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Medical Directives

Analgesia
Articles 8
Bradycardia
Articles 6

Other

Other
Articles 3

If our patient has DKA, should we encourage patient insulin administration?

771
I recently attended a call for a 30 y.o. in DKA. The patients BGL registered as "high", he was exhibiting kussmaul respirations, hypotensive, intermittently bradycardic and GCS 3. We later found out from hospital staff that pts PH was 6.75. I am aware that the treatment plan in hospital was an i...

PCP or ACP - For a CTAS 1 patient who is in the back of ambulance?

579
Hello, In regards to a PCP and ACP working together. If we have a return CTAS 1 patient what is the direction we are being given as to who is in the back. If the PCP is comfortable being in the back and the care the patient is receiving is something within the PCP scope could they be in the back...

Could you please define the TBI contraindication for NSAID administration?

Patient Care

BLS
Articles 5

NPA use in mid-face and/or basal skull fracture patients

820
Is an NPA contraindicated with suspected mid-face or basal skull fracture?

Retained Products of Conception and Miscarriage

743
We had a patient that had a miscarriage this am, she was 3 months gestation. She had started to have vaginal bleeding 4 days ago. She was examined at civic on Saturday, after an ultrasound was informed that there was no heart sounds. My partner informed me that we needed to retrieve the tissues ...

Joint Reduction/Manipulation

726
Would RPPEO consider education on joint reductions/manipulations? Under the BLS, in Extremity Injury Standard (page 125 1. f.) it states, "If adequate circulation/sensation is absent, after splinting and re-manipulation is possible, gentle re-manipulate the extremity to restore neurovascular sta...

May the Canadian C-Spine Rule be applied in patient assessment

708
Just a question in regards to spinal immobilization. Is it still acceptable to apply the Canadian C-spine rule? Or was that just a temporary study and we should now revert to the BLS SMR standard?

Pharmacological Overdose Resources

Broselow tape
Articles 1

Pedi Stat App

732
Just wanting to confirm if the Pedistat app is a recognized resource by the RPPEO i.e. for pt weight, ETT size/depth etc.
Defibrillation
Articles 1

PCP Manual Defibrillation

717
As a PCP in my service for Medical cardiac arrest i am required to utalize the Analyze button on our monitor instead of manual interpretation. When asking my service why they state the BH doesnt want it, when asking at BH CME's im informed my service does not want it. I am slightly confused as to...
Interfacility transfers
Articles 2

Bladder Irrigation During Transfers

Inter-facility transfer of chest tubes

Patient Transport & Disposition
Articles 2

CTAS 1 and STEMI Bypass

784
I wanted to follow up on clarification of STEMI bypass and our CTAS level, in our companion documentation it shows a STEMI should be a CTAS 1 but our guide for bypass says a CTAS 1 is contraindicated and the paramedic cannot secure airway or ventilate. Is this pertaining to you can still go back ...

Trauma Timelines

738
Working for Cornwall SDG, our trauma bypass have amendments extending our transport time from 30 minutes to 60 minutes. In the contraindication for Trauma TOR, it states “patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital < 30 min transport away”. Does this 30...

Professionalism

Consent
Articles 3

PHIPPA and Death

779
I am curious on the PHIPPA guidelines surrounding a deceased patient that may be known to the paramedic's social circle. I appreciate that protecting patients health information is critical during 911 calls, does that change if the patient has died? For example, paramedic responds to a VSA in t...

Sharing of Personal Health Information

753
If a minor has harmed themselves (I.e. ingestion of drugs) what role does the parent or legal guardian have if the pt does not give consent to disclose information? RN at CHEO and PD stated parents MUST be notified. How does PHIPA apply to these situations?

Age of Consent

745
What is the minimum age that a patient needs to be to refuse treatment and transport to hospital?
Documentation
Articles 2

Is continuous normal ECG data required to be documentation on the ACR

817
With rhythm analysis, if the initial one added to the ACR is normal, and throughout the call/transport, if the rhythm remains normal, do you have to continue to upload the ECG to the call to show it continues to be normal, or is the initial rhythm plus documentation it remained normal enough?

AIV Documentation - Concentration

798
I was going over the PCP AIV package. In documentation, it states you have to document the drug concentration as well as dosage and route. In the ACR completion manual (version 3.0 2017), there is no mention of the need to document concentration. Is this an RPPEO requirement?
Paramedic Practice
Articles 18

Heated blankets for hypothermic/trauma patients

834
What is RPPEO's stance on the use of one time use heated blankets, with patients who are either hypothermic, or have suffered multi-system trauma?

Do we need to reassess patients in an MCI?

811
In the case of an MCI where one (or more) patients are VSA, when patients are initially triaged as "black" and do not be the criteria for obviously dead, should resuscitation be attempted if/when enough resources have arrived on scene?

Palliative Care Medications

795
Can you administer palliative medications to a palliative pt. if transport to hospital has been initiated? Does this require a patch? Is this applicable for any/all palliative meds or only select ones? Can you patch to administer palliative meds to a patient on the 911 side who isn't palliative.

Rigor Mortis

766
My question pertains to obvious signs of death, and specifically with respect to rigor mortis of the smaller muscles of the face. I recognize the standard for obvious signs of death as documented by the RPPEO is "gross rigor mortis" ie stiffening of the limbs/body. However, given that the onset...

Flail Chest Management

762
Regarding a flail chest, what is the RPPEO’s preferred treatment? There is conflicting data on whether to splint and do PPV. What is the RPPEO’s stance?

Posterior STEMI Bypass

752
In regards to STEMI protocol and bypass, does it apply to posterior STEMI? The colored coded card in the protocol booklet only shows lateral, inferior, septal, anterior. I understand we would still treat the patient under the cardiac ischemia protocol but as far as rerouting to a STEMI hospital o...

SET Protocol

751
Is SET protocol still the expectation from the RPPEO, why or why not? Should we still have the receiving hospital sign off on tube placement once TOC in the event of a Coroner's inquest? This was part of the protocol along with a c-collar and ETCO2/auscultation with every pt. movement in order to...

Defib Pad Placement

749
Does the RPPEO have a stance with respect to defibrillator pad placement?

Trauma VSA Transport Times

747
Following up on question #738 Trauma Timelines answered on October 16th, Currently in our OPCG Base Hospital app in the Destination Guidelines under Pediatric Bypass, there is a category for "greater than or equal to 16 years old, penetrating trauma VSA, 60 minute bypass to the Civic." This is ...

MAP vs. BP

744
Knowing that monitoring devices, (LP15/Zoll), use oscillometry to accurately detect MAP and not SIBP, have the MOH and BHs made any strides in reviewing and changing all medical directives to reflect MAP as the accurate measure of hypo-perfusion and not “SBP >90mmhg”?
Patch
Articles 2

BHP's Delegating Transport Destination

838
When patching to Base Hospital, can the Physician direct the crew to a specific destination when no bypass agreements/criteria have been met?

Patching to a BHP While Working for a Private Company

830
I'm employed as a PCP within the RPPEO. I work a second job with a private event EMS company with the full scope of practice of a PCP. We have a medical director, but he is not readily available by phone. If I was working a shift at this private company, would I be allowed to call a base hospita...