EMER 107 Flashcards
what is a paramedic
self-regulated health care professional with the skills and knowledge to respond to and treat the sick and injured out-of-hospital
what is patient care centred on
prevention, preservation of life, promoting better health and preventing the deterioration of our patient’s condition
1700 BCE Babylon
medical care professional would go into homes
Code of Hammurabi
“protocols and reimbursements for medical care including punishment for malpractice”
Hammurabi
the king who invented rule by law
1790’s (Napoleon’s time)
sending medical care to the patient was no longer done; care was now provided in the field
Jean Larrey
physician who developed ‘ambulances volantes’ (flying ambulances)
1950’s during the Korean War
discovered that bringing pre hospital services closer to field increased the survival rate
Mobile Army Surgical Hospitals (MASH units)
were helicopters; helped thousands of solders and civilians
Late 1950’s early 1960’s: Mobile Intensive Care Units (MICUs)
staffed by specifically trained physicians
Spread to North America and these physicians become short staffed
1965 (united states)
The National Academy of Sciences and the National Research Council released a paper which outlined 10 critical points to establish a functioning system
1966
National Highway Safety Act was enacted as a result of 1965 paper
It included the US Department of Transportation (US DOT)
US DOT
created to help development of basic and advanced life support programs
1971
First EMT textbook in USA published by American Academy of Orthopaedic Surgeons (AAOS)
Titled “Emergency Care and Transportation of the Sick and Injured”
1968
Basic training standards were developed
1969
Dr. Eugene Nagel (Miami, Florida) began training Miami firefighters with advanced medical skills
Dr. Nagel
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
1977
first National Standard Curriculum for paramedics was developed by the US DOT
Curriculum was based on work of Dr. Nancy Caroline
1832 Toronto
first organized ambulance service in Toronto
Mainly transported victims of cholera outbreak (acute diarrheal illness)
1946 Saskatchewan
One of the first Canadian Air Ambulance programs
1974 British Columbia
organized ambulance service was created
1984
The Canada Health Act was passed
The Canada Health Act
Canada’s legislation that funds health care insurance using public funds
5 principles of The Canada Health Act
Public administration Accessibility Comprehensiveness Universality Portability
Early 1990’s
paramedic training programs included in the Canadian Medical Association’s accreditation process
1984
Paramedic Association of Canada was formed
Paramedic Association of Canada (PAC)
formerly known as Canadian Society of Ambulance Personnel
Canada’s organization representing prehospital practitioners
Represents over 20 000 practitioners
2001
National Occupational Competency Profiles (NOCPs)
National Occupational Competency Profiles (NOCPs)
issued by PAC
First document to describe core competencies paramedics are required to practice in Canada
2006
review process for update of the NOCP began
2011
updated version of NOCP
2002
The Paramedic Chiefs of Canada (PCC)
The Paramedic Chiefs of Canada (PCC) function
incorporated as a national forum for info gathering, policy development and coordinated action by the leadership of Canada’s paramedic systems
2007
PCC paper “The Future of EMS in Canada: Defining the New Road Ahead
6 key strategic directions defined by PCC paper “The Future of EMS in Canada: Defining the New Road Ahead
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
what does NOCPs outline
each levels scope of practice
Document identifies competencies that must be met to practice in Canada
Helped standardize minimum education requirements across country
dispatcher
Key role in an emergency call;
must receive and enter all info;
interpret the info;
relay the info to resources
The Emergency Medical Responder
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
The Primary Care Paramedic and skills/abilities
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
The Advanced Care Paramedic and skills/abilities
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
The Critical Care Paramedic
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
4 levels of care in Canada identified in the NOCP document
Critical Care Paramedic Advanced Care Paramedic Primary Care Paramedic Emergency Medical Responder *not all provinces recognize all levels
scope of practice is based on
the level that you are licensed as in your province; not the level of training you have received
first responders in Saskatchewan duties
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
Basic Life Support duties
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
A non-transporting one person ALS rover unit duties
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
Saskatchewan Air Ambulance or STARS duties
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
National EMS Organizations
Canada
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
PAC’s function
Exists to promote quality care through cooperative working relationships among organizations with national EMS interests
SPEC’s function
Society for Pre-hospital Educators in Canada
Development and maintenance of standards for both initial and continuing education for EMS providers
PCOS’s function
paramedic Services Chiefs of Saskatchewan
Promotes ongoing development and awareness of the EMS profession through educational workshops
PCOC’s function
The Paramedic Chiefs of Canada
A national forum for policy development
Saskatchewan Health’s function
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
SCoP function
Governed by a council. Council includes six elected members as well as three members of the public appointed by the Ministry of Health
COPR’s functions
Canadian Organization of Paramedic Regulators
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
PAC’s history
Created in 1988
Over 14000 members
formerly the Canadian Society of Ambulance Personnel (CSAP)
Canadian Organization of Paramedic Regulators COPR history
est 2010
national exam that must be written by all practitioners in Canada to be licenced
Society for Pre-hospital Educators in Canada (SPEC) history
2005 workshop
2007 est
The Paramedic Chiefs of Canada (PCOC) history
est 2002
define registration
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
define reprocity
granting recognition to a paramedic from another province or agency
Saskatchewan College of Paramedics (SCoP) history
est via paramedics act in 2008
self regulated
Saskatchewan College of Paramedics (SCoP) code of conduct
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
quality assurance
process for evaluating problems and generating solutions
Continuous quality improvement (CQI)
process that evaluates problems and find solutions
Quality gap
difference between processes/outcomes in practice and those thought to be achievable with most current knowledge
Patient safety
absence of potential or occurrence of a health care system injury to a patient
Normalization of deviance
so comfortable that it deviates from standards to sub standard and leads to poor care, medical errors and bad patient outcome
common causes of medical errors
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
common EMS related errors
Airway choice and placement errors in 22 to 40 percent
Medication errors
Errors in pediatrics
what should a Continuous quality improvement (CQI) include
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
CQI can help prevent and identify stress points:
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
Profession
field of endeavour that requires specialized set of knowledge, skills and expertise
what percent of EMS communication verbal and what percent is non verbal
Only 7% is verbal (oral and written)
93% are nonverbal
key attributes for paramedics
ntegrity Empathy Compassion Accountability Communication Teamwork Respect Patient Advocate Injury Prevention Careful Delivery of Services
personal mission:
defining the personal, moral and ethical guidelines within your life work
patient advocacy:
is ensuring the best for the patient, defending patients’ rights, supporting patients’ wishes
patient advocacy outlined in NOCP
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
Agreed Upon Code of Conduct on Patient Advocacy- roles included:
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
Principles of advocacy are based on medical ethics (autonomy, beneficence, non- maleficence and justice)
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)
What Can Paramedics Do to Become a More Effective Patient Advocate?
Educate yourself Respect Them As a Person Care for Them Keep Them at Home and Provide Alternative Care Options Safeguard Communicate Handover
leadership:
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
Qualities of a leader
Communication Proficience Honesty Respect for other Integrity Credibility Trustworthiness Vision Empathy Professional Approachable Communication is most important quality
5 levels of leadership
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
what are the 9 leadership types
Transactional Transformational Autocratic Situational People Oriented Participative Charismatic Laissez- Faire Bureaucratic
Transactional leadership
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
Transformational leadership
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.
autocratic leadership
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
Situational leadership
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)
people oriented leadership
Focuses on organization and development of their followers
Find success in the success of those they mentor and coach
Ex: Gandhi
participative leadership
Leader takes into account opinions of team members
Ex: Walt Disney
charismatic leadership
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
Laissez- Faire leadership
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
bureaucratic leadership
Also known as “by the book” leadership
Expect policies and procedures to be followed to the letter no deviations
Ex: Abraham Lincoln
management vs leadership
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
10 differences between managers and leaders
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
delegation:
transferring responsibility for the performance of an activity or task while retaining accountability for the outcome
deciding to delegate
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
integrity:
be open, honest, and truthful with patients
most important attribute
empathy:
show that you acknowledge and understand the feelings of patients, their families, and other health care professionals
self motivation:
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
communication:
express and exchange thoughts/findings with colleges
Listen and speak directly without confusing words to patients and their families
Teamwork and respect:
required in EMS on every call
Patient advocacy:
act in the best interest of the patient; never allow personal feeling to affect the care you provide
Injury prevention:
if you spot a potential hazard talk about findings to patient or family member
Careful delivery of service:
deliver highest quality prehospital care
Pay careful attention to detail and evaluate and re-evaluate your performance
Follow policies, protocols and orders of superiors
primary responsibilities of paramedics
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
dignity
treating people with honour and respect
Elements of preserving patient dignity include:
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
Empathy:
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
To show compassion we must:
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
Age of Majority Act
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
The Ambulance Act
Outlines how the operator may deploy employees and resources
Outlines employee’s responsibility to the employer
PART IV of The Ambulance Act
info on hours allowed to work each shift/week
sleep requirements
The Ambulance Regulations
Outlines the rules for EMS
Part IV of The Ambulance Regulations
vehicle equipment and standards
PART VI of The Ambulance Regulations
Management of Ambulance Services
PART VIII of The Ambulance Regulations
Qualifications of Attendants
Appendix of The Ambulance Regulations
Ambulance accessory equipment General Patient care Medical equipment Als medical equipment
The Emergency Medical Aid Act
“good Samaritan act”
Non-liability for the provision of emergency medical services or first-aid assistance
The Coroner Act
Outlines the role of the coroner, their authority and who’s responsibility it is to contact them
when may coroner be Disqualified or Re- assigned from an investigation
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
Coroner or police must be immediately notified of any death that was:
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
powers of coroner
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
Health Care Directives year of best
Proclaimed in 2015
Outlines
who can make a health care directive
Anyone 16 years or older who has the capacity to make a health care decision
when is health care directive in effect
When person does not have capacity to make health care decisions
Remains in effect until person recovers
requirements of health care directive
Must be in writing
Dated and signed by person making it or proxy
Must have witness when signing it
Bill C-14 Medical Assistance in Dying
June 17 2016
Outlines who is eligible and the practitioners than can facilitate the request
Medical Assistance in Dying eligibility
At least 18
Grievous and irremediable medical condition
Voluntary request
Give informed consent
The Traffic Safety Act
Outlines rules pertaining to operation, registration and license of motor vehicles
Child and family Service Act
Designed to promote well being of children in need of protection
Outlines our responsibilities in the presence of suspected child abuse
when is a child in need of protection
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
Mental Health Services Act
Outlines responsibilities and obligations when caring for mental health patients
Paramedic Act of Saskatchewan
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
The Saskatchewan Employment Act (formerly The Occupational Health and Safety Act) and The Occupational Health and Safety/Regulations and what year
1972
Made health and safety the joint responsibility of management and workers
Protected workers’ fundamental rights
what are the workers’ fundamental rights
Right to know
Right to participate
Right to refuse
The Role of the Occupational Health and Safety Division
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.
Saskatchewan Paramedic Clinical Practice Protocols policies include
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
legal requirements for reporting abuse
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)”
Health Information Protection Act HIPA
year of eat
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
patients rights protected by HIPA
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
Personal Health Information Protection and Electronic Documents Act (PIPEDA)
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
not personal info
classification
salary
discretionary benefits
employment responsibilities
LA-FOIP
Local authority freedom of info and protection of privacy act (SK)
HIPA privacy violation levels
Near miss
Level I- unintentional
Level II – intentional but not malicious
Level III- Intentional and Malicious
Patient autonomy:
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
Patients are capable if they
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
3 ethical conditions for consent to be valid
Consent must be given by capable patient or substitute decision maker
Consent must be informed
Consent must be given voluntarily, without coercion or manipulation
info that must be provided when giving info on treatment in regards to gaining consent
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
Advance care planning:
expression of advance directives by capable patients of wishes regarding future health care choices and expected quality of life
Advance directives:
medical care and treatment wishes either oral or written
best interest of patient means considering:
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
what is The patient’s bill of rights: and what year was it est
1972
a statement of goals and aspirations of guidelines containing only a few legally binding statements
Consumer Rights in Health Care
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
Right:
something that can be enforced by a court of law
The Canadian Patient’s Book of Rights
Describes patients rights
patients rights on Hospital Insurance and Medicare
Every Canadian except few eligible for health insurance at a rate set by the province; not all hospital and medical services are insured
patients rights on The Right to a Physician of One’s Choice
Right to choose physician; physician does not have to take patient though
patients rights on consent to treatment
Right to consent or refuse any treatment of body or mind
patients rights on standard of care
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
patients rights on The Patient’s Property
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
patients rights on Medical Records and Confidentiality
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
patients rights on dearth
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
patients rights on after death
Patient has no right to will their body but can direct that it be used for transplants, research or education
which legal documents pertain to patients rights
Bill C14 Medical Assistance in Dying (MAID)
Health Care Directives and Substitute Health Care Decision Makers Act
Canadian Health Care Rights:
Right to be informed
Right to be respected’
right to participate in decision making affecting their health
Right to equal access to health care
Criteria for Consent
- Consent must be free, voluntary and genuine free of medication and has mental capability of understanding
- Consent may be given to guardian or relative if patient is not capable
- Must have legal capacity to give consent
- Patients commited to mental hospital can be treated without consent
- Persons suffering with communicable disease may be treated without consent
- Procedure performed must be procedure patient has consented
- No consent is valid unless aptient has been informed as to what he/she is consenting
Only time patient can be treated without consent:
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
3 elements of standard care
- individual and community
- the law
- the profession
negligence and when does it occur
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
4 elements of proof of negligence
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
3 lines of authority to answer to as a PCP
Medical director
Licensing agency
Employer
Delegation of function
when a physician delegates to another individual any functions that individual must have the training and qualifications to carry out duties
Transfer of function
the performance of a medical function by an individual which is certified to perform the procedure
Principles of Delegation
indirect medical control:
defined by medical directives, standing orders, guidelines or protocols
direct medical control:
orders may be given by a phone or radio
what do Medical Acts define
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
Vicarious liability
employees are held liable to compensate people for the harm cause by their employees in the course of their employment
Standard care:
what a reasonable paramedic in same situation would have done
Gross negligence:
reckless disregard, utter indifference or conscious disregard for safety of others
Proximate Cause
abandonment
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
Certification:
certain level of credentials based on hours of training and assessment examinations and address criteria met for minimum competency
Licensure:
privilege to practice at a level granted by a provincial agency or self governing professional authority
Mature minor rule:
provides minor with full understanding of consequences and nature of medical treatment may consent or refuse that medical treatment
2 types of consent;
informed and implied
4 steps to gain informed consent from patient
4 steps: Describe suspected injury or illness Describe treatment and risks associated Discuss alternative treatments Advice patient of consequences if treatment is refused
expressed consent
type of informed consent that occurs when patient demonstrates their giving you permission to provide care
implied consent:
consent is assumed by unconscious adults or adults too injured or ill to verbally consent to emergency life saving treatment
consent with minors
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
Decision making capacity:
The Prerequisite for Consent and Refusal
criteria for determining mental competence
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
psychiatric emergencies:
when persons life is not in dancger police officer is only person with authority to transport them to hospital against will
ethics:
philosophy of right and wrong moral duties, responsibilities, and behaviour
morality:
code of conduct defined by society, religion, culture or another person that affects someone character and conscious
4 important principles present in all ethical theories
autonomy
beneficence
non malfeasance
justice
Beneficence
doing what’s best for patient
Non-malfeasance
do no harm
Justice
reflects need for fairness and to “treat equal cases equally and unequal cases unequally”
Futile intervention:
interventions that do not benefit patients
Futility:
treatment is futile if it would not work
Circumstances to withdraw or withhold treatment:
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
core values of Paramedicine
integrity compassion accountability respect empathy
ethics vs morals
Ethics: a standard set by a profession, society, religion or culture
Morals: our own personal beliefs and thoughts about what is right and wrong
Code of Professional Conduct
SCoP developed a Code of Professional Conduct which clearly lists the principles of tethical behaviour, our responsibilities to the patient and to the profession
what’s included in PCP code of ethics
Conservation of life
Alleviation of suffering
Promotion of health
Do no harm
Deontological:
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
Teleological:
consequences of a maoral act determine the act’s worth and correctness
Protocol:
a treatment plan for a specific illness or injury
Standing order
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
Clinical practice guideline (CPG):
step above standing orders; statements that include recommendations to provide optimal care
sasks 3 levels of medical oversight
College of Physicians and Surgeons of Saskatchewan
Medical Advisor
Online Medical Direction
Following procedures must be followed anytime protocol deviation is performed
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
3 ethics of medicine
Do no harm
Act in good faith
Act in the patients best interest
cicil laws
Establish liability
Monetary compensation
Mostly resulting from vehicle crashes
Reasonable belief
criminal law
Action taken by the government for suspected violations of the law
May result in imprisonment and or fines
Beyond reasonable doubt
Violent Patients and Restraints
Scene and provider safety first
Only use force used against you
Patients who are a danger to themselves or others may be restrained
Negligence
good communication:
is being able to transfer a message with meaning clearly from one person to another
Reading
Communication:
act of transmitting info to another person; verbal or through body language
Active listening:
helps confirm info to make sure there are no misunderstandings
pay off questions:
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?
external factors for effective communication
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
Open ended questions
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?
close ended questions
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?
how to behave to get patients to respond
facilitate response be quiet clarify the response redirect response interpret response simplify and summarize response
common interviewing errors
making assumptions giving medical advice providing false hope assuming excessive authority sidestepping the truth distancing yourself from patients as people
Consider patients mental ability in the following ways:
sense of humour
timing of response to questions
memory
ability to obey simple commands
communication with patients who are not motivated to talk
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
communication with hostile patients
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
communication with very old
Don’t presume older people are hard of hearing
Must adapt to hearing, eye sight and mental and mobility of geriatric population
communication with very young patients
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
5 steps of communication process
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
3 tones of voice
expressive tone
directive tone
problem solving tone
barriers in communication
physical disability or limitation
cultural and language differences
Environmental Barriers
Emotional Barriers
main factors for good communication
choice of language tone of voice emphasis body language listening ability
type of non verbal communication
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
Proxemics: use of space Intimate space \_\_ inchs Intimate space _inch- _ft Public distance _feet or more Social distance _ft to _ ft
Intimate space 0-8 inchs
Intimate space 18inch- 4ft
Public distance 12 feet or more
Social distance 4 ft to 12 ft
6 emotions
fear, anger, disgust, surprise, happiness and sadness
important non verbal communication in ems
facial expression eye contact personal space position touch
4 stages of listening
sensing,
interpretation,
evaluation
reaction
sensing in terms of listening
Psychological process of how we hear: Loudness and clarity of voice Competing sounds Personal problems Hunger Work pressures
interpretation in terms of listening
and factors that affect interpretation
Attributes meaning to message Factors that affect: Preconvinced notions Lack of knowledge Complexity Evoking negative emotions
evaluation in terms of listening
involves decision to accept or reject message
Decision process largely based on how message coincides with personal values and beliefs
Cognitive dissonance
reaction in terms of listening
Response generated by message
May take form of direct feedback
Usually in form of indirect feedback (non verbal reactions)
tips to become effective listener
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
Ways to demonstrate respect:
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
empathy vs sympathy
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.
Tact and diplomacy
Tact: sensitivity in dealing with others in difficult situations
Diplomacy: dealing with people in a sensitive and effective way
rapport
relationships in which people understand each other’s feelings/ideas and communicate well
Therapeutic communication:
any communication between health care professional and patient that takes place to advance patients well-being and care”
3 main purposes of therapeutic communication:
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
clients of Ems
every patient we interact with
community we work with
government
public safety: police and fire
other healthcare facilities
main causes of miscommunication is Ems
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
Stress:
reaction of body to an individual or situation that requires adaptation
Often in response to a threatening situation
Triggers of stress
Loss of someone close Loss of possession that is meaningful major life event Personal illness or injury Family illness or injury Witness injury
Eustress
(positive stress): kind of stress that motivates a person to achieve
Distress
(negative stress): kind of stress that is overwhelming and debilitating
5 categories of reactions that should be removed from scene
anxiety blind panic depression overreaction conversion hysteria
de escalation strategies
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
Denial:
they may ignore or dismiss the seriousness of the situation
Regression
may return to an earlier age level of behaviour
Projection
attributing your own feelings, motives and behaviours onto others
Displacement:
redirecting an emotion from the original cause to an immediate substitute- can be seen as anger towards you
Day to day basis order:
identify problems, set patient care priorities; develop a pre hospital care plan; and execute that plan
4 cornerstones of effective paramedic practice
Gathering, evaluating ad synthesizing
Developing and Implementing a Patient Care Plan
Judgement and Independent Decision Making
Thinking Under Pressure
triage model
mortally wounded or dead
critical: need immediate prehospital care to survive
serious: need care within next few minutes
walking wounded or minimally injured
what’s considered a Critical patient
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
what’s considered a serious patient
Multi system trauma with relatively stable vitals
Various medical presentations; COPD, pneumonia, altered metal status from hypoglycemia
Significant burn injury
5 parts of critical thinking and clinical decision making on scene
concept formation
Data Interpretation
Application of Principle
Reflection in Action
Reflection on Action
Concept formation
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
data interpretation
During second stage of critical thinking
Evaluate all gathered info
application of principle
Next stage of critical thinking process
Initial diagnosis
What you feel is at the root of the patients problem
Differential diagnosis: other possibilities
Reflection in Action
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
Reflection on Action
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
6 R’s of critical thinking
read the scene read the patient react reevaluate revise plan review performance
6 R’s of critical thinking
read the scene
overall safety of scene
immediate surroundings
exit or entrance issues
mechanism of injury
6 R’s of critical thinking
read the patient
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
6 R’s of critical thinking
react
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
6 R’s of critical thinking
reevaluate
follow up on any interventions
6 R’s of critical thinking
revise plan
may need to change initial diagnosis or adapt based on any additional info you find out
6 R’s of critical thinking
review performance
reflect on what went well and what could’ve gone better
conflict
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
Useful functions of conflict in groups:
Conflict increases involvement of group members.
Conflict provides an outlet for hostility.
Conflict contributes to cohesiveness.
Conflict contributes to productivity.
Conflict contributes to commitment.
cooperation
individual attempts to satisfy the concerns of others
assertivness
individual attempts to satisfy their own concerns
5 steps of problem solving approach
- Define Conflict
- Examine Possible Solutions
- Test a Solution
- Evaluate the Solution
- Accept or Reject the Solution
Thomas Kilman Model of Conflict Resolution
Developed by two psychologists; Kenneth Thomas and Ralph Kilman
2 dimensions:
- Conflict response
- Assertive option: our attempt to get what we want
2.Cooperativeness option: helping others get what they want
5 options of Thomas Kilman Model of Conflict Resolution
Competing collaborating avoiding accommodating compromising
6 steps of conflict resolution theory
Antecedent Conditions Felt conflict Manifest behaviour Conflict resolution Resolution aftermath
Constructive feedback:
communication that brings an individuals attention to an area in which their performance could improve and helps individual understand that
Constructive Feedback is:
Useful
Meaningful
Impactful
Easy to understand
Constructive Feedback is NOT:
Critical
Accusatory
Vague
3 techniques for giving back feedback
help to understand
gain acceptance
inspire action
effective feed back characteristics
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
2 types of constructive feedback
praise and criticism
confidence vs over confidence
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
assertive vs aggressive behaviour
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
PCR
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
who writes PCR
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
Style of writing in PCR
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
PCR in court 2 things must exist
- Has to be proved as a routine situation
2. Must be proven its part of normal practice and completed within right amount of time
Errors in info or spelling on PCR
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
who has access to PCRs
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
Retention of Records
Maintained minimum 10 years or till patient is 19 whichever is longer
things to include in PCR
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
extra thing to include in MVC PCR
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
extra thing to include in chest pain PCR
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.
extra thing to include in diabetes PCR
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
extra thing to include in GSW PCR
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
extra thing to include in no transport call PCR
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
extra thing to include in overdose PCR
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
extra thing to include in paediatric PCR
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
extra thing to include in pregnancy PCR
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
extra thing to include in respiratory distress PCR
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)
extra thing to include in stab wounds PCR
Level of consciousness Type of accident Ambulatory after accident Head-to-toe assessment Special circumstances Scene survey
3 main types of verbal documentation
radio patch
medical consult/request
verbal report
radio patch how to
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)
medical consult/request how to
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
verbal report how to
Patient name, age c/c, history of chief complaint past medical history allergies and meds treatment and patient changes
Signs to watch for to validate comprehension of patient
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
what should you always communicate to patient
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
SAMPLE
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
Research:
can provide info that is collected in a systematic way
Research project:
consists of a systematic plan that furthers knowledge beyond the specific situation
Research methods:
and 2 classifications
procedures that are employed by the researcher to answer or address
quantitative and qualitive
Inferences:
generalizing a larger group based on observations results made on the sample
Internal validity:
degree of confidence on has that the conclusions are accurate or true
External validity
how well findings can be generalized to the population, events or contexts outside of the sample
Experimental:
researcher Intervenes to determine who gets what treatment
Observational:
researcher does not intervene at all but collects data
intervention group:
receive intervention
control group:
those who do not receive intervention
qualitative research
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
Quantitative research
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
quantitive research process
Planning the study
Data collection
Data analysis
Writing, Presenting and Sharing
Evidence- Base Practice
“Formal development of clinical guidelines and standards of care in medical practice”
“Research is conducted through validated scientific processes”
Evidence informed practice
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”’
5 steps of Evidence based decision making
- identify the problem or gap regarding patient care
- develop PICO question
- Perform an evidence search to find the best evidence that helps to answer the question
- Appraise the evidence to decide if a particular study is good enough to use. Determine the level and class of the evidence
- Apply and report your findings. Integrate the evidence and write about it
PICO question
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?
Internal search
“process of discovering or identifying what you already know about your subject and how that knowledge can help you plan and write your essay”
External search:
process of learning more about your topic by investigating other peoples research”
Prehospital Evidence Based Practice Project (PEP)
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
Canadian EMS Research Network CERN- RCRSP which year was it est.
Est 2013
“Allows for knowledge transfer and exchange of paramedic research, collaboration at the national level and promotion of membership”
Canadian Agency for Drugs and Technologies in Health (CADTH)
Non profit and independent
Provides people with objective evidence to help in decision making
Finds the evidence, analyses it and provides recommendation
Levels of Evidence
Must evaluate evidence because its not all equal
2 methods: Levels of Evidence and the Class of Evidence
4 risks of over confidence
ignorance
excessive risk
poor patient plans
dismissal of others opinions
