Slide 1 ___________________________________

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ADVANCED PATIENT CARE THEORY 1 ___________________________________
UNIT 1, PART 1: Introduction to ACP Practice
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Rob Theriault BHSc., EMCA, RCT (Adv.), CCP(F)
Professor, Georgian College
© Copyright 2010, 2009, 2007 ___________________________________
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Learning Outcomes

Upon successful completion of unit 1, the student will

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demonstrate the ability to:
 Discuss protocols, standing orders and directivesNOCP ___________________________________
 Discuss reasonable and prudent judgmentNOCP
 Discuss effective problem solving [ critical thinking]NOCP
 List the components of a patient historyNOCP ___________________________________
 Define common medical terminologyNOCP
 Discuss triage and identify circumstances under which triage is
required4.2.c
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 Describe methods of discovering an incident history4.2.c
 Describe common components of an incident history4.2.c ___________________________________
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Slide 3 ___________________________________
Learning Outcomes

Upon successful completion of unit 1, the student will

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demonstrate the ability to:
 List methods of discovering a patient’s medical history4.2.d ___________________________________
 Describe common components of a complete medical history4.2.d
 List situations when information about a patient's last oral intake
may be required4.2.e ___________________________________
 List methods of discovering information regarding last oral
intake4.2.e
 Describe methods of discovering incident information4.2.e ___________________________________
 Explain primary assessment4.3.a
 Distinguish between trauma assessment and primary medical
assessment4.3.a ___________________________________
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Slide 4 ___________________________________
Learning Outcomes

Upon successful completion of unit 1, the student will

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demonstrate the ability to:
 Evaluate life threatening findings from primary assessment4.3.a ___________________________________
 Analyze initial assessments to determine patient's level of distress
and severity of illness or injury4.3.a
 Infer a provisional diagnosis4.3.a ___________________________________
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Slide 5 ___________________________________
Medical Direction

 Must be an emergency room physician who

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continues to work in the ER
 The medical director extends his/her license in order
that paramedics may performed controlled acts
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 The medical director, through the base hospital is
responsible to ensure:
 paramedics receive adequate continuing medical
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education (CME)
 Quality assurance measures are in place - e.g.
chart audits, remedial education.
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 has the authority to deactivate/reactive or
decertify/recertify ___________________________________
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Slide 6 ___________________________________
Standing Orders

 Pre-authorized medical orders

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 Do not require contact with a BHP
 drug, dose, timing, route ___________________________________
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Slide 7 ___________________________________
Protocols

 Broader than a standing order

 Standardized approach to a patient condition
 Describes the sequence of events under which a
standing order is to be carried out
 Incorporates indication(s), conditions, standing
orders, vital sign parameters, etc
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Slide 8 ___________________________________
Medical Directives

 Encompasses standing orders, protocols

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 Overall direction for a given condition or
circumstance
 May not necessarily contain a standing order, but a
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directive to call a BHP for online direction
 May include policies and procedures – e.g. field
pronouncement
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Slide 9 ___________________________________
Reasonable and Prudent Judgment

 Paramedics, like other health professionals, are held

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to a set of standards
 ALS Patient Care Standards
 BLS Standards
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 Medical Directives (provincial/local)
 “the legal test for negligence (i.e., that of the ___________________________________
reasonable or prudent man having regard to all of the
circumstances) is based on the legal reasoning in
Donoghue v. Stevenson” (Theriault, 2007) ___________________________________
 exercise the care that a reasonable and prudent
paramedic in similar circumstances would have
taken (Theriault, 2007) ___________________________________
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Slide 10
WORKING IN A ACP-PCP CREW
CONFIGURATION
Slide 11
WORKING IN A ACP-PCP CREW
CONFIGURATION
 Follow a routine
 Treat your PCP partner with respect – as a
colleague, not a subordinate
 Discuss who will do what in advance
Slide 12
ACP-PCP Roles (e.g. chest pain call)
ACP Lead
 Introduce you and partner
 Ascertain ABCD, c/c, HPI
 Auscultate chest
 Head to toe exam
 Administer ACP Rx (if
indicated)
 Patch to BHP prn
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PCP (non-lead)
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 O2
 Vital signs
 ECG, SpO2 ___________________________________
 Start IV (if certified)
 Elicit/gather medications
 Elicit Hx from family/bystanders ___________________________________
 Administer ASA & NTG (if ACP
hasn’t done so)
 Prepare stretcher
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Slide 13 ___________________________________
ACP-PCP Roles

When does ACP attend?

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 Any time an ACP intervention may be anticipated en
route – e.g. need to IV fluids or medication beyond
simply relief of symptoms
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 General rules
 All CTAS 1 ___________________________________
 99% of CTAS 2 (or all CTAS 2 if local policy
dictates)
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Slide 14 ___________________________________
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QUESTIONS?
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Slide 15 ___________________________________
Resources

ALS Pre-course Manual

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Provincial PCP IV Program Package
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