rock_shoes

Maybe I'm getting a little salty. I got blah blah blah... payed attention in class... Blah blah blah... did my job.

Oh and $12/hour for a Paramedic? Crikey am I happy to work in a country that respects us enough to pay a living wage.

On 9/18/2016 at 1:21 PM, Ruffmeister Paramedic said:

I appreciate the kind words my friend.  

One of the interviews is with a service I used to work for when I worked as a medic when I left EMS full time to go PRN in 2008 and the two people interviewing me are are still friends.    

I was also told that there is opportunities for the OR rotation for Intubation practice.  

My understanding is also that there is about a 2-3 week period of working as a 3 person crew before getting out there, which I think would be approximately a 2 month period for PRN staff.  But not sure.  I'll know more about this all after my interview.  

It sounds like the service's orientation plan should be sufficient to get you started again. To be honest ground based paramedicine doesn't change as quickly as we would like to believe. It's still treat with the procedures and medications your medical direction has chosen based on medical programs chosen indications/contraindications. It won't be anything mind blowing for an experienced provider like yourself. It'll be little things like a service going with lorazepam instead of diazepam for seizure management or using amiodarone instead of lidocaine.

Depends on the type of fluid and the bag in which it's stored. 

Personally I've been otherwise engaged taking a Critical Care Paramedic program (2 years of didactic and precepting). I'm at the halfway mark now. On the plus side it's employer sponsored so I'm not in the poor house while doing the program.

On 11/25/2016 at 10:13 AM, Jihadi_Jerry said:

Great news everyone! 

I am looking to become a PCP. I am currently in Toronto, and it looks like there are a lot of colleges for paramedics here. I am from Vancouver BC. There is a nice school there, Justice Institution of BC. 

My question is: If I get training in Ontario, does that mean I can only work in Ontario? And if I get trained in BC , does that mean I can only work in BC? Or is it good for all of Canada ? 

Also, I have a dual citizenship for US. Can I work in the USA as well? Or would I have to retake the program? 

Also, I want to work in a city, not some Shitville. Is it extremely hard to land a job in big cities ? 

 

Thanks for your answers ?

Let me rephrase this for you. "I would like to live in an urban centre. Will it be possible for me to obtain employment in an urban centre as a PCP?" See what I did there? I asked the same question without insulting every rural Canadian citizen reading your post. If you want to be a paramedic of any variety you'd best drop the attitude.

To answer your question yes it is possible to port your credentials province to province. It's called agreement in trade and is actually signed into federal law that applies to nearly all professions not just paramedics (something you could easily have discovered on your own with yellow belt google fu). As ArcticCat mentioned, there are still a few snafus due to variation in provincial practice standards. 

http://www.ait-aci.ca/labour-mobility/

Before you go to all that trouble however, I think a little more reading on what a paramedic actually is would be in your best interest. This should give you a bit of a broad overview.

https://en.wikipedia.org/wiki/Paramedics_in_Canada

10-33 or Code 33. We also have a emergency on the radios in metro areas. The policy is also that all non critical to the situation chatter stops until the situation is resolved.

You can definitely hold a license/registration in multiple provinces. I'm registered in Alberta as an EMT-P while working in BC as a licensed ACP/CCP student. Can't help you with the transfer process to Ontario unfortunately.

Dave are you working for Medavie back east now or in the great white north?

On 7/19/2016 at 11:45 AM, Off Label said:

ECMO is a game changer. Time was that it was only really practical in the pediatric/ neonate population, but with technological advances adults now benefit as well. I've participated in two quite thrilling saves of patients who wouldn't have had a chance of survival at all. One was a young lady in her late 20's with a PE and the other was a 50 yo sudden death/ occult severe left coronary artery dz. 

I certainly is. In the past, at least in my service, ECMO has been the occasional hail mary when the ALS provider felt it was worth trying to sell it to the Emerg department (usually fairly young, early CPR, prolonged VF/VT, maybe hypothermic). Even at that it required careful coordination to maintain quality CPR without a mechanical device. Good on those early pioneers for making the toss. I suspect the successes pushed this study into being.

This is a new trial my service is initiating in conjunction with one of our major cardiac centres. Essentially the trial has set out some specific inclusion criteria that, if met, will include applying a mechanical CPR device and transporting to the ECMO capable emergency department. The most important piece within the inclusion criteria are that the patients will be prolonged VF/VT, relatively young, and of previous good health.

http://www.cbc.ca/news/canada/british-columbia/cardiac-arrests-survival-rate-1.3677885

http://www.metronews.ca/news/vancouver/2016/07/13/st-pauls-hospital-tests-lifesaving-heart-attack-treatment.html

http://www.bcehs.ca/about/news-stories/news-roll/new-canadian-cardiac-resuscitation-system-trial-begins-in-bc

This is why we're starting to transport certain "dead people." For those meeting inclusion criteria (primarily prolonged VF/VT in a relatively young patient) a mechanical CPR device is applied and the patient transported for ECMO.

Just throwing this out there. Most services with high ROSC rates still use a plain old ET tube. Seattle and BCAS (within Metro Vancouver) come to mind. They also try to maintain a paired, tiered, and targeted ALS response within metro zones.

Overall skill retention/proficiency haven't been shown their due over the years and it shows. Don't get me wrong, the King is a great back up airway, but it feels like their is an appetite to solve the problem with toys instead of what's really missing; education.

Wow. I would work the couple of hours myself on the employees behalf if that were the only way to accommodate her request. Graduation with a degree for the employee described would have been her penultimate achievement in life to date. No manager should ever ask an employee to give up something like that.

It's actually an interesting debate. One of the more pronounced signs of an opiate overdose is a decreased level of consciousness. Minus any of the other classic signs (hypoxia, respiratory depression, pinpoint pupils etc.) is a trial of naloxone worthwhile after ruling out other immediately treatable causes? Many services have exactly this type of protocol in place (often referred to as an Unconscious Not Yet Diagnosed protocol). Typically an unconscious NYD would include rhythm, vitals, blood glucose, patient ventilation prn and BLS airway intervention. In the absence of hypoglycemia and arrhythmia a small starting dose of naloxone would be administered IM or SC (0.4 to 0.8mg).

I can't speak to the number needed to treat to demonstrate any benefit from such a protocol. The number needed to cause harm at such low dosing is extremely high. The thought process with such protocols seems to be that it's worth a go because the results from a successful treatment are so positive while the results of an unsuccessful treatment are of little consequence.

My own personal opinion is that, in the cases it has been shown beneficial, there were most likely other signs of opiate or polypharmacy overdose that the provider missed.

I don't know a lot about either school but the fact one has a wait list while the other does not is a potential tell. Do either of the schools have pre-entry information sessions outlining learning objectives, program structure, etc.?

14 hours ago, scubanurse said:

I want to be a flight nurse so bad somedays...

What's stopping you? If it truly is a passion it's certainly achievable with a tad more education and your current credentials. If you go rotary I highly recommend twin engine, two pilot operations that blind the pilots to patient condition information while they make flight decisions. Your odds of returning home at the end of the shift are significantly better.

I love the idea of ditching the #9 entirely for the sake of simplicity and patient safety during loading/unloading.

We're using the Zoll for airevac in BC. You'll love it once you're used to it's quirks (no rotary dial, manually starting EtCO2, Sync is a soft key etc.).

Sounds like a cue to start seeking other employment if in fact they're asking you to falsify legal documents.

Currently we're using a series of Pelican type cases. We've colour coded them so the two boxes we need for a scene call versus inter-facility are yellow. One contains medications/IV supplies etc. while the other is essentially an airway kit (the monitor is in a bag with all the normal accompanying pieces). Our crews are two Critical Care Paramedics and two Pilots so there are enough of us to carry everything even when there isn't a ground crew we're meeting.

The boxes have pluses and minuses like anything. They're excellent for sanitary purposes, keeping equipment organized, and preventing equipment damage. On the downside they don't have pack straps if you have to walk in any distance and they're heavier than a soft bag with equivalent storage capacity.

I like that we've separated the basics from the heavier ICU type equipment. If it's a longer flight we can still pull out the vent/pumps to set up on the way to the receiving instead of pre-departure. If it's a short flight we can manually ventilate and use push dose medications.

One of the pieces I most like about our system is the way our monitoring and life support equipment rack onto the stretcher allowing everything to continue without interruption until hospital staff are ready to transition to their equipment.

http://www.bcehs.ca/our-services/programs-services/critical-care-program

I'll keep trying to find a better picture of the system for you. It was originally custom engineered for our program which operates both rotary and fixed wing so it may be difficult to find.

Pump no work.

Think about all the places you're currently sore; now look for strength training programs focussing on those areas. If that's not quite enough to get you started try looking into EMT injury patterns and see which type of injuries are most prevalent (I'll give you a hint in that they mostly involve joints like back, knees, shoulders...).

Focus your strength training on injury prevention and your cardio on whatever you're going to do consistently.

A well managed union can have a place; particularly when the number of employees exceeds fifty and an individual contract with each employee becomes onerous for both parties (employer and employee). The unfortunate part is that a poorly managed union can simply become another workforce abuser with overly high dues and poor representation.

The greatest difficulty within a union shop is seniority. Seniority is a measurable number and as a result seniority can be used excessively by unions. Promotions are frequently based less on aptitude than years of service. So far as I'm concerned seniority should only ever be used as a tie break between equally qualified candidates. Being a minority within a particular union can be rather difficult as well. Majority rules and that means the minorities wants and needs are going to take a back seat (if they even see the light of day).

On the positive side, vacation allotments, wages, benefits, and pension plans are typically better within union shops. That bit's nothing to sneeze at.

The greatest issue I've seen crew-members have in getting coverage in BC has been a complete lack of understanding from WCB with respect to cumulative versus single event PTSD. Those who have been able to identify a particular event have had significantly greater success in being granted coverage than those suffering from cumulative operational exhaustion. And there lies the rub.

Most of the Paramedics I know who suffer are dealing with a cumulative form of PTSD. On the whole, Paramedics are what is referred to as having a "resilient" personality. That means for the majority these issues require repeated exposure to arise. All in all, the nature of our personalties and the nature of the profession have created a perfect storm for the development of complex/cumulative PTSD. All of us have been educated to care for the sick and injured. Almost none of us have ever really been educated to care for our own minds.

On 4/8/2016 at 9:54 PM, ERDoc said:

Ma'am, I found your TV remote.

 

I have a feel this thread is heading in a downward trajectory very quickly,

Oh come on. We've all had that chest pain call where a therapeutic 12 lead resolved the patient's complaint (AKA we removed the offending Dorito).

14 hours ago, Arctickat said:

 

100 units? I hope they realise it's  about $13k per application.

They do. The one thing patient's consistently complain about is the ride quality in ambulances. I think they finally realized there's a customer service component to EMS.

Interestingly enough, when I sat in on the design committee for this next batch of ambulances, some crazy small operator in Saskatchewan was mentioned as being an early adopter they wanted to watch for reliability issues with the tech.

I find the best solution is to picture myself treating that patient. What do I do when I form that image in my mind? What order do I do it in? etc.

If I still answer incorrectly at that point I probably have an error in my process requiring correction. The mark off is actually to my benefit in that it has identified an area of weakness.