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Clinical Development

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As paramedic practice becomes increasingly professionalized, paramedics are becoming more responsible for integrating skills and knowledge. Continuing education is an essential aspect of the fast-moving, specialized care that paramedics provide.

Continuing Medical Education

At the RPPEO, we use two annual "core" CME blocks to provide practise, knowledge and training for paramedics. The Spring CME period begins early in April each year and closes in June. It's meant to provide 8 hours of structured education for paramedics. While this represents a mandatory education event for ACPs, Primary Care Paramedics can also attend and we include PCP content. Fall CME begins in September and runs until January of the next year, offering 8 hours of education to both Primary Care and Advanced Care Paramedics.

The RPPEO uses principles of adult learning  to make engaging interactive curriculum for paramedic core CME. We quickly switched to online only learning in 2020 with the advent of the pandemic. It's been challenging to offer interesting, fun and useful learning that meets paramedic needs, but we're committed to making it better and better!

Elective CME

The RPPEO provides many elective CME opportunities for PCP and ACP clinicians, often through recognizing the educational content of specialized courses, workshops and conferences.

When we're assessing content for electives, we look at how the educational event relates to the 6 integrated roles of the Paramedic: clinician, professional, educator, advocate, team member, and reflective practitioner. In fact, we use this concept of the interconnected roles of the Paramedic in all of our educational planning and development.

ACPs require 8 hours of elective CME annually. The RPPEO encourages PCPs to use elective educational opportunities to round out their clinical development each year.

Excellence Highlight

Adult continuing clinical education for paramedics

We've partnered with St. Francis Xavier University to provide adult education courses to our staff to ensure we're creating the best learning opportunities for paramedics. ​

The Education team works increasingly in lock-step with our Quality & Patient Safety department. This way, we'll be able to identify clinical issues that would benefit from educational intervention and examine whether our education made a difference in safety and quality of care.

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Cost Recovery Fee Structure For Data Request

Funded studies will be levied a nominal fee to partially cover the costs associated with the retrieval of data.

Requests for research data will be subject to the following fee structure:

Description of Work Cost
Analyst Consultant Fee Report writing $50/hr
  Extraction of Data $50/hr
Document* Retrieval Electronic Document $1.00/unit
  Paper Document $1.25/unit
  Archived Document $2.00/unit
Photocopying/Printing   $0.35/page
De-identification of Document   $0.25/page
*Documents include: ACR (Ambulance Call Report), PCR (Paramedic Call Report), Patch Form, ECG report, ECG strip.
A $5.00 e-transfer fee will apply to all requests; 
Additional charges may apply depending on the time required to access and transfer prehospital data.

Exceptions to the cost recovery fee structure can be made at the discretion of the Program Director for non-funded studies.

An estimate of the cost to fill the research data request will be sent to the researcher. Please provide billing information and address to research@rppeo.ca. An invoice will be sent quarterly and payment is requested 30 days from the date of invoice.

Contact

Regional Paramedic Program for Eastern Ontario
2475 Don Reid Drive, Room C130
Ottawa, On, K1H1E2
Tel: 613-737-7228
Fax: 613-737-1028
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COVID-19

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COVID-19 Guidance for Paramedics

2019 NOVEL CORONAVIRUS

Last update: October 19, 2021

On October 19, 2021, the Medical Advisory Committee (MAC) released the latest memo Considerations for Paramedics Managing Patients during the COVID-19 Pandemic.

Information about COVID-19 and clinical intervention on this site that is dated October 19, 2021 or later is valid until the release of new considerations.

One Year Into the Pandemic

March 2021

A video message from Dr. Dionne

 

On the occasion of the one year anniversary of responding to COVID-19 in our communities, RPPEO Medical Director, Dr. Richard Dionne, took some time to speak directly to paramedics in Eastern Ontario.

Hear from Dr. Dionne as he reflects on the past year, on current practice in 911 paramedicine and on what paramedics are facing as we continue to respond.

If you'd like to leave comments about the video, please visit this page. As always, we welcome your questions and ideas.

As the pandemic progresses, the RPPEO will continue to promote the adaptation of clinical guidance as needed. The key considerations for us are paramedic safety and patient clinical needs. The changes are coming in phases, based on the epidemiology of COVID-19 in our region and in Ontario.

We are very closely monitoring the pandemic. The RPPEO is looking to Public Health Ontario, the Ministry of Health and the Ontario Base Hospital Group - Medical Advisory Committee for their direction on clinical practice.  If we find a need for specific guidance for our region - based on epidemiology and other factors in this region - the RPPEO's medical direction team is at the ready to provide clinical guidance for Eastern Ontario paramedics.

As always, we are counting on paramedics to provide the excellent, compassionate care that the public has come to expect. We realize that continuing to follow the Patient Care Standards while applying the additional considerations and medical direction is challenging. We are here to help. If you have any questions about the additional considerations issued to date, do not hesitate to reach out to us through MedicASK, by email or by calling.

We are answering paramedic questions as quickly as possible and updating answers as needed, given the variable speed at which the pandemic is evolving.

Thank you for your commitment to paramedicine and your devotion to the patients who need our help during this exceptional time.

 

COVID-19 public health measures and advice

Find out about the latest public health measures, advice and restrictions.

Ontario Public Health

Continue reading for more clinical guidance for paramedics.

  • MEMORANDUM

    Oct 19, 2021

    Considerations for Paramedics Managing Patients during the COVID-19 Pandemic

    Download Document

  • TRAINING BULLETIN 120: NOVEL CORONAVIRUS (COVID-19) V.1.6

    Updated Oct 5, 2020

    Download Document

  • Directive #4 for Ambulance Services and Paramedics

    Revised March 30, 2020

    Download Document

  • COVID-19 SCREENING TOOL FOR PARAMEDICS

    August 26, 2021

    Download Document

  • OUTIL DE DÉPISTAGE DU COVID-19 POUR LES AMBULANCIERS PARAMÉDICAUX

    26 aout 2021

    Download Document

In Brief

  • The provincial Medical Advisory Committee (MAC) continues to provide clinical guidance for paramedics during the COVID-19 pandemic. This section provides a summary of some of the important considerations from MAC. Please read MAC's guidance for the complete list of considerations.

  • After 18 months of providing patient care during the pandemic,  factors such as vaccination status, PPE or location should inform the paramedics' point of care risk asessment and subsequent clinical care.

  • The COVID-19 pandemic is an extenuating circumstance. Paramedics in this circumstance may not be able to provide all treatment that they’ve considered.

  • Paramedics should act as though all respiratory patients are COVID-19 positive while continuing to use the COVID-19 Screening Tool

  • MAC has identified the aerosol-generating medical procedures (AGMP) that are deemed higher risk for transmission of COVID-19. MAC gives these AGMP additional considerations and guidance which applies to all patients regardless of COVID-19 Screening Tool result. Please read MAC's guidance for the complete list of considerations.

  • Paramedics should consider withholding the following interventions:

    • Endotracheal Medication Administration
    • IN and buccal Medication Administration when other routes exist
    • Endotracheal and Tracheostomy Suctioning via an endotracheal or tracheostomy tube unless using a closed system suction unit
    • Use of CPAP if other treatment is available

  • Paramedics should continue to screen all patients using the Ministry of Health's COVID-19 Screening Tool for Paramedics

COVID-19 FAQ

Due to the questions and clinical practice considerations related to COVID-19 we have created a forum to post answers to paramedic questions and concerns.

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CLINICAL GUIDANCE FOR PARAMEDICS ON COVID-19

The Advanced Life Support Patient Care Standards allow for contingency in the face of extenuating circumstances. COVID-19 may affect the clinical situation and may be considered an extenuating circumstance, depending on the full context of the clinical (and possibly operational) situation.

The Medical Advisory Committee is providing additional clinical guidance on many of the clinical situations which may present increased risk of vial transmission during the pandemic. As the context changes, MAC updates this guidance.

To ensure your are up-to-date with the latest udiance, please read the Ontario Base Hospital Medical Advisory Committee’s “Memorandum: Considerations for Paramedics Managing Patients during the COVID-19 Pandemic,” the Ministry of Health’s “Training Bulletin 120: Novel Coronavirus (COVID-19),” and the Ministry of Health's COVID-19 Screening Tool for Paramedics for all the details.

For current information about COVID-19, including AGMP and other viral transmission risk considerations, Point of Care Risk Assessment, PPE advice and more, visit Public Health Ontario.

  • PATIENT ASSESSMENT

    For each patient, one paramedic should approach and use the COVID-19 Screening Tool. The result of this screening will help you orient your infection control precautions and care approach.

    The COVID-19 Screening Tool is a simple question and answer algorithm for paramedics that combines clinical and epidemiological information to identify patients whose condition should be investigated for 2019 novel coronavirus. It is based on the case definition from the Public Health Agency of Canada.

    A positive result to the screen means that the patient is a Person Under Investigation for COVID-19.

    Note that Central Ambulance Communication Centres are screening callers for 2019 novel coronavirus.

  • TREATMENT

    Paramedics should continue to care for all patients including those with respiratory symptoms according to Medical Directives, except where special guidance is given. The ALS PCS recognizes that in extenuating circumstances paramedics may not be able to provide all the treatments that they’ve considered. MAC considers the COVID-19 pandemic as an extenuating circumstance.

    For patients with respiratory signs or symptoms, including cardiac arrest, you may need to adapt your care plan. MAC advises additional considerations and guidance for care in the interventions where aerosolized pathogens may be a concern.

    See the MAC Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (COVID-19) for more information.

  • NOTIFICATION

    When caring for patients who screen positive, paramedics should notify the receiving facility that the incoming patient screened positive on the 2019 Novel Coronavirus Screening Tool.

    Paramedics may also indicate, or the emergency department may ask for, the following summary information:

    • Which clinical symptoms are present:
      • fever,
      • new onset of cough,
      • worsening chronic cough,
      • shortness of breath,
      • difficulty breathing
      • sore throat,
      • hoarse voice,
      • difficulty swallowing,
      • decrease or loss of sense of smell,
      • chills,
      • headaches,
      • unexplained fatigue/malaise,
      • diarrhea,
      • abdominal pain,
      • nausea/vomiting,
      • Pink eye (conjunctivitis),
      • runny nose/sneezing without other known cause, or
      • nasal congestion without other known cause
    • If the person is over 65 years of age, are they experiencing any of the following:
      • delirium,
      • unexplained or increased number of falls,
      • acute functional decline, or
      • worsening of chronic conditions
    • What epidemiological factors are present:
      • close contact with anyone with acute respiratory illness in the past 14 days
      • travelled outside of Canada in the past 14 days
      • confirmed case of COVID-19
      • had close contact with a confirmed case of COVID-19

  • DOCUMENTATION

    Paramedics should continue using the Ministry of Health’s Ambulance Call Report codes for COVID-19 patient screening. A patient who presents with conditions outlined in the screening tool is POSITIVE.

    • Miscellaneous Procedures - “407.02 - COVID-19 Screening POSITIVE”
    • Miscellaneous Procedures - “407.03 - COVID-19 Screening NEGATIVE”

    Documentation of your clinical and epidemiological findings and considerations is always very important. Include information about extenuating circumstances such as respiratory symptoms, a positive screen for COVID-19 or the considerations that led to your assessment and treatment in the Remarks section of your ACR. This is especially important if you modify care from that in the Medical Directives.

    As a reminder, you should also document on your ACR what routine practices and additional precautions you used. Guidance on infection prevention and control is available in the Training Bulletin and in version 2.2 of the Patient Care and Transportation Standards (PCTS) 

Provincial Longterm Plan for COVID-19 Public Health Management

Longterm COVID-19 Plan

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COVID-19 News

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IN BRIEF

Updated March 23, 2020 @ 18:00

The COVID-19 pandemic is an extenuating circumstance. Paramedics in this circumstance may not be able to provide all treatment that they’ve considered.

Paramedics should act as though all respiratory patients are COVID-19 positive while continuing to use the COVID-19 Screening Tool
For all patients with respiratory symptoms or where paramedics are considering respiratory interventions MAC has identified procedures that are deemed high risk for potential transmission of COVID-19. MAC gives these additional considerations and guidance which applies to all patients regardless of COVID-19 Screening Tool result:
  • Withhold Nebulized Medication Administration
  • Withhold Endotracheal Medication Administration
  • Withhold Endotracheal and Tracheostomy Suctioning via an endotracheal or tracheostomy tube unless using a closed system suction unit
  • Withhold Use of CPAP
  • Withhold tracheostomy reinsertion
  • Consider withholding intra-nasal (IN) and buccal administration of all medications when alternative routes exist.
  • Consider donning PPE for all airway procedures (BVM, SGA, etc) and all Cardiac Arrests.
  • Consider Paramedic Services communicate with local receiving facilities for pre-alerting the hospital if patient’s COVID-19 screen is positive.

Paramedics should continue to screen all patients using the Ministry of Health's COVID-19 Screening Tool for Paramedics

Continue reading for more clinical guidance for paramedics.
Familiarize yourself with guidance prepared by the RPPEO Medical Director, the Ministry of Health (MOH) and the Ontario Base Hospital Group - Medical Advisory Committee (MAC)

  • MEDICAL ADVISORY 2020-01: NEBULIZED MEDICATION ADMINISTRATION

    Read more

  • CONSIDERATIONS FOR PARAMEDICS MANAGING PATIENTS WITH POSSIBLE NOVEL CORONAVIRUS (COVID-19)

    Read more

  • TRAINING BULLETIN 120: NOVEL CORONAVIRUS (COVID-19)

    Read more

  • BULLETIN DE FORMATION 120 : NOUVEAU CORONAVIRUS (COVID-19)

    Read more

  • COVID-19 SCREENING TOOL FOR PARAMEDICS

    Read more

  • OUTIL DE DÉPISTAGE DU COVID-19 POUR LES AMBULANCIERS PARAMÉDICAUX

    Read more

  • Clinical Guidance for paramedics on 2019 novel coronavirus

    Please read the Ontario Base Hospital Medical Advisory Committee’s “Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (2019-COVID-19),” the Ministry of Health’s “Training Bulletin 120: Novel Coronavirus (COVID-19),” and the Ministry of Health's COVID-19 Screening Tool for Paramedics for all the details.

    For current information about 2019 Novel Coronavirus, visit Public Health Ontario.

  • PATIENT ASSESSMENT

    For each patient, one paramedic should approach and use the COVID-19 Screening Tool. The result of this screening will help you orient your infection control precautions and care approach.

    The COVID-19 Screening Tool is a simple question and answer algorithm for paramedics that combines clinical and epidemiological information to identify patients whose condition should be investigated for 2019 novel coronavirus. It is based on the case definition from the Public Health Agency of Canada.

    A positive result to the screen means that the patient is a Person Under Investigation for COVID-19.

    Note that Central Ambulance Communication Centres are screening callers for 2019 novel coronavirus.

  • TREATMENT

    Paramedics should continue to care for all patients including those with respiratory symptoms according to Medical Directives, except where special guidance is given. The ALS PCS recognizes that in extenuating circumstances paramedics may not be able to provide all the treatments that they’ve considered. MAC considers the COVID-19 pandemic as an extenuating circumstance.

    For patients with respiratory signs or symptoms, you may need to adapt your care plan. MAC advises additional considerations and guidance for care in the interventions where aerosolized pathogens may be a concern.

    See the MAC Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (COVID-19) for more information.

  • NOTIFICATION

    When caring for patients who screen positive, paramedics should notify the receiving facility that the incoming patient screened positive on the 2019 Novel Coronavirus Screening Tool.

    Paramedics may also indicate, or the emergency department may ask for, the following summary information:

    • Which clinical symptoms are present: fever, coughing or difficulty breathing?
    • What epidemiological factors are present:
      1. the patient received public health or medical advice to self-monitor or self-isolate OR
      2. in the last 14 days, the patient either
        1. traveled outside of Canada,
        2. had close contact with a confirmed or probable case of novel coronavirus OR
        3. had close contact with a person with an acute respiratory illness who has traveled outside of Canada

  • DOCUMENTATION

    Paramedics should now be using the Ministry of Health’s Ambulance Call Report codes for COVID-19 patient screening.

    • Miscellaneous Procedures - “407.02 - COVID-19 Screening POSITIVE”
    • Miscellaneous Procedures - “407.03 - COVID-19 Screening NEGATIVE”

    Documentation of your clinical and epidemiological findings and considerations is always very important. Include information about extenuating circumstances such as respiratory symptoms, a positive screen for COVID-19 or the considerations that led to your assessment and treatment in the Remarks section of your ACR. This is especially important if you modify care from that in the Medical Directives.

    As a reminder, you should also document on your ACR what routine practices and additional precautions you used. Guidance on infection prevention and control is available in the Training Bulletin and in version 2.2 of the Patient Care and Transportation Standards (PCTS) .

Read more …COVID-19 News

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CQI Electronic Databases

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Key Electronic Databases

Recommended electroninc databases for your research.

  • PubMed

    PubMed comprises more than 28 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

    Visit Site

  • The Cochrane Library

    Trusted evidence.
    Informed decisions.
    Better health.

    Visit Site

  • Medscape

    Medscape is a website providing access to medical information for clinicians and the general public. The organization also provides continuing education for physicians and health professionals.

    Visit Site

  • Google Scholar

    Google Scholar allows you to search for scholarly literature, including peer-reviewed papers, theses, books, preprints, abstracts and technical reports from all areas of research.

    Visit Site

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CQI External Links

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Research Links

  • PREHOSPITAL EVIDENCE BASED PRACTICE (PEP)

    The Prehospital Evidence Based Practice (PEP) PEP is a collaborative effort of Canadian and international EMS Clinicians (paramedics, physicians, nurses and other allied health professionals). PEP is sponsored and managed by the Dalhousie University Department of Emergency Medicine Division of EMS, and Emergency Health Services Nova Scotia.

    Read more

  • UCLA Prehospital Care and Research Forum

    "The Prehospital Care Research Forum is dedicated to fostering and improving research in EMS. Below you will find select podcasts discussing current research that affects EMS. These podcasts are meant to review methodology and applicability to prehospital care, promote healthy and respectful discussions, and inspire new research."

    Read more

  • Annals of Emergency Medicine

    Audio and Podcasting Archives

    Read more

  • Emergency Medicine Journal Jams

    Journal Jam is the EM Cases podcast that brings together leading EM researchers, EM educators and EM clinicians from around the world to discuss practice-changing EM articles; with your hosts Anton Helman & Teresa Chan. Together, we’re smarter!

    Read more

  • EM Ottawa – Emergency Medicine Ottawa

    This is the official blog for the Department of Emergency Medicine at the University of Ottawa. Our main goal is to share the results of our monthly Journal Club for people to view and for our staff/residents to have as a resource if the need arises to review the content. The scores and analysis of each article are derived from an initial critical review of the literature by a single reviewer, followed by a group discussion.

    Read more

  • KeyLIME - Key Literature in Medical Education

    Bringing the main points of a medical education article in a 20 minute podcast.

    "Key Literature in Medical Education (KeyLIME) is a bi-weekly podcast produced by the Royal College of Physicians and Surgeons of Canada. Articles that are important, innovative, or will impact your educational practice are discussed."

    Read more

  • Research & Reviews in the Fastlane

    Research and Reviews in the FastLane: where experts worldwide tell us what they think is worth reading from the emergency medicine and crit care literature.

    Read more

  • The Skeptics Guide to Emergency Medicine

    The Skeptics’ Guide to Emergency Medicine (SGEM) is a knowledge translation (KT) project. The goal of the SGEM is to shorten the KT window from over ten years down to less than one year. It does this by turning traditional medical education on its head.

    Read more

  • The Bottom Line

    This site has been built to create a compendium of all the landmark papers which are shaping the way we manage our critically ill patients. Each paper has been summarised and critiqued using a standard template and ends with a 'bottom line' paragraph to allow a quick reminder of the key points.

    Read more

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CQI Guides & Tools

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Research Guidelines

  • Phase 1: Planning your Research

    FORMULATE THE RESEARCH QUESTION:

    Where do Ideas for Research come from?

    Your interests and experience! Research is time consuming so it is best to begin with a topic that fascinates you. Think of your clinical experience and ask yourself:

    1. Why are things done this way?
    2. What is the process from which this situation arose?
    3. What would happen if…?
    Literature: JEMS articles can be helpful in alerting researchers to clinical trends or issues of clinical importance. Published research reports may suggest problem areas, identify limitations and recommend future research topics. 
    A research question should address the FINER criteria:

    1. Feasible (in terms of time, money, expertise, scope, etc.)
    2. Interesting
    3. Novel (confirms, refutes or extends previous research)
    4. Ethical
    5. Relevant
    A research question should address the PICO criteria:

    • Population of interest (what specific patient population are you interested in?)
    • Intervention being studied (if applicable)
    • Comparison group
    • Outcome of interest (what do you intend to measure, accomplish, improve or effect?)
    PICO criteria are useful to use in the development of a specific research question. Quite often, timing is added to denote the period of time over which a study is conducted. For more information on well-built clinical questions using PICO, click on the following link: https://healthlinks.washington.edu/ebp/pico.html

    Example of a Research Question:

    "What is the effect of an information and emotional support intervention (I) on the anxiety levels (O) of spouses of ICU patients (P) in the first 72 hours post admission? [C: spouses of ICU patients that do not receive support intervention]"
    A research question should contain a stem word (what, when, where, how, why).

    PERFORM A LITERATURE REVIEW

    It’s necessary to learn as much as possible about the status quo of current procedures relating to the research topic and to review existing practice guidelines or protocols.

    1. Literature Searching in 10 Steps
    2. How to perform a literature search

    DESIGN THE STUDY METHODS

    1. Select the design
    2. Determine the sample
    3. Select the measures
    4. Plan statistical analyses
    5. Design procedures
    6. Get feedback from your colleagues!
    7. Research Methods – Knowledge Base is a comprehensive web-based textbook that covers the entire research process including: sampling, measurement, research design and data analysis.

    OBTAIN ETHICS APPROVAL

    When humans are used as study participants, care must be exercised in ensuring that the rights of those humans are protected. Research Ethics Boards (REBs) ensure that ethical guidelines are met and followed in research activities.

    1. Ottawa Hospital Research Ethics Board (OHREB)
    2. OHREB sample consent & information sheet

    APPLY FOR FUNDING

    Guidebook for New Principal Investigators – CIHR

  • Phase 2: Conducting the research

    • Collect the Data
    • Analyze the Data

  • Phase 3: Disseminating the research

    Prepare Manuscript for Publication

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