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BCAS TREATMENT GUIDELINES FOR EMERGENCY MEDICAL RESPONDERS IN BC

FRONTLINE FIRST AID & EMERGENCY TRAINING

250-270-0205

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www.frontlinefirstaid.ca

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Frontline First Aid BCAS Treatment Guidelines for EMR in BC

Page 1 of 9 2018-02-08 www.frontlinefirstaid.ca | 250-470-0205 | [email protected]

Table of Contents

BC EMALB Professional Responder Protocols .............................................................................................. 2

BCAS Treatment Guideline 6.1 .............................................................................................................................. 3

Minimizing On-Scene time for Major Trauma ............................................................................................. 3


Estimating Burn Percentages ............................................................................................................................. 4

On-Scene Cooling Time for Thermal Burns ................................................................................................. 4


Determining Hyperglycaemia ............................................................................................................................. 5

Administration of Glucogel to an Unresponsive Patient ...................................................................... 5

BCAS Treatment Guidelines 7.2 ............................................................................................................................ 6

Hypothermia in Cardiac Arrest .......................................................................................................................... 6

Drug Monograph: Nitroglycerin ............................................................................................................................ 7

EMALB permits Licensed EMRs in BC to administer Nitroglycerin Spray .............................................................. 7

Minimum Systolic Blood Pressure .................................................................................................................... 7

Timing of Nitroglycerin Dosages ...................................................................................................................... 7

Drug Monograph: ASA ................................................................................................................................................ 8

Acetylsalicylic Acid (ASA) .................................................................................................................................... 8

EMALB permits Licensed EMRs in BC to administer Acetylsalicylic Acid (ASA) ................................................... 8

Drug Monograph: Entonox ........................................................................................................................................ 9

Nitrous Oxide (Entonox) ............................................................................................................................................ 9

EMALB permits Licensed EMRs in BC to administer Nitrous Oxide (Entonox) ..................................................... 9

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BC EMALB Professional Responder Protocols

The Canadian Red Cross, BC Ambulance Service and BC Emergency Medical Assistant's Licensing Branch follow the National Occupational Competency Profile (NOCP) for EMR skills...as required by the Paramedic Association of Canada (PAC). They also follow the specific protocols required for Emergency Medical Responders in British Columbia...as laid out in the BCAS Treatment Guidelines. For the most part, the BCAS Treatment Guidelines for EMR skills follow the same protocols as the NOCP. However, there are a few BCAS Treatment Guidelines which differ slightly from the PAC NOCP; which means you need to be aware of them for BC EMR Licensing purposes. These specific BCAS Treatment Guidelines include:

6.1 Trauma Management - Principles 6.5 Thermal Burns - Principles and Interventions 1.3 Hypo & Hyperglycaemia - Principles 7.2 Hypothermia – Cardiac Arrest Drug Monograph - Nitroglycerin Drug Monograph - ASA Drug Monograph - Entonox

BCAS Treatment Guidelines that are specifically relevant to Emergency Medical Responders in

British Columbia are listed in detail in this booklet.

Whenever the BCAS Treatment Guidelines contradict or supplement the PAC NOCP

guidelines included in your Canadian Red Cross Emergency Care Manual…you will follow the

BCAS Treatment Guidelines as an EMR in BC.


http://www.bctg.bcas.ca/

http://paramedic.ca/nocp/



https://bctg.bcas.ca/

https://bctg.bcas.ca/Condition/Principles/16


https://bctg.bcas.ca/Condition/Interventions/8


https://bctg.bcas.ca/Drug/Description/23





BCAS Treatment Guideline 6.1

Minimizing On-Scene time for Major Trauma What the BCAS Treatment Guideline says:

"To maximize survival, scene time must be kept to a minimum. The focus must be on basic care with provision of oxygen, basic airway care, control of bleeding, prevention of further spinal injury, and transport. Anything that can be done on route should be done on route.” • “Spinal stabilization should not delay basic airway care and rapid transport in patients with head

injury or shock. Much can be accomplished by simply reducing any gross neck movement”

“The only interventions that should be carried out prior to transport are: • basic C-spine stabilization during extrication • airway management and ventilatory support of patients with increasing airway obstruction or

failing respirations • relief of tension pneumothorax • simple stabilization of long bone and pelvic fractures

IV therapy, more definitive spinal immobilization, fracture stabilization and the majority of intubations should be carried out during transport."

What this means for Emergency Medical Responders in BC:

Emergency Medical Responders in British Columbia should not delay urgent transport to apply Traction Splints.

• Traction splints are appropriate for suspected femur fractures not involving the hip or knee.

• Traction splinting can be applied on-scene, only if the injuries are not immediately life-threatening.

Example 1: Suspected femur fracture, with no accompanying life-threatening conditions…

▪ Complete Secondary Survey on-scene ▪ Administer Entonox, if appropriate, on scene ▪ Traction Splint, as appropriate for the injury, on scene ▪ Transport should be initiated after the application of the Traction Splint.

Example 2: Suspected femur fracture, accompanied by life threatening conditions…

▪ Complete a Primary Survey and appropriate critical interventions to manage immediate life threatening conditions

▪ Provide simple stabilization of the femur fracture with anatomical/blanket splint ▪ Initiate transport ▪ Complete Secondary Survey on route ▪ Entonox and Traction Splint as appropriate, on route




http://www.bctg.bcas.ca/Condition/Principles/16


















Estimating Burn Percentages

What the BCAS Treatment Guideline says:

Estimating burn coverage…

"Accurate estimation of burn size is essential. Extensive burns are expressed as the total percentage of body surface area (TBSA) with more than superficial burns. Use the Lund and Browder chart to estimate percentage of body surface area..."

Contradictory Information in the Emergency Care Manual:

The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, indicates that the “Rule of Nines” should be applied for on-scene burn percentage estimates


Emergency Medical Responders in British Columbia need to be familiar with the Lund & Browder system for calculating burn percentages…as well as the “Rule of Nines”.

On-Scene Cooling Time for Thermal Burns


Cooling burns on scene… "Cool burns 1-2 minutes followed by clean dry dressings during transport."


The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, indicates that burns should be cooled until pain subsides and the burned area is cool to touch.


Emergency Medical Responders in British Columbia should only spend 1-2 minutes cooling major burns…while on scene.

Continue to cool burns following the Emergency Care Manual guidelines while enroute.

Once a burn has been sufficiently cooled, dry sterile dressings should be applied to prevent infection.




http://weebly-file/3/1/7/5/3175302/bc_emr_burn_calculations_-_lund_and_browder.pdf

http://weebly-file/3/1/7/5/3175302/bc_emr_burn_calculations_-_lund_and_browder.pdf

http://frontlinefirstaid.ca/uploads/3/1/7/5/3175302/bc_emr_burn_calculations_-_lund_and_browder.pdf

http://frontlinefirstaid.ca/uploads/3/1/7/5/3175302/bc_emr_burn_calculations_-_lund_and_browder.pdf


http://www.bctg.bcas.ca/Condition/Interventions/12

http://www.bctg.bcas.ca/Condition/Interventions/12




Determining Hyperglycaemia


Determining Hyperglycaemia… "Hyperglycaemia - elevated glucose level (higher than 11 mmol/L)"


The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that blood glucose levels above 8 mmol/L are considered Hyperglycaemic.


Emergency Medical Responders in British Columbia will consider capillary blood glucose (capBgl) levels higher than 11 mmol/L to be clinically Hyperglycaemic.

CapBgl levels below 11 mmol/L will not be considered Hyperglycaemic.

Administration of Glucogel to an Unresponsive Patient


Administration of Glucogel to Unresponsive Patients…

• "Position the patient – on side if unconscious"

• “Correct suspected or confirmed Hypoglycaemia o Glucogel”


The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that nothing, other than an airway management device, may be placed in the mouth of an unresponsive patient.


Emergency Medical Responders in British Columbia will administer oral Glucogel to an unresponsive patient, if Hypoglycaemia is suspected or confirmed.












When administering Glucogel to an unresponsive patient, follow the procedures outlined in the BCEHS “Oral Glucose Position Statement”.

BCAS Treatment Guidelines 7.2

Hypothermia in Cardiac Arrest


Determining Cardiac Arrest… “The hypothermic patient has reduced metabolic demands and may have significant bradycardia and

decreased respiratory rate.

For this reason, 30 seconds should be taken to accurately detect the presence of spontaneous

respirations and a pulse.”


The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that up to 45 seconds should be taken to assess the pulse of a patient with suspected Hypothermia.


Emergency Medical Responders in British Columbia should assess the pulse of a patient in suspected Hypothermia for at least 30 seconds before beginning CPR-AED protocols.


http://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/heath-care-partners/colleges-board-and-commissions/emergency-medical-assistants-licensing-board/emalb2015-05.pdf






Drug Monograph: Nitroglycerin EMALB permits Licensed EMRs in BC to administer Nitroglycerin Spray Medications not specifically listed as "EMR Interventions" in the BCAS Guidelines are considered "Out of the Scope of Practice" for Emergency Medical Responders in British Columbia

Minimum Systolic Blood Pressure What the BCAS Treatment Guideline says:

“Dosage (Adult) 0.4 mg spray SL - repeat q 3 min. - maintaining B/P > 90 systolic…"


The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that a Systolic Blood Pressure of less than 100 mmHg contraindicates the administration of Nitroglycerin

What this means for Emergency Medical Responders in BC: Emergency Medical Responders in BC will regard 90 mmHg as the minimum Systolic Blood Pressure required to administer Nitroglycerin.

Timing of Nitroglycerin Dosages What the BCAS Treatment Guideline says: "Dosage (Adult) 0.4 mg spray SL - repeat q 3 min. - maintaining B/P > 90 systolic..."


The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states Nitroglycerin can be administered Q5 (every 5 minutes).

The Emergency Care Manual also stipulates that no more than 3 doses can be administered in a 30-minute cycle.

What this means for Emergency Medical Responders in BC: Emergency Medical Responders in British Columbia can administer Nitro Q3-5 (every 3-5 minutes) for as long as the Chest Pain persists, and the patient maintains a minimum Systolic BP of 90 mmHg.




http://www.bctg.bcas.ca/Drug/Description/23









Drug Monograph: ASA

Acetylsalicylic Acid (ASA)

EMALB permits Licensed EMRs in BC to administer Acetylsalicylic Acid (ASA) Medications not specifically listed as "EMR Interventions" in the BCAS Guidelines are considered "Out of the Scope of Practice" for Emergency Medical Responders in British Columbia

Administer within the Indications, Contraindications and dosages outlined in your Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP.

Specific BC EMALB Licensing Requirement

BC EMALB has released a position statement outlining the importance of administering ASA as soon as possible, when appropriate for the management of cardiac related chest pain. Specifically, this document stipulates that ASA should be administered (if appropriate) before or during the collection of Vital Signs…not after.

What this means for Emergency Medical Responders in BC

When a patient is showing Signs and Symptoms suggestive of a possible heart attack, Responders should immediately utilize the SAMPLE-OPQRST mnemonics (History) to determine if ASA is appropriate.

If appropriate, have the patient chew two 81mg ASA or one 325 mg ASA before continuing with further assessment and treatments.

ASA is the only medication which does not require a full set of Vital Signs before Administration.




https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/heath-care-partners/colleges-board-and-commissions/emergency-medical-assistants-licensing-board/emalb2016-20.pdf



Drug Monograph: Entonox

Nitrous Oxide (Entonox)

EMALB permits Licensed EMRs in BC to administer Nitrous Oxide (Entonox) Medications not specifically listed as "EMR Interventions" in the BCAS Guidelines are considered "Out of the Scope of Practice" for Emergency Medical Responders in British Columbia

You should be familiar with the Indications, Contraindications and dosages outlined in your Canadian Red Cross Emergency Care Manual, as well as the BCAS Treatment Guidelines outlined below…

Entonox Indications:

• Relief of moderate to severe pain

• Cardiac related chest pain, where Nitroglycerin will be of no value, or is contraindicated. Must be followed by high flow oxygen when discontinued

• Isolated extremity injuries, pain associated with burns excluding mechanisms associated with potential inhalation injury, etc.

Entonox Contraindications:

Artificial, traumatic or spontaneous pneumothorax

Air Embolism

Decompression sickness

Following a recent sky dive

Severe bullous emphysema

Gross abdominal distension

Altered mental status

Inability to comply with instructions

Inhalation injury

BCAS Entonox Contraindication Mnemonic:

C – ability to COMPLY

D – DECOMPRESSION sickness

C – altered level of CONSCIOUSNESS

P – PNEUMOTHORAX

A – AIR emboli

I – INHALATION injury

N – NITROGLYCERIN use within 5 mins

Entonox Precautions:

Inability to ventilate area

Nitroglycerin use within 5 minutes of administration

BCAS Entonox Precaution Mnemonic:

S – SHOCK

A – ABDOMINAL distenstion

D – DEPRESSANT drugs

C – COPD

F – FACIAL injuries

Alternative Entonox Contraindication Mnemonic:

D – Decompression sickness

I – Inability to comply

V - Ventilation

I – Inhalation injuries

N – Nitrogen in the past 5 minutes

E – Embolism (air bubbles)





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