Base Hospitals Overview

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Questions and Answers

Which of the following is NOT one of the key responsibilities of the Regional Base Hospital Program?

Medical Delegation

Medical Advice/Oversight

Patient Care Documentation (correct)

Continuous Medical Education (CME)

What is the primary purpose of the Base Hospital programs in Ontario?

To train hospital staff on emergency protocols.

To provide emergency services to hospitals directly.

To establish legal guidelines for paramedic practice.

To oversee and guide prehospital emergency medical services. (correct)

What is the consequence of being Decertified as a paramedic?

Mandatory retraining sessions.

Temporary suspension of duties.

Approval for limited practice.

Permanent loss of practice privileges. (correct)

How are status changes for paramedics communicated?

To the paramedic, their supervisor, operations manager, and MOHLTC. Signup and view all the answers

What does Continuous Medical Education (CME) ensure for paramedics?

That they remain updated on medical standards. Signup and view all the answers

Which institution is NOT part of the Base Hospital program in Ontario?

Toronto General Hospital Signup and view all the answers

What aspect does the quality assurance role of the Regional Base Hospital Program involve?

Performing audits and evaluations. Signup and view all the answers

What status might a medic have if they are not actively practicing?

Deactivated Signup and view all the answers

What is the primary regulatory authority for paramedicine?

Ministry of Health Signup and view all the answers

Which of the following is a key question for paramedics regarding their professional identity?

Who are we in our professional identity? Signup and view all the answers

What is a significant challenge concerning emergency service demand?

Imbalance between call volume and resources Signup and view all the answers

What shift has occurred in paramedic education programs?

Shift to evidence-based and patient-centered competencies Signup and view all the answers

What issue is described by the term 'Code Zero'?

Demand exceeding resource availability Signup and view all the answers

Which population groups are predicted to contribute significantly to increasing call volumes?

Older age groups (70-84, 85+) Signup and view all the answers

What influences the growing clinical care needs in emergency services?

Aging populations and socio-cultural factors Signup and view all the answers

What role do labor unions play in the context of paramedicine?

Advocating for paramedic needs and work conditions Signup and view all the answers

What is a primary goal of Crew Resource Management (CRM)?

Fostering a collaborative environment Signup and view all the answers

Which decision-making model is characterized by being slow, deliberate, and objective?

Rational (System 2) Signup and view all the answers

What is emphasized in a Just Culture within healthcare?

Learning from errors Signup and view all the answers

The intuitive decision-making model is best described as:

Fast and context-dependent Signup and view all the answers

What component contributes significantly to patient safety alongside human factors in a Just Culture?

Crew Resource Management Signup and view all the answers

What does the transition of care (TOC) involve between Primary Care Paramedics (PCP) and Advanced Care Paramedics (ACP)?

Sharing of accountability Signup and view all the answers

How does Pat Croskerry's research contribute to emergency medicine?

Highlights the impact of thought processes on outcomes Signup and view all the answers

What is one of the key purposes of advocacy within paramedicine?

To seek consistency in care approaches Signup and view all the answers

What is a key trade-off in the 'cost-quality-time' triangle in service recovery?

Higher quality increases both time and costs Signup and view all the answers

What is one of the components of the Base Hospital System?

Research Signup and view all the answers

Which of the following best describes the role of Community Paramedics?

They provide healthcare services to enhance community health Signup and view all the answers

What does the 'Grabbing Hands' effect refer to in healthcare funding?

Personal liability concerns impacting funding decisions Signup and view all the answers

What is the highest level of certification for paramedics listed in the content?

Advanced Care Paramedic Signup and view all the answers

Which of the following reflects a common misconception about government processes in healthcare?

They are often slow-moving and self-interested Signup and view all the answers

Why is certification important for paramedics in the Base Hospital System?

It confirms they have met educational and professional standards Signup and view all the answers

Which of the following does NOT typically fall under the responsibilities of Base Hospitals?

Direct patient treatment Signup and view all the answers

What does the principle of non-maleficence emphasize in patient care?

Avoiding actions that could cause unnecessary harm Signup and view all the answers

How does the principle of beneficence apply in paramedicine?

By administering the most effective and timely treatment Signup and view all the answers

Which of the following is NOT considered a professional value in paramedicine?

Apology Signup and view all the answers

What is an example of respecting patient autonomy in emergency situations?

Asking for informed consent before administering treatment Signup and view all the answers

How does the principle of justice manifest in patient care?

Giving equal attention to every patient without discrimination Signup and view all the answers

In the context of ethics, what is meant by 'avoiding harm' in patient treatment?

Being cautious with interventions to minimize side effects Signup and view all the answers

What professional value involves valuing the dignity and rights of individuals?

Respect Signup and view all the answers

What ethical principle is violated when a paramedic administers risky treatment without clear benefits?

Non-maleficence Signup and view all the answers

What is the primary purpose of studying ethics in healthcare for paramedics?

To navigate complex decision-making and ensure patient-centered care Signup and view all the answers

Which principle of ethics emphasizes the patient's right to make informed decisions?

Autonomy Signup and view all the answers

In what situation might a paramedic face an ethical dilemma regarding patient autonomy?

When the patient refuses treatment after being fully informed Signup and view all the answers

How do ethics contribute to building public trust in the paramedic profession?

By fostering ethical behavior and accountability Signup and view all the answers

What is the focus of the principle of beneficence in healthcare?

Acting in the best interest of the patient Signup and view all the answers

Which of the following best describes the role of ethics in paramedic practice?

Guiding professional behavior in complex situations Signup and view all the answers

What is NOT a key reason for paramedics to study ethics?

To learn how to administer medical procedures Signup and view all the answers

How should paramedics approach situations involving patients' rights and autonomy?

Honor the patient's choices if they are competent to decide Signup and view all the answers

Study Notes

Lecture 10: Base Hospitals

Regional Base Hospital Program (Ontario) provides oversight, guidance, and quality control for prehospital emergency medical services in Ontario.
Institutions involved: Sunnybrook, Durham, Ottawa, Hamilton, London, Sudbury, and Thunder Bay.
Medical Delegation: Delegation of medical procedures and guidelines to paramedics.
Medical Advice/Oversight: Ongoing guidance for paramedic teams.
Continuous Medical Education (CME): Training for paramedics to stay updated on medical standards.
Quality Assurance: Audits, evaluations, and patient safety checks.
Program Planning: Aligning Base Hospital services with departmental and accreditation standards.
Policies and Procedures: Establishing standards for patient care and documentation.
Human Resources Management: Hiring standards and certification requirements for paramedics, evaluation of paramedic qualifications, system-wide training, certification maintenance, and clinical placements compliant with MOHLTC.

Paramedic Practice Status

Practice Status Levels: Paramedics' ability to practice depends on their status within the Base Hospital.
Status can be: Active, Provisional, Deactivated, or Decertified.
Decertified: Permanent loss of practice privileges.
Status changes are communicated to the relevant parties (paramedic, supervisor, operations manager, and MOHLTC).

Quality Assurance Measures

ACR Audits: Evaluation of Ambulance Call Reports.
ACE (Ambulance Call Evaluation): Regular patient safety evaluations.
Follow-ups: Ensuring continuous improvement through follow-up checks.
Quality Programs: Identifying contributory causes for incidents.
Strategies for system improvement and practice enhancements.

Patient Safety and Critical Incident Examples

Critical Safety Concerns: All aspects of patient safety are critically important.
Drug mix-ups (e.g., Morphine vs. Epinephrine).
Rhythm misinterpretations (shockable vs. non-shockable).
Incident Analysis: Discovery of contributing factors (human factors, crew resource management, and clinical decision-making).
Root Cause Analysis: Assessing errors using human factors and system design.

Human Factors in Patient Safety

Definition: Study of factors impacting the ability to perform work correctly.
Principle: Mistakes are common, and support systems are needed for error reduction.

Case Study – Just a Routine Operation

Breakdown of: Teamwork, assertive communication, and leadership aspects highlighted as essential components affecting operations.

Paramedic and Combat Aviation - Comparison of Roles

Similar Task Breakdown:
- Combat Aviation: Aviate, Navigate, Communicate.
- Paramedicine: Resuscitate (ABCs), Differentiate (diagnose), Communicate.
Challenges: Task saturation or "Helmet Fire" (overwhelmed by tasks, leading to tunnel vision).

Crew Resource Management (CRM)

Goals: Shared accountability and responsibility, joint decision-making, and open communication.
Practice: Optimize team performance, minimize errors, and enhance patient outcomes.

System Design

Evaluation of Competence.

Decision-Making in Clinical Settings

Impact on Patient Safety: Influence of thought processes on patient outcomes
Pat Croskerry's Contributions: research on decision-making in emergency medicine
Healthcare Decision-Making Models: Rational (System 2), and Intuitive (System 1).
Rationale - slow, deliberate, objective, scientific, fewer errors
Intuitive - fast, autonomous - context dependant, qualitative - prone to error
- System 2 (slow, deliberate, objective, more accurate, fewer errors)
- System 1 (fast, automatic, more likely to error)

Just Culture

Definition: A culture that emphasizes learning from mistakes instead of punishing them.
Goals: Self-reporting of errors, and improving systems and practices for better patient safety.
Components: Human factors, crew resource management, and system design.

Paramedicine – Vision and Advocacy

Key Advocacy Questions: Who are we? What do we aim to achieve?, and when and how committed are we?
IAFF (International Association of Fire Fighters): Role in Fire Fighters Political Association Committee, and labor relations are covered.
Legislation and Regulation (MOH): Primary regulatory authority for paramedicine with mention of self-regulation and union influence.

Identity and Professional Development

Key questions for paramedics: What are we? What do we want to become?
Paramedic Education: Shift to extended programs, evidence-based and patient-centered education, and focus on competencies.

Current Challenges – Demand and Resources

Code Zero: Demand exceeding resource availability, due to population increase, need for emergency service availability, and imbalance between call volume and resources.
Offload delay issues lead to longer wait times.

Healthcare System Challenges

Shortage of primary care physicians and aging physician workforce.
Staffing shortages and recruitment insufficient to meet demand.

Proposals - Right Care, Right Time, Right Place

Promote treatment alternatives for emergency department visits.

Funding and Cost Management

Total healthcare spending Canada projected to reach $331 billion in 2022
Major expenses: Hospitals, physicians, and drugs.
Funding challenges: service recovery costs, cost-effectiveness factors, and inflationary impacts on operational costs.

Tension Points in Funding and Policy

Slow-moving government processes.
Liability concerns due to budget constraints.

EPIC Program (Community paramedicine)

Study the types of medical conditions addressed by the Community Paramedics.
Understand the role and goals of the Community Paramedics, noting their importance for community health.
Review EPIC practices and pay attention to the medical conditions cared for.

Base Hospital Lecture - Objectives

Overview of the Ontario Base Hospital System
Components of the Base Hospital:
Description of the role of Base Hospitals
Paramedic's relationship with the Base Hospital
Roles of the Base Hospital Committees and their duties.
Delegation of Medical Acts

Base Hospital Design

Components of the Base Hospital: Certification, Education, Professional Standards & Compliance, and Research.

Levels of Certification

Educational institutions provide certificates
Base hospitals verify paramedics to practice according to their medical director's license
Paramedics are not licensed (in this context) in these national certifications:
- Emergency First Responder
- Primary Care Paramedic
- Advanced Care Paramedic
- Critical Care Paramedic

Medical Direction

Medical Directives
Online Direction

Delegation of Controlled Acts

Regulated Health Professions Act (RHPA) and the regulated medical acts performed.
Medical directors responsibilities and liabilities for medical delegation

Development of Medical Directives

Developed by Local Base Hospitals and approved by the Medical Advisory Committee (MAC).
Signing MD is responsible -- Evidence-based approach to directives
Contact with MD, availability and procedures
Documentation standards and QA (self-reporting)

Paramedic's Working Medical Status

Paramedics' practice privilege depends on their Base Hospital status.
- Status Levels: Active, Provisional, Deactivated or Decertified
Changes of status communicated to Paramedic, Supervisor, Operations Manager, and MOHLTC.

Certification

Initial Certification: Symptom relief and defibrillation testing.
- Maintenance of Certification: Not inactive > 90 days , performing minimum 10 calls, completing 8 CME hours, and responding to all call audit requests from Base Hospital Physicians.
- Causes of de-certification or loss of privileges.
- Gross professional misconduct, falsification of documentation, gross negligence in patient care, failure to complete remediation

Additional Information

Research includes retrospective reviews, randomized controlled trials (RCTs), field evaluations

Ethics Consideration: According to Week 10 Reading

Ethics: Guiding principles influencing decision making in healthcare.
Why study ethics?: Navigate complex decisions, Ensure patient-centered care, Build public trust, Guide professional behavior.
Principles of Ethics: Autonomy, Beneficence, Non-Maleficence, and Justice.
Application of Ethics in a Patient Encounter: Respecting patient autonomy, and practicing beneficence, avoiding harm
Professional Values: Integrity, Compassion, Competence, Respect for patients, Confidentiality.
Fairness: Treating each patient with unbiased consideration

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Description

This quiz provides an overview of the Regional Base Hospital Program in Ontario, detailing its role in emergency medical services oversight, medical delegation to paramedics, and continuous medical education. It explores the institutions involved, quality assurance practices, program planning, and human resource management pertaining to paramedic services.