Overview and Rationale of Content Changes to Professional ...

Overview and Rationale of Content Changes to Professional Responder Program

Chapter 1: The Professional Responder

New Program Legacy Program Rationale/Change Professional Responder Training Levels

Minimal information was provided with generalized comments.

This information was added to enhance this section in support of the NOCP requirement. It provides clarity on the various training levels. Training levels are specified and complete descriptions of each are provided. Responders should learn how they fit into pre-hospital care training.

Preceptorship This is a new topic which was added. The content defines the process and provides an overview of preceptorship. Preceptorship is a relationship between an experienced responder (the preceptor) and a new responder. The preceptor serves as a coach and mentor, providing support, guidance, and assessment in the field.

Community Paramedicine The addition of this new content provides an overview of community paramedicine as noted in the NOCP competencies. Community paramedicine is the delivery of healthcare services by paramedics in community-based, non-emergency-care roles.

Medical Oversight Communicating with the Medical Director

We have now provided a clear definition of the role of a medical director, and the methods by which medical control is delivered: direct or online medical control and indirect or offline medical control.

The Professional Responder We have now added Lifeguards to the list of professionals who have a duty to respond. The lifeguard performs a specialized role within the professional responder discipline.


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New Program Legacy Program Rationale/Change Self-Care Critical Incident Stress

Management

Self-care is essential to ensuring the well-being of those in the professional responder role. It is important in maintaining effectiveness in delivering proper care to the patient. The new self-care sub-topic includes: death and dying, critical incident stress, and post-traumatic stress disorder. Given the nature of the work that responders do, they are exposed to vicarious and traumatic stress. Self-care is an important part of staying healthy both physically and mentally.

Legal and Ethical Issues Content on patient advocacy was added: This content was required to meet NOCPs. Patient advocacy refers to the practice of hearing and representing a patient’s concerns, respecting his or her rights, and making every effort to ensure that the patient receives effective care that is in accordance with his or her wishes.

Electronic Patient Care Reports (e-PCRs)

We have now included information on Electronic Patient Care Reports (e-PCRs). The new content provides an overview of what you may encounter in your role. E-PCRs are becoming more popular in Canada. They are tablet-style devices that allow data to be rapidly entered, collected, and analyzed.



Chapter 2: Responding to the Call

New Program Legacy Program Rationale/Change Part 2 Introduction The introduction to Part 2 of the Legacy text, “Establishing Priorities

of Care” (listing all the chapters within Part 2) has now been moved into individual chapters

Preparing for the Emergency Response

We have inserted additional content on workplace emergency response plans in this chapter. These plans have become an integral part of an organization’s emergency response, and in many jurisdictions, they are compulsory under regulations. Workplace emergency response plans are developed for specific workplaces. They typically identify trained personnel on site, the locations of emergency supplies and equipment, the communication system that is used in emergencies (including how to call for external emergency assistance, such as an ambulance), and the evacuation routes for the building.

Managing Hazards at the Emergency Scene

Specific emergency scenes

This section was split into two sections to provide for clarity of the sub-topics:

• Special Emergency Scenes includes content on crime scenes, drug labs, hostile bystanders, hostage situations, and natural disasters.

• Specific Emergency Scenes now includes content on hazardous materials, water and ice, downed electrical lines, fire, traffic, unsafe structures, confined spaces, and wreckage.

• This distinction emphasizes the need for specialized response resources that the professional responder needs to be aware of to safely and effectively respond.

Psychological Preparation Mental and Emotional Aspects A simple change to the heading was made here to better reflect the topic’s content.



Chapter 3: Infection Prevention and Control

New Program Legacy Program Rationale/Change Infection Prevention and Control

Preventing Disease transmission

New chapter title: This change was made to broaden the scope for the chapter’s content and also to provide an opportunity to enhance the content in future under the same heading.

Disease-Causing Pathogens Found in Table 3-1 The content is now broken out of the table and into the chapter under separate headings, providing better clarity and additional content for the learner and Instructor. The table was often overlooked in the past and now with separated headings will provide learners with more focused access to the information.

Epidemics and Pandemics Definitions have been added for “epidemic” and “pandemic”:

An epidemic occurs when there is an increase, especially a sudden increase, in the number of cases of a disease in a given group of people or geographical area, above what is normally expected for that population or area. A pandemic is an epidemic that involves multiple countries, usually affecting a large number of people.

Vancomycin-Resistant Enterococci (VRE)

New content has been added on Vancomycin-Resistant Enterococci (VRE). Professional responder may encounter this in the course of their responses, so awareness of this topic is now included. VRE are strains of enterococci bacteria that are resistant to the antibiotic vancomycin. Vancomycin is not effective in treating a VRE infection.

The Body’s Natural Defenses Included 3 different types of immunities (innate, adaptive, passive)

This content was removed.



New Program Legacy Program Rationale/Change Diseases That Cause Concern Content on Coronavirus was not included in our legacy text.

Coronaviruses are a group of six viruses that typically cause upper respiratory-tract illnesses. It was important to provide this information so that professional responders would have the background to recognize signs and symptoms of a coronavirus in their patient assessments.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) content was added. Professional responders may encounter MERS during an incident and need to be able to recognize the signs and symptoms. Since April 2012, cases of MERS-CoV have been identified in a number of countries in the Middle East. Several other countries have also reported MERS-CoV cases in individuals who have travelled to the Middle East. The symptoms of MERS-CoV are similar to severe pneumonia and include fever, cough, shortness of breath, and other breathing difficulties.

Preventing Disease Transmission

Protecting Yourself from Disease Transmission

Based on feedback from our stakeholders, we have added content on personal hygiene and reorganized the content on personal protective equipment (PPE). An updated table of recommended PPE for pre-hospital settings is now available for quick reference. We also changed the terminology from “putting on and removing gloves” to “donning and doffing PPE”.



Chapter 4: Anatomy and Physiology

New Program Legacy Program Rationale/Change New Anatomy and Physiology Chapter

All Anatomy and Physiology content has been consolidated into the new A & P chapter. In the legacy text each chapter covered the specific A & P for the topics covered within that chapter (e.g., the Respiratory Emergencies chapter included A & P content on the lungs, airway, etc.). By centralizing all the anatomy and physiology in this chapter, it provides far more flexibility to the learner and Instructor.

Illustrations Outdated Illustrations New bio-medical illustrations have been inserted throughout this chapter, including anatomical overlays of the body’s systems and functions. This was a major enhancement of the Emergency Care text.

Agonal Respirations The ability to recognize if agonal respirations are present is important during the patient assessment in an unresponsive collapse. Detailed information added to this chapter includes the following: • Agonal respirations are an inadequate pattern of breathing

associated with cardiac arrest states. • Agonal respirations originate from lower brainstem neurons as

higher brain centres become increasingly hypoxic (oxygen-deprived) during cardiac arrest.

• In agonal respirations, the diaphragm is still receiving intermittent residual impulses from the brain, resulting in sporadic gasping breaths.



Chapter 5: Assessment

New Program Legacy Program Rationale/Change Level of responsiveness/ unresponsiveness (LOR)

Level of consciousness/ unconsciousness (LOC)

Basic terminology change to “level of responsiveness/unresponsiveness (LOR)”. This is the preferred term in patient assessment as it refers to objectively observable facts (“the patient responds to stimuli”) rather than the subjective experience of the patient (“the patient is conscious of stimuli”) which cannot be directly observed.

Scene Assessment Scene Survey “Scene assessment” is the new term. This is more in line with the various steps performed when assessing a scene, not just “surveying a scene” as in the past. The term “assessment” indicates that the responder is seeing, hearing, and processing the various aspects of the scene and determining what action to take based on this assessment. We have also inserted “Donning PPE” as a designated step. The rationale for adding this is to emphasize the importance personal protective equipment in your role as a professional responder. At times distractions or urgently required actions cause responders to overlook even some of the simple steps. Adding this step drives home the importance of safety for both the responder and the patient.

Request Additional Resources

Obtain More Advanced Medical Care

The phrase “obtain more advanced medical care”, which appeared throughout the legacy text, has been changed to “request additional resources”. Professional responders will have the training to recognize and request resources that provide assistance or interventions, including extrication that could expedite the patient’s treatment and/or transport to a medical facility. Such resources may include rescue teams (including marine, technical, haz-mat, and auto extrication), air evacuation, or advanced life support.

Primary Assessment Primary Survey Changed term from “primary survey” to “primary assessment” as this better reflects the actual process.



New Program Legacy Program Rationale/Change

Spinal Motion Restriction (SMR)

We now introduce spinal motion restriction (SMR) in the primary assessment. SMR is the new process for the assessment and application of spinal management. It is driven from the change in evidence in spinal management which indicates a shift in practice: SMR techniques are now only applied when indicated, as opposed to being used routinely as a proactive measure. Spinal motion restriction is the reduction or limitation of spinal movement.

Pulse Oximetry Pulse oximetry was located in the secondary survey

Pulse oximetry has been formally added to the primary assessment for all professional responder programs. Measurement of oxygen saturation is essential in assessing the need for oxygen supplementation. Education in interpreting oxygen saturation through pulse oximetry is required. When possible, the responder should attempt to get an SpO2 reading before administering supplemental oxygen to a patient. You must always consider the clinical presentation of the patient in addition to the SpO2 reading

Transport Decision Transport decision is now included as a step within the primary assessment. The rationale was based on the risk of creating an unnecessary delay in patient transport. A transport decision may be made at any point after arrival at an incident based on many factors. Decisions about transport can be updated at any time should if the incident scene or the patient’s conditions change.

Rapid Transport Category (RTC)

The new term “Rapid Transport Category (RTC)” has been adopted. This is a common term in industry and emphasizes the importance of rapidly transporting the patient to a medical facility.



New Program Legacy Program Rationale/Change Patient Positioning Patient positioning has been added as a step within the primary

assessment to ensure that patients are positioned appropriately for their condition and any transport requirements.

Last Oral Intake Last Meal Changed term to reflect the need for an accurate account of any products consumed orally, not just a “meal”

Vital Signs – Blood Pressure

We now recommend that before taking a patient’s blood pressure the responder should check the patient’s arm for abnormalities to avoid causing further harm to the patient and to ensure as accurate a reading as possible. The rationale came from the CCFAE recommendation to address the importance of doing a rapid assessment of the patient’s arm prior to taking a blood pressure reading. The responder is looking for any injuries, CSM, or concerns such as fistulas (dialysis ports found in the lower arm) or swollen lymph nodes (e.g., in a cancer patient).

Vital Signs – Manual Blood Pressure

Added content on manual blood pressure assessment. In many situations, blood pressure can be taken using an automatic blood pressure cuff. Nevertheless, it is important that you be able to take blood pressure manually in case the automated equipment fails or is unavailable. The rationale is a CCFAE recommendation: Your first blood pressure should always be a manual blood pressure. After a baseline manual pressure has been taken, a non-invasive blood pressure (NIBP) automatic cuff may be used. Never rely solely on NIBP as technology does have limitations.

Capillary Refill Capillary refill was located in the Musculoskeletal chapter of the legacy text.

Capillary refill (cap refill) has been relocated to the primary assessment. It is a valuable peripheral circulatory assessment tool.



New Program Legacy Program Rationale/Change Ongoing Assessment Secondary Transport Decision

stated in legacy text: “Make your decision based on any additional information you learn during the secondary and ongoing survey. Update the hospital and medical direction of your plans and any care you provide.”

This content is now considered part of the ongoing assessment as opposed to being a separate step. CCFAE provided this recommendation, and the rationale for this change is that the new approach provides clarity for the decision-making process during a patient contact. Knowing that both the environment and patient’s condition are always evolving it is necessary to re-evaluate often. New content: “If at any point the patient’s condition deteriorates, you must re-evaluate whether rapid transport is necessary. This decision can occur at any point in your assessment or during care for the patient, even before you have completed your primary assessment (though the assessment should still be completed once any necessary interventions are performed).”

Documentation of Findings “Documentation of Findings” has been added as a step. The rationale for adding this content is to ensure that thorough patient information (findings, interventions, care) is documented, which enhances the continuity of care during the transfer-of-care process, improves quality assurance within an organization, and legally protects responders in the event of an incident.

Ongoing Assessment “Ongoing Assessment” has been added to the model. This was a CCFAE recommendation, and provides clarity for the decision making process during a patient contact. Knowing that both the environment and the patient’s condition are always evolving, it is necessary to revaluate often.



Chapter 6: Airway Management and Respiratory Emergencies

New Program Legacy Program Rationale/Change Airway Management and Respiratory Emergencies

Airway and Ventilation Respiratory Emergencies

Two legacy chapters have been combined under the new title “Airway Management and Respiratory Emergencies”. The objective was to reorder content to create a more logical flow (following the “ABC” assessment process) to reflect how responders assess and prioritize patients who may have life-threatening conditions. This chapter now covers the equipment, interventions, and care for airway and respiratory emergencies.

Airway Obstruction Choking was categorized as either mild or severe in the legacy text: These are lay First Aider terms.

An airway obstruction is now referred to as either “partial” or “complete”.

In addition, two categories of airway obstructions have been defined within the new text: anatomical obstructions (such as a blockage formed by the patient’s tongue) and foreign body airway obstructions (FBAOs), which are blockages caused by foreign objects such as food, blood, or small toys. An FBAO may also be referred to as a “mechanical obstruction”.

Unresponsive Patient With Absent Breathing

Added a new algorithm chart for FBAO in an unresponsive adult or child for quick reference. This chart is also located in the chapter summary.

Respiratory Conditions Specific types of breathing

emergencies Changed the heading of this sub-topic and added new content on bronchospasm, which was absent from our legacy text.

Respiratory Pathophysiology

We have introduced a new term in this chapter: dyspnea. When referring to breathing difficulties, this is the proper medical term and is in line with professional responder terminology.

Nebulization Added information regarding risks to the responder and how to reduce them.

Assisted Ventilation Rescue Breathing Responding to requests from our audiences, we have updated terminology throughout Emergency Care to address the difference between basic first aid terms and professional pre-hospital care terms.



New Program Legacy Program Rationale/Change We have replaced “rescue breathing” and “rescue breaths” with “assisted ventilation”. Assisted ventilation is a technique for delivering atmospheric air and/or oxygen into a patient’s lungs when his or her breathing is inadequate. When performing assisted ventilation, you are actively pushing air into the patient’s lungs, not just supplying it for the patient to inhale.

Resuscitation Devices Located in oxygen delivery devices in the legacy text.

Resuscitation masks and bag-valve-masks (BVMs) have been relocated to the new sub-topic “resuscitation devices”.

Using a BVM Added enhanced content on single-responder BVM operation with an emphasis on skill proficiency. The rationale was that a BVM can be operated by a single responder as manpower resources may be limited. However, maintaining the skill is key to a single-responder BVM operation. The preferred method is still two-responder BVM.

Supplemental Oxygen Content added to enhance the section on oxygen cylinder duration calculation. Additional examples have been inserted to support the learner.

Oxygen Delivery Devices Oxygen delivery device content has been moved out of the legacy table and now a description is provided for each device.

Supraglottic Airways Supraglottic airways (SGAs) have become more common in pre-hospital care and therefore professional responders need to have a heightened awareness of these devices. Some jurisdictions may indicate their use by an EMR and therefore the need for this information exists.

Nasopharyngeal Airways Some jurisdictions within Canada are now indicating the use of Nasopharyngeal Airways (NPAs) for First Responders, so NPAs will now be included in First Responder training. FR’s must refer to their applicable legislation and scope of practice for more information. NPAs are also included in the Airway Management (AM) course



Chapter 7: Circulatory Emergencies

New Program Legacy Program Rationale/Change Prevention Content This chapter was heavily-laden with prevention content in the legacy

text. That content has now been relocated out of the text. The rationale for this change again lies with the role of the professional responder: Although the information is good to know, it is not applicable in emergency situations.

BLS CPR HCP CPR Basic Life Support Cardiopulmonary Resuscitation (CPR) skills have replaced the legacy Health Care Provider (HCP) CPR skills and knowledge. This reflects a professional level of resuscitation.

Angina We have now defined stable and unstable angina in this chapter. This distinction enhances the learner’s knowledge on this topic.

Cardiac Arrhythmias and Defibrillation

Disturbances In Heart Rhythm We have renamed this section, added new content on arrhythmias, and emphasized the important role of defibrillation. New graphics for cardiac rhythms have been inserted.

Compression Fraction/Off-Chest Time

We have inserted key information on compression fraction and off-chest time. This content emphasizes the importance of maximizing time spent compressing the chest during CPR. When compressions are interrupted the pressure in the circulatory system begins to drop almost immediately, so minimizing interruptions is crucial

Team Approach This section focuses on the team approach to CPR and the importance of designated roles in a cardiac arrest event. The team approach is both easier and more strongly associated with positive patient outcomes. Cooperation and effective communication between responders are crucial. Using a choreographed team approach to CPR can help ensure that these key components are present.

Compression Depth - Adult Legacy recommendation was to compress “at least 5 cm (2 in.)” on an adult.

The IFRC 2016 International First Aid guidelines recommend compressing the chest of an adult at least 5 cm (2 in) while avoiding a depth of compression greater than 6 cm.



New Program Legacy Program Rationale/Change Compression Rate Legacy compression rate was

“at least 100 per minute” New evidence shows that the optimum rate of chest compressions is 100 to 120 per minute (30 compressions in 15-18 seconds).

CPR Summary (Table) CPR Table Fig: 8-17 Updated content and added a column on Neonate CPR (neonate CPR was not included in the legacy text). Now clear guidelines on this age group are included. Neonate age is defined as 0 to 28 days with 0 being day of birth.

Neonate contraindication for defibrillation –AEDs are not to be used on neonates.

Chest Recoil We have inserted a paragraph on chest recoil to emphasize the importance of allowing the

chest to recoil completely after each compression. Do not rest or lean on the patient’s chest between compressions. When the chest recoils completely it allows the heart to expand and fill with blood, which is then forced into the circulatory system with the next compression.

Defibrillator Care and Maintenance

Added general guidelines on defibrillator care and maintenance. This is an important consideration and also addresses regulatory requirements on content.

Neonatal Resuscitation Added information on neonate resuscitation. There was no information on neonatal resuscitation in the legacy program. Resuscitation methods must be adjusted when the patient is a neonate. Because the cause of cardiac arrest in neonates is almost always respiratory in origin (not cardiac), there is more of a focus on ventilations: The ratio of compressions to ventilations is 3:1. Defibrillation is not indicated for neonatal patients.



New Program Legacy Program Rationale/Change Cerebrovascular Accident (Stroke)

Stroke Updated information on CVAs and TIAs to provide clarity on providing care to a patient.

A patient experiencing a CVA or TIA may have difficulty managing his or her airway. Do not give a patient with a suspected CVA or TIA anything to eat or drink (NPO, or no products orally). Position the patient so that you can either manually clear the airway (recovery position) or easily provide suction. If a patient must be rolled into the recovery position and is experiencing weakness or paralysis on one side, position the patient with the affected side of the body downwards.

Chapter 8: Shock New Program Legacy Program Rationale/Change

Relocated Chapter This chapter was moved to before “Hemorrhage and Soft Tissue Trauma”.

Types of Shock Found in Table 10-1 in legacy text

Information on the types of shock have been broken out into paragraphs with enhanced content. This clarifies the differences between the types of shock.

Stages of Shock This sub-topic was broken out and the content clearly defined. A chart showing the progression of (hypovolemic) shock was inserted.

The three stages of shock are compensated, decompensated, and irreversible.

Care for Shock Added content on controlling environmental factors in accordance with the CCFAE recommendation.



Chapter 9: Hemorrhage and Soft Tissue Trauma

New Program Legacy Program Rationale/Change Hemorrhage and Soft Tissue trauma

“Bleeding” and “Soft Tissue Injuries”

Two legacy chapters (“Bleeding” and “Soft Tissue Injuries”) have been combined into one chapter in the new program called “Hemorrhage and Soft Tissue Trauma”.

Revised Chapter Organization

The chapter has been organized to proceed from minor to major injuries.

Stages of Wound Healing New content has been added to meet NOCP and CSA standards, as this topic was absent from our legacy Emergency Care text. Healing is the general term used to describe the body’s process of repairing damaged tissues.

Infection Previously located in the Preventing Disease Transmission chapter.

Added more content on infection and the signs of infection and relocated it to this chapter.

Information on infection is more applicable to content in this chapter. Dressings and Bandages Legacy text did not break down

various types of dressings and bandages.

Inserted table of common types of dressings and bandages (9-1). This table is a quick reference for the reader and provides a description and example of use for each item.

Tourniquets Legacy Text:

“Document the time the tourniquet was applied and tightened as well as any release times. Reassess the patient’s distal circulation. After 10 minutes, you may slowly remove the tourniquet. Check that the previously applied pressure bandage is secure and controlling the bleeding. If the bleeding reoccurs, reapply the tourniquet.”

We no longer recommend removing a tourniquet once it is applied. There is no evidence to support the belief that removing a tourniquet in the field will positively change the outcome (in an urban setting), and this change in protocol also increases ease of training and participant confidence.



New Program Legacy Program Rationale/Change Tourniquets Assess the patient’s distal

circulation and neurovascular status before and after application.

We removed the instructions to perform a distal circulation and neurovascular check before and after application of a tourniquet

Ballistic Injuries We recognized that a gap within our program content existed and have added content on ballistic injuries.

If you encounter a patient who has been injured by a firearm, look for both an entry and an exit point for the bullet. If no exit point is found the bullet may still be inside the patient’s body.

Open Wounds Open Wounds: Abrasions, lacerations, avulsions, and punctures were all included within one sub-topic.

Abrasions, lacerations, avulsions, and punctures now form separate sub-topics with the “Open Wounds” topic. This allows the learner to easily reference the specific information required.

Burns We have clarified that the indicated care is to apply dry, non-stick, sterile dressings and loosely bandage them in place.

Major Soft Tissue Trauma New content was added on high pressure injection (HPI) injuries. This content was a requirement for the workplace and was missing from our legacy text.



Lesson 10: Musculoskeletal Injuries

New Program Legacy Program Rationale/Change Upper Extremity Injuries Content on peripheral pulse

assessments was not clear. Capillary refill

Added emphasis on peripheral pulse assessment.

Injuries to the upper extremities may also damage blood vessels, nerves, and soft tissues. It is important to ensure that blood flow and nerve function have not been impaired. Always check the peripheral pulse and ensure that sensation below the injury site is normal both before and after splinting. Capillary refill was relocated to the assessment chapter.

Lesson 11: Chest, Abdominal, and Pelvic Injuries

New Program Legacy Program Rationale/Change Relocated Chapter This chapter was moved to before “Head and Spinal Injuries”.

Types of Chest injuries Specific Types of Chest Injuries

Hemothorax and pneumothorax content has been broken out in more detail, and now includes both spontaneous and tension pneumothorax. Subcutaneous emphysema was also added to this section to meet NOCP and CSA guidelines.

Care for Penetrating Chest Injuries

Care for Puncture Injuries

Legacy text recommended applying an occlusive dressing to the sucking chest wound, taping the dressing in place on three sides (excluding the side closest to the ground).

The current recommendation is to use a non-occlusive dressing. The concern with a penetrating chest wound is that the wound will become occluded, meaning that the wound would no longer allow air to enter or exit. Occlusion significantly increases the risk of a tension pneumothorax. If the dressing becomes saturated with blood, it will become occluded: Monitor the dressing closely and replace saturated dressings immediately.



New Program Legacy Program Rationale/Change Care for Chest Injuries Added content to the care for chest injuries:

“Place the patient in a position of comfort that allows for ease of breathing. If you roll the patient into the recovery position, make sure the injured side is towards the ground.”

Care for Pelvic Injuries Pelvic binding content has been added:

Pelvic fractures typically result from mechanisms that are of a high-velocity nature. The fracture(s) cause significant internal injuries and blood loss which is life-threatening. Pelvic binding is a technique that creates even pressure on a fractured pelvis from all sides, supporting the bones and reducing the risk of additional damage to internal structures. Professional responders are required to stabilize a patient using pelvic binding and place the patient in the rapid transport category.

Three-Plane Assessment of the Pelvis

Added info on three-plane assessment of the pelvis. If you suspect a fracture of one of the pelvic bones, perform a three-plane assessment to assess its stability. Apply gentle pressure to the pelvis, first inwards, then upwards, and finally downwards. This allows you to assess the pelvic girdle as a whole, followed by the pubis, and finally the sacral coccygeal spine. If the pressure causes the patient any pain, stop the assessment and initiate pelvic binding.



Chapter 12: Head and Spinal Injuries

New Program Legacy Program Rationale/Change Injuries to the Brain Added information on Cushing’s reflex. Cushing’s reflex (or Cushing’s

response) is the body’s natural response to an increase in intracranial pressure (for example, as a result of cerebral hematoma) and often indicates a serious head injury.

Concussion Minimal information on this sub-topic in the legacy text.

Significantly more content on concussions has been added following a strong recommendation from CCFAE.

Due to the complexity of symptoms and signs, providers can find it difficult to identify a concussion. This can lead to a delay in the patient receiving proper concussion management and post-concussion advice and treatment.

Evidence stresses that providers must recognize that no two concussions are identical in either their cause or presentation. The degree of the signs and symptoms resulting from the physical trauma can be very different.

Subarachnoid Hematoma No information on subarachnoid hematoma in legacy text.

Added information on subarachnoid hematomas.

A subarachnoid hematoma is arterial bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. The subarachnoid space is the path through which the cerebrospinal fluid circulates, and which is responsible for protecting the brain from serious injuries.

Spinal Motion Restriction (SMR)

Multiple options for spinal motion restriction are now presented in addition to full immobilization.



New Program Legacy Program Rationale/Change In the EMS community there has been recent evidence of harm from the unnecessary application of a long backboard.

Since incorrect application of a cervical collar could result in further injury, and since evidence is available of adverse events (e.g. increased intracranial pressure) when applying such collar, correct application would require training and regular practice.

Many jurisdictions have local protocols around the topic of spinal motion restriction. In some regions, spinal motion restriction may include the application of a cervical collar and placing the patient on a soft mattress rather than full spinal immobilization.

Canadian C-Spine Rule The Canadian C-Spine Rule has been added to the SMR section in the new text. The Canadian C-Spine Rule is a process that was developed to simplify and standardize the assessment of patients with suspected spinal injuries. It is used by both pre- and in-hospital providers of emergency care. There is a new quick-reference chart to support the learner. This chart is also located in the chapter summary.

Standing Take-Down The standing take-down has been removed from the program. With changes to spinal management and the implementation of SMR, along with the risk of injury to responders, it was deemed safest and most in line with best practices to remove this procedure.



Lesson 13: Acute and Chronic Illnesses

New Program Legacy Program Rationale/Change Acute and Chronic Illnesses

Sudden Illnesses The chapter title has been changed to better reflect the content.

Diabetic Emergencies Clarified the definition of Type 2 Diabetes: Type 2 diabetes can be insulin-dependent or non-insulin-dependent. It occurs when the body does not produce enough insulin for its needs, or when the body does not properly use the insulin it produces

Glucagon Added new content on glucagon to meet industry and CCFAE recommendation. If glucagon is within your scope of practice or regulatory jurisdiction there is now information in the text to support you.

Glucagon is a substance that can be injected (intramuscularly or subcutaneously) into a hypoglycemic patient to increase his or her blood glucose level (BGL) by accelerating the breakdown of glycogen into glucose.

Glucose Tablets Added information on glucose tablets.

Glucose tablets should be used for treating symptomatic hypoglycemia in responsive individuals (able to follow directions and swallow safely).

Administration of glucose may be repeated if symptoms persist after 10 minutes.

Glucose tablets are the preferred treatment for hypoglycemia when the patient is awake, able to respond and swallow. Less effective but acceptable forms of sugars can also be used in the absence of glucose tablets.



New Program Legacy Program Rationale/Change Status Epilepticus New content has been added on status epilepticus seizures to support

the learner.

Status epilepticus is a seizure that lasts longer than 5 minutes or a series of repeated seizures lasting longer than 5 minutes without a return to normal responsiveness between them.

Migraines New content has been added on migraines. This is a CCFAE recommendation and is required for Marine and workplace competencies.



Chapter 14: Poisoning

New Program Legacy Program Rationale/Change Commonly Misused and Abused Substances

New content has been added on opioid overdoses and naloxone.

There is an increased incidence of opioid-related deaths, and overdose education and naloxone distribution programs are becoming more common.

Basic life support should not be delayed to administer naloxone.

The availability of naloxone and naloxone training vary by region and jurisdiction.

Bedbugs Content on bedbugs has been added. Their bites can cause skin irritation that can be intensely uncomfortable and creates the risk of infection. Professional responders are coming into contact with bedbugs during their incidents and this information supports the learner.

Crowd Management Agents

Added content on crowd management agents. Also referred to as riot control agents, these are a group of substances used by law enforcement personnel to temporarily incapacitate groups of people. The content that has been inserted in this chapter is a CCFAE recommendation and NOCP requirement.



Chapter 15: Environmental Illnesses

New Program Legacy Program Rationale/Change Environmental Illnesses Heat- and Cold-Related

Emergencies New chapter title: This change was made to broaden the scope for the chapter’s content.

Temperature Homeostasis How Body Temperature Is Controlled

Added substantially more content on the mechanisms (both internal and external) that affect body temperature.

New tables and infographics have been added to illustrate concepts such as human thermoregulation responses, mechanisms of heat loss, and the impact of wind chill and humidity on the effects of temperature on the body.

High-Altitude Illness New content has been added on high-altitude illness, and this topic has been moved out of the Sudden Illnesses chapter.

SCUBA-Related Illness New content on SCUBA-related illnesses has been added. New sub-topics include: • The Divers Alert Network (DAN) • Barotrauma of descent • Barotrauma of ascent • Arterial gas embolism • Decompression sickness • Nitrogen narcosis



Chapter 16: Pregnancy, Labour, and Delivery

New Program Legacy Program Rationale/Change Pregnancy, Labour, and Delivery

Childbirth New chapter title: This change was made to broaden the scope for the chapter’s content.

This chapter has also been moved ahead of “Special Populations”.

Care and Assessment for the Neonate

New content on assessment and care of the neonate has been added. There is also a new flow chart which guides the learner through the neonatal resuscitation process.

Topics with new or expanded content include: • Assessing a neonate • Using a bulb syringe • Ventilating and resuscitating a neonate • Transporting a neonate

Midwives and Home Births Added content on midwives and home births. Specified that most home births occur safely, but that when responders are called there has likely been an unexpected complication that creates a medical emergency.

Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, labour, birth, and the postpartum period.

Complications During Pregnancy

Updated and expanded content in this section.



Chapter 17: Special Considerations

New Program Legacy Program Rationale/Change Special Populations Special Populations and Crisis

Intervention Crisis intervention content has been moved into its own chapter (“Crisis Intervention”).

Pediatric Patients Added content on the stages of development to clarify the characteristics of various age groups. This was not clearly defined in the legacy text.

Measles/Mumps Added new content on measles and mumps:

Measles is a highly contagious viral infection that is transmitted both through direct contact and airborne transmission.

Mumps is a contagious disease caused by a viral infection.

Sudden Infant Death Syndrome (SIDS)

Added content emphasizing the importance of psychological support for both responders and caregivers, regardless of the outcome.

Geriatric Patients Older Adults Changed the subject heading to bring it into line with medical and pre-hospital care terminology (from “older adults” to “geriatric patients”).

Added content on dementia and Alzheimer’s disease, including background pathophysiology and information on assessment and care for patients with these conditions.

Bariatric Patients Added a new section on bariatric patients. Bariatrics is the science of providing healthcare for those who have obesity

Patients with Disabilities Added a new sub-topic on service animals, including background information and tips for providing care to a patient who has a service animal.



Palliative Patients The Terminally Ill Patient Added new content and language around this topic. Palliative patients are those with terminal illnesses: Treatment consists of improving quality of life and making patients as comfortable as possible.

Chapter 18: Crisis Intervention

New Program Legacy Program Rationale/Change Crisis Intervention Special Populations and Crisis

Intervention Crisis intervention content has been moved into its own chapter.

Psychological Crisis Behavioural or Psychiatric Disorders

Updated wording within this section.

Psychosis Included an example of chronic psychosis. Excerpt: “One example of chronic psychosis is schizophrenia, which is a group of mental disorders that may present with distortions in language and thought. A patient with schizophrenia may also experience delusions, hallucinations, and social withdrawal.”



Chapter 19: Reaching, Lifting, and Extricating Patients

New Program Legacy Program Rationale/Change Reaching, Lifting, and Extricating Patients

Reaching and Moving Patients New chapter title: This change was made to broaden the scope for the chapter’s content and to incorporate appropriate pre-hospital terminology.

Gaining Entry to Buildings New information has been added on gaining entry to buildings, including content on buildings with multiple stages of entry.

Motor Vehicles Added content on special considerations for extricating patients from vehicles, including content on:

• Hybrid and electric vehicles • How and when to enter a vehicle • Stabilizing vehicles • Vehicle proximity keys • Risks posed by airbags and other supplemental restraint

systems (SRS) There is also increased emphasis on the importance of being properly trained for the type of extrication being performed.

Bariatric Patients Added a section on moving, lifting, and transporting bariatric patients (including guidelines on preventing injury and content on bariatric stretchers).



Chapter 20: Transportation

New Program Legacy Program Rationale/Change Emergency Vehicle Maintenance and Safety Check

Updated the content on when and how to remove a vehicle from service.

Beginning and Ending a Shift

Added content outlining the basic steps to perform at the beginning and end of a shift of work.

Topics to cover during a shit change include transferring information between responders, equipment used and replaced, and any issues with the vehicle

Safe Vehicle Operation Updated content on parking, reversing, and positioning a vehicle at an emergency scene.

Clarified that another responder should always act as a spotter, especially when you are reversing.

This change was brought about by safety and best practices showing a gap previous in our program.

Air Medical Transportation Added content on patient considerations for air medical transportation.

An excerpt: “When preparing a patient for air medical transport, consider the requirements of the aircraft. While most modern aircraft used for medical evacuation allow full monitoring of patients during flight, some may offer fewer options, so the patient should be positioned in the safest manner for his or her condition.”



Chapter 21: Multiple-Casualty Incidents

New Program Legacy Program Rationale/Change Incident Command System (ICS)

Content in this section has been updated, and a new infographic has been added with updated terminology.

CBRNE Emergencies A new section has been added with content on CBRNE incidents, as required by the NOCP competencies. CBRNE stands for “Chemical, Biological, Radiological, Nuclear, Explosive”. It is the general term used in Canada to refer to weapons of mass destruction (WMDs) and refers to the intentional use of these materials to cause harm.

Topics include types of chemical and biological agents, methods of dissemination, CBRNE-specific PPE, establishing perimeters, control of contaminated casualties, decontamination procedures, and the psychological impact of CBRNE events.

Chapter 22: Pharmacology New Program Legacy Program Rationale/Change

Pharmacology This chapter has been moved to a new location in the text.

Specific drug Profiles The specific drug profiles (e.g., Entonox, Atrovent, Epinephrine, Nitroglycerin, ASA, Oral Glucose, Oxygen, and Ventolin) have been removed from the text. These are now available on Boulevard. This move allows more flexibility in profile changes (additions or deletions) should the need arise



Assisting with Medication vs. Administering Medication

General Guidelines for Assisting With Medications

The heading and content have been updated. Clarified the distinction between “assisting with medication” and “administering medication”:

Administering medication means making the decision to give a medication to a patient and then actually introducing the drug into the patient’s body.

Assisting with medication means following a patient’s specific direction to help with medication.

How to Administer Medication Intranasally

Content on intranasal administration of medication has been added.

Chapter 23: Marine Environment New Program Legacy Program Rationale/Change

Maritime Occupational Health and Safety Regulations (MOHS)

New content has been added on the Maritime Occupational Health and Safety Regulations (MOHS), including contextual information about the MOHS document as well as specific content on topics such as the Medical Guide and how to complete a first aid record.

Toxicological Hazards on Board a Ship

Information on the Global Harmonized System (GHS) has been added.

Psychological Well-Being of Seafarers

A new section has been added to discuss the psychological impact of marine environments on seafarers and offer strategies for self-care.

Marine Pharmacology This section has been updated and several pages of the drug profiles have been removed. This content is now available on Boulevard.

More information about the requirements for medication on ships has been added.



Chapter 24: Workplace

New Program Legacy Program Rationale/Change Workplace First Aid Equipment

Information about the CSA standards for first aid kits has been added, along with additional information about AEDs in the workplace.

Power Take-Off (PTO) Information on Power Take-Offs (PTOs) has been added.

A PTO is a device used to transfer power from an engine (e.g., in a tractor) to another piece of equipment (e.g., a brush mower being towed by the tractor). When the engine is running, the PTO shaft rotates at engine speed, transferring energy from the engine to the attachment. PTOs cause many injuries on the farm. Injuries can occur when clothing becomes snagged or tangled in the rotating shaft. Amputations often occur in this situation, and these injuries are often fatal.



Appendix & Glossary

Organizational Changes:

• The appendices have been revised: o Appendix A - Abbreviations for Documentation o Appendix B - Sample Ambulance Equipment List o Appendix C - Phonetic Alphabet o Appendix D - Medical Terminology

• Glossary has been updated with new terminology. • Index has been significantly updated.

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