Paramedics in Canada - Scope of Practice - Skills


Although there is a great deal of variation in what paramedics in Canada are trained and permitted to do from province to province, these are the baseline skills performed by all paramedics in Canada:

Treatment issue PCP skills ACP skills Critical Care Paramedic skills
Airway management Manual and repositioning, Oro- and nasopharyngeal airway adjuncts (in some case supraglottic airways like the King LT) manual removal of obstructions, suctioning endotracheal intubation (in some cases, naso as well), advanced airway management, deep suctioning, use of Magill forceps Rapid sequence induction, surgical airways (including needle cricothyrotomy and others)
Breathing Initial assessment (rate, effort, symmetry, skin color),pulse oximetry, obstructed airway maneuver, passive oxygen administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by Bag Valve Mask (BVM) device. pulse oximetry, active oxygen administration by endotracheal tube or other device using BVM Use of mechanical transport ventilators, active oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracotomy)
Circulation Assessment of pulse (rate, rhythm, volume), blood pressure and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets Ability to interpret assessment findings in terms of levels of perfusion, intravenous fluid replacement, vasoconstricting drugs, intraosseous (IO) cannulation (placement of needle into marrow space of a large bone) intravenous plasma volume expanders, blood transfusion, central venous access (central venous catheter by way of external jugular, subclavian or umbilical lines) and Arterial Line Monitoring
Cardiac arrest Cardiopulmonary resuscitation, airway management, manual ventilation with BVM, semi-automatic external defibrillator Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), ECG interpretation (may be limited to Lead II) Semi-automatic or manual defibrillator Expanded drug therapy options, ECG interpretation (12 Lead), manual defibrillator, synchronized mechanical or chemical cardioversion, external pacing of the heart
Cardiac Monitoring Cardiac monitoring and interpretation of ECGs 12-lead ECG monitoring and interpretation 15 & 18-lead ECG monitoring and interpretation
Drug administration Limited oral, limited aerosol, limited injection (usually IM). IV administration admitted in some provinces Intramuscular, subcutaneous, intravenous injection (bolus), IV drip per ETT, per rectal tube, per infusion pump
Drug types permitted Low-risk/immediate requirements (e.g. ASA (chest pain), nitroglycerin (chest pain), oral glucose (diabetes), glucagon (diabetes), epinephrine (Allergic Reaction), ventolin and/or Atrovent (Ipratropium Bromide) for Asthma. Note: Some jurisdictions also permit naloxone (Narcotic Overdose), nitrous oxide (for pain); considerable variation by jurisdiction Considerable expansion of permitted drugs, but still typically limited to about 20, including analgesics (narcotic or otherwise) (for pain), antiarrhythmics (irregularities in heartbeat), major cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation), sedatives Dramatically expanded (up to 80) drug list, Note: In some jurisdictions Critical Care Paramedics are permitted to administer any drug, as long as they are familiar with it.
Patient assessment Basic physical assessment, 'vital' signs, history of general and current condition. Specific assessments such as auscultation, glucometry, pulse oximetry, etc. Capnography and ECG interpretation in some provinces. All PCP skills along with capnography and ECG interpretation Interpretation of lab results, interpretation of chest x-rays, interpretation of cranial CT scan, limited diagnosis (e.g. rule out fracture using Ottawa Ankle Rules)
Wound management Assessment, control of bleeding, application of pressure dressings and other types of dressings Wound cleansing, wound closure with Steri-strips, suturing

Read more about this topic:  Paramedics In Canada, Scope of Practice

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