Advanced Paramedic Advanced Paramedic SkillsSkills

Fleming CollegeYear 2- Paramedic Program

Mary Osinga – A-EMCA , CCFP –BSc

What are we covering? What are we covering? Standards and DMAsAdvanced patient assessmentSafety and professionalismACR and Documentation of DMA’sCardiac Monitoring, 12-Lead and AED Medication AdministrationIV Therapy (Starts and Monitoring)Working With Advanced Care ParamedicsACP Drugs

Focus of the CourseFocus of the CourseEstablish criteria for mandatory core requirement for

paramedics from the Ministry of Health

Introduce the Provincial Base Hospital standards for Symptom Relief , Defibrillation, IV therapy for PCPs and 12/15 Lead

Introduce Regional requirements for local equipment, knowledge and practice

Familiarity with practical applications of the above

Make you competent! (and safe!)

Scope of PractiseScope of PractisePCPACPCCP

See Regulation 257 and KNOW how it applies to YOU!

Ambulance Act requirements for Paramedics

Legal Requirements for Legal Requirements for ParamedicsParamedicsAmbulance Act & Regulations Health Care Consent Act Regulated Health Professions Act Child & Family Service Act Coroner's Act Health Protection & Promotion Act Highway Traffic Act Mental Health Act PHIPAOccupational Health & Safety Act

Advance Life Support Patient Advance Life Support Patient Care Standards V. 3.0Care Standards V. 3.0

Why?StandardsUse of Protocols

Difference between Standards and Difference between Standards and ProtocolsProtocolsProtocols - Guidelines for prehospital patient care.

Only the portion of the guidelines which are designated “medical directives" may be undertaken before contacting on-line medical control. ◦ Standing orders - Advanced life support interventions

which may be undertaken after contacting on line medical control

◦ On-line medical control - Medical direction of prehospital ACP activities by direct radio or telephonic communications with an on-line medical control physician.

Standards- prescribed accepted medical treatment that is set by a governing body (E.g BLS standards)

See example

Medical Directives Medical Directives Example of Standing Order–components

◦ E.g NTGHow they are written is CRITICAL!!

◦ List the headings◦ A◦ B◦ C◦ D◦ E

Consent to Treatment/RefusalOther StandardsAuxiliary Medical Directives

Consent –Imperative to obtainConsent –Imperative to obtainTwo types

◦Implied – either given spontaneous-e.g hand outstretched or assumed (e.g. unconscious) that person would want to have treatment or procedure

◦Informed – requires discussion of procedures, risks, consequences and outcomes

◦See Aid to capacity evaulation

Maintenance of Certification Maintenance of Certification Policy Appendix 6Policy Appendix 6 ALSPCS Vs 3.1ALSPCS Vs 3.1

What does it mean to you?

Investigations branch of MOH

Code 7 Calls

Your requirements under Ambulance Act

Medical PPE, Splash/Contact Medical PPE, Splash/Contact Medical protective gear is IMPERITIVEDon’t become one of the statisticsBlood and body fluid contact IS part of the

job. Minimize risk via◦Gloves and/or double glove◦Gowns for certain situations◦Eyewear , goggles and face shield◦Mask, surgical or N95◦Proper uniform adherence

Remember this?Remember this?

What is Universal What is Universal Precautions?Precautions?an infection control principle that treats all an infection control principle that treats all

human blood and other potentially infectious human blood and other potentially infectious materials as infectiousmaterials as infectious

The new normal after SARS!The new normal after SARS!

SharpsSharpsWhat are sharps? In the prehospital

environment?IV cathetersEnd of IV tubingSyringes for drugs such as glucagon,

epinephrine, Preloads (ALS)Other drugs, Morphine, lasix, etc

HOW SHARP INJURYS OCCURREDHOW SHARP INJURYS OCCURREDDid the injury occur: Before use 0% During use 8% Between steps 16% Disassembling 0% Preparing for reuse 0% Recapping 0% Withdrawing from resistant material 0% Other after use, before disposal 59% Item left on disposal container 0% Putting item into disposal container 16% After disposal 0% Pierced side of disposal container 0% Pierced side of inappropriate disposal container 1 % Restraining 0% Other 6%

Serious StuffSerious Stuff After performing phlebotomy on a patient with AIDS, a health

care worker sustained a deep needlestick injury with the used phlebotomy needle. Blood from the collection tube also spilled into the space between the wrist and cuff of the health care worker's gloves, contaminating her chapped hands. The health care worker removed the gloves and washed her hands immediately. She had a negative baseline HIV test and refused zidovudine prophylaxis. Because her patient was not known to have HCV infection and did not have clinical evidence of liver disease, the health care worker did not receive baseline testing for exposure to HCV. Eight months after the incident, the health care worker was hospitalized with acute hepatitis. She was found to be seropositive for HIV 9 months after the incident. Sixteen months after the incident, she tested positive for anti-HCV antibodies and was diagnosed with chronic HCV infection. Her clinical condition continued to deteriorate, and she died 28 months after the needlestick injury [Ridzon et al. 1997

Needle Stick InjuriesNeedle Stick InjuriesRisk –The risk of infection varies depending on the

pathogen: HIV carries a 3% risk of transmission, 5% for Hep C , and 6%-30% for Hep B.

HBV infections among health care workers has declined dramatically over the last ten years, due to widespread immunization of healthcare workers with the hepatitis B vaccine,

Many factors will affect transmission of pathogens◦ Type of needle used (gauge)◦ Pre-post patient contact◦ Depth of stick injury◦ Muscle vs sub cut vs scratch◦ Post needle stick care

Needle Stick InjuriesNeedle Stick InjuriesPreventionPrevention

Comply with universal precautionsMinimize exposure or risk Necessary procedure?Use of safer devices such as needlelessProhibition of recapping, or removing

contaminated needles Training in appropriate engineering controls

and work practices Post-exposure evaluation and follow-up,

including post-exposure prophylaxis when appropriate

Needles vs Needle-less!Needles vs Needle-less!

Move towards making systems needle-less

These devices take a while to get used to for health care workers who are used to needle

Greatly reduce risk when used properlyIV catheters, syringes are most commonly

seen in the prehospital environment

From a medic point of viewFrom a medic point of viewBe professional when using needles, syringesPrepare your equipmentHave sharps container nearby and readyKnow how equipment worksAnticipate patient movementMove slowly, haste makes extra holes!ALWAYS dispose of sharp IMMEDIATELY after

useKnow reporting procedure for injuriesWash immediately after injury with soap and

water, get assessment

Be Safe!Be Safe!Readings

Safety 2 Ready Introduction to ALS PCS V 3.1 Look At PCP Handbook -CEPCP READ Defib protocols ALS PCS Cardiac Arrest 27.72-end chapter 27

Scenario: You are driving to the cottage, when you come across an accident. There is a 7yr old boy lying on the road, ejected from the vehicle. He has a pulse but no respirations. What do you do? What protection will you use if there is blood in the airway?