FIRST NATIONS EMS - TBRHSC · Naotkamegwanning First Nations EMS 3rd & 4th Quarter 2013 1. ... Dan McCormick 053 Kenora District ... Medication Administration and Fluid Therapy by

NAOTKAMEGWANNING

FIRST NATIONS EMS

3rd & 4th Quarter Report

July 1- Dec 31, 2013

Introduction

“A Base Hospital is a hospital that has been designated as such by the Minister to assist

and work with the Ministry to monitor and ensure the quality of ambulance based pre-

hospital patient care. A Base Hospital provides medical direction and advice to

ambulance based pre-hospital emergency healthcare providers within a broad based,

multi-disciplinary, emergency health services system in a specified geographical area.

This involves the Base Hospital acting as a resource centre and facilitator to assist the

Ministry in ensuring that ambulance based pre-hospital care and transportation meets

the patient care standards as set out in Regulation 257/00. The Base Hospital also

functions in the advisory capacity to the Ministry of Health and Long-Term Care on

matters relating to ambulance based pre-hospital emergency care. Base Hospitals will

support and work cooperatively with the Ministry towards the accomplishment of

Emergency Health Services Branch objectives. A Base Hospital is a vital part of the

Ministry of Health & Long Term Care’s team in its partnership with Upper-Tier

Municipalities and Designated Delivery Agents for the provision of Land Ambulance

Services”. (Regional Base Hospital Performance Agreement, Page 5, Item 2.0)

Thunder Bay Regional Health Sciences Centre (TBRHSC), formerly known as the

McKellar Hospital, has been designated as a Base Hospital by the Minister since 1986.

In 2008 the Ontario Base Hospital system was downsized from 22 provincial sites to 7;

Thunder Bay Regional HSC was re-designated as the Host Hospital for the NW Region

Base Hospital Program at that time. The NW Region Base Hospital Program services

the geographical area of Northwestern Ontario; the combined area spanning east/ west

from Manitouwadge to the Manitoba border and north/ south from Red Lake to Rainy

River.

Contact

Ms. Elaine Graham, Program Manager

NW Region Base Hospital

289 Munro St. Lower Level

Thunder Bay, ON P7A 2N3

(807)683-2733

[email protected]

Dr. Andrew Affleck, Program Medical Director

NW Region Base Hospital

289 Munro St. Lower Level

Thunder Bay, ON P7A 2N3

(807)683-2731

Naotkamegwanning First Nations EMS 3rd & 4th Quarter 2013 1

mailto:[email protected]

Vision Mission Values

Vision We will lead and inspire paramedics to provide exceptional pre-hospital care in Northwestern Ontario.

Mission

We will provide medical direction and oversight that promotes trust and supports best

practice through our education, training, and quality assurance programs.

Values

We value patient and family centered care; we will instill dignity and respect, communication and information sharing, collaboration, and participation in the delivery of pre-hospital care. We value partnerships that are accountable, participative, and respectful. We value life-long learning and education that is supportive, innovative, and dynamic. We value continuous quality improvement that promotes safety, best practice, efficiency, and professionalism.

We value research that is pre-hospital care focused.

Key Performance Indicators (KPI)

NW Region Base Hospital deliverables and performance measures are based on 4 Key

Performance Indicators (KPI) as set out by the Minister of Health within the Regional

Base Hospital Performance Agreement:

Medical Delegation

Medical Oversight

Education

Continuous Quality Improvement (CQI)

This report is a combined 3rd & 4th Quarter Report for the period July 1, 2013 to Dec 31,

2013:

Section 1: Regional Program Reports

Section 2: Naotkamegwanning First Nation EMS Service Reports



SECTION 1:

Regional Program Reports

3rd

& 4th

Quarter 2013


Section 1: Regional Program Reports

Medical Directorship

Medical Director Name

Title

Dr. Andrew Affleck NW Regional Program Medical Director

Dr. Bill MacGregor ACP Medical Director

Dr. Cameron McGillivray PCP Medical Director

As of Dec 31, 2013

Designated Delivery Agents and Number of Paramedics

Designated

Delivery

Agent

EMS

Service

Name

Manager /CAO/

Director/ or

Chief of EMS

Number of Paramedics Employed

EMA / PCP / ACP

Naotkamegwanning First Nations

Naotkamegwanning EMS

Jim Green 0 18 0

Rainy River District

Services

Administration Board

Rainy River District EMS

Dan McCormick

0 53 0

Kenora District

Services Board Northwest EMS

Andrew Tickner

1 105 0

City of Thunder Bay Superior North EMS Norman Gale 0 162 19

Number of Paramedics Employed by More than One EMS Service = 19

Total Number of Paramedics in NW Region minus the number of paramedics employed by

more than one service = 339


ALS Equipment & Data Management

EMS Service Name

ACR Type

ACE Type

ECG Type

SAED Model

Naotkamegwanning EMS Electronic Electronic Electronic Zoll

Rainy River District EMS Electronic Electronic Electronic Zoll

Northwest EMS Electronic Electronic Electronic Zoll

Superior North EMS Electronic Electronic Electronic MRx

As of Dec 31, 2013

Certification Requests

Completed by NW Region Base Hospital

3rd & 4th QTR July 1-Dec 31/2013

Type of Certification

Request

Absence from practice/college

< 90 days

> 90 days to 1 year

> 1 year to 2 years

Over 2 years

New Hire Initial Cert

PCP 0 PCP 0 PCP 1 PCP 1

ACP 0 ACP 0 ACP 0 ACP 0

LOA Return to Work (RTW) Cert

N/A PCP 6 PCP 3 PCP 0

N/A ACP 0 ACP 0 ACP 0

Sub Totals 6 4 1

Total 11


Advanced Life Support Patient Care Standards (ALSPCS)

NW Region Base Hospital ensures that all current certified paramedics/EMAs are

qualified to perform the Delegated Controlled Acts and/or other medical procedures as

recommended by the Provincial Medical Advisory Committee (PMAC) and Director.

The NW Region Base Hospital adheres to the Provincial Medical Directives

recommended by the Provincial Medical Advisory Committee (PMAC) and approved by

the Director;

For this reporting period ALS patient care has been monitored by the NW Region Base Hospital in accordance with the Advanced Life Support Patient Care Standards (ALSPCS), Nov 2011, Ver. 3.0

Approved Non Delegated Controlled Acts: Medical Oversight Only

Approved Non Delegated Controlled Acts Procedure/Therapy Requires Medical Oversight

PCP ACP

Lead II Cardiac Monitoring Yes Yes

Lead II ECG Interpretation NSR, Bradycardia, Tachycardia, Asystole, V-Fib, Pulseless V-Tach, PEA

Yes Yes

Lead II ECG Interpretation PSVT, BBBs, A-Fib, A-Flutter, V-Tach (with pulse), Paced, Junctional, PVCs

No Yes

Supraglottic (King LT) Airway* Yes Yes

Continuous Positive Airway Pressure (CPAP* Yes Yes

As of Dec 31, 2013

Medical Oversight for Non Delegated Medical Acts may include, but is not limited to:

Review and approval of all course material to ensure consistency with the

provincial education requirements;

Development of educational material

Approval/assistance in selecting service instructors and regional educators

Participation/presence (auditing) during train-the-trainer, didactic, and clinical

sessions

Refresher training for regional educators and service instructors;

Chart Audit

Medical Quality Care Review

Guidance on choice of patient care equipment.


Approved Delegated Controlled Acts: Medical Delegation Required

Delegated Controlled Act:

Procedure/Therapy Requires Medical Delegation

PCP ACP

Blood Sampling: Glucose Yes Yes

Analyze-automated Device(no shock delivered) Yes No

Semi Automatic Defibrillation: Adult & Pediatric Yes No

Manual Defibrillation: Adult & Pediatric *Yes Yes

12 Lead Interpretation *Yes Yes

Central Venous Line Maintenance (Access) No Yes

Extubation(unintentional) No Yes

Extubation by Provider(Intentional) No Yes

Needle/Surgical Cricothyroidotomy No Yes

ORO-Tracheal Intubation No Yes

Unsuccessful E.T.T Intubation No Yes

E.T.T Suctioning No Yes

E.T. Tube Verification No Yes

IV Saline Lock *Yes Yes

Ringers lactate No Yes

Fluid Bolus *Yes Yes

IV Discontinued by Provider(Intentional) *Yes Yes

Intraosseous Infusion Initiation No Yes

Unsuccessful Intraosseous No Yes

Pronouncement of Death Yes Yes

Cardioversion No Yes

Carotid Sinus Massage No Yes

IV Normal Saline *Yes Yes

Valsalva Manoeuvre No Yes

Needle Thoracostomy No Yes

Unsuccessful Needle Thoracostomy No Yes

Nasal Tracheal Intubation No Yes

Unsuccessful E.T.T Nasal No Yes

Laryngoscopy/Foreign Body Removal/McGill Forceps No Yes

Return of Spont. Circulation(ROSC) Yes Yes

Unsuccessful Attempt-Laryngoscopy/Foreign Body Removal/McGill

No Yes

* Currently not available in all NW Region EMS Services


Approved Delegated Controlled Acts: Medical Delegation Required

Medication Administration and Fluid Therapy by Route

Medication or Fluid Therapy

Route

PO SL NB AE ETT PR IM **IV IO

Adenosine A A

Aspirin A/P

Atropine A A A

Benadryl(Diphenhydramine) A/P A/P* A

D50W A/P* A

Dopamine A A

Epinephrine 1:1,000 A/P A/P

Epinephrine 1:10,000 A A A

Glucagon A/P

Glucose: Oral A/P

Gravol(Dimenhydrinate) A/P A/P* A

Lasix(Furosemide) A A

Lidocaine Drip A A A

Lidocaine Spray.5% A

Midazolam(Midazolam) A A A

Morphine A A A

Narcan(Naloxone) A A A

Nitroglycerin A/P

Normal Saline A/P* A

Salbutamol A/P A/P

Valium(Diazepam) A A A A

Sodium Bicarbonate A A

A= ACP P= PCP *P= PCP (IV) **IV includes CVAD


On Line Medical Control: Base Hospital Physician Patches

NW Region Base Hospital (NWRBH) ensures that all Base Hospital Patch Physicians

(BHPPs) are knowledgeable regarding paramedic practice and provincial medical

directives and that they are available for online medical direction and control on a 24/7

days a week basis. Every designated BHPP is “appointed” he/she attends an

information session with the Program Medical Director or designate and is provided a

BHPP information manual prior to commencing this work.

Base Hospital Patch Physician and Paramedic online interactions (patches) are subject

to medical quality care review on a regular basis by the Base Hospital. 100% of BHPPs

are reviewed by the NW Region Base Hospital.

Refer to the following Base Hospital Policies & Procedures for review of the patching

procedures in your area:

On Line Medical Control PCP - Policy MC 100

On Line Medical Control PCP Back Up Procedures (PCP) - Policy MC 100A

On Line Medical Control ACP – Policy MC 100B

Base Hospital Patch Physician (BHPP) Report

3rd & 4th QTR July 1- Dec 31/2013

EMS Service

Name

Patches by

PCPs Patches by

ACPs

Patch Failure

Reports

Superior North EMS 20 76 4

Northwest EMS 11 2

Rainy River District EMS 2

Naotkamegwanning EMS 4

Total 37 76 6

There were a total of 113 patches to BHPPs made by NW Regional Paramedics

in the 3rd & 4th QTR 2013 (July - Dec)

6 reports of failed attempts to patch to the BHPP were received by the NW

Region Base Hospital during this period.

o Location of failed patch: 4 in Thunder Bay(City)

reason: poor cell service/dropped call

reason: put on hold/no BHP pick up

reason: BHP unavailable to come to phone

reason: patch number out of service

o Location of failed patch: 2 in NWEMS

reason: dispatcher error

reason: BHP hung up, medic didn’t hear doctor on line was

speaking with patient at time.


Each report of patch failure is reported to the EHS Branch as per the

Performance Agreement

Follow up on each patch failure report is completed by the NW Region Base

Hospital to ensure system and human errors are corrected as soon as possible

Education

The setting of standards for education, evaluation, continuing medical education and

competency maintenance of Paramedics/EMAs is the exclusive right of the Ministry of

Health and Long-Term Care (MOHLTC).

The NW Region Base Hospital provides a process to confirm and/or ensure the

education and standard of practical skills necessary for certification and delegation of

specific Delegated Controlled Acts approved by the Provincial Medical Advisory

Committee (PMAC) to Paramedics/EMAs;

Regional Base Hospitals are required to provide a minimum amount of education per

Paramedic/EMA each year. Currently the minimum requirements are: Primary Care

Paramedic – 8 hrs and Advanced Care Paramedic – 24 hrs.

Education Hours

Level of Paramedic

Annual

Mandated Hrs of

Education

Annual Skills

Review

Clinical CME

Didactic CME

Voluntary

CME*

Total Hrs of Education Offered by

NWRBH Each Year

ACP 24 4 hours 8 hours 12 hours 24

PCP 8 4 hours 0 hours 4 hours 8

*Voluntary CME opportunities may be offered from time-to-time as resources permit.

Attendance is strictly voluntary (non compensatory) and test results do not affect certification status.


Patient Care Deficiencies: Omissions

If a paramedic has performed a Controlled Act or any patient care below the recognized

standard/guidelines, the Base Hospital response is guided by the severity of the event in

accordance with the following:

Minor Omission/Commission is defined as an action or lack of action by the

Paramedic/EMA that did not have any direct effect on patient morbidity, however, may

have affected patient care in a minor way. If a minor deficiency is identified the

paramedic may be given verbal counseling (confirmed in writing) or written counseling

via the ambulance call review process.

Major Omission/Commission is defined as an action or lack of action by the paramedic

that has affected or has the potential to affect patient morbidity, however, the outcome

would not be life threatening. If a major deficiency is identified, or there is a repetition of

minor deficiencies, the paramedic will be given written counseling and may be required

to complete remedial education. At the discretion of the medical director the paramedic

may be deactivated.

Critical Omission/Commission is defined as an action or lack of action by the

paramedic that has a clear affect on patient morbidity with a potential life threatening

outcome. If a critical deficiency is identified or there is a repetition of major or

combination of major and minor deficiencies the paramedic will be given written

counseling and will be required to successfully complete remedial education. At the

discretion of the medical director the paramedic may be decertified.

ACP and PCP Omission Report

3rd

& 4th

QTR July 1-Dec 31/2013

Minor Omission Major Omission Critical Omission

Rainy River District EMS 0 0 0

Northwest EMS 5 1 0

Naotkamegwanning First Nations EMS 1 0 0

Superior North EMS District Operations

8 2 0

Superior North EMS City: ACP 0 0 0

Superior North EMS City: PCP 1 0 0

Total: 15 3 0


Remedial Education Program

A remedial education program based on individual needs will be made available to the Paramedic/EMA at the Base Hospital Medical Director’s discretion. Remedial education may consist of, but is not limited to, self directed didactic review, scenario practice, clinical rotations or supplementary educational programs as deemed necessary by the Program Medical Director.

Deactivation and Decertification

If at any time in the judgment of the Base Hospital Program Medical Director, conditions

for certification have not been maintained, the Base Hospital Medical Director may

deactivate or decertify the Paramedic/EMA.

Deactivation is the temporary suspension of selected certified paramedic privileges to

perform Controlled Acts by the Base Hospital Medical Director for the purposes of

performing remediation.

Decertification is the revocation of a paramedic’s privileges to perform Controlled Acts.

NW Region Base Hospital Deactivation and Decertification Report

3rd

& 4th

QTR

July1-Dec 31/2013

Number of

Paramedics

Administrative Deactivation

> 90 Day LOA

Separated from Service

8 14

Clinical Deactivation

Deficiencies/Remedial Education Required 0

Administrative Reactivation Return to Work:

Greater than 90 Days

Greater than 1 Yr

Greater than 2 Yr

4 3 0

Clinical Reactivation

Remedial completed 0

Decertification 0


Continuous Quality Improvement (CQI)

Paramedics/EMAs must demonstrate competency and adherence to standard protocol

and legislation associated with the performance of Controlled Acts and the provision of

patient care at their level of certification. This will be determined through Base Hospital

CQI initiatives which may include, but are not limited to:

Chart Audits

Peer Review

Ride-Outs

Dispatch/Base Hospital Physician Communication Review

Field Performance Evaluation

Successful Performance at CME

Call Review

Policies & Procedures

The NW Region Base Hospital Policy & Procedure Manual is reviewed annually and is

otherwise updated as necessary. Notices of policy updates are distributed to all regional

stakeholders as required. It is the responsibility of every certified Paramedic/EMA to

ensure they have read all Base Hospital policies and procedures, remain current and are

compliant with the required practices.

Our policy and procedure manual is available electronically and can be located on the

NW Region Base Hospital website:

http://www.tbrhsc.net/clinical_partners/base_hospital/base_login/base_login.asp

User Name: basehosp Password: policies

Human Resources Inventory

Maintenance of Certification requires that every Paramedic:

Be employed by an Emergency Medical Service and work as a Paramedic or Paramedic Preceptor (and meet the annual eligibility requirements outlined in the Provincial Base Hospital Standards);

Notify the Base Hospital of any period of absence from practice greater than 90 days;

Be scheduled to work a minimum of 144 hours per year.

Please ensure that your EMS services have established a tracking and reporting

process to provide this information to the Base Hospital each year as required.


http://www.tbrhsc.net/clinical_partners/base_hospital/base_login/base_login.asp

Regional Educator (RE) Report

Certified Regional Educators

3rd

& 4th

QTR July 1-Dec 31/2013

Regional Educator By Name

Level of Certification

EMS Service By Name

Year of Certification

Jesse Laybourne PCP NWEMS Feb 2005(Resigned Dec-2013)

Charlene Mackey PCP NWEMS Feb 2005

Kristy McQuay PCP RRDEMS Feb 2005

Cheryl Kallaste PCP RRDEMS Feb 2011

Paula Verin PCP SNEMS Feb 2005

David Black PCP RRDEMS Mar 2013

Robin Pollard PCP RRDEMS Mar 2013

Amy Welsh PCP RRDEMS Mar 2013

Melanie Depue PCP SNEMS Mar 2013

Jennifer Hamilton PCP SNEMS Mar 2013

Kristen Perozik PCP SNEMS Mar 2013

Evan McDonald PCP NWEMS Mar 2013

Rachel Parsons PCP NWEMS Mar 2013

Martha Paris PCP NWEMS Mar 2013

As of June 30, 2013

Regional Educator Activity Report

Activity Report 3

rd & 4

th QTR

July 1-Dec 31/2013

Session Type Activity

Type & Format # Sessions Facilitated

Paramedic Attendance

Annual Skills Review Type: Scenario & Practical Skills Testing Format: Assisted / Testing Stations

35 228

Return to Work Testing

Type: Scenario & Practical Skills Testing Format: Independent/Testing Stations

3 3

CME(Spring) Format: Independent Teaching 0 0


SECTION 2:

Naotkamegwanning First Nations EMS

Service Report

3rd

& 4th

Quarter 2013


Section 2 Naotkamegwanning First Nations EMS Reports

The Delegated Controlled Act Activity Report below indicates the number of times that

each Delegated Controlled Act (DCA) was performed by EMS station.

Delegated Controlled Act Activity Report Naotkamegwanning EMS

Combined 3rd

& 4th

QTR July 1– Dec 31/2013

Delegated Controlled Act Procedure

Code Naotkamegwanning EMS

Analyze - Automated Device (no shock advised)

308 2

ASA 504 7

Blood Sampling - Glucose 352 7

Defibrillation - Semi-Automatic 307 0

Dimenhydrinate (Gravol) 533 4

Diphenhydramine (Benadryl) 534 1

Epinephrine 1:1000

540 0

Glucagon 560 0

Glucose Oral 561 0

NTG Spray (0.4 Mg/Spray)

615 4

Salbutamol (Ventolin) 650 0

Pronouncement of Death 366 1

This information has been reviewed by the Program Medical Director for quality

assurance purposes. Paramedics may require additional education or follow up as

deemed appropriate by Dr. Andrew Affleck.


Comments:

Many of the approved Delegated Controlled Acts (DCA) are not being performed

on a regular basis by Naotkamegwanning First Nations Paramedics. This is

most likely due to the low number of calls in the service area;

Base Hospital conducts a mandatory Spring CME each year to help offset the issue of low ALS patient assessment and ALS skills but self directed CME is also necessary;

Maintenance of ALS skills is becoming increasingly difficult especially concerning

Paramedics/EMAs who have worked for extended periods in the low call volume

areas throughout their career or extended periods. Low call volume over time

presents difficulties in retaining information and skills. NW Region Base Hospital

would like to stress the importance and benefits of Paramedics being pro-active

in performing regular self directed CME while at work; making sure to involve and

or encourage your peers. Additionally Paramedics should contact Base Hospital

should they have any questions or concerns related to their ALS skills.

Total ALS Call Audited: ACE Distribution Report

Naotkamegwanning EMS

3rd QTR

July 1 – Sept 30/2013

4th QTR

Oct 1 – Dec 31/2013

Total ALS Calls Audited 13 8

ACE Distribution: Teaching Points 8 8

ACE Distribution: Response Required 0 0

Naotkamegwanning EMS Operator is reminded to ensure King LT and CPAP is part of

their audit and education processes - to ensure competence through review and training

sessions for Paramedics. NW Region Base Hospital does incorporate review and

education of these skills through call review and during certification re /testing, annual

skills, and CME each year

Medical Oversight Naotkamegwanning EMS

Combined 3rd

& 4th

QTR July 1 – Dec 31/2013

ALS Skill Total Attempts Successful Attempts

Unsuccessful Attempts

King LT 1 1 0

CPAP 0 0 0


SAVE RECOGNITION

We would like to clarify that we do not expect or encourage you to contact the receiving

hospitals directly to obtain patient outcomes as this would violate the PIPHA legislation.

If you feel there may have been a save in your area as a result of prehospital care,

please contact us. We do not want to miss the opportunity to congratulate the

paramedics involved in any save.

We will continue to recognize paramedics for saves at the annual skills review. This has

been well received by NW Region paramedics. We are pleased to take the opportunity

to acknowledge your great work.

Chart Audit By Station Report Naotkamegwanning EMS

Station Name 3rd QTR

July 1 – Sept 30/2013 4th QTR

Oct 1 – Dec 31/2013

Naotkamegwanning EMS 13 8

VSA: Save by Station Report Naotkamegwanning EMS

Combined 3rd & 4th QTR July 1– Dec 31/2013

Station Number of VSA’s Confirmed Saves

Naotkamegwanning EMS 1 0


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FIRST NATIONS EMS - TBRHSC · Naotkamegwanning First Nations EMS 3rd & 4th Quarter 2013 1. ... Dan McCormick 053 Kenora District ... Medication Administration and Fluid Therapy by