northernmedic

On call is a great series of books. The regular On Call was a required text for my paramedic course and it was probably the most useful book I used.

We have many dr's that ride with us as well as some nurses. Emerg residents must do 1 month of EMS time in Canada and in my service they are usually split 1 week each on BLS, ALS, dispatch and air ambulance.

Rid we are doing this trial in Vancouver since my service is part of the ROC. It is being run in conjunction with the ITD valve study and the analyze early/analyze late study for cardiac arrest. Basically for the study you initiate your normal IV line of NS and then you piggy back on a 250 cc bag of a double blind study solution which is either 0.9% NS, 7.5% HS or 7.5% HS with 6% Dextran. After its run in you carry on with normal trauma resuscitation outcomes. The patient's get a bar coded bracelet and it all gets reported to the study centre in Seattle where they match up the results. Looks like around 5000 patients being enrolled over 3-4 years. In Canada it includes Vancouver, Toronto and Ottawa and in the US I know Seattle is involved as well as San Diego but I forget where else.

ACP in Lotus Land (Vancouver). Hopefully going to move to CCP and the air ambulance service in the next few years. The unit I work on is very busy and does around 7000 calls a year in a targeted ALS system.

Thankfully we use LP 12 with 12 lead, NIBP, SPO2 and capnography. After using various Zoll models in ACLS/PALS and other courses I have found them to be less than adequate and prefer the physiocontrol products.

ACP in Vancouver. Also have a BSc from Simon Fraser University. Was formerly an ocean lifeguard/swift water rescue tech before I started in EMS.

We don't transport anything without a pulse unless it is a hypothermic arrest. Asystolic blunt trauma arrests we don't even start. traumatic arrests in a PEA get worked where they are but unless you get some kind of ROSC it gets discontinued. reality is almost all of them stay dead.

I don't really care what the titles are as long as there is some consistency. The terms EMT and Paramedic have been established in the USA for quite a while so the general public and other health care providers are somewhat familiar with the differences. Our problem in Canada right now is that Alberta is insisting on using their own titles which is different than everyone else. Our NOCP lays out EMR, PCP, ACP and CCP very specifically. Everyone needs to use these titles and educate the public as to our own national terminology. My license clearly says ACP on the back. Before that it said PCP. I don't give a rat's ass about a name but there has to be some consistency.

Hey BEP, I can only offer you my experience from the west coast. I recently finished my ACP and I had 7 years experience when I was accepted into the course. Here you need a minimum of 3 years and 1000 911 patient contacts as well as doing a written exam, 4 OSCE's and an interview. I am a firm believer that experience will only help you. Education is very important but I think you really need the right combination of education, experience and maturity to be an excellent ALS provider. I worked in a variety of station all the way from downtown Vancouver with tons of resources down to the lone PCP unit with no backup for miles in a rural area. Working and developing your own practice and clinical judgement is very different on your own than with a preceptor. For me one of the hardest things to develop was the ability to defend my treatment plan for a pt. Experience gives you the confidence to do this, especially with hospital staff. Certain hospitals around here have notorious nurses that give you the gears about anything. Some things that I found that really helped me to prepare for ACP when I was a PCP: 1) Work lots, see lots of pts, preferably in a role where you are responsible for making decisions and developing a treatment plan and not being a glorified driver for an ACP. 2) Do rideouts with an ACP unit. 3) Follow up on all pts that you bring in, especially complex cardiac or respiratory pts. Talk to the ER doc, review the hospital ECG and the doc's diagnosis. 4) Do some prestudy. Not sure exactly what references you guys use but crack the books and review medical directives, ACP pharmacology and brush up on all your respiratory and cardiac patho. I found that when I revisted my patho a couple years after school I was able to really relate it to real life a lot more after seeing a few hundred more pts, rather than just learning in lectures/labs. 5) Forget physical skills for the time being. You will get lots of opportunity to practice IV's, intubation etc. 6) Become a leader. Most of the good ACP's I know are good leaders and role models. Think about mentoring young PCP students and be the type of paramedic where you are respected by everyone from the hose monkeys to the emerg docs.

Just got it. Basically agree with everyone else's comments. Looks like it will become one of the required texts for our revamped CCP course here in BC. Looks like sunnybrook got CMA accreditation for their CCP. If it wasn't 18 000 I'd definitely think about going to take it.

VS-eh come west young man. You will have combitubes, benadryl, gravol and as many 12 leads as you want. I agree with kevkei. Especially when you are starting out, you need to see the low acuity pts to learn to differentiate the sick from the not so sick. Establishing you differential diagnosis for something like chest pain requires pratice and exposure to lots of different pt presentations.I would say in Vancouver you would average between 7 and 19 calls per shift on a BLS unit and 6-10 on an ALS unit.

Th ebest thing you can probably do for this guy at a PCP level is assist ventilations with a BVM to lower his blood pressure via the respiratory pump mechanism and increase his intraalveolar pressures. Cardiac asthma is almost never ruled in or out by auscultation findings alone. The biggest indicators in this pt will be the history. Does he have: SOB on exertion? PND? Orthopnea? New onset nocturia? The elderly are rarely diagnosed with asthma (usually a misdaignosis by their GP) Is he a smoker/COPD Hx? Any cough, in particular non-productive or whitish? Fever/chills/pleuritic CP to indicate pneumonia? He most likely has a Hx of hypertension as well. Any drugs like ACE inhibitors/beta blockers/CCB's etc should really raise you index of suspicion. What is his I:E ratio? He is also hypoxemic, tachycardic, diaphoretic and hypertensive. While not unique to CHF it certainly raises my index of suspicion right away. Giving this pt epi will probably kill him or at least make him seriously sick. The last thing this guy needs is more afterload and a higher myocardial oxygen demand. Moving this pt is going to be tricky and will need to be very gentle so his dyspnea is not aggravated.

I am interested in obtaining copies of Edmonton and Calgary EMS medical directives. I have searched extensively online but have been unable to find any Alberta EMS medical directives. If anyone can help me out shoot me a PM. Thanks.

Well to be honest I haven't totally lost faith yet. Since I started in EMS 8 years ago, the education requirements have been slowly increasing every year and I think we are getting some really good young people into our service. They are green and definitely need mentorship and experience but they're gung ho. I don't care how dumb you are, with a good attitude you will eventually become a good EMS provider.

VS I believe you are right about the 20 tube minimum being a CMA thing. We also had to have a min of 20 tubes in the OR but everyone in my class did at least 50 between OR and preceptorship.

I think a big factor is not just initial training but also continuous exposure to the skill of intubation. With more and more all ALS systems on the market in North America, there just isn't enough intubations to go around. A simple tenent of any branch of medicine is the more you do the better you get. Nobody in my service does less than 40 tubes a year. Our most recent QI data shows a 97% success rate with no unrecognized esophageal tubes (We also don't have RSI). Our number one area of failure is actually in cardiac arrest in patient's with a grade III or IV airway according to the data.

At the JIBC here in BC we use the Canadian edition of EMR and the workbook for EMR. For PCP: Merck Manual Essentials of Paramedic Care Canadian Edition (great books) Porth Pathophysiology: Alterations of Human Body Function For ACP: Mosby's Paramedic Text Porth Pathophysiology ECG workout On Call: Principles and Protocols Anyone Can Intubate ACLS + ACLSEP PEPP NRP Clinical Assessment and Manifestations of Respiratory Disease (quite a good book meant for RT students) Physiocontrol Essentials of 12 Lead for Prehospital Providers Lilly: Pathophysiology of Heart Disease (wicked book used here in 2nd year med school, everything you need to know about cardiac abnormalities explained in a straightforward manner) CCP: Entire program currently under review

We discontinue 99.9% of our codes in the field in Vancouver unless there is some kind of extenuating circumstance.

If you take the EMR course here in BC then it meets all the requirements for industry first aid. I think there are at least 3 agencies now that are accredited by the Alberta College of Paramedics (i.e. you can take the course in BC and automatically write the ACP exam). There are lots of EMR jobs here in the gas industry and there is a huge construction boom right now from the Olympics.

very similar to us. Our intubation success rate is about 96% and I think has gotten better since we got bougies in our system. It would be nice to have paralytics but our medical directors seem to have a similar philosophy to yours. Is Dr. Sookram still your director?

Hey Kev I heard you guys have an RSS protocol in Edmonton. What do you use and how do you like it?

Dextrose 10% D10W

We started carrying it a year ago and i've used it twice on big bloody trauma airways and loved it. They're dirt cheap I don't know why more agencies don't use it. It's way cheaper than other stuff like view max etc.