PARAMEDIC SPECIALIST (PS) CONSULTATION BY PARAMEDICS ON 911 SCENE REQUIRED:
When a patient indicates a non-transport decision AND after evaluation is found to have any one of the following conditions:
Altered mental status.
Evidence of threat to self or others.
Unable to verbalize an understanding of the illness/injury and/or;
Unable to verbalize rational reasons for refusing care despite the risks.
When a patient/legal guardian indicates a non-transport decision AND after evaluation is found to have any one of the following conditions:
Has abnormal vital signs.
Has just experienced an Apparent Life-Threatening Event (ALTE) (including near drowning and resolved airway obstruction).
Hazardous material exposure.
Significant traumatic injury. (*see Appendix A)
Significant mechanism of injury or risk factor. (*see Appendix A)
When encountering Tier Two and Tier Three CBRNE/HAZMAT/HRH events consistent with Technical Advisor policies and procedures.
Application of the Non-Medical Transport Procedure.
When encountering any involvement in a planned, impending or current Law Enforcement action.
Uncertainty to initiate resuscitative efforts. (note: paramedics must start CPR and then contact the Paramedic Specialist)
Uncertainty about treatment and/or application of treatment guidelines.
PARAMEDIC SPECIALIST (PS) CONSULTATION RECOMMENDED:
Uncertainty about patient acuity or clinical condition including advice about clinical upgrades or downgrades.
Hospital decision support such as when there is uncertainty about hospital destination or difficulties arising from advance notification of destination hospital.
Unexpected patient response to treatment.
Patient condition worsening on scene or en-route.
Health Care Professional on scene and wanting to maintain/assume responsibility of patient care and/or disagreement regarding patient management.
Competing priorities among ambulance transport requests.
When encountering Tier One CBRNE/HAZMAT/HRH events.
At the discretion of the paramedic.
CLINICALL EPOS CONSULTATION BY ANY PARAMEDIC ON SCENE IS REQUIRED:
Any termination of resuscitation other than obvious death situation.
Early transport decisions in cardiac arrests.
Refusal of Transport involving an in-custody patient.
When a patient indicates a non-transport decision AND after evaluation is found to have no legal guardian available to determine transport decisions.
Research trial patient enrolment as per the patient identification / enrolment study protocol.
Certain local bypass hospital authorizations. (e.g. hot stroke, ECMO, etc.)
CCP level authorization request for drug/procedure not specified in the Regulation.
When a Treatment Guideline specifies physician consultation.
When Joint Rescue Coordination Centre (JRCC) personnel requesting medical consultation.
Uncertainty about appropriateness of MOST orders, advance directive, DNR order, and/or representation agreement.
EPOS CONSULTATION RECOMMENDED:
When paramedic developing management/transport plan with external or federal agency. (e.g. Search and Rescue, STARS, Parks Canada, etc.)
Non transport decision made by patient/legal guardian and patient is over the age of 65 or under the age of 12 and/or is considered a vulnerable patient. (see Protecting Children and Vulnerable Adults under Patient Care Policy)
At the paramedic’s discretion for any clinical uncertainty or dilemma.
PARAMEDIC SPECIALIST (PS) ESCALATION TO EPOS REQUIRED:
If the PS receives a call that meets the required EPOS direct consultation criteria, the PS should escalate the call to the EPOS physician.
PARAMEDIC SPECIALIST (PS) ESCALATION TO EPOS RECOMMENDED:
Any clinical questions, concerns or uncertainty requiring physician consultation.
Uncertainty about patient viability and decision to initiate resuscitative efforts.
All penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee
Two or more proximal long-bone fractures
Crushed, degloved or mangled extremity
Amputation proximal to wrist or ankle
Open or depressed skull fracture
Paramedic impression of major trauma
Adults: greater than 3 m (10 feet) or 5 stairs
Children: greater than 3 m (10 feet) or 2-3 times the height of the child
Axial load to the head
High-risk motor vehicle trauma [including rollover, extrication time > 20 minutes, impact > 40 km/h (unrestrained) or impact > 60 km/h (restrained)]
Interior compartment intrusion greater than 30 cm occupant site or greater than 45 cm into any area of the passenger compartment
Ejection (partial or complete) from automobile
Death in same passenger compartment
Auto vs. pedestrian/bicyclist thrown, run over, or with significant (greater than 10 km/hr) impact
Motorcycle crash greater than 30 km/hr
Assault with a blunt or edged weapon (not exclusively hit by fist or feet)
Extremes of age
Older Adults: Risk of injury/death increases after age 55
Children: Especially for 12 years and younger
Time sensitive extremity injury such as an open fracture or fracture with neurovascular compromise
Pregnancy greater than 20 weeks