northernmedic

Check your facts. The strike is over and we have been training ACP's again for months. There are 2 licensing exams this summer and 12 people just got licensed with another 20 on the way here in the GVRD. Oh yeah, there was also the release of the 2 year EMS diploma and a longer ACP course with more post secondary pre requisites. My partner is precepting a student all month as we speak. I love all the "BC experts" on here who don't have a clue about anything first hand. Let me know if I can correct any more of your opinions for you.

If there is any OPS paramedics here can you send me a PM? I have some questions for you.

My vote: Pelican 1500 with Conterra inserts King LTS EZ-IO Inline suction catheters Cook needle thoracentesis kit (or Turkell if you prefer)

How come you couldn't just take the Paramedics in Industry one day bridging course? That's what everyone here takes to get signed off by the WCB for industrial work. I've never heard of people having to take the entire course.

I have had 40+ potential expossures and 8 confirmed cases including 2 severe. I had my seasonal flu shot as well as my H1N1 shot last week. It seems like many of the rural public health providers are not including EMS here in BC but so far I haven't seen this to be the case here in Vancouver. I would we have actually had a better immunization roll out than most of the hospitals for staff. Since last friday I would estimate we have vaccinated over 800 staff. There are some mobile vaccine vans starting up this week to hit more of the rural stations. The public health department response so far seems to be less than coordinated. Rock Shoes, You should be kicking up a fuss with your local public health since they are supposed to be including EMS with the rest of front line health care staff. I suspect this is a small town mentality as I haven't seen this at all in any of the urban areas to date.

We have some mobile vaccine vans starting in the GVRD for staff this week. There has been mass innoculation going on at holiday picks over the past 5 days. The public health clinics seem to be completely disorganized. Some are over run and others don't have a single person in line. Several hospitals have vaccinated have their staff here in Vancouver but then have run out of vaccine until friday.

A lot of the special event standbys are being covered by managers so people like the CFL and NHL don't get PO'd. Also our regional director here has tried stunts like diverting a street unit to special event coverage which you don't have any choice in since you are working you're normal paid full time shift.

try going to Sooke. It's not too far west and you can go to the Sooke Potholes. Also the Sooke harbour house has a great restaurant. Victoria Inner harbour has tons of bars and places to eat. If you like wine you can drive up the Saanich peninsula to Sidney and hit some of the great vineyards up there.

I think tniuqs raised a good point about associated dislocations. I completely concur with his statement. It is a bit of a different cup of tea realigning a mid third humerus fracture vs. an ankle. I will be the devil advocate and make a point that in most cases it probably isn't necessary. In a lot of situations EMS should be able to have the pt at the hospital promptly and advance notification should stream line the process. In super rural areas this may not be an option but for limb threatening injuries aeromedical EMS could potentially be an option (which may bring providers with greater experience and training). We use Sager splints on compound fractures and have been doing so since we invented it around 20 years ago. I checked with an orthopedic surgeon at our trauma center here in Vancouver after reading this thread and he completely agreed it is an acceptable practice, in fact the surgeons are big fans of proper application of traction splints to reduce tissue damage and stabilize limbs in place prior to surgery.

We have a division known as Medical Programs. This covers physician medical direction, CQI and clinical education. All CME is provided (some in house courses, some contracted to a 3rd party). We have QI officers as well as training officers that have specific roles in each area. I can try and find the job descriptions for you.

1000 ACP's would probably be most of the ACP's in all of Ontario. There is a country wide shortage of ALS and getting worse by the day. Obviously Liepart hasn't read the document from Dalhousie on the national shortage of ACP's and retention. We are not even training enough right now to meet retirement attrition as it is. If things get bad enough in AB I think she's forgeting that AIT is also a 2 way street. In all practical sense, there is never a big movement of EMS providers across the country. Most people tend to stick around in the general geographic area where they are established.

I would recommend the book Pathphysiology: Concepts of Altered Health States by Porth. That was one of our course books and it is quite good. I am also partial to the On Call series, in particular On Call: Cardiology.

There are plenty of jobs in western Canada depending how far you want to relocate.

I don't know whether NREMT-P will be accepted in BC you need to contact the EMA licensing board. I do know that Nova Scotia will give you direct ACP equivalency if you hold a current NREMT-P. My recommendation would be to obtain Nova Scotia registration (relatively easy) to get your foot in the door in Canada so to speak. Once you are registered in one province it is much much easier to transfer interprovincially. I make 36.72 as a 4 year ACP with a 16.67% shift adjustment due to the shift pattern I work.

We have been using D10W to treat hypoglycemia in my service for well over 15 years now. In my opinion it has several benefits such as a more gradual increase in blood glucose as well preventing a big spike then a big drop. In addition you can provide a small maintenance infusion to help maintain blood glucose if the person is unable to tolerate food PO. We carry it in 500cc bags and typically give it in 100cc bolus' titrated to effect (blood glucose >4.0 mmol/L or improvement in mental status). There was a study done in the UK comparing D10W to D50W for treatment of hypoglycemia. I will track it down on Pubmed tomorrow when I'm at work.

There is absolutely no provision in BC for personal emergency vehicle lights. I don't even know of any volly fire depts that have them on personal vehicles. Emergency driving is covered in the Emergency Vehicle Driving regulation (EVDR) http://www.qp.gov.bc.ca/statreg/reg/M/Moto...icle/133_98.htm

I would say do the preread and pay attention to the pretest. Last time I did it the written exam was remarkably similar to the written pretest (like ACLS). The scenarios are pretty straight forward. Just follow the assessment model and make the required ABC interventions. Other than that really all they are looking for is timely packaging and transport.

Regarding this study http://www.ncbi.nlm.nih.gov/pubmed/16418091 which Doczilla referenced: I was referred to this study last year by the director of the spinal unit at the hospital where I normally transport to. His opinion is that the scoop is superior to the LSB in every respect and that is all that they use for transferring and moving spinal patients in the largest spinal cord trauma unit in Western Canada. Granted this study was a small sample size and sponsored by Ferno but I have used the scoop many, many times with great success. Our normal policy at the above hospital is that every patient in taken off the LSB/scoop on arrival in emergency and left with a C-Collar on a transaver and care is transferred to the bedside nurse. The emergency staff specifically request pts be removed from spinal equipment on arrival to prevent pressure sores and aid in more rapid assessment.

Wow. I'd probably kill myself if I had to get online orders from a nurse for every pt I treated. Fortunately I rarely have to patch for orders and if I do it's only to the emergency physician.

Anthony, I'm a little confused on your ALS patching. Are you saying you get orders from a nurse for an IV en route?

My personal preference would be scrap the skill stations and such (leave them for another time) and go with more of a rounds format. We have monthly interesting case rounds and a different station hosts every month. The crews from that station present some challenging cases, or better yet a call where a mistake was made and a lesson to be learned. The floor is then opened up to comments and/or questions and lively (but constructive) discussion. It is actually a pretty fun get together and our medical director buys pizza and sushi for everyone. I have found this to be a great way of learning. If you have 10 stations and each station hosts then everyone is only hosting barely once a year. It is difficult to do in EMS, but what we are attempting to establish is a culture of personal reflection and responsibility for patient safety.

Our system sounds similar to yours. We don't notify unless it is something of significance or unless there is some special requirement, i.e. sexual assault team or social work etc. I would say the sicker the pt, the less the triage. For CTAS 1 and 2 patients I pretty much just go right to the bedside and give a report directly to the emergency physician and bedside nurse. For lower acuity pts generally the triage nurse will do a more complete triage. Sometimes it drives me insane because you end up giving a bigger report than you would at the bedside. CTAS 4 and 5 pts usually just get put in the waiting room (as long as they are ambulatory) and the transporting crew can clear. The 2 major hospitals that I normally transport to are excellent and both are large teaching hospitals, trauma centers and cardiac centers so they have great staff and we have a very good working relationship. You get the normal occasional attitude on both sides but normally it's very good and we do go out and party together as well.

Check out the Canadian EHS Research Consortium: http://www.paramedic.ca/cerc/ I don't know if they have specific funding allocated but they do receive it from other sources. It is in the beginning stages but seems to be quickly building momentum.

We have been running PRIMED since last summer. So far I think we are well over 700 patient enrollments. Enrollment in the hypertonic saline study has not been as high as was hoped unfortunately. We use the lifepak 12 with all the standard stuff (capnography, SpO2, NIBP and 12 lead) and all the defibs get downloaded at your station using the lifenet DT express software. All cardiac arrest and major trauma info in compiled in the central CAMT provincial registry and is all dual transmitted to the BC ROC staff and St. Paul's hospital. By the end of this year the remaining lifepak 500's will be replaced with the lifepak 1000 with the pediatric SAED and basic cardiac monitoring package. I think the ROC is great because it pulls many large EMS services together on the same page for research and allows very large studies like PRIMED to go ahead. I know my service is planning to stay a part of ROC and there is more studies planned in the next several years. I count myself fortunate that my medical director is the Canadian rep for NAEMSP and she is very pro-research and always on the hunt for stuff like this to get us involved in.

Given the Hx you have provided I would say the benefit of treating the pt with ASA far outweighs the risk (provided there are no contraindications). I agree with what Doczilla said. With a history that extensive this guy should pretty much get the full deal until he has a complete cardiac workup. 12 leads are useful but it seems like they are becoming they new EMS lunchbox toy. The only difference it makes to my treatment plan at the end of the day is whether I am going to transport to a STEMI receiving hospital or not.