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Jeff Segal, A-EMCA
Junior Member
Username: Jeff_segal

Post Number: 10
Registered: 03-2004
Posted on Thursday, March 01, 2007 - 06:50 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Hello everyone,

I am posting this to see what others think, I totally understand about getting our Dr. to sign off us on using an AED, however I am not allowed to take it out on duty till I have my standing orders, but if I am not in SJA uniform and I see someone go down and becomes VSA I can take an AED off the wall and use it.. What’s the logic in that?? Also training is good for people who don’t use the equipment every day, and its good to go over the protocols in your head, but I am a paramedic and use my skills every day and I find it boring going though my AED protocols every year.. Yes I have to do something similar with my service however they say do one scenario and I am done for that year.. so much easier then a whole day of training…


What are your thoughts??
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Jeff
Intermediate Member
Username: Trexer

Post Number: 21
Registered: 10-2002
Posted on Thursday, March 01, 2007 - 06:59 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I know that here in BC that we simply need to do one scenario a year to stay current rather than doing the entire course again.
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Jeff Segal, A-EMCA
Member
Username: Jeff_segal

Post Number: 12
Registered: 03-2004
Posted on Thursday, March 01, 2007 - 07:16 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Its a little different in York Region, Every year we need to do the course all over again, and we also need a 6 month test to make sure we are doing it correctly.. Not to mention the self directed CME's
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Michael Lawrence, RN
Senior Member
Username: Spud

Post Number: 70
Registered: 10-2002
Posted on Friday, March 02, 2007 - 01:10 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Hey Jeff,

Just as your Base Hospital physician needs you to recert each year for SR and defib, our physician (Dr. Wasser) requires you do the same. I agree that it may feel redundant, but it is truly the only way to ensure competency and making sure everyone is comfortable with protocols.

Also, you are correct that although you require medical direction to provide AED with St. John (for both legal purposes in Ontario as it still a delegated medical act, and for our insurance) you, as a member of the public have little fear of recourse if you took one off the wall. In fact, if you look at the latest AED Prescribed Practice document for Ontario SJA, Dr. Wasser encourages members to use AED outside of SJA duty if the situation presents itself and/or there is an AED available.

And even though I have been teaching AED since 2000, and defib patients at work, I still have to attend an AED recert course each year as well to ensure that I am up to date with our protocols (which this year there are some significant changes as we incorporate the 2005 AHA guidelines).

Cheers,
Michael L.
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John Renacure
Junior Member
Username: Johnrenacure

Post Number: 6
Registered: 10-2005
Posted on Friday, March 02, 2007 - 03:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I dont get it, can someone direct me to the legislation that states that an AED is a deligated medical act, as for every other organization but SJA that was out the door a few years ago!
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Jeff Segal, A-EMCA
Member
Username: Jeff_segal

Post Number: 14
Registered: 03-2004
Posted on Friday, March 02, 2007 - 10:10 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks for more info Spud... I just don't understand why this cant just be done as a recert every year then just like your cpr, why the need for the 6 month test and the CME's? don't you find this to be a little overkill??
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Simon Martin, A-EMCA, Flight Paramedic
Senior Member
Username: Als_medic

Post Number: 57
Registered: 08-2004
Posted on Saturday, March 03, 2007 - 04:54 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Jeff, I think it all comes down to liability concerns. Some physicians are concerned about the competence of non-healthcare providers with AED, especially due to infrequent use and little patient contact. You and Spud (and I) do patient assessment and treatment every working day, whereas the average SJA member rarely sees a major complaint, in fact rarely treats anyone. Long before SJA had an AED program (8 or 9 years ago) I had a meeting with the medical director of the local Base Hospital to discuss trying to set up an AED program for SJA. She was very progressive in her support of pre-hospital care but again thought that rater than the Annual recert the Paramedics were doing, something at least every six months would be necessary for her to be comfortable delegating to lay-people. Of course now, with 12 year olds being taught to use AEDs in some places, and the safety mechanisms built in to the newer devices, this might be a tad excessive. Just my 2 cents.
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Jeff Segal, A-EMCA
Member
Username: Jeff_segal

Post Number: 15
Registered: 03-2004
Posted on Saturday, March 03, 2007 - 06:02 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Simon, I understand what your saying, and agree with it, but then for the Medical professionals (example, RN, Paramedic, DR) should there be a clause in there saying we can recertify once a year without a 6 month test and CME's? Similar to the MFR challenge right now, I have not taken an MFR course but I was allowed to challenge the written test and did some practical scenarios..
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Simon Martin, A-EMCA, Flight Paramedic
Senior Member
Username: Als_medic

Post Number: 58
Registered: 08-2004
Posted on Saturday, March 03, 2007 - 06:58 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Jeff, I think some sort of reciprocity arrangement is essential to keep membership. Health care providers do not want to jump through hoops, to volunteer their time, to do something they know how to do anyway. I understand that SJA needs some sort of assurance that one is appropriately qualified, but I think that showing proof of annual Base Hospital recertification should be adequate. At the time I looked at rejoining SJA there was no reciprocity for MFR and I think that exemption from training and still requiring testing is still excessive. If the SJA MFR course meets the Paramedic Association of Canada NOCPs then by definition, my accredited ACP, and CCP programs include all the material of the lower levels. MFR and AED are not things that SJA created and it would be nice to recognize the relevant experience and education members have. Just my 2 cents, but I think it would help in gaining and retaining members who work in healthcare, especially Paramedics.
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Michael Lawrence, RN
Senior Member
Username: Spud

Post Number: 71
Registered: 10-2002
Posted on Saturday, March 03, 2007 - 12:13 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

John, the legislation to make AED open to everyone in the public without training never made it through final reading at the provincial legislature. There is however another bill being proposed to make AED truly public, but I have not heard anything else final yet.

AED IS a delegated medical act under the RHPA (regulated Health Professions Act) in Ontario. It provides an overview of the types of things that medical professionals are able to do once granted a license to practice by their governing college (ie. College of Nurses, College of Physicians and Surgeons, etc). It prevents members of the public from performing surgery on each other, dispensing/prescribing medications, and from defibrillating each other.

As an organization, we have to ensure that our members are "certified" by a medical doctor (ie. he delegates the skill of AED to us) to minimize liability. Regardless of legislation in ontario, we will still need to certify our members for AED, even if deregulated, in order to minimize risk. In fact, the AHA recommends that AED programs do not need to be run or led by a physician, but any suitable health care professional (nurse, RT, Paramedic) - but that is just a position statement from them.
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Kevin Morgan
Senior Member
Username: Kmorgan

Post Number: 65
Registered: 02-2003
Posted on Saturday, March 03, 2007 - 01:53 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Simon:

There is an equivalency for AMFR1 now. You still (as discussed already) have to do the AED portion, but if that's all you have to do it's not so bad.

I would have to look at the MFR instructor book to be sure, but I am pretty sure for paramedics you just need proof of active employment as a paramedic. For other health care professionals employed in relevant areas I believe they can challenge the course (do a bunch of skills stations and testing). I'm at work now and can't check, but I will look when I get home and if it is any different than this I will post again.
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Michael Lawrence, RN
Senior Member
Username: Spud

Post Number: 72
Registered: 10-2002
Posted on Saturday, March 03, 2007 - 03:50 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Kevin, you are correct...

Paramedics who are actively employed can be granted reciprocity for the AMFR-1 and need only be certified for AED (to be familiar with our protocols). Other Health Professionals can "challenge" the course content by attending a modified AMFR-1 course (which provides time for testing, skills stations and review of core content only).
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Simon Martin, A-EMCA, Flight Paramedic
Senior Member
Username: Als_medic

Post Number: 59
Registered: 08-2004
Posted on Saturday, March 03, 2007 - 05:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks for the info Spud, I might look at volunteering locally then.
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John Renacure, RN, MScN
Junior Member
Username: Johnrenacure

Post Number: 7
Registered: 10-2005
Posted on Sunday, March 04, 2007 - 12:56 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Michael,
that is correct but dont forget that the RHPA does not apply in the event of a "first aid emergency", and since AEDs are used in emergencies the act would not apply. I did some reading up and the legislation they are currently attempting to pass does not directly identify the issue of Designated act or not but more on the liability aspect.

I just think the SJA guidelines are excessive, for example Red Cross requires annual re-certification with NO 6 month supervised or CME's which makes sense, as AEDs are not brain science.
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Jeff Segal, A-EMCA
Intermediate Member
Username: Jeff_segal

Post Number: 17
Registered: 03-2004
Posted on Sunday, March 04, 2007 - 02:12 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks John, at least someone understands what i mean
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Jeff Segal, A-EMCA
Intermediate Member
Username: Jeff_segal

Post Number: 18
Registered: 03-2004
Posted on Sunday, March 04, 2007 - 02:15 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks John, at least someone understands what i mean
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Steven Boa
Intermediate Member
Username: Xlq771

Post Number: 21
Registered: 02-2004
Posted on Friday, March 09, 2007 - 04:36 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Here is a link to the College of Physicians policy on delegation of controlled acts:

www.cpso.on.ca/policies/delegation.htm

It specifically mentions under the Emergency Situations section the example of a passer-by using an AED in an airport as not being in violation of the RHPA.

(Message edited by xlq771 on March 09, 2007)
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John Renacure, RN, MScN
Junior Member
Username: Johnrenacure

Post Number: 9
Registered: 10-2005
Posted on Saturday, March 10, 2007 - 04:32 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

That is a perfect link to review which provides clear evidence that AED usage in an emergency is not required to be deligated by a physician.

Yes they use an example of a passer-by using an AED in an airport but it clearly states

Although the RHPA prohibits performance of controlled acts by those not specifically authorized to perform them, it does not apply if the person performing the act is doing so to render first aid or temporary assistance in an emergency....Although applying a form of energy prescribed in the regulations is a controlled act under the RHPA, when it is done in an emergency it is not prohibited.

So, as an agency, SJA should begin to follow the other leading canadian agencies and decrease the "technicalities" and "hoops" to jump through that we are well known for.

Should AED be a training session as a refresher during a training night, sure! but do we need the CME's and forced 6 month NO!, we must face it:

Step 1 : Turn on Power
Step 2 : Follow Prompts
Step 3 : Transfer Patient to Paramedics

That is pretty simple!
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Paul W. J. Irwin
Senior Member
Username: Pirwin

Post Number: 149
Registered: 02-2003
Posted on Saturday, March 10, 2007 - 05:48 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The statements on the use of an AED device in an emergency ring true with me. I had conversed with someone about a PAD hanging on a wall without knowing that within the hour I would be pulling it from the cabinet in an emergency, having discovered that not one person in the building had been taught how to use it during my conversations the hour before. Although the patient in that case had signs of circulation, and thus the device not applied, I made no hesitation to ensure its immediate availability to them. There was never any question from any responding professional EMS or doctors in the hospital why the device was noted as having been available. It was in fact not less than praised.
"Be Good All Day"
Paul
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Kevin Morgan
Senior Member
Username: Kmorgan

Post Number: 67
Registered: 02-2003
Posted on Saturday, March 10, 2007 - 06:05 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Everyone is right that to use an AED as a passerby in an aiport it is not in violation of the RHPA, and to perform a controlled act in an emergency situation to render temporary aid it is not a violation of the RHPA, but if performing the act is part of your expected duties I am pretty sure you need to have medical delegation.

Since we carry the AED with us and tell clients that we offer the service, it is part of our "expected" duties. I think the RHPA exemption for temporary aid in an emergency does not apply to us when our MFR units are at an event, since those emergency situations are what we are there and intended to handle.

Since medical delegation is then necessary, we have the process of obtaining standing orders. Members of the general public can take a course, and take it again a year later without doing and CME or supervised practice. It is only the Patient Care Providers and those clients that have an AED program administered by our medical director that have to jump through all the "hoops".
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Jeff Segal, A-EMCA
Advanced Member
Username: Jeff_segal

Post Number: 35
Registered: 03-2004
Posted on Saturday, March 10, 2007 - 08:14 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Kevin, Thats what i am trying to say.. who can we approach on to changing the "rules" for the medical directive on AED's, Its not hard to use. Turn on and follow the directions...... yes it can shock VT with a pulse but thats why we check for a pulse before we put the masheen on...

i am still good with a CME every year (just a quick 1hr) to say yes i still know how to use the masheen.. but this 1 yr recert and then a refresher every 6 months and lets not forget the CME's...

i think for voulenteers this is over kill..

sorry about my spelling, not at my computer and no spell check on this computer
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John Renacure, RN, MScN
Junior Member
Username: Johnrenacure

Post Number: 10
Registered: 10-2005
Posted on Saturday, March 10, 2007 - 09:17 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

SJA having an AED is just as if the arena had their own AED, and in the event of an emergency it doesnt need to be deligated.

The only training agency that still has medical "directives" is SJA, all of the other programs that I know of do have medical advisors, but no formal "directives" and they are training many AED programs throughout the communities.
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Kevin Morgan
Senior Member
Username: Kmorgan

Post Number: 68
Registered: 02-2003
Posted on Saturday, March 17, 2007 - 10:08 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I disagree John.

SJA having the AED present is the same as OPT or another paid medical service having an AED, and they have medical directors. The factor that differentiates between "public access" and "targeted responder" is the availability of the machine. If it's on a wall where anyone can grab and use it, it is PAD. If it's carried by an individual, or locked away or in any way restricted from anyone grabbing it and using it is not PAD. There is still a difference between PAD and targeted responders.
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Jeff Segal, A-EMCA
Advanced Member
Username: Jeff_segal

Post Number: 39
Registered: 03-2004
Posted on Saturday, March 17, 2007 - 10:44 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Ok, i understand that we are providing patient care, and other services have standing orders, but most of those standing orders are for symptom relief drugs. Second I just don't understand, how I can go on duty, and when I do the AED course, I can carry the AED, but it expires because I don't go back and do a scenario at the 6 month mark. And lets not forget the CME'S.... however if I am just Joe Shmoe on the street and I come across the VSA I can grab one off the wall and use it with no problems (if it goes well your called a hero, if you screw up it looks bad on you).. I do see a problem with this.. or if I do let my certification for my AED expire, I have to sit there and twiddle my thumbs, because I don't have the standing order anymore.. I have said this before "THIS IS OVERKILL" Once a year re-certification is fine! Yes if members are starting to forget how to use an AED they should go to there Divisional Training officer and request for one night to go over as a refresher..

Do you ever think that Dr. Wasser will ever approve Paramedics, RN's, Dr's with Symptom relief drugs? And do you think he would cross certify for those members who work for an emergency service?
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John Renacure, RN, MScN
Member
Username: Johnrenacure

Post Number: 13
Registered: 10-2005
Posted on Saturday, March 17, 2007 - 11:08 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Kevin,
I agree that SJA is the same as other paid medical services, however I can tell you, being a part owner of one of those medical services, we do not have "medical directives" for the AED, only for drugs and IV starts. I have ran this through our medical director numerous times, and directives were not needed, and I know of many companies in the same boat.

Reality is, the SJA protocols are OVERKILL as Jeff States. Good lord we dont have to do our ACLS that often where manual defib and powerful drugs are involved, so its a bit much for an AED.

If SJA is that worried about liability of the members using the machines that this much training and recertificaiton is involved, then maybe we should not be carrying AEDS as there is clearly a lack of trust and competency
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Jeff Segal, A-EMCA
Advanced Member
Username: Jeff_segal

Post Number: 40
Registered: 03-2004
Posted on Saturday, March 17, 2007 - 11:29 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I do agree John

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