HellsBells

Fair enough, I read through your statement and realized that I misunderestimated your original post. However, without getting into an argument on gun laws in America vs Canada, I will simply restate my position that I have never in the past, nor presently feel the need to arm myself, I do however own and use a protective vest.

Wow, Fox I like that uniform shirt you posted the link for, ts a really sharp looking design.

I think that carrying pepper spray on duty is a terrible idea, at least if you panic and decide to spray the patient in the back of the ambulance. As far as the issue of carrying a gun on duty, I've never felt the need to do so, and never known anyone who has done so. Of course I live in Canada, where the idea of carrying a concealed weapon is basically unheard of. I do however, think that wearing a ballistic vest is a good practice and offers some protection from both physical assault and blunt trauma related to MVC's. I think that the most prudent course of action is to retreat and leave the scene in these cases. If your gun truly is well "concealed" how long will it take to remove it and defend yourself with it? Are you seriously saying that you would consider shooting someone who was altered due to a diabetic emergency? There is always the what if scenario where one is confronted by violence they can't safely walk (or run) away from, but I think those instances are rare. But, I do agree that in instances where society breaks down (i.e. Hurricane Katrina, LA riots) it would be good for piece of mind to be packing some heat.

Lets not get ahead of ourselves quite yet. This is the proposed model coming forth in April, and nobody knows exactly what things are going to look like yet. There has been a lot of talk about increasing the autonomy of paramedics here, but little actual detail an how that is going to be achieved. Obviously there is going to have to be some changes in training, protocols, and in the whole concept of medical direction as we know it Check out this thread for more info... Alberta Takes a Huge Step Forward

Thats wonderful advice if the seizure is lasting 3-5 min, but a sustained grand mal seizure lasting for 20 min requires some sort of intervention. Think about the physiological process in an actively seizing patient, how much oxygen do you think he is getting if there is a seizure lasting for 20 min? What effect could this hypoxia possibly have on his future brain function? Do you think he will get better oxygenation with the O2 you are trying to give him as he seizes, or at the hospital where he can receive medication to stop the seizure. These are questions you should ask yourself to guide your treatment.

How many blowhard, egomaniacal, former paramedics with an I told you so attitude are too many? Why don't you give us all a break? This is a isolated case, and does little to prop up your opinion that all cancellations should be monitored by a supervisor. It actually is a perfect example of the need for educated practitioners and hiring/ training practices that weed out incompetent paramedics.

Little person, They prefer to be called a little person

I know I know, It was stupid, but I learned never to do it again.

One particular case sticks in my mind reading this forum. I am usually quite particular about checking the equipment list before my shift. However, on one occasion the previous crew stated they didn't do any calls that day and the unit was fully stocked when they checked in the morning. They did have a transfer from the hospital to the airport to return a NICU team to their plane, but nothing else. I thought to myself, OK ill trust these guys, no need to check the unit. We arrive at our first call, a man with chest pain. I open the rear doors, there is no stretcher in the back... oops. Turns out the crew had left it in the hospital when they loaded the air teams equipment and forgot to pick it up. So, now I always make sure to do a full check no matter what anyone says.

Well, Beyond the call for a provincial union, has anyone heard anymore news from the province. The change is only three months away and I have heard zero new input from the province as to what the transition will look like.

Kaisu, I wasn't trying to start a bash USA thread, I have nothing but love for our neighbours down south, but I live in Canada, there are differences in our medical system and I think that our textbooks should reflect that. Thanks DocHarris I will try to see if I can get a copy of that text.

IF there is already a signed refusal form, why do you think that the word of a another "supervisor" who talked to the pt over the phone would hold any more weight? In our service our refusal forms must also be signed by a competent family member or friend, I think that that is all the safeguard one needs.

...and you never answered the question, how can a supervisor render a competent medical assessment via phone?

I have a problem, because its a bad use of resources, and it wont be needed, if the EMS service takes the time to unsure they have hired the proper staff. Supervisors have other jobs to do besides babysitting crews. Not only that, how on earth can a "supervisor" render a valid medical assessment over the phone?

Ok, in response to your question of what would we suggest to fix the problem (which I'm not sure even exists in the first place), I guess we could all start protocols stating that we transport all patients, no matter what the compliant. Some services do have that policy. However, start doing things that way and we have a number of other problems. For one more ambulances are tied up transporting patients unessesarily. The EMT's and Paramedics get burnt out faster, because management places no value on them and they don't use critical thinking skills, it just becomes a you call, we haul mentality. Emergency rooms get backed up with all the non-emergency patients that EMS has brought in and crews get to sit in the hallway all day or night with the patients they have brought in for no good reason. Not a good way to do business in my opinion. Actually, the real solution (and its been mentioned on this sight many, many times) is better education. Prevent the medics and EMT's from getting burnt out in the first place. Have a hiring process that hires competent and educated medics. Make sure continuing education programs are in place to keep employees up to date. Fire people who can't or wont keep up with training and continuing education. Furthermore, let the Paramedics do their job, if they are trained properly there should be no need to call a supervisor for every refusal. Oh and one more thing, specious statements like "just one death is to many" are completely meaningless.

Yeah, I have the same supplement for my text; but is that all we get? A thin little booklet packaged in with the canadian version of the textbook? Granted, its not that huge of a deal for me, as most of the content applies. However, its just kind of annoying to read about blood glucose tests in dl/ mg and not as mmol/L, or to read that I must call medical direction to give any drug for any reason, etc.

Ok, I tried your little test, then I put in the statement doctors blamed for death, and doctors sued over death, there were a lot more hits for those. There are major faults to your logic, which I think you have to address. However, lets talk your statement at face value. Your Hypothesis (if you can call it that) is that of all the 911 calls 250, 000, 000, there are 2,500,000 that result in death. There are two major flaws with that logic 1. You assume that these pts would have lived with transport to the hospital, even with the best care from all medical providers, some pts will die. 2. You assume that any error or omission from a paramedics care will result in death. Believe me there is NOT 2,500,000 deaths occurring a year due to failure to transport, it would not go unnoticed.

In another thread about declining ACLS standards tniuqs made a point about Canadian Heart and Stroke just adopting the US guidelines, and this got me thinking about a subject that has annoyed me since I was in EMT school. It seems like the vast majority of texts we get for school are from the US, all the references to laws, and regulations are specific to the US. So, I was curious if anyone uses a text that is written and published in Canada for Canadian providers. If not, why the hell isn't there one?

crotchitymedic I fail to see what purpose a supervisor talking to you over the phone would serve. If a pt is of sound mind they can choose not to go to the hospital, you can't force someone who has made up their mind not to go. However, if I believe that a pt is in serious trouble, I will do everything in my power to convince them to go, including calling a doctor and having him try to convince the pt to go. If the pt still doesn't want to go document well and obtain a signature.

I admit it, I am much more of a lurker than a poster on this site. At the moment, I am studying very hard for end of term finals in my paramedic program. So, the time I spend here is mostly just for a break, and to see if there is anything worth reading about. I don't always find the need to post, as a lot of the time things progess quite well without my input. For example a recent scenario subject was about a college girl having a dystonic reaction with her head stuck, looking up. I found the discussion very interesting, as I had very little knowledge about the subject. However, by the time I read the thread there was nothing left for me to add on the matter. So crotchity I am not scared, I just don't care enough to respond to every subject.

...And to add to that, don't worry so much about whether it is right or left sided, treat the symptoms. Does the patient have pulmonary edema related to CHF? DO they have a decent BP? If so treat with nitrates, and so on...

Did you beat her in Kansas?

OK, you're a Whacker So, whats the alternative here? Carrying the whole bag around your leg?

Well no-visualized airways don't really protect against aspiration the same way intubation does, nor do we have sedation or paralytics. Yes, I agree that you shouldn't even be attempting to give activated charcoal if there is any chance of airway compromise. That said, I don't really know why activated charcoal isn't in our scope of practice, but that was the only explanation I could come up with, maybe ACP has a better reason.

What do you all think of giving vasopressin to replace the first or second dose of Epi in a code?