Title: Purpose and Goals of the Base Hospital Program Number: 2.1 Category: 2.0 Base Hospital Roles and Responsibilities Written By: M. Epp Approved By: Dr. R. Vandersluis Issue Date: October 2002 Review Date: March 2005 PURPOSE: To provide Paramedic s with training for present positions and to provide opportunities for continuous education to promote individual development. The Base Hospital consists of a group of health care professionals that support their staff whose purpose is to provide leadership and medical direction in the provision of pre-hospital and interhospital emergency health services in a specified geographic region in order to insure that services provided are medically sound and well coordinated. Serving as a Regional resource by providing education, consultation and guidance to the pre-hospital care worker and other health related agencies, we also monitor and audit the quality of pre-hospital patient care and coordinate the placement and transfer of emergency patients, all done in a manner consistent with the hospital mission statement. Standard 1 All new employees attend a facility-wide Orientation Program before commencing work in their departments. Standard 2 All employees attend yearly re-certification/annual endorsement. Standard 3 Education records of attendance are regularly recorded
Title: Objectives Number: 2.2 Category: Base Hospital 2.0 Base Hospital Advanced Roles Life and Support Responsibilities Program for Durham Region Written By: M. Epp Approved By: Dr. R. Vandersluis Issue Date: October 2002 Review Date: March 2005 Philosophy of Paramedicine in Durham Region The Paramedic Ambulance Service functions in the community to provide Advanced Life Support in the pre-hospital setting. The early recognition and treatment of the critically ill or injured person will enhance their recovery and return to active involvement in the community. OBJECTIVES 1. To be able to respond safely and promptly to any emergency situation 24 hours a day. 2. To act on behalf of the Base Hospital Physician providing assessment and early treatment of acute medical emergencies and trauma in the pre-hospital setting. 3. To safely transport the ill or injured person to the appropriate medical facility based on his/her presenting conditions. 4. To participate in the Emergency Medical System by reporting accurate history and assessment findings when presenting the patient to the Emergency Department. 5. To act as a liaison between the medical community and other emergency services. (Police, Fire Dept., etc.) 6. To promote public health awareness on a daily basis. 7. To provide courteous and efficient service thereby enhancing the public image of the Health Care Professional.
Title: Standards for Pre-hospital A.L.S. Number: 2.3 Category: 2.0 Base Hospital Roles and Responsibilities Written By: M. Epp Approved By: Dr. R. Vandersluis Issue Date: October 2002 Review Date: March 2005 Advanced Life Support Standards All equipment, including communication equipment pertaining to the provision of pre-hospital A.L.S. measures is maintained in good repair and ready for service. Any problems should be immediately documented and reported to the Service Manager or his/her designate Defective equipment should be repaired, exchanged, or replaced as soon as possible. An adequate stock of essential A.L.S. drugs and supplies is continuously monitored and documented Communication is maintained with the C.A.C.C. to provide a link with the Base Hospital Program All established radio and communication protocols are understood and utilized as indicated by the employer and the C.A.C.C. All medical orders other than those covered by approved medical directives must be communicated directly to the Paramedic by the Base Hospital Program A Paramedic can only perform delegated acts in the practice of medicine on direct order from a Base Hospital Physician, or as directed by Base Hospital approved medical directives. When a physician is on scene, the Paramedic will ascertain what treatment has already been given, record this on the patient record along with the physician s name, and advise the Base Hospital Physician prior to commencing with any approved medical directives. The Paramedic may place the on-scene physician in contact with the Base Hospital Physician and allow them to communicate while he/she performs patient assessments The Paramedic will only provide medical care approved by the Base Hospital Physician and transport to the facility directed by the Base Hospital Physician The A.L.S. provider is the senior health care provider at the scene, unless a physician is present who is willing to take responsibility for the scene The A.L.S. provider will not informally train anyone in the practice of medicine.
The A.L.S. provider may be assisted at the scene by a B.L.S. provider but the B.L.S. provider can only assist to the level specified in his/her job description/specification All patients encountered will be systematically assessed according to the program guidelines, including the determination of: degree of distress, chief complaint, history pertinent to the incident, past medical history, current medications, drug allergies, level of consciousness and Glasgow Coma Scale, vital signs (pulse, respirations, blood pressure, skin, pupils) and Trauma Score (if pertinent), physical examination (H/N, chest, CVS, abdo, extremities), cardiac monitoring and evaluation by ECG, any changes in the above, a working assessment, and any response to treatment The patient s condition in relation to the treatment intervention must be continuously evaluated and reassessed The A.L.S. provider will ensure that all pertinent data is communicated to the Base Hospital Physician and accurately recorded, and that all documentation is completed accurately and legibly as soon as possible after the vent has occurred A.L.S. personnel will provide patient care to the level of their certification and job description/specification including acts in the practice of medicine All care rendered will be focused on providing the greatest benefit to the patient The safety of patients, staff and the public is on the utmost concern at all times A.L.S. care will be provided by qualified personnel who have successfully completed the didactic and clinical objectives of an approved program of instruction delivered by the Base Hospital All training and certification procedures are authorized by the Base Hospital Program Medical Director
STANDARDS FOR PARAMEDICINE Reports for duty presentable to the public, mentally and physically prepared for the days events Performs vehicle and equipment checks at the beginning of each shift, ensuring that all equipment is clean and serviceable and the ambulance is mechanically sound Checks the drug bag and signs narcotic control records in front of witness Informs the Central Ambulance Communications Centre (C.A.C.C.) of availability at all times and is always ready to respond within one minute of receiving a call At The Scene Of An Emergency, The Paramedic Will: Assess the environment for potential hazards and take action for the safely of himself/herself and others. Perform a physical examination and record all data pertaining to: Incident history Chief complaint Vital signs Past medical history, including medications and allergies Interpretation of life-threatening dysrhythmias Initiate Basic Life Support measures, including: Airway maintenance Ventilation CPR Control of haemorrhage Oxygen administration Splinting of fractures Contact the Base Hospital Physician when required and report concise and exact information regarding the patient s condition to enable medical decisions to be made. Carry out Medical Directives where applicable Anticipate forthcoming orders and prepare equipment accordingly Perform Controlled Delegatable Medical Acts, including: Patient assessment and interpretation of findings Initiating intravenous therapy Administering life saving drugs
Cardiac defibrillation Airway management Drawing of venous blood samples Trans thoracic pacing Cardioversion Will decide the priority of transport based on the urgency of the patient s condition, and proceed to the most appropriate medical facility At The Medical Facility, The Paramedic Will: Transfer the patient from the ambulance to the department lifting the patient from the ambulance stretcher to the hospital bed in the most appropriate manner. Ensure continued patient care by providing nursing and medical staff with detailed information concerning patient history and changes en route. Upon Completion Of A Call, The Paramedic Will: Accurately complete the necessary charting, including: A.C.R. form Prepare the ambulance for service by cleaning and replacing any equipment used Re-stock the drug bag supplies in the spare drug bag and from supplies available in the Paramedic Supply Cupboards and sign the appropriate record sheets. Notify C.A.C.C. when available.
STANDARDS FOR PRE-HOSPITAL A.L.S. CARE 1. Advanced Life Support is Readily Available to the Region of Durham on a 24 Hour Basis: i. Vehicles are adequately staffed by trained pre-hospital care workers at all times and located in such areas as to provide the most efficient emergency service. ii. Vehicles and equipment, including communications equipment are maintained in good repair and ready for service. iii. Vehicles are adequately stocked with essential A.LS. drugs and supplies. 2. Effective Communication is Established and Maintained Between All Components of the A.L.S. System: i. Communication is maintained with the Central Ambulance Communication Centre (C.A.C.C.) to provide a link with the Base Hospital Physician ii. Established radio and communication protocols are understood and utilized as indicated. 3. A.L.S. Treatment is Provided as Indicated By the Assessed Needs, Physicians, Orders and/or Established Treatment Protocols: i. The patient is systematically assessed according to the program guidelines ii. All pertinent data is communicated to the Base Hospital Physician and recorded. iii. Judgement is exercised when administering prescribed treatment or implementing treatment protocols. 4. The Patient s Condition in Relation to the Treatment Intervention is Continuously Evaluated and Re-assessed: i. Current data is maintained as to the patient s condition ii. Patient s and families concerns are monitored iii. Appropriate intervention is sought as judged necessary iv. Upon arrival at receiving hospital, detailed information concerning patient history and changes n patient condition en-route is communicated to medical and /or nursing staff to ensure continued patient care
5. The Safety of Patients, Staff and the Public is of the Utmost Concern at all Times: i. All measures are taken to ensure the safe access to and appropriate transport of the patient ii. Steps are taken to reduce or eliminate environmental hazards iii. A.L.S. treatment is administered in a safe manner by qualified personnel using good judgement and in the best interest of the patient 6. All Relevant Data is Recorded on the Approved Forms and is Complete, Accurate, Legible and in Accordance with the Recognized Program Guidelines: Completed patient information forms include: i. Relevant patient information ii. All patient assessment and evaluation data iii. Treatment intervention iv. Signatures of all physicians and care providers involved at the Base Hospital and receiving hospital All A.L.S. drugs and equipment record sheets are complete, including: i. Morphine control and administration ii. Pharmacy record iii. M.A.S.T. record book 7. A.L.S. Will Be Provided By Qualified Personnel Who Have Successfully Completed the Didactic and Clinical Objectives of the Pre-hospital A.L.S. Training Program: i. It is a pre-requisite for this course that Emergency Medical Care Assistant personnel successfully complete the established precourse test. ii. Training is provided by the Base Hospital Staff and designated Paramedics, under the supervision of the Medical Director of the Base Hospital Program iii. Training and certification is authorized by the Medical Director of the Base Hospital Program and the governing body of the Hospital. 8. The Paramedic Staff Apprise Themselves of Available A.L.S. Continuing Education: i. Certified personnel ensure records of continuing education are updated monthly.
Title: Overview of Base Hospital Program Responsibilities Number: 2.4 Category: 2.0 Base Hospital Roles and Responsibilities Written By: M. Epp Approved By: Dr. R. Vandersluis Issue Date: October 2002 Review Date: March 2005 General Overview The development, implementation and maintenance of Advanced Life Support (ALS) Programs is contingent on a Base Hospital being designated. The Base Hospital is responsible for the following as defined in the Ministry of Health Guidelines: The provision of medical direction and support to ambulance attendants and other pre-hospital emergency providers. Monitoring the quality of care provided and auditing basic life support services delivered by ambulance attendants as part of the Ministry s Quality Assurance and re-certification program. The direction of ambulance transportation of emergency patients to the nearest facility where the medical attention required for the care of the patient is available. The development and promotion of area-wide arrangements for the transfer of patients between heath facilities and the coordination of medical transfer teams for the transfer of critically ill and injured patients. Promoting the cost efficient use of emergency health care resources within the Region. In a Region where Advanced Life Support services are provided, a Base Hospital is also responsible for: The provision of supervised clinical training to paramedic trainees and bonding between paramedic trainees and Base Hospital Physicians in accordance with criteria established by the Ministry of Health. The delegation of medical acts to paramedics by emergency physicians in the Base Hospitals as authorized by the College of Physicians and Surgeons of Ontario. Assuming legal responsibility for patient care and for medical acts delegated by the Emergency Physicians and performed by Paramedics in the field until the patient is admitted into the Emergency Department of the receiving hospital.
Directing the transport of patients on ALS vehicles to the nearest appropriate facility for treatment, bypassing one or more hospitals is necessary. Conducting reviews of cases where medical acts have been delegated to Paramedics, to evaluate the accuracy of patient assessment, appropriateness and quality of ALS provided, the quality of communication in describing patient condition and accuracy and completeness of documentation of treatment rendered. Providing a Continuing Education Program for Paramedics and testing their skills as part of the Ministry s Quality Assurance and Re-certification Program. Maintaining an adequate supply of drugs used by Paramedics in prehospital care. Providing specified information and records of ALS patients to the Ministry and cooperating with the evaluation of the overall ALS Program. As you can see without a Base Hospital as ALS Program cannot exist. However, a Base Hospital can exist without an ALS Program. Summary The Ministry of Health will provide the guidelines and policies for pre-hospital care in Ontario. The Ministry of Health will designate Base Hospitals and provide funding The Ministry of Health will approve ACP Program levels and content and provide funding. The Base Hospital is responsible, in conjunction with the health care community for the determination of what level of ACP Program will be recommended for the area it covers. The Base Hospital is responsible for the coordination and training of the ACP and other pre-hospital health care providers. The Base Hospital will certify the graduates, review performance and recertify as required. The Base Hospital in conjunction with the receiving hospitals and ambulance services will coordinate the Quality Assurance Program for ALS in accordance to the established performance levels. The Base Hospital will acquire appropriate liability insurance for its employees. The licensed Ambulance Service will employ ACPs as approved by the Ministry of Health and trained and certified by the Base Hospital. The licensed Ambulance Service will ensure ALS driver/attendants are available to the areas as approved by the Ministry of Health. The licensed Ambulance Service will acquire all necessary ALS equipment from the Ministry of Health or with their approval.
The licensed Ambulance Service will acquire appropriate liability insurance for its employees. The licensed Ambulance Service will provide a job description and/or specification for the ACP. The licensed Ambulance Service will retain all employer rights over the employees that work for him/her. The ACP and PCP will adhere to the job description and/or specifications issued by the employer. The ACP will adhere to all medical directives and/or direct orders of the Base Hospital Physician for the performance of delegated acts in the practice of medicine as approved in the job description/specification. The ACPs and PCPs will ensure all equipment issued is in working order or report to the appropriate parties. The ACPs and PCPs will ensure documentation is completed as soon as possible after the event has occurred. All parties, including all receiving hospitals, will work in a cooperative spirit to ensure the successful development, implementation and maintenance of ALS pre-hospital programs.