Is it acceptable to give oral medications to a patient wearing a cervical Caller that meets the indications for the medication and none of the contraindications? 

How would someone go about reporting an individual paramedic under the BLS Paramedic conduct standard bullet point #11. Is there a whistleblower policy or a way other than ask Mac to go about this? There is an individual ACP who is constantly sedating patients (unethically, just the other day this individual sedated a drunk female for no reason whatsoever- did not meet the combative pt directive under the ALS PCS). This issue has been brought forward to management on multiple occasions and nothing is being done. A lot of paramedics are now scared that this individuals actions on calls for service may now impact other paramedic’s careers. Not to mention the magnitude of what those patients are experiencing when being cared for by this medic. There has been inappropriate use of directives including controlled substances, improper exams and a fear now of being sued by this paramedic personally if someone attempts to stand up against their decisions. 

Can you please clarify the CPR ratio for different ages with the new neonatal resuscitation changed from 30 days to 24 hours. At what age are we performing 3:1 CPR, 15:2. and 30:2?

Can you do chest thrusts on someone who is unresponsive with a DNR?

If a patient is capable – why is there a section for “Emergency Treatment of a Capable Patient without Consent”?

My question is in regards to when an IV certified medic is working with a non-certified medic. If the certified medic establishes IV access and has a lock in place, but doesnt give any fluids or medications can the non-certified medic still continue to attend the call? Or does the certified one become the attending. Specific example would be a Code Stroke where we established IV access prior to leaving scene, but it was originally the non-certified medics call.

Can you assist ventilations when a patient has a DNR? I had a call recently where a patient had a DNR, she was GCS 6, breathing spontaneously at a rate of 20 but there was very little air movement and an O2 sat in the low 80’s after we put her on a high concentration mask. I decided it was appropriate to assist her ventilations with a BVM to try to push oxygen deeper in her lungs. This did seem to help because when we arrived at the hospital she was now opening her eyes spontaneously, had a GCS of 10 and her O2 sats got to low 90’s. I just want to clarify the difference between assisted ventilations and using a BVM for resuscitation when it comes to DNR’s.

can you insert an OPA in an old person

What is the language for medical directives and inter-facility transfers with escorts? If a patient meets the indications and conditions for a medical directive and has no contraindications for treatment, and this is something you would treat in the field, if the nurse escort says no to your med administration – Whats next? For example, chest pain transfer for possible STEMI, sending facility gave 160 mg ASA and stated patient has had their full dose of ASA so they cant get any from EMS, and the sending doctor does not want patient having treatment from EMS.

So we had a call to a burn victim that was grossly charred, but was breathing. He started to deteriorate in transport but we made it to the hospital. I was wondering if he were to arrest if that would be a traumatic VSA, I know it’s not a blunt or penetrating trauma but it doesn’t make much sense as a medical cardiac arrest either. Also could a patient meet the standards for an obvious death after patient contact?

I have had a few calls to nursing homes where the patients IV fell out and the patient is being sent to the hospital for an IV restart. If the patient does not have any complaints otherwise, would an IV certified crew be able to start the IV and patch to not have the patient transported? If so, would this be documented as a refusal? I have always transported these patients but it would be helpful to know if there are other options to avoid an unnecessary trip to the hospital. Thank you!

The current AHA guidelines do not seem to support the use of back blows for conscious choking adults yet this is often taught in Red Cross or St. John courses. Am I mistaken or is there disparity between the current teaching?

Can you please clarify what I should do if a midwife requests we transport to a different receiving facility as opposed to the closest?

Mom is having a post-partum hemorrhage CTAS 1-2 and there is a stable neonate, can we leave neonate on scene with Dad and call for 2nd unit for baby or can we leave? Do we have to wait until arrival of 2nd unit? No policy on this.

Is there anywhere to go and practice scenarios with an educator for those of us who learn better hands on and want to freshen up on some skills and directive (including the companion doc, and bypass rules)?

I was just curious to see if there has ever been talk about the idea of reducing fractures in the field, rather then just femur fx’s? Obviously following all of the same protocols as the sager. Not that I have done much research, but could the possibility that some sort of equipment be readily available? We have done so many of those calls that could have gone much smoother and at more of a comfort for the patient in the long run.

This has been a question of mine recently that not many people have the answer for in my service. My question is; if we have given the pt any sort of medication or initiated an IV can the pt be offloaded to the waiting room or to a bed in the hallway? Thank you in advance!

In regards to an IV that you have established are other medical professionals allowed to use it to give drugs on way to hospital? Back story, picked up a female patient who had just given birth with significant post partum hemorrhage. Midwife onscene was unable to establish a line but you subsequently start one. Midwife wants to push oxytocin through the IV that you have established is this OK?

What is our responsibilities once a patient has been arrested under the mental health act? Is it considered implied consent? Are we responsible for vital taking, blood sugar and treatment if the BG is below four? Can the patient refused treatment with a decreased BG and a GCS of 14(confusion)?

Tension pneumothorax Could someone please clarify the BLS section on ventilating a suspected tension pneumothorax. Is it just slower and not as hard of a squeeze as usual

On our ACRS, when we have rhythm interpretation and if we are unsure of what the rhythm is, is it okay to leave it blank?

Is external manual compression of the chest and appropriate prehospital consideration for peri-arrested or arrested asthma exacerbated patients who are showing obvious signs of chest hyperinflation and air trapping. I have read about its anecdotal use on website like EMDocs.net and in the Prehospital Care Journal (Harrison, R. Chest compression first aid for respiratory arrest due to acute asphyxic asthma. Emerg Med J 2010;27:59€“61. doi:10.1136/emj.2007.056119) as a few sources. I have also seen it performed in the emergency department by emergency physicians. I assume with good technique, it can assist with expiration and minimize the risk of barotrauma in these patients who require ventilation. Thank you!

Hello, I was wondering if SWORBHP can offer out some assistance in obtaining CMEs for this year. Since there are no conferences to attend to, the hosting/posting of webinars doesnt seem to happen anymore and online courses are fairly expensive. Could you link in some approved resources that we could utilize? I would love to see SWORB return to posting webinars more frequently.

When we have a patient who is sob and we have decided to put CPAP on, what code and ctas is mandatory even though they are stabilized because of cpap? Is it code 4 ctas 1 always? And are we suppose to pre alert for an RT?

Question: With the lockdown in place and time on our hands can we contract out an application programmer to develop a more user friendly protocol app. We have updated to the current version and it still takes almost 10 minutes each time to no matter the device to load. Not very functional on a time sensitive ACP call. I’m sure there are plenty of software engineer students out there bored not in school.

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Clarification: all of the info regarding the protocols say “consider”, but all of your response say “should not”. Why can’t BH come out and say do not, at least where other routes of treatment exist? Or maybe a should not with a patch point if you think you have to? There is so much up in the air right now, a little black and white would be nice.

Question: Why did we receive the latest OBHG recommendations today (Monday, Apr 6th) when they are dated April 3rd?

*Updated: Are ACPs still required to complete 24h of CME for 2020, given the COVID pandemic?

What is a hydrophobic submicron filter? What does it do and does it have other names? FYI – Equipment standard has it listed on page 57

Are sublingual medications part of the considerations, since IN and buccal are?

Are there any expected changes coming in regards to transporting an organ donor VSA patient? Is there a more appropriate receiving facility to consider and what should we do with an organ donors body after obtaining a TOR?

Why isn’t there a “febrile medical directive” to give Tylenol? having something like this especially around flu season would enhance patient care.

Question: With the recent training surrounding hemorrhage control will we potentially see TXA administration added to our medical directives? Also wondering if you see pelvic binding brought into our skill set in the future?

Question: Can ACPs use xylometazoline nasal spray to aid in the treatment of epistaxis? It seems to be the go to start to treatment in the Emergency Department, why not get started prehospital?

Question: Are paramedics in Ontario authorized to adhere to a person’s DNR wishes documented on a completed ‘CCAC Plan of Treatment’ as an alternative to a completed ‘DNR Confirmation Form?

Question: The new BLS that will be introduced in December 11, 2017 mentions that treatment and transport refusal would require the completion of the refusal of service. The question is whether it is required to be completed for any refusal of treatment or just treatment with possible negative outcome to patient example refusing collar vs. Dimenhydrinate or any analgesic?

Question: In regards to the BLS version 2.0 – extremity injury, bone/joint, there’s a guideline regarding elbow dislocations. It says that if we encounter an elbow dislocation with nerovascular compromise, that we can contact receiving hospital or Base Hospital Physician for advice regarding manipulation or in-line traction. In the new BLS 3.0, this guideline has been left out. Are we still expected to perform the guideline if we ever encounter this, or has this been purposely taken out? Thank you.

Question: Why are all the directives based upon an urban setting assumption given that there are very rural areas in which paramedics work in besides big cities? Further to this, one could suggest that certain advanced skills are more appropriate if not life saving the further from a hospital. Has there ever been any consideration to consider such advanced care skills such as midazolam for seizures, needle thoracostomy, peds IO and even cricothyrotomy to name a few. Why are these not even considered in areas with transport times exceeding well over 1-2hrs. These are skills that overall can make a significant difference in patient outcomes especially when no other care is available. To add, these are not skills that can be deemed to be well learned for even experienced ACP’s as actual prevalence even in an urban setting is very low. Thus, the number needed learn position can be put forth ACP’s anymore than PCP’s but the difference in distance to more advanced care certainly can.

Question: One frustration or perhaps lack of knowing is why the Medical Directives differ so much from province to province even for PCPs. Does “evidence based medicine” stop at provincial borders or is it that interpretation and application of such depends more on who, as well as financial politics and liabilities more than evidence based medicine and timely patient care? I can provide examples but I do not think it is specifically necessary-helpful per say in answering the primary question. Look forward to your response.

Question: When the Ministry of Health’s DNR forms are filled out, can the section where the patient’s name goes have a sticker from the hospital with the patients name/health card #/DOB, etc. instead of having the name printed or does that make the form invalid. The form specifically states the patients name should be printed clearly. I wasn’t sure if the ID sticker was something we could accept instead or if that section can only be filled out by hand.

Question: CPR guidelines: I understand that we start CPR with a patient less than 16 years old, heart rate less than 60 and signs of poor perfusion, agonal respirations as per the CPR guidelines. My question is if we have the same situation with an adult patient, what would be beneficial for this type of patient (CPR)?

Question: I’ve heard of crews being asked to transfer patients between facilities with indwelling tubes and lines that are not within their scope, and they don’t have suitable escorts. I had a colleague asked to transport a patient with a chest tube, without an RN escort, to which they refused, but recently saw a crew transporting a patient with a nasal epistax in-situ. I know these have the potential to migrate and cause airway obstruction so didn’t think we should move these without a hospital escort. Could the Base Hospital provide some direction so that it is clearer to paramedics as to what they should do in these cases?

Question: How many liters to we run a BVM at?

Question: How is the DNR standard in the BLS PCS reconciled with this statement in the ALS PCS: “if a paramedic is aware or is made aware that the person has a prior capable wish with respect to treatment, they must respect that wish (for example, if the person does not wish to be resuscitated).”

Obviously the ideal situation is that the patient has the DNR confirmation form and there are no issues. The issue comes up with regards to verbal DNRs issued by a capable patient or SDM (that are reasonable), or in such cases where the patient has a DNR, living will or other advanced directive that specifies the patients wishes, but no prehospital DNR form. Is this form not redundant provided there is a reasonable indication that the patient does not wish to be resuscitated or have aggressive life sustaining therapies delivered?

How can the BLS PCS DNR standard be reconciled with the ALS PCS regarding honouring a prior capable wish when the provider is made aware of such wish (provided its reasonable)? Especially given that in nearly ever other case, a directive in the ALS PCS over-rides the BLS-PCS. Given that this issue is not nearly as cut and dry in reality, or in any other healthcare setting, as it seems to be made out to be in EMS in this province what is the situation with regards to this? Especially given that end-of-life issues are increasingly common, the issue is not going to disappear. There are many other provinces that use a similar wording or philosophy to that mentioned in the ALS-PCS under consent and capacity.

Question: If you work in 2 services under the same base hospital and you are certified and work in one as an ACP, but one service is now only PCP, can you perform any ACP skills if you feel necessary while working in the PCP service? (for example, cardioversion or pacing, epi in arrests?)

Question: Can a PCP, certified AEMCA in good standing with their Base Hospital, administer symptom relief medication while off duty? We know that some medics carry their own first aid kit in their car and that some services support this.

Question: Are we allowed to accept photocopied DNR? I have heard several discrepancies on this question.

Question: My question is concerning the 5ml vials of Gravol and Toradol that some services are now carrying. Should these be thrown out after opening and removing one dose? Or are we to keep them and use them again for another patient?

Question: Are we required to complete a patient refusal and obtain a signature for any patient who for example refuses gravol administration, or does not want a medication given by IV, but accepts the medication administered IM, or refuses oxygen. Or any similar instance where there is a refusal, but the patient is still being transported to hospital.