northernmedic

Others have pretty much summed it up above. I would say that if you are coming to BC and have a national registry certification you will likely have a better chance of obtaining reciprocity. Probably the biggest hurdle to overcome will be the immigration issues itself. To be honest the easiest way would be to find a Canadian to marry. The reciprocity generally works in Canada is as follows: Paramedic schools are accredited by the Canadian Medical Association (if they aren't completed it yet they will in the near future). Accreditation is done according to the National Occupational Competency Profile for Paramedicine which lays out all the specific learning objective for each level of training and set minimums for skills you must perform in clinical and preceptorship. If you have graduated from a CMA accredited paramedic school it is much easier to move between provinces. If you haven't graduated from a CMA school then you basically have to go through the reciprocity process where all of the NOCP objectives are matched up with the ones you went to school with to deem equivalency. This can be a long process. I only know of one American that has come to BC and tried to get equivalency and was denied so he went to the media and raised a big fuss. I do know however that several of my coworkers have attend training in the USA and obtained equivalency upon return therefore it is definitely possible. If you have management experience and/or desires we often have management positions posted that don't require current licensure that pay well and have quite interesting and varied areas of work.

I would say go with the basics, but lots of it (especially for FR level care). Lots of dressings/bandages, splints, as many blankets as you can get your hands on, wound care, irrigation solution etc. You specified first aid kit so I am guessing you already have stuff like potable water, food, light etc. If you email the BCAS disaster coordinator in your area they can give you a list of what is in the Victoria area Zulu (MCI) units which would give you a rough idea in terms of quantity.

I don't think all trauma calls are necessarily created equal. Presumably the gangbanger study mostly focussed on patients with penetrating torso trauma due to GSW. I think there are lots of trauma patients where EMS can make a critical difference. What about the blunt chest trauma with a life threatening tension pneumo that is decompressed on the way to hospital? Head trauma with airway compromise? Prevention of hypoxemia in these patients prevents a dramatic increase in mortality. I think that P3 raises some excellent points however about load and go. I work in the inner city and we do lots of trauma and probably >90% of the patient management is solid BLS skills and minimizing the scene time as much as possible. I did post previously on this topic with regard to the Canadian Multicenter Trauma study and the comparison between 3 types of prehospital systems with regard to trauma survival.

I really don't like Zoll. We have used the LP12 for a long time and it works very well (we have the fully loaded ones). I recently had a chance to try out the LP1000 and it is a great piece of kit for BLS units.

Devilbliss suction unit all the way. We used to use Laerdal but recently switched to the Devilbliss unit and it kicks butt.

We carry both and mix up our own if we need it. We have both MDI's as well as nebules and we use the AMBU spur bags where you can sideport the MDI for severely dyspneic or intubated patients. Generally I give the first neb with atrovent/ventolin and then repeat the ventolin once or twice depending on the patient's response and the transport time.

We mostly use D10W which I much prefer.

Basically what NSmedic said. About 96% of our stuff is needless. Maybe a half dozen drugs still requiring needles.

Asys Send me a PM if you come out I live and work in Vancouver and maybe we can hook up and I'll show you around.

In BC PCP: Full time about $29.00-32.00/hr. ACP: Start at $32.00/hr and goes up to around $40.00/hr for CCP flight paramedic, maybe a bit more. We also get a shift adjustment paid on top of hour hourly wage. I don't know about PCP but for ACP it is around another $240.00 a paycheck.

Get your boss to order the 10cc multidose vials of 1:1000 epi. That's mostly what we use and it's way easier.

We use the scoop all the time for spinal immobilization. Not sure why ITLS has their thing about it.

I would start by trying a Valsalva maneuver then failing that go to 6 or 12 mg of adenosine. I have seen plenty of calls like this and usually they convery nicely with adenosine (providing there isn't another underlying cause such as drug use etc). I have had some success using the Valsalva, especially in younger otherwise healthy pts.

AP or AL placement of pads will work for pacing (at least with the LP 12). I recently encountered a similar situation where there was no response with atropine and there was electrical capture with pacing but no mechanical capture. I generally have 1 or 2 patients a month that I end up pacing and on the 3 occasions I have no received capture, it was in a situation where the pt had a massive MI and ended up in a 2nd or 3rd degree block. I think AZCEP mentioned above that acidosis makes it harder to get capture. My ultimate reasoning: S**t happens and patients die. Also that's why we have orders for catecholamine infusions if we need them. It sucks to have to patch for orders for pacing when a patient is heading south, glad we don't have to do that here.

There are also different classes of sodium channel blockers (weak, moderate and strong) otherwise known as Vaughn-Williams Classes Ia, Ib and Ic. Lidocaine is a weak sodium channel blocker which is used as was explained above. Use of lidocaine (or other sodium channel blockers) is still a little bit controversial. Just about everyone who used to have an MI got lidocaine. Now the focus is more on treating underlying ischemia or finding a treatable cause (as was previously mentioned). We could go crazy on uses and indications here but we'd have to get kevkei in here for some freaky in depth physiology and pharmacology :wink:

NSmedic is right about diagnostic mode. The LP12 will print in diagnostic mode so it can be used in this capacity. I can't speak to the Zoll monitors since my service used all medtronic products.

I have always prided myself on being a less is more type of guy. You can always give another drug if you really need to but you can't take it back once you give it. I think in many places we have cultivated a culture where we judge a provider by the by their scope of practice. This is bad. My partner and I recently had a paramedic from Alberta ride with us. My system is a targeted ALS system where we only do ALS calls so all our ALS providers get a lot of hands on exposure to maintain skills. We have quite progressive medical directives but nothing too crazy. This individual proceeded to lecture us on how they had learned things like percardiocentesis, ABG sampling and intrapartal exams in their course ( but only on manikins) and how we were behind the times. My point is this: an individual is juding us based only the tools in our kit not core paramedic abilities like history taking, physical exam skills or the ability to develop an effective treatment plan and interact with the patient. A person like this in mind is the most dangerous type of paramedic since they are only thinking of what they can do TO the patient not what they can do FOR them. Rant off.

I would say no, you can't make that diagnosis base only on 2 leads. Personally I would but more stock in your clinical assessment of the patient's presentation, in particular the history to help you make a decision. If you see ST changes in lead II or III it would highly elevate your suspicion but I don't think you can definitively diagnose STEMI.

Flumazenil....bad. Very few people actually die from a benzo overdose. The biggest concern is protecting the airway and sometimes hypotension depending on the dose. Sounds like you basically managed both of those. Seroquel can cause hypertension and tachycardia as well as some rigidity and other neurologic sequelae so it may have actually helped to prevent some benzo related hypotension.

The CG EMT school is in Petaluma and they do a 3 week NREMT-B crash course.

Does anyone currently use these in their service? We are in the process of switching to them to come in line with our hospital's airway management program in the prevention of ventilator acquired pneumonia. I have heard they are stiffer and may be a bit more difficult to intubate with. We are just gearing up for our training so any input is helpful.

I like JEMS way better. I also subscribe to Prehospital Emergecy Care but it is an actual journal and is only published quarterly I believe (and it is way fricking expensive).

I sometimes take a bit longer if the pt is stable. If the pt is critical I get loaded up. We work on dual ALS trucks and respond in a targeted ALS system. If the pt is critical then my partner and I get the BLS crew to drive us in and both of us work in the back. I do agree that having a dual ALS truck allows you to get a lot accomplished. Our transports are around 5-7 minutes where I work. I did a very sick hypotensive inferior/posterior/RV MI call the other day and we had the pt in our care for 13 minutes total and managed to get everything done on the way to the cath lab.

Go to www.jibc.bc.ca and click on the library section. They have a whole resource there on formatting but it uses APA style which was the requirement for my ACP course. I haven't looked lately but they may have an MLA link as well.

In the process of training all 3300 of our staff. I think around 1000 are done. Not sure what the numbers are like so far. I've done 4 codes the past two weeks and all were trauma so I don't think they really count.