rock_shoes

In my area police and rescue turn to us. Typically the police direct traffic and rescue does whatever we need to safely extricate the patient(s). Most of the time we're first on scene. When the police get there first they turn over to us on arrival and ask what we need. When we leave with our patient(s) the police assume control and reestablish traffic flow. Things change a little if it's a hazmat situation. In that instance fire/rescue take control until the hazardous material is taken care of. It's all about which department is more qualified for the situation at hand. We don't tell fire how to put out a blaze nor do we tell the police how to deal with a domestic dispute. In return they don't tell us how to deal with a medical emergency. We've consistently been able to work together in a professional courteous manner. I wish every area could be so fortunate.

Currently it is being called an ACP Advanced Diploma. Like all ACP programs of any value it will be accredited by the Canadian Medical Association. It will still be the JIBC which is recognized as a post secondary institution. Ironically one of the only bachelor's degrees offered by the JIBC currently is in Fire Studies. The JIBC is basically all of BC's emergency service providers lumped into one school. It's really more like three schools on one campus (police, fire, paramedicine) Fortunately for us the man in charge of paramedic programs is of a similar mind to you and I and is fighting tooth and nail for a full and proper bachelors degree. The current plan beyond ACP is to form 2 branches for a full degree. One for Physician Assistants and another for Management. ACP's are not nearly as common in BC as they should be. The two ambulances in my home town which serve approximately 12000 people are staffed by PCPs. The nearest ACP staffed car is 30 minutes away L/S. The nearby city of Kamloops (pop. apprx. 80000) has 2 ALS cars during the day (1 Critical Care Paramedic car and 1 ACP car), and one ALS car at night. Kamloops is scheduled for a helicopter staffed by CCPs to serve the region in the not too distant future. If you head north things get even worse. The last ALS car is in Prince George (right in the middle of the province). The rest of the province is staffed by PCPs. Remote cars with call volumes of less than 500 per year are often staffed by EMRs (equivalent to EMT-. It's my own personal mission to bring ALS to my home community. The next step along the way is to take the ACP. If you're wondering. CCP (Critical Care Paramedic) is one level beyond ACP. CCPs must be ACPs first and are then put through an additional year of education that includes large portions of a CCRN program and RT program. These men and women are the best pre-hospital providers I've ever had the pleasure to work with. Currently they are used much like physician assistants for critical care transports whenever they aren't in use on a regular car. BC is a frustrating place to work in EMS. We have excellent ALS provider that are in drastically short supply.

Dust I didn't hear a single firemonkey, bucket head, or volley-wacker. Where you feeling alright? Those damn anger management people got to you didn't they. On the note of education I think you'll be surprised to hear BC is finally getting on board. The shiny new Advanced Care Paramedic program will have all of us finishing with 120 university level credits. Entry into the program now requires either an allied health background (RN's RT's etc.) or a PCP license (PCP in BC is evaluated as equivalent to 33 credits) with an additional 22 credits of education. The additional 22 credits include courses in A&P, pharmacology, pathophysiology, english, and statistics. The ACP program itself will be an additional 65 credits. I'm not sure how things work post secondary state side so here is a run down of how university credits work in Canada. Most university programs average 15 credits per semester (via 5 3 credit courses per semester). That totals 30 credits per year unless you choose to go straight through and attend summer semester. A typical bachelors program ranges from 120-130 credits.

Well I'm going to have to pull out of this one. I'm taking a mental health holiday instead. I'll be going climbing in Nevada with a very cute female partner. 8) Only one out of country holiday a year until I at least finish the Advanced Care Paramedic program I'm afraid. :roll:

How receptive are local ambulance crews to you coming in and picking their brains? Maybe running a few scenarios? That might be your best bet. Particularly if any of the crew has recently completed a PCP program.

Perhaps one of the issues you're having is the fact that you're doing a part time course. Those of us who did full time PCP courses had to eat sleep and breath the content. I think that helped in a lot of ways. Do you have the opportunity to run practise scenarios between classroom days? It isn't too difficult to hammer through bookwork on your own but running practical scenarios is a whole different story. If you have the option you might want to try running scenarios with classmates and grading each other using the same methods as your instructor. Be brutal with each other and eventually you will find a call flow that works for you.

Am I correct in understanding that you are expected to verbalize every action and consideration? If that's the case I can certainly understand the difficulty you may be having. The whole idea behind the verbalization is memorization of the patient assessment model. Once you have are completely comfortable with that model everything will start coming together for you. Did you have difficulty with public speaking when you where younger? In my experience people who have difficulty with public speaking also have difficulty performing scenarios in front of others in class. Remember you're all students and none of you are able to function at a higher level than the next. Sometimes scenarios are as much about learning to perform in public as they are about displaying your knowledge. Don't discount this skill as the reality is it's something you are going to be expected to do for the rest of your career. You'll get there. Take solace in the fact that school scenarios and real calls are very different. Thus the importance of precepting and hospital clinicals.

Saskatchewan Institute of Applied Science and Technology. :wink:

You may want to ask one of the mods to move this to the Canadian forum BTW. Other Canadians will better understand the PCP scope and be able to assist you.

Are you having problems with a specific type of call or just scenarios in general? As for school calls of the type that will be used in your licensing exams they are essentially a checklist. I was fortunate to have a lead instructor who didn't follow that philosophy in class but that is not the norm. Where are you finding you trip up first?

Scene landings are done, though nearby open soccer fields and such are often first choice. Night operations do happen though they are restricted and avoided if at all possible. I suspect night operations are about to increase significantly in BC as all of our regular use helo's are in the process of being up fitted with with specialty lighting systems for night ops. We have been more restrictive with night-time operations but I don't think that is bad thing. I guarantee it has saved lives. Night flying is a special endorsement on a pilot's license in Canada. I don't know if that is the case in the US or not.

Happyness I was unaware that 2 of the bodies where recovered. Thank you for the more up to date information. I'm not sure having more details makes me feel any better about the incident having happened but more knowledge is always better.

The strike vote is going on right now. We won't be engaging in any kind of job action until April at which time we will have to meet with the BC labour relations board to determine essential service levels. Following April 1st some form of job action is likely. Whether that comes in the form of overtime/secondary bans I don't know. It's too early to tell.

That's precisely why it works in BC. BC Ambulance (an agency of the provincial government) is the sole provider of HEMS in the province. On occasion STARS, a non-profit out of Alberta, will provide services in communities closer to Calgary or Edmonton than Vancouver. There is no favourtism because there is only one provider. Sometimes safety and service effectiveness are more important than having wide open free enterprise. As far as I'm concerned HEMS is one of those services.

It appears as though HEMS incidents are becoming an epidemic on your side of the border Spenac. Corporate greed is costing good people their lives needlessly. One thing I can say about flight paramedicine in BC is that our centralized dispatch has saved lives. Since the inception of the provincial service in 1974 there has been one air incident total. It took the lives of two ITT paramedics (ALS for paediatrics/obstetrics), one physician, and two pilots. The Learjet went down at sea and none of them where seen again. Hopefully better regulation regarding safety standards is forthcoming for you folks. It's really disheartening to see good people lost for no reason.

I don't understand how advocating for a higher level of paramedic care in your home community would leave you with a black mark. Regardless of whether or not people agree with you it's difficult to fault someone for trying to make improvements to a service. Perhaps there are more politics at play than I am aware of?

Don't feel too bad for the PCP's Dave. Since this last set of changes I do actually get credit for it. I won't have to take any of the courses like "Introduction to Paramedic Practise" that everyone else has to and I will enter with the same group of university credits (A&P, Pharmacology etc.). The diversity in backgrounds this will introduce into the field is actually going to be a positive change. Imagine how great it's going to be to have a RT for a partner on a SOB call. I think this has the potential to be a big step in the right direction for paramedic practise in BC.

You asked for it Akroeze :wink:. Here are the changes I would make. This is a bit of a run on sentence. I would suggest breaking it up. This sentence seems to run and is a little wordy. I would put a period after heart and make this line two sentences. I would say one ACP unit as opposed to one ACP. All in all it's still a great letter. I think Mobey's idea of throwing in cost per ALS run figures could be a good sway.

Great letter. I see you have already added in Arizonaffcp's suggestions. A little proofreading (noticed a couple spelling/grammar errors) and you'll be all set. This is a cause near and dear to me. My home town is also without ALS coverage and is of a great enough size it should. The difficulty here in BC is that I'd have to convince BCAS the sole EMS provider not just my local municipality.

Running medications makes a big difference. You may for example need to run medication at 0.01mg/Kg/hour using a solution that is 0.1mg/mL. From that you need to calculate the appropriate drip rate. If you're keeping a maintenance rate with just NS, D5W, Ringer's ect. things are much simpler. There are certain rates that are typically appropriate and easy to maintain. 1gtt/6 seconds for example corresponds to 60mL/hr (with a 10gtt/mL set). Here is how that's calculated. Divide 60 seconds by the number of seconds between drips. With 6 seconds between drips the answer is 10 drips in 60 seconds. With a 10gtt/mL set 10gtt/min corresponds to 1mL/min(60seconds). To get the rate in mL/hour multiply by 60 (60 min in an hour right). 1mL/min=60mL/hour (a good maintenance rate for many sizes of IV catheter).

To what end are you using drip rate calculations? Are you calculating rates for med admin or are you doing maintenance rates with NS, D5W, Ringer's ect.? If you're just doing standard solution maintenance rates there are some quick and dirty methods for on car that work well. Using a 10gtt/mL set 1gtt every 6 seconds yields 60mL/hr for example.

Finding blood/body fluids on equipment is my biggest pet peeve. Then I have to put the car down while I decontaminate the whole damn thing (because god only knows what else they've contaminated that I don't see). Leaving the car with less than 3/4 tank of fuel would be number 2.

Due to the introduction of the LP15? Is the LP12 even available for purchase anymore? Akroeze do you have survival rate information for patients who would most benefit from ACP care available to you? That will probably be your best friend in winning over the powers that be. I would target seizure, anaphylaxis, and major trauma requiring needle decompression. As was already mentioned going based on 12 lead STEMI potential won't do much for you without a cath lab within a workable distance.

Akroeze mentioned the service using SAED's and doing 3 lead so it could easily be some other type of machine. I don't know if the LP12/LP15 or Zoll E can come as 3 lead only models or not.