Category Archives: Education & Development

Paramedic Individual Issue Smartphone

I am pleased to announce that Toronto Paramedic Services has procured Apple iPhone 12 smartphones for all Paramedic staff currently in the workplace, and a rollout of individual issue smartphones will commence in the coming months.

The procurement of individual issue smartphones is the result of a comprehensive plan developed in collaboration with TCEU Local 416, and based on interest from Paramedic staff and from subsequent feedback collected from the 2023 Staff Communications Survey.

A smartphone trial group was launched in November 2023, which included 10 Operations Paramedics. Following the receipt of valuable feedback from the trial participants, the group was expanded in February 2024.

Each iPhone 12 smartphone will come with an OtterboxDefender case, a charger, and a setup guide.Superintendents will issue the devices, facilitate devicesetup, and provide supporting information. Paramedics are required to acknowledge receipt of the device and that they understand the City of Toronto Acceptable Use Policy.

If you have any questions, please speak with your Superintendent.

Sincerely,

(Original signed by)
Leo Tsang

Toxic Drug Supply in Ontario

In recent weeks, Toronto’s Drug Checking Service has identified new and dangerous substances that have been introduced into Toronto’s unregulated drug supply. These drugs, Medetomidine (veterinary tranquilizer) and Dexmedetomidine (strong human sedative), have been found in samples expected to be fentanyl, fentanyl derivatives, or central nervous system depressants.

This dangerous combination of substances, referenced in a February 2024 memorandum from Ontario Chief Medical Officer of Health (CMOH) Dr. Kieran Moore, can result in cardiac depression, respiration depression, and a deep state of unconsciousness unresolved by naloxone administration.

Further to this, a substantial number of toxicity events requiring emergency medical care have occurred in Belleville, Ontario, which may or may not be associated with Medetomidine and/or Dexmedetomidine.

Considering this information, Paramedics are reminded to maintain a high index of suspicion regarding the potential for additional non-identified toxic substances to be involved when managing a suspected overdose. This is particularly the case when naloxone administration does not improve the patient’s level of consciousness.

In addition to the Basic Life Support Patient Care Standards (BLS PCS) – General Standard of Care, Paramedics should review the Patient Care Standards that pertain to the management of suspected overdose, including but not limited to: Altered Level of Consciousness Standard and Toxicologic Emergency Standard, and provide patient care in accordance with the BLS PCS.

If you have any questions, please contact your Superintendent.

(Original signed by)               (Original signed by)
April Hugh                               Dr. Russell MacDonald

CACC Deployment to Back-up Communications Centre – March 13-14, 2024

Toronto Paramedic Services Communications will deploy to the Back-up Ambulance Communications Centre on Wednesday, March 13, at 06:30. The planned return to 4330 Dufferin St. is Thursday, March 14, at 18:30. This deployment is required to complete maintenance at 4330 Dufferin St.

Paramedics can contact CACC using the regular station ‘hotline’ phones.

As per usual operations, the CACC may deploy to the back-up location at any time, planned or unplanned. During these events, the Dispatcher will notify all operational crews of the situation. In the unlikely event of a phone system failure, Paramedics will be required to contact CACC via portable radio or using 416-489-2115.

If you have any questions, please speak to your Superintendent.

Sincerely,

(Original signed by)
Leo Tsang

Update on the PITSTOP Trial – 1000 Patient Milestone!

We have reached an important milestone for the PITSTOP trial as over 1000 participants have been enrolled!

As of February 22, 2024, 1004 participants have been enrolled by paramedics from Toronto Paramedic Services, Halton Region Paramedic Services, and Peel Regional Paramedic Services (see figure below). This represents almost 50% of the target sample size of 2040 participants. We will also be expanding recruitment to York Region Paramedic Services in March 2024.  This trial would not be possible without the ongoing support and enthusiasm from paramedics at all participating services – thank you!

Protocol deviations remain infrequent but are most commonly associated with eligibility criteria errors. Please refer to the PITSTOP medical directives or the inclusion/exclusion list that is printed directly on the PITSTOP kit if you are unsure whether a patient is eligible.

Continue reading…

Important reminders:

  • Fever: Can be any temperature ≥ 38.0°C measured by a paramedic or measured during the previous 24 hours by the patient or caregiver
  • Hypotension: Can be any sBP measurement that is <100mmHg, not just the initial sBP
  • The most common exclusion criteria error is missing that the patient has been receiving an anticoagulant; please ensure the patient’s medications are checked whenever possible prior to enrolment.  We have added a label to the study kits listing commonly used anticoagulants (note that aspirin and Plavix are allowed)
  • A patient must meet all eligibility criteria to be enrolled.  This means that if they have any of the exclusion criteria that relate to either of the treatment interventions (antibiotics or fluids), they can’t proceed in the study.  The reason is that the randomization occurs simultaneously for both interventions once the kit is opened.

Please also continue to use all 3 PITSTOP documentation codes in the ePCR:

  • Use Enrollment Code 932.2 – to document that all eligibility criteria have been met and indicate which randomization kit # was used.
  • Use Study Drug Code 850.1 – to document the time the IM injection was given.
  • Use Fluid Arm Code 933.62 Aggressive OR 933.63 Standard – to allow the study team to collect data about fluid allocation, time of fluid bolus, and total volume of fluid that was delivered.

This study has the potential to change how patients with sepsis are treated across health systems – and to improve outcomes.  Focusing on treating patients based on WHEN they need therapy, rather than WHERE they are physically located may lead to LIVES SAVED!

For questions or additional information, please contact the PITSTOP Coordinating Centre at:  pitstop@sunnybrook.ca.