rock_shoes

I find it interesting how heavily they relied on the BCAS model when discussing the efficacy of a targeted ALS model. Even someone on the outside looking in can tell AMPDS is the bain of our existence in a targeted system.

Which region did you interview in? If you haven't had any luck in a particular region you do have the option of applying to a different region.

Such amazing research from this team.

I wonder how much of a tongue lashing these two received from their wives.

Safe travels out there folks. On and off duty.

All the best to the four families as they grieve and slowly heal. On another note, why were they in an S76A instead of at least an S76C or one of the brand spanking new AW139's ORNGE just bought? Sent from my SGH-T989D using Tapatalk 2

Welcome. You'll find a fair number of Canadians on here to converse with. In addition to opening discussion with Paramedics and EMT's from around the world, you can expect to find input from nurses, physicians and RT's.

The easiest place to inquire is probably Alberta. I would recommend starting there. http://www.collegeofparamedics.org/ It sounds as though your education should be inclusive enough you can obtain reciprocity but that is going to be between you and the registration body.

The answer to the OP's opening question is very simple. Can you safely secure the patient article in question within the ambulance you're using at the time. If the answer is yes by all means take it along. If the answer is no then leave it behind. If the patient is adamant that they require said article make reasonable effort to ensure it is transported to the patient's destination.

For your perusal. http://eurheartj.oxfordjournals.org/content/26/19/2063.full.pdf

I would recommend focusing less on your students basic skills like vitals and more on their decision making process. Taking a set of vitals is EMT stuff. If they can't handle taking an accurate set of vitals forget the rest and boot them of your truck. What should make you nervous is if they fail to make timely and accurate patient care decisions. That's where a preceptor makes or breaks a student. Explore your student’s thought processes. Do they have errors in process, or knowledge base? Errors in process are where a good preceptor truly shines. You would have preferred your preceptor babysit you unnecessarily?

I'm a Paramedic working targeted ALS in Vancouver BC. I'm registered in both BC and Alberta.

I don't share in your displeasure HellsBells. This appears to be an earnest effort to ensure practitioners actually engage in continuing education as opposed to just clicking a mouse in CIMS. I agree the credit allotments are going to need to be tweaked (especially the AGM stuff) but that's doable. I sent Tim an e-mail this morning with a number of questions and look forward to his response. We have an educated paramedic professional at the helm right now. Lets give him a chance here.

Wow. Was a parking spot really worth criminal charges?

Beyond that ALS crews can consult the EP and call it earlier than 30 minutes. Entirely depends on the situation of course. In my own experience I have only transported a pulseless patient once since coming back as an ACP. The hospital was literally 2 minutes away, including the patient move, and the patient had a potential treatable cause we didn't have the drugs required to treat (Hydroxocobalamin for a patient pulled out of a house fire). I haven't encountered this particular issue. Most likely that's because ALS crews are considered to be on a relatively equal footing to nurses where I work. If anything nurses are considered a lower level of care than ACP's/CCP's in the out of hospital environment.

First off, sorry your agency's personal equipment policy sucks. Let's just carry half of the kit in our pants shall we! Secondly, I'm with everyone else. 5.11 makes great duty pants. I'm sure they'll have a style that suits you.

With the company I worked for this last September meals were included at the camp or you were paid a daily per diem ($40/day, non-taxable). All required equipment/medical direction was supplied (bring your own stethoscope if you don't like garbage and a pulse ox if you don't like hyper-oxygenating your patients). Flights to and from were payed for. Pay was $625/day for EMT-P/ACP, and $325/day for EMT-A/PCP. They were great to work for and took care of their people better than most public ambulance services. I ended up working both sides of the BC/Alta. border because I'm dual registered (something I highly recomend doing). The pay rates I quoted are predicated on being dual registered. If you're not you can knock $25/day off of the rates I just quoted. If I wasn't working targeted ALS in Vancouver right now I would work for these guys again. PM me if you're interested in getting a hold of them.

A&P and Pharm will get you through just about anything a paramedic class can throw your direction if you truly understand them. It really is that simple. All of the basic things like placing a patient in spinal precautions or basic wound management should have been covered off when you did your EMT program. The truth is being a paramedic is much easier than it's made out to be. You need three things to be a great paramedic and only one of them comes from your paramedic class. 1) Education: Not just your intitial A&P, patho, pharm etc. but regular continuing education. Paramedicine is in a constant state of flux just like every other part of medicine and you had damn well better be prepared to spend the rest of your career re-educating yourself. 2) Compassion: Grandma doesn't give a shit that you slotted the tube into her dying husband first pass like a total rockstar. She cares that you took a moment to let her kiss her husband of 50 years goodbye before whistling him off to the hospital where he is unlikely to survive to discharge. 3) Adaptability: Murphy's Law is reality. If you want to be great at this job you have to have your wits about you well enough you can tell Murphy to stick it. Anybody can take the education. Compassion and adaptability are things you either have or you don't. No amount of education will give you them.

Considering that EMT-B is little more than an advanced first aid course, I would recommend going to Paramedic School prior to setting foot on an ambulance. Depending on your circumstances/program availability either choose a minimum 2 year paramedic program that includes a significant amount of college level A&P/Patho or take said courses prior to starting into your paramedic. If you were in Canada I would say take a CMA accredited PCP program, get a couple of years experience, then do a CMA accredited ACP program (making sure to take programs with recognised credits usable to complete a bachelors degree). Overall education to become an ACP is typically 3 years full time study. Canada of course is an entirely differenct kettle of fish with many of our PCP programs including more educational content than the typical US EMT-P program (PCP is considered to be a BLS level). Once you have your education I strongly recommend spending some time in a system with targeted ALS deployment. Nothing sharpens your wits faster than having to decide ALS or BLS with every patient you assess and only carrying patient's you determine are in need of ALS care (BLS crews carry the BLS patients we don't abandon them).

My number one mission, if I'm ever to have a student, is to allow them the freedom to generate their own style. I only ever want to step in during a call if it's required for patient care. Do not interupt your student in the middle of their assessment! They may not do things in the same order you do or ask the same questions. That doesn't make them incompetent. It makes them different. The worst preceptors I've ever dealt with are the preceptors who strive to make little freshly minted carbon copies of themselves. It stifles creative process and in the end the profession. Secondly, discuss every call for better or worse with an open mind. What did the student find that lead them to the decisions they made? If there was an error was it an error in knowledge base or process? Both are very different. If your student struggles with something in particular share what your own experience has taught you about that topic. I've had preceptors both great and atrocious. Without fail atrocious preceptors are the ones who have decided the only correct way to do things is their way.

Precisely. It's all about giving the receiving staff a reason to respect you. If they respect you, your patients receive better, more timely, care. Thank you for posting Kaisu. I'll give this a go the next time I have a hemodynamically stable patient with a wide complex tachycardia.

BC Ambulance does the same thing. Tahoes with a full police interceptor package and a storage rack system. They're fantastic to work out of and, as evidenced by police fleets, Tahoes have excellent re-sale (ie. great cost recovery at end of service life).

I know BCAS is strongly considering following suit. Currently only flight crews are using it. Is AHS following the cases for study purposes or is it just across the board implementation?

That was basically my thought process with this one. Thus the early decision to trial pacing. Certainly an atypical presentation. I asked my partner (35+ years working targeted ALS) about it and he said he's seen it about once every 4-5 years.

Correct with regard to the pig study and ROC-PRIMED. It's enough to warrant study specific to the issue though don't you think? Currently working in a service that is a huge supporter of the various ROC studies has given me some insight into this and honestly ROC is very well run overall. There are some inconsistencies like any study but the efforts behind it are both genuine and effective overall.