Advanced Care Paramedic – Canada (4 year education) Airway management Assessment, manual repositioning, oropharyngeal and nasopharyngeal airway adjuncts, manual removal of obstructions, suctioning Use of supraglottic airway devices such as the I-Gel or King-LT airway Endotracheal intubation, cricothyrotomy (surgical airway), delayed and rapid sequence induction (in some jurisdictions), use of magill forceps, airway suctioning. Breathing Assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, supplemental oxygen administration by nasal cannula, rebreathing and non-rebreathing mask, positive pressure ventilation by bag valve mask (BVM). CPAP Decompression of tension pneumothorax by needle or incision thoracostomy, BIPAP, use of mechanical transport ventilators. Circulation Control of hemorrhage using direct and indirect pressure, tourniquets, wound packing and hemostatic agents, basic shock management and hypothermia prevention, pelvic binding. IV fluid resuscitation. Intraosseous (IO) cannulation (placement of needle into marrow space of a large bone), central venous access (using central venous catheter by way of external jugular or subclavian), pericardiocentesis. Cardiac arrest Cardiopulmonary resuscitation, basic airway adjuncts, suctioning, BVM ventilation, semi-automatic defibrillation. Expanded resuscitation skills including supraglottic airway placement, monitoring of capnography, administration of epinephrine/adrenaline (in some jurisdictions). Expanded drug therapy options (epinephrine, anti-arrhythmics), ECG interpretation, manual defibrillation, intubation, ultrasound. Cardiac Monitoring Placement of ECGs electrodes and ability to transmit to hospital for interpretation. Twelve lead ECG monitoring and interpretation Advanced ECG interpretation Drug administration Oral, nebulized, and intramuscular injection of a limited list of drugs limited list of drugs for intramuscular, subcutaneous, intravenous injection (bolus), intravenous drip, and transdermal. Infusion pump and intraosseous access. Drug types permitted Low-risk and immediate requirements, e.g., aspirin and nitroglycerin (chest pain), oral glucose and glucagon (hypoglycemia), epinephrine (anaphylaxis or respiratory failure), albuterol (asthma), and naloxone (narcotic overdose). Intravenous fluids, dextrose infusion (hypoglycemia), and symptom relief medications such as ondansetron (nausea), dipenhydramine (pruritus), and non-narcotic pain management (nitrous oxide, methoxyflurane, ketorolac, acetaminophen). Significantly expanded drug list, most commonly narcotics, sedatives, vasopressors, antidotes, neuromuscular blockers, and advanced cardiac and respiratory medications. In some jurisdictions, paramedics may also permitted to administer blood products, tranexamic acid, and antibiotics. Patient assessment Basic physical assessment, vital signs, history taking, lung auscultation, pulse oximetry. More detailed physical assessment and history, capnography. Advanced assessment, 4 and 12-lead ECG interpretation, ultrasound, point-of-care blood chemistry interpretation (glucose, lactate, hemoglobin, troponin). Other procedures Splinting of bone fractures, uncomplicated and complicated childbirth. Wound closure (butterfly stitches, suturing), fracture/dislocation reduction, umbilical venous access, chemically facilitated extrication, emergency surgical procedures such as escharotomy or field amputation (in some jurisdictions).
advanced care paramedic – canada (4 year education) airway management assessment manual repositioning oropharyngeal and nasopharyngeal airway adjuncts manual removal of obstructions suctioning use of supraglottic airway devices such as the i-gel or king-lt airway endotracheal intubation cricothyrotomy (surgical airway) delayed and rapid sequence induction (in some jurisdictions) use of magill forceps airway suctioning breathing assessment (rate effort symmetry skin color) obstructed airway maneuver supplemental oxygen administration by nasal cannula rebreathing and non-rebreathing mask positive pressure ventilation by bag valve mask (bvm) cpap decompression of tension pneumothorax by needle or incision thoracostomy bipap use of mechanical transport ventilators circulation control of hemorrhage using direct and indirect pressure tourniquets wound packing and hemostatic agents basic shock management and hypothermia prevention pelvic binding iv fluid resuscitation intraosseous (io) cannulation (placement of needle into marrow space of a large bone) central venous access (using central venous catheter by way of external jugular or subclavian) pericardiocentesis cardiac arrest cardiopulmonary resuscitation basic airway adjuncts suctioning bvm ventilation semi-automatic defibrillation expanded resuscitation skills including supraglottic airway placement monitoring of capnography administration of epinephrine/adrenaline (in some jurisdictions) expanded drug therapy options (epinephrine anti-arrhythmics) ecg interpretation manual defibrillation intubation ultrasound cardiac monitoring placement of ecgs electrodes and ability to transmit to hospital for interpretation twelve lead ecg monitoring and interpretation advanced ecg interpretation drug administration oral nebulized and intramuscular injection of a limited list of drugs limited list of drugs for intramuscular subcutaneous intravenous injection (bolus) intravenous drip and transdermal infusion pump and intraosseous access drug types permitted low-risk and immediate requirements eg aspirin and nitroglycerin (chest pain) oral glucose and glucagon (hypoglycemia) epinephrine (anaphylaxis or respiratory failure) albuterol (asthma) and naloxone (narcotic overdose) intravenous fluids dextrose infusion (hypoglycemia) and symptom relief medications such as ondansetron (nausea) dipenhydramine (pruritus) and non-narcotic pain management (nitrous oxide methoxyflurane ketorolac acetaminophen) significantly expanded drug list most commonly narcotics sedatives vasopressors antidotes neuromuscular blockers and advanced cardiac and respiratory medications in some jurisdictions paramedics may also permitted to administer blood products tranexamic acid and antibiotics patient assessment basic physical assessment vital signs history taking lung auscultation pulse oximetry more detailed physical assessment and history capnography advanced assessment 4 and 12-lead ecg interpretation ultrasound point-of-care blood chemistry interpretation (glucose lactate hemoglobin troponin) other procedures splinting of bone fractures uncomplicated and complicated childbirth wound closure (butterfly stitches suturing) fracture/dislocation reduction umbilical venous access chemically facilitated extrication emergency surgical procedures such as escharotomy or field amputation (in some jurisdictions)