1. Base Hospital Physician Update

2. Why am I watching this?
The MOHLTC requires the Base Hospital to orient all the physicians that will answer the patch phone to EMS in Ontario and update the same group on a regular basis
We are also required to prove that Base Hospital Physicians (BHPs) have completed the orientation to the MOHLTC

3. The Advanced Life Support Standards
MOHLTC Document –
Version July 11/17
Version 4.1 Dec. 11/17
Created by – MAC
Provincial Medical Advisory Committee (7 Regional Medical Directors)
Common protocols across our region and across the province
Version to take effect July 17, 2017, which includes Emergency Childbirth Directive. Trach care and suctioning 3

4. App for Smart Phone Download Ontario Paramedic Clinical Guide
All directives at your finger tips

5. The Patch Phone

6. Patching Consider transport time when making decision
What do they want from me on the phone?
Termination Of Resuscitation (TOR) or Field Pronouncement
Medication Orders
Unusual circumstances
medical knowledge vs operational advice
Direction in dynamic arrest / very sick patient
Often the medic has a PLAN- Ask what it is!
They may not be seeking the orders you are giving
Consider transport time when making decision

7. Patching Critical information to allow for pairing patch sheet to ACR:
Get the paramedic’s run number – if they don’t have it make sure to document date, time, service
New patch form, doesn’t have extraneous checklist on the side regarding type of call. Just document pertinent info in each of the boxes. Putting in the run number is helpful as the acr can then be matched to the patch form (orders)

8. Local Protocol Patch Points
ACP
PCP
Pronouncement or further direction with arrest
Trauma TOR
Needle thoracostomy
Dopamine/TCP
Sedation (cardioversion and pacing)
Amio/Lido/Adenosine
Calcium Gluconate/Ventolin hyperK+
Bicarb in TCA or hyperkalemia (as well as CaGluc)
IVF DKA age < 12
Medical TOR
Trauma TOR
Direction
Adam

9. Specific patch points

10. Opioid Toxicity – PCP and ACP
Applies to both PCP and ACP providers
No longer need to patch for Narcan administration
Special circumstances – potential synthetic OD cases may still patch for further doses
Important in the directive is the inability to adequately ventilate, with an indicated resp rate of less than 10 to be included into this directive
Contraindications include an allergy or sensitivity to naloxone, or uncorrected hypoglycemia

11. Tension Pneumothorax - ACP
Due to time sensitive nature of this procedure, and the time delays that are often associated with patches, you may see (very rarely) a medic do a ‘retro’ patch, where they patch after the procedure is done. Again, this procedure is rarely done, and waiting for the go-ahead from BHP may lead to worse outcomes, and as such a medic may go through with this prior to patch.

12. Hyperkalemia - ACP
Digoxin use is a contraindication for the medics to give calcium, however, if uncertain, just ask

13. Summary of Changes

14. Summary of Changes No more Narcan patches
Calcium gluconate and Ventolin in Hyperkalemia

15. Nitro in STEMI
Morphine in STEMI
Modified 12 leads
Adrenal Medication Assist
Emergency Childbirth
Suctioning Directive
D10 for hypoglycemia

16. I have a question, who do I contact?
Overall program questions
Dr. Matt Davis
Central Region (Elgin, Lambton, Middlesex, Oneida, Oxford)
Dr. Sean Doran
North Region (Bruce, Grey, Huron, Perth)
Dr. Don Eby
South Region (Chatham-Kent, Essex)
Dr. Paul Bradford
SWORBHP Website