EMS Legislation

Question 1

The Ambulance Act covers responsibilities of who and what kind of responsibilities?

Answer 1

1) MOH - regarding administration, funding, and enforcement of the legislation of provision of ambulance services
2) upper-tier municipalities & other agents who operate daily amulance services

Question 2

The only act protecting paramedics is which act?

Answer 2

Ambulance Act (because no regulatory college)

Question 3

The definition of “paramedic” and certifications/controlled acts with necessary qualifications are defined in which act?

Answer 3

Ambulance Act

Question 4

Define paramedic

Answer 4

1) employed by or volunteer for an ambulance service who has the qualifications (AEMCA)
2) authorized to perform one or more controlled acts under authority of base hospital medical director
3) and NOT a physician, nurse, or other HCP that attends the call for an ambulance

Question 5

What are the standards of care as per the Ambulance Act (there are 4)

Answer 5

1) BLS PCS - for all paramedics
2) ALS PCS - for ACPs or CCPs
3) Patient Care Model Standards - additional patient care standards
4) Patient Care and Transport Standards - additional patient care standards

Question 6

How does the Health Care Consent Act enhance autonomy of persons who are receiving treatment (3 points)

Answer 6

1) Allowing incapable persons to apply to the Consent and Capacity Board for review of the finding
2) allowing incapable persons to request a representative to be apponited by the Board to assist with decision making re: treatment
3) Requiring adherence to treatment wishes expressed by persons while capable at 16+ years old (i.e. if 16 y.o. was capable and had DNR and is now 40 and incapable, you grant their wishes re: treatment that were expressed when they were 16 and capable)

Question 7

What are the four patient care models within the Patient Care Model Standards? These were new amendments to the Ambulance Act.

Answer 7

1) Alternate Destination Transport
2) Treat and Release (on scene)
3) Treatment and refer to alternate health care provider (HCP)
4) Low acuity patients to be referred to appropriate community care during 911 call

Question 8

According to the Health Care Consent Act, a health practitioner is allowed to administer treatment when they obtain consent in one of the two ways:

Answer 8

1) Patient is capable + consent received

2) Patient is incapable so consented received from SDM

Question 9

True or False: When someone who is incapable becomes capable and withdraws consent, you are allowed to continue providing treatment because they initially consented.

Answer 9

FALSE - consent is a fluid process so you need to stop ok

Question 10

True or False: Health Care Providers (HCPs) are allowed to rely on someone’s assertion that they are someone’s SDM (don’t need verification of their status as SDM)

Answer 10

True

Question 11

List the SDM hierarchy (highest to lowest)

Answer 11

Legally appointed:

1) Court appointed guardian
2) POA
3) Rep appointed by Consent and Capacity Board

Automatic family member SDMs:

1) Spouse/Partner
2) Parent or children
3) Parent with right of access only
4) Siblings
5) Any ofther relatives

Last resort:
1) PG&T

Question 12

True or False: SDM has more power than the patient themselves (if patient is capable) since SDM has already been appointed

Answer 12

FALSE - If patient is capable, SDMs don’t apply so obtain consent and discuss treatment related decisions with patient directly

Question 13

Requirements to be an SDM

Answer 13

• Willing to be SDM and make decisions re: treatment
• be available in person, phone or electronic communication
• must be capable of understanding treatment and care being provided, and the consequences of consenting/refusing tx
• be at least 16 y.o (unless parent of incapable person)
• Not prohibited by court order/separation agreement from acting as SDM

Question 14

What does PHIPA stand for?

Answer 14

Personal Health Information Protection Act (2004)

Question 15

True or False: The Act presumes that everyone has such capacity (i.e. able to understand tx information and foreseeable consequences of a decision/lack of decision)

Answer 15

True

Question 16

Rules related to PHIPA apply to who?

Answer 16

Health Information Custodians (HICs) and those that receive personal health information

Question 17

What is the overall purpose of PHIPA?

Answer 17

To protect patients and their health information by setting out rules regarding collection, use, and disclosure of personal health information

Question 18

Give 3 reasons as to why personal health information would be shared?

Answer 18

1) Patient care and treatment
2) Health research
3) Managing publicly funded health care system

(obviously you would be asking for consent!)

Question 19

True or False: A plan of service for individuals requiring long term care is not considered personal health information

Answer 19

False

Question 20

True or False: ANY information about an individual that is included in a record that contains personal health information is also included as personal health information

Answer 20

True

Question 21

True or False: Donation of body parts/bodily substances and related tests is considered personal health information

Answer 21

True

Question 22

True or False: Consent under PHIPA can be expressed/implied. Why or why not?

Answer 22

True - ex. disclosing information from one health information custodian to another (such as paramedic to hospital staff) allows for providing health care in a more seamless manner (unless consent is specifically withdrawn/withheld)

Question 23

Which of the following is not an offence under PHIPA?

1) To wilfully obstruct the Commissioner
2) Dispose of a record with the intent to evade an access request
3) Dispose of a record in a manner that is secure
4) Collect, use or disclose the health card # in a manner that is not consistent with rules that apply to persons who are not custodians

Answer 23

3) Dispose of a record in a manner that is secure (it’s only an offence if you throw personal health information into the garbage for example, and it’s not secure)

Question 24

Individuals may be fined up to __________ and organizations may be fined up to ________ if they are found guilty based on the offence

Answer 24

Individuals: $50 000
Organizations: $250 000

Question 25

What does the RHPA stand for?

Answer 25

Regulated Health Professions Act (1991)

Question 26

Why does the RHPA pertain to paramedics?

Answer 26

Paramedics are indirectly affected as the Act outlines delegation of medical acts (that allows paramedics to perform controlled acts)

Question 27

What are controlled acts?

Answer 27

Procedures which may pose a risk to the public if not performed by a qualified practitioner

Question 28

Give 5 examples of regulated health professionals that PARAMEDICS will encounter.

Answer 28

1) Physicians
2) Nurses
3) Midwives
4) Respiratory Therapists
5) Occupational Therapists babbyyyyyy

Question 29

True or False: According to the Regulated Health Professionals Standard in the BLS PCS, if a physician (regulated health professional) asks you as a paramedic to assist with care and delegates an act to you beyond what you are authorized to do, you are allowed to do so because it has been delegated by a physician.

Answer 29

False - listen to your base hospital doctor and only do what you are authorized to do regarding controlled acts by your base hospital doctor

Question 30

What are the three things you must document on an ACR when patient care involves another regulated health profession?

Answer 30

The regulated health professional’s

1) name
2) what kind of professional they are
3) any care provided by them

Question 31

True or False: One of the purposes of the Coroners Act is to ensure coroner’s inquest does not interfere with ongoing criminal investigations or trials

Answer 31

True

Question 32

Who is the grandfather of Ontario’s EMS system?

Answer 32

Dr. Norman H McNally

Question 33

What piece of legislation was the first to govern ambulance services in Ontario?

Answer 33

Ambulance Act (1975)

Question 34

What is the purpose of the coroner’s inquest?

Answer 34

To investigate circumstances of a death to prevent future occurrences of similar circumstances

Question 35

What is the purpose of a mandatory inquest?

Answer 35

To address deaths related to workplace accidents or while being detained/in custody (so if it’s sus, they investigate)

Question 36

What are the three factors that are considered during a discretionary inquest (i.e. up to the coroner’s discretion to call for an inquest)?

Answer 36

1) Whether the answers to the 5 questions are known
2) Whether it is desirable for the public to have open and full hearing of the circumstances of the death
3) the need for preventative measures in the community

Question 37

What does CFSA stand for?

Answer 37

Child and Family Services Act

Question 38

Why do you, as a paramedic who suspects child abuse, have to report directly to CAS?

Answer 38

Because too many hands in the pot = bystander effect and then everyone assumes someone else did it (that’s a big no no)

Question 39

What are the types of abuse/harm that a child may need protection from?

Answer 39

1) abandonment
2) inadequate care
3) sexual exploitation
4) sexual molestation
5) emotional harm
6) physical harm

1) and 2) fall under a pattern of neglect

Question 40

True or False: Under CFSA, the duty to report child abuse supercedes PHIPA

Answer 40

TRUE

Question 41

Under what age do you have a mandatory duty to report?

Answer 41

under the age of 16 - mandatory (YOU MUST REPORT)

however if you have reasonable grounds to believe that a 16 or 17 year old may need protection, a report can be made even if you are not required

Question 42

Which of the following is not typically a sign/pattern of injury for a child who may be abused?

1) Injuries on forearms/lower legs
2) Sock-glove like distribution
3) Fractures in different stages of healing
4) Handprint injuries
5) no splash marks

Answer 42

1) injuries on forearms/lower legs are typically from accidental falls or more in line with developmentally appropriate activities a child may be doing

Question 43

What does the term “reasonable grounds” mean when we talk about determining duty to report child abuse?

Answer 43

Reasonable grounds: refers to the information that an average person, using normal and honest judgement, would need in order to decide to report

Question 44

Within the section “Child in Need of Protection Standard” within the paramedic BLS PCS, which of the following are true?

1) The paramedic shall transport the patient in all cases
2) The paramedic shall make no accusations or comments about child abuse suspicions in front of parents or bystanders
3) The paramedic shall obtain a clear history of the incident (as able) and display no personal curiosity
4) All of the above

Answer 44

DO THEM ALL

Question 45

True or False - the failure to report a suspicion in the circumstances set out in the CFSA (Ontario) is an offence under that Act

Answer 45

yes it’s true

Question 46

Under the CFSA, do you have a duty to report child abuse for ANY child you encounter in your professional duties even if they are not your patient?

Answer 46

yes you better report

Question 47

What is the definition of “mental disorder” under the Ontario Mental Health Act?

Answer 47

“any disease or disability of the mind”

Question 48

When would someone be subject under involuntary detainment (there are 4 situations)?

Answer 48

1) Form 1
2) Form 2
3) Under subsection 17 of the MHA
3) Form 3 and 4

Question 49

Describe Form 1

Answer 49

It’s a form completed and signed by a physician for an individual to undergo a psych assessment to determine whether further admission is required (either voluntary or involuntary) or discharge - valid for 72 hours

Question 50

Describe Form 2

Answer 50

“Order of examination” for a psych assessment to be done by a physician, this form is signed by a Justice of the Peace) and usually based on sworn statements by family members/people close to the individual

Question 51

Describe subsection 17 of the MHA

Answer 51

a police officer taking someone into custody for an assessment by a doctor without a Form 1 or 2 BECAUSE:

1) There’s no time for a Form 2 - office has reasonable cause that it’s too dangerous to wait for a JP to sign the Form 2
2) Office has reasonable and probable grounds to believe that the person is acting/has acted in a disorderly manner and basically meets the same qualifications as the Form 1

Question 52

What is Box A of a Form 1? (long answer ahead lol)

Answer 52

known as the “serious harm test” and outlines criteria in which a physician would check off when filling out the Form 1 to detain someone for the 72 hours

they have reasonable cause to believe that the person: (this is the past/present test)

1) has threatened or attempted to cause bodily harm to self (or is currently threatening or attempting to do so)
2) basically above but threatening to do so towards another person (or has already caused harm to them)
3) has shown or is showing a lack of competence to care for self

Question 53

What is the “future test” in Box A of the Form 1? (three criteria)

Answer 53

The MD is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that will likely result in:

1) Serious bodily harm to the person
2) Serious bodily harm to another person
3) Serious physical impairment of the person

Question 54

Under the Highway Traffic Act, besides being able to go through red lights (obviously if it’s safe to do so), what are two other exemptions of the Act that does not apply during an emergency?

Answer 54

1) drive on a closed highway or part thereof in intentional disobedience of signs/traffic control devices
2) overtake or pass another vehicle (ambulance trucks are allowed to drive off roadway)

Question 55

MOHLTC was previously known as:

Answer 55

Emergency Health Services Division of Ontario Hospital Services Commission

Question 56

Prior to 1960’s, what did EMS services look like?

Answer 56

• A mix of funeral homes, hospitals, and FD with no real regulated certification, training, and/or funding
• also no formal 911 number for the public to call

Question 57

Which act includes legislation of controlled acts, response time performance plans, and standards of care for patients/reports/documentation?

Answer 57

Ambulance Act

Question 58

Define ambulance as per Ambulance Act:

Answer 58

means a conveyance used or intended to be used for the transportation of persons who,

(a) have suffered a trauma or acute onset of illness either of which could endanger life, limb, function OR
(b) have been judged by a physician/HCP (designated by a physician) to be in an unstable medical condition and to require, while being transported, the care of a physician, nurse, other HCP, emergency medical attendant or paramedic, and the use of a stretcher;

Question 59

Required qualifications of paramedics as per Ambulance Act (9):

Answer 59

1) read, write, speak English fluently
2) cannot have 6+ demerit points on record (as per HTA) within the last year starting from date of employment
3) maintained driver’s license within last 2 years from the date of employement (and continue to maintain)
4) no criminal code stuff that prevents vehicle operation within the last 3 years starting from date of employment
5) have F class license and maintain it
6) have no communcable diseases set out in Table 1 of “Ambulance Service Communicable Disease Standards”
7) have a valid and MD-signed vax card that states that paramedic is immunized against ^ those diseases
8) not been convicted of any crime involving moral turpitude for which the person has not been pardoned (basically don’t be morally evil or do anything unjust)
9) annual CPR recert required (BLS or ACLS)

Question 60

True or False: HCCA covers rules regarding consent to treatment which is to be applied variably in all settings, as well as treatment and decision making for those with capacity.

Answer 60

False. It is too be applied consistently in all settings, and covers treatment and decision making for those lacking capacity.

Question 61

Which of the following is the purpose of the HCCA?

1) increase communciation between HCP and patients
2) ensure role of supportive family registrants when a person lacks capacity to make a decision regarding treatment
3) permit intervention by PG&T as a last resort for decision making re: treatment
4) 1 and 3 only
5) all of the above
6) none of the above

Answer 61

all of the above

Question 62

The definition of capacity under the HCCA:

Answer 62

A person is capable with respect to a treatment, admission to a care facility or a personal assistance service if the person is:

(a) able to understand the information that is relevant to making a decision about the treatment, admission or personal assistance services, as the case may be, and
(b) able to appreciate the reasonably foreseeable consequences of a decision or lack of decision

Question 63

All of the following statements are true re: PHIPA except:

1) individuals cannot request their own personal health information due to confidentiality reasons
2) a health information custodian must notify the individual if PHI is stolen, lost or accessed by an unauthorized person
3) implied consent under this act allows for paramedics to provide triage reports and ACRs
4) all of the above are true

Answer 63

1) individuals cannot request their own personal health information due to confidentiality reasons

Question 64

PHI includes written or oral information about the individual, if the information is: (8)

Answer 64

1) re: someone’s physical/mental health including family health hx
2) re: provision of health care, including indentification of persons providing care
3) is a plan of service for individuals requiring LT care
4) re: payment/eligibility for health care
5) re: donation of body parts/bodily substances or is derived from testing or examination of such parts of substances
6) OHIP #
7) identifies their SDM
8) any other info about someone that is included in a record containing PHI is also included in the definition

Question 65

A health information custodian may disclose PHI without consent under what circumstances?

Answer 65

if reasonable grounds that disclosure is necessary to reduce or eliminate significant risk to self/others (bodily harm)

Question 66

It is an offence under PHIPA to: (9)

Answer 66

1) wilfully collect, use, and disclose PHI in contravention of the Act
2) make a request to access or correct a record of PHI under false pretences
3) knowingly make certain false statements in connection with a collection, use or disclosure of PHI or access to a record
4) dispose of a record with the intent to evade an access request
5) wilfully dispose of a record in a manner that is not secure
6) collect, use or disclose health care number in a manner that is inconsistent with the rules that apply to persons who are not custodians
7) wilfully obstruct the Commissioner
8) wilfully make a false statement to the Commissioner
9) wilfully fail to comply with an order of the Commissioner

Question 67

True or False. RHPA covers scope of practice including controlled acts, health regulatory colleges, Health professions Regulatory Advisory Council, and Health Professions Appeal and Review Board.

Answer 67

True

Question 68

As per the Regulated Health Professionals Standard in the BLS, what are the 5 steps a paramedic shall do?

Answer 68

1) recognize the trainings and quals of the RHP
2) determine nature of request for ambo service
3) obtain confirmation (can be verbal) that the RHP is registered with their College within Ontario, and that the patient under their care
4) upon request, assist RHP with patient care only to the level in which the paramedic is authorized
5) follow Documentation of Patient Care Standard and document on ACR: name and type of RHP, and any care provided by them

Question 69

All of the follows are true regarding the Coroners Act except:

1) dictates when mandatory inquests are required
2) establishes procedures for inquest
3) appeal processes re: inquests or coroner’s decision
4) establish time limits regarding when an inquest can be called

Answer 69

4) establish time limits regarding when an inquest can be called
* there is NO time limit as to when an inquest must be called

Question 70

The five questions that an inquest is trying to answer are what?

Answer 70

1) who was the deceased?
2) where did the death occur?
3) when did the death occur?
4) how did the death occur (i.e. medical cause)?
5) by what means did the death occur (i.e. classficiation/manner of death: natural, suicide, accident, undetermined, etc.)

Question 71

What are the two types of inquests?

Answer 71

Mandatory - to address deaths via workplace accidents or while being detained/in custody

Discretionary - dependent on Coroner’s discretion to call for an inquest (consdering if all 5Q’s have been answered/known, whether a hearing re: the circumstances of death for the public would be desirable, and wheher there is the need for preventative measures in the community)

Question 72

With regards to disclosing PHI for a child in need of protection, a health information custodian may disclose PHI to who?

Answer 72

1) CAS
2) PG&T
3) children’s lawyer
4) Residential Placement Advisory Committee

Question 73

As per child abuse, classify the following as either abuse or accident:

1) head
2) forearms and shins
3) cheeks/ears/face
4) hands and feet
5) chest and abdomen
6) femur/genital regions
7) upper arm
8) shoulders
9) hips
10) neck

Answer 73

1) accident/abuse (if it’s skull and facial fractures)
2) accident
3) abuse
4) abuse
5) abuse
6) abuse
7) abuse
8) accident
9) accident
10) abuse

Question 74

All of the following are signs of child abuse except:

1) little eye contact with adults
2) protecting abuser for fear of punishment
3) inappropriate response to pain
4) all of the above

Answer 74

all of the above are signs of child abuse

Question 75

As per the Child in Need of Protection Standard in the BLS, the paramedic shall follow what 6 general steps?

Answer 75

1) ensure patient is not left alone
2) request police assistance at scene if believed that patient is at risk of imminent harm
3) obtain clear hx of the incident with NO display of personal curiosity
4) make no accusations or comments about your suspicions in front of the parents or bystanders
5) transport the child in all cases
6) report suspcisions to the receiving hospital and complete the duty to report to the CAS

Question 76

As per Child in Need of Protection Standard in the BLS, item 3 states the following:
(3) obtain as clear a hx of the incident as possible, with no display of personal curiosity. Attempt to determine….

What are you trying to determine? (4)

Answer 76

1) how valid the hx provided is. Consider children in need of protection if:
- story changes frequently or parent’s stories differ
- parents are vaue about what happened/blame each other
- nature of injury appears inconsistent/improbably with explanation given
- mechanism of injury is obviously beyond the development capabilities of the child
- there has been prolonged, unexplained delay in seeking tx
- there is a hx of recurrent injuries

2) interaction (or lack thereof) between parents & between parents and child (being hostile, child is inappropriate fearful, child avoiding the parents or protecting abusive party)
3) appropriateness of parental/caretaker response to child’s injury and/or emotional distress (lack of concern, lack of comforting, inappropriate anger towards child)
4) appropriateness of chid’s behaviour relavant to situation/injury (i.e. inappropriate fear, indifference, lack of emotion)

Question 77

As per the Child in Need of Protection Standard in the BLS, what types of injuries/pediatric problems are noteworthy for specific attention when determining if the child may be in need of protection?

Answer 77

1) submersion injuries
2) ALL burns
3) accidental ingestions/posioning
4) other types of in-home injuries (falls)

Question 78

As per the Child in Need of Protection Standard in the BLS, what scene observations may prompt consideration that the patient is a child in need of protection?

Answer 78

1) dirty household or siblings, unkempt/disarray
2) evidence of violence (overturned or broken furniture)
3) animal/pet abuse
4) evidence of substance abuse (empty liquor bottles, drug paraphernalia)

Question 79

As per the Child in Need of Protection Standard in the BLS, physical signs which may prompt consideration that the patient is a child in need of protection include: (8)

Answer 79

1) gross/multiple deformities incompatible with incident hx (especially in those less than 2y.o who are developmentally incapable of sustaining this type of injury)
2) multiple new/old bruises not reported or all reported as new
3) distinctive marks/burns (belts, cigarette burns, etc.)
4) bruises in unusual areas (chest, abdo, genitals, butt)
5) burns in unusual area (butt, genitals, soles of feet)
5) signs of long-standing physical neglect (malodourous skin, dirty, severe diaper rash, uncut/dirty fingernails)
6) signs of malnutrition - slack skin folds, extreme pallor, dull/thin hair, dehydration
7) signs of shaken baby syndrome (hemorrhages over whites of eyes; hand grip print on neck/upper arms/shoulders; head injury unrelated to incident hx)

Question 80

In regards to protection services, what happens after an investigation is completed and there is a determination that ongoing CAS services are required?

Answer 80

1) A family service worker is assigned and helps the child determine where they go next (stay in their own home, ST foster care, or with other family)
2) then it’s determined if the crown takes the child away from someone and arranges adoption, legal custody, or LT care; OR they go back to the family
3) if kid goes into long term care, continued care and support is up to 21 y.o.

Question 81

Which of the following is false re: MHA?

1) the Act sets out powers and obligations of psych facilities in Ontario
2) outlines the specific types of restraints allowed to use during voluntary/involuntary transport of a psych patient
3) governs admission process including different patient admissions and directives regarding assessment, treatment and care
4) outlines powers of police and justice of the peace (JP) to make orders for an individual to undergo a psych exam by an MD

Answer 81

2) outlines the specific types of restraints allowed to use during voluntary/involuntary transport of a psych patient

Question 82

What is the purpose of Box B of the Form 1?

Answer 82

to provide authority to involuntarily admit persons who suffered from recurrent mental disorders that have responded to treatment in the past

Question 83

What does Box B of the Form 1 state?

Answer 83

MD has a reasonable belief that the person:

1) has previously received tx for mental disorder that when not treated may result in serious bodily harm to self/others OR substantial mental/physical deterioration of the person or serious physical impairment of the person

and MD is in the opinion that the person:

1) is apparently suffering from the same mental disorder as the one they previously received tx for
2) given the person’s hx of mental disorder and current condition is likely to cause serious bodily harm to self or others OR likely to suffer substantial mental or physical deterioration or serious physical impairment
3) in incapable of consenting to tx in psych facility and consent from SDM has been obtained

Question 84

Regarding the MH standard in the BLS, it is recommende to consider underlying organic disorders in situations involving a patient with emotional disturbance.

Answer 84

True

Question 85

As per the MH standard in the BLS, in cases of patients with known or suspected suicide attempts or self harm, what should a paramedic ask the patient?

Answer 85

1) assume that all attempts are of serious intent

2) ask the patient directly if they have ideations or intent of suicide/self harm

Question 86

As per the MH standard in the BLS, in cases in which a patient is being transported without consent, not proceed with transport unless in possession of the appropriate documentation and/or escort. When shall a paramedic recognize the need for an escort?

Answer 86

1) if patient is violent or potentially violent
2) if patient is in custody under Court or Ontario Review Board Disposition, a JP or hospital’s officer in charge or delegate will designate the escort

Question 87

As per the MH standard in the BLS, what are the considerations with use of restraints?

Answer 87

1) only restrain if directed by a MD or police officer, an unescorted patient becomes violent en route, or use of restraints is required to provide emergency treatment as per Patient refusal/emergency treatment standard
2) only the reasonable and minimum force shall be used to restrain the patient
3) if restraints are applied prior to leaving the scene, a physician escort/delegate or police officer ordering the restraint is required to accompany the patient in the ambulance
4) concurrent with 3, if the patient is handcuffed, DO NOT proceed with transport until police officer takes patient into custody and is present in the patient compartment

5) for interfacility transports:
- if sending facility is requesting for restraints, they or police are to provide and apply them prior to transport
- if patient is restrained, paramedic shall not procee with inter-facility transport unless the sending facility agrees that the patient can be transported safely with/without an escort, patient does not appear to be a safety risk or become violent en route, and paramedic feels comfortable with the decision of no potential risk/ violence en route

Question 88

True or False. The BLS (under the Mental health standard) indicates that you cannot transport a patient in prone position.

Answer 88

True

Question 89

True or false. As per the MH standard in the BLS, a persons who is recommended by an MD for admission to a psych facility as an informal or voluntary patient pursuant to the MHA may be transported without consent.

Answer 89

False - all voluntary and recommended admissions, you need consent

Question 90

Which patients can be transported without consent as per MH standard?

Answer 90

Anyone who is subject to a Form 1, Form 2, subsection 17 of the MHA, and Form 3/4

Question 91

If the patient is restrained, what do you document on your ACR?

Answer 91

1) that the person was restrained
2) description of patient’s behaviour that required that he/she be restrained or continued to be restrained
3) a description of the means of restraint, including method of restraint
4) person ordering the restraint (MD, police, paramedic)
5) position of the patient during restraint
6) clinical response to the restraint

Question 92

True or False: Restrained patients are more susceptible to rapid deterioration

Answer 92

True

Question 93

What are the guidelines for initiating/preparing a restraint, as per MH standard of the BLS?

Answer 93

1) attempt to organize the team before attempting restraint
2) prepare all equipment in advance
3) inform patient of the need to restrain and explain procedure
4) immobilize their limbs and head in one coordinated effort (grasp each limb at main joint and between main joint and distal joint)
5) place patient in supine “spread eagle” position or in left lateral position

6) restrain extremities as follows:
- one arm above head and other to the stretcher at waist level, or secure both hands to one side of the stretcher
- elevate the head of the stretcher to protect airway and allow paramedic greater visibility
- secure feet
- ensure limbs are secured to main frame of stretcher, not to the side rails

7) if patient is spitting, put a mask on them

Question 94

How are “emergency response vehicles (ERVs)” defined within the Highway Traffic Act?

Answer 94

means a vehicle operated by an ambo service that is used to provide emergency response services and has been assigned an ERV number by the Emergency Health Services Branch of the MOHLTC

Question 95

True or False: Emergency Response Vehicles (ERVs) while being used to provide emergency response services are not subject to speed limits prescribed under section 128 of the Highway Traffic Act.

Answer 95

True

Question 96

True or False. As per the OHSA, the right to stop work in dangerous circumstances does not apply to workplaces in which specified types of healht workers are employed where the stoppage of work would directly endanger life, health, or safety of another person

Answer 96

True

Question 97

Health Protection and Promotion Act purpose

Answer 97

provides for the organization and delivery of public health programs and services, the prevention of spread of disease, and promotion/protection of healht of people of Ontario

Question 98

When can the Chief Medical Officer of Health (CMOH) issue a directive to any HCP/health care entity to be followed to protect the public’s health?

Answer 98

when they are of the opinion that there exists or may exist an immediate risk to people in Ontario

Question 99

What are the two directives in the HPPA re: COVID-19 that impacts paramedics?

Answer 99

Directive 4: precautions

• PCRA done before EVERY patient interaction
• minimum contact and droplet precautions used or all suspected, presumed, or confirmed COVID-19 cases (gloves, gown, face shields/goggles, surgical/procedural masks)
• If patient is suspected to have COVID and it is anticipated to require aerosol-generating medical procedures (AGMP), paramedics should use PCRA and clinical judgment to determine need to change into N95 respiratory or better

Directive 6: proof of COVID-19 vaccination