ALS Advanced Life Support Patient Care Standards

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Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. To all users of this publication, The information contained herein has been carefully compiled and is believed to be accurate at date. of publication Freedom from error however cannot be guaranteed. For further information on,the Advanced Life Support Patient Care Standards. please contact,Ministry of Health and Long Term Care. Emergency Health Services Branch,5700 Yonge Street 6th Floor. Toronto ON M2M 4K5,Phone 416 327 7900,Queen s Printer for Ontario 2015 Fax 416 327 7911.
Advanced Life Support Patient Care Standards Version 3 3. Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. TABLE OF CONTENTS,Introduction,Acknowledgements 1,Level of Paramedics 2. Purpose of Standards 2, Format of the Advanced Life Support Patient Care Standards 3. Use of the Medical Directives by Paramedics 3, Regional Base Hospital Compliance with CPSO Policy 3. General Structure of a Medical Directive 4,ALS Patient Care Standards Paramedic Skill Set 4. Consent to Treatment and Capacity Assessment 5,Refusal of Treatment 6.
Comprehensive Care 7, Intravenous Access and Therapy by Primary Care Paramedics 7. Home Medical Technology and Novel Medications 8,Patching 9. Incident Reporting 9,Controlled Substances 10,Responsibility of Care 10. Research 11,Conventions 11,List of Abbreviations 14. Reference and Educational Notes 17,Table of Appendices 18.
Appendix 1 Primary Care Paramedic Core Medical Directives. Appendix 2 Advanced Care Paramedic Core Medical Directives. Appendix 3 Primary Care Paramedic Auxiliary Medical Directives. Appendix 4 Advanced Care Paramedic Auxiliary Medical Directives. Appendix 5 Chemical Exposure Medical Directives, Appendix 6 Provincial Maintenance of Certification Policy. Advanced Life Support Patient Care Standards Version 3 3 i. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. ADVANCED LIFE SUPPORT PATIENT CARE STANDARDS,ACKNOWLEDGEMENTS. The development of this edition of the Advanced Life Support Patient Care Standards is the result of a. collaborative effort of a number of stakeholders including. Association of Paramedic Chiefs OAPC,Ontario Base Hospital Group OBHG. Ministry of Health and Long Term Care Emergency Health Services Branch MOHLTC EHSB. EHSB Medical Advisory Committee MAC, In particular the Ministry would like to gratefully acknowledge the following members of the MAC and Regional.
Base Hospitals RBH who provided the medical input into these standards. Dr Michael Lewell Chair Dr Jason Prpic Past Chair, Dr Andrew Affleck Mr Andy Benson Chair Education Subcommittee. Mr Chris Day Primary Care Paramedic Rep Dr Richard Dionne. Mr Kyle Grant Advanced Care Paramedic Rep Dr Derek Garniss. Ms Mary Osinga College Rep Dr Bruce Sawadsky,Dr Rudy Vandersluis Dr Richard Verbeek. Dr Michelle Welsford, Advanced Life Support Patient Care Standards Version 3 3 1. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. LEVELS OF PARAMEDICS, In Ontario there are three occupational levels of paramedics Primary Care Paramedic PCP Advanced Care.
Paramedic ACP and Critical Care Paramedic CCP A level of paramedic is specified in Ontario Regulation. 257 00 made under the Ambulance Act RSO 1990 c A 19 Schedules 1 2 and 3 to this regulation specify the. mandatory controlled acts for each level of paramedic. A paramedic may be authorized by a Medical Director of a RBH to perform controlled acts from the Schedule. immediately above their prime occupational level In this circumstance the paramedic will perform the skill to. the specific standard set for the skill This general concept also applies to the performance of all advanced. medical procedures that are not listed as controlled acts in Schedules 1 2 and 3 but which are also specified in. these standards,PURPOSE OF STANDARDS, The purpose of the Advanced Life Support Patient Care Standards ALS PCS is to guide the specifics of patient. care that are to be undertaken consistent with the scope of practice of the three occupational levels of. paramedics,The ALS PCS, Reflects current practices for paramedics in Ontario and provides benchmarks for paramedic performance. Communicates the standards of practice and care by paramedics in Ontario to paramedics patients other. disciplines and the public in general, Delineates paramedic professional responsibilities and accountabilities. Provides a basis for evaluation of patient care practice by Ontario s paramedics. Recognizes that the scope of practice for each occupational level of paramedic may have incremental. add ons with appropriate rationale and accountability. ALS PCS for the three occupational levels of paramedics in Ontario establish the practice and patient care. parameters needed to provide high quality patient care in the varied settings throughout the province The. standards are designed to be dynamic in order to allow for changes based upon new medical evidence and or. standards of medical practice, Advanced Life Support Patient Care Standards Version 3 3 2. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care.
FORMAT OF THE ADVANCED LIFE SUPPORT PATIENT CARE STANDARDS. This document is comprised of an Introduction section and six 6 appendices Appendix 1 PCP Core Medical. Directives Appendix 2 ACP Core Medical Directives Appendix 3 PCP Auxiliary Medical Directives. Appendix 4 ACP Auxiliary Medical Directives Appendix 5 Chemical Exposure Medical Directives and. Appendix 6 Provincial Maintenance of Certification Policy Critical Care Paramedics and Advanced Primary. Care Flight Paramedics will perform controlled acts in accordance with the Base Hospital Medical Directives. issued by the Ornge Base Hospital Physician,USE OF THE MEDICAL DIRECTIVES BY PARAMEDICS. These Medical Directives apply to paramedics who provide patient care under the license and or authority of. the RBH Medical Director Delegation of controlled acts or Medical Directives in the ALS PCS to paramedics falls. under the exclusive oversight of the MOHLTC s RBH Programs. The Medical Directives are designed to guide a paramedic in the provision of timely and appropriate care to ill. and injured patients in the prehospital setting in accordance with the paramedics training and authorized skill. set While great care has been taken in developing these Medical Directives they cannot account for every. clinical situation Thus they are not a substitute for sound clinical judgment. REGIONAL BASE HOSPITAL COMPLIANCE WITH CPSO POLICY. As licensed physicians in the Province of Ontario the RBH Medical Directors must comply with the policies of the. College of Physicians and Surgeons of Ontario CPSO The Delegation of Controlled Acts CPSO policy as may be. amended from time to time provides direction to Ontario physicians on the delegation of controlled acts. regardless of practice setting or type RBHs will also follow a parallel process for delegation of other advanced. medical procedures included in these Standards, Advanced Life Support Patient Care Standards Version 3 3 3. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. GENERAL STRUCTURE OF A MEDICAL DIRECTIVE, All Medical Directives follow the same format and are comprised of the following sections. Indication The general medical complaint or problem to which the medical directive applies. Conditions Clinical parameters that must be present for a procedure to be performed or for a. drug to be administered, Contraindications Clinical parameters that if present preclude the performance of a procedure or.
the administration of a drug, Treatment Description of the type of procedure to be performed or the dosing of a drug. Clinical Considerations Key clinical points that provide general guidance to the proper performance of a. procedure or the administration of a drug, All of these sections must be taken into account before and during the implementation of a Medical Directive. ALS PATIENT CARE STANDARDS PARAMEDIC SKILL SET, The mandatory skill set for each level of paramedic is derived from the controlled acts outlined in Schedules 1 2. and 3 as referenced above and is implemented through the PCP and ACP Medical Directives A paramedic. must meet all applicable requirements set out in Regulation 257 00 to receive delegation from a RBH Medical. Additional Auxiliary skills may be delegated though use of the Auxiliary Medical Directives Delegation of. Auxiliary Medical Directives by a RBH Medical Director to paramedics is optional and may be introduced after. consultation and mutual agreement between the RBH and the certified ambulance service operator that. employs the paramedic Some PCP and ACP Medical Directives contain the phrase if available This phrase. qualifies the skill or procedure as optional i e auxiliary even if included in PCP or ACP Medical Directives. Advanced Life Support Patient Care Standards Version 3 3 4. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. CONSENT TO TREATMENT CAPACITY ASSESSMENT, Except in emergency circumstances described below paramedics must obtain the patient s consent prior to.
initiating treatment Consent may be informed or implied Informed consent may be either verbal or written. Implied consent may be assumed where a person provides a physical indication that they consent to the. treatment For example a patient who cannot speak but extends his hand to a paramedic after the paramedic. indicates she is going to perform a simple procedure such as a blood glucose determination may be giving. implied consent to the procedure, The elements required for consent to treatment are. consent must be given by a person who is capable of giving consent with respect to treatment. consent must relate to the treatment,consent must be informed. consent must be given voluntarily and, consent must not be obtained through misrepresentation or fraud. Consent to treatment is informed if before it is given to the person he or she has. received the following information that a reasonable person in the same circumstances would require in. order to make a decision about the treatment,the nature of the treatment. the expected benefits of the treatment,the material risks of the treatment.
the material side effects of the treatment,alternative courses of action. the likely consequences of not having the treatment and. received responses to his or her requests for additional information about those matters. The paramedic who proposes a treatment to a person shall ensure that consent is obtained Valid consent. requires that a person has the capacity to provide consent A person is presumed to have the capacity to provide. consent with respect to treatment and a paramedic may rely on that presumption However a capacity. assessment may be required if it is not reasonable in the circumstances to presume the person is capable of. consenting to the treatment, Advanced Life Support Patient Care Standards Version 3 3 5. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. A patient is capable with respect to treatment if the patient is. Able to understand the information that is relevant to making a decision about the treatment or. alternatives being proposed and, Able to appreciate the reasonably foreseeable consequences of a decision or lack of decision with. respect to treatment, If a paramedic is aware or is made aware that the person has a prior capable wish with respect to treatment.
they must respect that wish for example if the person does not wish to be resuscitated. If a person is incapable with respect to a treatment consent may be given or refused on his or her behalf by a. person who is authorized to do so under section 20 of the Health Care Consent Act 1996. In some instances a person may present in an emergency situation where the person for whom the treatment is. proposed is apparently experiencing severe suffering or is at risk if the treatment is not administered promptly. of sustaining serious bodily harm, A paramedic may administer treatment to a person without consent in an emergency situation if there is no. other authorized person available to give or refuse consent and in the opinion of the paramedic. the person is not capable of giving a consent or refusal to treatment and. the delay required to obtain a consent or refusal on the person s behalf will prolong the suffering that. the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm. REFUSAL OF TREATMENT, If a patient refuses treatment either in whole or in part a paramedic must comply with the applicable directions. contained in the Basic Life Support Patient Care Standards BLS PCS Section 1 Part I Patient Refusal of. Treatment and or Transport, Advanced Life Support Patient Care Standards Version 3 3 6. Introduction, Emergency Health Services Branch Ontario Ministry of Health and Long Term Care. COMPREHENSIVE CARE, While initiating and continuing treatment prescribed by these Medical Directives a paramedic must ensure that.
the patient simultaneously receives care in accordance with the BLS PCS. It is acknowledged that there may be circumstances and situations where complying with ALS PCS is not. Advanced Life Support Patient Care Standards Version 3 3 To all users of this publication The information contained herein has been carefully compiled and is believed to be accurate at date of publication Freedom from error however cannot be guaranteed For further information on the Advanced Life Support Patient Care Standards

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