HomeMy WebLinkAboutFIR 03-22Report to Council
Report Number: FIR 03-22
Date: July 11, 2022
From: Steve Boyd
Fire Chief
Subject: Agreement to Provide Medical Oversight Services
-Lakeridge Health Central East Prehospital Care Program (CEPCP)
-File: A-1440-001-22
Recommendation:
1.That Report FIR 03-22 of the Fire Chief, regarding the Agreement to provide
Medical Oversight Services between Pickering Fire Services and Lakeridge Health, be
received;
2.That the Mayor and City Clerk be authorized to execute the Agreement with Lakeridge
Health Central East Prehospital Care Program (CEPCP) to provide Medical Oversight
and training to the Pickering Fire Department, set out in Attachment 1 to this report,
subject to minor revisions as may be required by the Director, Community Services and
the Director, Corporate Services & City Solicitor; and
3.That appropriate City of Pickering officials be authorized to take the necessary actions to
implement the recommendations in this Report.
Executive Summary: The purpose of Report FIR 03-22 is to seek Council’s approval to
extend the Agreement, set out in Attachment 1, between the City of Pickering and Lakeridge
Health Central East Prehospital Care Program to provide Medical Oversight and Training to the
Pickering Fire Department.
This is a three year extension of an existing program between both parties that provides the
required training and certification to Fire Services staff responding to a range of medical calls.
Financial Implications: As approved in the 2022 Current Budget, under Emergency
Medical Training (501110), the total annual cost for the three year agreement is estimated to
be $42,500.00 per year.
Discussion: Pickering Fire Service staff respond to a range of medical calls, including but
not limited to, cardiac arrest, VSA (vital signs absent), uncontrolled bleeding, unconscious
individuals, motor vehicle accidents, and other medical emergencies as required.
Through these responses, Fire Services staff utilize the skills they have acquired through EMR
Direct Delivery Program training in first aid, CPR, AED (automatic external defibrillator) use,
and symptom relief (epi-pen and Naloxone) administration.
FIR 03-22 July 11, 2022
Subject: Agreement to Provide Medical Oversight Services Page 2
Fire Services staff are required to recertify in these areas on an annual basis, and must be
signed off under the medical oversight of the Physician heading the Lakeridge Health Central
East Prehospital Care Program.
Lakeridge Health CEPCP base hospital services currently provides this training and oversight
to all Pickering Fire Services staff on an annual basis, and also provide training to all new
recruit hires with Fire Services.
This agreement provides a three year extension to the program currently in place.
Attachment:
1. Agreement to Provide Medical Oversight Services January 1, 2022 to December 31, 2024
Prepared/Endorsed By:
Original Signed By:
Steve Boyd
Fire Chief
SB:jm
Recommended for the consideration
of Pickering City Council
Original Signed By:
Marisa Carpino, M.A.
Chief Administrative Officer
Agreement to Provide Medical Oversight Services
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Agreement to Provide
Medical Oversight
Services
Between
Pickering Fire and Emergency Services
and
Lakeridge Health
January 1 st 2022 to December 31 st 2024
Attachment #1 to Report FIR 03-22
Agreement to Provide Medical Oversight Services
CEPCP and Pickering Fire and Emergency Services Page 2 of 27
Contents
1. RECITALS ............................................................................................................................................. 3
2. DEFINITIONS........................................................................................................................................ 3
3. INTERPRETATION ............................................................................................................................... 6
4. AGREEMENT........................................................................................................................................ 7
5. MEDICAL EDUCATION ........................................................................................................................ 8
6. MEDICAL ADVICE RELATING TO PATIENT CARE ........................................................................... 8
7. TRAINING ............................................................................................................................................. 9
8. AUTHORIZATION AND RE-AUTHORIZATION ................................................................................... 9
9. QUALITY ASSURANCE ..................................................................................................................... 10
10. INFORMATION SHARING .............................................................................................................. 10
11. SUPPLIES AND EQUIPMENT ........................................................................................................ 11
12. RESEARCH .................................................................................................................................... 11
13. INSURANCE AND INDEMNIFICATION ......................................................................................... 12
14. TERM AND TERMINATION ............................................................................................................ 14
15. GENERAL PROVISIONS ................................................................................................................ 14
SCHEDULE A - Designated Representatives............................................................................................. 20
SCHEDULE B – Training Programs ........................................................................................................... 21
SCHEDULE C – Standard First Aid ............................................................................................................ 23
SCHEDULE D – Fees & Payment for Services .......................................................................................... 25
SCHEDULE E – Quality Assurance ............................................................................................................ 26
SCHEDULE F – Controlled Acts and Advanced Medical Procedures ........................................................ 27
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AGREEMENT
BETWEEN:
Pickering Fire and Emergency Services
– and –
Lakeridge Health (“LH”)
1. RECITALS
WHEREAS Pickering Fire and Emergency Services provides patient care when called to provide
assistance to the residents of the City of Pickering;
AND WHEREAS Pickering Fire and Emergency Services and the Central East Prehospital Care
Program (“CEPCP”) located at LH wish to enter into an agreement for the provision of Medical
Oversight subject to and in accordance with the terms and conditions set out below.
NOW THEREFORE in consideration of the respective covenants and agreements contained in this
AGREEMENT and for other good and valuable consideration, the receipt and sufficiency of which the
parties acknowledge, Pickering Fire and Emergency Services and LH hereby agree as follows:
2. DEFINITIONS
In this AGREEMENT, in addition to the terms defined above, the following terms shall, unless the context
otherwise requires, have the respective meanings set out below:
a. “AED” means Automated External Defibrillation.
b. “AGREEMENT” means this agreement as the same may be amended or restated from time to
time and includes all schedules and all uses of the words “hereto”, “herein”, “hereof”, ‘hereby” and
“hereunder” and similar expressions refer to this AGREEMENT and not to any particular section
or portion of it.
c. “Applicable Law” at any time and in respect of any Person, property, transaction or event,
means all laws including statutes, regulations, treaties, judgments and decrees then applicable to
that Person, property, transaction or event and, whether or not having the force of law, all
applicable official directives, rules, consents, approvals, authorizations, guidelines, bullet ins,
orders and policies of any Governmental Authority then having or purporting to have authority
over that Person, property, transaction or event.
d. “Approved” means something that has been reviewed and/or sanctioned by LH.
e. “Business Day” means any day other than a Saturday, Sunday or any statutory or civic holiday
observed by one or both Parties.
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f. “Call Report” means a record of patient care in paper or electronic form.
g. “Case Review” means the routine review of call reports submitted by Pickering Fire and
Emergency Services and performed by LH.
h. “CEPCP Standards” means the standards of CEPCP related to the provision of Medical
Oversight and prehospital emergency care developed by the Medical Advisory Board of the
CEPCP and based on best practices and evidenced based medicine.
i. “CME” means continuing medical education that is provided to the individual firefighter.
j. “Controlled Act” has the meaning ascribed to it in the Regulated Health Professions Act, 1991,
(Ontario), S.O. 1991, c.18.
k. “CPSO” means the College of Physicians and Surgeons of Ontario.
l. “CPR” means a potentially lifesaving procedure, that combines chest compressions and
ventilations to partially restore oxygenated blood flow to the essential organs.
m. “CPSO Policy” means the CPSO policy for the Delegation of Controlled Acts and Guidelines for
teaching Controlled Acts under Section 28 of the Regulated Health Professions Act, 1991 and
under the Medicine Act, 1991, S.O. 1991, c. 30.
n. “Data” has the meaning ascribed to it in Section 9 herein.
o. “Designated Representative” is the designated representative of a Party as set out in
SCHEDULE A .
p. “Direct delivery” is when the training program provided is delivered by staff of the CEPCP.
q. “EFR” Emergency First Responder is a program that authorizes a firefighter in CPR and the
Controlled Acts and Advanced Medical Procedures (SCHEDULE E ) following an initial
authorization course (duration of up to 24 hours depending on individuals skill level) and
maintains their authorization through approximately 8 hours of CME delivered annually.
r. “EMR” Emergency Medical Responder is a program that authorizes a firefighter in CPR and the
Controlled Acts and Advanced Medical Procedures (SCHEDULE E ) following an initial
authorization course (duration up to 120 hours) and maintains their authorization through
approximately 16 hours of CME delivered annually.
s. “Firefighter” is a person currently employed by Pickering Fire and Emergency Services, and has
the meaning ascribed to it under the Fire Protection and Prevention Act, 1997, S.O. 1997, c. 4.
t. “Governmental Authority” means any domestic or foreign government including any federal,
provincial, state, territorial or municipal government and any domestic or foreign government
agency, board, commission, tribunal or other authority exercising executive, legislative, judicial,
regulatory or administrative function of, or pertaining to, government.
u. “Host Hospital” means Lakeridge Health (LH).
v. “Including” means “including without limitation” and shall not be construed to limit any general
statement which it follows to the specific or similar or matters immediately following it.
w. “Instructor” is a person trained and approved by CEPCP to deliver training.
x. “Investigation” means the process of review arising from a concern regarding patient care
provided by Pickering Fire and Emergency Services.
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y. “Medical Advisory Board” means the Physicians that comprise the Medical Advisory Board of
the CEPCP that provides medical oversight.
z. “Medical Oversight” has the meaning described in section 4.2.
aa. “Medical Director” means a physician appointed to the Medical Advisory Board of the CEPCP.
bb. “Medical Education” has the meaning described in section 5.
cc. “Order” means a direction from a CEPCP Medical Advisory Board physician with legislative
ordering authority that permits performance of a procedure by another.
dd. “Paramedic” has the meaning ascribed to it under the Ambulance Act, R.S.O. 1990, c. A.19 and
any regulations thereunder;
ee. “Parties” means Pickering Fire and Emergency Services and LH; and “Party” means either one
of them.
ff. “Patient” is any person who has suffered a medical or traumatic emergency and receives medical
attention, care, or treatment by Pickering Fire and Emergency Services.
gg. “Person” shall be broadly interpreted and includes an individual, body corporate, partnership,
joint venture, trust, association, unincorporated organization, the Crown, any Governmental
Authority or any other entity recognized by law.
hh. “Personal Health Information” has the meaning ascribed to it in the Personal Health Information
Protection Act, 2004,(Ontario), S.O. 2004, c.3, Sch. A.
ii. “PHIPA” means the Personal Health Information Protection Act, 2004, (Ontario), S.O. 2004, c.3
Sch. A.
jj. “Purposes” has the meaning ascribed to it in Section 9.1.
kk. “Self delivered” is when the training program provided is delivered by CEPCP trained and
approved staff of the service named in this contract.
ll. “Standard First Aid” (SFA) means a standardized program created by CEPCP and approved by
the Worker’s Safety Insurance Board (WSIB) designed to provide immediate assistance to a person
suffering illness or injury.
mm. “Standards” means all industry accepted standards of practice relating to the provision of
Medical Oversight and prehospital emergency care in the Province of Ontario.
nn. “Term” has the meaning ascribed to it in Section 14.
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3. INTERPRETATION
3.1. Statutes
Unless specified otherwise, reference in this AGREEMENT to a statute refers to that statute as
such statute may be amended from time to time, or to any restated or successor legislation of
comparable effect, and refers to any regulations then in force and effect thereunder.
3.2. Headings
The division of this AGREEMENT into articles, sections and schedules and the insertion of
headings are for convenience of reference only and shall not affect the construction or
interpretation of this AGREEMENT. The article, section and schedule headings in this
AGREEMENT are not intended to be full or precise descriptions of the text to which they refer
and are not to be considered part of this AGREEMENT. Reference to an Article, Section or
Schedule refers to the applicable article, section or schedule of this AGREEMENT.
3.3. Number and Gender
In this AGREEMENT, words in the singular include the plural and vice-versa and words in one
gender include all genders.
3.4. Entire Agreement
This AGREEMENT constitutes the entire agreement between the Parties pertaining to the subject
matter hereof and supersedes all prior agreements, negotiations, discussions and
understandings, written or oral, express or implied, between the Parties related thereto. There
are no representations, warranties, conditions, other agreements or acknowledgements, whether
direct or collateral, express or implied, that form part of or affect this AGREEMENT, or which
induced any Party to enter into this AGREEMENT or on which reliance is placed by any Party,
except as specifically set forth in this AGREEMENT.
3.5. Amendment
This AGREEMENT may be amended, modified or supplemented only by a written agreement
signed by each Party.
3.6. Waiver of Right
Any waiver of, or consent to depart from, the requirements of any provision of this AGREEMENT
shall be effective only if it is in writing and signed by the Party giving it, and only in the specific
instance and for the specific purpose for which it has been given. No failure on the part of any
Party to exercise, and no delay in exercising, any right under this AGREEMENT shall operate as
a waiver of such right. No single or partial exercise of any such right shall preclude any other or
further exercise of such right or the exercise of any other right.
3.7. Governing Law
This AGREEMENT shall be governed by, and interpreted and enforced in accordance with, the
laws in force in the Province of Ontario (excluding any rule or principle of the conflict of laws
which might refer such interpretation to the laws of another jurisdiction). Each Party irrevocably
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submits to the non-exclusive jurisdiction of the courts of Ontario with respect to any matter arising
hereunder or related hereto.
3.8. Performance on Holidays
If any action is required to be taken pursuant to this AGREEMENT on or by a specified date that
is not a Business Day, then such action shall be valid if taken on or by the next succeeding
Business Day.
3.9. Schedules
The Schedules to this AGREEMENT are as follows:
SCHEDULE A - Designated Representatives
SCHEDULE B – Training Programs
SCHEDULE C – Standard First Aid
SCHEDULE D – Fees & Payment for Services
SCHEDULE E – Quality Assurance
SCHEDULE F – Controlled Acts and Advanced Medical Procedures
4. AGREEMENT
4.1. General
LH, through its Medical Advisory Board of the CEPCP, agrees to provide Medical Oversight to
Pickering Fire and Emergency Services, who hereby agrees to the provision of such Services,
subject to and in accordance with the terms and conditions set forth in this AGREEMENT.
4.2. MEDICAL OVERSIGHT
The Parties hereby agree that LH shall provide to Pickering Fire and Emergency Services the
following (collectively hereinafter referred to as “Medical Oversight”):
(a) authorization to qualified Firefighters to perform the specified controlled acts as per
section 8;
(b) provide medical advice to Pickering Fire and Emergency Services to ensure a smooth
and medically sound transfer of care from Pickering Fire and Emergency Services to
Paramedics;
(c) provide quality assurance information to Pickering Fire and Emergency Services as per
SCHEDULE E
4.3. The Parties agree that Pickering Fire and Emergency Services will provide the resources
necessary to act as a designate of the Medical Director, and at the sole discretion of a Medical
Director, in accordance with the terms and conditions set forth in this AGREEMENT.
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4.4. The Parties agree that LH, at its sole discretion, will utilize the Medical Director and/or LH
program staff as required, subject to and in accordance with the terms and conditions set forth in
this AGREEMENT.
4.5. Pickering Fire and Emergency Services will, where possible, provide LH with the use of a desk
and private meeting space, and make available to LH access to electrical power in order to
facilitate the provision of Medical Oversight pursuant to the terms and conditions of this
AGREEMENT including Section 7.3 herein.
5. MEDICAL EDUCATION
5.1. LH, through its Medical Advisory Board of the CEPCP, and a Medical Director shall establish
policies and procedures to support Medical Education to Pickering Fire and Emergency Services
in accordance with applicable laws, standards and the CPSO policy. LH shall review such
policies, procedures, and Medical Education materials as required and will advise Pickering Fire
and Emergency Services of any changes as necessary.
5.2. LH, through its Medical Advisory Board of the CEPCP will develop and review all training and
delivery of Medical Education provided to Pickering Fire and Emergency Services. These
programs will comply with Applicable Law, applicable Standards and the CPSO Policy.
5.3. Qualifications of Physicians
LH, through the Medical Advisory Board of the CEPCP, shall ensure that the program Medical
Directors maintain current and valid certificate of registration with the CPSO and a current
certificate of professional conduct from the CPSO or such other documents as may be issued by
the CPSO to evidence that the Medical Director has the appropriate registration, status,
qualifications, skills, experience and training to perform the role of Medical Director.
6. MEDICAL ADVICE RELATING TO PATIENT CARE
6.1. LH, through the Medical Advisory Board, may at its sole discretion, provide advice and guidance
to Pickering Fire and Emergency Services with respect to the Fire Service’s policies and
procedures as it pertains to Medical Education and Medical Oversight.
6.2. LH will provide written medical directives for controlled acts to Pickering Fire and Emergency
Services.
6.3. Where the Patient care provided by a Firefighter does not meet the applicable Standards, LH will
so advise Pickering Fire and Emergency Services including by providing feedback (as per
SCHEDULE E ) regarding the nature and type of Patient care provided by the Firefighter(s) and
the nature of the identified Patient care issue.
6.4. An annual meeting between Pickering Fire and Emergency Services and LH will be scheduled
for a mutually agreeable time and may be supported by additional meetings as requ ired or
requested.
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7. TRAINING
7.1. Training records will be maintained by the delivery agent – either the Fire Service or LH. Upon
request the training records for each Firefighter who is authorized to receive Medical Oversight
will be shared with the other party.
7.2. LH will be responsible for ensuring that the training content for the Firefighters to receive Medical
Oversight is in accordance with Applicable Law, the applicable Standards and CPSO Policy.
7.3. Pickering Fire and Emergency Services agrees to reimburse LH for additional costs incurred for
additional training beyond that prescribed in the schedule(s).
7.4. Where required, scheduling will be done by LH in consultation with Pickering Fire and
Emergency Services.
7.5. All training is mandatory to maintain authorization.
8. AUTHORIZATION AND RE-AUTHORIZATION
8.1. LH will provide appropriate authorization to eligible candidates identified by Pickering Fire and
Emergency Services. Pickering Fire and Emergency Services will ensure that eligible candidates
have met the following criteria:
(a) are either employed by Pickering Fire and Emergency Services on an indefinite or fixed
term basis or have received an offer of employment from Pickering Fire and Emergency
Services that has not expired, AND;
(b) have successfully completed all LH required training and evaluation.
8.2. Pickering Fire and Emergency Services will advise LH of any changes in the status of a
Firefighter that may affect his/her authorization.
8.3. LH will contact Pickering Fire and Emergency Services immediately upon identification that a
Firefighter requires remedial training to continue to receive authorization. LH is responsible for
the development of remedial training (as required) and that training may be delivered by LH or
Pickering Fire and Emergency Services.
8.4. The Parties agree that LH may oversee the Controlled Act and Advanced Medical Procedure
(SCHEDULE F) training and testing of eligbile Pickering Fire and Emergency Services staff.
8.5. The Parties agree that each Firefighter receiving Medical Oversight will complete a LH approved
annual re-authorization process.
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9. QUALITY ASSURANCE
9.1. Pickering Fire and Emergency Services and LH acknowledge and agree that:
(a) LH must receive all of the information contained in the Call Report (the ”Data”) in order
to facilitate its quality assurance obligations under this AGREEMENT;
(b) LH is a Health Information Custodian (HIC) as defined in the Ontario Personal Health
Information Protection Act, 2004 (“PHIPA”), and therefore is required to comply with
PHIPA, and as such is required to take steps that are reasonable in the circumstances
to ensure that Personal Health Information, including the Data, in LH’s custody or control
is protected against theft, loss and unauthorized use or disclosure and to ensure that the
records containing such personal information are protected against unauthorized
copying, modification or disposal;
(c) where the Data contains Personal Health Information, Pickering Fire and Emergency
Services and LH further agree to collect, hold and disclose Personal Health Information
pursuant to the provisions of PHIPA as Health Information Custodians (HIC) and Section
19 of the Act as applicable;
(d) in light of the foregoing, Pickering Fire and Emergency Services agrees to provide LH
with access to the Data for the purposes set out in (a) above and as otherwise required
or permitted by Applicable Law (the “Purposes”);
(e) Pickering Fire and Emergency Services and LH shall each notify the other of any
problem with or errors in the Data of which such party may become aware.
9.2. LH shall develop and implement a quality assurance program consistent with applicable
Standards including:
(a) monitoring the delivery of patient care related to Medical Oversight provided by Pickering
Fire and Emergency Services Firefighters through Case Reviews;
9.3. LH will provide annual biomedical services for the AEDs used in EMR and EFR programs.
10. INFORMATION SHARING
10.1. Issues Resulting from Information Sharing
(a) Case Reviews will be performed by LH, through the Medical Advisory Board, on all
patient care calls involving a controlled act provided by Pickering Fire and Emergency
Services Firefighters,
(b) All concerns received by Pickering Fire and Emergency Services pertaining to Medical
Oversight issues will be forwarded to LH for Investigation and action and LH will notify
Pickering Fire and Emergency Services of the results of its Investigation within two
Business Days of completion of the Investigation.
10.2. Investigations
(a) LH will be lead investigative organization in the case of any/all investigations involving
Medical Oversight. The final report will be provided to Pickering Fire and Emergency
Services from LH and Pickering Fire and Emergency Services will be responsible for
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communicating the report and its findings to any external parties to the extent Pickering
Fire and Emergency Services deems appropriate.
(b) LH may draw on any internal resources or personnel of the other Party that may assist
the lead investigator in conducting and concluding investigations.
(c) In the event an investigation has both service delivery as well as Medical Oversight
issues as a component of the overall scope of the investigation Pickering Fire and
Emergency Services shall remain the lead investigative authority, but will have LH
address the Medical Oversight issues as a co-investigation organization or upon mutual
agreement separate the oversight issues for investigation by LH.
10.3. Information To Be Shared between the Parties
To the extent requested, the following shall be shared between the Parties during an
Investigation:
(a) All relevant written/typed incident reports;
(b) All relevant audio recordings;
(c) All relevant Call reports pertaining to an Investigation or Case Review;
(d) Contact information of individuals involved in the Investigation; and
(e) Other details as deemed appropriate by the parties.
11. SUPPLIES AND EQUIPMENT
11.1. LH and Pickering Fire and Emergency Services will collaborate regarding the supply, use and
evaluation of equipment and supplies specific to Medical Oversight.
12. RESEARCH
12.1. LH will obtain the approval in writing of Pickering Fire and Emergency Services for all LH
research proposals involving Pickering Fire and Emergency Services. If applicable, LH will
obtain the approval of the Director of the Emergency Health Regulatory and Accountability
Branch, Ministry of Health.
12.2. Pickering Fire and Emergency Services, at its discretion, may agree to support research
conducted by LH with in-kind resources, if acceptable to LH, or financial resources. Any such
support jointly agreed to by Pickering Fire and Emergency Services and LH shall be included in
the budget of each study protocol.
12.3. Each Party will seek advice and input from the other for all publications relating to research
described in Section 12.1 or 12.2 at least 30 days prior to submission for publication without peer
review or, when applicable, for submission of the manuscript for peer review. The Parties each
agree to keep confidential prior to publication all information contained in a publication or
manuscript that has been submitted by the other for advice and input.
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12.4. Authorship on any document submitted for publication will be granted in accordance with the
guidelines outlined in the Uniform Requirements for manuscripts submitted to biomedical
journals (NEJM Vol.336 (4); 1997: pp309-315) as regularly updated and published.
12.5. Each Party will acknowledge the other Party’s contributions to the study and/or publicatio n in any
publication or presentation derived from the study, if the other Party’s contribution does not meet
the Uniform Requirements for authorship.
13. INSURANCE AND INDEMNIFICATION
13.1. Insurance of Pickering Fire and Emergency Services
Pickering Fire and Emergency Services shall, at its own expense, obtain and maintain in full
force during the Term, all insurance that would be necessary and appropriate for a prudent
Person in the same business. Such insurance shall include the following:
(a) commercial general liability insurance on an occurrence basis for third party bodily
injury, personal injury and property damage, to an inc lusive limit of not less than
$10,000,000 per occurrence and the policy shall include LH as an additional insured
with respect to liability arising in the course of performance of the Services or under
or in connection with this AGREEMENT. Such policy shall include but not be limited
to the following:
i. products and completed operations;
ii. personal injury;
iii. cross liability;
iv. contractual liability;
v. 30-days’ prior written notice of change to the policy, cancellation, and/or non -
renewal.
(b) errors and omissions liability insurance insuring for liability for errors and omissions in
the performance of or failure to perform its obligations under this AGREEMENT, in an
amount not less than $10,000,000 per claim.
(c) Network Security and Privacy Liability Coverage of not less than two million
dollars ($2,000,000) and underwritten by an insurer licensed to conduct
business in the Province of Ontario. Coverage shall include unauthorized
access, electronic security breaches, theft or destruction of data within
Provider’s computer network or other electronic information system. The
Privacy Liability coverage shall include the theft of private personal information
and include the failure to comply with privacy laws and their respective
regulations regarding the collection, access, transmission, use and
accuracy. Coverage shall be extended to include the costs associated with
notification of affected parties as well as any fines or penalties imposed as a
result of the breach.
13.2. Insurance of LH
LH shall, at its own expense, obtain and maintain in full force during the Term, all insurance
that would be necessary and appropriate for a prudent Person in the same business. Such
insurance shall include the following:
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(a) commercial general liability insurance on an occurrence basis for third party
bodily injury, personal injury and property damage, to an inclusive limit of not
less than $10,000,000 per occurrence and the policy shall include Pickering Fire
and Emergency Services as an additional insured with respect to liability arising
in the course of performance of the Services or under or in connection with this
AGREEMENT. Such policy shall include but not be limited to the following:
i. products and completed operations;
ii. personal injury;
iii. cross liability;
iv. contractual liability;
v. 30-days’ prior written notice of change to the policy, cancellation, and/or
non-renewal.
(b) errors and omissions liability insurance insuring for liability for errors and
omissions in the performance of or failure to perform its obligations under this
AGREEMENT, in an amount not less than $10,000,000 per claim.
(c) Network Security and Privacy Liability Coverage of not less than two million
dollars ($2,000,000) and underwritten by an insurer licensed to conduct
business in the Province of Ontario. Coverage shall include unauthorized
access, electronic securit y breaches, theft or destruction of data within
Provider’s computer network or other electronic information system. The
Privacy Liability coverage shall include the theft of private personal information
and include the failure to comply with privacy laws and their respective
regulations regarding the collection, access, transmission, use and
accuracy. Coverage shall be extended to include the costs associated with
notification of affected parties as well as any fines or penalties imposed as a
result of the breach.
13.3. Indemnification by Pickering Fire and Emergency Services
Pickering Fire and Emergency Services agrees to defend, indemnify, and hold harmless, LH and
its officers, directors, employees, agents and representatives (the “Indemnified Parties”) from
and against any and all liability, loss, costs, damages and expenses, causes of action, actions,
claims, demands, lawsuits or other proceedings (“Claims”) which the Indemnified Parties, or any
of them, may suffer or incur as a result of LH entering into this AGREEMENT. Pickering Fire and
Emergency Services shall not however be responsible for any such Claims to the extent it is
solely caused by the negligence or misconduct of LH.
13.4. Indemnification by Lakeridge Health
LH agrees to defend, indemnify, and hold harmless, City of Pickering Fire and Emergency
Services and its officers, directors, employees, agents and representatives (the “Indemnified
Parties”) from and against any and all liability, loss, costs, damages and expenses, causes of
action, actions, claims, demands, lawsuits or other proceedings (“Claims”) which the Indemnified
Parties, or any of them, may suffer or incur as a result of City of Pickering Fire and Emergency
Services entering into this AGREEMENT. LH shall not however be responsible for any such
Claims to the extent it is solely caused by the negligence or misconduct of Pickering Fire and
Emergency Services.
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14. TERM AND TERMINATION
14.1. Term
This AGREEMENT shall commence on/as of January 1st, 2022 and shall continue for the period
of 3 years, expiring on December 31st, 2024 or as terminated pursuant to this Article 15 (the
“Term”).
14.2. Termination by Either Party
Either Party may, at any time, and for any reason, terminate this AGREEMENT upon giving 30
days’ prior written notice to the other Party.
14.3. Effective Date of Termination
The effective date of the termination of this AGREEMENT shall be the last day of the notice
period or such other date as the Parties agree.
14.4. Consequences of Termination
Upon termination of this AGREEMENT the provisions which by their nature are intended to
survive beyond such termination will remain in effect. The termination of this AGREEMENT shall
not relieve either of the Parties of their respective obligations or rights accrued up to and
including the date of such termination.
14.5. Force Majeure
Notwithstanding anything contained in this AGREEMENT, neither Party shall be liable for any
failure or delay on its part to perform any of the terms, conditions, covenants or obligations of
this AGREEMENT to the extent that such failure or delay is the result of a cause beyond its
reasonable control including such things as unavailability of material, equipment, utilities,
services, an act of God, a fire, an act of the public enemy, an act of Her Majesty in her sover eign
capacity, laws, a flood, a quarantine restriction, an epidemic, a labour dispute, a riot, a civil
commotion, vandalism, malicious mischief or other similar cause beyond its control and not
avoidable by the exercise of reasonable foresight (excluding the inability to pay for the
performance of such obligation) and which occurs without the default or negligence of the Party
seeking relief. The Party being delayed shall be entitled to extend the time for fulfillment of such
obligation by a time equal to the duration of such delay and the other Party shall not be entitled
to any compensation for any loss or inconvenience occasioned thereby. The Party delayed shall
however, use its best efforts to fulfill the obligation in question as soon as reasonably possible.
15. GENERAL PROVISIONS
15.1. Co-operation
Pickering Fire and Emergency Services shall co-operate with and provide assistance to LH as
reasonably required by LH to facilitate the provision of LH’s obligations under this AGREEMENT.
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CEPCP and Pickering Fire and Emergency Services Page 15 of 27
15.2. Confidentiality
LH shall not disclose to any third party any trade secret of or confidential information about
Pickering Fire and Emergency Services that LH may acquire through the use of the Data.
Confidential information is Data and information which is designated as such by Pickering Fire
and Emergency Services (“Confidential Information”). LH shall use Confidential Information
only for the Purposes. LH shall limit disclosure of Confidential Information within its own
organization to its directors, officers, employees, agents, consultants and other representatives
having a need to know and shall not disclose Confidential Information to any third party (whether
an individual, corporation, or other entity) without the prior written consent of Pickering Fire and
Emergency Services The parties herein mutually agree that the confidentiality covenant herein
shall survive the termination or discharge of this AGREEMENT.
Pickering Fire and Emergency Services shall not disclose to any third party any trade secret of
or confidential information about LH that Pickering Fire and Emergency Services may acquire
through the use of the Data. Confidential information is Data and information which is
designated as such by LH (“Confidential Information”). Pickering Fire and Emergency
Services shall use Confidential Information only for the Purposes. Pickering Fire and
Emergency Services shall limit disclosure of Confidential Information within its own organization
to its directors, officers, employees, agents, consultants and other representa tives having a need
to know and shall not disclose Confidential Information to any third party (whether an individual,
corporation, or other entity) without the prior written consent of LH, except where required by
law. LH acknowledges that Pickering Fire and Emergency Services and Pickering Fire and
Emergency Services are subject to the Municipal Freedom of Information and Protection of
Privacy Act, R.S.O. 1990, c.M.56, The parties herein mutually agree that the confidentiality
covenant herein shall survive the termination or discharge of this AGREEMENT.
15.3. Nature of Relationship
Nothing contained in this AGREEMENT shall be construed as making the Parties (or their
respective successors or permitted assigns), partners or joint venturers or construed as m aking
any Party, its directors, officers, employees, volunteers, agents or other representatives an agent
of any other Party. For greater certainty, none of the employees, principals, shareholders or
independent contractors of Pickering Fire and Emergency Services shall be or be deemed to be
employees of LH.
15.4. Assignment
Neither this AGREEMENT, nor any rights or obligations hereunder, may be assigned by LH or
Pickering Fire and Emergency Services without the prior written consent of the other Party and
any purported assignment done without such consent shall be of no force or effect. This
AGREEMENT is binding upon and shall enure to the benefit of the Parties and their respective
successors and permitted assigns and shall not be enforceable by or otherwise enure to the
benefit of any other Person.
15.5. Invalidity
If any provision of this AGREEMENT is determined to be invalid, illegal or unenforceable in any
respect by a court of competent jurisdiction, the validity, legality or enforceability of the remaining
provisions of this AGREEMENT shall not in any way be affected or impaired thereby so long as
Agreement to Provide Medical Oversight Services
CEPCP and Pickering Fire and Emergency Services Page 16 of 27
the economic or legal substance of the matters contemplated hereby is not affected in any
manner materially adverse to either Party.
15.6. Costs
Each Party shall bear its own costs with respect to the drafting, negotiation and interpretation of
this AGREEMENT.
All other costs are outlined as per SCHEDULE C of this AGREEMENT.
15.7. Notices
Any notice, demand or other communication (in this Section 16.6 a “Notice”) required or
permitted to be given or made hereunder shall be in writing and shall be well and sufficiently
given or made if it is:
(a) delivered in person during normal business hours on a Business Day and left with a
receptionist or other responsible employee of the relevant Party at the applicable
address set forth below;
(b) sent by prepaid first class mail; or
(c) sent by any electronic means of sending messages, including facsimile transmission,
which produces a paper record (an “Electronic Transmission”);
in the case of LH, addressed to it at:
Lakeridge Health
1 Hospital Ct
Oshawa, ON
L1G 2B9
Attn: Chief Financial Officer
Fax: 905-721-4862
Tel: 905-576-8711
and in the case of Pickering Fire and Emergency Services addressed to it at:
Pickering Fire Services
1616 Bayly Street
Pickering, ON L1W 3N2
Attn: Fire Chief
Fax: 905.839.6327
Tel: 905.839.9968
Any Notice given or made in accordance with this Section shall be deemed to have been given or made
and to have been received:
(a) on the day it was delivered, if delivered as aforesaid;
(b) on the third Business Day (excluding each day during which there exists any general
interruption of postal services due to strike, lockout or other cause) after it was
mailed, if mailed as aforesaid; and
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CEPCP and Pickering Fire and Emergency Services Page 17 of 27
(c) on the day of sending if sent by Electronic Transmission during normal business
hours of the addressee on a Business Day and, if not, then on the first Business Day
after the sending thereof.
Any Party may from time to time change its address for notice by giving Notice to the other Party in
accordance with the provisions of this Section.
15.8. Further Assurances
Each Party shall do such acts and shall execute and deliver such further agreements,
documents, conveyances, deeds, assignments, transfers and the like, and shall cause the doing
of such acts and the execution and delivery of such further it as are within its power and as the
other Party may in writing at any time and from time to time reasonably request, in order to give
full effect to the provisions of this AGREEMENT.
15.9. Remedies Cumulative
The rights and remedies under this AGREEMENT are cumulative and in addition to, and not in
substitution for, any other rights and remedies, available at law or in equity or otherwise. No
single or partial exercise by a Party of any right or remedy precludes or otherwise affects the
exercise of any other right or remedy to which that Party may be entitled.
15.10. Counterparts and Facsimile Execution
This AGREEMENT may be executed in any number of counterparts, each of which shall be
deemed to be an original, and all of which together shall be deemed to be one and the same
instrument and receipt of a facsimile version of an executed signature page of this AGREEMENT
by a Party shall constitute satisfactory evidence of execution of this AGREEMENT by such Party.
15.11. Dispute Resolution/Consultation and Negotiation
(a) In the event of a dispute between the Parties, each Party’s Designated Representative
shall meet to attempt to resolve the Dispute. Each Party acknowledges that it is in their
mutual interest to have their respective Designated Representative resolve all matters
by mutual agreement and each agrees to act reasonably and in good faith to permit and
encourage their respective representatives to do so.
(b) If such Designated Representatives are not able to resolve any Dispute referred to them
within 15 Business Days, the matter shall be referred to the Director of LH and the Fire
Chief or his designate of Pickering Fire and Emergency Services, each of whom shall be
fully briefed on the matter and shall have the authority to negotiate on behalf of and bind
their respective Party. If such senior representatives are not able to resolve any Dispute
referred to them within 15 Business Days (the “Resolution Date”) of such referral, then
the matter shall be referred to arbitration as provided for herein.
15.12. Dispute Resolution/Arbitration
(a) If the Parties do not reach a solution pursuant to Section 16.10 by the Resolution Date,
the Dispute shall be arbitrated and finally resolved, pursuant to the National Arbitration
Rules of the ADR Institute of Canada, Inc., as amended from time to time, by a single
arbitrator appointed pursuant to Rule 14(d) of the said Rules. The place of arbitration
shall be Toronto, Canada. The language of the arbitration shall be English.
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CEPCP and Pickering Fire and Emergency Services Page 18 of 27
(b) Judgment upon the award rendered in any such arbitration may be entered in any cou rt
having jurisdiction thereof, or application may be made to such court for a judicial
acceptance of the award and an enforcement, as the law of such jurisdiction may require
or allow.
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CEPCP and Pickering Fire and Emergency Services Page 19 of 27
IN WITNESS WHEREOF the Parties hereto have duly executed on the day of
, 2021.
Pickering Fire and Emergency Services
By:
Name:
Title:
By:
Name:
Title:
LAKERIDGE HEALTH
By:
Name:
Title:
By:
Name:
Title:
Agreement to Provide Medical Oversight Services
CEPCP and Pickering Fire and Emergency Services Page 20 of 27
SCHEDULE A - Designated Representatives
LH
Jennifer Shanley, Manager Office Operations
Lakeridge Health
1 Hospital Ct
Oshawa, Ontario L1G 2B9
Tel: 905-433-4370
Fax: 905-721-4737
Pickering Fire and Emergency Services
Steve Boyd, Fire Chief
Pickeirng Fire Services
1616 Bayly Street
Pickering, Ontario L1W 3N2
Tel: 905-839-9968
Fax: 905-839-6327
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CEPCP and Pickering Fire and Emergency Services Page 21 of 27
SCHEDULE B – Training Programs
Emergency First Responder – Self Delivery
Core Program Description
“EFR”
Self Delivery
Self delivered program by LH trained and approved internal candidates
HSFO CPR certification
Controlled Act and Advanced Medical Procedure certification (see SCHEDULE F )
Medical directives
Access to CEPCP Learning Management System
Medical liability coverage
Quality assurance – call reviews
Remediation programs as required
Annual meeting
Annual Biomedical service for AEDs
Approximately 8 hours annual training
In-house instructor(s) provide(s) all training (initial, maintenance and remedial)
Annual Instructor certification (up to 8 hours, CPR instructor annual renewal)
Options
“EFR” New
Instructor training
Direct delivery by LH
40 hour course
HSFO CPR Instructor and Controlled Act certification
Medical directives
Emergency First Responder – Direct Delivery
Core Program Description
“EFR”
Direct Delivery
Program training delivered by LH staff
CPR certification
Controlled Act and Advanced Medical Procedure certification (see SCHEDULE F )
Medical directives
Access to CEPCP Learning Management System
Medical liability coverage
Quality assurance – call reviews
Remediation programs as required
Annual meeting
Annual Biomedical service for AEDs
Approximately 8 hours annual training
Includes one new hire certification class (maximum 8 participants) per year
Options
“EFR” Additional
New Hire
certification
Direct delivery by LH
Up to 24 hours of training
CPR certification
Controlled Act and Advanced Medical Procedure certification (see SCHEDULE F )
Medical directives
(maximum class size 8)
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CEPCP and Pickering Fire and Emergency Services Page 22 of 27
Emergency Medical Responder – Direct Delivery
Core Program Description
“EMR”
Direct delivery
Program training delivered by LH staff
CPR certification
Controlled Act and Advanced Medical Procedure certification (see SCHEDULE F )
Medical directives
Access to CEPCP Learning Management System
Medical liability coverage
Quality assurance – call reviews
Remediation programs as required
Annual meeting
Annual Biomedical service for AEDs
EMR manual (digital) per participant
Approximately 16 hours annual training
Includes one new hire certification class (maximum 8 participants) per year
Options
“EMR” Additional
New Hire
certification
Direct delivery by LH
Up to 120 hour course
CPR certification
Controlled Act and Advanced Medical Procedure certification (see SCHEDULE F )
Medical directives
EMR manual (digital) per participant
(maximum class size 8)
Emergency Medical Responder – Self Delivery
Core Program Description
“EMR”
Self delivery
Self delivered program by LH trained and approved internal candidates
HSFO CPR certification
Controlled Act and Advanced Medical Procedure certification (see SCHEDULE F )
Medical directives
Access to CEPCP Learning Management System
Medical liability coverage
Quality assurance – call reviews
Remediation programs as required
Annual meeting
Annual Biomedical service for AEDs
EMR manual (digital) per participant
Approximately 16 hours annual training
In-house instructor(s) provide(s) all training (initial, maintenance and remedial)
Annual Instructor certification (up to 8 hours, CPR instructor annual renewal)
Options
“EMR” New
Instructor training
Direct delivery by LH
40 hour course
HSFO CPR Instructor and Controlled Act certification
Medical directives
EMR manual (digital) per participant
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CEPCP and Pickering Fire and Emergency Services Page 23 of 27
SCHEDULE C – Standard First Aid
Program Delivery
Fire Department agrees to deliver all Standard First Aid (SFA) training following the Lakeridge
Health (LH) program as written and in its entirety using only materials created or approved by LH.
All delivered courses will meet all requirements set out by W SIB including but not limited to;
(a) Standard First Aid courses must be a minimum of 16 hours in duration with a minimum of 13
hours of instructional time.
(b) Emergency First Aid courses must be a minimum of 8 hours in duration with a minimum of
6.5 hours of instructional time.
(c) Standard First Aid recertification courses must be a minimum of 8 hours in duration with a
minimum of 6.5 hours of instructional time.
i. Recertification courses may only be taught to those participants who originally took
the LH program
ii. Participants may only complete one re-certification course and then must take the
complete course (the cycle would be to take the complete course, 3 years later take
the re-certification courseand then 3 years later take the complete course again)
(d) The participant instructor ratio must not exceed 12 participants per one instructor.
(e) The participant manikin ratio must not exceed 2 participants per one manikin.
(f) Each participant must be provided a copy of the LH Standard First Aid Participant Manual
and on successful completion of the course a LH approved wallet card and wall certificate.
(g) Courses must be delivered in facilities with sufficient space and appropriate for the delivery of
a SFA program.
(h) All courses delivered by Fire Department will be to Fire Department employees.
Equipment
(i) All equipment utilized in the delivery of courses will be the responsibility of the Fire
Department. Equipment needs for each course must be in accordance with the LH list of
course equipment.
Materials
LH will provide the Fire Department with an electronic copy of all printed materials including the
Standard First Aid Participant Manual required for the delivery of SFA courses. The Fire
Department will be responsible for the printing of sufficient copies of these materials for each SFA
course delivered under this agreement. The Fire Department agrees that reprinting of any of
these materials for purposes not covered by this agreement is prohibited.
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Instructor Training
LH will deliver instructor training to Fire Fighters selected by The Fire Department on a schedule
and at a location agreeable to both parties. On successful completion of the instructor training
and having been monitored during the delivery of a SFA program by LH staff the Fire Fighters will
be designated as SFA Instructors.
Instructor training will be a minimum of 16 hours in length
Instructor candidates will be provided a copy of an Instructor manual by LH
On completion of Instructor training, each Instructor candidate must be monitored during their
delivery of a SFA program course a minimum of once by LH staff prior to being designated a SFA
Instructor.
Documentation
The Fire Department will provide LH with complete rosters of all courses delivered by The Fire
Department under this agreement within 30 days of the course completion. These rosters will
include;
Course date
Course Type
Course Length
Client group
Instructor names
Participant names
Course Progress Report
Participant Skill Tracking Sheet
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SCHEDULE D – Fees & Payment for Services
Item Frequency Amount Initial
Selection 2021 2022 2023
EFR Direct
delivery program Annual $140 per
firefighter
$140 per
firefighter
$140 per
firefighter
EFR Additional
New Hire As required
$1200 per course
(max 8
participants)
$1200 per course
(max 8
participants)
$1200 per course
(max 8
participants)
EFR Self
delivered program Annual $110 per
firefighter
$110 per
firefighter
$110 per
firefighter
EMR Direct
delivery program Annual $275 per
firefighter
$275 per
firefighter
$275 per
firefighter
EMR Additional
New Hire As required
$1200 per course
(max 8
participants)
$1200 per course
(max 8
participants)
$1200 per course
(max 8
participants)
EMR Self
delivered program Annual $240 per
firefighter
$240 per
firefighter
$240 per
firefighter
EFR/EMR
Additional New
Instructor
As required $3000 per
instructor
$3000 per
instructor
$3000 per
instructor
SFA Participant
administration
and registration
Per course $15 per
participant
$15 per
participant
$15 per
participant
Instructor Training As required
$2000 per
instructor training
course, (max 8
instructor
candidates)
$2000 per
instructor training
course, (max 8
instructor
candidates)
$2000 per
instructor training
course, (max 8
instructor
candidates)
Instructor
Monitoring/
Auditing
As required $500 per day $500 per day $500 per day
Notes:
LH will invoice Pickering Fire and Emergency Services once annually by December 31st for:
1. the total number of Firefighters who receive medical oversight from the Medical Advisory Board of
CEPCP, at any point during the calendar year.
2. any additional items required by Pickering Fire and Emergency Services
The Parties agree to negotiate and append additional fee structures for work not described in this
AGREEMENT.
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CEPCP and Pickering Fire and Emergency Services Page 26 of 27
SCHEDULE E – Quality Assurance
It is recognized that the quality assurance requirements will need to be reviewed regularly to ensure that
the needs of both Parties are being met and in fulfillment of the terms of this AGREEMENT.
Data Requirements:
Data will be provided to LH as described in the AGREEMENT. The minimum data required are to be
captured in a form mutually agreed to by both Parties.
Case reviews:
LH will audit all calls where a Call Report for patient care involving controlled act(s) is received by LH from
Pickering Fire and Emergency Services Fire Department, using a standardized audit tool.
The results of a chart audit will be available no later than five weeks following the commencement of the
audit.
The Parties agree to the following process:
LH will issue individual case feedback forms when clarification is required. Pickering Fire and
Emergency Services will make reasonable efforts to encourage a response within 3 weeks of
receipt. An additional 2 weeks may be added where the Firefighters are reasonably unavailable to
complete the request, or where it is likely that the feedback form was not received.
Report Requirements:
LH will provide the following minimum reports to Pickering Fire and Emergency Services. If additional
reports are required they will be negotiated and appended to this AGREEMENT:
Case Review reports:
Semi-annual.
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CEPCP and Pickering Fire and Emergency Services Page 27 of 27
SCHEDULE F – Controlled Acts and Advanced Medical Procedures
Pickering Fire and Emergency Services requests authorization to perform the following Controlled Acts
and Advanced Medical Procedures, in accordance with CEPCP’s Fire Services Medical Directives,
Policies and Guidelines.
Pickering Fire and Emergency Services to initial beside each item they are requesting delegation to
perform.
Directive and Controlled Act and Advanced Medical
Procedures Fire Service Initials
Cardiac Arrest General Medical Directive
Use of AED and provide defibrillation
Medical Cardiac Arrest Medical Directive
Use of AED and provide defibrillation
Hypothermia Cardiac Arrest Directive
Use of AED and provide defibrillation
Trauma Arrest Medical Directive
Use of AED and provide defibrillation
Foreign Body Airway Obstruction Cardiac Arrest Medical Directive
Use of AED and provide defibrillation
Neonatal Resuscitation Medical Directive
Advanced medical procedures
Anaphylaxis Medical Directive
Administer Epinephrine, IM
Opioid Toxicity Medical Directive
Administer Naloxone, IN
Emergency Bandage Application Medical Directive
Medical grade tourniquet application