Capnography provides continuous, non-invasive information about ventilation by measuring exhaled carbon dioxide (CO₂). While the ETCO₂ number is useful, the waveform and trends can provide additional information about ventilation, airway patency, perfusion, and changes in a patient’s clinical condition. Understanding what the waveform is showing can help paramedics recognize problems earlier, confirm interventions, and identify deterioration before changes in other vital signs become obvious.

This tip will help paramedics to interpret ETCO₂ values and capnography waveforms in the context of the patient's overall clinical presentation and recognize clinically significant changes in ventilation and perfusion.

Transfer of care, or, patient handover, is a critical component of the emergency care process. This begins with the initial notification to the receiving facility, continues through potential offload delays, and is completed with a report to the receiving clinician who will be assuming responsibility for the patient’s ongoing care. A well-organized handover is essential for maintaining continuity of care, preventing communication gaps, and promoting patient safety. Handover report frequently occurs during high-stress medical emergencies, where competing priorities and environmental distractions can make it easy to miss pertinent patient information. Regardless of the receiving clinician or setting, it is important to ensure priority information and concerns are clearly communicated.

By the end of this tip, paramedics will be able to deliver a structured patient handover using the ISBAR framework to communicate critical information clearly and support safe continuity of care.

Recognizing Acute Altered Level of Awareness in Older Adults

When evaluating an altered LOA, the geriatric population throws out the standard rulebook.

Older adults may present atypically because reduced physiologic reserve, blunted compensatory responses, comorbid illness, and polypharmacy can mask expected findings. A subtle change in attention, behaviour, or level of awareness may be the earliest sign of infection, shock, occult trauma, stroke, medication toxicity, or metabolic illness. The most important first step is to establish whether the patient has acutely changed from their usual baseline.

By the end of this tip, paramedics will be able to identify an acute change from baseline, recognize high-risk atypical patterns, and complete a focused assessment for reversible causes of altered LOA in an older adult.

Early Transport Decisions in Cardiac Arrest

Out-of-hospital cardiac arrest management requires paramedics to balance the benefits of on-scene resuscitation with the potential advantages of rapid transport. High-quality CPR, rhythm analysis, defibrillation, and airway management are often best performed in a controlled on-scene environment. However, some patients who are unlikely to meet Termination of Resuscitation (TOR) criteria may benefit from early transport, and this is not limited to the H’s and T’s of reversible causes. The decision to transport prior to 20 minutes of resuscitation should be guided by objective clinical factors and the ability to maintain high-quality resuscitation throughout extrication and transport.