EMS, Controlled acts, other trivia/minutia

Question 1

What is on-line vs off-line medical direction

Answer 1

online: direct physician to paramedic contact (radio, telephone, onsite)
offline: pre-authorized written instructions – eg, standing orders, with specific inclusion and exclusion criteria

Question 2

What are the levels of “targeted responders” (Canada-wide)?

Answer 2

Emergency Medical Responder (EMR)
Primary Care Paramedic (PCP)
Advanced Care Paramedic (ACP)
Critical Care Paramedic (CCP)

Question 3

What is the scope of practice of an Emergency Medical Responder?

Answer 3

(Typically firefighters)

CPR
First Aid
Basic Airway Management
Emergency Delivery
Spinal Immobilization
Oxygen Admin
Assisted Ventilation
\+/- AED

Question 4

What is the scope of practice of a Primary Care Paramedic?

Answer 4

EMR scope plus:

AED (may do manual defib)
Lead II interpretation
12-lead ECG
“Symptom Relief” medications
\+/- Peripheral IV initiation
\+/- additional specific therapies (CPAP)

Question 5

What are the meds that primary care paramedics can administer?

Answer 5

5 “Symptom Relief” medications similar across Canada:

Nitroglycerin (sl for ACS and CHF)
ASA (po/chew for ACS)
Salbutamol (Neb/MDI for Asthma/COPD)
Epinephrine (IM for anaphylaxis or Neb for severe croup)
Glucagon (IM for hypoglycemia)

Question 6

What is the scope of practice of an Advanced Care Paramedic?

Answer 6

PCP scope plus:

IV and IO access
IV Medication administration 
Advanced Rhythm Interpretation
Endotracheal Intubation
Manual Defibrillation, Cardioversion, and pacing
Cricothyrotomy
Needle Thoracostomy

Question 7

What additional meds can ACPs deliver (over PCPs)?

Answer 7

IV meds:

Morphine/ naloxone
Midazolam
Epinephrine, Atropine
Lidocaine/ Amiodarone
Adenosine
Benadryl / Gravol
Dextrose
Sodium Bicarbonate

Question 8

What is the scope of practice of a Critical Care Paramedic?

Answer 8

Over an ACP:

Expanded med admin
IV infusion pumps
Blood product admin
CXR and lab interpretation
Mechanical ventilation, and setting ventilatory parameters
End-tidal CO2 monitoring
Doppler monitor use
12-lead interpretation
Arterial and central venous catheter monitoring and maintenance
Maintenance of transvenous pacing
Management of chest tubes and chest drainage systems
Foley catheter and NG tube insertion and maintenance

Question 9

What are the 14 things that can only be done by Regulated Health Professions?

Answer 9

1. Communicating a diagnosis
2. Performing a procedure below the dermis
3. Setting or casting a fracture of a bone or dislocation of a joint.
4. Moving the joints of the spine beyond the usual physiological range of motion.
5. Administering a substance by injection or inhalation.
6. Putting an instrument, hand or finger: [orifices]
7. Applying or ordering the application of a form of energy.
8. Prescribing, dispensing, selling or compounding a drug.
9. Prescribing or dispensing vision devices, contact lenses or eye glasses.
10. Prescribing a hearing aid for a hearing impaired person.
11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance.
12. Managing labour or conducting the delivery of a baby.
13. Allergy challenge testing.
14. Treating, by means of psychotherapy technique ….

Question 10

Who are not RHPs?

Answer 10

Paramedics and Physician Assistants are not RHPs

Delegation allows non-RHPs to perform these acts in specific circumstances

Question 11

What does each RHP have?

Answer 11

A College

Question 12

What is #6 on the list of 14 things that can only be done by RHPs?

Answer 12

6. Putting an instrument, hand or finger:
   i) Beyond the external ear canal,
   ii) Beyond the point in the nasal passages where they normally narrow,
   iii) Beyond the larynx,
   iv) Beyond the opening of the urethra,
   v) Beyond the labia majora,
   vi) Beyond the anal verge,
   vii) or into an artificial opening in the body.