In this issue

• Leading the Way: A Video Message for You from Your Medical Director
• The Unexpected Consequences of Epinephrine in BHP Corner
• Side Hustle: How about a part-time gig with RPPEO?! In Announcements
• The Missed Opportunity: How Paramedics Can Influence Patient Outcomes in Quality & Patient Safety
• Discharge Risks: A Comprehensive Guide for Paramedics in A Window on Care
• The Game-Changers: The Latest Medical Advisories You Can't Afford to Miss
• Are YOU Authorized for Patient Discharge? in Continuing Education

The Ontario Base Hospital Group Education Subcommittee (OBHG ESC) has released its Companion Document for the Advanced Life Support Patient Care Standards version 5.1. 

The Companion Document is an educational tool that helps to provide clarification on changes and updates to the Advanced Life Support Patient Care Standards.

Medical Directives Page

In cases of cardiac arrest where a patient’s wishes are for do not resuscitate (DNR) but no Ministry of Health DNR Confirmation Form is available, paramedics should consider patching to a Base Hospital Physician (BHP) to consult on the appropriateness of withholding further resuscitation.

Paramedics should read Medical Advisory 2023-03 on Acceptance of Verbal or Written Do Not Resuscitate Requests. Paramedics may also view the video message from RPPEO Associate Medical Director Dr. Mark Froats that supports this Medical Advisory. Contact the RPPEO at info@RPPEO.ca should you have any questions or concerns.

The Regional Paramedic Program for Eastern Ontario today rescinded Medical Advisory 2023-02 entitled, "DimenHYDRINATE (Gravol) for Patients 65 and Older."

Paramedics should now follow guidance provided by the Ministry of Health on consideration and use of dimenHYDRINATE when ondansetron is not available.

On April 3, 2023, the Ontario Ministry of Health issued a memorandum to paramedic services providing guidance on the use of dimenHYDRINATE (Gravol) for patients who are 65 years old or older when ondansetron is not available. This memo supersedes the RPPEO guidance, therefore we have rescinded MA-2023-02.

On April 12, 2023, the RPPEO distributed via email a Memorandum called, "Rescinding Medical Advisory on DimenHYDRINATE (Gravol) for Patients 65 and Older," to all RPPEO-certified paramedics.

Given the direction provided by the Ministry of Health, patching is optional for administration of dimenHYDRINATE in the identified senior population. RPPEO paramedics are encouraged to consult with a Base Hospital Physician when you are considering dimenHYDRINATE for patients 65 years of age or older, or in any situation where you would like to discuss the relative risks and benefits of medication.

For your convenience, the rescinded RPPEO-issued Medical Advisory 2023-02 from February 16, 2023, will remain available on the RPPEO site for information.

Should you have any questions or concerns, please contact info@RPPEO.ca.

RPPEO_Memo_re_Rescinding_Medical_Advisory_on_DimenHYDRINATE_Gravol_for_Patients_65_and_Older_20230412.pdf

The Regional Paramedic Program for Eastern Ontario is pleased to announce that every paramedic in the RPPEO region is now using the RPPEO’s Online Medical Consultation (OMC) service for all patch consultations with our dedicated group of base hospital physicians (BHP).

As of March 27, 2023, all paramedics in the RPPEO region calling for a patch or consultation will be talking with a dedicated, select group of specially-trained emergency BHP experts. These BHPs are not situated in a busy emergency room. Instead, they are on-duty with OMC and eagerly awaiting calls from paramedics!

Now, when paramedics from Hastings-Quinte, Lennox & Addington, Frontenac, and Leeds-Grenville call for patch and consultation, they will no longer reach the Emergency Department of Kingston Health Sciences Centre. Instead, these calls are now directed to base hospital physicians staffing the OMC service. 

The transition happened seamlessly behind the scenes on Monday March 27 in the morning.

There is no disruption to patching services so long as paramedics continue to use the established 1-800 primary patch telephone number.

The Regional Paramedic Program for Eastern Ontario is pleased to launch Spring 2023 CME's online learning component on Monday, March 27, 2023.

In Spring 2023 CME, RPPEO presents "Discharge from Care," provincially developed training about out of hospital treat and discharge. This is the training that paramedics require to receive authorization to apply the new auxiliary medical directive options in the Advanced Life Support Patient Care Standards (ALS PCS) version 5.1 for patient discharge planning.

Spring 2023 CME will be conducted in a hybrid learning environment. The prerequisite didactic content will be available in MedicLEARN beginning on March 27, 2023.

Each paramedic will be scheduled for a subsequent four-hours of in-class learning with an RPPEO Facilitator. For more information on your class time, please refer to your paramedic service.

"Discharge from Care” is a learning package developed by the Ontario Base Hospital Education Subcommittee for the entire province. RPPEO is providing this package as well as additional learning supports for discharge planning in Spring 2023 CME.

Your paramedic services have all agreed to provide this mandatory hybrid training for all PCP and ACP in the Spring session. That means that Fall CME this year only will be focused on ACP learning.

The BLS Patient Care Standards are the Ministry of Health and Long-Term Care expectations with respect to how paramedics will interact with their patients.

Go to Medical Directives

In this issue

• BHP Corner Talks Pearls and Pitfalls of Discharge
• Risk in Non-transport: It’s Manageable in Quality & Safety
• No Surprises as we Announce the Focus of Spring 2023 CME for ACPs… and PCPs
• Documenting Safety for Vulnerable Patients in A Window on Care
• RPPEO is Hiring! In Announcements

Ondansetron (Zofran) is the preferred medication over dimenHYDRINATE (Gravol) to treat nausea / vomiting in patients 65 and older. Paramedics can consult (patch) a Base Hospital Physician (BHP) if they believe an antiemetic is indicated for patients 65 and older and ondansetron is not available.

Paramedics should read Medical Advisory DimenHYDRINATE (Gravol) for Patients 65 and Older. If you have any questions, please contact quality@RPPEO.ca.

Effective February 9, 2023, the Ontario Base Hospital Group’s Memo, “Considerations for Paramedics Managing Patients during the COVID-19 Pandemic COVID-19” is repealed. Consult the OBHG February 9, 2023, Memorandum for more information. 

Paramedics should now refer to the patient care standards as presented in the Advanced Life Support Patient Care Standards (ALS PCS) and any provincial, regional or local guidance issued by the Ministry of Health, the RPPEO or your paramedic service.  

As SARS-CoV-2 becomes endemic, our health care system is integrating care of COVID-19 patients into regular operations. Paramedics are familiar with response to infectious disease and will continue to provide appropriate care to patients with possible or confirmed COVID-19 using the standards and pathways developed for these purposes. 

The Auxiliary Medical Directive, “Assessment of Patients with Possible COVID-19,” available for both PCP and ACP, remains an applicable option for those who are authorized in its use. 

RPPEO has removed COVID-specific clinical guidance from our available resources. 

COVID-19_Considerations_update_2023_02_09.pdf