Category Archives: Advisories

CREMS Referrals

Did you know that CREMS Referrals with consent (i.e. CREMS “yes”) go directly to Home & Community Care Support Services (HCCSS)?

Home & Community Care Support Services, formally known as the Local Health Integration Network (LHIN), oversees the referral and provision of homecare services in Ontario. When your patient consents to a CREMS referral, it will be sent directly to service providers who will complete an assessment for homecare service eligibility. HCCSS only receives information that is included in the CREMS section and does not include any other “free text” areas (such as the “Remarks” section) of the ePCR. Only CREMS non-consent (i.e. CREMS “no”) referrals are directed to the Community Paramedicine Unit for follow-up.

Did you forget to include your CREMS Referral in your ePCR or do you have urgent concerns about unmet needs in the home?

Please email details to cphome@toronto.ca and the Community Paramedicine Unit will follow up. Please provide as many details as possible such as Run #, Name, Address, etc.

Did you know that Toronto Paramedics submitted over 4,500 CREMS Referrals in 2022?

Thank you for continuing to be patient advocates!

Contact Information:
Email – cphome@toronto.ca
Phone – 416-397-4322
Fax – 416-696-3500

Updated COVID-19 Infection Prevention and Control (IPAC) Measures

Toronto Paramedic Services is updating the Divisional Infection Prevention and Control (IPAC) standards to align with the latest public health recommendations from Public Health Ontario.

The following changes will be effective as of 06:00 hours on May 10, 2023:

Pre-Screening – Active pre-shift screening will be discontinued. Staff and visitors will be required to complete a self-screening for the common symptoms of COVID-19 and other infectious diseases prior to entering the workplace. A self-screening aid will be posted in workplaces and is attached. Staff who fail the self-screening must contact their Superintendent or the SSC and must not enter the workplace.
Isolation Period/Return to Work – Staff who test positive for COVID-19 or have symptoms of any febrile respiratory illness may return to work once their symptoms have been improving for at least 24 hours (48 hours if gastrointestinal symptoms were experienced) AND are fever free (temperature <38.0°C). Rapid Antigen Testing (RAT) kits will be provided upon request.

Wearing a medical grade surgical mask is strongly recommended for 10 days from the onset of symptoms.

Test-to-Work – Mandatory Test-to-Work for staff who have a high risk exposure to COVID-19 will be discontinued. Staff are encouraged to self-monitor for symptoms of COVID-19. Rapid Antigen Testing (RAT) kits will be provided upon request.

Service-based PCR testing will be discontinued.

Masking in Patient Care Settings – A Paramedic Services supplied medical grade surgical mask will be the minimum level of respiratory protection required for ALL patient care activities, as well as entry into patient care spaces (including hallways where patient care is performed).

An N95 respirator is required in the following circumstances:

Known or anticipated performance of an aerosol generating medical Procedure (AGMP)
Patient fails the Point-of-Care Risk Assessment

Staff may choose to wear a higher level of personal protective equipment based on their assessment of the situation, at their discretion.

We will continue to monitor guidance from Public Health Ontario, and work with our Health and Safety Team and Union partners to ensure a safe and healthy workplace.

Sincerely

(Original signed by) (Original signed by)
Adam Thurston Dr. Russell MacDonald

Nausea and Vomiting Medical Directive – Ondansetron Shortage

In follow up to the recent communication from the Ministry of Health regarding the Nausea and Vomiting Medical Directive and ondansetron shortage, we would like to provide the following clarification and authorization:

For adults who are 65 or older and who are experiencing nausea and vomiting, ondansetron remains the preferred treatment. However, if unavailable, paramedics are authorized to administer dimenhydrinate without patching to a base hospital physician when the patient meet all other requirements of the directive.

Paramedics should weigh the benefits of symptom relief versus the risk of sedation and delirium which can complicate the hospital assessment, delay diagnosis, cause discomfort for the patient and interact with other anticholinergic/sedating medications that the patient may be prescribed.

To reduce potential adverse events or side effects in older adults, paramedics should administer a dose of 25mg of dimenhydrinate. If paramedics feel the patient would benefit form a greater or repeat dose, they should patch for base hospital authorization.

The Ministry has indicated that they will be updating the Nausea and Vomiting Medical Directive in the next version of the ALS PCS to reflect this direction in the absence of ondansetron.

Thank you,”

Sheldon Cheskes
MD, CCFP (EM), FCFP, DRCPSC
Medical Director
Regions of Halton and Peel

Michael Feldman
MD, PhD, FRCPC Medical
Director
Simcoe, Muskoka, Rama and Beausoleil

Morgan Hillier
MD, MSc, FRCPC
Base Hospital Medical Director
Toronto Paramedic Program

Medical Directive For Transports

University Health Network Stabilization Centre Medical Directive For
Transports Redirected from a UHN Emergency Department to Centre

DOWNLOAD PDF

uhn stabilization centre - operational medical directive - redirect - rdm 20230209

University Health Network Stabilization Centre Medical Directive For
Transports Directly to Centre

DOWNLOAD PDF

uhn stabilization centre - operational medical directive - direct - rdm 20230209

DOSE VF with Toronto Fire Services Consideration for Toronto Paramedic Services

With the recent release of the Provincial ALS PCS v 5.1, questions have arisen around the Cardiac Arrest Medical Directive and the direction regarding treatment for patients in Refractory Ventricular Fibrillation/Pulseless VT.

At the time of writing of the directive, the Double Sequential Defibrillation for Refractory Ventricular Fibrillation Randomized Controlled Trial had not yet been published. As such, the current directive ALS PCS standard appears to conflict with previous MOH guidance around the use of the DOSE VF research protocol for trained services pending the study’s final results.

Please note that the approved use of the DOSE VF research protocol for those trained during the research trial SUPERCEDES THE CURRENT ALS PCS direction for refractory VF/pulseless VT in v 5.1. As such, trained paramedics should continue to use the DOSE VF research protocol for patients presenting in Refractory Ventricular Fibrillation/pulseless VT. With the release of the study results and the ILCOR draft recommendation supporting the use of DSED, the MAC is moving forward with a provincial change in the medical directive for patients in Refractory Ventricular Fibrillation. This should occur over the next few months.

Additionally, Toronto Fire Services is currently training to employ the Vector Change protocol used during the DOSE VF study. Should a Toronto Firefighter receive three consecutive AED “shock advised” prompts, they will then change the vector to the anterior-posterior (AP) position. They will continue to provide additional AP shocks until paramedic arrival and transfer of care.

I hope this memo clarifies any confusion in relation to the use of DSED for refractory ventricular fibrillation.

Any questions, can be directed to myself Morgan.Hillier@sunnybrook.ca or Scott Gorsline at Scott.Gorsline@sunnybrook.ca

Yours Truly,

Morgan Hillier MD, MSc, FRCPC
Base Hospital Medical Director
Toronto Paramedic Program