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Medical Directives

Articles 8
Articles 6


Articles 3

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

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?

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

Articles 5

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

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

Retained Products of Conception and Miscarriage

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

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

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

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

PCP Manual Defibrillation

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

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

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...


Articles 3

PHIPPA and Death

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

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

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

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

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

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 16

Palliative Care Medications

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

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

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

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

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

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

Trauma VSA Transport Times

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

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”?

Rounding Medication Doses

When preparing medication, for example IM Midazolam for a 36kg pt, the 0.2mg/kg dose would be 7.2mg. Using a 5mg/ml concentration that would be 1.44ml volume of medication. Using a 3ml syringe, I would only be able to accurately measure 1.4ml dose. Is it acceptable to round down the dose in this...

Palliative Care Medications

With palliative care directives now becoming a core directive, what is the RPPEOs stance on using these medications for general practice. Examples include: using hydromorphone for pain management for someone who has previous hx of hydromorphone use, ondansetron IV as opposed to SL (we still are o...