EMSEDU

Tories' grand plan for health a little unsettling Don Braid, Calgary Herald Published: Tuesday, December 16, 2008 Health Minister Ron Liepert has said candidly he doesn't want to unveil his whole health care plan all at once, in case he "scares the hell out of people." Now we can see the whole plan, pretty much, in the McKinsey report that was slipped quietly onto a government website on Monday. This document sets goals that seem impossible to achieve. Yes, it's going to scare the hell out of people. In a fascinating section, the report says if all its reforms are implemented, the annual operating cost of health care will be reduced by $1.5 billion by 2020. The population will rise sharply, but somehow Alberta won't need as many health care professionals --5,000 fewer nurses, for example. This is either magic or a recipe for sharply declining health care. The cost projection is also at odds with the minister's own words. Liepert insists at one news conference after another that his measures so far "are not about cost-cutting." He says operating costs will rise next year, although at a slowing rate. Yet, the report shows cost-cutting --not relative, but absolute--is a major goal of the reforms. Liepert insists the goals are not unrealistic, though. "A lot of what they've uncovered is what's been wrong with the health-care system all along--it's incredibly inefficient," he says. He's undoubtedly right in theory, but in the real world it's hard to imagine a system that costs less providing better care for more people. There can be no doubt the role of rural hospitals is about to change radically. The future state of those hospitals, the report says, will be marked by investments in ambulatory care centres, tele-health, selected rural hospitals and EMS. Crack the code and the message is: Alberta will have fewer rural acute-care hospitals. Some will be converted into what those of us who don't write bureaucratic reports would call clinics. The system will rely on ambulances to get sick rural people to city hospitals. The trend that spread across Saskatchewan years ago is coming here. In fact, some patients in big cities are already being steered to smaller hospitals for elective surgeries. This may mean communities near Edmonton and Calgary will keep their full-service hospitals. What it means farther out is much less clear, although getting sick in High Prairie might not be a good idea. This rural reform could prove to be the toughest thing the Stelmach government ever does, because it will inflame passions in the Tories' rural heartland. If you've wondered why they moved with such blazing speed to uproot the old health regions, here's your answer. No rural regions exist to raise the alarm at hospital closures and conversions. Meanwhile, the report is full of doomsday predictions about what will happen if the system isn't changed. By 2020, Alberta will need 32 per cent more acute-care beds, 51 per cent more long-term beds, 39 per cent more doctors and 40 per cent more nurses. Acute-care beds in Calgary hospitals, 92 per cent full now, will run at 97 per cent occupancy. The dying David Thompson region (Red Deer area) will rise from 89 per cent to 110 per cent. Nobody wants the status quo in health care, but this utopian report tries to convince us the government can completely reverse these trends in a growing province with fewer staff and less money. Frankly, the grand plan sounds impossible-- and that's scary. Dbraid@theherald.canwest.com

Two quick thoughts - waiting until this situation is fait accompli is a dangerous plan. And I wouldn't count on an "uproar" from the public, especially a public who has no idea what the differences are or what it would mean to them. There is a reason why clear and decisive information is not being made available. Think about it.

According to this, when the city trimmed it's budget to reduce the tax increase they got rid of the EMS budget that Bronco originally allocated. I also doubt that the city would top up the budget, especially after the fiasco that was contract negotiations last spring. If the province says they can run it for less, the city would jump at the chance to move the funding elsewhere. But then, there is no funding anymore anyway. Calgary city council approved its first major cut to the controversial 2009-2011 budget Tuesday evening, as it continued to go through the document line by line looking for more places to trim. Aldermen approved Mayor Dave Bronconnier's suggestion to remove the operating costs for the city's Emergency Medical Services from the budget, after the province pledged to take over that responsibility effective April. By removing the $15.1 million in EMS expenses for next year from the budget, the council was able to bring down the proposed property tax increase for 2009 to 7.8 per cent, compared to the 9.6 per cent originally proposed. Council also managed to trim another $1.3 million in other expenses on Tuesday. That barely puts a dent in a proposed $2.5-billion operating budget for 2009, but council was only a quarter of the way through the budget documents by mid-afternoon. To make the cuts, council members have agreed to trim funding for consultants, cut four new jobs in park maintenance and delay hiring some staff in the asset-management department for six months. Council Trims Controversial Budget

No, you didn't imagine that, I read it as well, and in fact, mentioned this to my buddy, but he said that the city can do nothing to stop it even if they wanted to, which they don't. The province backed down 3 years ago but it won't happen this time: The province is hell-bent on going forward with this, even as members of their planning committee are admitting that the time allotted to plan this transition is ridiculous.

Recently was out for drinks with a very high-ranking City of Calgary employee whom I trust implicitly. He related to me a conversation that he had with a equally high-ranking member of Calgary EMS management. Apparently, during a recent meeting between members of the "planning committee" in charge of the transition of EMS to the Province and said member of management, it was indicated that the budget for Calgary and area (read: Southern Alberta) was significantly lower than the current budget for running Calgary EMS alone. When the "planning committee"member was asked how they planned on running Calgary plus surrounding areas on a budget that is more than 4 million dollars short of what it takes to run Calgary alone, the answer was "get rid of the Paramedics, go BLS except for a few speciality units, which would respond to ALS calls". Said "planning committee" member went on to defend this practice by claiming that with such a short planning/transition period, this was the ONLY possible solution and that the province was providing them with an impossible budget. I completely admit that I'm hearing this 3rd-hand, and the actual conversation may have been distorted by the time it reached me. However, if there is even a grain of truth to this, then my colleagues in Calgary and elsewhere need to be aware of the potential eradication of their jobs. I don't know about you, but I plan on being pretty damned persistent in trying to find some answers about this transition and ending the speculation. And as for a provincial union... hurry hurry hurry!

Word on the street today is this is the last straw for a LOT of people. It may sound nice on paper but unless they bring some people with actual field experience into the decision-making process, this may end up being a huge step backwards. I'm very interested to see how they plan on pulling this off.

Alberta Health & Safety Training has an ITLS Trauma course posted for June, last I checked there were 8 spots left.

All rightie then. You can just continue to call yourself a "paramedic" in Alberta and see how much respect you get from your EMT-P co-workers. Clearly, everyone involved in PAC/ACoP has no idea what they're talking about, no education to back up their decisions, no experience in this area. You, obviously, know more than they do and are in a better position to make decisions. Yes, it MUST be that I'm being "fed" from ACoP, couldn't have anything to do with working along side with PAC, CMA, etc etc. Couldn't be that I'm simply educated in the processes and history, must be that I just buy into whatever I'm told. Yeah. Sure. That must be it.

hahahahahahahahahahah oh that was good.

How helpful.

Ummm, no, actually GAP training had very little to do with the NOCP, it referred to changes in the AOCP. :cyclops:

"Did you read this whole thread?? First off I cannot obtain my EMT-P because that course is not offered in Canada anymore!" Uh... yeah, I don't know how you can justify that statement. EMT-P is, of course, offered in Alberta. And believe me, ACoP will not be changing the title anytime soon. Check your registration card, and tell me what it says. Even if all EMT-P courses in Alberta are recognized at the ACP level by CMA, they are still designated as EMT-P Programs. Ditto with EMT/PCP. Because if they weren't, they would not include the AOCP.

www.calgaryparamedics.com I'm pretty sure they are talking per day per Calgarian.

Worried about a half-baked, scab version of EMS? Don't be ... the walkout won't happen UPDATED: 2007-07-20 01:39:45 MST By RICK BELL Union votes to strike Strike but no strike. The moves on the chess board will be made but there is no reason for fear or loathing. Our ambulances will not disappear from Calgary streets. Citizens will not face some half-baked contingency plan where city staff with basic ambulance operation and first-aid training try to make Emergency Medical Services work. Such is the commitment of Iris (Not An Idiot) Evans, the province's minister responsible for labour, who is also a Calgary-trained nurse and former Alberta Health head honcho. Yes, our world-class paramedics voted 354 to 4 this week for a strike and their union execs discuss today when to serve a three-day notice of a walkout. Yes, the paramedics will give the 72-hour notice, probably sometime early next week. But the province, as the clock ticks down the 72 hours, is expected to declare an emergency exists and send the city and the paramedics to an arbitrator who will impose a deal binding on both sides. A strike will have been called and paramedics will come close to hitting the bricks but a strike will not actually occur. Paramedics will be sent back to work. Calgary EMS will be treated as an essential service without being an essential service written in law. "The bottom line now is we're not going to let Calgarians be put at risk. We can't have an interruption of service. We're going to effectively stop any public emergency," says Iris, who speaks similar sentiments when she meets with the Sun last week during a Stampede visit. "The process can be put in place and start right away." Mayor Bronco insists the city has the bases covered with a backup plan using EMS management in ambulances and other city workers as drivers. "It will not provide the service Calgarians have come to expect," admits Bronco. No kidding. The mayor even offers voluntary arbitration, a case of too little, too late. Iris says she remains "always hopeful" the city and paramedics can somehow come to an 11th-hour handshake, but she's a realist. And, also as a realist, Iris is almost certainly not going to use the provincial government's other option, to send the mess to a mediator who can stall the strike but only offer a suggested settlement either side can punt. In this dispute, the two sides are too far apart. Mediation is a waste of time. The city offers 12% over three years, paramedics want 18% plus an adjustment of the pay grid adding up to a total 30% hike over three years. Even the United Nations can't bridge that kind of gulf. Grumblers may not like these numbers, but EMS staff do a stand-up job, their skills are much in demand and there is already a shortage of trained people here. And, in case you didn't notice, the cost of living is booming and the tide of this boom isn't lifting all boats equally. The show-and-tell set can't mouth about how much money they're making and then expect those without a seat on the gravy train to not want a slurp of the sauce. Besides, the strike vote shows how united the paramedics are in their position. The membership is very unhappy, frustrated over their dough, especially when compared to some other city workers, and peeved about short staffing where some paramedics are on the job upwards to 60 hours a week. The move of Iris to grab the gong and end the show is not going to create too many sobs over at the paramedics union HQ. "They'll do what they do and we'll follow," says Bruce Robb, president of the paramedics union, a man who has been through over a year of back-and-forth blither and blather with the city and still has somehow managed to stay on an even keel. Bruce says they've tried everything to get a deal. Going to a third party for a binding agreement is a gamble but the odds at this table aren't bad. "Shouldn't they have been bargaining rather than building a contingency plan providing half the service or a quarter of the service?" asks Bruce. "We've tried. At some point the employer has to take responsibility. Every once in awhile you have to re-right the balance. This is the day." There is a day to vote for a strike, a day to notify the city and the public of a strike but not a day to go on strike. I guess our paramedics provide us too valuable of service to risk a game of chicken. Hope their value will now be acknowledged. - Calgary Sun.

This is on the Union website... take it as you will. I found it very interesting. BACKGROUNDER FACT SHEET • Calgary Paramedics received their last wage increase in late December 2004. • EMT-A employees are the Crew Members on an ambulance unit. These employees receive 1 ½ years of training with Basic Life Support. Their starting wage rate is $21.96/hour. After 23 years an EMT-A earns $26.70/hour. The annual start wage rate is $47,960. The annual wage rate after 23 years is $58,312. • EMT-P employees are trained in Advance Life Support. This certification requires 3 ½ years of training. The starting wage rate for an EMT-P is 23.74 for an annual wage of $51,848. After 23 years the wage rate for an EMT-P is $30.26 for an annual wage rate of $66,087. • Crew Chief is the employee in charge of the ambulance unit and they are required to be certified EMT-P. The starting wage rate for a Crew Chief is $30.26 per hour. The annual rate is $66,087. After 23 years a Crew Chief earns $33.53 per hour for an annual rate of $73,229. • EMS service in the City of Calgary costs Calgarians $1.81 per month. EMS represents 6% of what the Calgary taxpayer pays for Fire, Police and EMS service. Police service costs taxpayers $16.03 per month and Fire $10.03. • Calgary EMS receives 25% of 911 calls. In 2006 Calgary Police handled 107,152 emergency calls. Fire responded to 35,252 calls. Calgary EMS responded to 95,178 calls. • Calgary EMS has the fewest number of employees in Calgary’s emergency response system. Police handled 68.2 incidents per employee. Fire handled 33 calls per employee. Calgary EMS responded to 190 calls per employee. • A city employee who sends out the ambulance bills to users receives an hourly start rate of $22.05 and achieves their top wage rate of $29.49 after 4 years. • A city employee who cares for sick and injured animals earns $23.48 per hour as a start rate and $31.40 per hour after 4 years. • A city employee who test our drinking water quality is paid $25.01 per hour on hire and $33.44 after 4 years. • A city employee who answers and dispatches 911 emergency calls receives $23.98 as a start rate and $31.76 after 7 years.

Calgary EMS Meets Gold Standard Emergency Medical Services The Commission on Accreditation of Ambulance Services (CAAS) was established to encourage and promote quality patient care in America's medical transportation system. Based initially on the efforts of the American Ambulance Association, the independent Commission established a comprehensive series of standards for the ambulance service industry. Accreditation signifies that this service has met the "gold standard" determined by the ambulance industry to be essential in a modern emergency medical services provider. These standards often exceed those established by state or local regulation. Calgary Emergency Medical Services has officially received recognition as a "gold standard" service, after being awarded accreditation by the International Commission on Accreditation of Ambulance Services (CAAS) External Site.. Calgary EMS takes great pride in receiving this accreditation, being only the second Canadian service to be recognized in this fashion. The process includes a comprehensive self-assessment and an independent outside review of the EMS organization. This independent process provides verification to your Board of Directors, city council, medical community and others that quality care is provided to the community. All ambulance systems are eligible for the three-year accreditation including private, public, fire department and hospital-based. For more information you can visit the CAAS website.

EMS strike vote starts today UPDATED: 2007-07-16 01:26:03 MST City says contingency plan in place as union members head to polls By KATIE SCHNEIDER, SUN MEDIA The fate of ambulance service in the city will be in the hands of union members this week when its more than 400 Calgary EMS staff head to the polls starting today. With a sizable wage gap between what is being offered and what the union is seeking, contingency plans are being made for the event of the a strike, city spokeswoman Vickie Megrath said. However, if the union does decide to strike, Megrath said EMS service will still continue. "Public and health safety is of primary concern," she said. "We do have a contingency plan in place." Though fewer ambulances would be on the road, managers who are trained paramedics will staff them and be available to care for patients. She said the city values its EMS employees and the job they do and is willing to continue negotiations with the union. "Our primary goal is to reach a negotiated settlement with them," she said. The union is seeking a 30% wage increase over three years including market adjustments to the base pay and the city is offering a 12% increase plus shift differential and a supplemental pension plan. Megrath said the 12% increase is in line with what the city and transit union settled on during their negotiations in June. It is also affordable for taxpayers, and would keep the city's paramedics among the highest paid in Western Canada, she said. Polling stations will be set up at four locations in the city and open for seven hours, today through Wednesday. Bruce Robb, president of Canadian Union of Public Employees Local 3421, said the strike vote will give members a chance to have a voice. "I'm hoping the members make a decision and I'll respect that decision whatever it is," Robb said. The Alberta Labour Board will notify the city of the results on Thursday. __________________ EMS to decide on strike notice City digging in, say 'fair offer' was made Sean Myers, Calgary Herald Published: Monday, July 16, 2007 Calgary EMS workers are deciding over the next three days whether to issue a strike notice as the city accuses the paramedics union of demanding an unreasonable pay raise that totals 30 per cent. The city ran newspaper ads on Sunday saying the 18 per cent raise the union has asked for combined with the market and pay grid adjustments also demanded actually total a 30 per cent bottom-line increase. That's well above the 12 per cent hike offered by the city during negotiations. "We've made what we feel is a fair offer that will see Calgary paramedics continue to be the top paid in Alberta and the second highest paid in Western Canada," said city spokeswoman Vickie Megrath. The average paramedic salary last year, according to T4 slips, was $75,000, said Megrath, and the union request would put that average over $100,000, she claimed. "That's not affordable to Calgary taxpayers," said Megrath. "We value paramedics and what they do, but we also have to be answerable to Calgary taxpayers." Bruce Robb, president of the paramedics union, said a suggested percentage for the market adjustments has not been finalized. "Those are the city's numbers, not ours," said Robb. "I'm not prepared to debate this through the media." Over 400 EMS workers are eligible to vote today through Wednesday. Robb described a strike vote as a tool to be used in negotiations. Both sides said they are willing to go back to the table to come to a negotiated solution, but Robb didn't seem optimistic. "They haven't talked to us since the talks went south in mid-June," said Robb. The city has been asking the province for several years to declare EMS an essential service along with police and firefighters, which would remove their right to strike. Premier Ed Stelmach has said he is in favour of the move and was awaiting a report on the issue from Employment, Immigration and Industry Minister Iris Evans. If the province determines that a strike action is a threat to health and safety of Calgarians, it could intervene by ordering a disputes inquiry board or recommending the lieutenant-governor declare an emergency resolution tribunal, which is binding. "We are monitoring the negotiations very closely," said employment, immigration and industry spokeswoman Lorelei Fiset-Cassidy. Paramedics have been without a contract for almost a year. The city is offering a 12 per cent increase over three years and a 10-cent increase in the hourly differential to 85 cents. The union wants five per cent for the last six months of 2006, five per cent in 2007 and 2008 and three per cent in the first half of 2009. As well, it is asking for a market adjustment that would be retroactive to the end of June, which would range between nine and 11 per cent. The union wants to see the hourly differential double to $1.50 before the end of the contract. smyers@theherald.canwest.com

Oh the irony: Calgary EMS wins 'Excellence in EMS' award ZOLL Data Systems, Inc., a wholly owned subsidiary of ZOLL Medical Corporation, announced the annual 'Excellence in EMS' award winner at Summit 2007, their annual users conference. The 2007 award was given to The City of Calgary EMS, located in Alberta, Canada, the fastest growing province in the country. The entries were judged by a panel of executives from fellow EMS services. The EMS organization entries were judged based on four core values: * Patient-focused excellence * Valuing staff * Social responsibility and community health * Managing for innovation The award finalists were The City of Calgary EMS in Canada, Cypress Creek EMS in Texas, Leon County EMS in Florida, Montgomery County Hospital District in Texas, and Pinellas County in Florida. Established as its own entity in 1984, The City of Calgary Emergency Medical Services is an Advanced Life Support, third emergency service of the municipal government. Serving the needs of a municipal population of just over 1 million, the service responds to an average of more than 113,000 calls annually. "Calgary EMS is thrilled and honored to receive this award," said Terry Abrams, ePCR Project Manager at The City of Calgary EMS. "This award is really a tribute to our staff, and the progressive environment in which we work," he continued. To demonstrate their ability to manage for innovation, Calgary EMS has produced a ten- year "view of the future" report anticipating changes and future trends such as aging in place, the graying of the baby boomers and its effect on call volumes, changes in technologies, the rate of staff growth versus the rate of employee attrition, changes in health care consumer attitudes, hospital capacities and construction trends, and utilization patterns for acute care and ambulances by community. To date, two forecasting reports have been created: Planning for EMS in 2010 and Planning for EMS in 2015. "We are continually striving to improve service to our community with a focus on patient care. This award recognizes our efforts," added Mr. Abrams.

Wow, I'm appalled at the message from the city above. It is extremely misleading. Yes, most definately that figure $75000 includes vast amounts of overtime, one only has to look at the hourly rates to see that without overtime that figure is impossible. Secondly, the city is completely overlooking the fact that CEMS now hires more and more EMTs, and I can assure you that their salary is nowhere NEAR the above figure. Here's some food for thought for you: The city staff who do scheduling for Calgary EMS make more than the people they are scheduling.

Honestly, most EMTs I know who work for CFD are not interested in crossing over LOL! Let's not forget, however, that the city owns the ambulances, so technically that solves the transport issue. Don't forget, with the exception of 5-10 stations, EMS here are based out of fire stations. Let me rephrase, they share stations. It will be an interesting few weeks here, that's for sure. I'm interested to see what will happen with patients being deserted at the hospital - if no-one has taken their patient by the end of their shift, as a refusal of OT are they just going to walk out? We'll see I guess.

As noted, 1991 Calgary EMS went on strike and it lasted for 11 days (if I remember correctly). In place of EMS, we had bus drivers driving Dr's around to calls. Somehow, I don't think that this will please transit workers, who just finished their own strike. In addition, population in Calgary has probably come close to doubling since '91. I do know a couple of people who have received "soft" calls from the city, inquiring if they would be willing to work casual in the event of a strike. Most of them will not cross the line against other workers, even if they are not union or calgary employees. It's nice that CEMS is waiting until after the Stampede to take a strike vote, but work-to-rule during Stampede is going to create a huge disaster, since most of it is overtime. Now, Calgary Fire has been requiring all applicants be a minimum of EMR for the last little while. A good number of those who started with CFD in the last year or so are actually registered EMTs. I guess we'll see what happens. Just for a frame of reference, I know several waitresses in Calgary who make $25.00hr before tips, plus benefits. Tim Hortons is paying $17/hr these days. A decent secretary in Calgary makes $28+/hr.

EMS work to rule Paramedics will refuse overtime in lead-up to post-Stampede strike vote Kim Guttormson, Calgary Herald Published: Tuesday, June 26, 2007 The city's paramedics will start working to rule as of Thursday and will hold a strike vote the week after the Stampede is over. Bruce Robb, president of the paramedics' union, said his more than 400 members will start refusing overtime shifts. "To make up for the staffing shortfall, our members are regularly working overtime on their days off," Robb said. "It's not unusual for members on their days off to be called two or three times to come into work." The union, CUPE local 3421, also voted 99 per cent in favour of taking a strike vote. After talks with city negotiators and a mediator broke off last week, a 14-day cooling-off period began. While the paramedics are in a position to hold a strike vote as of July 7, Robb said they will wait until after Stampede to cast their ballots. Voting will take place the week of July 16. They would then have to give 72-hours notice before walking off the job. The only issue in dispute is wages. The city has offered 12 per cent over three years, while the paramedics are looking for five per cent in each of the three years, along with a one-time market adjustment of between nine and 11 per cent, depending on the job. The premium for night shifts is also in dispute, with the city having offered a 10 cent increase to 85 cents an hour. Paramedics, unlike police and fire, are not an essential service and can go on strike. However, the province can determine that strike action is a threat to the health and safety of Calgarians and intervene. The minister of employment, immigration and industry could order a disputes inquiry board, recently used with ambulance workers in Flagstaff County, who reached a deal last week. The board, which would prevent EMS from striking, uses an independent third party to clarify issues. The minister could also recommend the lieutenant-governor declare an emergency resolution tribunal. An EMT makes $21.96 an hour to start, with a top wage of $26.70 an hour. The hourly wages for paramedics range from $23.74 to $30.26, while crew chiefs make $30.26 to $33.54.

A few things to consider: 1) very few CEMS medics want to strike - however, the city knows that the public will look down on such action, and are using such knowledge as a bargaining tool - as in, calling their bluff. CEMS knows that the ONLY way to negotiate with the City of Calgary is to strike. It has been proved previously, in CEMS and in other City Services. 2) there will still be ambulance service in Calgary. the list of non-union EMT/EMT-Ps is long, and i expect they will receive calls from the City this week to check on their availability in the event of a strike. 3) if the City is smart, they will zip it and start being a little generous. CEMS is losing employees daily to the industrial section. the city spent a fortune in the last 12 months recruiting for new medics and emt's. they could have saved their money if they treated their employees better to begin with. 4) every calgary medic paid close attention to contract talks between the city and fire in the past few years. i don't think the medics are asking too much by expecting to receive pay that is equivalent to fire. and i'll bite my tongue now and leave it at that.

je ne comprend pas. what makes you sick regarding this issue? on a side note, the average salary comment - $75,000 - that is total and complete BS. Do the math based on the first post - which is an accurate portrayal of the hourly wages, and it is impossible for the average salary to be $75,000. Typical of the Calgary Sun...their "journalism" skills are always... interesting. Time to write a letter to the editor!

I'm not suggesting that the ACP pass rate is the be-all end-all of decision-making tools. However, if you can't make it past ACP, you won't ever have a chance to demonstrate all the other potentially fabulous things you were taught at your school. It's a hoop everyone has to go through. There are good schools out there who can 1) teach you how to succeed at ACP and 2) prepare you for how the real world will work as well. I know students who were so-called "honour students" at their school and failed ACP 3x. To me, as an educator, that means that the institution in question is NOT doing their job properly. I have posted previous posts regarding advice on how to choose a good school for EMT training, and asking about the ACP pass rate is just one of the many steps I suggest. Here are some of them. 1- ask for the employment and graduate data. All schools in AB are required to submit this info to Alberta Learning on a yearly basis, and are actually required to provide it to prospective students. 2- find out where their practicum sites are, and go visit - ask questions about the quality of previous students that have come from that school 3- go visit the school. I can't believe how many students choose to spend upwards of $4000 on schools they've never seen. Ask to meet the instructor. Ask to sit in on a class to see the quality of instruction. 4- find out the ratio of instructor/students for lab/skills days 5- compare the method of delivery - are you going to be doing most of your learning on your own, or will you have a full time instructor to help you? 6- how often will you be doing labs or skills? who will be instructing you on skills? how many hours will you be working on skills vs. didactic? 7- are there guest speakers? Will you be learning how to write a proper PCR? Are there field trips? 8- what is the marking scheme? Are there exit points in the program? Do you need a 50% to pass, or a 90%? 9- ask to meet the administrative team. they will be interviewing you - you have every right to interview them first. 10- go with your gut. but educate yourself first. I always recommend to EMT candidates - make a chart. Be organized and thorough about your search. Know what your options are, and know what the potential consequences (postive or negative) are with your choice. I am always amazed that there are students out there willing to spend $4000 on a product they know nothing about. There. All the advice I have to give today LOL.