rock_shoes

The shot is completely unnecessary. If you've read my other posts you know that I'm a strong advocate for improved ALS coverage everywhere including my home province of BC (which I freely admit has atrocious ALS coverage). As things currently stand Alberta has far better ALS coverage than BC. I would hate to see the citizens of Alberta lose what they currently have due to the short-sightedness of a few. I'm not sure what you're experience is with EMS budgets but I can tell you this. 122 million is a woefully inadequate sum to provide ground EMS to an entire province.

When responding to calls I go out however I'm dispatched. Dispatch should have a far better understanding of patient accuity than I at that point. When actually transporting a patient it's my call. I only ever run emergently from a scene if quicker delivery to a higher level of care can make a legitamate difference to patient outcome. "Running hot" all the time regardless is negligent and puts you, your partner, your patient, and the public at undue risk.

I would be inclined to mirror normal placement in this case. Unless the patient had a medical alert of some kind (as was mentioned in a previous post) it's highly unlikely you would know anyways. A cardiologist would be able to give you the best answer of course.

Nothing earth-shattering or surprising in this article but it's a great reminder to look at all the facts when evaluating a patient. There is good reason that BP is not your only vital sign. In fact it's frequently one of the last to show significant change.

Stelmach only budgeted an additional 122 million to cover the cost of taking over ground EMS services? What universe does he come from? It's going to cost more than that just to give us a decent raise in BC. Maybe Stelmach will put a more realistic price tag on things when he's the one having a coronary and all he gets is nitro, ASA, and Entonox, because ALS is unavailable. Forget a 12 lead, conversion of arrythmia's, proper pain management, pacing if neccessary, or a STEMI protocol direct to cath-lab.

Good to hear that you saw the value in going through one of the better programs. With that being the case you may have better luck than most. If Alberta doesn't work out you may want to try another province. Based on results to date it seems as though Nova Scotia has a more permissive reciprocity process than most. My understanding of programs stateside is that there are some excellent associate degree programs and there are some atrocious "medic-mill" programs. Much of the difficulty seems to come from the fact that the cert is considered the same whether it be obtained through and associates degree or a "medic mill". If that's the case you can't help but have what is supposed to be the same level of provider vary wildly in quality.

First off. The thread you are refering to involved a select group of MEDICAL SCHOOL STUDENTS at an individual and isolated medical school. To make such a broad statement citing a single incident is both ignorant and naive. Secondly. Kevkei's line, "Perhaps when hell freezes over. (You'll understand if and when you understand who and what ACoP is)", clearly was not meant as an insult against americans. Alberta College of Paramedics is the self regulated EMT/Paramedic registration body that governs paramedic practise in Alberta. Gaining reciprocity can be extremely difficult to obtain with ACoP coming from another Canadian province. Never mind coming from another country. Now do you understand? It wasn't a slight against someones education just a statement of the way things currently are.

These are just a few of the positives that come with a provincial service. This is exactly why I will fight to keep a provincial service in BC despite the litany of problems we currently have. You'll here me complain about things like BCAS' dismal ALS coverage and our archaic licensing body but our basic deployment structure is a good thing when staffed appropriately. The provincial model has the potential to be superior in nearly every way but it also has the potential to turn into an impossible to manage nightmare. The results of which I'm living through right now.

What a stellar offer 'snipe'! I might just have to hop the border and go through ACoP reciprocity. Who are they expecting to attract at those rates? Only a comlete newb who still has stars in his eyes that they (the hiring service) "actually let him do this" never mind pay him, would fall for it. Granted it's still better than what I'm paid, but BCAS is "special" and Edmonton is far from cheap to live in. It's pretty hard to justify working at those rates when it's possible to make significantly more elsewhere. Come to think of it what the hell am I doing sticking around with BCAS? If I wasn't working my way towards the ACP program I would be long gone already. With the mentorship program in place here you pretty well need to be a BCAS employee first.

It looks like CUPE is hard after the opportunity to represent paramedics in Alta.. They make a strong case for themselves but whether or not they "get the job" is going to make for interesting viewing for the rest of us.

And the depressing truth comes forth....

Well we are now officially on strike. Of course with the essential service order that has been issued by the BC Labour Relations Board their will be no change in service levels to the public. Our job action will mainly consist of things like picket lines and not scanning our PCR's into the digital record to delay billing. It's shaping up to be a long drawn out battle at this point.

Best of luck to you Scubamedic. I forgot about Nova Scotia having a more permissive reciprocity process. If you do decide to come to Canada and "Start over" I would suggest going to school in Ontario. They currently have the best educational standards at the PCP (Primary Care Paramedic) level which is where all of us have to start out.

Sorry to be the bearer of bad news but it's my understanding that EMS in Quebec is unique from the rest of Canada (just like everything else it seems some days). As for reciprocity. I can't say for certain but I think you are SOL and would have to start from scratch.

I recently spoke with an ALS member here in BC about that. The program is being run "In House" right now (same idea as what Toronto EMS does with their ACP program). I suspect (not 100%) some or possibly many of the instructors come from or have been borrowed from BCIT programs thus the confusion. That would make sense as BCIT runs a number of specialist nursing programs like Critical Care Nursing. I do know that the only way into the program right now is to apply (from within) and be selected for it. Licensing is rather interesting at the moment for this level as well. Currently the expanded scope of practise a CCP works under in BC is listed as a series of endorsements on an ACP license. As far as I know (A BC CCP would know for certain) they are currently only able to use their expanded scope when on a call that has been designated a CCT(Critical Care Transport). A proper licensing definition is in the works and should be released within the next year or so. The scope utilized by these people seems to be in a constant state of flux much like the higher levels of any other health care profession. As of right now it looks as thought the only CCP program available in Canada that any of us can access without working for BCAS is through ORANGE. Pretty safe bet competition is as fierce as it gets. Sorry for getting so off topic Now back on topic. I seem to remember reading in one of Squint's posts that that EMT's and Paramedics in Alta. are going to be members of the Health Sciences Association of Alta.. Don't shoot me for saying it but long term this may be a good thing. I know the Health Sciences Association of BC has managed to negotiate far better contracts on behalf of their membership than CUPE 873 has for BCAS employees. I'm not blaming CUPE for our woes here but I do think the results are worth a ponder. Maybe a dedicated health care union will be able to provide better representation.

Possibly, but only if people are willing to work a horrendous amount of overtime to make it happen. I'm talking 12-14 days of 10-14 hour shifts just getting hammered for nearly every ACP in the province. The normal full time rotation for paramedics in BC is 4 days of 12 hour shifts followed by 4 days off, averaging 84 hours per 2 week pay period. Not entirely true. ALS is existent in the larger centres. The Lower Mainland, Kamloops, Kelowna, Prince George, and oddly enough Trail all have ALS providers. The number of providers is short even in the mentioned locations though. The BC residents who are really getting the shaft are in the rural areas where if you're lucky you will get a CCP flight crew but most likely you will only get the local PCP crew. The situation in BC is still exactly what I've mentioned before. We have some excellent ALS providers. We just don't have anywhere near enough of them. If I'm not mistaken one of only 2 CMA accredited CCP programs is located in BC and is provided by the British Columbia Institute of Technology (don't be fooled by the name it's actually one of the best schools in the province and includes a number of other programs such as a BSN in nursing). Please correct me if I'm wrong, but I believe the only other such program is run by ORANGE. Rest assured Alex you would be welcomed warmly here in BC should you decide to make the move. Not to worry there is plenty of room for more ALS providers here. I will warn you though that obtaining an unrestricted license here is a bit of a drawn out process. The positive side is that you are paid at the starting ACP rate the entire time you are working under a restricted license.

We are officially on strike as of 0001 this morning. Not that it's going apply a whole lot of pressure in the short term. The BC Labour Relations Board essential service order has seen to that. The order states that "All full-time staff are to submit to overtime as per normal and all part-time staff are to continue submitting their typical amount of availability." The biggest impact we are going to be able to make in the short term is drastically delaying billing by not scanning our PCR's into the digital record. The real pressure is going to come as the olympics approach. BCAS has promised an additional 55 ambulances, 1 dedicated air ambulance, and ALS at every major venue. Good luck finding the staff if we're still on strike. The Labour Relations Board has no jurisdictional right to force us into the overtime that will be required to make these additional resources available for "Special Event Coverage". Looks like BC and Alta. are both in for a real roller-coaster ride in the upcoming months.

Yikes! Are these physicians not being instructed in intubation by anesthetists? Preferably in a cadaver lab to beging with. If that where in fact the case I don't understand how these residents would pick up said "bad habits" from television shows.

That sounds more like the hospital health authorities used here in BC. Each hospital region functions independantly with patients only being transferred between health authorities when the services a pariticular patient require are unavailable within the region they reside. The upcoming changes in Alta. seem to be somewhat of a blend using bits from the provincial model and bits from the Ontario model. All in all anything that improves patient care and medic working conditions is a good thing. Whether or not the changes being made in Alta. provide either remains to be seen. At this point it's my hope that they do and my suspicion that they won't. Maybe working in BC has made me a little bitter when it comes to government oversight of emergency health services.

Don't let them fool you. BCAS has multiple regions aswell. The multiple regions do nothing to prevent cars from one region being called in to cover areas and do calls outside of their region (this is a common occurence at stations in the "borderlands"). I work in what's known as region 3 for example. I've done calls and shifts in other regions as operationally required with no real regard for the fact that it is not my region. Don't let them sugarcoat it for you. Hold their feet to the fire in every way possible.

This is exactly what was done in BC prior to AMPDS. It actually worked far better than AMPDS until management in their wisdom decided we needed to "modernize" and follow trends set by other services. AMPDS opens the door to use lesser trained (read cheaper) people as dispatchers. By the way I voted for priority dispatching thinking in terms of triaging calls not the use of AMPDS. Regardless of the system or method used a dispatch centre must have a way to prioritize calls.

How disheartening. I was hoping Nova Scotia would take advantage and learn from the mistakes that have been made in BC. A provincial system has excellent potential if managed correctly. Sure ALS members get to take all the "glory" calls in our targeted system but it also means that a great number of patients who would benefit from ALS care don't receive it because ALS is simply unavailable. I don't know if you've been to BC before or not Dust, but the distance between ALS cars is extreme in some cases. The last ALS car in BC as you head north is in Prince George (which happens to be in the middle of the province). All this is what scares me about what's going on next door in Alberta. Alberta currently has far better ALS coverage than BC. From what I've seen to date it appears as though Stelmach is doing his best to copy the BC model which has the worst ALS coverage (though the few providers available are very good) in the country. While provincial services have great potential, the longest running example of it (BC Ambulance), is currently in a shambles. BCAS has steadily declined from being one of the most progressive services to the most antiquated. Whether or not it can be salvaged and returned to it's former self remains to be seen. Rest assured I will be sticking it out and doing everything I can to help with that. It isn't in me to abandon the people of my home province and run away to greener pastures. If we all do that things will never improve.

We use AMPDS in BC and speaking from my own experience it is a complete failure. The number of unneccesary "hot" runs to scene has increased dramatically with no relatable increase to positive patient care outcomes. Both crews and the public are being put at risk by this system without any tangible benefit. The majority of dispatchers here are at minimum Primary Care Paramedics (similair scope to EMT-I stateside) before they are ever dispatchers (many of our people who have experienced career ending injuries end up in dispatch). They know the questions that need to be asked without having to follow a computer based flow chart. Society has become so litigious that anything allowing an employer to "blame the computer system" is considered good practise.

Perhaps you mean a drastic shortage of ALS providers paired with an employer unwilling to try alleviating said shortage? Oh and don't forget an antiquated licensing body that seems to think IM injection is too complicated for a PCP while SC is just peachy. Maybe it's squashing a 1 year PCP program into a 4 month time frame. Yes the material is actually covered in that time frame. I know first hand. How much of it people remember and are able to apply afterwards varies wildly from person to person. Maybe you mean working for up to 5 years at slave wages before a "full-time" position can become a reality for you? Those are the realities in BC right now. I hope for the sake of NS's citizens that isn't the case there.

If Grandma or little Becky bake you some cookies, say thank you and share them with the rest of the crew. If someone tries to give you money, a gift certificate etc. the answer must always be thank you but I can't accept. If they persist suggest a few charities like the Heart and Stroke Foundation or your local hospital's auxillary.