public service agency

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39
Q

The Primary Care Paramedic and skills/abilities

A

Skills and abilities include:
Oxygen, wound care, splinting and basic treatment modalities
administration of a select medications for symptoms of ischemic chest pain and shortness of breath
defibrillate unstable cardiac rhythms
in some cases; provide advanced airway procedures using supraglottic airways
initiate or maintain IV lines and provide certain types of fluid therapy

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40
Q

The Advanced Care Paramedic and skills/abilities

A

Builds on the knowledge/skills of PCP
Skills and abilities include:
Provide ALS
Provide specific airway measures
Intubation, cricothyrotomy and needle decompression
Administer a variety of medications to manage cardiac, respiratory, neurologic and endocrine emergencies

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41
Q

The Critical Care Paramedic

A

primarily work with air ambulance or land based critical care interfacility transfer services
move critically ill patients between facilities and may also transfer of patients requiring highly specialized therapies such as extra corporeal life support
Patient often complex needing multiple medications, blood products, and mechanical ventilation

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42
Q

4 levels of care in Canada identified in the NOCP document

A 
Critical Care Paramedic 
Advanced Care Paramedic 
Primary Care Paramedic 
Emergency Medical Responder 
*not all provinces recognize all levels
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43
Q

scope of practice is based on

A

the level that you are licensed as in your province; not the level of training you have received

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44
Q

first responders in Saskatchewan duties

A

Dispatched for each 911 medical request along with EMS response
First responder team offers initial medical care until EMS arrives
May be incorporated within the volunteer or municipal fire dept.
Saskatchewan police and RCMP are deemed to be first responders as well
Some offering AED or initial medical care

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45
Q

Basic Life Support duties

A

EMS unit dispatched initially and capable of transport
ALS unit can be staged encase of request from BLS or can be dispatched simultaneously on “time sensitive” calls
The BLS can begin transport and have the responding ALS intercept
First responder and fire services can still be part of this response

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46
Q

A non-transporting one person ALS rover unit duties

A

Staged within service area; allows efficient coverage to all areas
When dispatched simultaneously with EMS unit it can have shorter response times and provide ALS more quickly
First responder and fire services can still be part of this response

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47
Q

Saskatchewan Air Ambulance or STARS duties

A

Any EMS crew can begin initial request
Most cases 911 system pre-alerts STARS anticipating EMS will follow up with a request for service
Saskatchewan Air Ambulance is limited to facility pick up and transport of the patient
STARS can be dispatched directly to scene

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48
Q

National EMS Organizations

Canada

A

Paramedic Association of Canada (PAC)
Paramedics Chiefs of Canada
Society of Prehospital Educators in Canada (SPEC)
Canadian Transport Medicine Association (CTMA)
Canadian Association of Emergency Physicians (CAEP)
Heart and Stroke Foundation

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49
Q

PAC’s function

A

Exists to promote quality care through cooperative working relationships among organizations with national EMS interests

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50
Q

SPEC’s function

Society for Pre-hospital Educators in Canada

A

Development and maintenance of standards for both initial and continuing education for EMS providers

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51
Q

PCOS’s function

paramedic Services Chiefs of Saskatchewan

A

Promotes ongoing development and awareness of the EMS profession through educational workshops

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52
Q

PCOC’s function

The Paramedic Chiefs of Canada

A

A national forum for policy development

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53
Q

Saskatchewan Health’s function

A

Collaborates with the Saskatchewan College of Paramedics and Saskatchewan College of Physicians and Surgeons on the “Paramedic Clinical Practice Protocols” and the Scope of Practice for all EMS providers

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54
Q

SCoP function

A

Governed by a council. Council includes six elected members as well as three members of the public appointed by the Ministry of Health

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55
Q

COPR’s functions

Canadian Organization of Paramedic Regulators

A

As one of their tasks they determined the four different levels of practice in Canada (EMR, PCP, ACP and CCP) and defined scope of practice and standard of care for them

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56
Q

PAC’s history

A

Created in 1988
Over 14000 members
formerly the Canadian Society of Ambulance Personnel (CSAP)

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57
Q

Canadian Organization of Paramedic Regulators COPR history

A

est 2010

national exam that must be written by all practitioners in Canada to be licenced

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58
Q

Society for Pre-hospital Educators in Canada (SPEC) history

A

2005 workshop

2007 est

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59
Q

The Paramedic Chiefs of Canada (PCOC) history

A

est 2002

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60
Q

define registration

A

means that records of your training local licensure and recertification will be held by a recognized board of registration and implies you have successfully completed the required provincial testing

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61
Q

define reprocity

A

granting recognition to a paramedic from another province or agency

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62
Q

Saskatchewan College of Paramedics (SCoP) history

A

est via paramedics act in 2008

self regulated

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63
Q

Saskatchewan College of Paramedics (SCoP) code of conduct

A

Code Requires:
members recognize their limitations
recognize the skills of others in the care and treatment of patient
provide care within scope
seek consultation when necessary
assume responsibility for personal and professional development

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64
Q

quality assurance

A

process for evaluating problems and generating solutions

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65
Q

Continuous quality improvement (CQI)

A

process that evaluates problems and find solutions

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66
Q

Quality gap

A

difference between processes/outcomes in practice and those thought to be achievable with most current knowledge

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67
Q

Patient safety

A

absence of potential or occurrence of a health care system injury to a patient

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68
Q

Normalization of deviance

A

so comfortable that it deviates from standards to sub standard and leads to poor care, medical errors and bad patient outcome

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69
Q

common causes of medical errors

A 
Communication errors 
Increasing specialization and fragmentation of health care 
Human errors from overwork/burnout  
Manufacturing errors  
Equipment failure 
Diagnostic errors  
Multiple choices for care 
Poorly designed vehicles, buildings and facilities
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70
Q

common EMS related errors

A

Airway choice and placement errors in 22 to 40 percent
Medication errors
Errors in pediatrics

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71
Q

what should a Continuous quality improvement (CQI) include

A 
Identify any system wide problem 
Review process for problems 
develop a list of remedies 
Develop action plan 
Enfore action plan 
Re-examine issues 
Identify and promote excellence in patient care 
Identify modifications to protocols  
Identify situations that are not addressed by protocols
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72
Q

CQI can help prevent and identify stress points:

A 
Medical direction issues 
Training and education 
Communications 
Prehospital treatment 
Transportation issues 
Financial issues 
Receiving facility review 
Dispatch 
Public info and education 
Disaster planning 
Mutual aid 
Responsible for reporting adverse events or near missed to authority
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73
Q

Profession

A

field of endeavour that requires specialized set of knowledge, skills and expertise

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74
Q

what percent of EMS communication verbal and what percent is non verbal

A

Only 7% is verbal (oral and written)

93% are nonverbal

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75
Q

key attributes for paramedics

A 
ntegrity  
Empathy 
Compassion  
Accountability  
Communication 
Teamwork  
Respect  
Patient Advocate  
Injury Prevention  
Careful Delivery of Services
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76
Q

personal mission:

A

defining the personal, moral and ethical guidelines within your life work

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77
Q

patient advocacy:

A

is ensuring the best for the patient, defending patients’ rights, supporting patients’ wishes

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78
Q

patient advocacy outlined in NOCP

A 
Function as patient advocates 
Know when advocacy is required 
Explain how a practitioner can advocate for the patient 
Know the value of patient advocacy 
Integrate advocacy into clinical care
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79
Q

Agreed Upon Code of Conduct on Patient Advocacy- roles included:

A

Patients best interest as primary concern at all times
Seeking consent
Assessing patients’ needs and providing
Maintaining dignity, confidentiality and privacy
Ensure indiscriminatory medical care

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80
Q

Principles of advocacy are based on medical ethics (autonomy, beneficence, non- maleficence and justice)

A

Patients have the right to consent or refuse treatment (autonomy)
The Paramedic should work in the best interest of the patient (beneficence)
The paramedic should do no harm (non- maleficence)
The paramedic should ensure that health care resources are distributed fairly and equally (justice)

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81
Q

What Can Paramedics Do to Become a More Effective Patient Advocate?

A 
Educate yourself 
Respect Them As a Person 
Care for Them 
Keep Them at Home and Provide Alternative Care Options 
Safeguard 
Communicate 
Handover
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82
Q

leadership:

A

passion and desire that a paramedic has to make a difference in someone else’s life. Having the courage to face any challenge that may be present

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83
Q

Qualities of a leader

A 
Communication 
Proficience 
Honesty 
Respect for other 
Integrity 
Credibility 
Trustworthiness 
Vision 
Empathy 
Professional 
Approachable 
Communication is most important quality
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84
Q

5 levels of leadership

A

1.Position (rights)
People who follow you will give you the least amount of their energy and effort
2.Permission (relationship)
They like you, you like them
3.Production (Result)
Produce and accomplish results
4.People Development (Reproduction)
Start developing people and making them better
5.Personhood (respect)
People follow you because you have helped so many others you have become bigger than life in their eyes

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85
Q

what are the 9 leadership types

A 
Transactional 
Transformational 
Autocratic 
Situational 
People Oriented 
Participative 
Charismatic 
Laissez- Faire 
Bureaucratic
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86
Q

Transactional leadership

A

Focuses on supervision and performance
Positive actions are rewarded; negative are punished
Leaders direct efforts of others through tasks and structure and provide vision
Ex: Steve Jobs

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87
Q

Transformational leadership

A

Centered on the connection between a leader and a follower
Encourage individual success and growth
“quiet leaders” lead by example; inspirational
Ex: Martin Luther King Jr.

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88
Q

autocratic leadership

A

Individual control over all decisions and little input from others
Can be very effective if used correctly
If used incorrectly it can result in poor moral, high turnover rate of employees and misunderstanding
Ex: Mark Zuckerburg

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89
Q

Situational leadership

A

When leader changes their leadership style based on specific situations
Adaptive leadership style
Encourages leaders to learn about their members, workplace and choose a style that best fits goals and circumstances
Best suited for EMS because the environment is always changing
Ex: Dwight D. Eisenhower ( former US president and military general)

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90
Q

people oriented leadership

A

Focuses on organization and development of their followers
Find success in the success of those they mentor and coach
Ex: Gandhi

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91
Q

participative leadership

A

Leader takes into account opinions of team members

Ex: Walt Disney

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92
Q

charismatic leadership

A

Uses leader’s own enthusiasm and energy to motivate others
Success is often credited to the leader and not the actions of the individual
Mother Teresa

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93
Q

Laissez- Faire leadership

A

Means “leave it be”
Leadership is a hands off approach
Leader will give broad direction and leave it up to the individual to fill in the blanks
This style is only effective with people that are motivated and work well independently
Ex: Queen Victoria

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94
Q

bureaucratic leadership

A

Also known as “by the book” leadership
Expect policies and procedures to be followed to the letter no deviations
Ex: Abraham Lincoln

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95
Q

management vs leadership

A

Management consists of controlling a group or set of entities to accomplish a goal
Leadership is an individuals ability to influence, motivate and enable other to contribute toward organizational success

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96
Q

10 differences between managers and leaders

A

leaders develop followers; managers manage people and things
Essence: managers=stability leaders=change
Rules: manager= make them leaders= break them
Approach: manager=plan details leaders= sets direction
Culture: manager= execute leaders= shape
Conflict: manager= avoid leaders= use
Direction: manager= comfortable leaders= new
Credit: manager= take leaders= give
Decisions: manager= makes leaders= facilitates
Vision: managers= tell leadership=sells
Style: manager= transactional leaders= transformational

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97
Q

delegation:

A

transferring responsibility for the performance of an activity or task while retaining accountability for the outcome

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98
Q

deciding to delegate

A

 You should always perform your own assessments
 Consider the other care providers level of training and experience
 Never delegate a task that is out of another practitioner’s scope
 Be clear and specific of the task you want to be completed
 Treat others with respect

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99
Q

integrity:

A

be open, honest, and truthful with patients

most important attribute

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100
Q

empathy:

A

show that you acknowledge and understand the feelings of patients, their families, and other health care professionals

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101
Q

self motivation:

A

internal drive for excellence; continuously educate yourself, accept feedback and perform with minimal supervision
This is a driving force to ensure that you always behave professionally

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102
Q

communication:

A

express and exchange thoughts/findings with colleges

Listen and speak directly without confusing words to patients and their families

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103
Q

Teamwork and respect:

A

required in EMS on every call

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104
Q

Patient advocacy:

A

act in the best interest of the patient; never allow personal feeling to affect the care you provide

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105
Q

Injury prevention:

A

if you spot a potential hazard talk about findings to patient or family member

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106
Q

Careful delivery of service:

A

deliver highest quality prehospital care
Pay careful attention to detail and evaluate and re-evaluate your performance
Follow policies, protocols and orders of superiors

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107
Q

primary responsibilities of paramedics

A

Preparation: be mentally, physically and emotionally prepared
Response: respond in a timely, safe matter
Scene management: first priority is safety of yourself and team; then patient and bystanders
Patient assessment and care: perform organized assessment of each patient based on principles
Management and disposition: follow protocols
Transfer of Care: when arrived at facility continue to act as a patient advocate
Documentation: extremely important that PCRs are filled out immediately
Return to service: responsible for restocking and preparing the unit quickly

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108
Q

dignity

A

treating people with honour and respect

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109
Q

Elements of preserving patient dignity include:

A

Acceptance of everyone’s identity
Inclusion of patients in their treatment plans
Safety and communication
Recognition and validation of patients concerns and complaints
Understanding of a patient’s needs and circumstances

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110
Q

Empathy:

A

sensing and understanding or trying to understand the emotions and experiences of others
Putting yourself in their shoes; imagine what they are thinking and feeling

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111
Q

To show compassion we must:

A

Accept others for who they are and see their potential for good
Never stop trying to heal those in need
Take action. Must have more than just compassionate thoughts
Have courage. Must always have the courage to try

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112
Q

Age of Majority Act

A

Defines the age of majority in Saskatchewan as 18 years and outlines how the age pertains to legal matters
Age of majority: 18 years old but not 19 yet

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113
Q

The Ambulance Act

A

Outlines how the operator may deploy employees and resources
Outlines employee’s responsibility to the employer

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114
Q

PART IV of The Ambulance Act

A

info on hours allowed to work each shift/week

sleep requirements

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115
Q

The Ambulance Regulations

A

Outlines the rules for EMS

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116
Q

Part IV of The Ambulance Regulations

A

vehicle equipment and standards

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117
Q

PART VI of The Ambulance Regulations

A

Management of Ambulance Services

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118
Q

PART VIII of The Ambulance Regulations

A

Qualifications of Attendants

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119
Q

Appendix of The Ambulance Regulations

A 
Ambulance accessory equipment  
General 
Patient care 
Medical equipment 
Als medical equipment
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120
Q

The Emergency Medical Aid Act

A

“good Samaritan act”

Non-liability for the provision of emergency medical services or first-aid assistance

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121
Q

The Coroner Act

A

Outlines the role of the coroner, their authority and who’s responsibility it is to contact them

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122
Q

when may coroner be Disqualified or Re- assigned from an investigation

A

Has been a physician for the deceased within 30 days prior to death
Has performed post mortem examinations of the body of the deceased
Death may have been cause at a place where the coroner has a financial interest

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123
Q

Coroner or police must be immediately notified of any death that was:

A

Result of accident/violence/self inflicted
Cause other than disease or sickness
Result of negligence, misconduct or malpractice
Suddenly and unexpectedly when deceased appeared to be in good health
Body not available because
Body or part has been destroyed
In a place where it cannot be recovered
Cannot be located
Stillbirth without medical practitioner
Direct or immediate consequence of deceased being engaged in employment, an occupation or business
Occurred under circumstances that require investigation

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124
Q

powers of coroner

A

May enter and inspect any place where dead body is
Examine and make copies of any records relating to deceased
Take charge ofpersonal belonging of deceased
Remove objects from area with chiefs approval
Seize bodily fluids obtained from deceased before death

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125
Q

Health Care Directives year of best

A

Proclaimed in 2015

Outlines

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126
Q

who can make a health care directive

A

Anyone 16 years or older who has the capacity to make a health care decision

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127
Q

when is health care directive in effect

A

When person does not have capacity to make health care decisions
Remains in effect until person recovers

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128
Q

requirements of health care directive

A

Must be in writing
Dated and signed by person making it or proxy
Must have witness when signing it

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129
Q

Bill C-14 Medical Assistance in Dying

A

June 17 2016

Outlines who is eligible and the practitioners than can facilitate the request

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130
Q

Medical Assistance in Dying eligibility

A

At least 18
Grievous and irremediable medical condition
Voluntary request
Give informed consent

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131
Q

The Traffic Safety Act

A

Outlines rules pertaining to operation, registration and license of motor vehicles

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132
Q

Child and family Service Act

A

Designed to promote well being of children in need of protection
Outlines our responsibilities in the presence of suspected child abuse

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133
Q

when is a child in need of protection

A

As a result of action or omission by childs parent:
Suffered or likely to suffer physical harm
Suffered or likely to suffer a serious imparment of mental or emotional functioning

Child has been or likely to be:
Exposed to harmful interaction for a sexual purpose
Sexually exploited by another person

Medical, surgical or other care/ treatment needed but not likely to be provided to child

Childs development is likely to be seriously impared by failure to remedy a mental, emotional, or developmental contition

Child has been exposed to interpersonal violence or severe domestic disharmony likely to result in physical or emotional harm to child

There is no adult who is able and willing to provide for cilds needs and physical or emotiona harm has or will occur

Child is less than. 12 and: 
Commited an act that if child were 12 years of age or more would constitute under 
Criminal code 
Controlled substance and drugs act 
Cannabis act
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134
Q

Mental Health Services Act

A

Outlines responsibilities and obligations when caring for mental health patients

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135
Q

Paramedic Act of Saskatchewan

A

Replaces parts of the Ambulance Acts and Regulations

Defines duties of the SCoP
Serve and protect the public and act in the public interest not in the interest of the members

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136
Q

The Saskatchewan Employment Act (formerly The Occupational Health and Safety Act) and The Occupational Health and Safety/Regulations and what year

A

1972
Made health and safety the joint responsibility of management and workers
Protected workers’ fundamental rights

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137
Q

what are the workers’ fundamental rights

A

Right to know
Right to participate
Right to refuse

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138
Q

The Role of the Occupational Health and Safety Division

A

division helps people in the workplace understand and fulfill their responsibilities

officers support occupational health committees and worker representatives, inspect workplaces, and enforce compliance with health and safety requirements. 

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139
Q

Saskatchewan Paramedic Clinical Practice Protocols policies include

A 
Intercepts 
Clinical trials 
Communication failure 
Conflict between health care providers 
Conflict with online medical control 
Death in the field 
Destination and bypass 
Health care directives 
Load and go 
Medication administration in rare, life threatening conditions 
Palliative care deaths 
Pandemic protocol 
Physician/medical consultation 
Physician on scene 
Protocol development 
Protocol deviation 
Public access AED 
Refusal of care 
Vaccine administration
140
Q

legal requirements for reporting abuse

A

any person who has reasonable grounds to believe that a child is in need of protection from physical, emotional, or sexual abuse, or neglect, shall report the information to an officer of the Provincial Department of Social Services or to a peace officer (police)”

141
Q

Health Information Protection Act HIPA

year of eat

A

September 1 2003
Provide requirements with respect to collection, storage, use and disclosure of personal health information
privacy of individuals with respect to personal health info

142
Q

patients rights protected by HIPA

A

To know why info is being collected
What the info will be used for
Whom the info will be shared with
Request that a record be amended
Consent to the release of info which Is being disclosed
Informed of those disclosures upon request
Take my concerns to the Privacy Commissioner

143
Q

Personal Health Information Protection and Electronic Documents Act (PIPEDA)

A

Requirements for protecting patient info
Criminal sanctions and civil penalties for releasing a patients private medical information in an unauthorized manner
Medical info can be disclosed only if it is necessary patient treatment or for administrative operations

144
Q

not personal info

A

classification
salary
discretionary benefits
employment responsibilities

145
Q

LA-FOIP

A

Local authority freedom of info and protection of privacy act (SK)

146
Q

HIPA privacy violation levels

A

Near miss

Level I- unintentional

Level II – intentional but not malicious

Level III- Intentional and Malicious

147
Q

Patient autonomy:

A

patients have right to direct their own medical care including end of life care
Autonomy is dependent on patients capacity to express their wishes regarding treatment

148
Q

Patients are capable if they

A

1) have ability to understand info regarding their health and treatment
2) appreciate the consequences of given decision or lack of decision
Has the well-recognized right to determine what happens to his or her own body to accept or refuse medical treatment

149
Q

3 ethical conditions for consent to be valid

A

Consent must be given by capable patient or substitute decision maker
Consent must be informed
Consent must be given voluntarily, without coercion or manipulation

150
Q

info that must be provided when giving info on treatment in regards to gaining consent

A

Why treatment is needed, recommendations and alternatives
Benefits and probability of them
Risks and probability of them
Side effects and probability of them
How they would treat said possible side effects and risks
Possible consequences of denying treatment
Health cares recommendation and point of view
Any questions from patient or substitute

151
Q

Advance care planning:

A

expression of advance directives by capable patients of wishes regarding future health care choices and expected quality of life

152
Q

Advance directives:

A

medical care and treatment wishes either oral or written

153
Q

best interest of patient means considering:

A

other values, beliefs, or goals that would influence decision
whether recommended treatment would improve quality of life or slow, reduce, prevent deterioration of health
whether benefits of treatment would outweigh risks
whether the same outcomes could be achieved with a less intrusive plan

154
Q

what is The patient’s bill of rights: and what year was it est

A

1972

a statement of goals and aspirations of guidelines containing only a few legally binding statements

155
Q

Consumer Rights in Health Care

A

The right to be informed
The right to be respected
The right to participate in decision making affecting his or her health
The right to equal access to health care

156
Q

Right:

A

something that can be enforced by a court of law

157
Q

The Canadian Patient’s Book of Rights

A

Describes patients rights

158
Q

patients rights on Hospital Insurance and Medicare

A

Every Canadian except few eligible for health insurance at a rate set by the province; not all hospital and medical services are insured

159
Q

patients rights on The Right to a Physician of One’s Choice

A

Right to choose physician; physician does not have to take patient though

160
Q

patients rights on consent to treatment

A

Right to consent or refuse any treatment of body or mind

161
Q

patients rights on standard of care

A

Right to receive average, reasonable and prudent care if best care is not available
If patient fails to get standard care and suffers foreseeable injury they may sue for damages due to negligence

162
Q

patients rights on The Patient’s Property

A

Health care facility not legally responsible for patients belongings
If belongings are taken by hospital for safekeeping must be cared for if its damaged or lost patient has right to be compensated

163
Q

patients rights on Medical Records and Confidentiality

A

No one has right to records without a court order
Patient has right to confidentiality of record but cannot prevent it from being shown to all those involved in patient care

164
Q

patients rights on dearth

A

Patient has right to die by refusing treatment
Not doctors duty to keep patient alive by unreasonable or extraordinary means
Suicide is not a crime but it’s a crime to help or advise a person to commit suicide

165
Q

patients rights on after death

A

Patient has no right to will their body but can direct that it be used for transplants, research or education

166
Q

which legal documents pertain to patients rights

A

Bill C14 Medical Assistance in Dying (MAID)

Health Care Directives and Substitute Health Care Decision Makers Act

167
Q

Canadian Health Care Rights:

A

Right to be informed
Right to be respected’
right to participate in decision making affecting their health
Right to equal access to health care

168
Q

Criteria for Consent

A
  1. Consent must be free, voluntary and genuine free of medication and has mental capability of understanding
  2. Consent may be given to guardian or relative if patient is not capable
  3. Must have legal capacity to give consent
  4. Patients commited to mental hospital can be treated without consent
  5. Persons suffering with communicable disease may be treated without consent
  6. Procedure performed must be procedure patient has consented
  7. No consent is valid unless aptient has been informed as to what he/she is consenting
169
Q

Only time patient can be treated without consent:

A

Threat to life or health
Threat must be immediate
Threat cannot be delayed
Patient is not able to consent or refuse
Relatives who ordinary would consent on be half of the patient are not available

170
Q

3 elements of standard care

A
  1. individual and community
  2. the law
  3. the profession
171
Q

negligence and when does it occur

A

something was not done or done incorrectly

occurs when:
Legal duty to act
Breach of duty
Breach of duty was the proximate cause of injury or harm

172
Q

4 elements of proof of negligence

A

There has to be a duty to act

There had to be a breach

The patient must have suffered a loss

Causation must be identified

173
Q

3 lines of authority to answer to as a PCP

A

Medical director
Licensing agency
Employer

174
Q

Delegation of function

A

when a physician delegates to another individual any functions that individual must have the training and qualifications to carry out duties

175
Q

Transfer of function

A

the performance of a medical function by an individual which is certified to perform the procedure
Principles of Delegation

176
Q

indirect medical control:

A

defined by medical directives, standing orders, guidelines or protocols

177
Q

direct medical control:

A

orders may be given by a phone or radio

178
Q

what do Medical Acts define

A

minimum qualifications of those who may perform various health services
Skills that each type of practitioner is legally permitted to use
Establishes means of licensure or certification for different health care professionals

179
Q

Vicarious liability

A

employees are held liable to compensate people for the harm cause by their employees in the course of their employment

180
Q

Standard care:

A

what a reasonable paramedic in same situation would have done

181
Q

Gross negligence:

A

reckless disregard, utter indifference or conscious disregard for safety of others
Proximate Cause

182
Q

abandonment

A

Form of negligence that involves the termination of medical care without patients consent

Must not leave patient in any area of hospital where they won’t be attended and assessed by medical personnel

183
Q

Certification:

A

certain level of credentials based on hours of training and assessment examinations and address criteria met for minimum competency

184
Q

Licensure:

A

privilege to practice at a level granted by a provincial agency or self governing professional authority

185
Q

Mature minor rule:

A

provides minor with full understanding of consequences and nature of medical treatment may consent or refuse that medical treatment

186
Q

2 types of consent;

A

informed and implied

187
Q

4 steps to gain informed consent from patient

A 
4  steps: 
Describe suspected injury or illness 
Describe treatment and risks associated 
Discuss alternative treatments 
Advice patient of consequences if treatment is refused
188
Q

expressed consent

A

type of informed consent that occurs when patient demonstrates their giving you permission to provide care

189
Q

implied consent:

A

consent is assumed by unconscious adults or adults too injured or ill to verbally consent to emergency life saving treatment

190
Q

consent with minors

A

minors have no legal status and cannot consent or refuse medical care except in certain cases
children with legal guardians must have consent from guardian
if guardian is not available emergency treatment to sustain life can be given without consent under doctrine of implied consent

191
Q

Decision making capacity:

A

The Prerequisite for Consent and Refusal

192
Q

criteria for determining mental competence

A

patient is oriented to person, place and day
patient responds to questions approperiatley
no significant mental impairment from alcohol, drugs, head injury or other illness
patient demonstrates that they understand nature of their condition and risks of not going to hospital
patient can describe reasonable plan for follow up care
oxygen saturation are within normal limits
blood glucose levels are within normal limits

193
Q

psychiatric emergencies:

A

when persons life is not in dancger police officer is only person with authority to transport them to hospital against will

194
Q

ethics:

A

philosophy of right and wrong moral duties, responsibilities, and behaviour

195
Q

morality:

A

code of conduct defined by society, religion, culture or another person that affects someone character and conscious

196
Q

4 important principles present in all ethical theories

A

autonomy
beneficence
non malfeasance
justice

197
Q

Beneficence

A

doing what’s best for patient

198
Q

Non-malfeasance

A

do no harm

199
Q

Justice

A

reflects need for fairness and to “treat equal cases equally and unequal cases unequally”

200
Q

Futile intervention:

A

interventions that do not benefit patients

201
Q

Futility:

A

treatment is futile if it would not work

202
Q

Circumstances to withdraw or withhold treatment:

A

Patient or substitute decision maker requests it
Treatment has not achieved the goals
Treatment is not working
Burdens exceed benefits and the patient or substitute consents
Treatment is out of accepted and standard level of prehospital care

203
Q

core values of Paramedicine

A 
integrity
compassion
accountability
respect
empathy
204
Q

ethics vs morals

A

Ethics: a standard set by a profession, society, religion or culture
Morals: our own personal beliefs and thoughts about what is right and wrong

205
Q

Code of Professional Conduct

A

SCoP developed a Code of Professional Conduct which clearly lists the principles of tethical behaviour, our responsibilities to the patient and to the profession

206
Q

what’s included in PCP code of ethics

A

Conservation of life
Alleviation of suffering
Promotion of health
Do no harm

207
Q

Deontological:

A

duty centered- understand nature of whats right and wrong and it does not depend on the outcome but on principles of fundamental and objective rules

208
Q

Teleological:

A

consequences of a maoral act determine the act’s worth and correctness

209
Q

Protocol:

A

a treatment plan for a specific illness or injury

210
Q

Standing order

A

protocol that is written document

signed by medical director

outlines specific directions, permissions and prohibitions regarding care given prior to contacting medical control ex defibrillation

211
Q

Clinical practice guideline (CPG):

A

step above standing orders; statements that include recommendations to provide optimal care

212
Q

sasks 3 levels of medical oversight

A

College of Physicians and Surgeons of Saskatchewan

Medical Advisor

Online Medical Direction

213
Q

Following procedures must be followed anytime protocol deviation is performed

A

Do complete assessment to determine if deviation is needed

Consult peer of appropriate level or medical control

Proceed only if comfortable and in scope of practice

Notify receiving physician of deviation and clearly document of PCR including reason for it, clinical supporting data, mitigating risk and the response notes

Report to your medical advisor and SCoP within 30 days

214
Q

3 ethics of medicine

A

Do no harm
Act in good faith
Act in the patients best interest

215
Q

cicil laws

A

Establish liability
Monetary compensation
Mostly resulting from vehicle crashes
Reasonable belief

216
Q

criminal law

A

Action taken by the government for suspected violations of the law
May result in imprisonment and or fines
Beyond reasonable doubt

217
Q

Violent Patients and Restraints

A

Scene and provider safety first
Only use force used against you
Patients who are a danger to themselves or others may be restrained
Negligence

218
Q

good communication:

A

is being able to transfer a message with meaning clearly from one person to another
Reading

219
Q

Communication:

A

act of transmitting info to another person; verbal or through body language

220
Q

Active listening:

A

helps confirm info to make sure there are no misunderstandings

221
Q

pay off questions:

A

questions that aren’t routine medical questions that will give you info to a presumptive diagnosis
ex:
Have you ever felt like this before?
Have you been upset about anything lately?
Are you afraid of someone (ask privately in ambulance)?
Have you been thinking about hurting yourself?
What happened the last time you felt like this?

222
Q

external factors for effective communication

A 
watch your tone of voice
always respond to patient
tell ppl who you are
use patients name
anticipate and deal with fear
respect importance of pain
respect and protect peoples modesty
help do not judge
223
Q

Open ended questions

A 
Question that doesn’t have a yes or no answer or specific options to choose from 
ex:
How have you been feeling lately? 
What do you think is causing this? 
What other health concerns do you have? 
What else would you like to discuss?
224
Q

close ended questions

A

Good idea to develop standard set of questions for medical history that you ask almost all patients

ex
Have you ever had any heart problems? 
Any lung problems? 
High or Low Blood Pressure? 
Diabetes? 
Seizures? 
Fainting spells? 
Any prior head injury? 
Do you have both lungs and kidneys?
225
Q

how to behave to get patients to respond

A 
facilitate response
be quiet
clarify the response
redirect response
interpret response
simplify and summarize response
226
Q

common interviewing errors

A 
making assumptions
giving medical advice
providing false hope
assuming excessive authority
sidestepping the truth
distancing yourself from patients as people
227
Q

Consider patients mental ability in the following ways:

A

sense of humour
timing of response to questions
memory
ability to obey simple commands

228
Q

communication with patients who are not motivated to talk

A

No need to force if patient refuses to talk and theres no signs of altered mental status
Make eye contact, express concern, explain everything you are doing, invite them to answer question
Let them know its alright if they don’t want to talk

229
Q

communication with hostile patients

A

Never respond back the way they’re speaking to you
May not be able to defuse someone anger; may have to call cops
Learn to look for aggressive body behaviour

230
Q

communication with very old

A

Don’t presume older people are hard of hearing

Must adapt to hearing, eye sight and mental and mobility of geriatric population

231
Q

communication with very young patients

A

Children can be hard to communicate with
Tend to protest pain
May be afraid of strangers
May panic away from parents
Minimize movements and lower voice
Get to childs eye level
Involve patient in prehospital care if patient is young
Toys are useful when parents are not
Adolescents may not want parents there for questions
Parents who want to monitor conversation with adolescent should raise concern

232
Q

5 steps of communication process

A

Sender has an idea to communicate

Sender Encodes the Idea in a Message

Message Travels Over a Channel

Receiver decodes message

Receiver understands message and sends feedback to the sender

233
Q

3 tones of voice

A

expressive tone
directive tone
problem solving tone

234
Q

barriers in communication

A

physical disability or limitation
cultural and language differences
Environmental Barriers
Emotional Barriers

235
Q

main factors for good communication

A 
choice of language
tone of voice
emphasis
body language
listening ability
236
Q

type of non verbal communication

A

Body orientation: which way we face
Posture: communicates attitude, emotion or status
Gestures: some are agreed upon others are unintentional
Voice: tone, volume, pitch (paralanguage)
Touch: strong relational dimension
Physical attractiveness: influences our reception and attentiveness
Clothing: may convey messages about economic level, education level, social position
Proxemics: use of space

237
Q 
Proxemics: use of space 
Intimate space \_\_ inchs 
Intimate space _inch- _ft 
Public distance _feet or more 
Social distance _ft to _ ft
A

Intimate space 0-8 inchs
Intimate space 18inch- 4ft
Public distance 12 feet or more
Social distance 4 ft to 12 ft

238
Q

6 emotions

A

fear, anger, disgust, surprise, happiness and sadness

239
Q

important non verbal communication in ems

A 
facial expression
eye contact
personal space
position
touch
240
Q

4 stages of listening

A

sensing,
interpretation,
evaluation
reaction

241
Q

sensing in terms of listening

A 
Psychological process of how we hear: 
Loudness and clarity of voice 
Competing sounds 
Personal problems 
Hunger 
Work pressures
242
Q

interpretation in terms of listening

and factors that affect interpretation

A 
Attributes meaning to message 
Factors that affect: 
Preconvinced notions 
Lack of knowledge 
Complexity 
Evoking negative emotions
243
Q

evaluation in terms of listening

A

involves decision to accept or reject message
Decision process largely based on how message coincides with personal values and beliefs
Cognitive dissonance

244
Q

reaction in terms of listening

A

Response generated by message
May take form of direct feedback
Usually in form of indirect feedback (non verbal reactions)

245
Q

tips to become effective listener

A 
Learn art of silence 
Have awareness of emotional filters 
Become slow to judge 
Lack of interest into avid interest 
Ask questions to focus listening 
Focus on what’s important 
Engage in active concentration
246
Q

Ways to demonstrate respect:

A

Listen
Be encouraging
Give positive feedback and reinforcement
Use persons name when speaking to them
Be helpful
Show cultural competency
If you show respect they will often show it back

247
Q

empathy vs sympathy

A

empathy:
Understanding what others are feeling because you have experienced it yourself, or can put yourself in their shoes.

sympathy:
Acknowledging another person’s emotional hardships, and providing comfort and assurance.

248
Q

Tact and diplomacy

A

Tact: sensitivity in dealing with others in difficult situations
Diplomacy: dealing with people in a sensitive and effective way

249
Q

rapport

A

relationships in which people understand each other’s feelings/ideas and communicate well

250
Q

Therapeutic communication:

A

any communication between health care professional and patient that takes place to advance patients well-being and care”

251
Q

3 main purposes of therapeutic communication:

A

To collect healthcare related info about pt
Provide feedback in form of healthcare related info, education and training
Assess patients behaviour and when appropriate modify that behaviour

252
Q

clients of Ems

A

every patient we interact with

community we work with

government

public safety: police and fire

other healthcare facilities

253
Q

main causes of miscommunication is Ems

A

Risk of miscommunications is higher during stroke, STEMI, trauma or sepsis emergency scenes
Every EMS patient goes through at least 1 handoff to another provider
Time sensitive patients are treated by multiple providers
Delayed care for time sensitive patient can be more harmful than medical error
Communication most important in chaotic emergency scenes but also most difficult

254
Q

Stress:

A

reaction of body to an individual or situation that requires adaptation
Often in response to a threatening situation

255
Q

Triggers of stress

A 
Loss of someone close 
Loss of possession that is meaningful 
major life event 
Personal illness or injury 
Family illness or injury 
Witness injury
256
Q

Eustress

A

(positive stress): kind of stress that motivates a person to achieve

257
Q

Distress

A

(negative stress): kind of stress that is overwhelming and debilitating

258
Q

5 categories of reactions that should be removed from scene

A 
anxiety
blind panic
depression
overreaction
conversion hysteria
259
Q

de escalation strategies

A 
Undivided attention 
Being non-judgmental 
Focus on feelings 
Allow silence 
Clarify message 
Develop a plan 
Use a team approach 
Use positive self-talk 
Recognize personal limits
260
Q

Denial:

A

they may ignore or dismiss the seriousness of the situation

261
Q

Regression

A

may return to an earlier age level of behaviour

262
Q

Projection

A

attributing your own feelings, motives and behaviours onto others

263
Q

Displacement:

A

redirecting an emotion from the original cause to an immediate substitute- can be seen as anger towards you

264
Q

Day to day basis order:

A

identify problems, set patient care priorities; develop a pre hospital care plan; and execute that plan

265
Q

4 cornerstones of effective paramedic practice

A

Gathering, evaluating ad synthesizing

Developing and Implementing a Patient Care Plan

Judgement and Independent Decision Making

Thinking Under Pressure

266
Q

triage model

A

mortally wounded or dead

critical: need immediate prehospital care to survive
serious: need care within next few minutes

walking wounded or minimally injured

267
Q

what’s considered a Critical patient

A

Majour multisystem trauma
Devastating single system trauma
Airway compromise or unsecure
Sever hemodynamic instability
Severe burn or injury, including facial and airway burn or inhalation injury
Acute presentations of chronic conditions

268
Q

what’s considered a serious patient

A

Multi system trauma with relatively stable vitals
Various medical presentations; COPD, pneumonia, altered metal status from hypoglycemia
Significant burn injury

269
Q

5 parts of critical thinking and clinical decision making on scene

A

concept formation

Data Interpretation

Application of Principle

Reflection in Action

Reflection on Action

270
Q

Concept formation

A

Initial assessment
Identify any serious threats to patient’s life

Perform physical exam
Identify chief complaint
Get pertinent medical history
medications

General impression
Assessment of patient’s affect
vital signs
other measurements (glucose, bp, spo2, cardiac monitor, stethoscope, capnometer

Evaluate MOI for trauma

Asses patients LOC

271
Q

data interpretation

A

During second stage of critical thinking

Evaluate all gathered info

272
Q

application of principle

A

Next stage of critical thinking process

Initial diagnosis

What you feel is at the root of the patients problem

Differential diagnosis: other possibilities

273
Q

Reflection in Action

A

Actively treating patient while monitoring effects of treatments
Thinking while doing
Check weather what you’re doing is solving patients problems and actually making them feel good
Reassessment!!! Allows you to monitor accuracy of your preliminary diagnosis

274
Q

Reflection on Action

A

Review or critiques
look back at call and reflect how you processed signs and symptoms to reach all the decisions you did
gives you. Chance to continuously improve

275
Q

6 R’s of critical thinking

A 
read the scene
read the patient
react
reevaluate
revise plan
review performance
276
Q

6 R’s of critical thinking

read the scene

A

overall safety of scene
immediate surroundings
exit or entrance issues
mechanism of injury

277
Q

6 R’s of critical thinking

read the patient

A

As you approach does patient track you with eyes
Introduce yourself
Ask who called 911 and why

Observe patients general appearance 
paient LOC and level of comfort or discomfort 
Skin color 
Position 
Work of breathing 
Any obvious deformities 
Talk to patient 
Determine chief complaint 
Is this a new problem or pre-existing that has worsened? 
Obtain history of present problem 
Obtain medical history

Touch the patient to do assessment
What is skin temp and moist level?
Assess pulse rate, regularity and strength

Listen to lung sounds
Confirm adequacy or inadequacy of respirations
Reassess patency airway

Identify life threats
Correct life threats (ABC’s) in order found

Obtain vital signs
Every patient baseline set of vitals
Serious patients 2 sets
Critical patients 3 or more

278
Q

6 R’s of critical thinking

react

A

address life threats in order based on assessment findings

Next consider worst case scenario that could be causing the symptoms and rule it out or in

Determine most common probable cause for current condition

Administer high flow oxygen and place patient in position of comfort

279
Q

6 R’s of critical thinking

reevaluate

A

follow up on any interventions

280
Q

6 R’s of critical thinking

revise plan

A

may need to change initial diagnosis or adapt based on any additional info you find out

281
Q

6 R’s of critical thinking

review performance

A

reflect on what went well and what could’ve gone better

282
Q

conflict

A

an expressed struggle between at least two interdependent parties, who perceive incompatible goals, scarce rewards, and interference with the other party in achieving their goals

283
Q

Useful functions of conflict in groups:

A

Conflict increases involvement of group members. 
Conflict provides an outlet for hostility. 
Conflict contributes to cohesiveness. 
Conflict contributes to productivity. 
Conflict contributes to commitment.

284
Q

cooperation

A

individual attempts to satisfy the concerns of others

285
Q

assertivness

A

individual attempts to satisfy their own concerns

286
Q

5 steps of problem solving approach

A
  1. Define Conflict
  2. Examine Possible Solutions
  3. Test a Solution
  4. Evaluate the Solution
  5. Accept or Reject the Solution
287
Q

Thomas Kilman Model of Conflict Resolution

A

Developed by two psychologists; Kenneth Thomas and Ralph Kilman

2 dimensions:

  1. Conflict response
    - Assertive option: our attempt to get what we want

2.Cooperativeness option: helping others get what they want

288
Q

5 options of Thomas Kilman Model of Conflict Resolution

A 
Competing  
collaborating
avoiding
accommodating
compromising
289
Q

6 steps of conflict resolution theory

A 
Antecedent Conditions 
Felt conflict 
Manifest behaviour 
Conflict resolution 
Resolution aftermath
290
Q

Constructive feedback:

A

communication that brings an individuals attention to an area in which their performance could improve and helps individual understand that

291
Q

Constructive Feedback is:

A

Useful
Meaningful
Impactful
Easy to understand

292
Q

Constructive Feedback is NOT: 

A

Critical
Accusatory
Vague

293
Q

3 techniques for giving back feedback

A

help to understand
gain acceptance
inspire action

294
Q

effective feed back characteristics

A

Describes the behavior which led to the feedback.

Is done as soon as possible after an incident, and at an appropriate time

Is direct from the sender to the receiver

Owned by the person giving the feedback by using “I” sentences

Includes the real feelings of the person giving the feedback – “I get frustrated when”

Checked for clarity to make sure the information given is accurate and factual

Asks relevant questions for clarification of information
Is specific on consequences of actions

Is asked for by the receiver

Refers to behaviors which the receiver can change and has control over

295
Q

2 types of constructive feedback

A

praise and criticism

296
Q

confidence vs over confidence

A

Confidence: believing in ability to handle task

Facts and figures
I can do that
Trusting yourself to do it

Over confidence: thinks their smater than they actually are

Speculations
Only I can do that
Trust yourself beyond ability

297
Q

assertive vs aggressive behaviour

A

Aggressive Behaviour

Interrupts and talks over others 
Speaks loudly 
Glares and stares at others 
Intimidates others with facial expressions 
Stands stiffly, crosses arms, and invades others personal space 
Controls groups 
Only considers their own feelings 
Demanding of others 
Values self more than others

Assertive Behaviour

Speaks openly 
Uses a conversational tone 
Makes appropriate eye contact 
Shows expressions that match the message 
Relaxes and adopts an open posture and expression 
Participates in groups 
Speaks to the point 
Involves others 
Values self equal to others
298
Q

PCR

A

PCR legal document completed after every call
1 PT= 1 PCR
Call with multiple PTs means use multiple PCRs
Any assessment findings, treatment plan, pt SAMPLE, anything important to call ex: scene, patient comments, bystander accounts, when patients refuse service
If unsure about whether to document, put it down
Avoid opinions; assumptions; nothing we can’t support
White is kept for EMS, yellow stays at hospital, pink goes to SHA

299
Q

who writes PCR

A

Person who attends patient or person in back of ambulance
Driver does not and anyone else who was helping
Leader writes PCR
Anyone licenced as a paramedic

300
Q

Style of writing in PCR

A

Avoid assumptions and opinions
Put patients or bystanders’ words in quotation
Even if there is profanity quote in their own words even if it’s not professional wording
Can’t put “Student A looks to be under influence” unless they confirm
Ex: pt admits to drinking “10 beer today”
PCR in Court

301
Q

PCR in court 2 things must exist

A
  1. Has to be proved as a routine situation

2. Must be proven its part of normal practice and completed within right amount of time

302
Q

Errors in info or spelling on PCR

A

Don’t scribble; put a single line straight through middle
Must initial
Errors must still be legible or it may look like you were trying to hide something

303
Q

who has access to PCRs

A

People within direct circle of care
Evaluate consequence of your words
Law enforcement can do their own thing, they can follow to hospital to get info
HIPA

304
Q

Retention of Records

A

Maintained minimum 10 years or till patient is 19 whichever is longer

305
Q

things to include in PCR

A

Observations
Pertinent negatives: things we did not find
Sometimes can gather more info from things not found than found
Ex: patient denies nausea and vomiting

Facts
Use quotations- try not to paraphrase unless a long winded unnecessary story

Time
24 hour clock!!!!!

Past medical history, medications, allergies, vital signs etc

306
Q

extra thing to include in MVC PCR

A 
Patient location in auto  
Seat belt or shoulder harness usage  
Loss of consciousness  
Velocity of accident  
Type of accident (head-on, roll-over)  
Type of vehicle damage  
Patient trapped or pinned  
Delay in extrication  
Patient ejected from vehicle  
Patient ambulatory at scene
307
Q

extra thing to include in chest pain PCR

A 
Activity at time of pain onset  
Radiation pain on movement  
Onset (gradual or sudden)  
Breath sounds (presence, quality, and quantity)  
Dyspnea  
Nausea and/or vomiting  
Diaphoresis  
JVD  
Peripheral edema  
Pain character (sharp, dull)  
For any type of pain, the PQRST acronym can be used.
308
Q

extra thing to include in diabetes PCR

A 
Level of consciousness  
Insulin-dependent or oral hypoglycemics  
Last meal  
Amount of exercise  
Last insulin injection and how much  
Any recent illnesses  
Gradual or rapid onset of symptoms  
Kussmaul breathing  
Alcohol or other drug use
309
Q

extra thing to include in GSW PCR

A

Number of wounds 
Location of wounds 
Type of weapon (handgun, rifle, or shotgun) 
Patient’s position at time of shooting 
Perpetrator’s position at time of shooting 
How many shots heard 
Head-to-toe assessment 
Note caliber of the weapon if it can be confirmed 
Amount of external hemorrhage noted 
Police notification

310
Q

extra thing to include in no transport call PCR

A

clear documentation 
Patient demographic information 
Patient informed of consequences of not being transported 
Methods used to encourage patient to accept treatment/transportation 
Alcohol or other drug usage 
Level of consciousness 
Patient’s reason for contacting EMS 
Individual responsible for contacting EMS, if not the patient 
Vital signs 
Physical exam 
Cancellations en route (e.g., police, fire, dispatch) 
Patient’s cooperation with your attempts to deliver care and transport 
Signature of patient 
Signature of witnesses

311
Q

extra thing to include in overdose PCR

A 
Level of consciousness  
Whether overdose was witnessed or not  
Medication or substance ingested  
Amount ingested  
Time of overdose or best approximation  
Any associated alcohol or drug consumption  
Prior overdose or suicide attempts  
Patient admission of intent to harm self  
Police notification
312
Q

extra thing to include in paediatric PCR

A 
Level of consciousness (crying, uninterested)  
Parent recognition  
Consolable  
Head bob  
Fontanelles (full, flat, or sunken)  
Child’s weight  
Skin condition  
Sucking reflex  
Finger grasp  
Response to pain  
Fever  
Length of illness  
Medications or treatments administered
313
Q

extra thing to include in pregnancy PCR

A 
Last menstrual period  
Estimated due date (if known)  
Number of pregnancies (gravids)  
Number of pregnancies carried to term (para)  
Prenatal care history (none, some, continuous)  
Complications with this pregnancy  
Complications with other pregnancies  
Water broke  
Back pain  
Urge to push  
Vaginal discharge  
Multiple births  
Type of pain  
Duration of pain  
Regularity of pain  
Interval between pains  
Progress during transport
314
Q

extra thing to include in respiratory distress PCR

A

Level of consciousness 
Skin colour and temperature 
Amount of distress (mild, moderate, or severe) 
Audible respiratory sounds (wheezes, rales, rhonchi) 
Onset of distress (sudden or gradual) 
Activity at time of onset 
Cardiac history 
COPD history 
Breath sounds (present, absent, wheezes, rales) 

315
Q

extra thing to include in stab wounds PCR

A 
Level of consciousness  
Type of accident  
Ambulatory after accident  
Head-to-toe assessment  
Special circumstances  
Scene survey
316
Q

3 main types of verbal documentation

A

radio patch
medical consult/request
verbal report

317
Q

radio patch how to

A

How to do it
Greet listener- “morning general “
Identify yourself (service or unit #) “this is grenfel ems”
Age, sex, LOC “we are en route with a conscious and alert 62 female”
CHAT:
Chief complaint (C/C) “complaining of shortness of breath”
History of c/c “
Assessment findings
Treatment and changes to patient after treatment “on arrival
Give estimated time of arrival (eta)

318
Q

medical consult/request how to

A

Call hospital- request doctor and confirm doctor’s name
State whether request is urgent or non-urgent
Identify yourself and your level of training
State what you are requesting
CHAT about patient
Ask for what you want
Confirm the order

319
Q

verbal report how to

A 
Patient name, age 
c/c, history of chief complaint 
past medical history 
allergies and meds 
treatment and patient changes
320
Q

Signs to watch for to validate comprehension of patient

A

The patient is engaged
The patient asks questions
The patient is able to paraphrase what you have told them
The patient does not just nod in response to questions, but rather verbally answers

321
Q

what should you always communicate to patient

A

Who you are and your level of training

What you have found in your assessments

What you are wanting to do for treatment plan

What are the risks associated with the treatment or refusal of treatment

Where you will be transporting the patient

322
Q

SAMPLE

A

S = Signs and Symptoms – What is happening, when did it start
A = Allergies – Any known allergies
M = Medications – Prescribed, over the counter, herbal remedies or vitamins
P = Past Medical History – Patient’s past medical history. We also call this the Big 7:
Coronary Artery Disease or Heart Attacks
Strokes 
Diabetes
Seizures
Respiratory problems
High or low blood pressure
Fainting/syncope
L = Last meal – what/when did they have their last meal
E = Events – What led up to this medical or trauma event

323
Q

Research:

A

can provide info that is collected in a systematic way

324
Q

Research project:

A

consists of a systematic plan that furthers knowledge beyond the specific situation

325
Q

Research methods:

and 2 classifications

A

procedures that are employed by the researcher to answer or address

quantitative and qualitive

326
Q

Inferences:

A

generalizing a larger group based on observations results made on the sample

327
Q

Internal validity:

A

degree of confidence on has that the conclusions are accurate or true

328
Q

External validity

A

how well findings can be generalized to the population, events or contexts outside of the sample

329
Q

Experimental:

A

researcher Intervenes to determine who gets what treatment

330
Q

Observational:

A

researcher does not intervene at all but collects data

331
Q

intervention group:

A

receive intervention

332
Q

control group:

A

those who do not receive intervention

333
Q

qualitative research

A

Focuses on human behaviour, motivations and behaviour
Focuses on why
Because of smaller sample sizes results don’t represent population
Results can have low reliability because results may not be able to be repeated

334
Q

Quantitative research

A

Systematic investigation into anything measurable
Focuses on description and measurement
Large sample sizes means results are true representation
Results have high reliability because results can be replicated or repeated

335
Q

quantitive research process

A

Planning the study
Data collection
Data analysis
Writing, Presenting and Sharing

336
Q

Evidence- Base Practice

A

“Formal development of clinical guidelines and standards of care in medical practice”

“Research is conducted through validated scientific processes”

337
Q

Evidence informed practice

A

Builds on evidence based health care
“Acknowledges many factors beyond evidence that influence decision making”
“Use research that’s already available and has been tested, tried and true”’

338
Q

5 steps of Evidence based decision making

A
  1. identify the problem or gap regarding patient care
  2. develop PICO question
  3. Perform an evidence search to find the best evidence that helps to answer the question
  4. Appraise the evidence to decide if a particular study is good enough to use. Determine the level and class of the evidence
  5. Apply and report your findings. Integrate the evidence and write about it
339
Q

PICO question

A

Patient or problem
What are Characteristics of patient or population?
What is Condition or disease that you are interested in addressing?

Intervention, prognostic factor, or exposure
What is the intervention or drug you are suggesting? Be specific

Comparisons
What is the alternative?

Outcome
What do you hope to improve or accomplish?

340
Q

Internal search

A

“process of discovering or identifying what you already know about your subject and how that knowledge can help you plan and write your essay”

341
Q

External search:

A

process of learning more about your topic by investigating other peoples research”

342
Q

Prehospital Evidence Based Practice Project (PEP)

A

1998 physicians from Dalhousie University
Purpose was to categorize EMS studies and create debate and growth towards evidence based clinical presentations
Resource for development of new practices

343
Q

Canadian EMS Research Network CERN- RCRSP which year was it est.

A

Est 2013
“Allows for knowledge transfer and exchange of paramedic research, collaboration at the national level and promotion of membership”

344
Q

Canadian Agency for Drugs and Technologies in Health (CADTH)

A

Non profit and independent
Provides people with objective evidence to help in decision making
Finds the evidence, analyses it and provides recommendation

345
Q

Levels of Evidence

A

Must evaluate evidence because its not all equal

2 methods: Levels of Evidence and the Class of Evidence

346
Q

4 risks of over confidence

A

ignorance
excessive risk
poor patient plans
dismissal of others opinions

PRIMARY CARE PARAMEDIC 2021/22 (12 decks)

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