Introduction
“A Base Hospital is a hospital that has been designated as such by the Minister to assist
and work with the Ministry to monitor and ensure the quality of ambulance based pre-
hospital patient care. A Base Hospital provides medical direction and advice to
ambulance based pre-hospital emergency healthcare providers within a broad based,
multi-disciplinary, emergency health services system in a specified geographical area.
This involves the Base Hospital acting as a resource centre and facilitator to assist the
Ministry in ensuring that ambulance based pre-hospital care and transportation meets
the patient care standards as set out in Regulation 257/00. The Base Hospital also
functions in the advisory capacity to the Ministry of Health and Long-Term Care on
matters relating to ambulance based pre-hospital emergency care. Base Hospitals will
support and work cooperatively with the Ministry towards the accomplishment of
Emergency Health Services Branch objectives. A Base Hospital is a vital part of the
Ministry of Health & Long Term Care’s team in its partnership with Upper-Tier
Municipalities and Designated Delivery Agents for the provision of Land Ambulance
Services”. (Regional Base Hospital Performance Agreement, Page 5, Item 2.0)
Thunder Bay Regional Health Sciences Centre (TBRHSC), formerly known as the
McKellar Hospital, has been designated as a Base Hospital by the Minister since 1986.
In 2008 the Ontario Base Hospital system was downsized from 22 provincial sites to 7;
Thunder Bay Regional HSC was re-designated as the Host Hospital for the NW Region
Base Hospital Program at that time. The NW Region Base Hospital Program services
the geographical area of Northwestern Ontario; the combined area spanning east/ west
from Manitouwadge to the Manitoba border and north/ south from Red Lake to Rainy
River.
Contact
Ms. Elaine Graham, Program Manager
NW Region Base Hospital
289 Munro St. Lower Level
Thunder Bay, ON P7A 2N3
(807)683-2733
Dr. Andrew Affleck, Program Medical Director
NW Region Base Hospital
289 Munro St. Lower Level
Thunder Bay, ON P7A 2N3
(807)683-2731
Rainy River District EMS 3rd & 4th Quarter Reports 1
Vision Mission Values
Vision We will lead and inspire paramedics to provide exceptional pre-hospital care in Northwestern Ontario.
Mission
We will provide medical direction and oversight that promotes trust and supports best
practice through our education, training, and quality assurance programs.
Values
We value patient and family centered care; we will instill dignity and respect, communication and information sharing, collaboration, and participation in the delivery of pre-hospital care. We value partnerships that are accountable, participative, and respectful. We value life-long learning and education that is supportive, innovative, and dynamic. We value continuous quality improvement that promotes safety, best practice, efficiency, and professionalism.
We value research that is pre-hospital care focused.
Key Performance Indicators (KPI)
NW Region Base Hospital deliverables and performance measures are based on 4 Key
Performance Indicators (KPI) as set out by the Minister of Health within the Regional
Base Hospital Performance Agreement:
Medical Delegation
Medical Oversight
Education
Continuous Quality Improvement (CQI)
This report is a combined 3rd & 4th Quarter Report for the period July 1, 2013 to
December 31, 2013:
Section 1: Regional Program Reports
Section 2: Rainy River District EMS Service Reports
Rainy River District EMS 3rd & 4th Quarter Reports 2
SECTION 1:
Regional Program Reports
3rd
& 4th
Quarter 2013
Rainy River District EMS 3rd & 4th Quarter Reports 4
Section 1: Regional Program Reports
Medical Directorship
Medical Director Name
Title
Dr. Andrew Affleck NW Regional Program Medical Director
Dr. Bill MacGregor ACP Medical Director
Dr. Paul Dupuis PCP Medical Director
As of Dec 31, 2013
Designated Delivery Agents and Number of Paramedics
Designated
Delivery
Agent
EMS
Service
Name
Manager /CAO/
Director/ or
Chief of EMS
Number of Paramedics Employed
EMA / PCP / ACP
Naotkamegwanning First Nations
Naotkamegwanning EMS
Jim Green 0 18 0
Rainy River
District Services
Administration
Board
Rainy River District EMS
Dan McCormick
0 53 0
Kenora District
Services Board Northwest EMS
Andrew Tickner
1 105 0
City of Thunder Bay Superior North EMS Norman Gale 0 162 19
Number of Paramedics Employed by More than One EMS Service = 19
Total Number of Paramedics in NW Region minus the number of paramedics employed
by more than one service = 339
As of Dec 31, 2013
Rainy River District EMS 3rd & 4th Quarter Reports 5
ALS Equipment & Data Management
EMS Service Name
ACR Type
ACE Type
ECG Type
SAED Model
Naotkamegwanning EMS Electronic Electronic Electronic Zoll
Rainy River District EMS Electronic Electronic Electronic Zoll
Northwest EMS Electronic Electronic Electronic Zoll
Superior North EMS Electronic Electronic Electronic MRx
As of Dec 31, 2013
Certification Requests
Completed by NW Region Base Hospital
3rd & 4th QTR July 1-Dec 31/2013
Type of Certification
Request
Absence from practice/college
< 90 days
> 90 days to 1 year
> 1 year to 2 years
Over 2 years
New Hire Initial Cert
PCP 0 PCP 0 PCP 1 PCP 1
ACP 0 ACP 0 ACP 0 ACP 0
LOA Return to Work (RTW) Cert
N/A PCP 6 PCP 3 PCP 0
N/A ACP 0 ACP 0 ACP 0
Sub Totals 6 4 1
Total 11
Rainy River District EMS 3rd & 4th Quarter Reports 6
Advanced Life Support Patient Care Standards (ALSPCS)
NW Region Base Hospital ensures that all current certified paramedics/EMAs are
qualified to perform the Delegated Controlled Acts and/or other medical procedures as
recommended by the Provincial Medical Advisory Committee (PMAC) and Director.
The NW Region Base Hospital adheres to the Provincial Medical Directives
recommended by the Provincial Medical Advisory Committee (PMAC) and approved by
the Director;
For this reporting period ALS patient care has been monitored by the NW Region Base Hospital in accordance with the Advanced Life Support Patient Care Standards (ALSPCS), Nov 2011, Ver. 3.0
Approved Non Delegated Controlled Acts: Medical Oversight Only
Approved Non Delegated Controlled Acts Procedure/Therapy Requires Medical Oversight
PCP ACP
Lead II Cardiac Monitoring Yes Yes
Lead II ECG Interpretation NSR, Bradycardia, Tachycardia, Asystole, V-Fib, Pulseless V-Tach, PEA
Yes Yes
Lead II ECG Interpretation PSVT, BBBs, A-Fib, A-Flutter, V-Tach (with pulse), Paced, Junctional, PVCs
No Yes
Supraglottic (King LT) Airway* Yes Yes
Continuous Positive Airway Pressure (CPAP* Yes Yes
As of June 30, 2013
Medical Oversight for Non Delegated Medical Acts may include, but is not limited to:
Review and approval of all course material to ensure consistency with the
provincial education requirements;
Development of educational material;
Approval/assistance in selecting service instructors and regional educators;
Participation/presence (auditing) during train-the-trainer, didactic, and clinical
sessions;
Refresher training for regional educators and service instructors;
Chart Audit
Medical Quality Care Review
Guidance on choice of patient care equipment
Rainy River District EMS 3rd & 4th Quarter Reports 7
Approved Delegated Controlled Acts: Medical Delegation Required
Delegated Controlled Act:
Procedure/Therapy Requires Medical Delegation
PCP ACP
Blood Sampling: Glucose Yes Yes
Analyze-automated Device(no shock delivered) Yes No
Semi Automatic Defibrillation: Adult & Pediatric Yes No
Manual Defibrillation: Adult & Pediatric *Yes Yes
12 Lead Interpretation *Yes Yes
Central Venous Line Maintenance (Access) No Yes
Extubation(unintentional) No Yes
Extubation by Provider(Intentional) No Yes
Needle/Surgical Cricothyroidotomy No Yes
ORO-Tracheal Intubation No Yes
Unsuccessful E.T.T Intubation No Yes
E.T.T Suctioning No Yes
E.T. Tube Verification No Yes
IV Saline Lock *Yes Yes
Ringers lactate No Yes
Fluid Bolus *Yes Yes
IV Discontinued by Provider(Intentional) *Yes Yes
Intraosseous Infusion Initiation No Yes
Unsuccessful Intraosseous No Yes
Pronouncement of Death Yes Yes
Cardioversion No Yes
Carotid Sinus Massage No Yes
IV Normal Saline *Yes Yes
Valsalva Manoeuvre No Yes
Needle Thoracostomy No Yes
Unsuccessful Needle Thoracostomy No Yes
Nasal Tracheal Intubation No Yes
Unsuccessful E.T.T Nasal No Yes
Laryngoscopy/Foreign Body Removal/McGill Forceps No Yes
Return of Spon. Circulation(ROSC) Yes Yes
Unsuccessful Attempt-Laryngoscopy/Foreign Body Removal/McGill
No Yes
* Currently not available in all NW Region EMS Services
Rainy River District EMS 3rd & 4th Quarter Reports 8
Approved Delegated Controlled Acts: Medical Delegation Required
Medication Administration and Fluid Therapy by Route
Medication or Fluid Therapy
Route
PO SL NB AE ETT PR IM **IV IO
Adenosine A A
Aspirin A/P
Atropine A A A
Diphenhydramine (Benadryl) A/P A/P* A
D50W A/P* A
Dopamine A A
Epinephrine 1:1,000 A/P A/P
Epinephrine 1:10,000 A A A
Glucagon A/P
Glucose: Oral A/P
Dimenhydrinate ( Gravol) A/P A/P* A
Lasix(Furosemide) A A
Lidocaine Drip A A A
Lidocaine Spray.5% A
Midazolam(Midazolam) A A A
Morphine A A A
Narcan(Naloxone) A A A
Nitroglycerin A/P
Normal Saline A/P* A
Salbutamol (Ventolin) A/P A/P
Valium(Diazepam) A A A A
Sodium Bicarbonate A A
A= ACP P= PCP *P= PCP (IV) **IV includes CVAD
Rainy River District EMS 3rd & 4th Quarter Reports 9
On Line Medical Control: Base Hospital Physician Patches
NW Region Base Hospital (NWRBH) ensures that all Base Hospital Patch Physicians
(BHPPs) are knowledgeable regarding paramedic practice and provincial medical
directives and that they are available for online medical direction and control on a 24/7
days a week basis. Every designated BHPP is “appointed” he/she attends an
information session with the Program Medical Director or designate and is provided a
BHPP information manual prior to commencing this work.
Base Hospital Patch Physician and Paramedic online interactions (patches) are subject
to medical quality care review on a regular basis by the Base Hospital. 100% of BHPPs
are reviewed by the NW Region Base Hospital.
Refer to the following Base Hospital Policies & Procedures for review of the patching
procedures in your area:
On Line Medical Control PCP - Policy MC 100
On Line Medical Control PCP Back Up Procedures (PCP) - Policy MC 100A
On Line Medical Control ACP – Policy MC 100B
Base Hospital Patch Physician (BHPP) Report
3rd
& 4th
QTR July 1- Dec 31/2013
EMS Service
Name
Patches by
PCPs Patches by
ACPs
Patch Failure
Reports
Superior North EMS 20 76 4
Northwest EMS 11 2
Rainy River District EMS 2 0
Naotkamegwanning EMS 4 0
Total 37 76 6
There were a total of 113 patches to BHPPs made by NW Regional Paramedics
in the 3rd & 4th QTR 2013 (July - Dec)
6 reports of failed attempts to patch to the BHPP were received by the NW
Region Base Hospital during this period.
o Location of failed patch: 4 in Thunder Bay(City)
reason: poor cell service/dropped call
reason: put on hold/no BHP pick up
reason: BHP unavailable to come to phone
reason: patch number out of service
o Location of failed patch: 2 in NWEMS
reason: dispatcher error
reason: BHP hung up, medic didn’t hear doctor on line was
speaking with patient at time.
Rainy River District EMS 3rd & 4th Quarter Reports 10
Each report of patch failure is reported to the EHS Branch as per the
Performance Agreement
Follow up on each patch failure report is completed by the NW Region Base
Hospital to ensure system and human errors are corrected as soon as possible
Education
The setting of standards for education, evaluation, continuing medical education and
competency maintenance of Paramedics/EMAs is the exclusive right of the Ministry of
Health and Long-Term Care (MOHLTC).
The NW Region Base Hospital provides a process to confirm and/or ensure the
education and standard of practical skills necessary for certification and delegation of
specific Delegated Controlled Acts approved by the Provincial Medical Advisory
Committee (PMAC) to Paramedics/EMAs;
Regional Base Hospitals are required to provide a minimum amount of education per
Paramedic/EMA each year. Currently the minimum requirements are: Primary Care
Paramedic – 8 hrs and Advanced Care Paramedic – 24 hrs.
Education Hours
Level of Paramedic
Annual
Mandated Hrs of
Education
Annual Skills
Review
Clinical CME
Didactic CME
Voluntary
CME*
Total Hrs of Education Offered by
NWRBH Each Year
ACP 24 4 hours 8 hours 12 hours 24
PCP 8 4 hours 0 hours 4 hours 8
*Voluntary CME opportunities may be offered from time-to-time as resources permit.
Attendance is strictly voluntary (non compensatory) and test results do not affect certification status.
Rainy River District EMS 3rd & 4th Quarter Reports 11
Patient Care Deficiencies: Omissions
If a paramedic has performed a Controlled Act or any patient care below the recognized
standard/guidelines, the Base Hospital Medical Director’s response is guided by the
severity of the event in accordance with the following definitions provided within the
current Maintenance of Certification Policy:
Minor Omission/Commission is defined as an action or lack of action by the
Paramedic/EMA that did not have any direct effect on patient morbidity, however, may
have affected patient care in a minor way. If a minor deficiency is identified the
paramedic may be given verbal counseling (confirmed in writing) or written counseling
via the ambulance call review process.
Major Omission/Commission is defined as an action or lack of action by the paramedic
that has affected or has the potential to affect patient morbidity, however, the outcome
would not be life threatening. If a major deficiency is identified, or there is a repetition of
minor deficiencies, the paramedic will be given written counseling and may be required
to complete remedial education. At the discretion of the medical director the paramedic
may be deactivated.
Critical Omission/Commission is defined as an action or lack of action by the
paramedic that has a clear affect on patient morbidity with a potential life threatening
outcome. If a critical deficiency is identified or there is a repetition of major or
combination of major and minor deficiencies the paramedic will be given written
counseling and will be required to successfully complete remedial education. At the
discretion of the medical director the paramedic may be decertified.
ACP and PCP Omission Report
3rd
& 4th
QTR July 1-Dec 31/2013
Minor Omission Major Omission Critical Omission
Rainy River District EMS 0 0 0
Northwest EMS 5 1 0
Naotkamegwanning First Nations EMS 1 0 0
Superior North EMS District Operations
8 2 0
Superior North EMS City: ACP 0 0 0
Superior North EMS City: PCP 1 0 0
Total: 15 3 0
Rainy River District EMS 3rd & 4th Quarter Reports 12
Remedial Education Program A remedial education program based on individual needs will be made available to the Paramedic/EMA at the Base Hospital Medical Director’s discretion. Remedial education may consist of, but is not limited to, self directed didactic review, scenario practice, clinical rotations or supplementary educational programs as deemed necessary by the Program Medical Director.
Deactivation and Decertification
If at any time in the judgment of the Base Hospital Program Medical Director, conditions
for certification have not been maintained, the Base Hospital Medical Director may
deactivate or decertify the Paramedic/EMA.
Deactivation is the temporary suspension of selected certified paramedic privileges to
perform Controlled Acts by the Base Hospital Medical Director for the purposes of
performing remediation.
Decertification is the revocation of a paramedic’s privileges to perform Controlled Acts.
NW Region Base Hospital Deactivation and Decertification Report
3rd
& 4th
QTR
July 1-Dec 31/2013
Number of
Paramedics
Administrative Deactivation
> 90 Day LOA
Separated from Service
8 14
Clinical Deactivation
Deficiencies/Remedial Education Required 0
Administrative Reactivation Return to Work:
Greater than 90 Days
Greater than 1 Yr
Greater than 2 Yr
4 3 0
Clinical Reactivation
Remedial completed 0
Decertification 0
Rainy River District EMS 3rd & 4th Quarter Reports 13
Continuous Quality Improvement (CQI)
Paramedics/EMAs must demonstrate competency and adherence to standard protocol
and legislation associated with the performance of Controlled Acts and the provision of
patient care at their level of certification. This will be determined through Base Hospital
CQI initiatives which may include, but are not limited to:
Chart Audits
Peer Review
Ride-Outs
Dispatch/Base Hospital Physician Communication Review
Field Performance Evaluation
Successful Performance at CME
Call Review
Policies & Procedures
The NW Region Base Hospital Policy & Procedure Manual is reviewed annually and is
otherwise updated as necessary. Notices of policy updates are distributed to all regional
stakeholders as required. It is the responsibility of every certified Paramedic/EMA to
ensure they have read all Base Hospital policies and procedures, remain current and are
compliant with the required practices.
Our policy and procedure manual is available electronically and can be located on the
NW Region Base Hospital website:
http://www.tbrhsc.net/clinical_partners/base_hospital/base_login/base_login.asp
User Name: basehosp Password: policies
Human Resources Inventory
Maintenance of Certification requires that every Paramedic:
Be employed by an Emergency Medical Service and work as a Paramedic or Paramedic Preceptor (and meet the annual eligibility requirements outlined in the Provincial Base Hospital Standards);
Notify the Base Hospital of any period of absence from practice greater than 90 days;
Be scheduled to work a minimum of 144 hours per year.
Please ensure that your EMS services have established a tracking and reporting
process to provide this information to the Base Hospital each year as required.
Rainy River District EMS 3rd & 4th Quarter Reports 14
Regional Educator (RE) Report:
Certified Regional Educators
3rd
& 4th
QTR July 1-Dec 31/2013
Regional Educator By Name
Level of Certification
EMS Service By Name
Year of Certification
Jesse Laybourne PCP NWEMS Feb 2005(Resigned Dec-2013)
Charlene Mackey PCP NWEMS Feb 2005
Kristy McQuay PCP RRDEMS Feb 2005
Cheryl Kallaste PCP RRDEMS Feb 2011
Paula Verin PCP SNEMS Feb 2005
David Black PCP RRDEMS Mar 2013
Robin Pollard PCP RRDEMS Mar 2013
Amy Welsh PCP RRDEMS Mar 2013
Melanie Depue PCP SNEMS Mar 2013
Jennifer Hamilton PCP SNEMS Mar 2013
Kristen Perozik PCP SNEMS Mar 2013
Evan McDonald PCP NWEMS Mar 2013
Rachel Parsons PCP NWEMS Mar 2013
Martha Paris PCP NWEMS Mar 2013
As of Dec 31, 2013
Regional Educator Activity Report
Activity Report 3
rd & 4
th QTR
July 1-Dec 31/2013
Session Type Activity
Type & Format # Sessions Facilitated
Paramedic Attendance
Annual Skills Review Type: Scenario & Practical Skills Testing Format: Assisted / Testing Stations
35 228
Return to Work Testing
Type: Scenario & Practical Skills Testing Format: Independent/Testing Stations
3 3
CME(Spring) Format: Independent Teaching 0 0
Rainy River District EMS 3rd & 4th Quarter Reports 15
SECTION 2:
Rainy River District EMS
Service Reports
3rd
& 4th
Quarter 2013
Rainy River District EMS 3rd & 4th Quarter Reports 16
Section 2 Rainy River District Reports
The Delegated Controlled Act Activity Report below indicates the number of times that
each Delegated Controlled Act (DCA) was performed by EMS station.
Delegated Controlled Act Activity Report By EMS Station
3rd
QTR July 1-Sept 30/2013
Delegated Controlled Act Code Rainy River
Fort Frances
Emo Atikokan
Analyze - Automated Device (no shock advised
308 0 1 2 1
ASA 504 1 10 4 5
Blood Sampling - Glucose 352 7 52 14 9
Defibrillation - Semi-Automatic
307 0 0 0 0
Dimenhydrinate (Gravol) 533 0 3 2 1
Diphenhydramine (Benadryl) 534 1 0 0 0
Epinephrine 1:1000 540 0 0 0 0
Glucagon 560 0 8 1 1
Glucose Oral 561 0 4 2 0
NTG Spray (.4 Mg/Spray) 615 0 4 1 1
Salbutamol (Ventolin) 650 1 3 1 2
Pronouncement of Death 366 0 0 1 0
Rainy River District EMS 3rd & 4th Quarter Reports 17
Delegated Controlled Act Activity Report
By EMS Station
4th
QTR Oct 1- Dec 31/2013
Delegated Controlled Act Code Rainy River
Fort Frances
Emo Atikokan
Analyze - Automated Device (no shock advised)
308 0 0 0 0
ASA 504 5 10 3 7
Blood Sampling - Glucose 352 6 20 16 7
Defibrillation - Semi-Automatic
307 0 1 0 0
Dimenhydrinate (Gravol) 533 2 6 1 7
Diphenhydramine (Benadryl) 534 0 0 0 0
Epinephrine 1:1000 540 0 0 0 0
Glucagon 560 0 1 0 1
Glucose Oral 561 0 1 1 1
NTG Spray (.4 Mg/Spray) 615 2 5 0 3
Salbutamol (Ventolin) 650 2 5 1 4
Pronouncement of Death 366 0 0 0 0
12 Lead Interpretation 313 4 11 3 6
This information has been reviewed by the Program Medical Director for quality
assurance purposes. Paramedics may require additional education or follow up as
deemed appropriate by Dr. Andrew Affleck.
Rainy River District EMS 3rd & 4th Quarter Reports 18
Comments:
Many of the approved Delegated Controlled Acts (DCA) are not being performed
on a regular basis by Rainy River District EMS Paramedics/EMAs. This is most
likely due to the low number of calls in the service areas;
Base Hospital conducts a mandatory Spring CME each year to help offset the issue of low ALS patient assessment and ALS skills but self directed CME is also necessary;
Maintenance of ALS skills is becoming increasingly difficult especially concerning
Paramedics/EMAs who have worked for extended periods in the low call volume
areas throughout their career or extended periods. Low call volume over time
presents difficulties in retaining information and skills. NW Region Base Hospital
would like to stress the importance and benefits of Paramedics being pro-active
in performing regular self directed CME while at work; making sure to involve and
or encourage your peers. Additionally Paramedics should contact Base Hospital
should they have any questions or concerns related to their ALS skills.
All Rainy River District EMS Operators are reminded to ensure King LT and CPAP is
part of their audit and education processes - to ensure competence through review and
training sessions for Paramedics. NW Region Base Hospital does incorporate review
and education of these skills through call review and during certification re /testing,
annual skills, and CME each year
Total ALS Call Audited: ACE Distribution Report Rainy River District EMS
3rd QTR
July 1- Sept 30/2013 4th QTR
Oct 1- Dec 31/2013
Total ALS Calls Audited 118 111
ACE Distribution: Teaching Points 36 54
4ACE Distribution: Response Required 4 4
Medical Oversight Rainy River District EMS
Combined 3rd
& 4th
QTR July 1- Dec 31/2013
ALS Skills Total
Attempts Successful Attempts
Unsuccessful Attempts
King LT 4 2 2
CPAP 0 0 0
Rainy River District EMS 3rd & 4th Quarter Reports 19
SAVE RECOGNITION
We would like to clarify that we do not expect or encourage you to contact the receiving
hospitals directly to obtain patient outcomes as this would violate the PIPHA legislation.
If you feel there may have been a save in your area as a result of prehospital care,
please contact us. We do not want to miss the opportunity to congratulate the
paramedics involved in any save.
We will continue to recognize paramedics for saves at the annual skills review. This has
been well received by NW Region paramedics. We are pleased to take the opportunity
to acknowledge your great work.
Chart Audit By Station Report Rainy River District EMS
Rainy River District by Station
3rd QTR July 1- Sept 30/2013
4th QTR Oct 1- Dec 31/ 2013
Rainy River 10 18
Fort Frances 69 45
Emo 21 23
Atikokan 18 25
VSA: Save by Station Report Rainy River District EMS
Combined 3rd & 4th QTR July 1- Dec 31/2013
Rainy River District by Station
Number of VSA’s Confirmed Saves
Rainy River 1 0
Fort Frances 2 0
Emo 2 0
Atikokan 2 0
Rainy River District EMS 3rd & 4th Quarter Reports 20