Everything BLS

Question 1

Patient Refusal/Emergency Treatment Standard:

Where a patient requires care and/or transport to a health care facility and the patient or SDM refuses such treatment and/or transport, the paramedic shall?

Answer 1

a. make reasonable efforts to inform the patient or SDM that treatment and/or transport are recommended and explain the possible consequences of such refusal

b. confirm that the patient or SDM has capacity utilizing the Aid to Capacity Assessment as per the Ambulance Call Report Completion Manual

c. advise the patient or SDM to call 911 again if further concerns arise; and

d. obtain signatures and complete additional documentation requirements as per the Ontario Documentation Standards and the Ambulance Call Report Completion Manual.

Question 2

Can a patient/SDM refuse to SIGN the Refusal of Service section of the ACR?

Answer 2

Yes, however paramedic has to document refusal and reason for failing to provide a signature.

Question 3

Emergency Treatment and Transport of an Incapable Patient Without
Consent:

1) The paramedic shall carry out emergency treatment and transport if?

Answer 3

a) patient does not have capacity

b) patient is experiencing severe suffering or at risk if treatment is not administered promptly, risk of sustaining serious bodily harm; and

c) delay required to obtain consent or refusal on patient’s behalf will prolong suffering that the patient is experiencing or will put the patient at risk of sustaining serious bodily harm.

Question 4

Emergency Treatment and Transport of a Capable Patient Without Consent:

1) The paramedic shall carry out emergency treatment and transport, if?

Answer 4

a) patient is experiencing severe suffering or is at risk, if treatment is not administered promptly, risk of sustaining serious bodily harm

b) communication required for patient to give or refuse consent cannot
take place because of a language barrier or because patient has a disability that prevents communication

c) steps (that are reasonable in the circumstances) have been taken to find a practical means of enabling the communication to take place, but no such means has been found

d) the delay required to find a practical means of enabling the communication to take place will prolong the suffering that the patient is apparently experiencing or will put the person at risk of sustaining serious bodily harm; and

e) there is no reason to believe that the patient does not want the treatment

Question 5

Deceased Patient Standard:

What does a “deceased patient” mean?

Answer 5

1) obviously dead

2) subject of a medical certificate of death, presented to the paramedic crew, in the form that is prescribed by the Vital Statistics Act (Ontario) and that appears on its face to be completed and signed in accordance with that Act;

3) without vital signs and the subject of an MOH Do Not Resuscitate (DNR) Confirmation Form

4.) without vital signs and the subject of a Termination of Resuscitation (TOR) Order given by a Base Hospital Physician; or

5) without vital signs and the subject of a Withhold Resuscitation Order given by a Base Hospital Physician.

Question 6

In all cases of death, the paramedic shall?

Answer 6

1) confirm the patient is deceased as per the Definitions above

2) ensure that the Deceased Patient is treated with respect and dignity

3) consider the needs of family members of the decedent and provide compassion-informed decision-making;

4) in cases of suspected foul play, follow the directions set out in the Police Notification Standard

5) if applicable, follow all directions issued by a coroner or a person appointed by a coroner or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act (Ontario)

6) if termination of resuscitation occurs in the ambulance en route to a health care facility, advise CACC/ACS to contact the coroner, and continue to the destination unless otherwise directed by CACC/ACS; and

7) for cases of obvious death, note and document the time at which the paramedic confirms the patient was deceased as per the Standards.

Question 7

In cases of unexpected death, the paramedic shall?

Answer 7

1) in the absence of police or a coroner on-scene, the paramedic shall advise CACC/ACS of the death, in which case CACC/ACS shall notify the police or coroner

2) if a coroner indicates that he/she will attend at the scene, the paramedic shall remain at the scene until the coroner arrives and assumes custody of the Deceased Patient. If the coroner indicates that he/she will not attend at the scene, the paramedic shall remain on
the scene until the arrival of a person appointed by a coroner or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act (Ontario)

3) notwithstanding paragraph 2 above, if police are present and have secured the scene, the paramedic may depart as soon as documentation has been completed or he/she is assigned to another call; and

4) where at any time the paramedic has not received any further direction from CACC/ACS, the paramedic shall request that CACC/ACS seek direction from the coroner concerning his/her responsibilities, including whether he/she may leave the scene.

Question 8

In cases of expected death, the paramedic shall?

Answer 8

1) the paramedic shall advise CACC/ACS of the death;

2) the paramedic shall make a request of a Responsible Person, if one is present, to notify the primary care practitioner or a member of the Palliative Care Team (if any) of the patient and request his/her attendance at the scene

3) if the Responsible Person is unable to provide the notice in paragraph 2 above, the paramedic shall advise CACC/ACS of the death, in which case CACC/ACS shall attempt to notify the primary care practitioner or member of the Palliative Care Team (if any) of
the Deceased Patient, and request his/her attendance at the scene

4) if the Deceased Patient’s primary care practitioner or Palliative Care Team member is contacted and indicates that he/she will attend at the scene, then the paramedic shall remain at the scene until his/her arrival

5) notwithstanding paragraph 4 above, if there is a Responsible Person present, and the paramedics reasonably believe that the Responsible Person will remain until the primary care practitioner or Palliative Care Team arrives, then the paramedic may depart as soon as all required documentation has been completed or he/she are assigned to another call. Alternatively, if the police are at the scene and are willing to remain until the arrival of the practitioner or Palliative Care Team member, the paramedic may leave the scene

6) if the primary care practitioner or Palliative Care Team member cannot be contacted or if he/she is unable to attend, or there is no Responsible Person on-scene, the paramedic crew shall advise CACC/ACS, in which case CACC/ACS shall notify the police or coroner of the death and that there is no one else at the scene who can take responsibility for the Deceased Patient; and

7) if requested by the coroner, the paramedic will provide the coroner with the circumstances of the death; the paramedic will either be released from the scene or instructed to remain with the Deceased Patient until the coroner or a person appointed by a coroner or to whom a coroner has delegated any powers or authority pursuant to the
Coroners Act (Ontario) or a Responsible Person can attend the scene and assume responsibility for the Deceased Patient.

Question 9

What interventions count as CPR/Life Saving Measures according to the DNR standard?

Answer 9

• Defibrillation
• Artificial Ventilation
• Transcutaneous pacing
• Endotracheal Intubation
• Chest compression
• Insertion of an OPA, NPA, or SGA
• Advanced resus drugs such as (but not limited to) vasopressors, antiarrhythmic agents, opioid antagonists.

Question 10

What should a paramedic do when they receive a DNR?

Answer 10

• Don’t start CPR if pt arrests
• Note time of arrest
• Make sure that pulses and resps absent for at least 3 mins from time that resp or arrest was noted

Question 11

If we receive a valid DNR, when can we start CPR?

Answer 11

• If pt is capable and CLEARLY expresses a wish to be resuscited
• If pt expresses a vague, incomplete, or ambiguous request (unclear what wishes of pt were/are)

Question 12

What do we do once it has been determined that death has occurred?

Answer 12

• Advise CACC/ACS
• Follow deceased pt. standard
• Document time of confirmation of deceased pt (3 mins post arrest)

Question 13

Can a DNR be a copy?

Answer 13

Yes, a valid DNR may be a fully completed original or a copy of a fully completed original.

Question 14

What must a complete DNR form include?

Answer 14

1) Full name of patient

2) Check box checked to indicate one of the following is met: - current plan of tx exists that reflects pt’s expressed wish when capable, or consent of SDM if incapable, that CPR not be included in the pt’s tx plan. - the physician’s current opinion is that CPR won’t or probably won’t help, and this was discussed with the pt or the SDM.

3) Check box checked to ID the professional designation of who signed the form.

4) Printed name of the MD, RPN, RN, or RN(EC) signing the form.

5) Signature from the appropriate medical professional.

6) The date the form was signed, which needs to make sense (not in the future).

Question 15

IV Directive

What can we monitor?

Answer 15

1) IV TKVO

2) IV for fluid replacement with,
* a max flow rate infused of up to 2 ml/kg/hr to a max of 200ml/hr,
* thiamine, multivitamin preparations,
* drugs within his/her level of certification, or
* potassium chloride (KCl) for patients ≥18 years of age, to a max of 10mEq in a 250 mL bag.

Question 16

When do we need to request a medically responsible escort for an IV?

Answer 16

1) Blood or blood product admin

2) KCl for a patient who is <18 years of age

3) Medication other than the ones we can monitor

4) When it requires electronic monitoring or uses a pressurized IV fluid infuser, pump, or central venous line

5) For a neonate or pediatric patient <2 years of age.

Question 17

What is the BLS IV pre-transport procedure?

Answer 17

1) Confirm physician’s written IV order with sending facility staff

2) Determine IV solution, flow rate, catheter gauge, catheter length, and cannulation site

3) Note condition of IV site prior to transport

4) Confirm amount of fluid remaining in bag

5) Determine amount of fluid required for complete transport time and obtain more fluid if applicable; and

6) Document all pre-transport IV info on the ACR.

Question 18

What is the BLS IV procedure during transport?

Answer 18

1) Monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required

2) If the IV becomes dislodged or interstitial, discontinue the IV flow and remove the catheter with particular attention to aseptic technique; and

3) Confirm condition of catheter if removed.

Question 19

When should an IV bag be changed?

Answer 19

When there is approx 150 mLs remaining.

Question 20

When should Paramedics complete Incident Reports?

Answer 20

As soon as possible. Complete reports prior to end of shift/work assignment during which the event occurred.

Question 21

What kinds of events/occurrences in which an incident report needs to be filled?

Answer 21

1) Unusual response or service delays that may have negatively impacted the provision of patient care

2) Delay in accessing a patient that may have negatively impacted the provision of patient care

3) Excessive amount of time on scene that may have negatively impacted the provision of patient care

4) Cases of suspicious or unexpected death that may be likely to result in a coroner and/or police investigation

5) Any circumstance that resulted in harm to a patient or any other person being transported in an ambulance, including equipment deficiencies

6) Any circumstance which resulted in a risk to, or endangerment of health or safety of a patient, or any other person being transported in an ambulance

Question 22

Field Trauma Triage Standard

The paramedic shall?

Answer 22

1) Assess patient to determine if they have one or more of the following PHYSIOLOGICAL CRITERIA (Step 1):

a) Pt does not follow commands
b) SBP <90 mmHg, or
c) RR <10 or >30 breaths per min - OR - need for ventilatory support (<20 infant aged <1 year)

2) If pt meets criteria listed in paragaph 1, AND land transport time is <30 mins to LTH or regionally designated equivalent hospital (RDEH) , transport PT to LTH or RDEH

3) If pt doesn’t meet criteria in paragraphs 1 & 2, assess pt to determine if they have one or more of the following ANATOMICAL CRITERIA (Step 2):

i) penetrating injuries to head, neck, torso and extremities proximal to elbow or knee
ii) Chest wall instability or deformity (i.e flail chest
iii) Two or more proximal long-bone fractures
iv) Crushed, de-gloved, mangled or pulseless extremity
v) Amputation proximal to wrist or ankle
vi) Pelvic fractures
vii) Open or depressed skull fracture, or
viii) Paralysis

Question 23

Field Trauma Triage Standard (cont’d)

If a patient meets anatomical criteria AND land transport time is approx. <30 mins to an LTH or RDEH, where does a patient go?

Answer 23

LTH or RDEH

Question 24

Field Trauma Triage Standard (cont’d)

If you’re unable to secure a patient’s airway, OR their survival to an LTH or RDEH is unlikely, where do you bring the patient?

Answer 24

Closest ED

Question 25

Field Trauma Triage Standard (cont’d)

Can the transport time be amended beyond 60 minutes?

Answer 25

No. It can only be amended UP to 60 minutes.

Question 26

Paramedic Conduct Standard

The paramedic shall?

Answer 26

1) Conserve life, alleviate pain and suffering, and promote health
2) Protect and maintain pt’s safety, dignity, and privacy
3) Provide care based on human need with respect for human dignity
4) Demonstrate empathy and compassion for pts and their families
5) Provide pt care until no longer required OR until another appropriately qualified health care professional has accepted responsibility
6) Discharge their duties with honesty, diligence, efficiency and integrity
7) Conduct and present oneself in such a manner so as to encourage and merit the respect of the public for members of the paramedic profession
8) Attempt to establish and maintain good working relationships with other colleagues and public
9) Assume responsibility for personal and professional development, including quality assurance initiatives such as reporting patient safety incidents
10) Maintain familiarity with current applicable legislation and practice, and strive to work to the fullest extent of his/her competencies
11) Report any incompetent, illegal, or unethical conduct by colleagues or other health care professionals to the ambulance service operator and/or base hospital