BC (Canada) PCP additions

[blindsideflank]

Primary care paramedics in British Columbia have some changes on the way. An anti emetic (presumably gravol), possibly TXA, CPAP, 12 lead ecgs (in select areas, and cyanide poisoning kits.

Pretty cool for them, any emts out there using cpap in your service? Is it bein used appropriately?

Our critical care guys are now puttin in arterial lines too, but not that exciting.


Bc has a service that really fails to serve the rural areas (tiered ALS response available only in metro areas) and its cool to see the BLS cars get to offer more. Hopefully some pain control one day.

 

[Medic Tim]

Primary care paramedics in British Columbia have some changes on the way. An anti emetic (presumably gravol), possibly TXA, CPAP, 12 lead ecgs (in select areas, and cyanide poisoning kits.

Pretty cool for them, any emts out there using cpap in your service? Is it bein used appropriately?

Our critical care guys are now puttin in arterial lines too, but not that exciting.


Bc has a service that really fails to serve the rural areas (tiered ALS response available only in metro areas) and its cool to see the BLS cars get to offer more. Hopefully some pain control one day.

I just got the email about that. I wish I had had access to antiemetics when I was a pcp.
Hopefully their next project is making emaccs login more user friendly.


I have been told PEI is looking to add fentanyl to the pcp scope under strict protocols... and allowing pcp to work under the acps license.ex acp instructs pcp to push an epi amp during a code.

 

[WolfmanHarris]

Are the increasing the didactic time for BC as well?

Anti-emetics and benadryl were added to the PCP scope in Ontario recently. IM/IV toradol is currently an auxiliary directive and my Base Hospital has chosen not to implement it yet since the directive is going to be adjusted significantly in the next few months and they didn't want to roll it out only to change it almost immediately.

We've had CPAP for a couple years and 12 lead (medic interpretation) with direct bypass to PCI for some time.

Otherwise the only big things coming down the pipe here are some community paramedicine initiatives that would see us transporting to urgent care for some patients rather than ED and a few other care pathways (especially for LTC patients). Those are held up with the Ministry of Health from what I understand.

 

[Medic Tim]

BC has schedule 1 and schedule 2 pcp. The added meds and scope is for the schedule 2 PCPs . Schedule1 are bare bones pcp ... I don't believe they even do IVs . They also need to go through training before they are cleared to administer / use the new meds/skills .

 

[ThadeusJ]

A lot of the US states allow CPAP to be used as a basic level skill. New York is in the process of introducing it now.

 

[blindsideflank]

Ontario rocks, I dream of a 2 year pcp program here.

Not fan of toradol, do the pcp's find much use in it? In bone breaks mostly?

Wolfman do they carry gravel only? Zofran?

 

[Av8or007]

Ontario is good, but you guys in BC have got the right idea with tx guidelines. Ontario is still really cookbook in regards to protocols.

BLS standards are a relic from the late 90's...

The only anti-emetic is gravol IV/IM and in some cases PO.

 

[WolfmanHarris]

Ontario is good, but you guys in BC have got the right idea with tx guidelines. Ontario is still really cookbook in regards to protocols.

BLS standards are a relic from the late 90's...

The only anti-emetic is gravol IV/IM and in some cases PO.

Standards are only getting worse with the standardized protocols. Thankfully I'm under one of the better base hospitals, but the way some of the other BH's are holding everyone back in ridiculous. Don't even get me starting on MOH EHS branch.

 

[Av8or007]

To me the BLS standards are even worse.

1. Oxygen is a medication, not a cure all. O2 is only indicated for S/Sx of hypoxia and or a SpO2 ≤94%. Non hypoxemic chest pain doesn't need o2.

Make pulse oximetry part of the prov equipment standards. The fingertip units are cheap if a service doesn't already have spo2 (which they should).

2. Spinal immobilization for all. Don't even get me started...
----------
As for the ALS, the pain protocol is terrible (for all levels but especially ACP).
Naloxone shouldn't require a patch and what is with only giving one dose of epi for anaphylaxis/severe asthma (when a wilderness FR can give more with an 80 hr course)...

And the icing on the cake - no matter what the directive for pcp's states, King LT sga's CAN be used outside of cardiac arrest as long as BLS airway has failed and pt is gcs of 3.

 

[ChillbroSwaggins]

To me the BLS standards are even worse.

1. Oxygen is a medication, not a cure all. O2 is only indicated for S/Sx of hypoxia and or a SpO2 ≤94%. Non hypoxemic chest pain doesn't need o2.

Make pulse oximetry part of the prov equipment standards. The fingertip units are cheap if a service doesn't already have spo2 (which they should).

2. Spinal immobilization for all. Don't even get me started...
----------
As for the ALS, the pain protocol is terrible (for all levels but especially ACP).
Naloxone shouldn't require a patch and what is with only giving one dose of epi for anaphylaxis/severe asthma (when a wilderness FR can give more with an 80 hr course)...

And the icing on the cake - no matter what the directive for pcp's states, King LT sga's CAN be used outside of cardiac arrest as long as BLS airway has failed and pt is gcs of 3.

Let's not forget some of the ridiculous patch points. I can just imagine the conversation the medical advisory council had when writing our protocols.

"Are our ACP's with 3 years of college education smart enough to administer Narcan under their own judgement....na they're way to stupid. Let's make it mandatory for them to patch and consult with a physician first. That's certainly not a giant waste of time."

 

[Av8or007]

Or the fact that cric and needle decompression require a patch.

Some of these protocols are so restrictive they are almost negligent...
..

 

[Medic Tim]

I knew Ontario was restrictive but didn't realize it was that bad.

 

[medicasaurus]

We have EPOS in BC now... which is a Doctor on call to discuss treatment options or to determine discontinuation vs transport in cardiac arrest. It is also used to discuss cases of intoxicated refusal and the like. However my treatments are my own and other than to discuss cases (particularly in arrest or refusals) we don't call.

I have called 3 times in 3 months. Twice on cardiac arrest to discuss early transport and possible causes of arrest. Once to discuss an intoxicated head trauma refusing to be assessed. All discussions were professional discussions not "mother may I". It stuns me to think you have to call for Naloxone or for life saving interventions. Treatment Guidelines are awesome btw our latest are here --> bctg.bcas.ca

 

[Av8or007]

To me, tx guidelines are what ALL Canadian services should be doing for the majority of treatments.
Especially in Ontario where the PCP program is 2 yrs in length.

Ontario is trying to implement some of that community medic stuff - i don't know how that's supposed to work when you can't even (insert one of many issues here, see above)...

Anyone have any ideas why Ont. is so behind the curve on both the protocols and autonomy fronts?

 

[AsAlways]

To me, tx guidelines are what ALL Canadian services should be doing for the majority of treatments.
Especially in Ontario where the PCP program is 2 yrs in length.

Ontario is trying to implement some of that community medic stuff - i don't know how that's supposed to work when you can't even (insert one of many issues here, see above)...

Anyone have any ideas why Ont. is so behind the curve on both the protocols and autonomy fronts?

Because paramedics are not a regulated health profession in Ontario (no college of our own under the regulated health professions act), and as such the profession is completely controlled by physicians.

As you know paramedics in Ontario are only permitted to perform controlled medical acts because they are delegated this ability by their medical director (an emergency physician who runs one of the 7 base hospitals). Since we're technically working under their license I assume they're very skiddish about what they let us do, since it's technically their license on the line. They'll never face direct action though, as they make the protocols insanely restrictive to cover their *** and make sure they can always point the finger at you for messing up any aspect of them.

Until we get a college and get our own licenses I don't see this changing. Unfortunately that may never happen, as the Ministry of Health inquired into the formation of college of paramedics and has received advice against it (much of which comes from the base hospitals surprise surprise). No final decision has been made but it mostly looks like we won't get a college. The medical directors don't want to relinquish control for whatever reason, and our autonomy suffers despite having some of the highest education standards in Canada.

 

[Av8or007]

Does BC have a college of medics? The whole tx guidelines thing seems very progressive.

 

[medicasaurus]

We are licensed through the Emergency Medical Assistant Licensing Board (EMALB). The Treatment Guidelines are driven by the provincial ambulance service (BC Ambulance) and are endorsed and supported by EMALB.

 

[fortsmithman]

Because paramedics are not a regulated health profession in Ontario (no college of our own under the regulated health professions act), and as such the profession is completely controlled by physicians.

Sounds like what we have in the Northwest Territories, where it's up to our individual medical directors what we can and cannot do.

 

[Av8or007]

Sounds like what we have in the Northwest Territories, where it's up to our individual medical directors what we can and cannot do.

Its worse in a way in ontario, since if there was a med director that was aggressive and progressive they are held back by "provincial standard" to the lowest common denominator...

 

[Medic Tim]

Sounds like what we have in the Northwest Territories, where it's up to our individual medical directors what we can and cannot do.

Not quite. Ontario has provincial standards for education and licensing. They just have little to no say in it.(from what I am told) there are some variations in protocol but Ontario is quite restrictive when compared to other parts of Canada.
I may be wrong but the nwt has absolutely no set standards on education or licensing beyond working under a doctors authorization. Most job posting I see for up there require licensure from another province.