rock_shoes

As has already been mentioned you should avoid BC for the time being. Your best bets will be Alberta, Saskatchewan, and possibly Nova Scotia. Depending on your current training it may be possible to have some of your past education recognized. That will all depend on the whim of your chosen province's regulatory body. If you want to try and come to BC anyway let me know and I'll help hold up the hoops for you to jump through.

Thank-you for saying what needed to be said. This is far and away the best solution. Grandfather those who can meet the required competencies and all new providers would be subject to an education with internship. If people don't like getting an education appropriate for the job then they should look for a different job. Professional respect, competence, and pay scales all improved dramatically for nursing when RN programs became bacheloreate degrees. Why would it be any different in paramedicine? It's time too take that step forward.

I agree with using the lowest number of people needed to do the job safely. Having too many people bumbling around can easily make the lift more dangerous. I use saline locks all the time so ditching the bag and dripset while maintaining IV access is a non-issue for me. As for O2 If the patient needs it they get it otherwise I'm not trying to pack the patient and an O2 bottle all at once. In my area we typically make it to calls before the FD so there is time to begin treatment prior the their arrival.

Having the FD carry the patient doesn't mean you fail to treat the patient. While waiting for the FD to arrive how about a full set of vitals(BGL too while we're at it) , Pt history, medications, 12-lead if available, last ins and outs, IV access if possible (not always an easy task with our larger clients), medical conditions, patients last activities prior to arrival... The usual work up. Unless the FD shows up with you there should be time to gather the information mentioned and have a working diagnosis while they are on the way.

I nominate this for best post of the thread. In all seriousness it would be my plan to call the fire department aswell. For the really rotund paitient I would dig out the "Manta Mat" (a tarp with handles for carrying the big-uns).

We don't shut the ambulance down during temperature extremes here either. We do however lock the ambulance and take the keys with us. Almost all of our ambulances are equiped with an anti-theft function that allows us to leave the ambulance run with the keys out and the doors locked. Even if we forget to lock the ambulance it kills the engine as soon as the brake is touched until the keys are put back in the ignition. It's always really entertaining watching the rookies jump in and kill the car as soon as they try to put it back in gear.

It's always good to have an insiders perspective on why things went the way they did. It sounds like you actually have a number of the things we are fighting for. Adequate staffing being one of the many bones of contention. Just to give everyone a bit of perspective as to the situation here in BC I'll outline the hour count for a typical two week pay period for me. Time out on calls: 76.34 hours Time between calls at the station: 88.62 hours Time on pager between calls: 82.58 (paid 110 hours as some of these hours I was attending calls which I didn't count for these purposes) There is a total of 336 hours in a two week period. Of those 336 hours 247.56 or 73.7% of them are under the control of my employer (out of the pay period in question). I'm considered to be "part-time". I don't receive benefits of any kind and I am payed 17% in lieu of holidays and benefits only on the hours that I'm out on calls. If I am injured on the job only the hours I spend on calls will be considered in the renumeration I receive. My rate of pay on a call is $20.57/hour (plus the 17% in lieu of holidays and benefits already mentioned). My rate of pay at the station is $10.80/hour. When I'm on pager I receive $2/hour. For the pay period in question (during which 7 call hours where paid at stat holiday rates) I grossed $3191.43 and subtracting $1053.50 in deductions cleared $2137.93. To put things in perspective a little bit I'll tell you about what someone with my level of license and experience makes working in private industry. Based on 12 hour days someone like myself will typicaly contract out at a rate of $350($29.17/hour) -400($33.33/hour) a day. If I worked a fairly typical 2 week on 2 week off camp rotation my average income for a 2 week period would come to a gross of $2450 at $350 per day or $2800 at $400 per day. To further put things in perspective in this situation only 25% of my time would be under the control of my employer vs. the 73.7% that is currently under my employer's control. **All dollar figures are in Canadian Dollars**

Well I guess Lillooet must be the other one then. I did several body removals while working in Lillooet. I haven't had to do any since lateralling to Merritt. Now I get to go in, confirm death, and leave the police to keep an eye on things until the coroner shows up. I have to say I much prefer leaving body transport for the coroner. Palliative patients left to die at home are usually pronounced at home by either the family doctor or public health nurse and the bodies removed by private funeral services.

In that case both the Cardiology III and the Master Cardiology are excellent. I ended up with the Cardiology III as a Christmas present from my sister and have used it enough to know I would replace it with the identical stethoscope should anything ever happen to it. Strangely enough I also had a run of pediatric calls right after acquiring a scope with a pediatric bell.

Vent, Squint, TIMEOUT . The fact of the matter is the system studied here has an atrocious intubation success rate. It's pretty hard to try and argue otherwise so I won't bother. This is one of a number of studies showing poor paramedic intubation success rates. I won't try and argue that point either. What I continue to strongly disagree with is the conclusions that have been drawn as a result. As long as intubation continues to be the "gold standard" in airway management field intubations should "remain on the skill-sheet". The fact that it would be easier to just have everyone using LMA's, King LTD's, Combi-tube's etc. is not an indication that it would be better. This aggressive move towards taking the easy way out instead of fixing the QA/QI, and educational insufficiencies is disturbing. Overall I would say most people here on the city are proponents of education, and evidence based decision making. Why so many pages of discussion when the best solution is education and continuing QA/QI? The better discussion would be what form said education and conitinuing QA/QI should take no?

Absolutely. However, from what I've read so far, a quickly and correctly placed tube does not negatively affect outcomes. It's the high (not everywhere of course) rate of pooched intubations that negatively affects patient outcomes. To the best of my knowledge intubation is still considered to be the "Gold Standard" in airway management. As long as that's the case doesn't it make the most sense to QI the living daylights out of everyone to the point that everyone is able to maintain a high success rate on the first try? If an individual is unable to attain that high success rate then intubation should cease to be a part of that individual’s repertoire. For example. In my current service I am allowed up to three attempts to start an IV. I never take more than two and usually only one attempt(s) because I know that my chances of success on the third attempt are extremely low given that I missed the first two. If you miss your first intubation attempt odds are good it would be more prudent to use a different adjunct and move on rather than mess around with repeated attempts. I'm not going to get into failure to confirm placement because frankly failing to confirm (or at least attempt to confirm) placement is just plain negligent. You wouldn't push D50W without making sure the patient’s IV was patent would you? If there is a better, more easily placed, adjunct available, then I agree whole heartedly that the ETT should be dropped from the pre-hospital environment. Maybe the next round of studies should focus on which adjunct would best replace the ETT? A design competition maybe? If multiple studies show something to be a problem shouldn't the next round of studies focus on what can be done to fix said problem? Why flog a dead horse when "Lazarus" himself is tapping you on the shoulder saying "I think it’s dead".

Why not use the rated harness that the patient is already in? Stokes or Junken work great if c-spine concerns are present of course.

I think this is exactly the point Squint was trying to make. Only competent educated professionals should be allowed to "triage" which patients require transport on scene. "Medic Mill" graduates need not apply. Anyone who just happens to wear the patch should be left in the dust while the rest of us strive to be educated, competent, compassionate, professionals.

I know. Most of us could have done a better job with 50 bucks and a camcorder.

That's an excellent add. Do you know which add agency was used. CUPE 873 here in BC could use the help.

Do the services transporting to the facility in question have any kind of quality assurance program? Say for instance any given medic must have X successful intubations per year to continue being allowed to intubate. In my opinion developing a proper quality assurance program would solve the majority of skill retention issues. Failure to ensure skill retention should result in a reduction in allowed scope of practise.

Actually we are working under an Essential Service Order. It’s a small change in words but a huge change in ramifications. We didn't "agree" to anything. We have been ordered to meet the provisions set out by the BC Labour Relations Board as outlined by the ESO. Every time we try to do anything that so much as inconveniences the employer they run to the LRB and have whatever the sticking point is declared "essential". "Special Operations" (meaning special event coverage for which BCAS is paid handsomely) have just been declared "essential". If members who have worked "special operations" in the past refuse to come in on their scheduled days off they can actually be charged with contempt of court. I know you're a great supporter docharris but it's really important for everyone to let this sink in. BC paramedics can be criminally charged for taking our scheduled days off! I'm not talking about everyone pulling together in the event of a disaster. I'm talking about forced overtime just to keep the service running. As for amending how we bargain the goal is to be included in what is currently known as the “Police and Fire services collective bargaining act”. Thus far, as can be seen by their superior wage and benefit packages, this act has ensured consecutive fair contracts for BC’s other emergency services. It includes provisions guaranteeing an independent third party arbitrator should talks between the two parties fail. First I need to secure some extra for myself. I work way too much to get by on one t-shirt . I'll order a couple extra and send them too you as soon as I figure out how I'm going to get some more. I've got a week off in August so let me know when you're coming through. Either way I'm sure I can spring for a beer when you blow through Merritt.

This sounds like an excellent thing to make mandatory for everyone operating an emergency vehicle. 3 weeks of vehicle operations training is a minimal investment for a career requiring emergency vehicle operation.

Funny ha ha. A minimum Blood pressure is still required to maintain adequate perfusion. The minimum BP required to perfuse the brain is dependent on someone’s intracranial pressure which isn't something we can measure in the field. The flipside is that maintaining the lower (90mmHg) systolic is better for major trauma not involving the brain. The higher you keep someone’s BP with fluid resuscitation the faster they are going to bleed out. Personally I'm looking forward to the days of synthetic blood products when we can eliminate one concern and focus on maintaining an adequate CPP (Cerebral Perfusion Pressure).

I think you're forgetting two important factors here Mobey. 1) It probably took you almost as much time and effort to obtain your EMT (equivalent to PCP in other provinces) cert as it does for someone stateside to go through one of the "medic-mill" programs dust refers to. This is all before you where even eligible to apply for an EMT-P (ACP in other provinces) program. 2) In Canada the algebra competency level required to be successful in an EMT-P program is covered in high school math courses (provided you take academic high school math as opposed to the bare minimum required to graduate). Any Canadian high school kid can also meet the language proficiency requirements provided they stuck to the academic path instead of the bare minimum (a huge portion sticks to the bare minimum unfortunately). A little aside for non-Canadian readers PCP stands for Primary Care Paramedic (called EMT-A in Alberta) and is roughly equivalent in scope to EMT-I ACP stands for Advanced Care Paramedic (called EMT-P in Alberta) and is roughly equivalent in scope to EMT-P By the way Mobey did you end up going to SAIT? Right now SAIT is at the top of my list of schools to apply to for the fall 2010 intake.

I'll be the first to admit that a number of the tactics attempted have been of little to no use whatsoever. The difficult part here is that an essential service strike is a completely different animal. EMS is the only emergency service in the province that can be forced into the position we're currently in. Police and Fire in BC are covered by provincial legislation that forces both sides to bargain in good faith and ensures indedendent third party arbitration should talks fail. BCAS paramedics don't have any of that. The real trick here is going to be to have the employer drag us into court for a perceived ESO violation which will allow us to begin challenging the ESO's multiple "Charter of Rights and Freedoms" violations. There are a number of cards yet to be played for sure. Long term the goal is to be included in the same peice of legislation that governs Police and Fire service negotiations. Don't get me wrong EMS should continue to fall within healthcare. Our bargaining practices however would be better off following a line closer to that of Police and Fire in BC. Both the afformentioned groups have been able to bargain fair contracts without affecting the public or even day to day operations in any way shape or form. I think that's something every public sector bargaining unit should strive for.

No Dust you did make such a comparison. ...[Comments regarding deleted content removed - Admin]...

Are you purposely trying to pick a fight with the Canucks? When it comes to pushing for better educational standards and better standards of practise you're usually right on the mark. Why the lack of research with regards to Canadian labour relations? Comparing US private and or municipal labour relations to those involving Canadian medics is like comparing oranges to potatoes. They're not even both fruit. The medics in Toronto for example actually still have a contract. The TEMS contract expires in December. TEMS medics have been pulled into this dispute because other Toronto municipal workers happen to be in the same union. One thing many TEMS medics want is their own local which would help prevent them from being pulled another trash collectors strike. In BC the provincial healthcare budget for 2009 is approximately $15.7 Billion CAD. The portion of that budget allotted to BCAS is approximately $314 million CAD. The BC provincial government is attempting to run EMS for the entire province on roughly 2% of the provincial health budget. How's that for a little bit of perspective? I don't know about you but I'm pretty sure EMS for an entire province is worth a little more than 2% of the health budget. Note I said 2% of the health budget not 2% of the provincial budget. In BC there is specific legislation governing collective bargaining for Police and Fire services called the "Police and Fire Services Collective Bargaining Act". Being included in this act eliminates these groups ability to strike. In return Police and Fire unions are entitled to an independent third party arbitrator should negotiations between the union and employer bargaining teams break down. One of CUPE 873's main goals is to be included in this act (CUPE 873 being the union local representing BCAS paramedics and dispatchers). An "Emergency Services Collective Bargaining Act" would end all strike action on the part of emergency services and ensure a fair collective bargaining process. That's all we're really asking for.

What a loaded question! 1) Always stop at a red light before proceeding through even if you are running L/S. Going through without ensuring other motorists have yielded right of way would be just plain stupid. 2) If you cannot make it through an intersection without forcing other motorists into said intersection on a red or amber light, shut off all emergency equipment and wait for the light to change before re-engaging. It's unacceptable to force others into a dangerous situation to reach a patient a couple of seconds sooner. 3) Only ever enter opposing lanes of traffic as an absolute last resort. This is one of the most hazardous things any of us do and should be avoided if at all possible. 4) Use your head and shut the L/S down if it becomes too dangerous. In my service we have the responsibility to exercise judgement and downgrade our response should continuing to run L/S put either ourselves or the public in undue danger. This decision can be based on traffic or weather conditions and is in fact well supported. Any service without a similair (or perhaps even better) policy is not worth working for. 5) Watch your speed. Ambulances are large, heavy vehicles that can do a lot of damage in a hurry. A one tonne van with an ambulance body does not handle like a sports car. So don't drive it like one. The amount of time saved by running L/S is usually minimal. Compound that with the fact that arriving 30 seconds sooner rarely makes any difference with regard to patient outcome, and you have to wonder if running L/S is ever worth the risk. Keep that in mind any time you find yourself "running hot". It will help keep you, your partner, and your patients, a great deal safer. This of course is only my own opinion, though I’m certain many share in it.

Without patients none of us would have anything to do. If we don't have anything to do how are any of us going to become injured or die in a way that is related to work? If you really think about it you can blame everything on the patient. Even your ever widening ass from all those fast food on the run days. In all seriousness I do think that the cot is the most likely culprit. In the service I work for the cot has more injuries related to it than any other piece of equipment by a pretty wide margin. That said many services blatant refusal to even attempt switching to power-lift cots must be a significant contributing factor.