Spring 2007 CMEPowerPoint Presentations Craig Williams Training/Quality Supervisor
Spring 2007 CME • Dates: May 4,7,8,9,11,22,23,24,28,29,30,31 June 1,4,5,6,8,12,18,19,20 • Location: Circled Pine Golf Course, Base Borden, Ontario • Time: 0800 – 1600 hours • During the above mentioned dates, the following training was delivered.
County of Simcoe Paramedics Services Public Access Defibrillator Program • Program explanation • Orientation to Zoll AED Plus • Explanation of Paramedic responsibilities when accepting patient care when a PAD is being used • Explanation of Defibrillation adapter box (Zoll pads to LP12 Defib) • Paramedic Well Being • Discuss types of injuries & how to prevent them Discuss types of emotional stressors on Paramedics & strategies to reduce their effects • Discuss dangerous situations & how to avoid them • Discuss vehicle accidents & how to avoid them
Basic Life Support Patient Care Standards 2.0 • Review updates from BLS 1.1 to BLS 2.0 • Complete BLS review exercise that encouraged Paramedics to reference information from BLS • Incubator Adaptor Deck • Orientation presentation • Reviewed updated strapping techniques • Encouraged use of IAD restraint straps
Management Forum • Provided opportunity for staff to ask questions of Management team • Exposure Prevention • Watched & discussed “Exposure prevention for emergency responders” • Reviewed internal employee exposure procedures
Infection Control • Reviewed C-Diff, MRSA, VRE • Reviewed importance of wearing PPE • Reviewed importance of washing hands regularly • Distributed MOH documents “Best practices for land ambulance Paramedics” and training bulletin “Enteric Diseases” as well as Greg Bruce’s memo • Documentation Standards • Reviewed “ Ambulance Service Documentation Standards” and “Ambulance Call Report Completion Manual” • Allowed for discussion to occur
ACR Snapshots • Displayed 3 well done ACRs and 3 poorly done ACRs and discussed differences • Encouraged good documentation habits • Allowed for discussion to occur
Basic Life Support Patient Care Standards Version 2.0 Agenda • General Layout • Removal of Appendances • General Standard of Care • Medical Patient Categories • Trauma Patient Categories • Environmental-Related Disorders • Obstetrical Conditions • Pediatrics • Geriatrics • Psychiatric Disorders • Presuming death criteria • Exercise
BLS Objectives • Ensure BLS level patient care is preformed in a safe, efficient, appropriate manner • Provides a measure of a protection for patients and Paramedics • Rational basis for Paramedics decision making and judgments • Assist less experienced Paramedics or recent grads
BLS Objectives • Provide fair and objective basis for assessment of Paramedics performance • Identify training and education needs of Paramedics • Provides direction in the development of assessment and testing programs for Paramedics • Provides direction in the development of audit and QA tools • Provides direction and decision making for EHS, operators and other stake holders
Practice & BLS • BLS is the minimum acceptable level of care • A Paramedic may practice at levels higher if … • They are qualified to do so, and, • Such practices is in accordance with their local service polices (Stroke and STEMI Bypass initiatives)
General Layout • Color coded sections • Independent page numbers • Consolidation of some standards
Removal of Appendices • Old = Separate Appendices • Contained policies, patient care guidelines and general information • New = No Appendices • Made into specific standards. Many are located within Section 1 – General Standard of Care • This reduces the need to reference!
General Standard of Care • Provides direction for calls • Not specific to any one condition • New standards • Air ambulance utilization • DNR standard • Intravenous line maintenance • Load and go patient standard • Oxygen therapy standard • Patients with vital signs absent (transportation) • Physician’s orders standards • Police notification standards • Self-administered medication standard • Paramedic conduct standard
Medical Patient Categories • Patients suffering for illness of a medical nature • Medical patient assessment • Defined by chief complaint (i.e., back pain, headache, respiratory arrest) • Each category includes key standard statements, specific condition standards, guidelines where considered appropriate
Trauma Patient Categories • Patients suffering for injuries as a result of trauma • Trauma patient assessment • Defined by chief complaint (i.e. amputation, chest injury and eye injury.) • Each category includes key standard statements, specific condition standards, guidelines where considered appropriate • Hypovolemic shock, sexual assault, eye burns
Environmental-Related Disorders • Lightning Injuries • Pit Viper bite • Stings / Bites-Insect Standard
Obstetrical Conditions • New standards • Trauma in the pregnant patient • Traumatic maternal cardiac arrest • Midwives on the scene standard • Changes with CPR guideline’s for neonatal assessments and management standards
Pediatrics • Changes to child abuse (suspect)
Geriatrics • Elder abuse (suspect)
Psychiatric Disorders • Emotionally disturbed patients – care and transportation standard • Restraint of patients care standard
Presuming Death • Legal Death Legal death only exists when a physician (including a base hospital physician acting through a Paramedic) has pronounced death. • Obvious Death – No physician present Upon completion of a thorough physical assessment and history taking, the Paramedic may “presume” death has occurred if gross signs of death are obvious, i.e. by reason of decapitation, transection, visible decomposing, putrefaction or otherwise Basic Life Support Patient Care Standards – Version 2.0
Obvious Death – “otherwise” Upon completion of a through physical assessment and history taking, the Paramedic may presume that death has occurred in circumstances where the patient exhibits: • Absence of vital signs, and • Obvious signs of death, ie. Grossly charred body; open head or torso wounds with gross outpouring of cranial or visceral contents; gross rigor mortis
Rigor Mortis • Defined as one or more of the following • Limbs and or body stiff; • Coldness and/or posturing of limbs, body; • Lividity (liven mortis); • Complete or partial corneal opacification associated with any of the above:
Presumption of death is based upon knowledge, skills & training in patient assessment and care. Should there be any doubt that death has occurred, every effort must be made to resuscitate the patient.
Ambulance Service Documentation Standards& Ambulance Call Report Completion Manual
Ambulance Service Documentation Standards • Part 1 – General • Written or electronic is acceptable • Retained for 5 years • Completeness and quality • Confidential • Complete ASAP • All parties involved must sign documents
Ambulance Service Documentation Standards • Part 2 – Collision Reporting Requirements • Must be completed when … • Collision between vehicle and any privet or publicly owned vehicle, or • Any person is injured, or • The vehicle collides with and causes damage to vehicle or property, whether stationary or moving.
Ambulance Service Documentation Standards • Cont. Part 2 • What information should be on a report?
Ambulance Service Documentation Standards • Scenario … • Responding code 4 incident involving a pool. You are approaching an intersection and are “cut off” by a driver approaching from the opposite direction. You swerve out of the way and strike a bus stop. • What steps should you take now. • What paperwork needs to be completed.
Ambulance Service Documentation Standards • Part III – Incident reporting Requirements • Must be completed when … • A complaint related to the operator’s service is received • An investigation is carried out by the operator or under the operators authority • At the operator request • There is an unusual occurrence
Ambulance Service Documentation Standards • Cont – Part III • Unusual occurrence include … • Unusual response or service delay • Delay in accessing the patient • Excessive amount of time on scene • After completing a code 5 or 6 call • Suspected or actual criminal circumstances • Equipment deficiencies • Any situation that resulted in harm to the patient, crew member or any other person • Risk or endangerment to the patient, crew member or any other person
Ambulance Service Documentation Standards • Con’t - part III • What else is needed?
Ambulance Service Documentation Standards • Con’t – part III • Examples … • A VSA child • Work pace accident • Call for CP at a residential grow operation • “Near miss” on Highway 400 • Delayed response by train (4 minutes) • Patient stuck in well … unable to assess • Conflict between fire and EMS
Ambulance Service Documentation Standards • Part IV – Patient and Patient care requirements • The patient care provider who has assessed and/or treated the patient is responsible for completing documentation • ACR is required for each ambulance request where a patient was assessed • When more then 1 patient is assessed and ACR should be done for each • In the event of a refusal the appropriate areas of the ACR are to be completed. When a signature can not be obtained from a patient a witness signature should be obtained (when possible)
Ambulance Call Report Completion Manual • Completed for all calls categorized response and or return codes 1 -7 • Must be accurate, legible and complete • ACRs are signed by both Paramedics • ACRs should be completed ASAP after call • Considered confidential • 24 hour clock is always used
Ambulance Call Report Completion Manual • All numbers should be right justified • Use black pen and press hard • A useful maxim is “not documented means not done”
Ambulance Call Report Completion Manual • Questions and Answers
Ambulance Call Report Completion Manual • Are the shaded areas the only necessary areas to fill in on the ACR? • No. All areas are to be considered. If an area in particular is not applicable then you must show consideration by sticking a line through it or writing N/A
Ambulance Call Report Completion Manual • Can the hospital Cardex be stamped in this section? • Yes. Providing it is clearly stamped and includes all the information required including the DOB in the order of year-month-day.
Ambulance Call Report Completion Manual • Do I have to enter the hospital registration number and health card number? • Yes. Whenever possible these two pieces of information need to be included. It helps with the billing process.
Ambulance Call Report Completion Manual • When entering the call type, do I check all the boxes that apply or just the most pertinent box? • You only check the most pertinent box
Ambulance Call Report Completion Manual • When entering the station number, what do I write? Collingwood 783 - 05 Craighurst 783 - 01 Elmvale RRU 733 - 07 Midland 733 - 03 Orillia 733 - 02 Stroud 783 - 04 Wasaga Beach 733 - 04 Washago 733 - 01 Alliston 783 - 06 Angus 783 - 03 Barrie North 783 - 08 Barrie Tiffin 783 - 02 Beeton RRU 783 - 05 Bradford 783 - 07 Coldwater 783 - 06
Ambulance Call Report Completion Manual • When entering the status box, what do I write? • 00 if at base • 77 if mobile • 88 if on standby
Ambulance Call Report Completion Manual • What is the dispatch problem code? • It is the code that you enter that best suits the call type information that dispatch gives you on the air. Remember to use the dispatch only codes when applicable.
Ambulance Call Report Completion Manual • Do I have to explain the special codes if I fill in this section? • Yes. The ACR manual states that future descriptions of special codes should be written in the remarks section.
Ambulance Call Report Completion Manual • Can I enter Transfer or MVA(MVC) in the Chief Complaint area? • Not by itself. This is meant for a description of the call as determined by the crew upon arrival after a MVC or transfer. Always try and determine what the patients top complaint is in their own words.