Post on 02-Jan-2016
Destination Determination
Changes effective _____? To be distributed ‘History in past 14 days’ changed to
‘extensive or relevant history’ Pt preference is way down the list
Stroke Criteria
Hamilton General Hospital is now a Regional Stroke Centre
(St. Joes is not) Provincial Stroke Card will be distributed
Stroke Card criteria
Facial Droop Unilateral Arm weakness or drift Slurred speech Time of onset of symptoms is clearly
known and patient can be transported to Stroke Centre within 2 hours of onset
Stroke Centre Contraindications
CTAS 1, or Airway, Breathing problems Symptoms are resolving (TIA) GCS <10 Hypoglycemia Palliative care Seizure at onset Pediatric patients
Blood Glucose Testing
Indications Any patient who exhibits any of the
following serious symptoms: agitation, decreased LOA/LOC, syncope, confusion, seizure or symptoms of stroke
Blood Glucose Testing
Hx of diabetes is not a criteria All stroke patients meet criteria Most reasons for not testing are not
acceptable (no time, knew it was a CVA)
HOWEVER --
CHF Protocol
Hamilton BH introduced a CHF protocol before the rest of the Province, but required BHP contact. A history of Nitro use was not required
The Standing Order was introduced by the Province, and we introduced it as written.
ADMINISTERING NITRO FOR CHF REQUIRES A HISTORY OF NITRO USE.
Monitors are not just for Chest Pain
Monitor should be used for most medical complaints, including – Dizziness– Nausea and vomiting – Shortness of Breath– Any SR treatment
Give ‘em the Oxygen
O2 sat is not an exclusion factor for O2 Easier to give it then justify not giving it
– eg - chest wall pain
ACR Documentation
General Appearance - still needs to be documented
SOB patients - Presence of cough and/or fever is relevant
ACR strips - we are collecting wallpaper Final Primary Problem ACP /PCP documentation when both at a
scene
Who Documents What?
ACP PRU on scene first, stays with patient ACP PRU on scene first, hands over care PCP transport on scene first, ACP arrives
and stays with patient PCP on scene first, ACP arrives and leaves ACP PRU on scene first, ACP transport
arrives
Reminder - Who is a Patient? If a person:
– Denies any injury or complaint– Is not obviously injured– Did not call for help
You may considered them not to be a patient, and do not need to assess the patient. AN ACR IS STILL REQUIRED.
If in doubt, Assess and Document!
ACR Completion
As per the MOH ACR completion manual:
An ACR is to be completed on calls where the crew arrives at the call scene or on all calls involving an unusual or noteworthy occurrence enroute to the scene.
What to do when you make a medication or other error?
Deliberate deviations from protocols
Learning from Errors Made
Take Home Points
Destination Determination will change Blood Glucose Testing Monitors and 02 for all significant
complaints Documentation with transfer of care