CliniCall Support Services
1-833-829-4099 or 604 829-4099
001 604 829 4099 via Sat Phone
CliniCall: Paramedic Specialist Call Criteria
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).
- Suspected poisoning.
- 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 Call Criteria
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.
Significant Traumatic Injury:
- All penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee
- Flail chest
- Two or more proximal long-bone fractures
- Crushed, degloved or mangled extremity
- Amputation proximal to wrist or ankle
- Pelvic fracture
- Open or depressed skull fracture
- Uncontrolled hemorrhage
- Paramedic impression of major trauma
Significant Mechanism of Injury / Risk Factor:
- 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
- Significant burns
- Time sensitive extremity injury such as an open fracture or fracture with neurovascular compromise
- Pregnancy greater than 20 weeks