The successful handover

Effective communication between paramedics and receiving staff is crucial in the delivery of emergency medicine. The interaction of the patient report serves as a vital link in the chain of patient care, ensuring that critical information regarding a patient’s condition is accurately relayed and understood. Clear communication impacts positively on patient outcomes, patient safety, and promotes timely and high quality care. As emergencies can be fast paced and stressful, communication failures often result from a disorganized approach, therefore structure is paramount in ensuring a successful patient report.

To carry out well-prepared handovers, you must know what information to include and prioritize. Clinical information provided to receiving staff should be timely, accurate, and contextual, and the amount of irrelevant or unnecessary information should be minimized.

A successful patient report should include the identity of the patient, the mechanism of injury, assessment findings, treatments/interventions performed including their results, the patient’s most recent vital signs and a differential diagnosis. There are a number of tools that paramedics can utilize including IMIST AMBO and SBAR, which can be reviewed below.

By using an organization tool to structure our patient reports, we can help patients receive relevant and consistent care and promote a culture of teamwork between paramedics and hospital staff.

Understanding Croup and Differentiating from Other Conditions

Assessing and managing the pediatric airway can be challenging, especially when dealing with conditions like croup, epiglottitis, and other respiratory pathologies. Here is what you need to know.

As paramedics, understanding the nuances between heat illness, heat exhaustion, and heat stroke is crucial for effective and timely intervention, especially during the summer months. Heat-related emergencies range from mild heat illness to severe heat stroke, and recognizing the signs and symptoms can be life-saving. This tip of the month provides evidence-based education on these conditions, highlighting clinical exam findings and treatment considerations aligned with the Ontario Basic Life Support Patient Care Standards (BLS PCS).

Traumatic cardiac arrest (TCA) in the pre-hospital setting demands immediate, specialized management by paramedics. TCA can result from blunt trauma (e.g., motor vehicle collisions, falls) or penetrating trauma (e.g., stab wounds, gunshot wounds). Management starts with a rapid C-ABCDE assessment to identify life-threatening injuries. Prioritize interventions based on clinical relevance, addressing reversible causes like hypoxia, tension pneumothorax, and hypovolemia per ALS/BLS Patient Care Standards. Airway management, utilizing basic or advanced adjuncts, is crucial but should not delay transport.

Hyperkalemia is a life-threatening condition characterized by elevated potassium levels in the blood, which can lead to serious cardiac dysrhythmias and other complications. It often occurs in patients with renal failure, severe dehydration, or those taking certain medications such as potassium-sparing diuretics or ACE inhibitors. Key clinical manifestations include muscle weakness, fatigue, and palpitations. On the physiological level, hyperkalemia affects the electrical conductivity of the heart, leading to characteristic changes on the ECG.

Screening cardiac arrest patients for reversible causes is a critical step in improving survivability and optimizing patient outcomes. By identifying reversible causes, paramedics can implement targeted interventions, or make the determination for early transport, that may significantly increase the chances of successful resuscitation.

Vector Change - Refractory VF/Pulseless VT

At any point a patient has had three (3) consecutive defibrillations, paramedics shall consider a vector change prior to the next defibrillation. If the first set of pads applied are placed in the anterior/lateral position, the second set of pads shall be placed in the anterior/posterior position.  Note: the first set of pads may remain in place but need to be disconnected from the monitor.  Once the second set of pads are applied in the anterior/posterior position, ensure that you connect them to the defibrillator. 

Positive Pressure Ventilation

Any patient that needs respiratory support with positive pressure ventilation (PPV) requires the use of a bag valve mask (BVM). In order to ensure this intervention is successful, NWRPCP recommends the following steps: