Introduction EMS Branch / Office of the Medical Director EMS … · 2020. 1. 31. · Introduction . EMS Branch / Office of the Medical Director . ... The OMD will eventually be moving

Welcome to the Emergency Medical Services Branch (EMSB) /Office of the Medical Director (OMD) Patient Care Maps & Procedures! These new patient care tools are the equivalent of the clinical sections of Emergency Treatment Guidelines (ETG), formerly developed by the Manitoba Emergency Services Medical Advisory Committee (MESMAC) and distributed by the Emergency Medical Services Branch. The new care maps and procedures will be created by the OMD and authorized by the EMSB, on behalf of the Minister. There have been dramatic changes to format, as well as updates to clinical content. The new formats have been developed to support best patient care, education design and delivery, quality assurance and continuing maintenance of competency. All new material is current, evidence-based, consistent with national standards, and aligns with the 2011 National Occupational Competency Profiles (NOCP). A00.1 PATIENT CARE MAPS: The concept of a care map incorporates elements of both a guideline and protocol. The care map allows for flexibility within some established parameters. They are strictly prescriptive for those with a basic scope of practice such as those licensed at the Technician level. However, they allow for greater clinical discretion for those with more experience and/or a broader skill set, such as those licensed as Technician-Advanced Paramedic. They will be applicable for all license categories, all provider skill levels, primary response and interfacility transfer missions, and for air as well as ground platforms. Look at the table of contents A00.1 Patient Care Maps. Every care map will have a version date. The updating, maintenance and revision of the care maps will be a continuous process and the version date will help authors and providers remain current and organized. The clinical care maps are divided into eight categories:

• A - General Assessment • B - Airway & Breathing Management • C - Resuscitation & Emergency Medical Conditions • D - Child Birth & Newborn Care • E - Medical & Non-traumatic Conditions • F - Traumatic & Environmental Conditions • G – Transport & Interfacility Transfer • H - References & Clinical Support

Each care map will have a unique alpha-numeric identifier code. For example, care maps outlining general patient assessment will have an identifier beginning with the letter A, while care maps for airway management will have identifiers beginning with the letter B, and resuscitation care maps will begin with the letter C, and so on. For many clinical conditions, there will be different versions of the same care map for patients of different ages. Some of these versions will have numerous differences, while some may be

Introduction EMS Branch / Office of the Medical Director

2015-11-26 EMS Protocols and Procedures

(formerly Emergency Treatment Guidelines): An Introduction to Care Maps & Procedures

Intro to Care Maps & Clinical Procedures Page 1

imperceptibly different. The age categories are clearly identified on each care map but will also be noted by a different letter after the final digit in the alpha-numeric care map identifier. As an example, C02A is the resuscitation map for adults while C02B is the care map for adolescent resuscitation; and C02C is for child resuscitation, and so on. PCM with no suffix letter will be applicable to all age categories. The standardized age categories are as follows:

Suffix Category Age range A Adult 17 years of age and older B Adolescent 10 up to 17 years of age C Child 1 up to 10 years of age D Infant 0 up to 12 months of age E Neonate Newly born up to 72 hours post-partum

None All ages 72 hours post-partum and older Near the top of A00.1, is the following statement, highlighted in yellow:

“License holders are responsible to maintain satisfactory knowledge and appropriate psychomotor skills for the safe application and performance of these care maps, and are required to be familiar with all relevant updates as distributed by the EMSB / OMD.”

The OMD will eventually be moving away from the current process of “annual recertification” for all delegated acts (transfers of function) to one of continuous “maintenance of proficiency” for clinical procedures where appropriate. This puts more responsibility on the individual provider to continually maintain their skills, and self-identify areas that need improvement, consistent with the expectations and responsibilities of all self-regulated professions. Initial entry into the care maps for all patients of all ages is by way of one of the following standard assessments:

• A01 Medical Assessment • A02 Trauma Assessment

These outline the standard scene and patient assessment for all medical patients or trauma victims. They are the entry point into the more specific patient care maps, and sometimes may be a returning point, as well. The standard assessment care maps will eventually lead into one or more specific care maps, usually by way of the chief complaint or identified clinical condition (H03 - Care Map Entry by Chief Complaint). Some specific care maps directly accessed from the assessment care maps are utilized for assessment and management of critical situations and include:

• Resuscitation (C01 & C02) • Airway & Breathing Management (B01) • Hypotension & Shock (C07) • Traumatic Hemorrhage & Shock (F09) • Head Injury (F11) • Unstable Bradycardia (C05)


• Unstable Tachycardia (C06) Two additional care maps are often used as adjuncts to the standard medical or trauma assessments. A04 Load & Go will help paramedics differentiate patients who require rapid transport with continuing assessment and treatment en route from those who can be safely assessed and treated on scene and then transported. A03 Multiple Casualty Incidents will be of help in situations where patient number and needs exceed initial resources. Take a look at any care map. Immediately to the right of the MHHLS logo and bison icon is the identifier code and the main clinical category of the care map, such as “B01A Airway”. Beneath this is the version date of the care map which, if you are holding the most current version, should correspond to the date in the table of contents (A00.1 Patient Care Maps). Beneath this is the age category that this care map applies to. Next to the right, you will see the “EMS Branch / Office of the Medical Director”. This indicates that the care map has been created within the EMSB by the OMD and its’ Executive Practice Committee (EPC). However, authorization of the care map must come from the EMS Branch. Below this is the title of the care map. Finally, to the extreme right is a group of icons (see appendix A). These icons each have a different shape, outline, filling and font color and identify which provider can perform which steps in the PCM. For example, all providers can perform steps identified by the white rectangular box, (with appropriate delegation for medications and procedures) while only those with the advanced skills set or greater can perform steps identified by the blue oval box (with appropriate delegation). Each care map will usually be in the format of a flow chart, followed by several boxes. These boxes will contain the INDICATIONS for the use of this particular care map; the CONTRAINDICATIONS to the use of part or all of this care map; and NOTES pertinent to the application of the care map. Some care maps may have one or more appendices containing readily accessible important clinical information, such as common causes of a certain clinical conditions. With many of the new care maps commonly used drug dosages will be included in a red box beneath the flow chart. At the bottom of each care map will be a running title and its’ identification code. Some sections found in the previous Emergency Treatment Guidelines and Protocols are noticeably absent from the new care maps. This information can usually be found in standard reference texts or EMS journals. While such information is important in preparation and training for patient care it is not usually required at the point of patient care. Specific information on medication administration or clinical procedures will now be found in A00.2 Medications or A00.3 Clinical Procedures.


A Few Words about the Flow Charts:

Performance studies show that flow charts are often easier to utilize at point of care compared to wading through pages of text. In regards to the flow diagrams themselves, you will notice boxes with different shapes, outlines, filling and font colors. These boxes align with the provider skill sets as indicated in appendix A. The white ones contain decision points (questions) or imperatives (actions) that all providers at all license levels will undertake (with appropriate delegation for medications and procedures). These actions include the administration of basic medications and performing one or more of the basic emergency care set of procedures. The pink rectangles contain actions for all paramedics with the primary skill set, or greater. The green boxes contain actions for providers the intermediate skill set and above. The blue rectangles outline actions for advanced level providers, while the red octagons indicate those for critical care paramedics. If you look at C02A Advanced Resuscitation – Adult as an example, there are two greyed-out boxes where the basic and primary boxes are usually located. This indicates that this particular care map applies only to those with the Technician-Advanced Paramedic license level or to those Technician-Paramedics under special considerations. One way arrows indicate a forward progression of steps, such as doing another action or referring to another care map. Bidirectional arrows indicate that one is to move on to a different step or care map that may, or will, eventually return to the original referring map. If you look at A01 Medical Assessment as an example, the white rectangular box “Assure patent airway & adequate breathing” leads to another white rectangle with a two-headed arrow. This means that either you refer to the “Airway & Breathing Management” care map (and may be returned to A01), or use them concurrently as appropriate. Although as an educational strategy we talk about steps occurring sequentially, experienced providers recognize that multiple steps in patient care are often occurring simultaneously or nearly so. Looking at A01 Medical Assessment again, you will notice that references to care maps appear in bold-faced print (“Load & Go”) while actions are not emboldened (“Contact legal authorities”). In keeping with the OMD philosophy (and supported by a burgeoning body of evidence) that providers at the scene are often best situated to determine patient needs, we are building discretion into many of the care maps. For example, if you look at the VF/VT Algorithm in care map C02A Advanced Resuscitation - Adult (algorithm A) you will see the phrase “Consider hyperkalemia” in a green rectangle. This word “consider” enables providers with an intermediate skill set and above to use their own clinical judgement. And although we may not always be correct in our judgements (health care providers are after all only human) we can design tools (such as our care maps) that create a safe process for providing good patient care. Although these changes in design, format and process may seem a little daunting, we hope that as users work through our new care maps, they will work for you and your patients: these are your tools. We will always welcome any suggestions for revision or improvement.


A00.2 MEDICATIONS :

The second major category of patient care tools are the protocols for medication administration. These will replace many parts of the previous Emergency Treatment Protocols. These are grouped into five sets (see also supplement Z05.2 Delegated Acts – Medications):

• Emergency Care (Basic) Medications (white rectangle) • Primary Care Medications (pink rectangle) • Intermediate Care Medications (green rectangle) • Advanced Care Medications (blue rectangle) • Critical Care Medications (red octagon)

A00.3 CLINICAL PROCEDURES:

The third major category of patient care tools is the protocols for clinical procedures and they too will replace much from the previous Emergency Treatment Protocols. These are also grouped into five sets (see also supplement Z05.1 Delegated Acts – Procedures):

• Emergency Care (Basic) Procedures (white rectangle) • Primary Care Procedures (pink rectangle) • Intermediate Care Procedures (green rectangle) • Advanced Care Procedures (blue rectangle) • Critical Care Procedures (red octagon)

Initially, the OMD will work with all Regions and Services to ensure that their existing clinical protocols are in adherence to the standards as set by the Minister. Eventually, the OMD will become the sole authorizing agent for Manitoba. Rather than continuously re-inventing the wheel, the OMD hopes to leverage the good work that already exists throughout the province for the benefit of all providers and patients At the OMD we intend to move away from the current so called current “merit badge” approval process for delegation of reserved medical acts (transfers of function) to a standardized scope of practice that includes a uniform group of skill. These skill “sets” will be in accordance with the 2011 NOCP. Although allowances will be made for unique regional needs and operational realities, we intend that providers at particular provider and / or licensing level will have the same skill set throughout the province (appendix A). For example, if a provider can do an IV start in one region, they will be able to do so in another region of the province, without the need for a formal “recertification” process. Unlike the care maps where paramedics with appropriate delegation will have discretion as to whether or not a particular skill is performed (ie. what is done), the Medication or Procedures will prescribe how that skill is to be done. These will become the standards expected by the OMD (and the employer, and the Regulator) for any clinical procedure or medication administration. If you look at A00.2 Medications or A00.3 Clinical Procedures you will again see that every protocol has a version date and an alpha-numeric identifier code. Medication administration protocols will begin with the letter M (and eventually N or O); while clinical procedure protocols will begin with the letter P (and eventually Q or R). And as with the care map, there may be different versions of the same protocol for patients of different ages. For example, while M14 Resuscitation Medications contains the protocols


for all age categories, P06 Tracheal Intubation is divided into adult (P06A), adolescent (P06B) and child (P06C) versions. The new Medications and Procedures are quite different from the previous Emergency Treatment Protocols. Many of them will have only three or four sections. These include:

• INDICATIONS – The medication can be administered or the procedure performed in these

clinical situations.

• CONTRAINDICATIONS - The medication or procedure is not appropriate in these situations or under these conditions.

• DRUG DOASGES – This is self-explanatory.

• NOTES – Other pertinent information that can be helpful at point of care. Some procedures will have flow diagrams analogous to those featured in the care maps. Some medications or procedures will have one or more appendices containing helpful or frequently used information, such as age-relative equipment sizes. Specific details, such as the actual steps to perform a procedure or administer a medication (for example, how to position the leads in acquiring an ECG) will be covered by other supplemental materials and by undergraduate education and post-employment training. Look at the highlighted statement at the top of A00.2 Medication or A00.3 Clinical Procedures.

“License holders are responsible to maintain satisfactory knowledge and appropriate psychomotor skills for the safe administration of these medications and performance of these procedures, and are required to be familiar with all relevant updates as distributed by the OMD.”

The individual license holder will now be required to play a greater role in continuing professional development and maintenance of proficiency in the performance of clinical procedures or administration of various medications. A00.4 REGULATION & ADMINISTRATION: This section will generally contain information, protocols and procedures required for you to carry out your professional responsibilities

• Materials, such as destination policies or documentation requirements that overlap between clinical care and operations will be included here. As an example, when we develop a pan-Provincial STEMI strategy, the clinical components will be in the Care Maps and / or Clinical Procedures sections, while procedures for bypass to a cardiac capable facility will be found here.

• Z01 is a code of ethics that all personnel are required to follow. • Z02 - Z05.2 are the documents that outline requirements/responsibilities related to delegation

of reserved medical acts.


• Z19.2 Cross References to Care Maps and Medications / Procedures will help providers, managers, and educators correlate all new OMD materials with existing guidelines and protocols. Over time this document will be phased out.

• Z19.1 Revisions Log will be maintained to allow for forward tracking of significant changes to the care maps and clinical procedures.

CONCLUSION:

The updating and revision of the patient care tools will be an ongoing and dynamic process. Our intent is to keep them as current as possible in the rapidly changing world of EMS. We welcome any suggestions, corrections, additions or deletions. Please contact the OMD ( [email protected]) or EMS Branch ([email protected]).

We are also most eager to benefit from the collective expertise out there. If any provider, service or medical director has protocols that they have created or come across otherwise, we would be happy to consider “placing a bison in the corner” and turning them into a Provincial resource.


mailto:[email protected]

mailto:[email protected]

APPENDIX A:

ICON

SKILL SET or

PROVIDER LEVEL

CURRENT PROVIDER

LEVEL

CURRENT PROVINCIAL

LICENSE LEVEL

NATIONAL PROVIDER

LEVEL

Basic

Basic

EMR

Technician

EMR

Primary

Primary

PCP

Technician - Paramedic

PCP

Intermediate

Intermediate

ICP

Technician-Paramedic

PCP

Advanced

Advanced

ACP

Technician – Advanced Paramedic

ACP

Critical

Critical

ACP

Technician – Advanced Paramedic

CCP

Not available at that license / provider level


Highlights of revisions to the ETG’s September 2015

Patient Care Maps

Reassessment of a patient The previous ETG’s (ETG’s) required that the primary survey be repeated at regular intervals (5 – 15 minutes).

The updated ETG’s as reflected in the Patient Care Maps, Medications & Clinical Procedures now indicate that:

The urgency of transport and complexity and frequency of monitoring en route will depend on the patient’s condition and stability, transport time, and the skill set of the treating personnel.

Airway management The previous ETG’s indicated that the nasopharyngeal airway(NPA) is contraindicated in patients under the age of 12. The updated ETG’s as reflected in the Patient Care Maps, Medications & Clinical now indicate:

There is no age restriction for using the NPA.

Breathing management The previous ETG’s indicated that “There are no contraindications to providing high flow oxygen in the out-of-hospital

environment.”

The updated ETG’s as reflected in the Patient Care Maps, Medications & Clinical Procedures now indicate:

Maintain adequate oxygenation. If pulse oximetry is within scope, oxygen should be titrated to “maintain adequate oxygenation”.

Resuscitation The previous ETG’s related to Resuscitation were outdated. The updated ETG’s as reflected in the Patient Care Maps, Medications & Clinical Procedures, include:

Basic resuscitation that follows current standards.

Patient Care Maps divided into age groups

Advanced cardiac resuscitation that follow current ACLS standards.

Addition of Post Arrest Patient Care Maps

C05 - Unstable Bradycardia & Tachycardia – all levels

Reflects current Advanced Cardiac Life Support standards

D01E - Newborn Care & Resuscitation The previous ETG’s related to Newborn Care and Resuscitation were outdated. The updated ETG’s as reflected in the Patient Care Maps, Medications & Clinical Procedures indicate:

Blow-by oxygen is only provided to a newborn if the heart rate is greater than 100 beats per

minute but breathing is labored, or central cyanosis persists beyond ten minutes.

Room air oxygen is used when ventilating the newborn

Ventilate with 100% oxygen after 90 seconds of CPR

Clarification of compression/ventilation ratio

Reassessment of neonate in distress required every 30 seconds.

E03 - Anaphylaxis – all levels

Providers with authorization may now administer Salbutamol.

E10 - Hypoglycemia The previous ETG’s related to hypoglycemia and diabetic emergencies were outdated. The updated ETG’s, as reflected in the Patient Care Maps, Medications & Clinical Procedures now indicate:

If LOC is decreased consider buccal application of glucose paste.

Adjustment to medication

F04 - Spinal Motion Restriction (SMR) The previous ETG’s related to immobilization were outdated. The updated ETG’s as reflected in the Patient Care Maps, Medications & Clinical Procedures was adjusted:

An adjustment to indications /contraindications

Adequate SMR can be achieved by the use of an appropriately-sized rigid cervical collar or other suitable device / method and the following steps:

Instructing the alert cooperative patient to minimize movement.

Minimizing transfers.

Log-rolling the patient for any necessary transfers.

Securing the patient in standard fashion to an EMS stretcher in the full recumbent position.

Utilizing the scoop stretcher or vacuum splint to transfer the patient.

Long spine boards are not required for adequate SMR and must not be used for prolonged immobilization.

They can be used for short periods of time for extrication and transfers.

Previously there was no specific ETG related to the following list:

Fever

General Pain Management

Headache

Nausea & Vomiting

C08A Ventricular Assist Device

E18 Chest Pain (Non ACS)

G02 IFT & Palliative Care - Adult

Procedures

Procedures may only be provided with appropriate delegation.

Age categories have been adjusted to be consistent for all procedures. Changes have been made to all Procedures, please review paying particular attention to:

indications

contraindications

procedure

***NEW***

Addition of Laryngeal Mask Airway as an option for airway maintenance

Medications

Medications may only be provided with appropriate delegation.

Changes have been made to all Medications, please review paying particular attention to:

indications

contraindications

age

dose ***NEW***

Adenosine

Haloperidol

Highlights of Revisions November 2015

Previously Released Patient Care Maps A number of previously released Patient Care Maps, Medication and Procedures, Administration and Regulation documents have been revised. Please refer to Z19.1 for details.

Newly created Patient Care Maps for previous Emergency Treatment Guidelines. HIGHLIGHTS

D02 – Prehospital Delivery The updated ETG, as reflected in the Patient Care Map, was adjusted and now indicates: That if delivery is not imminent the patient should be secured to the stretcher for transport, with the left hip/pelvis elevated. D03.1 – Prolapsed Umbilical Cord The updated ETG, as reflected in the Patient Care Map, was adjusted and now indicates: a. Insert a gloved hand into the vagina to hold the presenting part above the pelvic inlet (brim). Ensure

the hand does not compress or stretch the umbilical cord. THIS POSITION MUST BE HELD UNTIL ARRIVAL AT THE RECEIVING FACILITY, DELIVERY BECOMES INEVITABLE, OR FATIGUE SETS IN.

b. Mother should be appropriately secured to the stretcher for transport, with the hips elevated as much as possible.

c. Do not reinsert the umbilical cord into the vagina.

In flow chart it indicates: Cover cord in moistened sterile gauze

D03.2 – Mal-presentation The updated ETG, as reflected in the Patient Care Map, was adjusted and now indicates: That if delivery is not imminent the patient should be secured to the stretcher for transport, with the left hip/pelvis elevated. F03 - Burns The updated ETG, as reflected in the Patient Care Map, was adjusted and now indicates: • Burns greater than 10% BSA should be covered with clean dry dressings or sheets. Burns less than

10% BSA should be covered with clean moist dressings if less than 30 minutes old, and clean dry dressings if greater than 30 minutes old.

• Additional management for those with the primary skill set and above.

November 26, 2015

F06 – Fractures and Dislocations The updated ETG, as reflected in the Patient Care Map, was adjusted and now indicates: • Exposed bone does not contraindicate necessary reduction of a long bone fracture with possible

vascular or skin compromise. • With obvious deformity, if there is compromise of distal circulation and/or overlying skin, make one

attempt to restore perfusion by axial traction and gentle repositioning. If obvious deformity interferes with patient securement and transport, consider one attempt at repositioning by axial traction and repositioning. If any resistance to repositioning is encountered, splint in the position originally found. If repositioning leads to a loss or decrease in distal pulses, gently return to the original position and splint. Secure and transport the patient as safely as possible.

• Traction splints are difficult to apply and may cause increased pain or tissue injury. Basic splinting techniques (eg. leg-to-leg; arm-to-torso) are effective and safe for pain and injury reduction and transport. If traction splints are used, providers must adhere to manufacturer’s recommendations for application and monitoring.

• Providers with appropriate delegation may consider reduction of isolated joint dislocations as per P24 Reduction of Isolated Dislocations. P24 is currently under development.

• Additional managements for those with the primary skill set and above.

F12 – Amputations & Lacerations The updated ETG, as reflected in the Patient Care Map: • Additional management for those with the primary skill set and above. • Note (a) indicates Replace and/or reinforce dressings as required. Replacing a dressing should not

routinely occur, however special circumstances may require replacement.

ADAPTED from previous ETG’s to the new format: • D03.3 Multiple Gestations • D03.4 Maternal Hemorrhage • E12A Overdose & Poisoning – Adult • E12B Overdose & Poisoning – Adolescent • E12C Overdose & Poisoning – Child • E14A Seizures – Adult • E14B Seizures – Adolescent • E14C Seizures – Child • E12D Seizures – Infant

***NEW*** • E19A Cardiogenic Pulmonary Edema – Adult – for Advanced Level skill set • F09A Traumatic Shock – Adult • F09B Traumatic Shock – Adolescent • F09C Traumatic Shock – Child • F10A Permissive Hypotension in Trauma – Adult – for Advanced Level skill set • H04 O2 Consumption Guidelines

November 26, 2015

Procedures

***NEW*** • P25 Intranasal Drug Administration • P22.1 CPap

Medications

• M21 Nitroglycerine has been updated

***NEW*** • M38 NSAID

Administration and Regulations

Please review the following documents that have been updated from previous Emergency Treatment Guidelines: • Z03 Delegation of Reserved Acts • Z09.1 Emergency Vehicle Operation • Z10 Medical First Response • Z14 Infection Prevention Control • Z15 Controlled Substances • Z20 Home Births & Midwives • Z16 Legislation: replacement for Z16.1 Health Care Directives, Z16.2 Response to Expected Death at

home, and Z17 Personal Health Information Act

***NEW*** • Z11 Physical Restraint • Z13 Orders from Non-EMS Physicians • Z19.1 Revision Tracking log • Z19.2 Cross Reference Emergency Treatment Guidelines to Patient Care Maps.

November 26, 2015

Highlights of revisions to the ETG’s July 2016

The new Manitoba Health, Seniors and Active Living logo will be updated on all Patient Care Maps.

Patient Care Maps

A01 Medical Assessment • Alignment with ACLS • Alignment with trauma assessment • Simplified flowchart • Second flow chart specific to the Primary Survey • A04 Transport replaces “Load and Go”

A02 Trauma Assessment • Alignment with PTLS & ITLS • Alignment with medical assessment • Simplified flowchart • Second flow chart specific to the primary assessment • A04 Transport replaces “Load and Go”

A03 Mass Casualty Incident • Simplified flowchart • Name change from Multiple Casualty Incident

A04 Transport • Major conceptual change from “load & go” • More clinical discretion for on scene interventions • Name change from Load & Go

B01 Airway & Breathing Management – all ages • Reorganization of flow chart • Consolidation of age specific care maps into one document

B02 Airway Obstruction – all ages • Minor changes to flow chart • Consolidation of age specific care maps into one document

C01 – Basic Resuscitation for Cardiopulmonary Arrest From All Causes • Revised title • Alignment with 2015 HSFC Guidelines • Simplified algorithm • “Load and go” changed to transport in flow chart

E15.1A Acute Stroke

• Alignment with Bypass and IFT documents • “Load and go” changed to transport in flow chart

F04 - Spinal Motion Restriction (SMR)

• Alignment with revised A02 Trauma Assessment change. • “Load and go” changed to Transport in flow chart

H03 Care Map Entry/Complaint

• Adjusted Patient Care Map referencing ***NEW***

• 15.2 Stoke Bypass for Primary Response • 15.3 Stoke IFT • 15.4 Pre-arrival Notification of DSF with WRHA

Medications

Medications may only be provided with appropriate delegation.

The new Manitoba Health, Seniors and Active Living logo will be updated on all Medications. M16 - Oxytocin

• correction to dosage information.

Procedures

Procedures may only be provided with appropriate delegation.

The new Manitoba Health, Seniors and Active Living logo will be updated on all Procedures. P02.2 Laryngeal Mask Airway

• changed identifier number to align all airway adjuncts P02.3 Supraglottic Airway Insertion

• changed identifier number to align all airway adjuncts P02.4 Endotracheal Intubation

• changed identifier number to align all airway adjuncts P21.1 Medication Administration Level 1

• changed sublingual application to paste and gel only P21.2 Medication Administration Level 2

• added Sublingual application of spray or tablet

***NEW***

• P02.1 Basic Airway Adjuncts

Administration and Regulation

The new Manitoba Health, Seniors and Active Living logo will be updated on all Medications. Z05.1 Delegated Acts - Procedures

• Sublingual removed from Level 1 Medication Administration and added to Level 2 Medication Administration

• Physical Restraint for ACP changed to delegation for ACP’s Z05.2 Delegated Acts - Medications

• Simple Analgesic changed to delegation for EMR’s

Z09.1 Emergency Vehicle Operations • new titles to define roles and responsibilities:

o Responsibilities of ambulance crew – vehicle operator Section on operating the ambulance in non-emergency mode

o Responsibilities of ambulance crew - patient attendant new line item directing that patient attendant must remain with the patient at all times during transport in the patient care compartment of ambulance vehicle

Z14 Infection Prevention & Control

• revised web link for prevention Z19.2 Cross Reference to Patient Care Maps and Clinical Procedures

• updated to reflect changes to July 2016 release of Patient Care Maps and clinical procedures. ***New***

• Z06.1 Reporting Delegation Technician-EMR • Z06.2 Reporting Delegation Technician-PCP • Z06.3 Reporting Delegation Technician-ACP

A00.1 Care Maps Page 1

Individual license holders are responsible to hold and maintain the appropriate competencies (satisfactory knowledge and appropriate psychomotor skills) for the safe performance of these patient care maps. Clinical care is to be provided in accordance

with the protocols and procedures as established by the Provincial Medical Director and all patient care duties and functions must be performed in accordance with the EMS

Protocols and Procedures as published by the Minister.

A - Adult 17 years & older

B - Adolescent 10 up to 17 years

C - Child 1 up to 10 years

D - Infant 0 to 12 months

E - Neonatal Newly born

A - GENERAL ASSESSMENT Version

A01 Medical Assessment revised 2016-06-10 A02 Trauma Assessment revised 2016-06-10

A03 Mass Casualty Incident revised 2016-06-10

A04 Transport revised 2016-06-10

B - AIRWAY & BREATHING MANAGEMENT

B01 Airway & Breathing Management – All ages revised 2016-06-16 B02 Airway Obstruction – All ages revised 2016-06-16

C - RESUSCITATION & EMERGENCY MEDICAL CONDITIONS

C01 Basic Resuscitation for Cardiopulmonary Arrest From All Causes – All ages revised 2016-06-30

C02A Advanced Resuscitation - Adult 2015-06-17

C02B Advanced Resuscitation - Adolescent 2015-06-17

C02C Advanced Resuscitation - Child 2015-06-17

C02D Advanced Resuscitation - Infant pending

C03A Post Arrest Care – Adult 2015-06-05

C03B Post Arrest Care – Adolescent 2015-06-05

C03C Post Arrest Care – Child 2015-06-05

C04A ICD & Pacemaker Malfunction - Adult 2015-11-18

C05A Unstable Bradycardia – Adult 2015-06-05

C05B Unstable Bradycardia - Adolescent 2015-10-09

C05C Unstable Bradycardia - Child 2015-10-09

C06A Unstable Tachycardia - Adult 2015-06-05

C06B Unstable Tachycardia - Adolescent 2015-10-09

C06C Unstable Tachycardia - Child 2015-10-09

C07A Hypotension & Shock - Adult 2015-06-02

C07B Hypotension & Shock - Adolescent 2015-06-02

C07C Hypotension & Shock - Child 2015-10-09

C08A Ventricular Assist Device - Adult 2015-10-09

D - CHILD BIRTH & NEWBORN CARE D01E Newborn Care & Resuscitation 2015-05-26 D02 Prehospital Delivery 2015-11-18

D03.1 Prolapsed Umbilical Cord 2015-11-18 D03.2 Malpresentation 2015-11-18 D03.3 Multiple Gestations 2015-11-18

D03.4 Shoulder Dystocia Pending D04 Maternal Hemmorhage 2015-11-18

D05 Preeclampsia & Eclampsia pending

A00.1 Office of the Medical Director

2016-06-30 Patient Care Maps


E – MEDICAL & NON-TRAUMATIC CONDITIONS

E01A Abdominal Pain – Adult 2015-06-05

E01B Abdominal Pain – Adolescent 2015-06-05 E01C Abdominal Pain – Child 2015-06-05

E02A Agitation & Behavioural Emergencies – Adult 2015-08-26 E02B Agitation & Behavioural Emergencies– Adolescent 2015-08-26 E03A Anaphylaxis – Adult 2015-10-21 E03B Anaphylaxis – Adolescent 2015-10-21

E03C Anaphylaxis – Child 2015-10-21 E04A Acute Coronary Syndrome - Adult 2015-06-05 E05A Coma & Decreased LOC - Adult 2015-08-26

E05B Coma & Decreased LOC - Adolescent 2015-08-26 E05C Coma & Decreased LOC - Child 2015-08-26 E06A Dyspnea & Respiratory Distress - Adult 2015-11-13 E06B Dyspnea & Respiratory Distress – Adolescent 2015-11-08

E06C Dyspnea & Respiratory Distress - Child 2015-11-08

E06D Dyspnea & Respiratory Distress - Infant 2015-11-08

E07A Fever & Hyperthermia - Adult 2015-11-04 E07B Fever & Hyperthermia - Adolescent 2015-06-24

E07C Fever & Hyperthermia - Child 2015-06-24 E07D Fever & Hyperthermia - Infant 2015-06-24

E08A General Pain Management - Adult 2015-06-02 E08B General Pain Management - Adolescent 2015-06-02 E08C General Pain Management - Child 2015-06-02

E09A Headache – Adult 2015-06-02 E09B Headache - Adolescent 2015-06-02

E09C Headache - Child 2015-06-02

E10A Hypoglycemia & Diabetic Emergencies - Adult 2015-06-18 E10B Hypoglycemia & Diabetic Emergencies - Adolescent 2015-06-18

E10C Hypoglycemia & Diabetic Emergencies - Child 2015-06-18 E11A Nausea & Vomiting - Adult 2015-06-05

E11B Nausea & Vomiting - Adolescent 2015-06-05

E11C Nausea & Vomiting - Child 2015-06-05 E12A Overdose & Poisoning – Adult 2015-11-25 E12B Overdose & Poisoning – Adolescent 2015-11-25

E12C Overdose & Poisoning – Child 2015-11-25 E13A Hypertension – Adult pending E14A Seizures – Adult 2016-04-12

E14B Seizures – Adolescent 2015-07-15 E14C Seizures – Child 2015-07-15

E14D Seizures – Infant 2015-07-15 E15.1A Acute Stroke – Adult revised 2016-06-30 E15.2A Stroke Bypass For Primary Response – Adult New 2016-06-30 E15.3A Stroke Interfacility Transfer – Adult New 2016-06-30 E15.4A Pre-arrival notification of designated stroke facility with WRHA – Adult New 2016-06-30 E16A Syncope – Adult 2015-11-17 E16B Syncope – Adolescent 2015-11-17

E16C Syncope – Child 2015-11-17


E17A Undifferentiated Symptoms – Adult

E17B Undifferentiated Symptoms - Adolescent

E18A Chest Pain - Adult 2015-06-02 E18B Chest Pain - Adolescent 2015-06-05

E18C Chest Pain - Child 2015-06-05 E19A Cardiogenic Pulmonary Edema – Adult 2015-11-16 E20A Alcohol & Drug Withdrawal - Adult E20B Alcohol & Drug Withdrawal - Adolescent

F – TRAUMA & ENVIRONMENTAL CONDITIONS F01 General trauma pending F02A Exsanguinating External Hemorrhage - Adult pending

F02B Exsanguinating External Hemorrhage - Adolescent pending F02C Exsanguinating External Hemorrhage - Child pending F03 Burns 2015-11-17 F04 Spinal Motion Restriction revised 2016-05-24

F05 Eye Trauma & Other emergencies

F06 Fractures & Dislocations 2015-11-17

F07 Frost Bite & hypothermia F08 Impaled objects pending

F09A Traumatic Hemorhage and Shock – Adult 2015-11-12 F09B Traumatic Hemorhage and Shock – Adolescent 2015-11-12

F09C Traumatic Hemorhage and Shock – Child 2015-11-12 F10A Permissive Hypotension in Trauma – Adult 2015-11-17 F11 Head Injury

F12 Amputations & Lacerations 2015-09-30

G -TRANSPORT & INTERFACILITY TRANSFER

G01.1 Preparation for Ground Transport pending

G01.2 Preparation for Air Transport pending G02A Interfacility Transport & Palliative Care of the Imminently Dying Patient – Adult 2015-06-17

G03 Patient Positioning pending

H - REFERENCES & CLINICAL SUPPORT

H01 Pediatric Vital Signs 2015-01-22

H02 Pediatric Airway Sizes Correlated to Broselow Tape 2015-05-12 H03 Care Map Entry by Chief Complaint revised 2016-05-25 H04 Oxygen Consumption Guideline 2015-08-25

Individual license holders are responsible to hold and maintain the appropriate competencies (satisfactory knowledge and appropriate psychomotor skills) for the safe administration of these medications. Clinical care is to be provided in accordance with

the protocols and procedures as established by the Provincial Medical Director and all patient care duties and functions must be performed in accordance with the EMS Protocols and Procedures as published by the Minister.

VERSION M01 Adenosine 2015-08-19 M02 Simple Analgesics & Antipyretics 2015-11-06 M03 Opioid Analgesics 2015-06-17 M04 Antinauseants 2015-06-02 M05 Epinephrine for Anaphylaxis 2015-06-02 M06.1 Glucose 2015-06-18 M06.2 Dextrose 2015-06-18 M06.3 Glucagon 2015-06-17 M07 Benzodiazepines 2015-11-15 M08 Local Anesthetics pending M09 Furosemide pending M10 Hyperkalemia Therapy pending M11 Naloxone 2015-06-17 M12 Oxygen pending M13 Ketamine pending M14 Resuscitation Medications 2015-06-17 M15 Bronchodilators 2015-06-02 M16 Oxytocin revised 2016-05-24 M17 Neuromuscular Blockers pending M18 Anticholinesterases pending M19 Inotropes, Vasopressors & Inodilators pending M20 Sodium Nitroprusside pending M21 Nitroglycerin 2015-11-12 M22 Insulin pending M23 Corticosteroids pending M24 Magnesium Sulfate pending M25 Nitrous Oxide pending M26 Beta Blockers pending M27 Calcium Channel Blockers pending M28 Tranexamic Acid pending M29 Gastrointestinal Bleed Therapy pending M30 Intravenous Fluid pending M31 Mannitol pending M32 Vascular Expanders pending M33 Diphenhydramine 2015-07-10 M34 Haloperidol 2015-06-17 M35 Flumazenil pending M36 Propofol pending


2016-06-30 Medications

A00.2 Medications Page 1

M37 Platelet ADP Inhibitors pending M38 Non-Steroidal Anti-inflammatory Drugs 2015-08-26 M39 Anticholinergics pending M40 Antibiotics pending M41 Anticonvulsants pending M42 Thrombolytics pending M43 Anticoagulants pending

A00.2 Medications Page 2

Individual license holders are responsible to hold and maintain the appropriate competencies (satisfactory knowledge and appropriate psychomotor skills) for the safe performance of

these procedures. Clinical care is to be provided in accordance with the protocols and procedures as established by the Provincial Medical Director and all patient care duties and

functions must be performed in accordance with the EMS Protocols and Procedures as published by the Minister.

A - Adult 17 years & older

B - Adolescent 0 to 12 months

C - Child 1 up to 10 years

D - Infant 10 up to 17 years

E - Neonatal Birth to 72 hrs

VERSION P01.1 Forceps Removal of Supraglottic Foreign Body 2015-06-22 P01.2 Forceps Removal of Tracheal Foreign Body 2015-06-22 P02.1 Basic Airway adjuncts NEW 2016-06-30 P02.2 Laryngeal Mask Airway Insertion revised 2016-05-27 P02.3 Supraglottic Airway Insertion revised 2016-05-27 P04.1 Needle Cricothyroidotomy & Transtracheal Ventilation P04.2 Surgical Cricothyroidotomy P05A Drug Assisted Tracheal Intubation – Adult P05B Drug Assisted Tracheal Intubation – Adolescent P05 Drug Assisted Tracheal Intubation - Child P02.4A Tracheal Intubation –Adult revised 2016-05-27 P02.4B Tracheal Intubation –Adolescent revised 2016-05-27 P02.4C Tracheal Intubation –Child revised 2016-05-27 P02.4D Tracheal Intubation – Infant revised 2016-05-27 P07 Infusion Device Maintenance P08 Intraosseous Device Insertion 2015-11-08 P09 Peripheral Intravenous Cannulation 2015-06-11 P10 Cardiac Monitoring & Rhythm Recognition 2015-06-03 P11 Continuous Waveform Capnometry P12 Defibrillation, Cardioversion and Pacing 2015-06-17 P13.1 Determination of Obvious Death & Stillbirth 2015-11-13 P13.2A Discontinuing Resuscitation-Adult 2015-06-17 P14.1 ECG Acquisition 2015-06-17 P14.2 ECG Interpretation 2015-06-17 P15 Foreign Body Removal from Skin P16 Glucometry 2015-02-18 P17A Needle Thoracostomy for Decompression – Adult 2015-06-11 P18 Pulse Oximetry & Oxygen Administration / Titration 2015-06-03 P19.1 Maintenance of Established Devices – Level 1 2015-11-10 P19.2 Maintenance of Established Devices – Level 2 2015-11-10 P19.3 Maintenance of Established Devices – Level 3 2015-11-10 P19.4 Maintenance of Established Devices – Level 4 2015-11-10 P20 Eye Irrigation P21.1 Medication Administration – Level 1 revised 2016-06-30 P21.2 Medication Administration – Level 2 revised 2016-06-30


2016-07-04 Procedures

A00.3 Procedures Page 1

P21.3 Medication Administration – Level 3 2015-11-10 P21.4 Medication Administration – Level 4 2015-11-10 P21.5 Medication Administration – Level 5 2015-11-10 P22.1A Continuous Positive Airway Pressure (CPAP) Ventilation 2015-11-17 P22.2 Transport Ventilation P23 Emergency Reduction of Fractures & Dislocations P24.1 Reduction of Isolated Joint Dislocations - Shoulder P24.2 Reduction of Isolated Joint Dislocations - Jaw P25 Intranasal Drug Administration 2015-11-15

A00.3 Procedures Page 2

All patient care duties and functions must be performed in accordance with the EMS Protocols and Procedures as published by the Minister.

VERSION Z01 Code of Ethics 2015-09-16 Z02 Minimum Requirements for Practice 2015-05-29 Z03 Delegation of Reserved Acts 2015-11-10 Z04.1 Medical Director Requirements & Responsibilities 2015-11-12 Z04.2 Service Operator Requirements & Responsibilities 2015-11-12 Z04.3 Technician Requirements & Responsibilities 2015-11-25 Z05.1 Delegated Acts – Procedures revised 2016-07-04 Z05.2 Delegated Acts – Medications revised 2016-07-04 Z06.1 Reporting Delegated Acts for Technician NEW 2016-05-24 Z06.2 Reporting Delegated Acts for Technician-Paramedic NEW 2016-05-24 Z06.3 Reporting Delegated Acts for Technician-Advanced Paramedic NEW 2016-05-24 Z06.4 Suspension of Standing Delegation(s) Pending Approval Z07 Documentation Requirements Pending Approval Z08 Refusal of Care Pending Approval Z09.1 Emergency Vehicle Operations revised 2016-05-20 Z09.2 Operation of Ambulance by Fire Fighter Pending Approval Z10 Medical First Response 2015-07-08 Z11 Physical Restraint 2015-08-25 Z12 Other Professionals at Scene Pending Approval Z13 Orders from Non-EMS Physicians 2015-11-25 Z14 Infection Prevention & Control Post Exposure Care revised 2016-05-25 Z15 Controlled Substances 2015-09-22 Z16 Legislation 2015-11-18 Z17 Z18 Quality Assurance Monitoring Z19.1 Revisions Tracking Log revised 2016-07-05 Z19.2 Cross References: Treatment Guidelines to Care Maps revised 2016-07-04 Z20 Homebirths & Midwives 2016-07-04 Z21 Physician Accompaniment on IFT 2015-06-03 Z22 Discharge in the Field

A00.4 EMS Branch / Office of the Medical Director

2016-07-05 Regulation & Administration

A00.4 Regulation & Administration Page 1

The most recent changes are identified in RED

Office of the Medical Director

2016-07-05 Z19.1 Revision Log

Care Map or Clinical Procedure Number

Care Map or Clinical Procedure Name Revision Date Revision or Correction

A00 Emergency Treatment Guidelines 2015 Updated Name A.00.1 Patient Care Maps 2016-06-30 Updated version dates A.00.2 Medications 2016-06-30 Updated version dates A.00.3 Procedures 2016-07-04 Updated version dates A.00.4 Regulation & Administration 2016-07-05 Updated version dates

Patient Care Maps All Documents dated after June 1, 2016 will have the logo updated the Manitoba Health, Seniors and Active Living

A01 Medical Assessment 2016-06-10 Alignment with ACLS Alignment with trauma assessment Simplified flowchart Second flow chart specific to the Primary Survey A04 Transport replaces “Load and Go”

A02 Trauma Assessment 2016-06-10 Alignment with PTLS & ITLS Alignment with medical assessment Simplified flowchart Second flow chart specific to the primary assessment A04 Transport replaces “Load and Go”

A03 Mass Casualty Incident 2016-06-10 Simplified flowchart Name change from Multiple Casualty Incident

A04 Load & Go 2015-11-09 Flowchart – changed non-critical to non-clinical A04 Transport 2016-06-10 Major conceptual change from “load & go”

More clinical discretion for on scene interventions Name change from Load & Go

B01A B01B B01C B01D

Airway & Breathing Management - Adult Airway & Breathing Management - Adolescent Airway & Breathing Management - Child Airway & Breathing Management - Infant

Removed

B01 Airway and breathing Management – All ages

2016-06-16 Reorganization of flow chart Consolidation of age specific care maps into one document

B02A B02B B02C B02D

Airway Obstruction – Adult Airway Obstruction – Adolescent Airway Obstruction – Child Airway Obstruction by Foreign Body – Infant

Removed

Z19.1 Revision Log Page 1

http://www.gov.mb.ca/health/ems/epp/docs/pcm/b01a.pdf


http://www.gov.mb.ca/health/ems/epp/docs/pcm/b01b.pdf


http://www.gov.mb.ca/health/ems/epp/docs/pcm/b01c.pdf


http://www.gov.mb.ca/health/ems/epp/docs/pcm/b01d.pdf







B02 Airway Obstruction – All Ages 2016-06-16 Minor changes to flow chart Consolidation of age specific care maps into one document

C01 Basic Resuscitation for Cardiopulmonary Arrest From All Causes

2016-06-30 Revised title Alignment with 2015 HSFC Guidelines Simplified algorithm “Load and go” changed to transport in flow chart

C05B Unstable Bradycardia – Adolescent 2015-10-09 Header change- intermediate box removed No change to content C05C Unstable Bradycardia – Child 2015-10-09

C06B Unstable Tachycardia – Adolescent 2015-10-09 C06C Unstable Tachycardia – Child 2015-10-09 C07C Hypotension & Shock – Child 2015-10-09 Flowchart - change Low SBP to Normal SBP C08A Ventricular Assist Device – Adult 2015-10-09 Revisions to flow chart and accompanying notes E02A Agitation – Adult 2015-08-26 Name change- added behavioral emergencies E02B Agitation – Adolescent 2015-08-26 E03A Anaphylaxis – Adult 2015-10-21 ‘Supplemental oxygen’ removed from flow chart

as redundant, ensure oxygenation is part of the medical assessment flowchart.

E03B Anaphylaxis – Adolescent 2015-10-21 E03C Anaphylaxis – Child 2015-10-21 E05A Coma & Decreased LOC – Adult 2015-08-26 Appendix – added references E05B Coma & Decreased LOC – Adolescent 2015-08-26 E05C Coma & Decreased LOC – Child 2015-08-26 E06A Dyspnea & Respiratory Distress - Adult 2015-11-13 Flowchart – placed Consider NTG in pink box to

allow PCP administration. Clerical correction Clarification to Notes (d) Added sublingual nitro

E06B E06C E06D

Dyspnea & Respiratory Distress 2015-11-09 Clerical correction

E07A Fever & Hyperthermia – Adult 2015-11-04 Clerical correction E15.1A Acute Stroke 2016-06-30 Alignment with Bypass and IFT documents

“Load and go” changed to transport in flow chart F04 Spinal Motion Restriction 2015-11-17 In flowchart added penetrating head trauma.

Rearranged information in flow chart and notes, removed positioning the patient in full recumbent position. Removed contraindications.

F04 Spinal Motion Restriction 2016-05-24 Alignment with revised A02 Trauma Assessment change. “Load and go” changed to Transport in flow chart

H03 Care Map Entry/Complaint 2015-05-25 Adjusted Patient Care Map referencing


Care Map or Clinical Procedure Number

Care Map or Clinical Procedure Name Revision Date Revision or Correction

Medications M02 Simple Analgesics & Antipyretics 2015-11-06 Dosage changes

Clerical correction M07 Benzodiazepines 2015-11-15 Appendix C Midazolam, procedural sedation for

Adolescent dosage correction Clarified last contraindication

M16 Oxytocin 2016-05-24 correction to dosage information Procedures

P02.2 Laryngeal Mask Airway 2016-05-27 changed identifier number to align all airway adjuncts

P02.3 Supraglottic Airway Insertion 2016-05-27 changed identifier number to align all airway adjuncts

P02.3 Endotracheal Intubation – all levels 2016-05-27 changed identifier number to align all airway adjuncts

P08 Intraosseous Device Insertion 2015-11-25 Clerical correction Change to Notes (c) Removed appendix

P13 Determination of Obvious Death 2015-11-13 Added a number of factors for determination of death. Included stillborn

P19.1 P19.2 P19.3 P19.4

Maintenance of Established Devices 2015-11-10 Adjusted indications for each level, as well as the accompanying notes

P21.1 P21.2 P21.3 P21.4 P21.5

Medication Administration 2015-11-10 Changed from 4 levels to 5 levels. Adjusted indications for each level, as well as the accompanying notes

P21.1 Medication Administration Level 1 2015-11-10 Removed Assisting a patient with self-administration of prescribed medication. Delegation is not required.

P21.1 Medication Administration Level 1 2016-06-30 changed sublingual application to paste and gel only

P21.2

Medication Administration Level 2 2016-06-30 added sublingual application of spray or tablet


Identifier Name Revision Date Revision or Correction

Regulation & Administration Z03 Delegation of Reserved Acts 2015-11-10 Updated to reflect new regulations Z04.1 Medical Director Requirements &

Responsibilities 2015-11-12 First paragraph has been updated and now indicates:

The licensed Service Operator and their Local Medical Director retain the authority to determine which specialized medical functions will be utilized within the Service, based on the operational goals of the Service and the clinical needs of the patient population. The core medical functions represent the minimum scope of practice for EMS personnel providing direct clinical care.

Z04.2 Service Operator Requirements & Responsibilities

2015-11-12

Z04.3 Technician Requirements & Responsibilities

2015-11-12

Z05.1 Delegated Acts - Procedures 2015-11-25 Added Clinical Assessment Removed Nebulizer (placed under Medication Administration procedure Added Tourniquet Application Added Pelvic Binding to Basic Adjusted medication Administration levels Added Clinical Assessment for Diagnosis (integration) to intermediate Added Terminating Resuscitation (adolescent & child) to intermediate Added Blood Chemistry Interpretation and Blood Gas Interpretation to Advanced Added Temperature Probe Insertion to ACP Removed Continuous Positive Airway Pressure Ventilation - Duplicate of Non-invasive ventilation

Z05.1 Delegated Acts - Procedures 2016-07-04 Sublingual removed from Level 1 Medication Administration and added to Level 2 Medication Administration Physical Restraint for ACP changed to delegation for ACP’s

Z05.2 Delegated Acts - Medications 2015-11-13 Added Naloxone (nasal ) to Basic) Moved Oxygen (titration) to Basic Added Crystalloid with Additive9s) to Intermediate Added Purgatives & Laxatives Added Antidotes & Neutralizing Agents Added Osmotic Agents

Z05.2 Delegated Acts - Medications 2016-07-04 Simple Analgesic changed to delegation for EMR’s

Z09.1 Emergency Vehicle Operations 2016-05-20 new titles to define roles and responsibilities: Responsibilities of ambulance crew – vehicle operator Section on operating the ambulance in non-emergency mode Responsibilities of ambulance crew - patient attendant new line item directing that patient attendant must remain with the patient at all times during transport in the patient care compartment of ambulance vehicle

Z14 Infection Prevention & Control 2016-05-25 revised web link for prevention


Old version 2015 New Version

G1 Code of Ethics Z01 Code of Ethics PDF

G2 Scope and Function

Z02 Minimum Requirements for Practice PDF Z03 Delegation of Reserved Acts PDF Z04.1 Medical Director Requirements & Responsibilities PDF Z04.2 Service Operator Requirements & Responsibilities PDF Z04.3 Technician Requirements & Responsibilities PDF Z05.1 Delegated Acts – Procedures PDF Z05.2 Delegated Acts – Medications PDF

G3 Scene Assessment A01 Medical Assessment PDF A02 Trauma Assessment PDF

G4 Triage A03 Multiple Casualty Incident PDF

G5 Primary Survey A01 Medical Assessment PDF A02 Trauma Assessment PDF

G6 Shock

C07A Hypotension & Shock – Adult PDF C07B Hypotension & Shock – Adolescent PDF C07C Hypotension & Shock – Child PDF

G7 Load and Go A04 Transport PDF

G8 Secondary Survey A01 Medical Assessment PDF A02 Trauma Assessment PDF

G9 Unconscious Patient

E05A Coma & Decreased LOC – Adult PDF E05B Coma & Decreased LOC – Adolescent PDF E05C Coma & Decreased LOC – Child PDF

G10A Obstructed Airway Adult & Child

B02A Airway Obstruction – Adult PDF B02B Airway Obstruction –Adolescent PDF B02C Airway Obstruction – Child PDF

G10B Obstructed Airway Infant B02D Airway Obstruction by Foreign Body PDF

G11 Airway Management B01A Airway & Breathing Management – All ages PDF P02.1 Basic Airway Adjuncts PDF

G12 Dyspnea and Respiratory Distress

E06A Dyspnea & Respiratory Distress – Adult PDF E06B Dyspnea & Respiratory Distress – Adolescent PDF E06C Dyspnea & Respiratory Distress – Child PDF E06D Dyspnea & Respiratory Distress – Infant PDF

G13 Cardiopulmonary Resuscitation C01 Basic Resuscitation PDF

G14 Refusal of Care Z16 Legislation PDF G15 Determination of Death P13.1 Determination of Obvious Death PDF G16 Emergency Vehicle Operations Z09.1 Emergency Vehicle Operations PDF

G17 Medical First Response Z10 Medical First Response PDF G19 Infectious and Communicable Diseases Z14 Infectious Prevention & Control PDF G20 Controlled Substances Z15 Controlled Substances PDF G21 Response to an Expected Death at Home Z16 Legislation PDF G22 Automated External Defibrillation C01 Basic Resuscitation PDF G23 Other Professional at Scene Z12 Other Professionals at Scene

G24 Operation of Ambulance by Fire Fighter Z09.2 Operation of Ambulance by Fire Fighter M1 Chest Pain E04A Acute Coronary Syndrome PDF M2 Congestive Heart Failure E19A Cardiogenic Pulmonary Edema – Adult PDF

Office of the Medical Director

2016-07-04 Z19.2 Cross Reference to Patient Care Maps & Clinical Care

Procedures

M4 Chronic Respiratory Diseases B01 Airway & Breathing Management – All ages PDF E06A Dyspnea & Respiratory Distress - Adult PDF

M5 Cerebrovascular Accident E15A Acute Stroke PDF

M5B Acute Stroke Management

E15.2 Stroke Bypass for Primary Response PDF E15.3 Stroke IFT PDF G15.4 Pre-arrival Notification of DSF with WRHA PDF

M6 Seizures

E14A Seizures – Adult PDF E14B Seizures – Adolescent PDF E14C Seizures – Child PDF E14D Seizures – Infant PDF

M7 Diabetic Emergencies

E10A Hypoglycemia & Diabetic Emergencies - Adult PDF E10B Hypoglycemia & Diabetic Emergencies – Adolescent PDF E10C Hypoglycemia & Diabetic Emergencies – Child PDF

M8 Anaphylaxis

E03A Anaphylaxis – Adult PDF E03B Anaphylaxis – Adolescent PDF E03C Anaphylaxis – Child PDF

M9 Abdominal Pain

E01A Abdominal Pain – Adult PDF E01B Abdominal Pain – Adolescent PDF E01C Abdominal Pain – Child PDF

M10 Obstetrical Emergencies

D01 Newborn Care & Resuscitation PDF D02 Prehospital Delivery PDF D03.1 Prolapsed Umbilical Cord PDF D03.2 Malpresentation PDF D03.3 Multiple Gestations PDF D03.4 Shoulder Dystocia D04 Maternal Hemmorhage PDF D05 Preeclampsia & Eclampsia

M11 Poisoning

E12A Overdose & Poisoning – Adult PDF E12B Overdose & Poisoning – Adolescent PDF E12C Overdose & Poisoning – Child PDF

M12 Drug and Alcohol Abuse

E12A Overdose & Poisoning – Adult PDF E12B Overdose & Poisoning – Adolescent PDF E12C Overdose & Poisoning – Child PDF

M13 Mental Health Emergencies E02A Agitation & Behavioural Emergencies – Adult PDF E02B Agitation & Behavioural Emergencies – Adolescent PDF

M14 Obstetrical Triage TBA T1 Soft Tissue Injuries and Wounds F12 Amputations & Lacerations PDF T2 External and Internal Bleeding F02 Exsanguinating External Hemorrhage T3 Amputations F12 Amputations & Lacerations PDF T4 Fractures and Dislocations F06 Fractures & Dislocations PDF

T5 Central Nervous System Injuries F04 Spinal Motion Restriction PDF F11 Head Injury

T6 Eye, Ear, Nose, and Throat Injuries F05 Eye Trauma & Other Emergencies T7 Chest Injuries F01 General Trauma Management

T8 Abdominal Injuries

F09A Traumatic Hemorrhage & Shock – Adult PDF F09B Traumatic Hemorrhage & Shock – Adolescent PDF F09C Traumatic Hemorrhage & Shock – Child PDF

T9 Genital Injuries F01 General Trauma Management T10 Burns F03 Burns PDF T11 Sexual Assault TBA T12 Trauma Triage TBA

E1 Cold Related F07 Frostbite & Hypothermia

E2 Heat Related

E07A Fever & Hyperthermia - Adult PDF E07B Fever & Hyperthermia - Adolescent PDF E07C Fever & Hyperthermia - Child PDF E07D Fever & Hyperthermia - Infant PDF

E3 Near Drowning

E06A Dyspnea & Respiratory Distress – Adult PDF E06B Dyspnea & Respiratory Distress – Adolescent PDF E06C Dyspnea & Respiratory Distress – Child PDF E06D Dyspnea & Respiratory Distress – Infant PDF

A1 EMS Drug Formulary Medication Documents

A2 Routes for Drug Administration

P21.1 Medication Administration – Level 1 PDF P21.2 Medication Administration – Level 2 PDF P21.3 Medication Administration – Level 3 PDF P21.4 Medication Administration – Level 4 PDF

A3 Splinting and Immobilization F04 Spinal Motion Restriction PDF A4 Glasgow Coma Scale N/A A5 APGAR Scoring Scale N/A A6 Normal Vital Signs H01 Pediatric Vital Signs PDF A7 Age-appropriate Weights N/A A8 Fleetnet Radio Identification Numbers N/A A9 Priority for Patient Transport TBA A10 Personal Health Information Act Z16 Legislation PDF A11 Health Care Directives Act Z16 Legislation PDF A14 Medical Abbreviations TBA A15 Metric Conversion N/A A16 Process for Revision of Treatment Guidelines N/A

A17 Tubes Maintenance

P19.1 Maintenance of Established Devices – Level 1 PDF P19.2 Maintenance of Established Devices – Level 2 PDF P19.3 Maintenance of Established Devices – Level 3 PDF P19.4 Maintenance of Established Devices – Level 4 PDF

A18 End of Life Directive Z16 Legislation PDF A19 Pulse Oximetry P18 Pulse Oximetry & Oxygen Administration / Titration PDF