Question: At a meeting with Dr. Lewell in the past, he stated that there is no time set for the administration of medication. Some medics are directed by their services to deliver the medication within 5 minutes and yet the Base Hospital directive asks to have the monitor on in 5 minutes. Medication cannot be delivered without the monitor being applied, so is it correct to say that the time limit is not 5 minutes, but ASAP after the monitor is applied?

Question: When a hospital is on “consideration” and we are not accepted by this particular hospital due to their CTAS score or related clinical condition and they are to deteriorate while en-route to the next receiving hospital. What liability do we as paramedics wear in these situations?

Question: This question is a follow-up to clarify between two questions previously asked- specifically, regarding advanced resuscitation in the setting of DNR, and treatment of FBAO in the setting of DNR. In the most recent question the DNR validity form is quoted as stating that chest compressions should not be initiated on patients with a valid DNR, while in the earlier question it was stated that DNR does not preclude treatment for choking. Should we come across this situation, would we then only administer ‘Heimlich’-like abdominal thrusts and not proceed to chest compressions when the patient goes unresponsive, or should chest compressions be initiated until the heart has arrested and then discontinued (i.e. not proceeding to true CPR)?

Question: With respect to the Medical TOR, can we leave a deceased patient with family members after the TOR has been granted? It does not state in our medical directive who we can leave the body with (I always presumed it would Police, a family doctor, Coroner, Supervisor, Nurse at Nursing Home / patients home, etc.). In the Deceased Patient Standards it does state under responsible person / unexpected death chart… family members would be acceptable. I would imagine it would depend on the situation at the scene and family members state of mind. If you and your partner are at the scene of a medical TOR and another call comes in down the street for a code 4 – VSA for example, can both crew members leave the scene and have family take over care of the body? I know you could do a first response with one crew member, but again, two would be optimal. If you were a Supervisor on scene taking over care for your crew, could you leave the pt in the care of family and do a first response? You are on scene with a patient who has met the Obvious Death Criteria, can you leave the patient with family members or do we wait for Police, Supervisor etc. to attend the scene?

Just wanting clarification on who would be the ‘responsible person’. If a Paramedic felt that family would meet the criteria for ‘responsible person’, could we have family take over custody of the deceased person for Medical TOR or Obvious Death Criteria providing scene was safe, family coping well, no suspicious events at scene, etc.?

Question: The DNR confirmation form states the paramedic will not initiate basic or advanced CPR such as, TCP being one of them. From what I understand, until that person suffers cardiac or respiratory arrest, they are fair game for treatment. So, if a patient is in a 3rd degree block at 20bpm and they have a DNR, we are pacing this patient?

Also, what do they mean on the DNR confirmation form about palliative care? They say we are to provide care to alleviate pain/discomfort such as – NTG, ASA, benzodiazepine, epi for anaphylaxis, o2, Morphine etc. Is this merely an FYI on how to treat a pre-code patient? Clearly the patient would have to be alive to administer these drugs. Again it is said that the DNR does not come into play unless the patient codes. Why is this on the form?

Question: If a DNR only comes into play once the patient has suffered respiratory or cardiac arrest, why do hospitals use DNR as an excuse to downgrade CTAS or justify putting certain patients as a code 7?

Question: This is in regard to the Medical TOR protocol. If we’ve reached the mandatory patch point at three consecutive non-shockable analyses (and made the call to the BHP) and there is any sort of delay (meaning we’ve reached the fourth analysis), do we then transport? People are getting confused because some heard that they were to keep analyzing while they waited for the BHP to come on the line. That’s not how I perceived it. Regardless of any delay at any time, the protocol states that we only analyze a total of four times (unless you are an ERU) followed by CPR for the duration of the call, correct? People hear different things, and I just want clarification so that we can all be on the same page. Thanks

Question: Im not comfortable having to make critical decisions in the field, on calls that are few and far between, yet serious in nature. Is SWORBHP doing anything along with MOHLTC to advocate for regular training days to be a part of our regular schedule and duties? I’m all for continuing self-study, however, since so much of our job is practical application, dont you think it is wise to give your paramedics practical practice? As an aside, in my opinion, insufficient funds is an unacceptable excuse not to. Fire and Police have always had ample training time, and we are just as important to public welfare. So could it be possible for all parties to come together and find the funds necessary? Thank you for creating this site and allowing me to put this issue forward.

Question: I was talking to an ACP who informed me a standard of care I had not heard of. He told me that all Obstetrical patients who have a syncopal episode should have a 12 lead done. He also said that 12 lead can be done pretty much on anyone. I was under the impression that 12 leads were to be done on patient’s with chest pain. or symptoms consistent with ischemia. From what he was saying I was getting the impression that we should be doing 12 leads on most people to rule out any underlying cardiac conditions.

Question: In performing your ABCs on unconscious patients, the BLS has never clarified whether, after checking the airway you should, insert an airway then go to breathing OR go to breathing, insert 2 breaths, then insert an airway. Can you finally put an end to this debate?

Question: Can you explain what this part in the consent section means? It seems to give more flexibility to not begin resuscitation based on family members who seem reliable saying that that is what the patient wanted. “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).”

Question: I was just wondering in case Im asked by the Police Department… in a medical TOR, what physician signs the death certificate?

Question: I was on a call recently where I was instructed that all patients from a scene, where there has been a fatality, are CTAS 2. I had never heard of this so I asked our Quality Assurance and they said that all patients from the vehicle which had the fatality in it are CTAS 2. They also told me that Victoria Hospital (LHSC) is thinking about making them all CTAS 1. I asked around and not many people had heard about this. I looked through the original CTAS course module and could not find anything on this. I thought we were supposed to CTAS according to presenting condition. Some of these people are out walking around at the scene with no complaints.

Question: Called to a nursing home for 90 year old male. On scene staff state patient has valid DNR but they are unable to produce it. The crew continues to resuscitate patient as per usual. Enroute to receiving facility, CACC advises the crew that family has phoned in and stated that they have the DNR and they do not want the patient resuscitated. The attendant phones the attending BHP and advises him of the situation. The BHP orders EMS to cease resuscitation efforts on patient. Is this right or wrong?

Question: The PCP Medical TOR says that I can “move the patient to the ambulance prior to initiating the TOR if family is not coping well or the arrest occurred in a public place”. What is an example of a public place? and if I move them to the ambulance and then get the TOR, is this now the place of death and I have to wait for the coroner to arrive?

Question: Patient has a FBAO and a valid DNR (ex. nursing home). Resuscitate or not?