Hamilton Health Sciences
Base Hospital Program
POLICY AND PROCEDURE MANUAL
Last Updated: August 2008
August 2008
Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
Preface
It is the responsibility of every paramedic in the Hamilton Health Sciences Base Hospital
Program capture-area to know the information contained in this Policy and Procedure
Manual, which applies to their level of certification.
The policies and procedures outlined in this manual are to be followed in conjunction
with the BLS Patient Care Standards, Emergency Health Services policies and local
ambulance service policies. Any discrepancies, suggestions for changes, errors or
omissions should be sent to the attention of the Hamilton Health Sciences Base
Hospital Program at the address below.
Hamilton Health Sciences Base Hospital Program
40 Wing, Ground floor – Henderson Hospital
711 Concession St.,
Hamilton, Ontario L8V 1C3
Phone: 905-527-4322 Ext. 42362
Fax: 905-389-0699
Office Hours: 0800 - 1600 Monday to Friday
Preface
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Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
TABLE OF CONTENTS
Page
Section One – Roles and Responsibilities
MISSION STATEMENT
ROLES AND RESPONSIBILITIES
4
5
Section Two – Certification Policies
8
INITIAL CERTIFICATION
CROSS CERTIFICATION
INACTIVE POLICY
MAINTENANCE OF CERTIFICATION
CLARIFICATION OF TERMS AND CONDITIONS
Base Hospital
Emergency Medical Service
Hours of Service
Certification
Educational Certification
Provisional Certification
Deactivation
Reactivation
Decertification
Section Three – Communication and Documentation
17
BASE HOSPITAL PHYSICIAN PATCHES
UNAVAILABILITY OF BASE HOSPITAL PHYSICIAN
NOTIFICATION OF THE RECEIVING HOSPITAL
LOSS OF COMMUNICATION
ACR DOCUMENTATION REQUIREMENTS
DOCUMENTATION OF TRANSFERS
DOCUMENTATION OF OPQRST
CHART REVIEW PROCEDURES
Section Four – Supplies and Equipment
21
SUPPLIES AND EQUIPMENT
CONTOLLED SUBSTANCES
STORAGE OF ALS SUPPLIES AND EQUIPMENT (ENVIRONMENTAL CONDITIONS)
EXPIRED ALS SUPPLIES
REPORTING ALS EQUIPMENT PROBLEMS
INFECTION CONTROL, SHARPS, AND BIOHAZARDS
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Hamilton Health Sciences Base Hospital Program
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TABLE OF CONTENTS (continued)
Section Five – Defibrillation Issues
23
DEFIBRILLATION IN MOVING VEHICLE
BIPHASIC DEFIBRILLATION
DEFIBRILLATION IN PREGNANT VSA PATIENTS
DEFIBRILLATION OF PATIENTS WITH A PACEMAKER OR INTERNAL
DEFIBRILLATOR
DEFIBRILLATION OF PATIENTS IN WET CONDITIONS
DEFIBRILLATION OF PATIENTS ON A METAL SURFACE
DEFIBRILLATION OF PATIENTS WITH NITROPATCHES
TRANSFER OF RESPONSIBILITY AT THE SCENE - FIREFIGHTER
DEFIBRILLATION
TRANSFER OF RESPONSIBILITY AT THE SCENE – PUBLIC ACCESS
DEFIBRILLATION
LOCAL GUIDELINE FOR OBVIOUSLY DEAD PATIENTS
LOCAL POLICY FOR DNR PATIENTS
FIELD PRONOUNCEMENT OF DEATH
Section Six – Transfer of Care
25
INTERACTION WITH A MEDICAL DOCTOR ON SCENE
INTERACTION WITH AN R.N. ON SCENE
RESPONSIBILITIES WHEN WORKING WITH MIDWIVES
INTEREACTION WITH AND RELEASING FIRE DEPARTMENT PERSONNEL FROM
MEDICAL ASSISTANCE CALLS
INTERACTION WITH PRIVATE CONTRACTED PARAMEDICS & LAY RESPONDER &
HEALTH CARE PROVIDERS
RESPONSIBILITY FOR CARE ON INTERFACILITY TRANSFERS
SPLIT CREW CONFIGURATION
TRANSFER OF CARE BETWEEN PARAMEDICS PCP <-> ACP
TRANSFER OF CARE BETWEEN PARAMEDICS ACP <-> ACP
Appendices
A
B
C
D
28
PREHOSPITAL QUALITY OF CARE COMMITTEE TERMS OF REFERENCE
CERTIFICATION DOCUMENTS
DEFIBRILATOR MAINTENANCE RECORD
GLUCOMETER DAILY CHECK RECORD
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Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
Hamilton Health Sciences
Base Hospital Program
Mission Statement
Our Mission is to facilitate the finest pre-hospital care for all citizens in our
Region by providing excellence in Medical Education, Quality Improvement
in Clinical Care, Paramedic Professionalism, and System Performance. We
will endeavor to work with all providers to save lives, minimize morbidity
and alleviate patient suffering.
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Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
Base Hospital Roles and Responsibilities
(summarized from the Oct. 24/97 edition of this MOH document)
A Base Hospital provides medical direction, leadership, quality assurance and advice in
the provision of pre-hospital emergency health care in a specified geographical area, at
several different levels of certification with differing skill sets. This involves the Base
Hospital acting as a resource centre and facilitator to assist in ensuring that pre-hospital
care and transportation is meeting a community’s needs. In addition, the Base Hospital
provides training, quality assurance, continuing education and guidance to pre-hospital
emergency care providers. The Base Hospital also functions in an advisory capacity to
the Ministry of Health on pre-hospital emergency care.
Specific responsibilities which are to form the basis of an Agreement with the
EHS Branch:
1.
Provide emergency care providers and dispatchers with 24 hour access to
medical direction or advice consistent with EHS policies and the paramedic’s
approved scope of practice.
2.
Participate in the development of agreements and protocols that will determine
appropriate patient destinations and transfers. Also, participate in the
development of local tiered response agreements.
3.
Advise EHS of any complaints received regarding prehospital medical service. On
the request of EHS Branch or a service operator, investigate complaints relating
to the provision of pre-hospital emergency service.
4.
Establish a Base Hospital Utilization Committee (Prehospital Quality of Care
Committee), which meets at least twice a year to communicate and address
issues relating to pre-hospital patient care.
5.
Provide continuing medical education training at the Paramedic and Advanced
Paramedic levels using provincially standardized methodology.
6.
Provide education and certification regarding controlled medical acts, consistent
with provincial standards.
7.
Report to EHS a controlled medical act skills inventory for each paramedic
employed by a licensed ambulance service.
8.
Where approved to do so, deliver training programs for ambulance based prehospital emergency care providers. On request, assist the emergency service
operator in the review and validation of the patient care elements of local policy
and procedure manuals.
9.
Provide a Quality Improvement Program which may include monitoring the
delivery of controlled acts through chart audits, rideouts, patient outcome studies
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Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
on selected patients or types of medical conditions and clinical experience. Also
evaluate patient care through monitoring on-line medical control; reviewing a
percentage of canceled calls and soliciting emergency physician input. Annually
review compliance with controlled act protocols.
10.
Assist the service operator in monitoring patient care. Audit an agreed upon
percentage of all calls where a controlled medical act was performed or where a
controlled medical act was indicated but not provided.
11.
Provide each service operator with assistance and information necessary for the
development and implementation of the patient care components of a continuous
quality improvement program.
12.
Where patient care does not meet the Base Hospital’s standard for patient care
delivery, provide the service operator with qualitative and quantitative feedback
regarding the nature and type of patient care provided by a paramedic and the
nature of the identified patient care deficiency. Notify service operators and EHS
where a paramedic has had the delegation of one or more controlled medical
acts rescinded by the Base Hospital Medical Director.
13.
Provide individual feedback to each paramedic and collective service feedback to
the service operator on the results of the Base Hospital CQI Program.
14.
Maintain records regarding: CME, certification status, instances where a BHP was
unavailable for on-line medical control, complaints regarding ambulance service,
protocol violations or patient care concerns, ALS equipment failure, each call
where a controlled medical act was performed or indicated, completed ambulance
call evaluation forms, minutes from meetings, correspondence, investigations etc.
15.
On request, assist the operator with establishing a health and safety program
related to the provision of controlled acts.
16.
Co-ordinate with the service operator to ensure that Base Hospital policies do not
result in the service operator or their staff being in conflict with their collective
agreement, EHS policy or legislated requirements.
17.
Assist the service operators in developing and implementing a monitoring and
maintenance program for appropriate prehospital equipment.
18.
On request, assist local health planning agencies in defining the level and type of
pre-hospital care service required by a community.
19.
Assist local emergency service operators and EHS Field Office to ensure that the
patient care that is being provided meets community, district and regional needs.
20.
With prior written approval, promote and participate in research pertaining to prehospital care.
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Hamilton Health Sciences Base Hospital Program
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21.
Have a coordinated and cooperative working relationship with Central Ambulance
Communication Centre(s), service operators, receiving hospitals, fire, police,
DHC, ESN, and the area EHS Advisory Committee.
22.
Promote awareness of the patient care, QA, and continuing education
responsibilities of the Base Hospital to medical and nursing staff of receiving
emergency units.
23.
Plan for and manage the financial, staffing, facilities and equipment needs and
resources required for the Base Hospital program.
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Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
Policy
Certification Policy
Date:
Pages:
Section:
April 2003
8
General
This serves to document the steps necessary for Initial and Maintenance of Certification
for all Paramedics under the Hamilton Health Sciences Base Hospital Program. This
process is to ensure that all new Paramedics meet the high level of cognitive and skill
levels that are expected of current Paramedics. This process describes two distinct
guidelines for Certification depending upon whether the Paramedic is currently certified
by another Base Hospital designated by the MOHLTC&LTC. Additionally, it outlines the
Maintenance of Certification Policies for all Paramedics once certified.
A)
Initial Certification Process
This process applies if the Paramedic is not currently certified under a MOHLTC
designated Base Hospital.
1. Eligibility
The Paramedic must be eligible for employment by a licensed Ontario Ambulance
Service Provider under the Regulations of the Ambulance Act. The Service Provider
is responsible for ensuring these requirements are met.
2. Education Verification for Advanced Care or Critical Care
i) The Paramedic shall provide evidence of graduation from a MOHLTC
approved Paramedic education program in Ontario.
ii) If 2(i) is not applicable the Paramedic is required to obtain equivalency
verification from the MOHLTC and obtain documentation.
3. Provincial Exam
The Paramedic will provide evidence of successful completion of the provincial
examination for the appropriate level (if applicable).
4. Intent of Employment (Service Responsibility)
Upon successful completion of steps 1-3, the Service Provider will forward a written
confirmation of the intent to offer employment to the Paramedic pending certification
with Base Hospital. The service will also forward the following information: the
applicant’s name, OASIS number (if applicable), contact information, and
confirmation that they meet criterion 1.
5. Documentation
The Paramedic shall complete the Request for Certification Form for new applicants
and provide documentation, which includes the following:
i) Certification status and experience from all Base Hospital/Licensing
authorities/Education Programs under which the Paramedic is currently
certified/practicing.
ii) Certification status and experience from all Base Hospitals/Licensing
Authorities/Education Programs over the lasts three years.
iii) A declaration of any and all decertifications (or equivalent) as a Paramedic.
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iv) A declaration of all deactivations (or equivalent) in the last three (3) years.
v) List of Education programs completed (EMCA, ACP, CCP or equivalent) including
documentation.
vi) Permission for this Base Hospital to obtain information from other
identified Base Hospitals/Licensing Authorities/Education Programs regarding
Paramedic performance and skills and to verify information indicated above.
6. Base Hospital Evaluation/ Orientation
The Base Hospital will arrange for an evaluation, which may use written, scenariobased and oral evaluations with the Medical Director or delegate. The Base Hospital
will also provide an orientation to Base Hospital policies, procedures and medical
protocols. This process should not normally exceed two (2) days in duration.
7. Educational Certification
Upon the Base Hospital review of documentation received and orientation
/evaluation, the Medical Director may recommend “Educational Certification”1
pending completion of further clinical or field orientation/evaluation (step 8).
8. Field Orientation & Evaluation
i) Field Orientation
The Paramedic with be paired with at least one other experienced approved
Paramedic at the same certification level for the purposes of an orientation. The
orientation will focus on equipment, skills, and protocols. For Base Hospital
certification purposes, this will generally not exceed 30 calendar days or 160 hours.
This may be extended with agreement from the service provider. The service
provider will provide documentation when this orientation has been completed. The
service provider may have an additional requirement for orientation beyond this
period.
ii) Field Evaluation
During this period, the Base Hospital may perform 100% Ambulance Call Report
review. The Paramedic may be involved in clinical education /evaluation in areas
identified in step 6 and may be required to complete a field evaluation (8 hours) with
the Medical Director or Base Hospital delegate.
9. Final Certification
After completion of steps 1-8, the Base Hospital Medical Director will render a
decision whether or not to certify the Paramedic and notify the service provider. The
Base Hospital may recommend further clinical or field education/orientation but this
can only occur with agreement from the service provider.
1
“Educational Certification” is defined as the permission granted by the Base Hospital Medical
Director to a Paramedic, to perform controlled acts in the presence of a certified Paramedic (at
the same level or higher) for the purposes of orientation or a clinical supervisor for the purposes
of orientation, evaluation, and education.
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B)
Cross-Certification Process
To be eligible for cross-certification, a Paramedic must be currently certified at the same
level or higher elsewhere under a MOHLTC designated Base Hospital.
1. Eligibility
The Paramedic must be eligible for employment by a licensed Ontario Ambulance
Service Provider under the Regulations of the Ambulance Act. The Service Provider
is responsible for ensuring these requirements are met.
2. Intent of Employment
Upon successful completion of step 1, the Service Provider will forward a written
confirmation of the intent to offer employment to the Paramedic pending certification
with the Base Hospital. The service will also forward the following information: the
applicant’s name, OASIS number, contact information and confirmation that they
meet criterion 1.
3. Documentation
The Paramedic shall complete a form and provide documentation, which includes
the following:
i) Certification status and experience from all Base Hospitals/Licensing
Authorities/Education Programs under which the Paramedic is currently
certified/practicing.
ii) Certification status and experience from all Base Hospitals /Licensing
Authorities/Education Programs over the last three (3) years.
iii) A declaration of any and all decertifications (or equivalent) as a Paramedic.
iv) A declaration of all deactivations (or equivalent) in the last three (3) years.
v) List of Education programs completed (EMCA, ACP, CCP or equivalent)
including documentation.
vi) Permission for this Base Hospital to obtain information from other identified Base
Hospitals/Licensing Authorities/Education Programs regarding Paramedic
performance and skills and to verify information indicated above.
4. Base Hospital Evaluation/Orientation
The Base Hospital may arrange for an evaluation, which may use written, scenariobased and oral examinations with the Medical Director or delegate. The Base
Hospital will also provide an orientation to the Base Hospital policies, procedures
and medical protocols. This process should not normally exceed one (1) day in
duration.
5. Educational Certification
Upon the Base Hospital review of documentation received and
orientation/evaluation, the Medical Director may recommend “Educational
Certification” pending completion of further clinical or field orientation/education (step
4).
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6. Field Orientation & Evaluation
i) Field Orientation
The Paramedic with be paired with at least one other approved Paramedic at the
same certification level for the purposes of an orientation. The orientation will focus
on equipment, skills, and protocols. For Base Hospital certification purposes, this will
generally not exceed 36 hours. This may be extended with agreement from the
service provider. The service provider will provide documentation when this
orientation has been completed. The service provider may have an additional
requirement for orientation beyond this period.
ii) Field Evaluation
During this period, the Base Hospital may perform 100% Ambulance Call Report
review. The Paramedic may be involved in clinical education /evaluation in areas
identified in step 4 and may be required to complete a field evaluation (8 hours) with
the Medical Director or Base Hospital delegate.
7. Final Certification
After completion of steps 1-6, the Base Hospital Medical Director will render a
decision whether to certify the Paramedic, and notify the service provider. The Base
Hospital may recommend further clinical or field education/ orientation but this can
only occur with agreement from the service provider.
1
“Educational Certification” is defined as the permission granted by the Base Hospital
Medical Director to a Paramedic, to perform controlled acts in the presence of a certified
Paramedic (at the same level or higher) for the purposes of orientation or a clinical
supervisor for the purposes of orientation, evaluation, and education.
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Hamilton Health Sciences Base Hospital Program
Policy and Procedure Manual
Inactive Policy (Effective December 19, 2006)
Background:
The Ontario Base Hospital Group has developed policies outlining the certification requirements
for paramedics within the Province of Ontario. Maintenance of certification requires that the
paramedic be employed by an Emergency Medical Service and work as a paramedic and/or
paramedic preceptor and meet the annual eligibility requirements outlined in the Standards for
Certification/Recertification form of this document.
Policy
Notwithstanding the Maintenance of Certification Policy, a paramedic employed by an
Ambulance Service provider, who is not actively engaged in the provision of patient care as a
paramedic for the required minimum hours or patient contacts as outlined in the Standards for
Certification/ Recertification form may be granted certification as a paramedic with the provision
that they are “INACTIVE”. Paramedics must voluntarily request this status and be approved by
both their EMS Service Operator and the Medical Director. Paramedics who are certified but
“INACTIVE” will NOT be authorized to perform controlled acts at that level of certification.
Paramedic Certification - Inactive Status
The inactive paramedic shall:
• meet all conditions for employment and paramedic status as outlined in the Ambulance Act
• successfully complete all mandatory CME requirements
• demonstrate competency and adherence to standards, protocols and legislation associated
with the performance of controlled acts and the provision of patient care at their level of
certification. This will be determined through successful performance at CME, review and
demonstration of skills competency and at the annual recertification session.
If at any time, in the judgment of the Base Hospital Medical Director, conditions have not been
met or maintained, the Medical Director may deactivate or decertify the paramedic. The
employer will be notified in writing. The EMS provider (employer), the Base Hospital, and the
paramedic will meet to seek a suitable resolution.
The inactive paramedic will not be authorized to perform controlled acts at that level of
certification. The conditions for reactivation will be determined by the Base Hospital once
notified of a pending change of status that will place the paramedic back on active duty. An
Advanced Care Paramedic on inactive status may be authorized to perform controlled acts at a
skill set level of a Primary Care Paramedic (PCP) if the conditions required for maintenance of
certification of a PCP are met.
A Paramedic on inactive status may apply to gain educational certification status for up to a 3month time frame. The steps required to achieve educational certification will be decided on a
case-by-case basis at the discretion of the Medical Director. When the 3-month period is
complete, the paramedic must either return to inactive status or be successful in reactivation to
full certification.
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C)
Maintenance of Certification
Maintenance of Certification requires that the Paramedic:
1. Be employed by an Emergency Medical Service associated with this Base Hospital,
work as a Paramedic, and/or Paramedic Preceptor, and meet the annual eligibility
requirements outlined in the Provincial Base Hospital Standards. The Paramedic
must work a minimum of 144 scheduled hours (see chart) in the previous 12 months
in an emergency medical environment, with an absence from clinical activity of
no longer than 90 consecutive days. If these criteria are not fulfilled, an evaluation
may be initiated by the Medical Director to ensure competency in the skills the
Paramedic has been certified to perform. This will include, but not be limited to:
i) Proof of reasonable attempts to complete 144 scheduled hours of experience in
an emergency medical environment.
ii) Documentation of skills practice overseen by the Base Hospital.
2. Meets all Base Hospital administrative requirements including completion and
submission of forms and successful completion of all Hamilton Health Sciences
Base Hospital Program Continuing Medical Education (CME) requirements (see
chart). Credit for equivalent learning will be at the discretion of the Medical Director.
If a Paramedic is absent from CME, the Paramedic is responsible for contacting the
Program Manager to make arrangements to successfully complete the CME
objectives.
3. Demonstrates competency and adherence to standards, protocols and legislation
associated with the performance of Controlled Acts and the provision of patient care
at their level of certification. This will be determined through Base Hospital
Continuous Quality Improvement (CQI) initiatives. They may include, but are not
limited to:
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Ambulance Call Report (ACR) Reviews
Peer Reviews
Field Performance Evaluation
Dispatch/BHP/Receiving Hospital Communication Reviews
CME/Recertification Evaluations/Performance
Skills Maintenance/Inventory Reviews
4. Adhere to the Provincial Paramedic Conduct Directives. The Paramedic Conduct
Directives will apply whenever Paramedics participate in on-duty assignments or
duties related to the certification processes endorsed by individual Base Hospital
Programs. These Directives will be routinely evaluated and uniformly enforced by
the employer and the Base Hospital.
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Notes:
1. If at anytime, the Base Hospital Medical Director deems these conditions have not
been maintained, the Base Hospital Medical Director may Deactivate/Decertify the
Paramedic (or place the Paramedic on Educational or Provisional certification). The
employer will be notified and the employer and Paramedic will be given written
notice by the Base Hospital, which will outline the specific concerns. Upon receiving
notification from the Base Hospital, the employer will notify the Paramedic without
delay that s/he is to immediately contact the Base Hospital.
2. If Deactivated or Decertified, that Paramedic will not be authorized to perform
Controlled Acts. The conditions for Reactivation/Recertification will be determined
by the Base Hospital and shall be completed within two weeks of notification, unless
agreed to by the Paramedic, the Employer, and the Base Hospital. The conditions
will be communicated in writing to the Paramedic. If the Paramedic is placed on
Educational or Provisional Certification, that Paramedic will only be authorized to
perform controlled acts under the supervision or in the presence of a certified
Paramedic or clinical supervisor (at the level applied) as outlined in the specific
situation.
Maintenance of Certification Requirements Chart
Frequency of
Re-certification
Field Hours
(Minimum)
Successful
completion of
Certification
August 2008
PRIMARY CARE
PARAMEDIC
Once per year
ADVANCED CARE
PARAMEDIC
Once per year
144 hours
144 hours
8 hours - written & skills
evaluation
2 SAED scenarios
24 hours CME including clinical
& didactic evaluation
2 SAED scenarios
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D) Clarification of Terms and Conditions:
Base Hospital: means a hospital that is designated as a Base Hospital by the Minister
in accordance with the Ambulance Act of June 16, 2000.
In this document, unless otherwise stated, the use of the following terms refer to
ambulance personnel as defined by the Ambulance Act, as amended by the Ontario
Regulation 257/00:
Emergency Medical Attendant
Paramedic
Primary Care Paramedic
Advanced Care Paramedic
Critical Care Paramedic
Emergency Medical Service: means an Ontario ambulance service provider duly
licensed to perform this service as defined under the Ambulance Act.
Hours of Service: means work normally defined as field assignments. Where a
Paramedic has no clinical duties, but is a clinical educator/manager, working hours may
be credited on the condition that at least once every 12 months the Paramedic is tested
by the Base Hospital to ensure competency in the skills the Paramedic has been
certified to perform.
Certification: Is written approval to perform selected medical controlled acts under the
license/registration of a Base Hospital Medical Director.
Educational Certification: Is permission granted by a local Base Hospital Medical
Director to a Paramedic, to perform controlled acts in the presence of a certified
Paramedic (at the same level or higher) or a clinical supervisor, for the purposes of
orientation, evaluation, and education.
Provisional Certification: Is permission granted by a local Base Hospital Medical
Director to a Paramedic, to perform specified controlled acts while being monitored by
another certified Paramedic (at the same level or higher) or a clinical supervisor,
pending investigation or remediation. This will only occur with agreement of both the
Base Hospital and the Service Operator.
Deactivation: Is the temporary suspension of selected certified Paramedic privileges to
perform controlled acts by the Base Hospital Medical Director for the purpose of
performing investigation and/or remediation.
Deactivation may occur as a result of:
i. A critical omission/commission.
ii. A serious major omission/commission.
iii. Repeated major omission/commissions.
(Continued)
iv. Failure to respond to Base Hospital requests for feedback or interviews.
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v. Failure to successfully complete prescribed remediation for minor/major
omission/commission within a reasonable period of time (2 weeks).
vi. Professional misconduct deemed by the Medical Director to be remediable (see the
Provincial Paramedic Conduct Directives).
vii. Failure to Maintain Certification as outlined in section (C) of this document.
Reactivation: Is the reinstatement of the suspended privileges after a period of
deactivation. A Paramedic may be reactivated by the Medical Director at the time that
such requirements for remediation have been met. The remediation plan will be outlined
by the Base Hospital and be completed by the Paramedic within a reasonable period of
time (2 weeks). The expense of remediation delivery (excluding Paramedic attendance)
will be borne by the Base Hospital.
Decertification: Is the revocation, by the Medical Director, of a certified Paramedic’s
privileges to perform controlled acts while in the employ of a certified ambulance
service.
Decertification may occur as a result of:
i. Gross professional misconduct (Provincial Paramedic Conduct Directives).
ii. Falsification of documentation.
iii. A critical omission/commission.
iv. Failure to successfully complete prescribed deactivation remediation.
v. Repeated deactivations in similar clinical areas.
NOTE:
Upon deactivation or decertification, the Paramedic has a professional duty to notify
Medical Directors of all other Base Hospitals under which they are certified.
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Policy
Communication & Documentation
Date:
Pages:
Section:
January 2003
4
General
BASE HOSPITAL PHYSICIAN PATCHES
The Base Hospital protocols are not intended to be all encompassing of the complex medical situations
that may be encountered in the field. Since patients do not always fit into a “cook book” approach, these
protocols are not a substitute for good clinical judgment. Providers should utilize the resource of the Base
Hospital Physicians (BHP) for situations that fall outside of these protocols but who may benefit from
Advanced skills or medications.
BHP contact should be initiated for these situations unless there is insufficient time to complete the
contact prior to transfer of care at the hospital.
The BHP report should begin with a BRIEF SUMMARY INTRODUCTION that is similar to hospital prealert report. This summary should include
•
•
•
•
•
Unit call name and name or number of the Paramedic
The patients chief complaint
The level of severity
Relevant vital signs and physical findings
The reason(s) for the BHP consult.
The Paramedic must also indicate their level of certification (ACP or PCP)
The Paramedic should then be able to provide a full report to the BHP including the following information.
Note that the report may be tailored to the patient and to the request of the BHP.
Report may include:
ƒ Description of the scene
ƒ Patient’s age, sex, and weight
ƒ Patient’s chief complaint (elaborate as necessary)
ƒ Patient’s primary problem
ƒ Associated symptoms
ƒ Brief history of the present illness
ƒ Pertinent past medical history
ƒ Physical exam findings, including:
ƒ Level of consciousness (AVPU system)
ƒ Vital signs
ƒ Neuro exam
ƒ General appearance and degree of distress
ƒ ECG (if applicable)
ƒ Trauma index and Glasgow Coma Scale (if applicable)
ƒ Other pertinent observations, including significant positive and negative findings
ƒ
ƒ
Treatment given thus far
Estimated time of arrival (ETA) at hospital
The preferred method of contact to a BHP is via phone (landline or cell)
Radio communication is available as a back-up.
To initiate a phone patch dial 1-888-256-6629.
Using this number enables the exchange to be taped, which provides protection for all parties in difficult
calls.
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UNAVAILABILITY OF BASE HOSPITAL PHYSICIAN
In the event that a BHP is not available the crew is to follow established protocols and transport. Document
the incident on the ACR, and contact the Base Hospital as soon as possible.
NOTIFICATION OF THE RECEIVING HOSPITAL
The receiving hospital should be notified by a crew any time the patient's condition is such that it is in the
best interest of the patient and the ED that clinically significant information is passed along. Local policy
suggests receiving hospitals should be notified on all priority 4 patients (all CTAS 1 & 2). It is imperative that
the information provided is concise, brief and pertinent to the call.
LOSS OF COMMUNICATION
In the event of a communication breakdown while attempting to update a receiving hospital, HCACC will
relay the message for the crew. In the event of a communication breakdown during a patch to the BHP,
HCACC will not relay BHP orders. The crew must talk to the BHP directly for orders.
In the event of total communication breakdown during a patch to the BHP, the crew will follow established
protocols and transport to the receiving hospital. All communication failures involving BHPs should be
documented on the ACR, and the Base Hospital office should be notified as soon as possible.
ACR DOCUMENTATION REQUIREMENTS
Paramedics will document on the Ministry of Health ACR Forms. Paperwork must be completed as soon as
possible following the call and left at the receiving facility whenever possible. ACRs should be completed to
the standard of the ACR completion manual, and submitted to the service operator.
The service operator will forward the yellow copy of the ACR to the Base Hospital as per the service
agreement.
The ACRs serve as an important part of the patient’s medical document. As such, they are extremely
important in the patient’s ongoing care. Complete, thorough, and legible documentation is paramount to
its role as a medicolegal document. The ACR serves as a record of the Paramedic’s actions with a
patient and the legibility, accuracy, and completeness of the chart reflect on their overall care. The data
collected from the ACRs is also used to assess the overall system and improve the quality of patient care
by determining needs for new equipment, protocols, and education.
DOCUMENTATION OF ‘TRANSFERS’
The term ‘transfer’ has not been well defined. A transfer would not normally involve bringing a patient to
an Emergency Department. While nursing homes or other establishments may refer to a call that moves
a patient out of their care as a ‘transfer’, this definition would not be consistent with what we would
consider a transfer. Unless the patient has been assessed by a physician and is to be seen by a specific
individual or service in the ED other than the attending physician, the call should be treated as a request
for emergency services.
All patients cared for by and transported by Paramedics certified by this Base Hospital should be
appropriately assessed, and the findings of that assessment needs to be appropriately documented. This
includes ‘transfer’ patients. Certainly there are calls on which the potential for deterioration is far less than
on others. Unfortunately at this time, we do not have a system that allows someone calling for an
ambulance service to specify the degree of service that they desire. Currently all patients are entitled to
the full and complete care that can be expected from the Paramedics in our area.
Obviously the assessment should be tailored to the patient, and it is not necessary to document a
complete head to toe examination with chest and heart sounds for all patients. We do, however, insist
that all patients receive a basic assessment and at least one set of vital signs, and that this assessment
be adequately documented. A basic assessment might include the level of consciousness and the
absence of any voiced or obvious complaints. If there were a voiced or obvious complaint, this would of
course need to be explained further.
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DOCUMENTATION OF OPQRST
Hamilton Base Hospital requires documentation of a patient’s history to the extent that all of the questions
posed by the OPQRSP mnemonic have been addressed.
The OPQRST is included in the BLS Patient Care Standards and our Base Hospital Paramedic manual
as a generic guide to assessing pain and other medical disorders. The information elicited from these
mnemonic forms is the basis for a differential diagnosis, and will help to demonstrate whether or not the
parameters for the PCP or ACP protocols were met. It also provides a system to ensure that a
description of a complaint is complete, even if protocols are not utilized.
The information does not need to be organized into the order and format suggested by this scale, but all
of the information suggested by the mnemonic should be included.
Specifically when dealing with chest pain, the quality and provoking factors are required to determine if
the pain is likely of cardiac origin. Without this information it may not be possible to show that the
parameters of the chest pain protocol have been met, and therefore failure to document these factors will
be considered a protocol violation. Other information indicated by this system is important but, not
necessarily critical to determining the use of protocols. Therefore, failure to document the O, R, S, T
factors will be treated as a documentation deficiency.
CHART REVIEW PROCEDURES
The Ambulance Call Reports (ACRs) are delivered to the Base Hospital by the Service Operator
according to the terms of the applicable Letter of Intent with that service. A note will be made that
indicates the date that the forms are received.
The services are currently requested to send all ACRs to the Base Hospital for possible review.
A Clinical Coordinator or designate will sort ACRs.
•
•
•
•
ACRs are sorted into those that will be reviewed and those that go directly to Data Entry, according to
the following criteria.
- All calls that involve controlled medications, VSA patients, Cricothyrotomy, Needle Thoracostomy or
unusual circumstances will be reviewed (100%)
- All other Delegated Medical Acts (except Intravenous access), including the drawing of blood to
perform a blood glucose test, are to be reviewed at a rate of 50%.
- One of ten of the remaining ACRs will be reviewed.
ACRs will be separated - ACP and PCP, with each category of ACR being given to reviewers of
similar qualifications.
The ARIS run number of each ACR that is being sent to be reviewed will be recorded on the Hamilton
Base Hospital Chart Review form, along with the name of the reviewer, the date that the forms are
being placed in the reviewer’s mail slot and the amount of time that will be credited to the reviewer for
completing the ACRs.
The Coordinator will sort the ACRs and distribute to the reviewers and to data entry as appropriate.
ACRs will be reviewed by the reviewers according to the Base Hospital Ambulance Call Evaluation (ACE)
Auditor’s Guidelines, and the most recent specific directives from the Hamilton Base Hospital.
• The results of the audit will be entered on an Ambulance Call Evaluation (ACE) form.
• In addition to noting deficiencies and patient care issues, the reviewer may make appropriate
comments and suggestions on the ACE form.
• In addition to deficiencies and errors, the reviewer should also recognize excellence in
documentation and patient care.
• The reviewer will direct the charts to be returned to the Paramedic, sent to the medical director or
sent to data entry, according to the ACE guidelines.
• The reviewer will check off on the Hamilton Base Hospital Chart Review form where each ACR is
being directed.
• The ACRs will be sorted according to where they are being directed, and returned to the Base
Hospital Clinical Coordinator or designate.
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The Clinical Coordinator (or designate), on receiving the ACRs back from the reviewers, will check the
Chart Review form to ensure that all ACRs are accounted for.
• The Clinical Coordinator will do a random check to insure that the review has been complete,
accurate and the comments by the reviewers are appropriate.
• The Clinical Coordinator will evaluate the ACRs being directed to be returned to the Paramedics to
determine the most effective way of dealing with the deficiencies noted. The options involved include
returning the ACR to the medic or determining if the deficiency could be addressed by other methods,
such as a letter to the Paramedic or through an aggregate report from the database.
• The Clinical Coordinator will write letters to the Paramedics or direct that aggregate reports be
produced as per the above.
• The Clinical Coordinator will distribute the ACRs to data entry, to the Paramedics and to the Medical
Director.
• The Clinical Coordinator will perform these functions daily or as required.
The Medical Director(s) will review all ACRs directed to them, make appropriate comments or
suggestions on the ACE and return them to the Clinical Coordinator, along with directions as required.
The Service Operator will facilitate the return of ACRs to the Paramedics, the review of the comments or
concerns, and the return of the ACRs to the Base Hospital.
• The time to return the forms to the Base Hospital will be in accordance with the Letter of Agreement
between the Base Hospital and the Service Operator.
On receiving ACRs back from the Medical Director and the Ambulance Service (Paramedics), the Clinical
Coordinator will check the Base Hospital Chart Review form to insure that all ACRs are accounted for.
• The Clinical Coordinator will review ACRs returned by the service operator to insure that the
Paramedic has reviewed the deficiencies and that appropriate written responses have been entered
on the ACE.
• Directions received from the Medical Director will be followed, and ACRs distributed to data entry or
to the Paramedics as indicated.
The Clinical Coordinator will insure that occasional aggregate reports are prepared for the service and
the individual Paramedics, to highlight areas of reoccurring deficiencies.
The Base Hospital will facilitate periodic meetings of ACR auditors, to give specific direction based on
local and recent trends, and to allow reviewers to provide feedback to the Base Hospital.
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Policy
Supplies & Equipment
Date:
August, 2008
Pages:
Section:
2
General
SUPPLIES AND EQUIPMENT
Paramedics are ultimately responsible for ensuring that all patient care equipment is in working
condition prior to use with any patient. This includes following the developed daily check
schedule for glucometers and defibrillators. This includes ensuring that defibrillators are set to
the correct time (+/- 10 seconds).
Paramedics are also ultimately responsible for ensuring that all patient care supplies are
stocked to adequate levels, as per the most recent agreed on stock list, and ensuring that stock
is not expired.
Service Operators are responsible to ensure that defibrillators are serviced based on the
preventative maintenance schedule. Quarterly reports of defibrillator maintenance and the
results of daily testing of glucometers will be forwarded to the Base Hospital.
Expired Supplies
All equipment and supplies carried by Paramedics that have an expiry date should be checked
regularly to ensure that it has not expired. Supplies where the month and year are given as the
expiry date are considered to expire at the end of that month. Expired supplies should not be
used or administered.
STORAGE OF ACP SUPPLIES AND EQUIPMENT (ENVIRONMENTAL
CONDITIONS)
Medications (e.g. symptom relief kit or ACP drug bags) and ACP equipment (e.g. defibrillators
and glucometers) are not to be exposed to extreme cold or hot temperatures for significant
periods of time (i.e. greater than 2 hours). Drug supplies are sensitive to extreme cold and heat
and should be kept at controlled room temperature (15-30 C).
REPORTING ACP EQUIPMENT PROBLEMS
If any A.L.S. equipment or supplies (e.g. defibrillators, glucometers, monitoring electrodes,
batteries, defibrillation pads, syringes etc.) are found to be defective, the service operator should
be notified immediately. The Base Hospital office should also be advised.
If the failure occurred during a call, the incident should also be briefly documented in the remarks
section of the ACR.
INFECTION CONTROL, SHARPS, AND BIOHAZARDS
The Paramedic shall always practice universal precautions. Sharps should always be disposed
into a sharps container.
See also the most current local ambulance service Health and Safety Guidelines.
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CONTROLLED SUBSTANCES
Records
The Service Operator is responsible for ensuring accuracy and accountability of records
pertaining to the procurement, storage, disbursement and administration of controlled
substances in the pre-hospital and interfacility settings by paramedics. The records will be
forwarded to the Base Hospital in a format and in a time period approved by the Base Hospital.
These records will include:
ƒ Date & Time of Shift
ƒ The # of Vials of controlled substance in the cabinet at beginning of shift.
ƒ The name, OASIS, and signature of the medic and the witness when removing the vials for
use.
ƒ The date, run number, amount and patient name for each call where the controlled
substance was used.
ƒ The number of vials used and/or broken on each shift.
ƒ The number of vials added to the station cabinet during the shift.
ƒ The count in the cupboard at the end of the shift.
ƒ The name, OASIS, and signature of the medic and the witness when returning the vials.
Procurement
The Base Hospital Medical Director will provide a prescription for controlled substances to an
approved pharmacy or supplier at the request of a Service Operator providing that the service
operator has agreed to properly store, distribute, record and report on these substances. The
amounts of substances prescribed will be based on patterns of use or expected use. The
Service Operator will ensure that only authorized personnel have access to these substances
and that all acquisitions and transfers of substances are accurately documented and witnessed.
Storage
The Controlled substances will be stored in a double locked cabinet as approved by the Base
Hospital. Access to this cabinet will be restricted to persons authorized to carry or distribute
these substances.
Carried by Paramedic
Paramedics will ensure that controlled substances removed from the double-locked cabinet are
carried on their person or double locked in an approved vehicle storage cabinet. The amounts
carried by paramedics will be approved by the Base Hospital and based on expected use for
one shift. All controlled substances will be returned to the Service Operator storage cabinet
when the paramedic has completed his shift. Paramedics will not carry controlled substances
while off-duty.
Reporting Loss or Theft of Controlled Substance
The Service Operator will contact and file a police report with the local Regional Police
Services. The Service Operator will contact the Base Hospital. The Base Hospital Medical
Director is responsible to file a “Loss or Theft Report Form” directly with Health Canada.
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Policy
Defibrillation Issues
Date:
Pages:
Section:
January 2002
2
General
DEFIBRILLATION IN MOVING VEHICLE
While en-route to hospital, if defibrillation is indicated it should be performed. If in the opinion of the Paramedic, this
would risk injury to the crew, pull over and stop the vehicle when safe to do so and defibrillate as per protocol. If in doubt
as to whether delaying transport and stopping to perform defibrillation en-route is appropriate, contact the BHP. The
vehicle must be in a stationary position when analysing a patient's rhythm using a semi-automatic defibrillator.
BIPHASIC DEFIBRILLATION
The use of biphasic defibrillators is permissible in the prehospital setting with prior written approval of the Base
Hospital Medical Director. The manufacturer and type of defibrillator will determine the energy setting. The number
of shocks, and related protocols will not change, except for the energy setting.
If a Paramedic encounters a patient where shocks have been delivered prior to crew arrival with a biphasic
defibrillator, the Paramedic is expected to deliver all subsequent shocks at 360J as indicated by the patient’s rhythm.
The Paramedic will apply their monitor/defibrillator to the patient and take over patient care during the CPR phase of
patient care.
Include the number of shocks delivered prior to your arrival in determining how many more shocks you are authorized
to deliver. Remember the shock protocol is complete once 9 shocks have been delivered unless further orders are
received from the Base Hospital Physician.
The number of times in a row that a no shock advised message is given prior to your arrival should also be
considered when assessing the patient for further treatment. The no shock protocol is complete once 3 consecutive
no shock advised messages have been received.
DEFIBRILLATION IN PREGNANT VSA PATIENTS
There is no change in protocol. Proceed as per protocol for the adult VSA patient.
DEFIBRILLATION OF PATIENTS WITH A PACEMAKER OR INTERNAL DEFIBRILLATOR
There is no change in protocol for these patients. Avoid putting defib paddles/pads near the implanted device.
Note: If the internal defibrillator and/or pacemaker is firing, and the patient is VSA an organized complex may be visible
on the monitor. A semi-automated defibrillator may interpret pacemaker spikes or defibrillations as organized and will not
shock the patient.
DEFIBRILLATION OF PATIENTS IN WET CONDITIONS
Safety is the greatest consideration. Move the patient to a dry area if possible in a short period of time. Do not forget to
dry the patient’s chest.
DEFIBRILLATION OF PATIENTS ON A METAL SURFACE
Do not defibrillate patients lying on a metal surface. Move the patient to a safe area where the metal surface is no longer
under either the patient or the rescuer. Consider isolating the patient using a backboard, if appropriate.
DEFIBRILLATION OF PATIENTS WITH NITROPATCHES
There have been reports of nitro patches flaring up after coming into contact with high voltage defibrillation paddles
during emergency resuscitation.
Responders should remove medication patches from the chest before attempting resuscitation.
TRANSFER OF RESPONSIBILITY AT THE SCENE - FIREFIGHTER DEFIBRILLATION
Firefighters are responsible for patient care until Paramedics are present on the scene. Once on the
scene, the Paramedics are the senior medical authority and assume overall responsibility for patient care
and transportation. Patient care will continue to be delivered by both agencies.
TRANSFER OF RESPONSIBILITY AT THE SCENE – PUBLIC ACCESS DEFIBRILLATION
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Once on the scene, the Paramedics are the senior medical authority and assume overall responsibility for
patient care and transportation. Shocks delivered by a person other than trained responders are not
considered (counted) in the protocols for defibrillation. Paramedics cannot delegate further defibrillations
to the operator of a PAD.
LOCAL GUIDELINE FOR OBVIOUSLY DEAD PATIENTS
This guideline is an addendum to the Ministry of Health, EHS Manual of Operational Policy and Procedure,
Section 4.4 - Vital Signs Absent Patient (Approved May 30, 1994).
When responding to a call where the patient is vital signs absent, the crew should carefully and jointly
assess the condition of the patient and the circumstances surrounding the call. If the patient is found to be
obviously dead on your initial survey and assessment, it is not necessary to attach the cardiac monitor. The
criteria for obvious death are as follows:
i. Decapitation
ii. Transection
iii. Decomposition/putrefaction
iv. Gross rigor mortis
v. Gross charring
vi. Gross protrusion of cranial or visceral contents.
If the patient is obviously dead it is not necessary to contact the Base Hospital Physician.
In cases of obvious death with suspicious circumstances take care to preserve the scene as found.
LOCAL POLICY FOR DNR PATIENTS
This policy is an addendum to the Ministry of Health, EHS Manual of Operational Policy and Procedure,
Section 4.4 - Vital Signs Absent Patient (Approved May 30, 1994) and Section 4.0 – Arrival at Scene: 4.6
Inter-Facility Do Not Resuscitate Orders (Revised Jan. 25/99).
In some instances, Paramedics encounter patients who were expected to die (e.g. history of terminal
cancer or terminal illness) but who are not obviously or legally dead as described under the Ambulance
Act or the Ministry VSA Patient Policy. Some of these patients may have a written Do Not Resuscitate
(DNR) order. Others may not have a written order but may have made their wishes known to family
members.
There are currently no Ministry of Health Policies that would allow Paramedics to cease resuscitations in the
prehospital setting based on a DNR order. In these situations, all resuscitation measures for which the
Paramedic is certified should be initiated, including advanced care procedures.
It is permissible in these circumstances for Paramedics (ACP and PCP) to contact a BHP to consider field
pronouncement. If there is a delay in contacting the BHP or the BHP cannot be reached proceed with the
established protocols.
FIELD PRONOUNCEMENT OF DEATH
BHPs may exercise their medical judgement and pronounce death over the radio where the assessment
findings reported are satisfactory to them and they feel they can confidently pronounce death. If there is any
question surrounding the viability of the patient then the crew will be advised to resuscitate and transport to
the nearest receiving facility.
Once death has been pronounced, the body should not be transported by ambulance unless in a public
place and authorized to do so by CACC.
Note: Field pronouncement is not required if the patient is obviously dead as per the Ambulance Act and
the Ministry of Health Policy on Vital Signs Absent Patients.
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Policy
Transfer of Care
Date:
Pages
Section:
January 2002
3
General
INTERACTION WITH A MEDICAL DOCTOR ON SCENE
Paramedics should advise the on-scene physician that they cannot take orders from any M.D. other than the
Base Hospital Physician for controlled medical acts. If the on-scene M.D. does not wish to intervene, the
crew will follow established protocol. If the on-scene M.D. does wish to intervene, the crew should confirm
that the physician is a medical doctor licensed to practice in Ontario.
In the event that the on-scene physician intervenes, he should accompany the patient to the hospital in the
ambulance. If the physician refuses, ask him/her to sign the ACR.
In the event that an on-scene physician has pronounced death at the scene, the crew is to notify the Base
Hospital and clear the scene only after discussion with the Base Hospital Physician.
The on-scene physician's name must be documented on the ACR.
INTERACTION WITH A REGISTERED NURSE (R.N.) ON SCENE
Where an R.N. bystander is on scene and willing to assist with patient care, the R.N. may be permitted to do
so at the discretion of the Paramedics on scene. The Paramedics on scene are the senior medical
authority. An R.N. is not authorized to delegate an ACP procedure to Paramedics.
RESPONSIBILITIES WHEN WORKING WITH MIDWIVES
As of December 31, 1993, Midwives have become a registered health profession in Ontario (Midwifery Act).
Midwives now have the same status as a primary care giver for pregnant women, that a physician has for
their patients.
The ambulance system can expect to encounter and interact with midwives only in those circumstances
where an unexpected difficulty arises with a pregnancy or a birth in a home or birthing centre setting. A
registered midwife can easily be identified by a photo-identification card that is provided by the College of
Midwives.
When arriving upon a scene with a Midwife in attendance, Paramedics and Midwives will work cooperatively in making decisions and providing quality patient care to the mother and neonate at the scene
and enroute to hospital. A midwife is not authorized to delegate a controlled medical act to a
Paramedic. The name of the midwife must be documented on the ACR.
INTERACTION WITH AND RELEASING FIRE DEPARTMENT PERSONNEL FROM MEDICAL
ASSISTANCE CALLS
At the scene of a Medical Assistance Call where the ambulance is not on the scene Fire Department
Personnel will provide patient care within the limits of their training and skills. Upon arrival of the
Ambulance, Fire Department Personnel will give the Paramedics a thorough briefing, including incident
history, medical history, and treatment provided. Responsibility for care of the patient will then be
transferred to the attending Paramedic. Fire Department Personnel may assist in patient care, i.e. CPR,
extrications, multiple patient incidents, defibrillation protocol in progress, etc.
After patient assessment, the attending Paramedic will make a determination on the need for continued
assistance by fire department personnel at the scene and/or enroute to hospital. The attending
Paramedic will discuss the need for continued assistance with the Fire Department Officer. If the
Paramedic requests further assistance and the fire Department Officer is unable to accompany, then the
Paramedic should document this on the ACR and advise the Base Hospital office.
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INTERACTION WITH PRIVATE CONTRACTED PARAMEDICS & LAY RESPONDER HEALTH CARE
PROVIDERS
The following guidelines are to be applied when a Paramedic Crew encounters a privately contracted
Paramedic or a lay responder health care provider (initial responder) who has begun patient care prior to
the arrival of the Paramedic Crew. This situation is likely to become more frequent with the growth in
Public Access Defibrillation programs and the private contracting of EMS agencies to service special
community events.
Transfer of care will need to be determined on a case-by-case basis according to the level of medical
care required. The level of medical care will be identified by the sophistication of the medical
equipment/treatment that the initial responder is using on a particular call. (For example, a responder who
is using an endotracheal tube and administering intravenous medications is considered to be delivering a
higher level of medical care than a primary care Paramedic).
If the initial responder is delivering a level of medical care that is either below or equal to that provided
by the transporting Ambulance Paramedics, the Paramedics will assume patient care.
If the level of care being delivered by the initial responder is above that of the transporting Paramedics
and the two following conditions are met:
a) The transporting Paramedic deems that the patient requires other advanced life support measures
beyond his/her scope of practice, AND
b) The initial responder has the equipment and skills necessary to provide that care,
The initial responder must continue to attend to the patient using all available equipment and supplies to
deliver care to the patient during transport. The initial responder will ride in the back of the ambulance
during transport with the attending Paramedic as an assistant. The Paramedic should provide assistance
within his/her scope of practice.
If the transporting Ambulance Paramedic crew acts in a supportive role, brief medical information must be
obtained from the initial responder. The information obtained must be similar to that recorded during an
interhospital transfer. At a minimum it must include: patient identification, brief history of the present
illness, medications administered and allergies, a brief description of the procedures performed and
medications administered by the initial provider. This information must be recorded on the ACR. All
actions taken by the Ambulance Paramedic must be recorded. The initial responder must complete a
separate report. The ACR and the responder's report must be forwarded to the Base Hospital office.
If no further advanced life support measures are felt to be required and patient care is transferred to the
Ambulance Paramedic crew, a full history, physical examination and appropriate treatment as per current
Paramedic protocols must be done. (Any medications administered by the initial responder should be
treated, by the ambulance crew, as if the patient had self-administered his/her own medications).
Any occurrence where an Ambulance Paramedic feels that the initial responder should have attended to
the patient during transport but refuses to do so must be reported to the Base Hospital. The Ambulance
Paramedic must attend to the patient according to their scope of practice and must document the incident
on the ACR.
If a lay responder or private service Paramedic responder arrives after the Ambulance Crew and the
patient requires care beyond the scope of the transporting Ambulance Paramedics, care of the patient
may be assumed by the responder if the responder has the equipment and skills necessary to provide the
required care. The Ambulance crew should act during transport in a supportive role according to their
scope of practice. Appropriate documentation must be included on the ACR.
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RESPONSIBILITY FOR CARE ON INTERFACILITY TRANSFERS
When transferring a patient from one hospital to another, it is the sending hospital that is responsible for
the patient’s care until the patient arrives at the receiving hospital. The hospital may choose to send an
escort with the patient, or turn over care of that patient to the Paramedic. The hospital may also elect to
send an escort to care for the patient while waiting at the treating hospital, but may wish the patient to be
cared for by Paramedics while enroute.
The Paramedics must clearly establish before leaving a sending facility who is responsible for patient
care while enroute to another facility. If the Paramedics are responsible for patient care than an initial
assessment, including vital signs, should be performed prior to leaving the facility. The ACR
documentation must show the findings of that assessment and vital signs, or indicate that the escort was
responsible for patient care.
Paramedics may, on request, assist an escort in administering patient care, but an escort cannot
delegate orders for medical acts to a Paramedic.
SPLIT CREW CONFIGURATION
In all patient care, the higher level Paramedic has responsibility for the care of the patient. He/she may
choose to assign aspects of care and procedures to the lower level Paramedic within their skill set. The
highest level of Paramedic is responsible for the decision on the level of care required during transport.
The lower level Paramedic is responsible to alert the higher level Paramedic of any change in patient
status.
A patient who is assigned a CTAS level 1 should be attended by the highest level of certified Paramedic
available. CTAS 2 patients should also be treated by the higher level of certification, unless extenuating
circumstances exist, which should be clearly documented on the ACR.
TRANSFER OF CARE BETWEEN PARAMEDICS PCP
ACP
In the event of more than one ambulance crew at a scene, the highest level of Paramedic shall assess
the patient and make a decision on the level of care required and the Paramedic level to be responsible
for the patient. The highest level of Paramedic is the ultimate authority on the scene. If there is any
disagreement between the Paramedics the Base Hospital physician can be contacted. It is expected that
when a level of Advanced Life Support intervention has been provided, that level of Advanced Life
Support will remain with the patient.
TRANSFER OF CARE BETWEEN PARAMEDICS ACP
ACP
This policy concerns situations where an Advanced Care Paramedic, operating in a first response role
elects to transfer care to another Advanced Care Paramedic. Transfer of responsibility would only occur
after consultation with the responding crew with the following conditions:
• All the pertinent patient information is obtained and a report is given to the responding crew.
• Both Advanced Care Paramedics are comfortable with the passing of responsibility onto the
responding crew. If either Advanced Care Paramedic is uncomfortable in transfer of responsibility,
then the initiating Advanced Care Paramedic will accompany the patient and appropriate vehicle
staffing will take place.
• In cases where extensive resuscitation or treatment has been performed then the Advanced Care
Paramedic initiating treatment must remain with the patient.
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Appendix A
PQoCC Terms of Reference
Date:
November 2000
Pages:
Section:
3
Appendix
PRE-HOSPITAL QUALITY OF CARE COMMITTEE (PQOCC)
TERMS OF REFERENCE
OBJECTIVES:
The purpose of this committee is to review and critically appraise practices and procedures used in the
Hamilton and Affiliate EMS system in order to facilitate the following:
A.
B.
C.
Maintenance and/or enhancement of current strengths.
Improvements in identified areas of weakness.
Planning for future changes in local EMS system delivery
COMPOSITION:
The composition is based on the key individuals or agencies that affect the level of care provided to the
pre-hospital patient and to other stakeholders.
Chair
Secretary
=
=
Base Hospital Medical Director
Base Hospital Program Assistant
CONSUMERS OF SERVICE:
Member of the public
DHC Representative
Regional Government
Member of Health and Social Services Committee
Receiving Hospital Emergency Department
Director Representative
PROVIDERS OF SERVICE:
-
August 2008
M.O.H., EHS&LTC Regional Manager
EHS&LTC, Regional Service Training Instructor
Base Hospital
Clinical Coordinator
Clinical Program Manager(s)
Ambulance & Emergency Services, Service Operator or Delegate
CACC Manager
ACP Provider
PCP Provider
Fire Department Representative(s)
Regional Trauma Program Director
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PQOCC REPORTING RESPONSIBILITIES:
The reporting responsibilities of the committee are as depicted below:
DHC
H&SS
REGIONAL EHS
PQoCC
Tiered Response
Committee
CACC Management
Committee
FREQUENCY OF MEETINGS:
The PQoCC will meet four times annually, during September, December, March and June, or more
frequently as required at the call of the chair.
Task Forces may be formed and will meet as required.
To assist the committee in its work, the following reports should be forwarded to the secretary 6 weeks
before the meeting, along with suggested agenda items. Once compiled, an agenda will be mailed out 3
weeks before the meeting. Committee members will have an opportunity to review the summaries prior
to the meeting and come with ideas on how to assist in developing plans for system improvement.
Summary reports will include but will not be limited to the following (attempt to contain each summary to
less than one page):
MOH, EHS&LTC Regional Manager:
Changes potentially affecting patient care
EHS, Regional Services Training Co-ordinator:
Report on training.
Base Hospital:
Statistical summary and comparison with previous summaries/years
(including times, patient distribution, care rendered, types, etc.)
Chart Audit and Review Summaries
Research Reports
QA Activity Report
ACP & PCP CME Report
ACP & PCP Certification Report
Tiered Response Report
Call/Event of Major Concern/Benefit
Ambulance Service Operators:
Report on staffing/operational issues
Report on service related complaints/praise
Call/Event of Major Concern/Benefit
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ACP Provider:
Report on patient care issues
PCP Provider
Report on patient care issues
Fire Department Report from Tiered response Committee
Report on service and training
CACC Manager:
report on operational issues
Call/Event of Major Concern/Benefit
PQoCC System Evaluation – Methods:
Analysis of quality of care will be undertaken by the committee with consideration for the following:
1.
2.
3.
4.
Analysis of Time Factors:
a)
Recognition of an Emergency
b)
Call to 911
c)
911 Operator
d)
CACC Call Taker
e)
CACC Dispatch – Fire Dispatch – Police Dispatch
Send ACP / PCP - Send Fire Unit - Send Police
f)
Time to Patient
g)
Time at Scene
h)
Time to Hospital
i)
Time to Transfer to Definitive Care
Analysis of Call Factors:
a)
Call Type
Target resource and Training Requirements
b)
Call Location
Deployment of Resources
c)
Call Time
Scheduling
Analysis of Care Factors:
a)
Training of Protocols, Skills, Techniques
Frequency & Method of Review
b)
Patient Care
Appropriate
Consistent
Timely
Compassionate
Cost-effective
Influence Outcome
Management Factors:
a)
Clinical Supervision
On-line, First Response, Patrol
b)
Call Review
Compliance with protocols and guidelines from time of 911 call to patient arrival at
destination
c)
Effectiveness of workload management
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Appendix B
Certification Documents
Date:
January 2002
Pages:
Section:
4
Appendix
HAMILTON HEALTH SCIENCES
BASE HOSPITAL PROGRAM
CONFIDENTIALITY OATH
The Hamilton Health Sciences Paramedic Base Hospital Program has a legal and ethical responsibility to
safeguard the privacy of all patients and their families. This policy establishes our obligations to ensure
that confidentiality is maintained.
As a Paramedic certified under the Hamilton Health Sciences Paramedic Base Hospital Program, all
clinical, health related, personal, social and/or psychological information concerning patients and their
families must be held in strictest confidence. Paramedics may only divulge, obtain and/or use
confidential information as needed by them to perform their legitimate duties. Disclosure, misuse or
failure to safeguard confidential information is subject to severe disciplinary action up to and including decertification.
I acknowledge that I have read & understand the Hamilton Health Sciences Paramedic Base Hospital
Program Confidentiality Oath and that I will abide by this Oath.
_________________________
Signature
_______________________
Date
__________________________
Print Name
_______________________
Oasis Number
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HAMILTON HEALTH SCIENCES
BASE HOSPITAL PROGRAM
CERTIFICATION RESPONSIBILITIES
As a paramedic, you must be familiar with the following standards, policies, and guidelines. Please
indicate that you will assume professional responsibility for the following:
1.
Hamilton Health Sciences Base Hospital Program Confidentiality Policy
I have read, understand and agree to abide by the HHS Paramedic Base Hospital Program
Confidentiality Policy.
2.
Certification Status Change Policy
I agree that if my certification status changes (deactivation or decertification) at any other Base
Hospital, I will inform this Base Hospital within 48 hours. I understand that failure to do so may
result in an implication to my certification with this Base Hospital.
3.
Patient Care Standards and Local Protocols
I have received and reviewed the following standards, policies, and protocols and will abide by
these standards:
•
•
•
•
•
4.
Provincial BLS Standards
Provincial ALS Standards
Provincial Conduct Directives
HHS BH Program Primary Care Medical Protocols and Standards of Practice
HHS BH Program Advanced Care Medical Protocols and Standards of Practice
Certification Policies
I have received and reviewed the certification policies below and will abide by these standards. I
understand that it is my responsibility to inform the BH if there is any interruption in my delivery of
acute medical care for greater than or equal to 3 months (eg: administrative duties, leave of
absence, etc) prior to returning to those duties. It is also my responsibility to inform the Base
Hospital when I leave employment with an ambulance service in the BH coverage area.
•
•
Provincial Maintenance of Certification Policy
HHS Base Hospital Program Certification Policy
___________________________________
Signature
_______________________________
Date
___________________________________
Print Name
_______________________________
Oasis Number
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HAMILTON HEALTH SCIENCES
BASE HOSPITAL PROGRAM
REQUEST FOR CERTIFICATION
Thank you for applying for certification with the Hamilton Health Sciences Base Hospital Program. Please provide us
with the following information. Attach supporting documentation or additional information where required. After we
have received all documentation, you will be contacted regarding Base Hospital evaluation, orientation, and
certification.
Have you received an offer of employment or are currently employed by an Ambulance Service in our area?
Yes No If yes, please list Ambulance Service(s): ______________________________
Please Indicate Certification Level requesting:
Name
Address
___________________________
___________________________
SR/Defibrillation
ACP
CCP
Oasis number: _____________________
e-mail address: _____________________
___________________________
Contact Numbers:
Home: ______________
Education
EMCA
Advanced EMCA
Community College AEC Course
ACP Program
CCP Program
Mobile: _______________
Pager: _____________
Name of Institution/Program
Year completed
_______________________
_____________
_______________________
_____________
_______________________
_____________
_______________________
_____________
_______________________
_____________
Attach applicable education documentation for the above and recent CPR/BCLS, ACLS, BTLS, etc.
Certification
Symptom Relief
Semi-Automatic External Defibrillation
Advanced Care Paramedic
Critical Care Paramedic
Date of Initial
Certification
_____________
_____________
_____________
_____________
Date of most recent successful
Re-certification and Name of BH
___________________________
___________________________
___________________________
___________________________
Certification Status Declaration
1. Have you ever been decertified in any of your skills as a paramedic?
Yes
No
2. Have you been deactivated in any of your skills as a paramedic in the previous 3 years?
Yes
No
3. Are there any other incidents involving patient care concerns that are currently being investigated or have resulted
in termination of employment?
Yes
No
If you have indicated “yes” to any of the above questions please list each instance including details and resolution on
a separate sheet.
I confirm that the above information is complete and correct and give permission for the information to be
verified.
Name _____________________ Signature ____________________ Date _________________
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HAMILTON HEALTH SCIENCES
PARAMEDIC BASE HOSPITAL PROGRAM
REQUEST FOR CERTIFICATION
Legend
Skills Check List
Please complete this self-assessment as it refers to the
last 12 months using one initial from the Legend.
C = Performed in a clinical or field setting (last year)
S = Performed in a simulated setting only (last year)
A = Performed in past but not in last year
N = Not familiar with or academic knowledge only
Procedures:
Semi Automatic Defibrillation
Establishing Intraosseous Access
Manual Defibrillation
Endotracheal Intubation
Synchronized Cardioversion
Blind Nasotracheal Intubation
Transcutaneous Pacing
Needle Cricothyroidotomy
Establishing Intravenous Access
Pleural Decompression/Needle Thoracostomy
Please indicate the make/type of defibrillator(s) you are familiar with:
___________________________________________________
Medication Administration Routes/Procedures
Sublingual
Subcutaneous
Rectal
Oral
Capillary Glucose test
Aerosol
Intra-Muscular
Intravenous
Symptom Relief Medications Administration
Salbutamol
Glucagon
Epinephrine (1:1000)
Nitroglycrerine
Oral Glucose
ASA
ACP Medications
Adenosine
Diazepam
Furosemide
Midazolam
Atropine
Dopamine
Lidocaine (spray)
Morphine
Benadryl
Epinephrine (1:10,000)
Lidocaine (bolus)
Naloxone
D50W
Fentanyl
Lidocaine (infusion)
Sodium Bicarbonate
Neosynephrine spray or equivalent Nasal vasoconstrictor spray
I confirm that the above information is complete and correct and give permission for the
information to be verified.
Name _____________________ Signature ____________________ Date _________________
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A copy of this form will be kept on file at the Base Hospital as confidential information.
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Appendix C
Defibrillator Maintenance Record
Date:
April 2002
Pages:
Section:
1
Appendix
Defibrillator Quarterly Report
Serial Number: __________________ Type of Defibrillator: ______________________
Any concerns or malfunctions noted during a daily check?
[ ] Yes
[ ] No
If yes, please list concerns/malfunctions:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________
Biomed Testing
When Biomed performed regular testing please state any problems noted:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_____________________________________________
Service Required
If service was required any time during this quarter please provide a copy of the service report attached
to this report.
Date:
_____________________________
Service:
________________________________
Name (please print): ___________________________
Signature:
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Appendix D
Glucometer Daily Check Record
Date:
April 2002
Pages:
Section:
1
Appendix
Glucometer Quarterly Report
Serial Number: _______________
Type
of
Glucometer:
_______________
Did any daily check result in an ‘out of range’ reading?
[ ] Yes
[ ] No
If yes, please list date and reading recorded:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________
Were any other problems noted with this glucometer at this time?
[ ] Yes
[ ] No
If yes, please specify problem:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________
Resolution:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________
___________________________________________________________________________________
_________
Date:
_____________________________
Service:
________________________________
Name (please print): ___________________________
Signature:
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