Paramedic Professional Practice and Medical Directives

Comprehensive vocabulary flashcards covering paramedic professional practice, Treat and Discharge criteria, administrative levels of error, cardiovascular emergencies, respiratory directives (CPAP, Croup, Bronchoconstriction), allergic reactions, and traumatic hemorrhage management.

Direct Order

Instructions provided from an individual physician to another health care provider or group of health care providers directing a specific treatment for a particular patient.

Medical Directive

A standing authorization that allows certified paramedics to perform specified treatments when the required clinical and environmental criteria are met.

Treat and Discharge

A clinical process allowing authorized paramedics to safely discharge a patient from their care following treatment for specific low-acuity conditions that do not require prolonged observation or follow-up, provided mandatory criteria are met.

IDEAL Framework

A patient discharge communication process: Include patient and family as full partners; Discuss key areas to prevent problems; Educate in plain language; Assess understanding; and Listen to patient goals, preferences, and concerns.

Discharge from Care (Treat & Discharge)

A collaborative discharge initiated by patient or paramedic in agreement, requiring capacity and consent, limited to three directives (seizure, hypoglycemia, and tachydysrhythmias), mandating an on-scene responsible adult, and documented with a specific ePCR code without needing a patient signature.

Patient Refusal of Service

A patient-initiated decision to refuse transport or care that requires mental capacity, can apply to any medical directive or complaint, requires both patient and witness signatures on the ePCR, and does not require a responsible adult.

ePCR Treat and Discharge Screening Codes

Specific directive procedure codes documented on the ePCR: $407.04$ for hypoglycemia, $407.05$ for seizures, and $407.06$ for tachydysrhythmia.

Environmental Considerations (Treat and Discharge)

Mandatory conditions for discharge: a responsible adult agrees to stay with the patient for the next $4\,\text{hours}$, all questions are answered, a care plan is established, primary care follow-up is advised, 911 re-contact instructions are given, and discharge consent is provided.

Supraventricular Tachycardia (SVT)

An abnormal cardiac rhythm originating above the ventricles characterized by a regular rhythm, a heart rate $\ge 150\,\text{bpm}$, a narrow QRS complex ($< 120\,\text{ms}$), and an absence of discernible P waves and PR intervals.

Atrioventricular Nodal Reentrant Tachycardia (AVNRT)

A form of SVT where the reentrant electrical pathway loops and reenters directly through the atrioventricular node.

Atrioventricular Reentrant Tachycardia (AVRT)

A form of SVT in which the electrical circuit travels through an anatomical accessory pathway outside the AV node, such as in Wolff-Parkinson-White syndrome.

Valsalva Maneuver

A vagal maneuver involving forced expiration against a closed glottis (or blowing into a $10\,\text{cc}$ syringe for $15\,\text{seconds}$ while seated at a $45^\circ$ angle) to stimulate the vagus nerve and convert SVT to normal sinus rhythm.

Modified Valsalva Maneuver

A postural modification where the patient blows into a syringe for $15\,\text{seconds}$ at a $45^\circ$ angle, followed immediately by lying supine with legs elevated to $45^\circ$ for $15\,\text{seconds}$, achieving a $43\%$ success rate in the REVERT trial.

Consolidation Period

The mandatory post-certification operational period requiring newly certified Primary Care Paramedics (PCPs) to complete a minimum of $36\,\text{hours}$ and Advanced Care Paramedics (ACPs) or Critical Care Paramedics (CCPs) to complete a minimum of $168\,\text{hours}$.

Continuing Medical Education (CME) Annual Requirements

Mandatory annual training hours required to maintain certification: $8\,\text{hours}$ for PCP, $12\,\text{hours}$ for PCP Flight, $24\,\text{hours}$ for ACP, and $72\,\text{hours}$ for ACP and CCP Flight.

Minor Omission or Commission

A paramedic practice error involving an action or failure to act that may delay care or lengthen recovery, but has not negatively affected patient morbidity.

Major Omission or Commission

A paramedic practice error involving an action or failure to act that has negatively affected or could negatively affect morbidity, without producing a potentially life-, limb-, or function-threatening outcome.

Critical Omission or Commission

Performing a controlled act or advanced procedure without authorization, or an action or failure to act that causes or could cause serious harm, death, or a potentially life-, limb-, or function-threatening outcome.

Paramedic Practice Review Committee (PPRC)

An independent external committee convened through another Regional Base Hospital program to provide expert advice when a Medical Director is considering decertification after deactivation.

Deactivation

The temporary removal of a paramedic's medical authorization by the Medical Director due to patient care concerns, failure to maintain qualifications, or refusal to cooperate with investigations.

Decertification

The permanent revocation of a paramedic's certification by the Medical Director following formal review or termination of employment/volunteer service.

Stable Angina

Predictable chest pain or discomfort triggered by physical exertion, typically lasting a short duration, described as pressure or heaviness, and relieved by rest, nitroglycerin, or oxygen.

Unstable Angina

A change in a patient's established anginal pattern or new chest pain occurring at rest or with minimal activity, signaling greater risk of acute coronary syndrome.

Right Ventricular Infarction (RVI)

An infarction suspected in inferior STEMIs (leads II, III, aVF) when ST elevation $\ge 1\,\text{mm}$ is observed in lead V4R; contraindicates nitroglycerin due to severe preload dependence.

15-Lead ECG

An enhanced electrocardiogram adding leads V4R, V8, and V9, indicated when septal ST depression is present, signs of ischemia occur without 12-lead changes, or posterior/right ventricular infarction is suspected.

STEMI Bypass Protocol

A direct hospital transport protocol for patients aged $\ge 18$ presenting with ischemic symptoms under $12\,\text{hours}$ and ST elevation of $\ge 2\,\text{mm}$ in leads V1-V3 or $\ge 1\,\text{mm}$ in other contiguous leads, with transport time under $60\,\text{minutes}$.

Croup (Laryngotracheobronchitis)

A viral upper respiratory tract infection common in children aged $6\,\text{months}$ to $< 8\,\text{years}$ causing airway inflammation, a barking cough, and stridor at rest.

Nebulized Epinephrine (Croup)

Inhaled epinephrine ($1\,\text{mg/mL}$ - $1:1,000$) for croup with stridor at rest, dosed at $2.5\,\text{mg}$ for weight $< 10\,\text{kg}$ and $5\,\text{mg}$ for weight $\ge 10\,\text{kg}$.

Dexamethasone (Croup)

An oral corticosteroid administered for croup at a dose of $0.5\,\text{mg/kg}$ up to a maximum single dose of $8\,\text{mg}$.

Continuous Positive Airway Pressure (CPAP)

A non-invasive ventilation technique that provides positive end-expiratory pressure (PEEP) to pneumatically splint open upper airways and alveoli, improving lung compliance and reducing cardiac preload and afterload.

CPAP Contraindications

Specific clinical exclusions preventing CPAP administration: asthma exacerbation, suspected pneumothorax, unprotected/unstable airway, major trauma/burns to head/torso, tracheostomy, inability to sit upright, and inability to cooperate.

Paroxysmal Nocturnal Dyspnea (PND)

A sign of congestive heart failure where a patient awakens abruptly from sleep with severe shortness of breath caused by fluid redistribution while lying flat.

Salbutamol

A $\beta_2$-adrenergic agonist that relaxes bronchial smooth muscle during bronchoconstriction, with an onset of $10\,\text{minutes}$ and duration of $3\text{ to }4\,\text{hours}$.

Anaphylaxis

A severe, life-threatening systemic hypersensitivity reaction triggered by allergen exposure where IgE-mediated degranulation causes symptoms across two or more body systems (integumentary, GI, respiratory, cardiovascular) or a severe single ABC compromise.

Epilepsy

A neurological disorder diagnosed when a patient experiences two or more unprovoked seizures occurring more than $24\,\text{hours}$ apart.

Tranexamic Acid (TXA)

An antifibrinolytic agent administered for traumatic hemorrhage with hemodynamic instability in patients aged $\ge 16$, dosed at $1000\,\text{mg}$ in $50\,\text{mL}$ normal saline infused IV over $5\,\text{minutes}$, contraindicated if injury occurred $> 3\,\text{hours}$ prior or in isolated head injury.