EMS Legislation Test II Flashcards
(149 cards)
1
Q
What are the 6 core attributes of a paramedic?
A
1) Empathy & patient-centered approach (acting and performing in a way that you expected to be treated in an emergency; advocacy for patient’s best interest)
2) Honesty
3) Humility
4) Nonjudgmental/discriminatory attitude
5) Responsible/Accountable (self-reflection, keeping everything organized and certifications up to date)
6) Leadership and confidence (delegate and take direction)
2
Q
What is the minimum designation required to be employed in Ontario as a paramedic?
A
PCP
3
Q
What is a PCP’s scope of practice?
A
delivering BLS standards + delegated medical acts
4
Q
What is an ACP’s scope of practice?
A
delivering BLS standards + increased scope of delegated medical acts (ex. endotracheal intubation, needle decompression, controlled medications)
5
Q
What is a CCP’s scope of practice?
A
- at the level of mobile ICU (trained in lab & radiological data)
- wokring with advanced medical technology such a ventilators
- expanded medication scope
6
Q
Definition of Code 0/Black/Critical
A
When there is 1 or no ambulances available to repsond to emergency calls
7
Q
Community paramedicine is suitable for what types of calls/populations? (6)
A
- low acuity medical calls
- MH & addiction
- falls prevention/intervention
- palliative care
- chronic health problems (COPD, diabetes)
- homeless outreach
8
Q
Paramedic Conduct Standard. The paramedic shall (11 points):
A
1) conserve life, alleviate pain and suffering, and promote health
2) protect and maintain patient’s safety, dignitiy, and privacy
3) provide care based on human need with respect for human dignity
4) demonstrate empathy and compassion for patients and their families
5) provide pt care until it is no longer required or until another appropriately qualified HCP has accepted responsibility for patient care
6) discharge his/her duties with honesty, diligence, efficiency, and integrity
7) conduct and present oneself in such a manner so as to encourage and merit respect of the public for members of the paramedic profession
8) attempt to establish and maintain good working relationships with other professional colleagues and the public
9) assume responsibility for personal and professional development (QA initiatives, ex. reporting patient safety incidents)
10) maintain familiarity with current applicable legislation and practice, and strive to work to the fullest extent of her/her competencies
11) report any incompetent, illegal, or unethical conduct by colleagues or other HCPs to the ambulance service operator and/or base hospital
9
Q
Paramedic Misconduct standard. The paramedic shall not (9):
A
1) practice beyond level of certification
2) refuse/neglect to serve persons requiring services that are part of the normal performance of his/her duties
3) falsify documentation of any kind
4) misrepresent quals/credentials
5) threaten/use violent behaviour
6) take or possess drugs from ambulance service without authorization
7) disclose confidential info to anyone, unless required or permitted by law (i.e. identifying info, PHI, info obtained through one’s position as paramedic that is otherwise not available to the public in general)
8) have any form of inappropriate sexual contact, relations, or impropriety with a patient
9) engage in any other conduct unbecoming of a paramedic
10
Q
What are the 5 types of EMS delivery models in Canada?
A
1) provincial/territorial service
2) municipality- run service
3) fire-based EMS service
4) hospital-based service
5) private service operators
11
Q
What is a provincial/territorial service delivery model? Provide an example of a location/service that delivers ambulance services using this delivery model.
A
operated and funded provincially
ex. BC, Alberta, First Nations
12
Q
What is a municipality-run service delivery model?
A
cost is shared by province and municipality
13
Q
Ontario is primarily which service delivery model to provide ambulance services?
A
municipality-run service
14
Q
What is a fire-based service delivery model? Provide an example of a location/service that delivers ambulance services using this delivery model.
A
model where there is either an EMS division within fire, or firefighters are dual-response (firefighters and EMS)
- ex: Winnipeg Fire Paramedic service
15
Q
What is a private service operator delivery model? Provide an example of a location/service that delivers ambulance services using this delivery model.
A
ambulance services contracted by province/territories/municipalities that are still regulated by provincial/territories regulation but private
- ex. Medavie Health services (in N.S., N.B., PEI, Chatham-Kent & Elgin counties, rural Saskatchewan communities)
16
Q
How do the EMS service delivery models differ in the US (relative to Canada)?
A
- lack of federal oversight (responsibility is to each individual state)
- 1/4 are private service operators
- prevalent fire-based EMS
- no universal healthcare so large costs directly go to patients
17
Q
Who is the direct provincial oversight of how ambulance services are delivered in Ontario?
A
MOHLTC
18
Q
Who has authority over complaints and investigations of paramedics? (3)
A
- EMS Service
- Base hospital
- MOHLTC
19
Q
Land ambulance operators are mainly operated by ________________ (hint: one level below MOHLTC).
A
upper-tier municipalities
20
Q
What are the responsibilities of MOHLTC - Emergency Health Services Branch, as set out by the Ambulance Act (7)?
A
1) establishing standards for the management, operation and use of ambulance services
2) ensure compliance with said^ standards
3) the certification of ambulance services
4) credentialing of paramedics
5) designation of Base Hospitals to support paramedic service delivery
6) the inspection of ambulance service operations
7) investigation of complaints
21
Q
Land amublance service operators undergo formal certification process every ____ years by MOH.
A
3
22
Q
What happens when gross inadequacies occur with an ambulance service operator?
A
A Director’s Order may be issued under authority of the Ambulance Act (section II) which mandates operator to rectify all areas of weakness within a period of time
23
Q
Response times set out by MOH:
1) Sudden Cardiac Arrest patients
2) CTAS 1 patients
3) CTAS 2-5 patients
4) Dispatch - SCA/CTAS 1 patients
A
1) % of times that a person equipped to provide any type of defibrillation has arrived on scene to provide defib within SIX minutes
2) % of times that an ambulance crew has arrived on scene to CTAS 1 patients within EIGHT minutes
3) % of times that an ambulance crew has arrived on scene to CTAS 2-5 patients within response time targets set out by muncipality
4) % of times dispatch dispatches an ambulance within 2 minutes for SCA/CTAS 1
24
Q
What are the 7 MOH standards/documents set out for paramedics to follow?
A
1) BLS PCS
2) ALS PCS
3) Patient Care Model Standards
4) Ambulance Service Communicable Disease Standards
5) Ontario Ambulance Documentation Standards
6) Patient Care & Transport Standards
7) Provincial Equipment Standards for Ontario Ambulance Services
25
While MOHLTC cost-shares 50% of expenses for land ambulance services with municipalities, for what services do they cover 100% of the cost?
- Base Hospitals
- Dispatch
- CACC/ACS
- Ambulance Service to First Nations communities
- Territories without municipal organization
- Air ambulance program
26
True or False: Base hospitals are involved with providing oversight on controlled medical acts, QA/audits, continuing medication education, and competency maintenance activities.
True
27
How many base hospitals are there for land ambulances? Air ambulances?
Land: 7
Air: 1
28
What is the difference between core and auxiliary standards within ALS PCS?
Core: indicates that every paramedic across all services can and will perform the protocol for an indicated patient
Auxiliary: optional protocol that are opted in/out by ambulance services (ex. giving gravol for nausea/vomiting)
- typically new standards start off as auxiliary and if there is major benefit to patient care, then it becomes core standard
29
What are ambulance service operators (ASOs) and what are their duties?
Municipality EMS providers that lead the actual delivery of ambulance services in their local area (with use of an ambulance deployment plan which indicates # of ambulances need to cover the area and how/when these trucks are deployed)
Duties:
- developing a governance and organizational structure to enable delivery of services
- managing vehicles and paramedics
- funding ambulance operations
30
You are with Niagara EMS and are dropping off a patient at the trauma center in Hamilton. A high priority call comes in and assistance is required. However, this means you are providing care outside of your municipal zone. Are you allowed to attend the call?
Yes. Ambulances outside their municipal zone can still be required to respond to high priority calls if they are deemed as the closest available unit
31
Ambulance operational reporting is reporting what kinds of stats to MOH (6) ?
- # of EMS calls responded to
- length of time between call received and when it is dispatched to EMS unit
- length of time betwen call received by EMS unit and arrival
- time spent at hospital by ambulances
- # of hours of amulance service provided in the community
- hour cost of providing an ambulance service
32
What three provinces have a College of Paramedics?
- Saskatchewan (2000)
- Manitoba (2018)
- Nova Scotia (2017)
33
True or False: Self-regulation (as in having a governing body) is granted to those that put the interests of the public first over own professional interests
True
34
What is the Ontario Paramedic Association (OPA)?
not-for-profit organization that exists to advocate on behalf of members and to promote the profession (i.e. educating the public, lobbying politics)
35
What are tiered-response agreements?
Formal written documents that establish local protocols for multi-agency response to a life threatening/public safety incident (outlines capabilities, expectations, and limitations of each agency)
36
What is the intention of having tiered-response?
To provide a clear response time advantage in scene arrival by all the emergency services
37
List 6 situations that warrant tiered response.
1) Life-threatening medical emergencies (cardiac arrest, unconscious)
2) MCIs
3) Hazardous materials incident (CBRNE) involving casualties/potential for casualties
4) Large fires involving casualties/potential for casualties
5) Natural disasters resulting such occurrences as building collapse
6) MVCs
38
For every one minute delay in defibrillation, survival rate of a cardiac arrest decreases by _____% (range).
7-10
39
_______ play the largest role in favourable sudden cardiac arrest outcomes for hospital discharge
bystanders
40
What is the medical training for firefighters?
- All trained to BLS CPR
| - some have EMR too but not required
41
Typically there are 4 firefighters on a truck that attends a call. What are their roles?
1) Captain - overlooks scene, attempts to get pertinent information
2) Driver - does not typically come on scene but meets EMS outside to allow access into buildings; will often set up stretcher
3) Two others - will have PPE, kit, and AED and ready to assist if necessary
42
What kinds of calls would police be tiered on typically (6)?
- any calls with reported violence/weapon
- MVCs
- assault and sexual assault
- MH and attempted suicide
- OD
- unexpected death (including TOR or cases of obvious death patients)
43
According to the BLS, what are the radio codes to be used to contact police in extenuating circumstances?
10-20: no immediate danger is evident to patient or paramedic but requesting police presence
10-2000: immediate danger
44
What is the Police Notification Standard, according to the BLS?
General directive: notify police in any cases involving unusual/suspicious situations (sudden deaths, violence, foul play, accidents involving emergency vehicles)
1) if you request police, you have to:
- contact your CACC/ACS via phone/radio
- state nature of request
- indicate urgency of response and request ETA
- advise of possible hazards
- indicate access routes (where applicable)
- provide police with update when they arrive on scene
2) use radio codes in extenuating circumstances: 10-20, 10-2000
3) the use of police vehicle escorts during transport for the purpose of traffic control is discouraged due to prevalent danger it presents
45
If there is suspected foul play, what should be noted (in accordance with the BLS Police Notification Standard)?
In general, leave the scene as undisturbed/preserved as possible
Note:
1) once a body is moved it can never be put back in original position
2) careful attention required whenever something is moved
3) whenever possible, use the shortest, most direct path to patient and when leaving
4) attempt to preserve chain of evidence (do not discard linens/clothes after call completion without checking with receiving facility/investigating officer)
5) receiving facility staff should be informed re: suspected foul play
46
What is the Violent/Aggressive Patient Standard, according to the BLS (10)?
1. consider underlying organic disorders
2. give particular attention to personal safety as per General Measures Standard
3. request police assistance on-scene
4. wait for police assistance if: there is an active shooter, there is direct evidence of ongoing violence
5. if electing to delay service (and wait for police), immediately notify CACC/ACS
6. if patient is uncooperative, elicit info from others on scene and attempt to determine underlying cause triggering behaviour whether there is a past hx of violence
7. be alert for behavioural signs of impending violence
8. if confronted, seek safe egress and attempt to withdraw
9. if safe withdrawal not feasible, attempt to speak with and calm patient
10. consider need for restraints as per MH Standard
47
Who has the most reponsibility regarding occupational health and safety laws and legislation? Employee, employer, supervisor
employer
48
Duties of the employer re: occupational health and safety includes what (6)?
1) ensure workers know about hazards in the workplace and how to work safely
2) ensure every supervisor knows how to take care of health and safety on the job
3) create health and safety policies and procedures in workplace
4) ensure everyone knows and follows ^ procedures
5) ensure workers wear and use right PPE
6) do everything reasonable to keep workers from getting hurt/sick on the job
49
Duties of the supervisor re: occupational health and safety includes what (4)?
1) tell workers about hazards in the workplace and SHOW THEM how to work safely
2) make sure workers follow the law and policies/procedures
3) make sure workers wear and use right PPE
4) do everything reasonable to keep workers from getting hurt/sick on the job
50
Duties/Rights of the worker re: occupational health and safety includes what (6)?
1) follow the law and workplace h&s policies/procedures
2) always wear and use PPE required by employer
3) work and act in a way that won't hurt yourself/others
4) report any hazards found in workplace to supervisor
5) you have a right under OHSA to be told about the hazards in the work you do and be instructed on how to do your work safely
6) employer/supervisor cannot punish you in any way for doing what OHSA says or for asking them to do what OHSA expects them to do
51
How does the right to refuse unsafe work apply to paramedics?
tl;dr: it doesn't
- In specified circumstances, the right to refuse is limited for health care workers and persons employed in workplaces like ambulance services
- the right to stop work in dangerous circumstances do not apply to workplaces in which specified types of health workers that are employed & where the work stoppage would directly endanger life, health and safety of another person
52
The Joint Health and Safety Committee (JHSC) is composed of which individuals? What is the purpose of the committee?
- composed of worker and employer reps
| - purpose: address issues on both sides re: health and safety issues
53
When the workplace has 50+ workers regularly employed, how many people should be on the JHSC?
at least 4 (half of them must be employees that don't exercise managerial functions)
54
What is the greatest concern when sustaining a needlestick injury?
infectious fluids especially blood
55
What is the appropriate method of disposing and caring for needles?
Place needles in wide-mouth, puncture-proof containers and replace when 3/4 full
56
Why is a fit test used?
to determine if a respirator (ex. N95) is a good fit for a user's face (i.e. maks forms tight seal against face)
57
According to OHSA, when is a fit test warranted?
1) When test has never been done before on a worker and they are required to wear a respirator
2) At least every 2 years
3) If they are using a new resp. model/make
4) if there are any changes to user's physical condition that could affect the respiratory fit (weight gain/loss, surgery, major dental work)
58
Canada's national hazard communication standard is known as:
Workplace Hazardous Materials Information System (WHMIS)
59
What are the 4 key elements of WHMIS?
1) hazard classificatoin
2) cautionary labeling of containers
3) Safety Data Sheets (SDSs)
4) Worker education and training program
60
WHMIS requirements are laid out in what pieces of legislation, and how are requirements described in each of these pieces of legislation?
OHSA: requires employers to ensure hazardous products are identified, to obtain SDSs and make them available in workplace and provide instructions/training to workers
WHMIS Regulation: sets out employer's duties re: labels and SDS for hazardous products and prescribes content/delivery of worker education programs; also sets out types of confidential business info employe may withhold from label/SDS
61
Definitions and classification criteria of hazard class, category, and sub category are set out by what two pieces of legislation?
Hazardous Products Act (HPA)
| Hazardous Products Regulations (HPR)
62
Physical hazards vs health hazards
Physical: categorized based on characteristics such as flammability/reactivity
Health hazards: categorized based on their ability to cause a health effect (ex. toxicity, carcinogenicity, skin/eye damage, respiratory disorders, biohazardous)
63
A gas cylinder pictogram indicates what?
gas under pressure
64
A flame over circle pictogram indicates what?
for oxidizing hazards
65
A exploding bomb pictogram indicates what?
for explosion or reacting hazards
66
A corrosion pictogram indicates what?
for corrosive damage to metals, skin, and eyes
67
A skull and crossbones pictogram indicates what?
acute toxicity (can cause death or toxicity with short exposure with small amounts)
68
A biohazard pictogram indicates what?
biohazardous infectious materials (for organisms and toxins that can infect people and animals)
69
A health hazard pictogram indicates what?
may cause or suspected to cause serious health effects (carcinogenicity, respiratory effects, reproductive toxicity, specific target organ toxicity, mutagenicity of cells)
70
An environment pictogram indicates what?
may cause damage to aquatic environment
71
An exclamation pictogram indicates what?
- may cause less serious health effects (skin irritation, acute toxicity, drowsiness/dizziness)
- hazardous to ozone layer
72
A flame pictogram indicates what?
for fire hazards
- ex. flammable, self-reactice, pyrophoric, self-heating, organic peroxide, emits flammable gases if in contact with water
73
What are Safety Data Sheets (SDS)?
a technical document that summarizes health and safety information available about a hazardous product & supplements the warning information on a label
74
What are the 16 sections that need to be included in every SDS?
1) Identification
2) Hazard(s) identification
3) Composition/information on ingredients
4) First-aid measures
5) Fire-fighting measures
6) Accidental release measures
7) Handling and Storage
8) Exposure controls/personal protection
9) Physical and chemical properties
10) Stability and reactivity
11) Toxicological information
12) Ecological information
13) Disposal considerations
14) Transport information
15) Regulatory information
16) Other information
75
What is WSIB?
A workplace insurance system that provides benefits and services to workers who have been injured at work or who have diseases related to work
76
What is meant by WSIB being a "no-fault" system?
Based on collective employer libility which means that workers can get workplace safety and insurance benefits without proving that their employer is at fault for their injury/disease
- must only proive that the injury/disease was work-related (and in return, employers get protection from being sued for work-related injuries)
77
What is the main function/goals of WSIB?
- help injured workers RTW, recover, and re-enter into labour market
- provide compensation and other benefits to them
78
WSIB claims must be filed within what time frame for compensation?
6 months from day of accident OR within 6 months from the day you found out that the injury/disease was work-related if you didn't know before)
79
True or false: your employer has a legal obligation to do things to help you get back to work after the acident, and you are also legally obligated to do things to try and get back to work
True
80
What are the 6 purposes of the HCCA?
1) to provide rules re: consent to treatment that apply consistently in all settings
2) to facilitate treatment, admission to care facilities, and personal assistance services for persons lacking capacity to make decisions for such matters
3) to enhance autonomy of persons whom treatment is proposed, admission to care facilities is proposed, and persons who are to receive personal assistance services
4) to promote communication and understanding between health practitioners and their patients/clients
5) to ensure a significant role for supportive family members when a person lacks capacity to make a decision about a treatment, admission to a care facility or personal assistance service
6) to permit intervention by PGT only as last resort in decisions on behalf of incapable persons concerning treatment, admission to care facility, or personal assistance services.
81
According to the HCCA, how does the HCCA enhance autonomy of persons whom treatment is proposed, admission to care facilities is proposed, and persons who are to receive personal assistance services?
1) allowing those who have been found to be incapable to apply to a tribunal for review of the finding
2) allowing incapable persons to request a rep of their choice to be appointed by tribunal as SDM for decisions regarding treatment, admission to care facility, or personal assistance services
3) requires adherence to expressed wishes by persons while capable and 16+ year olds, re: treatment, admission to care facility or personal assistance services
82
What is the definition of "treatment" according to HCCA?
anything that is done for therapeutic, preventative, palliative, diagnostic, cosmetic or other health-related purpose, and includes course of treatment, plan of treatment, or community treatment plan
83
What 8 situations does the definition of "treatment" not include, according to HCCA?
1) assessment for the purpose of this Act of person's capacity with respect to treatment
2) assessment/exam of a person to determine the general nature of a person's condition
3) taking person's health history
4) communication of an assessment/diagnosis
5) admission of a person to a hospital/other facility
6) a personal assistance service
7) a treatment that under the circumstances poses little or no risk of harm to the person
8) anything prescribed by regulations as not constituting treatment
84
Consent given in writing/orally directly is known as...?
Expressed consent
85
You receive a call to a patient who is unconscious. What type of consent would allow you to perform lifesaving treatment?
implied consent - if patient is unable to give cosent in a lifethreatening situation, it is preseumed that a reasonable person would give consent to lifesaving treatment if the person were able to do so
86
In accordance to the HCCA, a health care professional who proposes a treatment shall not administer treatment and shall take reasonable steps to ensure that it is not administered, unless what conitions?
1) he/she is of the opinion that the person is capable with respect to treatment and the person has given consent
OR
2) he/she is of the opinion that the person is incapable with respect to treatment and SDM has given onsent on the person's behalf
87
In accordance to the HCCA, unless it is not reasonable to do so in the circumstances, a HCP is entitled to presume that consent to what two treatment situations?
1) variations/adjustments in treatment, if the nature, expeted benefits, material risks and material side effects of the changed treatment are not significantly different from the nature, expected benefits, materia; risks and side effects of OG treatment
2) to continue same treatment in a different setting if there is no significant change in expected benefits, material risks or material side effects of the treatment as a result of the change in setting in which it is administered
88
What are the 4 elements of consent?
1) consent must relate to the treatment
2) consent must be informed
3) consent must be given voluntarily (not under duress/coercion)
4) consent must not be obtaine through misinterpretation or fraud
89
Consent to treatment is informed if before giving consent, what two conditions are met?
1) the person received information that a reasonable person in the same circumstances would require in order to make a decision about the treatment
2) the person received responses to his/her requests for additional information about those matters
90
What sort of information regarding a treatment should be provided to a patient in order for them to provide informed consent (6)?
1) the nature of the treatment
2) the expected benefits of the treatment
3) the material risks of the treatment
4) material side effects of the treatment
5) alternative courses of action
6) the likely consequences of not having the treatment
91
Consent can be withdrawn at any time by who?
1) the patient if they are capable with respect to the treatment at the time of the withdrawal
2) the SDM if the person is incapable with respect to the treatment at the time of the withdrawal
92
An incapable patient is represented by his SDM to consent to treatment. However, the patient then becomes capable with respect to the treatmet in the middle of your call and refuses treatment. The SDM continues to encourage you that the patient requires this treatment. What are your next steps?
If the person becomes capable with respect to the treatment (based on your professional judgment considering circumstances and patient's condition), you must follow their wishes and stop providing treatment.
93
What is capacity?
The ability to understand information that is relevant to making a decision about a treatment and being able to appreciate the reasonably foreseeable consequences of a decision/lack of decision.
94
True or false: a patient can be capable with respect to some treatments and incapable to others.
True
95
List the hierarchy of SDMs.
Legally Appointed SDMs
1) court appointed guardian
2) POA for personal care
3) rep appointed by Consent and Capacity Board
Automatic Family Member SDMs
1) spouse or partner
2) parents or children
3) parent with right of access only
4) siblings
5) any other relatives
Last resort
1) PGT
96
What criteria does someone have to meet in order to be SDM for an incapable person?
1) they are capable (have capacity)
2) at least 16 y.o. unless they are the incapable person's parent
3) must not be prohibited by court order/separation agreement from having access to the incapable person OR giving/refusing consent on his/her behalf
4) must be available to be contacted
5) must be willing to be SDM
97
What is a POA?
a legal document giving one person the power to act for another person (they can have broad legal authority or limited authority to make decisions about the principal's property, finances, or medical care)
98
True or false: as per the BLS, the patient or SDM can refuse to sign the "refusal of service" section on the ACR.
True - there is no obligation on the patient or SDM to sign the ACR (paramedic should document their refusal and reason for failing to provide a signature)
99
What is the BLS standard for a patient with capacity who refuses treatment/transport?
1) make reasonable efforts to inform patient/SDM that treatment/transport is recommended and explain possible consequences of such refusal
2) confirm that the patient/SDM has capacity utilizing Aid to Capacity Assessment as per ACR Completion Manual
3) advise patient/SDM to call 911 again if further concerns arise
4) obtain signatures and complete additional documentation requirements as per Ontario Documentation Standards and Ambulance Call Report Completiong Manual
100
What is the BLS standard for emergency transport/treatment of an incapable patient without consent?
Paramedic shall carry out emergency treatment and transport if:
1) patient does not have capacity
2) patient is apparently experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm
3) the delay required to obtain consent/refusal on patient's behalf will prolong suffering or will put patient at risk of sustaining serious bodily harm
4) document the circusmstances that led to ^ decisions
101
What is the BLS standard for emergency treatment and transport of a capable patient without consent?
Carry out emergecny treatment and transport if:
1) patient is severely suffering or is at risk (if tx is not provided promptly) of serious bodily harm
2) communication required in order for patient to give/refuse consent cannot take place because of a language barrier or because they have a disability that prevents communication from taking place
3) you've already taken reasonable steps to find a practical means of enabling the communication to take place but no such means has been found
4) the delay required to find a practical means of enabling communication to take place will prolong patient's suffering or will put them at risk of serious bodily harm
5) there is no reason to believe that patient doesn't want treatment
6) ALWAYS document the circcumstances that led to decisions ^
102
In the Aid to Capacity Evaluation, what must you consider when asking the patient/SDM questions?
1) Patient verbalizes/communicates understanding of clinical situation? (i.e. what is wrong with you?)
2) patient verbalizes/communicates appreciation of applicable risks? (i.e. what would happen if I don't help you?)
3) Patient verbalizes/communicates ability to make alternative plan for care? (i.e. What will you do once I leave?)
4) Responsible adult on scene
103
What is auditing?
Evaluation of completed documentation typically completed by EMS peers
104
List 3 mechanisms used for ACR review.
1) Automated filtering process
2) self-reporting
3) external inquiry
105
Minor vs major vs critical omission/comission.
An action/lack of action (including performance of a Controlled Act or other advanced medical procedure listed in the ALS PCS by the paramedic that:
Minor - may have negatively affected patient care in a way that would delay care to the patient/lengthen their recovery period but not negative affect patient morbidity
Major - negatively affected or potential to negative affect patient morbidity without potential life, limb, function threat outcome
Critical - practicing beyond scope; or action/lack of action that negatively affected or had to the potential to do so affecting patient morbidity or mortality with potential life, limb, or function threat outcome
106
What is an Ombudsman?
an officer of the Ontario Legislative Assembly who is independent of government and political parties
107
What is the function of an Ombudsman?
To promote fairness, acountability, and transparency in the public sector by resolving and investigating public complaints and systemic issues within the Ombudsman's jurisdiction
108
What is a union?
A membership-based worker's organization that leads and is empowered by the voice and goals of its members
109
What is the function of a union?
To negotiate collective bargaining agreements that govern members' working conditions, pay, benefits, and scheduling; also to keep employer accountable
110
What are the main paramedic unions within Ontario (3)?
CUPE, OPSEU, Unifor
111
What is collective bargaining?
The negotiation process between a union and employer with a goal of reaching a collective agreement
112
Define grievance
A formal employee complaint that is an accusation of a violation of workplace contract terms or policy (basically negatively affected by their employer)
113
What is the purpose of having a steward or union rep at any disciplinary meeting?
- to consult with your union rep prior to and during the meeting about the subject of the meeting
- they can help clarify questions and assist you in refuting/explaining any allegations
114
What are two sources of law? Briefly describe each.
Common law/case law: law/decisions made by the courts (judge's decision)
- records not only the outcome but also the reasons for the decision and sources upon which the decision was based
Statute Law: laws made by legislators (federal/provincial)
- ex. acts passed by the parliament, Ambulance Act (provincial statute of Ontario)
115
What are the two divisions of law. Briefly describe each.
1) Public Law - reflects nature or source of disputes between individual and state
- ex. criminal law, constitutional law, regulatory law
2) Private Law - aka civil law; sets the rules between individuals by settling disputes and compensating victim
116
What is the highest level of courtroom in Canada?
Supreme Court of Canada
117
The decisions of Supreme Court are binding on all other courts in Canada. This is known as what?
Precedent
118
What is Precedent?
refers to a court decision that is considered as authority for deciding subsequent cases involving identical or similar facts, or similar legal issues.
119
Individual vs vicarious liability
Individual: law holds all individuals accountable for their conduct (so all health care professionals are expected to exercise independent judgement)
Vicarious: placing the liability for one's actions upon another person; if employment relationship is present then employer becomes responsible for acts/omissions of its employees
120
What is the Good Samaritan Law?
Indicates that Good Samaritans are protected from liability unless gross negligence
121
What is a tort?
A civil wrong that the courts will set right by ways of damages; it is NOT a crime
122
Briefly describe the civil law process.
1) plaintiff files a "Statement of Claim" that sets out the basis of the claim against the defendant and what compensation they are seeking
2) Pleadings - statement of claim & statement of defense
3) Discovery (pre-trial meeting to examine documents and evidence that is to be brought to trial)
4) Trial
123
Define: Tort of Assault
the willful attempt or threat to inflict injury upon a person, when couple with an apparent present ability to do so, and any intentional display of force such as would give the victim reason to fear or expect immediate bodily harm
124
Define: Tort of battery
the intentional bringing about of any harmful or socially offensive physical contact with another person (also without their consent)
125
True or false: paramedics attempting to transport or treat a patient without consent would be considered a tort of battery
True
126
True or false: spitting is not considered consistent with battery as the individual did not make physical contact
False
127
Define: Tort of Negligence (in the context of paramedics)
The failure to exercise the care that a reasonable and prudent paramedic in similar circumstances would have taken
128
True or False: The defendant does not have to intend the consequence of their action/inaction in order to be held liable for negligence
True
129
What are the 3 elements that must exist to support action for negligence?
1) duty of care
2) standard of care and its breach
3) causation of damage and harm to the patient
130
What does Duty of Care mean when discussing tort of negligence?
whether the defendant was under any legal obligation to exercise care for the plaintiff (ex. paramedics would have a legal obligation to care for patients while on duty, these paramedics would have a duty of care/duty to act the moment they make patient contact)
131
What does Standards of Care and its Breach mean when discussing tort of negligence?
determining whether paramedic has met expected standards within profession that is consistent with what other competent colleagues would do in a similar circumstance
132
What does Causation of Damage and Harm to the Patient mean when discussing tort of negligence?
When a duty of care exists and a breach of standards occurred, the action or inaction must be what directly causes the damage or harm of the patient (the harm has to be a REASONABLY foreseeable consequence)
133
Define abandonment
Unilateral termination of provider-patient relationship at a time when continuing care is still needed; a form of negligence that involves termination of care without patient's consent or formal refusal
134
What does "drop stretcher" mean? What do you do in situations like this?
When requested by supervisor to leave patient in the ED without a HCP overseeing their care
- ensure that the facility is aware of this, document conversation with supervisor, document any changes in patient status at time of drop, and the time when you leave
135
True or False: it is not considered abandonment if paramedics must exist a scene due to fear of safety.
True
136
Criminal law falls under what type of law domain and deals with what?
- falls under public law domain
- deals with wrongful acts that threaten/infringe upon fundamental social values to protect public's interests and punish offenders
137
# Define the following according to the criminal code of Canada:
1) Assault
2) Assault with a weapon
3) Assault causing bodily harm
4) Aggravated assault
1) Assault: intentionally applying force to another person without consent; and attempting or threatening to apply force to another person
2) Assault with a weapon: committing an assault while carrying, threatening to use, or using a weapon (or an imitation weapon)
3) Assault causing bodily harm: any assault that causes a "hurt or injury" that is more than transient or trifling
4) Aggravated assault: an assault that results in wounding, maiming, disfiguring, or endangering another person
138
Define: sexual assault
an intentional application of force to another individual of a sexual nature, without consent, or attempting/threatening such conduct
139
True or False: Dangerous driving and failure to provide necessities of life are considered criminal negligence.
True
140
What are the criteria/definition deeming someone as criminally negligent, according to the Criminal Code of Canada?
Every one is criminally negligent who:
1) in doing anything
2) in omitting to do anything that is his duty to do
shows wanton (deliberate and unprovoked) or reckless disregard for the lives or safety of other persons
141
How is the fault element of criminal negligence assessed (i.e. how much is someone at fault)?
by measuring the degree to which the accused's conduct departed from that of a reasonable person in the circumstances
142
Define: death that might have been prevented
where a person, by an act or omission, does anything that results in the death of human being although the death from that cause might have been prevented by resorting to proper means
143
Define: Death from treatment of injury
Where a person causes to a human being bodily injury that is of itself of a dangerous nature and from which death results (inspite of proper or improper treatment that is applied in good faith)
144
Define: acceleration of death
Where a person causes to a human being bodily injury resulting in death (but the effect of the bodily injury is only to accelerate his death from disease or disorder arising from some other cause)
145
What route of entry leads to the most work-related sickness?
Inhalation
146
What are the 4 routes of entry for hazardous materials to get into the body?
inhalation, ingestion, absorption, injection
147
Place in chronological order best to worst way to control chemical hazards:
1) Engineer the hazard out
2) Use PPE
3) Eliminate hazard
4) Institute administrative procedures and awareness training
5) Substitute a less hazardous chemical
1) Eliminate hazard
2) Substitute a less hazardous chemical
3) Engineer the hazard out
4) Institute administrative procedures and awareness training
5) Use PPE
148
What are the 3 identifiers required for a workplace label?
1) Product identifier
2) Safe handling instructions
3) Reference to SDS
*Hazard pictograms optional
149
Who is more likely to get hurt on the job?
1) Employee who has been with the company for decades
2) New employee - 1st week on the job
New employee - people starting new jobs are 3x more likely to get hurt during their first month on the job than any other time AND greatest risk among new workers are those 45+ y.o.
