NC Wk 4 h Ch 1 - EMS Systems, Roles, and Responsibilities

Licensure

The process of being officially recognized to practice as a paramedic after completing a training program.

Certification

A status indicating that you have successfully completed a training program and met provincial requirements, often equated with being licensed.

Registration

The process of having records of your training, local licensure, and recertification held by a recognized board of registration.

Accreditation

A process some provinces require for paramedic graduates to ensure they come from an accredited paramedic program.

Reciprocity

The process of granting recognition to a paramedic from another province or agency, which varies by province.

Medical Direction

The delegation of medical acts to paramedics, with the extent of delegation varying by jurisdiction, service, and physician agreement.

Professionalism

The conduct, aims, or qualities that characterize a professional, including adherence to standards and providing quality patient care.

Attributes of a Health Care Professional

Includes conforming to standards, providing quality patient care, instilling pride, striving for high standards, earning respect, and meeting societal expectations.

Professional Image and Behavior

The representation of your agency and professionalism, which includes making good first impressions and maintaining a professional appearance.

Integrity

Being honest, truthful, and open with patients.

Provincial Guidelines

Rules that determine your status after completing paramedic training, varying by region.

Training Program Transcript

A document that may be requested during the reciprocity process, detailing your educational background.

Continuing Education Hours

Hours of additional training that may be required for reciprocity in some provinces.

Good Standing

A status that some provinces may require for paramedics seeking reciprocity.

Quality Patient Care

Providing care that meets the standards expected in the healthcare profession.

First Impressions

Judgments made by people within the first 10 seconds of meeting, emphasizing the importance of a professional appearance.

Ongoing Education

Continuous learning required to maintain certification and competency in the paramedic profession.

Health Care Professional

An individual who has undergone extensive training to develop specialized knowledge, skills, and expertise in providing healthcare.

Unlawful Practice

Practicing as a paramedic without proper registration or licensure, which is considered practicing medicine without a license.

Subtle Differences

The distinctions between licensure, registration, and certification, which are discussed in detail in Chapter 4.

Physician Medical Director

The physician who supervises paramedics and oversees their practice.

Standards and Competencies

The benchmarks that paramedics must meet to be certified and maintain their professional status.

Empathy

Show understanding of patients' feelings and concerns.

Self-motivation

Continuously improve and seek excellence with minimal supervision.

Communication

Effectively exchange information with colleagues and patients; avoid confusing medical terms.

Teamwork and Respect

Work collaboratively with the team, respect all members, and remain flexible.

Patient Advocacy

Respect patients' wishes, values, and cultures, and report any suspected abuse (spousal, child, elder).

Injury Prevention

Identify and address hazards in the patient's environment to prevent future injury.

Careful Delivery of Service

Provide high-quality care, follow protocols, and use medical resources appropriately.

Preparation

Be physically, mentally, and emotionally prepared.

Response

Respond to events in a timely and safe manner.

Scene Management

Ensure the safety of yourself, your team, and the patient.

Patient Assessment and Care

Perform organized assessments based on patient needs and prioritize care accordingly.

Management and Disposition

Follow protocols and consult with the medical director when deviations are needed.

Transfer of Care

Provide a concise handoff report to the receiving facility staff.

Documentation

Fill out a patient care report immediately after transferring the patient.

Return to Service

Restock and prepare the unit for the next call promptly.

Public Education and Community Involvement

Educate the public about the importance of paramedics and injury prevention.

Other Health Care Responsibilities

In some regions, paramedics may also work in clinics, emergency facilities, and hospitals.

Advocacy and Education

Educate the public and media about the true scope of paramedicine.

Documentation & Communication

Document equipment repairs and checks, which are critical for ensuring the readiness of paramedic services.

Delegation of Medical Acts

The acts that can be delegated to paramedics depend on their level of training and the regulations governing paramedicine.

Direct Medical Control

Provides immediate patient care resources, allows for telemetry transmission, and offers real-time quality assessment and on-scene assistance.

Indirect Medical Control

Develops protocols, standing orders, procedures, quality improvement initiatives, and training programs.

Protocol

A treatment plan for specific illnesses or injuries, developed in conjunction with national standards (e.g., Heart and Stroke Foundation's advanced cardiac life support algorithms).

Standing Order

A written document signed by the medical director that outlines specific directions for prehospital care that can be performed without direct communication with the medical director (e.g., defibrillation).

Clinical Practice Guidelines (CPGs)

More flexible than protocols, CPGs include recommendations for optimal care and depend on the paramedic's ability to use critical thinking and decision-making skills to tailor care to the patient's specific condition.

Continuous Quality Improvement (CQI)

CQI focuses on assessing and improving current practices to reduce the chance of problems arising and is a dynamic process that evaluates and continually refines prehospital care.

Steps in CQI Process

1. Identify system-wide problems. 2. Conduct an in-depth review of the issues. 3. Evaluate and develop remedies for the issues. 4. Develop an action plan for correction, including time frames. 5. Enforce the plan of action. 6. Reexamine the issue for improvements. 7. Promote excellence found in patient care during the evaluation. 8. Identify modifications needed in protocols and standing orders. 9. Identify gaps in protocols and standing orders. 10. Review all ambulance calls, when feasible, to ensure quality care.

Quality Assurance

Involves peer review, which can be an educational tool when done properly, allowing colleagues to review and identify areas for improvement.

Peer Review

Allows colleagues to review and identify areas for improvement, with findings remaining confidential and reviewers being professional and constructive.

CQI Program Benefits

Helps to prevent problems by evaluating day-to-day operations and identifying stress points.

Areas of Focus for CQI

Medical direction issues, training and education, communications, prehospital treatment, transportation issues, financial issues, receiving facility review, dispatch, public information and education, disaster planning, mutual aid.

Reporting Adverse Events

Paramedics are responsible for reporting adverse events or near misses to improve the system.

Error Disclosure Processes

Involves paramedics, medical directors, and support staff meeting with patients and families to discuss errors and patient care concerns.

Role of the Medical Director

Physicians acting as medical directors are increasingly well-versed in prehospital care.