EMS Legislation Test II Flashcards
What are the 6 core attributes of a paramedic?
1) Empathy & patient-centered approach (acting and performing in a way that you expected to be treated in an emergency; advocacy for patient’s best interest)
2) Honesty
3) Humility
4) Nonjudgmental/discriminatory attitude
5) Responsible/Accountable (self-reflection, keeping everything organized and certifications up to date)
6) Leadership and confidence (delegate and take direction)
What is the minimum designation required to be employed in Ontario as a paramedic?
PCP
What is a PCP’s scope of practice?
delivering BLS standards + delegated medical acts
What is an ACP’s scope of practice?
delivering BLS standards + increased scope of delegated medical acts (ex. endotracheal intubation, needle decompression, controlled medications)
What is a CCP’s scope of practice?
- at the level of mobile ICU (trained in lab & radiological data)
- wokring with advanced medical technology such a ventilators
- expanded medication scope
Definition of Code 0/Black/Critical
When there is 1 or no ambulances available to repsond to emergency calls
Community paramedicine is suitable for what types of calls/populations? (6)
- low acuity medical calls
- MH & addiction
- falls prevention/intervention
- palliative care
- chronic health problems (COPD, diabetes)
- homeless outreach
Paramedic Conduct Standard. The paramedic shall (11 points):
1) conserve life, alleviate pain and suffering, and promote health
2) protect and maintain patient’s safety, dignitiy, and privacy
3) provide care based on human need with respect for human dignity
4) demonstrate empathy and compassion for patients and their families
5) provide pt care until it is no longer required or until another appropriately qualified HCP has accepted responsibility for patient care
6) discharge his/her duties with honesty, diligence, efficiency, and integrity
7) conduct and present oneself in such a manner so as to encourage and merit respect of the public for members of the paramedic profession
8) attempt to establish and maintain good working relationships with other professional colleagues and the public
9) assume responsibility for personal and professional development (QA initiatives, ex. reporting patient safety incidents)
10) maintain familiarity with current applicable legislation and practice, and strive to work to the fullest extent of her/her competencies
11) report any incompetent, illegal, or unethical conduct by colleagues or other HCPs to the ambulance service operator and/or base hospital
Paramedic Misconduct standard. The paramedic shall not (9):
1) practice beyond level of certification
2) refuse/neglect to serve persons requiring services that are part of the normal performance of his/her duties
3) falsify documentation of any kind
4) misrepresent quals/credentials
5) threaten/use violent behaviour
6) take or possess drugs from ambulance service without authorization
7) disclose confidential info to anyone, unless required or permitted by law (i.e. identifying info, PHI, info obtained through one’s position as paramedic that is otherwise not available to the public in general)
8) have any form of inappropriate sexual contact, relations, or impropriety with a patient
9) engage in any other conduct unbecoming of a paramedic
What are the 5 types of EMS delivery models in Canada?
1) provincial/territorial service
2) municipality- run service
3) fire-based EMS service
4) hospital-based service
5) private service operators
What is a provincial/territorial service delivery model? Provide an example of a location/service that delivers ambulance services using this delivery model.
operated and funded provincially
ex. BC, Alberta, First Nations
What is a municipality-run service delivery model?
cost is shared by province and municipality
Ontario is primarily which service delivery model to provide ambulance services?
municipality-run service
What is a fire-based service delivery model? Provide an example of a location/service that delivers ambulance services using this delivery model.
model where there is either an EMS division within fire, or firefighters are dual-response (firefighters and EMS)
- ex: Winnipeg Fire Paramedic service
What is a private service operator delivery model? Provide an example of a location/service that delivers ambulance services using this delivery model.
ambulance services contracted by province/territories/municipalities that are still regulated by provincial/territories regulation but private
- ex. Medavie Health services (in N.S., N.B., PEI, Chatham-Kent & Elgin counties, rural Saskatchewan communities)
How do the EMS service delivery models differ in the US (relative to Canada)?
- lack of federal oversight (responsibility is to each individual state)
- 1/4 are private service operators
- prevalent fire-based EMS
- no universal healthcare so large costs directly go to patients
Who is the direct provincial oversight of how ambulance services are delivered in Ontario?
MOHLTC
Who has authority over complaints and investigations of paramedics? (3)
- EMS Service
- Base hospital
- MOHLTC
Land ambulance operators are mainly operated by ________________ (hint: one level below MOHLTC).
upper-tier municipalities
What are the responsibilities of MOHLTC - Emergency Health Services Branch, as set out by the Ambulance Act (7)?
1) establishing standards for the management, operation and use of ambulance services
2) ensure compliance with said^ standards
3) the certification of ambulance services
4) credentialing of paramedics
5) designation of Base Hospitals to support paramedic service delivery
6) the inspection of ambulance service operations
7) investigation of complaints
Land amublance service operators undergo formal certification process every ____ years by MOH.
3
What happens when gross inadequacies occur with an ambulance service operator?
A Director’s Order may be issued under authority of the Ambulance Act (section II) which mandates operator to rectify all areas of weakness within a period of time
Response times set out by MOH:
1) Sudden Cardiac Arrest patients
2) CTAS 1 patients
3) CTAS 2-5 patients
4) Dispatch - SCA/CTAS 1 patients
1) % of times that a person equipped to provide any type of defibrillation has arrived on scene to provide defib within SIX minutes
2) % of times that an ambulance crew has arrived on scene to CTAS 1 patients within EIGHT minutes
3) % of times that an ambulance crew has arrived on scene to CTAS 2-5 patients within response time targets set out by muncipality
4) % of times dispatch dispatches an ambulance within 2 minutes for SCA/CTAS 1
What are the 7 MOH standards/documents set out for paramedics to follow?
1) BLS PCS
2) ALS PCS
3) Patient Care Model Standards
4) Ambulance Service Communicable Disease Standards
5) Ontario Ambulance Documentation Standards
6) Patient Care & Transport Standards
7) Provincial Equipment Standards for Ontario Ambulance Services
While MOHLTC cost-shares 50% of expenses for land ambulance services with municipalities, for what services do they cover 100% of the cost?
- Base Hospitals
- Dispatch
- CACC/ACS
- Ambulance Service to First Nations communities
- Territories without municipal organization
- Air ambulance program
True or False: Base hospitals are involved with providing oversight on controlled medical acts, QA/audits, continuing medication education, and competency maintenance activities.
True
How many base hospitals are there for land ambulances? Air ambulances?
Land: 7
Air: 1
What is the difference between core and auxiliary standards within ALS PCS?
Core: indicates that every paramedic across all services can and will perform the protocol for an indicated patient
Auxiliary: optional protocol that are opted in/out by ambulance services (ex. giving gravol for nausea/vomiting)
- typically new standards start off as auxiliary and if there is major benefit to patient care, then it becomes core standard
What are ambulance service operators (ASOs) and what are their duties?
Municipality EMS providers that lead the actual delivery of ambulance services in their local area (with use of an ambulance deployment plan which indicates # of ambulances need to cover the area and how/when these trucks are deployed)
Duties:
- developing a governance and organizational structure to enable delivery of services
- managing vehicles and paramedics
- funding ambulance operations
You are with Niagara EMS and are dropping off a patient at the trauma center in Hamilton. A high priority call comes in and assistance is required. However, this means you are providing care outside of your municipal zone. Are you allowed to attend the call?
Yes. Ambulances outside their municipal zone can still be required to respond to high priority calls if they are deemed as the closest available unit
Ambulance operational reporting is reporting what kinds of stats to MOH (6) ?
- # of EMS calls responded to
- length of time between call received and when it is dispatched to EMS unit
- length of time betwen call received by EMS unit and arrival
- time spent at hospital by ambulances
- # of hours of amulance service provided in the community
- hour cost of providing an ambulance service
What three provinces have a College of Paramedics?
- Saskatchewan (2000)
- Manitoba (2018)
- Nova Scotia (2017)
True or False: Self-regulation (as in having a governing body) is granted to those that put the interests of the public first over own professional interests
True
What is the Ontario Paramedic Association (OPA)?
not-for-profit organization that exists to advocate on behalf of members and to promote the profession (i.e. educating the public, lobbying politics)
What are tiered-response agreements?
Formal written documents that establish local protocols for multi-agency response to a life threatening/public safety incident (outlines capabilities, expectations, and limitations of each agency)
What is the intention of having tiered-response?
To provide a clear response time advantage in scene arrival by all the emergency services
List 6 situations that warrant tiered response.
1) Life-threatening medical emergencies (cardiac arrest, unconscious)
2) MCIs
3) Hazardous materials incident (CBRNE) involving casualties/potential for casualties
4) Large fires involving casualties/potential for casualties
5) Natural disasters resulting such occurrences as building collapse
6) MVCs
For every one minute delay in defibrillation, survival rate of a cardiac arrest decreases by _____% (range).
7-10
_______ play the largest role in favourable sudden cardiac arrest outcomes for hospital discharge
bystanders
What is the medical training for firefighters?
- All trained to BLS CPR
- some have EMR too but not required
Typically there are 4 firefighters on a truck that attends a call. What are their roles?
1) Captain - overlooks scene, attempts to get pertinent information
2) Driver - does not typically come on scene but meets EMS outside to allow access into buildings; will often set up stretcher
3) Two others - will have PPE, kit, and AED and ready to assist if necessary
What kinds of calls would police be tiered on typically (6)?
- any calls with reported violence/weapon
- MVCs
- assault and sexual assault
- MH and attempted suicide
- OD
- unexpected death (including TOR or cases of obvious death patients)
According to the BLS, what are the radio codes to be used to contact police in extenuating circumstances?
10-20: no immediate danger is evident to patient or paramedic but requesting police presence
10-2000: immediate danger
What is the Police Notification Standard, according to the BLS?
General directive: notify police in any cases involving unusual/suspicious situations (sudden deaths, violence, foul play, accidents involving emergency vehicles)
1) if you request police, you have to:
- contact your CACC/ACS via phone/radio
- state nature of request
- indicate urgency of response and request ETA
- advise of possible hazards
- indicate access routes (where applicable)
- provide police with update when they arrive on scene
2) use radio codes in extenuating circumstances: 10-20, 10-2000
3) the use of police vehicle escorts during transport for the purpose of traffic control is discouraged due to prevalent danger it presents
If there is suspected foul play, what should be noted (in accordance with the BLS Police Notification Standard)?
In general, leave the scene as undisturbed/preserved as possible
Note:
1) once a body is moved it can never be put back in original position
2) careful attention required whenever something is moved
3) whenever possible, use the shortest, most direct path to patient and when leaving
4) attempt to preserve chain of evidence (do not discard linens/clothes after call completion without checking with receiving facility/investigating officer)
5) receiving facility staff should be informed re: suspected foul play
What is the Violent/Aggressive Patient Standard, according to the BLS (10)?
- consider underlying organic disorders
- give particular attention to personal safety as per General Measures Standard
- request police assistance on-scene
- wait for police assistance if: there is an active shooter, there is direct evidence of ongoing violence
- if electing to delay service (and wait for police), immediately notify CACC/ACS
- if patient is uncooperative, elicit info from others on scene and attempt to determine underlying cause triggering behaviour whether there is a past hx of violence
- be alert for behavioural signs of impending violence
- if confronted, seek safe egress and attempt to withdraw
- if safe withdrawal not feasible, attempt to speak with and calm patient
- consider need for restraints as per MH Standard
Who has the most reponsibility regarding occupational health and safety laws and legislation? Employee, employer, supervisor
employer
Duties of the employer re: occupational health and safety includes what (6)?
1) ensure workers know about hazards in the workplace and how to work safely
2) ensure every supervisor knows how to take care of health and safety on the job
3) create health and safety policies and procedures in workplace
4) ensure everyone knows and follows ^ procedures
5) ensure workers wear and use right PPE
6) do everything reasonable to keep workers from getting hurt/sick on the job
Duties of the supervisor re: occupational health and safety includes what (4)?
1) tell workers about hazards in the workplace and SHOW THEM how to work safely
2) make sure workers follow the law and policies/procedures
3) make sure workers wear and use right PPE
4) do everything reasonable to keep workers from getting hurt/sick on the job
Duties/Rights of the worker re: occupational health and safety includes what (6)?
1) follow the law and workplace h&s policies/procedures
2) always wear and use PPE required by employer
3) work and act in a way that won’t hurt yourself/others
4) report any hazards found in workplace to supervisor
5) you have a right under OHSA to be told about the hazards in the work you do and be instructed on how to do your work safely
6) employer/supervisor cannot punish you in any way for doing what OHSA says or for asking them to do what OHSA expects them to do
How does the right to refuse unsafe work apply to paramedics?
tl;dr: it doesn’t
- In specified circumstances, the right to refuse is limited for health care workers and persons employed in workplaces like ambulance services
- the right to stop work in dangerous circumstances do not apply to workplaces in which specified types of health workers that are employed & where the work stoppage would directly endanger life, health and safety of another person
The Joint Health and Safety Committee (JHSC) is composed of which individuals? What is the purpose of the committee?
- composed of worker and employer reps
- purpose: address issues on both sides re: health and safety issues
When the workplace has 50+ workers regularly employed, how many people should be on the JHSC?
at least 4 (half of them must be employees that don’t exercise managerial functions)
What is the greatest concern when sustaining a needlestick injury?
infectious fluids especially blood
What is the appropriate method of disposing and caring for needles?
Place needles in wide-mouth, puncture-proof containers and replace when 3/4 full
Why is a fit test used?
to determine if a respirator (ex. N95) is a good fit for a user’s face (i.e. maks forms tight seal against face)
According to OHSA, when is a fit test warranted?
1) When test has never been done before on a worker and they are required to wear a respirator
2) At least every 2 years
3) If they are using a new resp. model/make
4) if there are any changes to user’s physical condition that could affect the respiratory fit (weight gain/loss, surgery, major dental work)
Canada’s national hazard communication standard is known as:
Workplace Hazardous Materials Information System (WHMIS)
What are the 4 key elements of WHMIS?
1) hazard classificatoin
2) cautionary labeling of containers
3) Safety Data Sheets (SDSs)
4) Worker education and training program
