Professional Development for Base Hospital Staff

Welcome to OBHG24: 15 Years in the Making, the essential Ontario Base Hospital Group professional development event for base hospital staff and collaborators happening from Tuesday evening, September 24 until noon on Thursday, September 26, 2024, at Andaz in Ottawa's historic Byward Market.

OBHG24 is presented as part of OBHG's AGM Week programming from Monday, September 23 until noon on Thursday, September 26, 2024.

The Annual Meeting is on September 23 & 24 and includes meetings for G8, G16, MAC, and sub-committees.

On this site, you'll find more information about both the Annual Meeting and OBHG24 events. If you plan to attend both events, please register for both OBHG24 and the Annual Meeting: you will need to complete two separate registrations.

About OBHG24

OBHG24 is a milestone event for invited participants to mark 15 years since the inception of the regional base hospital system in Ontario. A celebratory event, OBHG24 is a time to reflect on our journeys and achievements in shaping emergency healthcare in the province. With a curated array of experts and voices uniting Base Hospitals, healthcare professionals, and specialists from various disciplines, OBHG24 serves as a crossroads in our continued journey, bringing base hospital staff together for collaborative discussions amidst a healthcare landscape facing unprecedented challenges.

Emphasizing collaboration, this platform provides many opportunities to meet colleagues and potential collaborators, and to learn about the work we all do across this province. We've chosen a wonderful venue to support getting to know one another, and the OBHG24 Program focuses on working together.

OBHG24 invites experts in adult learning, quality management, risk assessment, emergency healthcare, research, technology, and partner engagement to animate discussions that can help our work. Acknowledging the ever-evolving nature of Ontario's emergency healthcare system, OBHG24 provides a space for dialogue and exploration of innovative strategies.

OBHG24 applauds the invaluable contributions of Base Hospitals in shaping emergency paramedic practice over the past 15 years. As we reflect on this journey, we recognize the uncertainty and anticipation surrounding the future of healthcare. Attendees will engage in dialogues that underscore the vital role of varied fields in recalibrating emergency responses for today and tomorrow while steadfastly maintaining person-centered care. It's an environment where diverse perspectives converge, fostering insightful exchanges and collective exploration.

Join us at OBHG24 as we celebrate the progress made in the last 15 years and chart the course for the future of emergency healthcare in Ontario. This is an opportunity to be part of a dynamic gathering where experts, professionals, and visionaries come together to shape the trajectory of paramedic care for the years to come.

Become a Sponsor

Sponsors

• 

  Zoll

• 

  OMS

• 

  PreHos

2025 Spring CME Case Studies

The CEC Team

Continuing Education and Certifications staff are available Monday - Friday from 8:00AM - 5:00PM.

To reach a coordinator you may call our MedicLINE 1-877-587-7736 Option 1

Certification is the means by which the Medical Director may authorize a paramedic to perform specific delegated controlled medical acts.

Certification to Practice

• Certification for Ontario Candidates to work as Paramedics

  Once you’ve graduated from a recognized paramedic program in Ontario, you may apply to the Ministry of Health for your AEMCA or ACP certificate. With one of these certificates, you may apply for work as a paramedic at Ontario paramedic services.

  In Ontario, every person who wishes to practice as a paramedic must be employed by a paramedic service. Once you have secured an employment offer, the paramedic service will request certification.

  To practice as a paramedic in Eastern Ontario, Primary Care or Advanced Care Paramedics must be certified by the RPPEO.

  If you change your level of competency, you will need to be certified in the new level before you begin using that scope of practice. A PCP who has trained as an ACP needs ACP certification before using the ACP scope of practice.

  The RPPEO’s certification process for both PCP and ACP scopes of practice uses scenarios to test a paramedic’s knowledge and skills.

  Once you successfully complete the RPPEO’s certification process, you will receive a Letter of Certification. This letter details the delegated controlled medical acts that the medical director authorizes you to use.

  CERTIFICATION REQUEST FORM FOR PARAMEDIC SERVICES

• Certification of Paramedics in training

  Paramedics in training who wish to undertake Delegated Medical Acts during preceptorship may be able to do so if their academic institution sponsors them in the Academic Certification process. Upon receipt of the college's request and with the agreement of the host paramedic service, the RPPEO may certify paramedics in training. Paramedics who receive this academic certification are supervised by a qualitied RPPEO certified paramedic. This is a special Academic Certification for training purposes for both PCP and ACP scopes of practice.

  A college may request Academic Certification on behalf of a paramedic using the form below.

  Certification Request Form for Colleges

• Cross certification within Ontario

  Paramedics currently certified by another Base Hospital in Ontario may apply for certification in Eastern Ontario through the Cross-Certification process. The RPPEO understands that training, skills and continuing education are quite similar across the province. The Provincial Patient Care Standards apply throughout Ontario. Paramedics already practicing elsewhere in Ontario may benefit from an expedited cross-certification if they wish to work for a paramedic service in the RPPEO’s coverage area. 

  Cross Certification Referral Form

• Certifying in Eastern Ontario from elsewhere in Canada or from abroad (Labour mobility)

  Paramedics who are licensed outside of Ontario must use the Ministry of Health’s Paramedic Equivalency Process in order to apply for an Ontario AEMCA or ACP certificate. Once you have obtained the certificate, if an employer in Eastern Ontario offers you employment you will enter the same certification process with the RPPEO as other paramedics at the PCP or ACP level.

  Labour Mobility and Equivalency in Ontario

Editing page content

• 

  Edit the Classroom Links page

  When you are logged in there will be an Edit button available at the bottom of the page. If the edit button is not displayed, the editor is already open by someone else.

• 

  Open the Yootheme Builder

  The Joomla atricle editor will open, however there will be a button where the article would normally be that says Yootheme Builder. Click this button.

• 

  Select the Module to Edit

  The grid module is used to create the list of content. The layout is very flexable and can be adjusted as needed.

  To edit the grid, click on the grid from the left hand side, or by hovering over the module and clicking the edit icon.

• 

  Edit the Grid

  When the grid element has been seleced you will see the Content options for the grid. You can adjust the ordering by draging items up/down, add new items, edit, duplicate or delete existing items.

  On main grid page you can also decide with itmes to display or hide. By default all are displayed.

• 

  Editing Grid Content

  Each panel in a grid has a Title, Meta, Content, Image, Link, Link Text. It is best to maintain a consist ant style within a grid layout. If a second grid, or another type of content is required additional elements can be added to the page.

• 

  Adjusting the Grid Settings

  The setting tab allows you to adjust the grid layout. You can adjust the number of columns, the panel style, and how all of the various element of the grid module are displayed.

• 

  Finish Editing

  When you have completed your changes to the page, the Save Layout button, saves the Yootheme Pro changes to the page.

  When  you click CLOSE you are returned to the Joomla articel editing layout. DO NOT navigate away from this page without clicking SAVE or CANCEL. When you forget to SVE or CANCEL before leaving this page, the content will be LOCKED and only you will be able to reopen the article. 

• 

  Grid Elements (Modules)

  There are many useful element/modules that can be added to a page. The Grid, List, and Panel modules are the most useful to quickly setup and display content. 

  Please do not add new sections or edit the existing section, column, etc. If additional layout changes are required please contact Niall Sheehan as these steps are beyond the scope of this How-to. 

Uploading and managing files

Creating QR Codes

Use your phone to scan and test this link.

QR Codes are scannable images that link to a specific URL.

To generate a QR Code, you will need the URL to a page, file, or other resource. Go to QRbot.net and paste the link into the URL filed and save the QR Code image. If the QR Code is going to be used for printing save a large version of the code.

If a file that has been saved to the Classroom Files folder needs to be updated, the existing file must be deleted and the new file must have EXACTLY the same filename for the QR Code to continue to work as needed.

The QR Code above represents the link:
https://www.rppeo.ca/manage-files-long/download-file.html?path=QRCODE-TEST-Station%2B1%2BCVAD.docx

• 

  Add an Element (Module)

• 

  Add a row

• 

  Add a Section

2025 Spring CME In-Person Activities

• 

  Tachydysrythmia

  Video - Cardioversion with an LP15

  Video - Cardioversion with a Zoll

  ---

  • Specific to this directive, treatments do not necessarily follow the order in which they should be administered.  The initial treatment choice will be based on rhythm interpretation (narrow vs. wide) and hemodynamic stability.
  • Early lead II and 12 lead acquisitions will prove invaluable for determining the origin of the electrical impulses, the rhythm regularity and the QRS durations.
  • Contraindications for Adenosine Administration:
    • Dipyridamole – brand name: Persantine.
    • Carbamazepine – brand name: Tegretol
  • Bronchoconstriction research has shown that inhaled adenosine provokes bronchoconstriction in asthmatic individuals (but not in the control group) and is therefore a contraindication for administration.
  • Adenosine Therapy:
    • Has changed to 6 mg and 12 mg based on AHA guideline findings that a second 12 mg dose is likely ineffective. No BHP patch is required for the administration of adenosine for narrow complex regular tachycardia.
  • Lidocaine Dosing:
    • Initial dose: 1.5 mg/kg to a max of 150 mg. The second and third doses are calculated as 0.75 mg/kg with the same maximum dose of 150 mg.
    • Lidocaine is limited to a maximum of 3 mg/kg total dosing via IV.
    • Topical doses of Lidocaine as administered in the intubation directive count towards a 5 mg/kg total dose.
    • In the event the patient receives the maximum dose of Lidocaine and then experiences cardiac arrest, he/she will not receive further doses of Lidocaine.
  • Amiodarone Dosing:
    • An Amiodarone infusion may be initiated following a BHP order.
  • FYI:
    • Cardioversion can be performed during pregnancy without affecting the rhythm of the fetus.
    • The electrode paddle (or patch) should be at least 12 cm from the pulse generator and an anteroposterior paddle position is recommended. When these precautions have been used, cardioversion with either monophasic or biphasic shocks is safe and effective in patients with an implantable device 
    • There is currently no evidence surrounding the use of Lidocaine prehospitally for atrial fibrillation as it is only effective on ventricular arrhythmias.
    • If the wide complex tachycardia (WCT) recurs or persists (refractory) following initial attempts at pharmacologic interventions and electrical cardioversion, further evaluation should focus upon the presence of arrhythmia triggers (ie: ischemia, electrolyte abnormalities, and drug toxicity).  Amiodarone is generally the most effective agent for treatment of recurrent or refractory WCT, particularly VT. Synchronized cardioversion or defibrillation should be repeated as necessary in patients who are hemodynamically unstable. Multiple recurrences of WCT should raise concern about cardiac ischemia, hypokalemia, digitalis toxicity, and polymorphic VT with or without QT prolongation, all of which have specific appropriate therapy.
• 

  Bradycardia

  Video - Pacing with an LP15

  Video - Pacing with a Zoll

  ---

  • Hemodynamic instability refers specifically to hypotension (SBP < 90 mmHg) that requires pharmacologic or electrical intervention(s).
  • 12 lead ECG should be obtained as early as possible.
  • Atropine is to be administered in the setting of sinus bradycardia, junctional bradycardia, atrial fibrillation, first degree block or second degree block type I. Further, patients presenting in second degree type II or third degree block may receive a single dose of atropine while preparing pacing or if pacing is unavailable or unsuccessful.
  • Transcutaneous pacing should not be delayed to initiate IV access if the patient is unstable.
  • Transcutaneous pacing is to be initiated at a rate of 80 bpm with milliamps (mAmps) then increased to obtain electrical capture. Capture is highly variable depending on patient size, weight, pad placement, skin condition, etc. It is difficult to state the target values for capture, however 80 to 100 mAmps is common. If unable to gain capture at maximum mAmps, pacing should be discontinued. Treatment should not be discontinued if the patient responds and develops an improved blood pressure.
  • Pad placement for pacing should follow the cardiac monitor manufacturer’s recommendations but typically include anterior/posterior or sternum/apex.
  • Transcutaneous pacing is initiated when the patient is hypotensive. As the blood pressure improves, pacing is not discontinued, but the patient may be more aware of the discomfort and may require sedation.
  • Patients may receive multiple interventions to maintain their heart rate and blood pressure. The treatment
    provided must be permitted time to take effect and to be evaluated before moving on to the next treatment.
  • A contraindication to DOPamine administration is mechanical shock. Examples of mechanical shock include tension pneumothorax, pulmonary embolism, and cardiac tamponade.
  • Notify the receiving hospital staff if the DOPamine drip goes interstitial as DOPamine can cause tissue necrosis which can be mitigated by a phentolamine injection at the hospital into the affected tissue.
• 

  Intubation

  Video - Laryngoscopy

  Video - Orotracheal Intubation

  Video - SALAD Technique

  ---

  • ETI (Endotracheal Intubation) is not mandatory. The importance of definitive airway management has given way to basic airway management and less invasive approaches.
  • The contraindication which references age < 50 refers specifically to patients experiencing an asthma exacerbation and who are NOT in or near cardiac arrest.
  • The onset of action for topical Lidocaine is within 1 minute but it may take up to 3 – 5 minutes to have full effect.
  • In the treatment statement, “consider intubation” is followed by “with or without facilitation devices”. This is a generic statement to address everything from the air trach, to the bougie to all things as yet undefined. The generic statement enables us to continue to use the directives despite changes in technology without being prescriptive.
  • The formula that is recommended for sizing a cuffed pediatric endotracheal tube is 3.5+(Age in years/4). This formula allows for a slightly smaller tube as the cuff will create the seal versus the tube only.
  • It is recommended that paramedics start with smaller volume of air when inflating the cuff (example 1 ml increments) and continue until no air is heard on auscultation escaping past the cuff. It is also appropriate to use a smaller syringe such a 3ml or 5ml to avoid over inflating the cuff in smaller patients.
  • ETI confirmation has been updated and now requires ETCO2 waveform capnography as the only primary method. It is the most reliable method to monitor placement of an advanced airway (AHA guidelines 2015, Part 7). In the event it is not available, three (3) secondary methods must be used; for example: colourmetric detector that changes color with exposure to CO2.
  • Definition of intubation attempt: Introducing the laryngoscope into the patient’s mouth with the intent to then insert an endotracheal tube is considered an attempt and should be documented as such including success or failure.
  • The number of advanced airway attempts is clearly defined as two (2) attempts per patient regardless of the route chosen.

  FYI:

  • Nasal intubation should only be performed with the appropriate equipment. This means that the tube being used should have a trigger to curve the end.
• 

  Central Venous Access

  Video - CVAD

  ---

  • While establishing a new peripheral IV line is preferred in the prehospital environment, central venous access devices (CVAD) offer additional parenteral routes of therapy administration should a routine IV be difficult or impossible to place and a patient has a CVAD in place.
  • The patient must be critically ill to access a CVAD device. This requirement is due to the associated risks involved with CVAD access including contamination of the line requiring replacement.
  • The steps for accessing a CVAD are very specific. Please refer to provided skill sheets.
  • Access must be performed with meticulous consideration of maintaining sterility, as CVAD lines carry with them an increased risk of infection. Connectors must be cleaned thoroughly before access, including all the cracks and grooves.
  • If unable to aspirate blood, re-clamp the lumen and attempt to use another if available. If clots are present during aspiration, do not proceed. Failure to properly aspirate can embolize microthrombi that can form around the distal tip of these catheters, bringing with them a risk of stroke, coronary event, pulmonary embolus or extremity thrombus.
  • If a CVAD is accidentally dislodged, place firm pressure on the insertion site for at least 10 minutes with several sterile 4x4 gauze squares or a trauma dressing to control bleeding.
  • The following are some examples of CVAD devices (not an exhaustive list):
    • Hickman: Central catheter inserted through the anterior chest wall.
    • Peripherally Inserted Central Catheter (PICC): Located on the patient’s upper arm, but is still direct to central circulation.

Questionnaire

Please take a moment and fill out our CME Survey!  We want to hear from you and build better CME experiences in the future!

Scan the QR code with your smartphone, or click the link below.

Click here for the In-Class survey.