As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPs?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address enhanced parameters for specific restricted activities.
4.1.4.1 Fractures
to set or reset a fracture of a bone for the purpose of alignment and
immobilization to set or reset a fracture of a bone.
All regulated members are authorized to set or reset fractures of the bone for the purposes of alignment and immobilization (splinting for extrication and transportation).
Despite being enabled by the regulation, no regulated member is currently authorized to perform the restricted activity of setting or resetting a fracture of a bone for the purposes of long-term immobilization (casting).
Scenario:
Saru, an Advanced Care Paramedic, is working in a rural ground ambulance setting when she and her partner Gene are dispatched to a construction site for a worker who has fallen from a height. Upon arrival, Saru and Gene assess a 38-year-old male patient who is alert but in significant pain.
During the assessment, Saru identifies an obvious deformity to the patient’s left lower leg consistent with a fracture. The limb is angulated, and the patient reports severe pain with movement. A distal pulse is not present and capillary refill is delayed.
Saru recognizes that addressing this injury may involve performing a restricted activity under the Health Professions Restricted Activity Regulation (HPRAR). Specifically, Saru considers the Standard of Practice 4.1.4.1 Fractures, which permits regulated members to set or reset a fracture of a bone for the purposes of alignment and immobilization (splinting for extrication and transportation).
Before proceeding, Saru and Gene ensure they are practicing in accordance with the Standards of Practice. Saru confirms with Gene that they are educated, trained and competent in fracture management, and that this intervention aligns with their clinical practice setting and employer policies.
She then assesses the risks and benefits associated with performing a gentle realignment of the limb. The potential benefit includes improved circulation and reduced risk of further tissue damage, while risks include increased pain or potential worsening of the injury if performed incorrectly. Saru then communicates these risks and benefits to the patient and obtains informed consent to proceed.
Prior to any manipulation, Saru conducts and documents a thorough neurovascular assessment, including distal pulse, motor function and sensation. She then administers appropriate analgesia in accordance with her clinical protocols.
Once adequate pain management is achieved, she applies gentle, in-line traction to the affected limb to improve alignment. The goal of this intervention is not to achieve perfect anatomical positioning, but rather to restore adequate circulation and allow for effective splinting by Gene.
Following the realignment, Saru reassesses and documents the patient’s neurovascular status to ensure there has been no deterioration and a pulse has been restored. Gene then applies an appropriate splint to immobilize the fracture for transport, ensuring the joints above and below the injury are secured. Saru continues to monitor the patient throughout transport, reassessing circulation, sensation and movement so she can adjust care as necessary.
Saru is aware that while they are authorized to perform fracture alignment for short-term immobilization, they are not authorized to perform long-term immobilization, such as casting. This level of care will be provided in a hospital setting once they arrive.
This scenario demonstrates a regulated member’s responsibilities under Standard 4.1.4 Enhanced Parameters for Specific Restricted Activities while also referencing the sub-Standard 4.1.4.1, Fractures, in which all regulated members are authorized to set or reset fractures of the bone for the purposes of alignment and immobilization (splinting for extrication and transportation). It is important to remember that despite being enabled by the regulation, no regulated member is currently authorized to perform the restricted activity of setting or resetting a fracture of a bone for the purposes of long-term immobilization (casting).
This scenario demonstrates a regulated member’s responsibilities under Standard 4.1.4 Enhanced Parameters for Specific Restricted Activities while also referencing the sub-Standard 4.1.4.1, Fractures, in which all regulated members are authorized to set or reset fractures of the bone for the purposes of alignment and immobilization (splinting for extrication and transportation). It is important to remember that despite being enabled by the regulation, no regulated member is currently authorized to perform the restricted activity of setting or resetting a fracture of a bone for the purposes of long-term immobilization (casting).