Medic Minutes

Welcome to episode 14 of the BCEHS Medic Minutes podcast. A podcast for Paramedics by Paramedics.

Episode Description & Summary:

In this episode, host Dugg Steary talks with Lucas Hawkes-Frost about pain management fundamentals. This is an audio recording captured from the introductory video of the Learning Hub course “Pain Management Fundamentals”.

Host:

Dugg Steary, MA, CCP – BCEHS Paramedic Practice Leader, Clinical Governance and Professional Practice

Twitter: @DuggSteary

Guest:

Lucas Hawkes-Frost MA, ACP – BCEHS Executive Director, Clinical Governance and Professional Practice

Twitter: @HawkesFrost

Contacts:

Clinical questions – [email protected]

Learning questions – [email protected]

Podcast feedback & suggestions – [email protected]

We have had a bit of a break since rebooting this podcast in August 2022. Many factors made it more difficult than expected to post monthly. We are working to produce this resource more regularly but need your help to do it. Do you have an idea for a podcast episode? Know a paramedic that would make an awesome guest? We want to hear from you; please email us!

Timestamps:

(00:56) Why is pain management important?

(01:28) What is the outcome of proper pain management?

(02:38) Pain management is more than pharmacology.

(02:99) Why should we care about pain management?

(03:44) Challenges of pain management.

(04:19) What is a multimodal approach to pain management?

(06:05) The importance of pain assessment, pain scores, and reassessments.

(08:22) Documentation, why is it so important?

(10:24) Course design overview.

(10:54) Medication, new options, and future options.

(12:24) Conclusions

References & Links:

BCEHS Pain Management Clinical Practice Guidelines:

https://handbook.bcehs.ca/clinical-practice-guidelines/e-medical-emergencies/e08-pain-management/

BCEHS Pain Management Fundamentals for EMR and PCP including Penthrox Learning Hub course:

https://learninghub.phsa.ca/Courses/29995

Welcome to the reboot of the BCEHS Medic Minutes podcast. A podcast for Paramedics by Paramedics.

Episode Description & Summary:

In this episode, host Dugg Steary talks with Stu Woolley about Assess, See, Treat, and Refer (ASTaR) pathways. We discuss the benefits of these pathways for your patients and how to utilize the pathways during paramedic care.

Host:

Dugg Steary, MA, CCP – BCEHS Paramedic Practice Leader

Twitter: @DuggSteary

Guest:

Stu Woolley FdSci, DipHe, PGCert, MCPara, ACP – BCEHS Paramedic Practice Leader

Twitter: @NorthernMedic

Acknowledgements:

Thanks to Erin Garrity, BCEHS Stakeholder and Internal Relations Officer, for her ongoing support as we reboot this podcast.

Contacts:

Clinical questions – [email protected]

Podcast feedback & suggestions – [email protected]

Do you have an idea for a podcast episode? Know a paramedic that would make an awesome guest? We want to hear from you; please email us!

Timestamps:

(01:03) What is ASTaR?

(01:36) What does ASTaR mean for the paramedic in British Columbia?

(02:04) How is ASTaR better for the patient?

(02:40) Referral does not always mean non-conveyance.

(03:50) What ASTaR pathways are in place currently?

(05:26) What myths exist around ASTaR pathways?

(07:33) How to find out more information on ASTaR pathways.

(08:06) Conclusions

References & Links:

BCEHS Assess, See, Treat and Refer (ASTaR) Pathways: https://handbook.bcehs.ca/clinical-pathways/assess-see-treat-and-refer-astar/

BCEHS Assess See Treat and Refer (ASTaR) - Webinar #1:

https://www.youtube.com/watch?v=MzlizhET0OM

COVID-19: Clinical Practice Summary - April 3rd

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Hosts:

Gord Minaker - PCP-IV, UBC Medical Student

Kaela Richardson - Respiratory Therapist, UBC Medical Student

Date of Episode Release:

April 3, 2020

Episode Description & Summary:

In this episode, we review the clinical practice changes that have occurred this week at BCEHS with respect to the COVID-19 pandemic. 

Please see below for a synopsis of this episode.

Please refer to the BCEHS Handbook for the latest guidelines: https://handbook.bcehs.ca

Contacts:

Clinical Questions - [email protected]

Podcast feedback & suggestions - [email protected]

Podcast Synopsis & Timeline:

1:45 - A reminder to listen to our PPE episode, to reduce COVID exposure amongst other crew members and to plan ahead for your safety during the COVID-19 pandemic. 

3:36 - A reminder to use your full region, call sign, and reason for phoning when calling CliniCall. 

4:08 - A reminder about no more nebulizers, and to try to use patient MDI's when possible. MDI's are being distributed in a prioritized fashion. We review ways to safely ensure that the patient's MDI is not expired and how to know when an MDI is empty. 

6:48 - A discussion around new oxygen flow rates. https://handbook.bcehs.ca/covid-19/covid-update-march-31/clinical-practice-updates-covid-19-march-31/

8:30 - A review of the airway management updates to date: https://handbook.bcehs.ca/covid-19/covid-update-march-31/pandemic-airway-practice-update-v7/

10:10 - We discuss precautions for adult resuscitation, reminder to call CliniCall / EPOS at 15 minutes or earlier for transport discussion. Identifying reversible causes early and transport of patients with CPR ongoing will only be recommended in exceptional circumstances. We emphasize good communication with receiving ED if this is the case, and how to handle re-arrests en-route to the ED.

14:15 - We discuss where to find all clinical summaries to date with respect to COVD. https://handbook.bcehs.ca/covid-19/covid-19-clinical-practice-dashboard/

15:40 - Transport of COVID-positive patients in Victoria and Southern Vancouver Island. South Island COVID-19 Transport Directive

18:00 - A reminder to reach out to CISM if you experience Moral Distress. Stay tuned for resilience resources and sessions coming soon!

20:20 - Fire First Responders will not be attending covid positive patients. They will only be dispatched to purple calls, red calls where ambulances are expected to be delayed, and for technical rescues. 

21:04 - Skincare with frequent hand washing - use moisturizer! Notify your supervisor and notify the workplace call centre if you think you have dermatitis.

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Hosts:

Gord Minaker - PCP-IV, UBC Medical Student

Kaela Richardson - Respiratory Therapist, UBC Medical Student

Date of Episode Release:

March 26, 2020

Episode Description & Summary:

In this episode, we summarize and consolidate the clinical practice changes that have occurred at BCEHS as of March 26, 2020.

We also make a correction to our previous PPE podcast, which can be found here: https://blubrry.com/bcehs/57679523/ppe-precautions-paramedic-safety-covid-19/

Please see below for links to resources.

Please refer to the BCEHS Handbook for latest guidelines: https://handbook.bcehs.ca

Contacts:

Clinical Questions - [email protected]

Podcast feedback & suggestions - [email protected]

References & Links:

BCEHS Handbook for latest guidelines: https://handbook.bcehs.ca

Clinical Practice Summary Page: https://handbook.bcehs.ca/covid-19/covid-19-pratice-updates-summaries/

PPE, Precautions & Paramedic Safety: COVID-19

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*** March 26th Update *** The podcast is now current as of March 26th. Slight changes were edited and re-recorded near the end of the presentation regarding the cleaning of ambulances and the proper PPE to be worn while doing so. These changes are consistent with the policies found in the BCEHS Handbook under ‘Cleaning and Disinfection’, and have been validated by Janie Nichols, our infection control specialist. These changes include limiting PPE for routine cleaning of ambulances after COVID transports to using gloves and ACCEL wipes, ventilating ambulances for 20 minutes only after an aerosol-generating medical procedure was performed in the back, and very limited scenarios where N95's and full PPE are required for cleaning.

Resources for Cleaning & Disinfecting: https://handbook.bcehs.ca/clinical-resources/infection-prevention-and-control/cleaning-and-disinfection/

Hosts:

Gord Minaker - PCP-IV, UBC Medical Student

Kaela Richardson - Respiratory Therapist, UBC Medical Student

Guest:

Kevin Lambert - Critical Care Paramedic, Paramedic Practice Educator

Acknowledgements:

Janie Nichols, Infection Prevention Specialist

Date of Episode Release:

March 25, 2020

Episode Description & Summary:

In this episode, we review best practices regarding personal protective equipment (PPE), precautions to be taken on COVID calls, and paramedic safety in the context of COVID-19.

Please see below for a timeline of the questions we ask during this episode, and for links to resources.

Please refer to the BCEHS Handbook for latest guidelines: https://handbook.bcehs.ca

Contacts:

Clinical Questions - [email protected]

Podcast feedback & suggestions - [email protected]

Podcast Timeline:

1:03 - How is COVID-19 spread?

2:16 - What can paramedics do on a day-to-day basis?

4:21 - Are calls still being screened for “Influenza Like Illness” waits?

6:00 - What calls should we be wearing PPE on?

7:14 - What should do before we arrive on-scene to prepare?

9:23 - How should we prepare the ambulance for transport?

13:14 - Are surgical masks ever acceptable when encountering COVID cases?

14:59 - What sort of eye protection should we use?

16:35 - Should we use the buddy system for PPE?

18:19 - Reviewing Donning and Doffing

22:00 - Should we be double gloving?

22:44 - Should we wear boot covers?

24:08 - Limiting gear exposure in the ambulance during transport

26:47 - Reverse Isolation for Patients

27:49 - Who do we need to notify of COVID calls?

29:19 - Reducing the number of people exposed on calls

30:33 - When should drivers doff? What PPE should we wear in the cab of the truck?

32:36 - How should we reduce hospital exposure?

36:15 - How should we clean the ambulances?

39:50 - What PPE should we wear to clean?

44:20 - A final word from Kevin Lambert

References & Links:

BCEHS Doorway Assessment: https://handbook.bcehs.ca/covid-19/covid-19-update-march-23rd/on-scene-doorway-assessment/

Donning PPE video here: https://youtu.be/btrFMvj3Gm8

Hand Hygiene video here: https://youtu.be/J7aILlTnE78

Doffing PPE video here: https://youtu.be/Rro4RJ5Az88

Donning & Doffing Poster: https://handbook.bcehs.ca/clinical-resources/infection-prevention-and-control/ppe/donning-and-doffing/

Hand Hygiene Poster: https://handbook.bcehs.ca/clinical-resources/infection-prevention-and-control/hand-hygiene/cleaning-your-hands/

Cleaning and Disinfecting Resources: https://handbook.bcehs.ca/clinical-resources/infection-prevention-and-control/cleaning-and-disinfection/

Metered Dose Inhalers (MDIs) & COVID-19

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Hosts

Gord Minaker - PCP-IV, UBC Medical Student

Kaela Richardson - Respiratory Therapist, UBC Medical Student

Date of Episode Release:

March 23, 2020

Episode Description & Summary

In this episode, Gord & Kaela review best practices for the use of Metered Dose Inhalers (MDIs) in the prehospital setting. They discuss the benefit of MDIs over nebulizer medications in the context of the COVID-19 pandemic.

Please refer to the BCEHS Handbook for the latest guidelines: https://handbook.bcehs.ca

Contacts:

Clinical Questions - [email protected]

Podcast feedback & suggestions - [email protected]

We need your input! Are these podcasts working for you? Do you have an idea for a podcast episode? Know someone that would make an awesome guest? Please take a moment to fill out our Medic Minutes Survey

Host

Ole Olson - Critical Care Paramedic and Paramedic Practice Leader with BCEHS

Guests

Nina Preto, Ethicist, [email protected]

Alexandra Olmos Perez, Ethicist, [email protected]

Date of Episode Release:

January 15, 2019

Episode Description & Summary

Ethics is a philosophical discipline. It reflects on questions such as: What is valuable? What is good/bad? Is this right/wrong? Why do we think this is right or wrong?

When we say we want to act ethically, we mean that we want to act according to our values, to what we think is important. Sometimes, we may encounter a situation in which we are not sure what to do because there are many options or courses of actions to choose from. Our values will help guide us in choosing what the right thing to do is. When the situation is such that we have to choose between two different values, we are encountering an ethical dilemma.

In the biomedical ethics field, there are many relevant principles, but there are 4 key principles that constitute the most widespread amongst the contemporary Western tradition: Respect for Autonomy, Beneficence, Non-maleficence, and Justice.

In order to have a more clear picture of the situation we are dealing with, there are certain tools that help us understand the situation better, and guide us in breaking down what our options are, and having a thorough analysis of their consequences, but mostly setting the ground for an open discussion, knowing who should be involved and what is really at stake. These are what we call ethics frameworks.

The EHS Ethics framework can be found online: https://intranet.bcas.ca/areas/qsrma/qps/pdf/bcehs-ethics-framework.pdf

Within an emergency care environment, sometimes there is no time to go through the five steps and engage in discussion with others, and must immediately make a choice and sometimes is hard to make a sound ethically justified decision within seconds. And this is when most providers go to the JAY Tool, which stands for:

J – Justifiable: Would I be able to justify my decision.

A - Accountable: Would my peers and coworkers perform this action? Do I think other team members would do the same in my situation? Would they make the same choice?

Y – You: Would you want this, if you were the patient?

To learn more about the BC EHS Ethics Framework or for any ethics related questions please contact the PHSA Ethics Service: 

Alice Virani, Director

[email protected]

Nina Preto, Ethicist

[email protected]

Alexandra Olmos Perez, Ethicist

[email protected]

You can also find more about ethics at PHSA on the POD: http://2pod.phsa.ca/quality-safety/ethics/Pages/default.aspx

Question? Comments? Email: [email protected]

In this episode, Leon Baranowski interviews Mike Christian in a follow-up to Dr. Christian’s Clinical Rounds presentation. He discusses his experiences with London HEMS and gives a unique perspective on exposure to trauma, operational stress, and building resilience. Find the original Clinical Rounds Presentation here: https://youtu.be/WcpEGjKxro0

Host: Leon Baranowski, Paramedic Practice Leader

Guest: Dr. Mike Christian, Research & Clinical Effectiveness Lead with London’s Air Ambulance

twitter: @DrMikeChristian

We need your input! Are these podcasts working for you? Do you have an idea for a podcast episode? Know someone that would make an awesome guest? Please take a moment to fill out our Medic Minutes Survey.

Email: [email protected]