Applying a Form of Energy
Applying a Form of Energy
The “application of a form of energy”, which is listed as a controlled act in the RHPA, is not authorized to Respiratory Therapists under the Respiratory Therapy Act, 1991. One of these procedures outlined under this controlled act, can apply to the practice of Respiratory Therapy, and may be performed under specific circumstances, with the requisite knowledge, skill and competency. This includes:
use of an Automatic External Defibrillator (AED)
The use of an AED can only be performed if authorized by:
An order and delegation, or;
Exercise of the emergency exception in the RHPA.
The Ontario Ministry of Health has now amended the Controlled Acts Regulation (s. 7.1 (1) – O. Reg. 107/96 ) to enable Respiratory Therapists to utilize diagnostic ultrasound in their practice under the order of a physician or nurse practitioner. Delegation is no longer required. RTs who wish to use diagnostic ultrasound in their practice (e.g., radial arterial line catheterization, lung ultrasound) no longer require delegation only a valid order (direct order or medical directive). Information regarding the delegation process can be found in the CRTO’s Delegation of Controlled Acts PPG. Information regarding orders can be found in the CRTO’s Orders for Medical Care PPG.
How to Authorize the Use of an AED
Order and Delegation
The preferred authorization mechanism is the combination of an order and delegation. Under this approach, the order serves to authorize the use of the AED (the application of energy) and the delegation transfers that authority to the RT. Ideally, this is done “in the moment” on a case-by-case basis, although this may not be practical in the urgency associated with the management of a cardiac arrest. As such, it is permissible to use a standing medical directive and delegation that would apply in these scenarios (i.e., an organization-wide medical directive and delegation that allows any RT who has been trained in the use of AEDs to apply them in specified situations, such as a cardiac arrest).
There is an emergency provision in the RHPA that allows for an exception to the restriction on controlled acts. This exception assumes that performance of the controlled act in question is not carried out frequently and that it is truly an emergency. Further, it is important to distinguish between an unforeseen emergency and a “regular” emergency. This distinction is recognized in the Good Samaritan Act, 2001, which provides immunity from negligence lawsuits for health professionals who provide “emergency health care services or first aid assistance” at a place other than a hospital or health care facility, thereby implying that those are unforeseen emergencies, whereas the work they do IN hospital and health care facilities are “regular” emergencies. The combination of an order and delegation would be the most appropriate approach for managing “regular” emergencies, although clearly not all cardiac arrests are foreseeable. Therefore, it is acceptable for an RT to apply an AED under the emergency exception, yet only in circumstances where an order and delegation are not available.