Lecture 9: Ambulance Act & RHPA PDF

🚑 Lecture 9: Ambulance Act & RHPA Ambulance Act of Ontario (from PARA 126 - Ambulance Act LEC1.pdf) Overview The Ambulance Act in Ontario regulates ambulance services, covering standards and requirements for ambulance oper...

🚑 Lecture 9: Ambulance Act & RHPA Ambulance Act of Ontario (from PARA 126 - Ambulance Act LEC1.pdf) Overview The Ambulance Act in Ontario regulates ambulance services, covering standards and requirements for ambulance operators, paramedics, dispatch centers, response times, and controlled medical acts that paramedics can perform. This legislation ensures that emergency medical services (EMS) meet safety and operational standards to provide high-quality care in Ontario. Key Areas Covered by the Ambulance Act 1. Ambulance Operators Vehicle Standards: Ambulances must meet specific standards for equipment, safety, and functionality. Equipment Standards: Required medical and non-medical equipment must adhere to established guidelines. Financial Documentation: Operators must maintain accurate financial records and submit them as required. Vehicle Liability Insurance: Operators need sufficient liability coverage for all ambulance vehicles. Record Keeping: Operators are responsible for maintaining comprehensive records regarding vehicle use, maintenance, and patient care. Lecture 9: Ambulance Act & RHPA 1  2. Paramedic Qualifications Education: Paramedics must complete an ambulance/paramedic program through an accredited College of Applied Arts and Technology or possess equivalent experience/qualifications approved by the Director. Certification (AEMCA): Paramedics must pass the Advanced Emergency Medical Care Assistant (AEMCA) examination or have equivalent qualifications. From regulation: ‘successfully completed an ambulance and emergency care program or a paramedic program provided by a College of Applied Arts and Technology’ ‘Obtained a pass standing in an Advanced Emergency Medical Care examination’ Additional Requirements: Grand-fathering provisions may apply for those with previous qualifications. Must demonstrate English language proficiency. Must hold a valid Class F Driver’s License. Be free of communicable diseases (as outlined in a specified table). Maintain immunizations and be free from criminal convictions involving “moral turpitude.” Up-to-date CPR certification. 3. Basic Life Support (BLS) Standards Patient Care Standards: Operators, emergency medical attendants, and paramedics must ensure patient care aligns with the Basic Life Support Patient Care Standards. Advanced Care Standards: Advanced and critical care paramedics must follow the Advanced Life Support Patient Care Standards for more complex cases. 4. Central Ambulance Communication Centers (CACC): Under section Vll Lecture 9: Ambulance Act & RHPA 2  CACCs, when provincially funded, have specific obligations: Call Taking: Efficient handling of incoming emergency calls. Dispatching of Calls: Coordinating the dispatch of ambulance services. Dispatch Records: Maintaining records of dispatched services, which the Ministry may review. 1. Response Time Standards Definition: Response time is measured from the notification of an emergency to: Arrival on-scene of someone equipped for defibrillation, particularly for cardiac arrest patients. Arrival of the ambulance crew on-scene. Arrival based on the priority level of the return to the scene. Controlled Acts - Defined Levels The Act outlines specific controlled medical acts, organized into three schedules based on the level of training and certification: 1. Controlled Acts - Schedule 1 Administration of medications: Glucagon, Oral Glucose, Nitroglycerin, Epinephrine, Salbutamol, ASA (in 80 mg form) Semi-Automated External Cardiac Defibrillation (SAED). 2. Controlled Acts - Schedule 2 Includes Schedule 1 medications plus any additional medications approved by the Director. SAED and additional procedures: Peripheral intravenous (IV) therapy. Endotracheal intubation. Non-automated external cardiac defibrillation and monitoring. Lecture 9: Ambulance Act & RHPA 3  3. Controlled Acts - Schedule 3 Includes all procedures and medications in Schedule 2 plus additional advanced procedures: Manual defibrillation, electrical cardioversion, and pacing. Maintenance and monitoring of arterial/central venous (CV) catheters. Gastric intubation and suctioning. Mechanical ventilation. Interpretation of lab blood values. Management of chest tubes and drainage systems. Chest x-ray interpretation. Insertion of urinary catheters. Administration of intravenous blood products. Use of Doppler flow monitors and infusion pumps. Other advanced airway management techniques. Important Notes on the Ambulance Act Regulation and Compliance: The Ambulance Act establishes standards that ensure quality and safety within Ontario’s EMS, ensuring all operators, paramedics, and associated services follow strict guidelines. Ministry Oversight: The Ministry of Health reserves the right to review records and enforce standards, particularly with CACCs and ambulance operators. Continuous Professional Development: Paramedics are expected to maintain current certifications, meet health requirements, and uphold ethical standards as part of their professional role. Lecture 9: Ambulance Act & RHPA 4  Ambulance Act of Ontario, Self-Regulation, and Controlled Medical Acts: SELF STUDY 1. Ambulance Act Ontario – Key Terms and General Regulations This section covers essential terminology and roles under the Ambulance Act, particularly for paramedic services in Ontario: Ambulance: Defined as a vehicle used for providing emergency medical transport. Base Hospital Program: An administrative body overseeing paramedic care, offering medical direction, education, and certification. Primary Care Paramedic (PCP) and Advanced Care Paramedic (ACP): Different levels of paramedic certification with specific skill sets and responsibilities. AEMCA (Advanced Emergency Medical Care Assistant): Certification needed for paramedics in Ontario. Controlled Act: A medical act requiring specific authorization to perform. Medical Director: A physician responsible for overseeing medical aspects of paramedic services. Patient: The individual receiving medical services. 2. Part 3 - Paramedic Qualifications Qualifications: A paramedic must meet several qualifications, including a valid driver’s license with minimal demerit points, specific certifications, and no criminal record involving “moral turpitude” (a term referring to actions that violate societal moral standards). #5&6 - Page 3 CPR Certification: Must be regularly recertified to ensure up-to-date skills. Key Regulations to Note: Clause 5-4: Details on permissible demerit points. Lecture 9: Ambulance Act & RHPA 5  Clauses 7-1d and 2-1,2: Guidelines for paramedic certification and recertification. Clause 4-a, b: Outlines certification process details. Regulation 8-4: Specifies professional conduct standards. 3. Part 5 - Standards of Operation #11 page 6 Operator Responsibilities: Operators must ensure that all standards are met to provide safe and effective ambulance services. Required Standards: Operators are held to specific benchmarks and must follow documented references to maintain compliance. 4. Part 6 - Operations and Deceased Persons #12 Page 6, 1,2,3 Role of the Operator: Operators must ensure proper operational standards are maintained, including specific protocols for handling deceased individuals. Deceased Persons: The Act outlines protocols for managing cases involving deceased individuals to ensure respectful and lawful handling. 5. Part 8 - Response Times Defined page 8-23,24 Definition of Response Time: Response time is measured from when a call is received to the moment a medical responder or ambulance arrives on the scene. Variation in Response Time: Response times may vary depending on the patient’s complaint, presentation, and priority level. CTAS (Canadian Triage and Acuity Scale): Used to prioritize response levels based on the severity of the patient’s condition. 6. Schedules 1, 2, and 3 - Controlled Acts for Paramedics Lecture 9: Ambulance Act & RHPA 6  This section lists controlled medical skills and procedures assigned to paramedics based on certification level: PCP Skills (Primary Care Paramedics): Specific skills authorized for PCPs are outlined in Schedule 1. Skills from Schedule 2 and Schedule 3: PCPs may perform some skills from Schedule 2, but fewer from Schedule 3. The scope and number of skills vary depending on the paramedic's level and certification, often limited to ensure safe practice. 7. Base Hospital Programs Southwest Ontario Regional Base Hospital Program: This program provides oversight for paramedic services in Southwest Ontario, offering resources, training, and medical direction to ensure quality prehospital care. Purpose of Base Hospitals: These institutions support paramedic services by providing clinical guidance, education, and medical oversight. Prevalence in Ontario and Other Provinces: Base hospitals are established across Ontario, although not all provinces have similar systems. SWORBHP Mission, Vision, and Values: The Southwest Ontario Regional Base Hospital Program (SWORBHP) emphasizes quality, integrity, and continuous improvement in paramedic care. BH Certification: After PCP certification through a Base Hospital, a paramedic may work in various healthcare settings under its guidance. 8. Self-Regulation of Paramedics Self-Regulation Concept: Refers to a profession’s authority to govern its standards, licensing, and practice requirements. Professional College: An organization that regulates a profession, setting standards for entry and practice. Lecture 9: Ambulance Act & RHPA 7  Current Status of Paramedics in Ontario: Paramedics in Ontario are not fully self-regulated. Benefits of Self-Regulation: Self-regulation allows for autonomous management, accountability, and higher professional standards. OPA's Efforts for Self-Regulation: The Ontario Paramedic Association (OPA) advocates for self-regulation to ensure higher oversight and professional development. HPRAC (Health Professions Regulatory Advisory Council): Advises the Ontario government on which health professions should be regulated, including paramedics. Oversight Layers: Currently, paramedics operate under multiple oversight layers, each providing checks to reduce risk and harm in patient care. 9. Controlled Medical Acts Delegation of Controlled Acts: Only certain healthcare professionals can perform controlled acts, and in some cases, physicians may delegate these acts to other qualified personnel. Scope of Practice: Defines what acts a paramedic (or other healthcare provider) is legally authorized to perform. #14 page 1 Unregulated Professions: Individuals in unregulated roles are limited in performing controlled medical acts. Comparing Controlled Acts with Schedules: Schedules 1, 2, and 3 in the Ambulance Act outline similar principles as controlled medical acts but are specific to paramedics. While the principles align, the skills permitted may differ based on certification level. Key Considerations for Controlled Medical Acts Role of First Aiders: First aiders are limited in scope compared to regulated paramedics. Lecture 9: Ambulance Act & RHPA 8  Scope in Emergencies: Paramedics cannot exceed their scope, even if directed by a physician, without facing professional repercussions. Differences and Similarities with Controlled Act Schedules: The controlled acts align with the schedules but vary based on the regulatory framework and specific professional capabilities. 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