BCAS TREATMENT GUIDELINES FOR EMERGENCY MEDICAL RESPONDERS IN BC
FRONTLINE FIRST AID & EMERGENCY TRAINING
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Frontline First Aid BCAS Treatment Guidelines for EMR in BC
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Table of Contents
BC EMALB Professional Responder Protocols .............................................................................................. 2
BCAS Treatment Guideline 6.1 .............................................................................................................................. 3
Minimizing On-Scene time for Major Trauma ............................................................................................. 3
BCAS Treatment Guideline 6.5 .............................................................................................................................. 4
Estimating Burn Percentages ............................................................................................................................. 4
On-Scene Cooling Time for Thermal Burns ................................................................................................. 4
BCAS Treatment Guideline 1.3 .............................................................................................................................. 5
Determining Hyperglycaemia ............................................................................................................................. 5
Administration of Glucogel to an Unresponsive Patient ...................................................................... 5
BCAS Treatment Guidelines 7.2 ............................................................................................................................ 6
Hypothermia in Cardiac Arrest .......................................................................................................................... 6
Drug Monograph: Nitroglycerin ............................................................................................................................ 7
EMALB permits Licensed EMRs in BC to administer Nitroglycerin Spray .............................................................. 7
Minimum Systolic Blood Pressure .................................................................................................................... 7
Timing of Nitroglycerin Dosages ...................................................................................................................... 7
Drug Monograph: ASA ................................................................................................................................................ 8
Acetylsalicylic Acid (ASA) .................................................................................................................................... 8
EMALB permits Licensed EMRs in BC to administer Acetylsalicylic Acid (ASA) ................................................... 8
Drug Monograph: Entonox ........................................................................................................................................ 9
Nitrous Oxide (Entonox) ............................................................................................................................................ 9
EMALB permits Licensed EMRs in BC to administer Nitrous Oxide (Entonox) ..................................................... 9
Frontline First Aid BCAS Treatment Guidelines for EMR in BC
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BC EMALB Professional Responder Protocols
The Canadian Red Cross, BC Ambulance Service and BC Emergency Medical Assistant's Licensing Branch follow the National Occupational Competency Profile (NOCP) for EMR skills...as required by the Paramedic Association of Canada (PAC). They also follow the specific protocols required for Emergency Medical Responders in British Columbia...as laid out in the BCAS Treatment Guidelines. For the most part, the BCAS Treatment Guidelines for EMR skills follow the same protocols as the NOCP. However, there are a few BCAS Treatment Guidelines which differ slightly from the PAC NOCP; which means you need to be aware of them for BC EMR Licensing purposes. These specific BCAS Treatment Guidelines include:
6.1 Trauma Management - Principles 6.5 Thermal Burns - Principles and Interventions 1.3 Hypo & Hyperglycaemia - Principles 7.2 Hypothermia – Cardiac Arrest Drug Monograph - Nitroglycerin Drug Monograph - ASA Drug Monograph - Entonox
BCAS Treatment Guidelines that are specifically relevant to Emergency Medical Responders in
British Columbia are listed in detail in this booklet.
Whenever the BCAS Treatment Guidelines contradict or supplement the PAC NOCP
guidelines included in your Canadian Red Cross Emergency Care Manual…you will follow the
BCAS Treatment Guidelines as an EMR in BC.
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BCAS Treatment Guideline 6.1
Minimizing On-Scene time for Major Trauma What the BCAS Treatment Guideline says:
"To maximize survival, scene time must be kept to a minimum. The focus must be on basic care with provision of oxygen, basic airway care, control of bleeding, prevention of further spinal injury, and transport. Anything that can be done on route should be done on route.” • “Spinal stabilization should not delay basic airway care and rapid transport in patients with head
injury or shock. Much can be accomplished by simply reducing any gross neck movement”
“The only interventions that should be carried out prior to transport are: • basic C-spine stabilization during extrication • airway management and ventilatory support of patients with increasing airway obstruction or
failing respirations • relief of tension pneumothorax • simple stabilization of long bone and pelvic fractures
IV therapy, more definitive spinal immobilization, fracture stabilization and the majority of intubations should be carried out during transport."
What this means for Emergency Medical Responders in BC:
Emergency Medical Responders in British Columbia should not delay urgent transport to apply Traction Splints.
• Traction splints are appropriate for suspected femur fractures not involving the hip or knee.
• Traction splinting can be applied on-scene, only if the injuries are not immediately life-threatening.
Example 1: Suspected femur fracture, with no accompanying life-threatening conditions…
▪ Complete Secondary Survey on-scene ▪ Administer Entonox, if appropriate, on scene ▪ Traction Splint, as appropriate for the injury, on scene ▪ Transport should be initiated after the application of the Traction Splint.
Example 2: Suspected femur fracture, accompanied by life threatening conditions…
▪ Complete a Primary Survey and appropriate critical interventions to manage immediate life threatening conditions
▪ Provide simple stabilization of the femur fracture with anatomical/blanket splint ▪ Initiate transport ▪ Complete Secondary Survey on route ▪ Entonox and Traction Splint as appropriate, on route
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BCAS Treatment Guideline 6.5
Estimating Burn Percentages
What the BCAS Treatment Guideline says:
Estimating burn coverage…
"Accurate estimation of burn size is essential. Extensive burns are expressed as the total percentage of body surface area (TBSA) with more than superficial burns. Use the Lund and Browder chart to estimate percentage of body surface area..."
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, indicates that the “Rule of Nines” should be applied for on-scene burn percentage estimates
What this means for Emergency Medical Responders in BC:
Emergency Medical Responders in British Columbia need to be familiar with the Lund & Browder system for calculating burn percentages…as well as the “Rule of Nines”.
On-Scene Cooling Time for Thermal Burns
What the BCAS Treatment Guideline says:
Cooling burns on scene… "Cool burns 1-2 minutes followed by clean dry dressings during transport."
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, indicates that burns should be cooled until pain subsides and the burned area is cool to touch.
What this means for Emergency Medical Responders in BC:
Emergency Medical Responders in British Columbia should only spend 1-2 minutes cooling major burns…while on scene.
Continue to cool burns following the Emergency Care Manual guidelines while enroute.
Once a burn has been sufficiently cooled, dry sterile dressings should be applied to prevent infection.
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BCAS Treatment Guideline 1.3
Determining Hyperglycaemia
What the BCAS Treatment Guideline says:
Determining Hyperglycaemia… "Hyperglycaemia - elevated glucose level (higher than 11 mmol/L)"
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that blood glucose levels above 8 mmol/L are considered Hyperglycaemic.
What this means for Emergency Medical Responders in BC:
Emergency Medical Responders in British Columbia will consider capillary blood glucose (capBgl) levels higher than 11 mmol/L to be clinically Hyperglycaemic.
CapBgl levels below 11 mmol/L will not be considered Hyperglycaemic.
Administration of Glucogel to an Unresponsive Patient
What the BCAS Treatment Guideline says:
Administration of Glucogel to Unresponsive Patients…
• "Position the patient – on side if unconscious"
• “Correct suspected or confirmed Hypoglycaemia o Glucogel”
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that nothing, other than an airway management device, may be placed in the mouth of an unresponsive patient.
What this means for Emergency Medical Responders in BC:
Emergency Medical Responders in British Columbia will administer oral Glucogel to an unresponsive patient, if Hypoglycaemia is suspected or confirmed.
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When administering Glucogel to an unresponsive patient, follow the procedures outlined in the BCEHS “Oral Glucose Position Statement”.
BCAS Treatment Guidelines 7.2
Hypothermia in Cardiac Arrest
What the BCAS Treatment Guideline says:
Determining Cardiac Arrest… “The hypothermic patient has reduced metabolic demands and may have significant bradycardia and
decreased respiratory rate.
For this reason, 30 seconds should be taken to accurately detect the presence of spontaneous
respirations and a pulse.”
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that up to 45 seconds should be taken to assess the pulse of a patient with suspected Hypothermia.
What this means for Emergency Medical Responders in BC:
Emergency Medical Responders in British Columbia should assess the pulse of a patient in suspected Hypothermia for at least 30 seconds before beginning CPR-AED protocols.
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Drug Monograph: Nitroglycerin EMALB permits Licensed EMRs in BC to administer Nitroglycerin Spray Medications not specifically listed as "EMR Interventions" in the BCAS Guidelines are considered "Out of the Scope of Practice" for Emergency Medical Responders in British Columbia
Minimum Systolic Blood Pressure What the BCAS Treatment Guideline says:
“Dosage (Adult) 0.4 mg spray SL - repeat q 3 min. - maintaining B/P > 90 systolic…"
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states that a Systolic Blood Pressure of less than 100 mmHg contraindicates the administration of Nitroglycerin
What this means for Emergency Medical Responders in BC: Emergency Medical Responders in BC will regard 90 mmHg as the minimum Systolic Blood Pressure required to administer Nitroglycerin.
Timing of Nitroglycerin Dosages What the BCAS Treatment Guideline says: "Dosage (Adult) 0.4 mg spray SL - repeat q 3 min. - maintaining B/P > 90 systolic..."
Contradictory Information in the Emergency Care Manual:
The Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP, states Nitroglycerin can be administered Q5 (every 5 minutes).
The Emergency Care Manual also stipulates that no more than 3 doses can be administered in a 30-minute cycle.
What this means for Emergency Medical Responders in BC: Emergency Medical Responders in British Columbia can administer Nitro Q3-5 (every 3-5 minutes) for as long as the Chest Pain persists, and the patient maintains a minimum Systolic BP of 90 mmHg.
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Drug Monograph: ASA
Acetylsalicylic Acid (ASA)
EMALB permits Licensed EMRs in BC to administer Acetylsalicylic Acid (ASA) Medications not specifically listed as "EMR Interventions" in the BCAS Guidelines are considered "Out of the Scope of Practice" for Emergency Medical Responders in British Columbia
Administer within the Indications, Contraindications and dosages outlined in your Canadian Red Cross Emergency Care Manual, which follows the PAC NOCP.
Specific BC EMALB Licensing Requirement
BC EMALB has released a position statement outlining the importance of administering ASA as soon as possible, when appropriate for the management of cardiac related chest pain. Specifically, this document stipulates that ASA should be administered (if appropriate) before or during the collection of Vital Signs…not after.
What this means for Emergency Medical Responders in BC
When a patient is showing Signs and Symptoms suggestive of a possible heart attack, Responders should immediately utilize the SAMPLE-OPQRST mnemonics (History) to determine if ASA is appropriate.
If appropriate, have the patient chew two 81mg ASA or one 325 mg ASA before continuing with further assessment and treatments.
ASA is the only medication which does not require a full set of Vital Signs before Administration.
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Drug Monograph: Entonox
Nitrous Oxide (Entonox)
EMALB permits Licensed EMRs in BC to administer Nitrous Oxide (Entonox) Medications not specifically listed as "EMR Interventions" in the BCAS Guidelines are considered "Out of the Scope of Practice" for Emergency Medical Responders in British Columbia
You should be familiar with the Indications, Contraindications and dosages outlined in your Canadian Red Cross Emergency Care Manual, as well as the BCAS Treatment Guidelines outlined below…
Entonox Indications:
• Relief of moderate to severe pain
• Cardiac related chest pain, where Nitroglycerin will be of no value, or is contraindicated. Must be followed by high flow oxygen when discontinued
• Isolated extremity injuries, pain associated with burns excluding mechanisms associated with potential inhalation injury, etc.
Entonox Contraindications:
Artificial, traumatic or spontaneous pneumothorax
Air Embolism
Decompression sickness
Following a recent sky dive
Severe bullous emphysema
Gross abdominal distension
Altered mental status
Inability to comply with instructions
Inhalation injury
BCAS Entonox Contraindication Mnemonic:
C – ability to COMPLY
D – DECOMPRESSION sickness
C – altered level of CONSCIOUSNESS
P – PNEUMOTHORAX
A – AIR emboli
I – INHALATION injury
N – NITROGLYCERIN use within 5 mins
Entonox Precautions:
Inability to ventilate area
Nitroglycerin use within 5 minutes of administration
BCAS Entonox Precaution Mnemonic:
S – SHOCK
A – ABDOMINAL distenstion
D – DEPRESSANT drugs
C – COPD
F – FACIAL injuries
Alternative Entonox Contraindication Mnemonic:
D – Decompression sickness
I – Inability to comply
V - Ventilation
I – Inhalation injuries
N – Nitrogen in the past 5 minutes
E – Embolism (air bubbles)