rock_shoes

The service I work for runs a fleet of Crestline "New Era" type III's built on E350's. Currently we're in the process of switching over to GM chassis (still Crestlines) due to Fords failure to offer a diesel van chassis. There are a few 4x4 type I's built on F350's but they number less than 10 in the whole province. Having used one of the 4x4's and actually needing the 4x4, I can honestly say they are an interesting experience.

If it wasn't New Jersey I would say fire there asses and revoke their certification. Since it is New Jersey. What can you really do? Kick them out of the club?

BMI in and of itself is a poor evaluation of job fitness. BMI does absolutely nothing to take structure or muscle mass into account. If you're of average height and build it works well. The all or nothing approach would have been by decision of the school. The CPAFLA is simply an evaluation while the school dictates the required score. It is entirely possible to go on a criteria by criteria basis and leave out BMI altogether. The whole thing is kind of funny in some ways. I had to go through a 24hr blood pressure monitoring session to pass due to "White-coat syndrome". Every time the doc takes my BP it's elevated while my normal resting BP is on the low side of normal.

Agreed. New employees must meet said standard prior to being hired, and current employees must meet said standard within a reasonable time frame or face termination. My service uses the Canadian Physical Activity, Fitness and Lifestyle Appraisal (CPAFLA) to evaluate new hires. It's actually a well rounded test that takes everything from lifting ability/endurance to dexterity into account. Unfortunately there is no recuring evaluation which results in no incentive to maintain a reasonable standard of fitness once hired (beyond personal pride and motivation of course). I concur that maintaining a reasonable fitness standard is the responsibility of the individual. I do however feel that some onus must be placed upon the employer to ensure that people actually work to said standard. An "unhealthy" individual doesn't just put themself at risk. They put everyone they work with at risk.

EMS will never be viewed as a profession until this kind of garbage can be squashed. My chosen career is not a stepping stone, nor is it a "quick fix" for people who have lost there job at Starbucks. It isn't "a fun thing to do for a couple years", nor is it acceptable to give it away for free. Every time I see something like this I gain a little more resolve in seeking higher education pertinent to my chosen career. It really pisses me off that so many others treat it with so little respect.

We do a considerable number of crashes at my current station and patients wearing their seat-belts have consistently faired better than those who did not wear them. It only makes sense that something that prevents you from flying through a windshield or being crushed by a rolling car will improve your chance of survival.

I suspect I'm the exception to the rule. The bell gets cleaned between every patient. The entire scope gets cleaned every shift. My pen gets cleaned every shift. It may be a cliche but this is a clear case of "If you're not part of the solution. You're part of the problem." Call me crazy but I make a concerted effort not to bring things home to my family or spread them among patients. Don't forget one of the most horrendous of all offenders. The car cell-phone!

You can expect to work part time in BC for about 5 years before you will be able to get into a full time position. Full time positions are filled on a "senority" basis. All full time staff have higher senority than part time staff. If there is not a full time member who puts in for a full time posting, the posting will go to the part time paramedic with the earliest date of hire. If you decide to come back to BC and go through the whole process you can expect to end up in the Lower Mainland working as an irregularly scheduled employee at multiple stations for 3-4 years before you have the senority required to obtain a regularly scheduled spot at a regular station. It will take 5-10 years of working in the lower mainland as a full timer before you are able to return to the interior. This is the current situation. Things will change in the not too distant future. The number of retirements in the next 5 years is enormous. There are also other ways to shorten the wait. You can sentence yourself to three years in dispatch. You can sentence yourself to trasnfer fleet. Or you can educate yourself to the ACP level and obtain a full time position far quicker (There is a drastic shortage of ACP's in BC).

First you will need to go through one of Ontario's 2 year Primary Care Paramedic programs just to work as a BLS provider. Then you will be entering a highly competitive job market as Toronto EMS is a very difficult service to get in to. It's also worth noting that there is an abundance of PCP's in Ontario at the moment.

I would be willing to wager that intubation has a great positive impact on patient outcome. With one caveat of course. Intubation success rates need to be kept very high through a combination of practise and continuing education. Multiple failed attempts are of course to the detriment of patient care and, in the end, outcome. Intubation also needs to be used intelligently. We can't go around putting tubes down peoples airways just because we can.

Gotta love using fire as a litmus test! In all seriousness though, this is a particularly disturbing incident. Is the area in question known to have scene safety issues? If not I would imagine it is now flagged by dispatch. I never cease to be amazed by the number of US practitioners who seam to work in a war zone. There are some places in Canada with similair issues but the number is drastically less. Having spent time working in some of these areas I can honestly say your level of awarness needs to be on full alert all the time. We were fortunate in having police on scene with us the majority of the time but that isn't an excuse for letting your guard down. Ps. Dust clean out your inbox. I've been trying to PM you for the last week.

Excellent question. Silly medic. Hazmats are for fire-men.

In reference to a diesel engine "Glow Plugs" are a starting aid only. Once the engine is running combustion is solely due to heat and compression. Not all diesel engines use glow plugs. Some use an intake grid heater instead (the 5.9 and 6.7 litre cummins engines for example) while others use a combination of the two (later versions of the 6.6 litre duramax). The benefits to using a diesel engine (in an ambulance) outweigh the negatives in a number of ways (In my opinion of course). First off diesel engines are inherently 20-40% more fuel efficient than similair sized gas engines. The service life of a diesel is significantly longer than that of a gas engine and the torque curve associated with diesel power is far better suited to moving large loads efficiently. There is a reason heavy industry uses diesel technology almost exclusively. Negatives, though not inconsequential, are fewer than the positives. Initial outlay for a diesel engine is significant and a diesel engine is heavier. The weight issue isn't nearly the problem people think it is when a vehicle is already as heavy as an ambulance. In addition to that their are a number of new technologies well on the way reducing that weight penalty (Compacted Graphite Iron). As for performance and power diesel has become the "more power" option. A new Duramax pick-up for example puts out 365HP, apprx. 650lbFt of torque, and lower overall emissions than a big block gas. If you still doubt the performance potential of a diesel engine keep the multiple Le Mans winning Audi R10 TDI in mind. North Americans as a whole have turned their collective noses up at diesel for far too long. Everyone thinks of the failed Oldsmobile 350 diesel beltching black smoke in the late 70's and early 80's. Overall european car sales are apprx. 50% diesel primarily for fuel efficiency reasons.

This video does an excellent job of illustrating both the benefits and risks of paralytic use. It's a very good reminder for everyone with RSI in their tool-kit

Thank god we are switching to GM Chassis at my service. If you think it costs a lot of money running a fleet of diesels you don't even want to think about how much it's going to cost running a fleet of 6.8L V10 gas guzzlers. Ambulances are heavy vehicles and the torque curve of a diesel engine is far better suited to the application. In spite of the the higher outlay for a diesel vehicle, the overall decrease in maintenance costs and the extended service life of the vehicle more than make up the difference.

Potential mechanism + Poor historian = Spinal precations. Had the patient been a reliable historian without head, neck or back pain (proximal to the spine) in a low speed MVI, spinal precautions most likely wouldn't be neccessary.

Sorry to be the bearer of bad news but it is extremely unlikely you will be able to go back to Kamloops right away. Here is how the process works. It's pretty complicated so if you have any further questions feel free to PM me. First off. To practise in BC you require a valid EMA license (EMR, PCP, PCP-IV, ACP-R, ACP, CCP), and a class 4 drivers license (taxi, chauffer etc.). Following that you will need to complete a hiring package. If you live in Kamloops you're in luck as the regional HR office is in Kamloops. After handing in the package it's a waiting game to find out if you will be granted an interview. If you are selected for interview it will follow the STAR format (Situation, Task, Action, Result) for behavioural interviews. If you pass the interview your name will go into a hiring pool from which stations, needing to fill positions that can not be filled via lateral transfers, will draw from. That's just to get your foot in the door as a part time PCP. ACP's that are hired will go imediately to full time postitions as there is a serious shortage of ACP providers. Desirable stations that take part-time staff like 314 and 315 in Kamloops fill the available part-time positions with lateral transfers from other stations. If you would like to know what it's like to work all the time and still be classed as part time let me know. I can tell you all about it.

I like J.B. Goodhue myself. No matter what you go with buck up for the composite toe/shank. It's worth every penny.

You need to look at death and injury rates within the province of BC. In BC paramedics have similair injury rates and a higher death rate. Yes that includes air ambulance, but you have to consider that air-ambulance operations in BC have one of the best safety records in North America. Also remember that any paramedic in BC can end up participating in flight operations should the right set of circumstances arise. It isn't that BC paramedics are taking more foolish actions than paramedics in other parts of Canada. It's the fact that Police and Fire in BC have a stellar safety record compared to many other places. Kudos to them.

Experience is useless without education. Without education how can you possibly gain from your experience. Great you know how to bring someone's blood glucose up by injecting them with 1mg of glucagon. Do you also know that there is no point in giving a second dose of glucagon should the first fail because the first dose virtually depleted the bodies glycogen stores? Do you know that it is now doubly important that your patient take in some calories because you just depleted their bodies "emergency" stores? Do you know that glucagon also has smooth muscle relaxant effects? Great you "Fixed" your patient. Now what do you do if the results aren't what you're protocol said they would be? Without education you have nothing to base your experience on. There is a reason that recognized professional designations require that you complete your initial education first. It produces a better end product. What is it that causes those of us in EMS to believe we are somehow different?

Bump. Our negotiations are still ongoing and it is extremely unlikely we will have a contract prior to the current one expiring. The current situation will probably evolve into the worst contract negotiation since the inception of BC's provincial ambulance service in 1974.

Oh I know. That's why I added the .

This is meant to be a joke right? :shock: :wink:

I should have included a link to the new ACP program description. JIBC ACP Program It is also worth noting that graduates who pass BC Emergency Medical Assistant licensing will only receive a restricted Advanced Care Paramedic license (ACP-R). Obtaining an unrestricted ACP license will require successful completion of a mentorship/residency program lasting a minimum of 6 months. Mentorship begins as a fairly dependant state of practise and proceeds to greater levels of independence over the course of the process. Throughout the entire mentorship phase the mentee will participate in hospital rounds and case reviews with both the mentor and emergency physicians.

Good on you Alex. Even if your recommendations aren't heeded, at least your letter has the potential to open some eyes for the next time around.