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.

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.

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.

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

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?

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.

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: 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: 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: 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: I have recently came across a situation where an ACP/PCP crew decided to have the non-IV cert PCP attend a Stroke Protocol call, and the ACP replied that he/she did not think it was necessary. Because the protocol requests a IV be established whenever possible, should the ACP have attempted an IV and attended?

Question: In the thermal burns webinar very near the end, mention was made of London Fire carrying an ointment for treating burns. If Fire had not applied this prior to a paramedic taking over care for the patient, could the medic allow the ointment to be applied or apply it themselves? Or would this fall out of our scope of practice because such treatment isn’t mentioned in the BLS or Medical Directives?

Question: I’ve heard the discussion among crews about allowing certain procedures to be performed on patients while still on EMS stretchers and on delay. I’ve received conflicting responses. I am perfectly fine with 12 lead, blood samples and going to x-ray while patient is with EMS. I’m not comfortable with any medications being given outside my scope of practice while under my care. Some crews say no “hospital” procedures are to be done until the patient is accepted by the ER. My personal opinion is that is possibly delaying patient care and causing more back up delays in the ER. I’ve received different opinions by our management. I know MAC cannot answer to service direction but what is the direction of MAC to what can or should be allowed to be performed by ER staff while under EMS care.

Question: I am asked to transport a patient to the cath lab. The new onset unstable angina patient (who is bradicardic with a lowest rate of 38 and multiple unifocal pvcs) and is only CP free because of the nitro during patch put on by the ER doctor.

Does leaving the patch on constitute me giving a medication that is out of my skill set? Since she/he is bradicardic (but has a good pressure) do I have to remove it? Do I have the ability/obligation to remove a treatment started by the attending ER physician? Escort required? Other suggestions?

Question: I work out of a first response vehicle. If I start an IV to deliver a med such as gravol, and the patient will not require anymore treatment via IV and I am handing the patient over to a crew that is not IV certified what is my responsibility? Do I have to accompany the patient? Or can I lock the IV or can they monitor the IV TKVO?

Question: To what extent am I allowed to take orders from a physician who is riding out with me? Are there any set guidelines to direct us and the physicians in this aspect? A recent resident riding with me said they had no issue with providing the order if it seemed reasonable. Narcan administration was used as an example as something that seemed reasonable. However the resident felt (and I agreed) something like a TOR order warranted a call to a BHP. Discussion of this subject would be appreciated.

Question: Can an off duty medic who stops to assist an on duty crew the care (in the area for which he works and is certified) at an accident scene or medical event provide advanced care i.e. IV, med administration injections etc.?