rock_shoes

Yep I made a nursing home neglect/incompetence run during my PCP precepting that I'll never forget. We're called to a Nursing home for a 76 y/o female IDDM patient with a decreased LOC. We do our initial assessment and low and behold her BGL registers as low (below the range of the glucometer). So we start a line, run 100mL of D10W into her with 50mg of Thiamine and she perks right up with a BGL of 6.2mmol/L. As we look at the patients care record and question the RN in charge we discover the cause of the sudden low. The RN gave this patient 40 units of Humulin with a starting BGL of 3.9mmol/L when the patient's BGL usually registers around 11mmol/L. All this and the patient had yet to eat that day. I guess this particular nursing home is where the bottom feeders of the nursing class end up.

No worries about failure to wear appropriate kit here. I wear the high visibility vest. Puke neon green with big wide reflective strips.

My service has a no cell-phone use while driving policy. It happens to be one of the policies I wholeheartedly agree with. If your service doesn't have a similar policy it needs to create one.

If an image does not end with .jpg or .gif, it will not link like that.

And, just for everyone's info, departments with reflective crap on their uniforms typically get less press than agencies without. Those reflections fark up photography in a really annoying way, both still and video, so the photogs will frequently not use the film, instead choosing pics of cops or wrecked cars without you in them.

I don't really care about photography when I'm at work. I care about not getting hit by a car.

No child left behind strikes again! :shock: Wow am I glad we let the kids who aren't willing to put the work in fall behind here. Anyone who isn't classed as mentally handicapped can get through basic algebra if they put the work in. Kudos to you for going out and getting the knowledge on your own Dust. I agree with you that the little drug formulae are junk when some simple math is so much more accurate.

Forget the formulas they try to teach you and just revert back to the simple "solving for X" method you learned in College Algebra. It is much more intuitive, results in more precise calculations, and doesn't entail memorising silly new formulas, like most crap paramedic schools try to teach.

You DID take College Algebra before attempting paramedic school, didn't you? If not, now you know why you should have. :wink:

Did you really have to attend college to learn algebra for drug calculations? I had to learn that much algebra and more to finish high school. Are these differences between the US and Canadian public education systems or are they differences of generation? I can't really say but I must admit I'm curious.

Does your agency require that reflective stripes on the uniform pant leg be used.

Only a few flight paramedics have reflective pant stripes in BC. I do think they are a good idea if you have the option though.

The degree programs I've seen so far are geared towards management almost exclusively. The rumours at this point are that the JI's program will split in to two streams following the ACP. One a management degree program. The other a practicioner program. I have taken a quick look at the AIT. It's going to be an interesting couple of years!

In the mean time what's it like coming over to the patch as a PCP? I did it as an EMR for a stretch and it was a real pain. Do you still have to go through the entire ACoP process or is there an expedited process for those already licensed in other provinces (in light of the upcoming AIT)? I still prefer working a public emergency cars but I need to bankroll my next stint in school.

I'll keep that in mind Tniuqs. At this point I'm going to take my lumps and do the new pre-requisites. I think that overall they are a step in the right direction and I want to support these kind of movements even when it costs me to do so. If nurses can have a bachelor's degree program then so should paramedics who have to be able to function as independent providers right from the word go.

The responsibility placed on paramedics is enormous for the educational requirements overall. I want to see the education meet and exceed the level of responsibility.

Everything else aside, I have to say that I really like the prerequisite list! That is an excellent start, and will finally put them heads above most anything in the U.S. I'd like to see the rest of the curriculum though.

So would I. The curriculum hasn't been released yet. I'm doing what I can to take the best program available and based on the pre-requisites it will be one of the best. Hopefully the curriculum is released before they have my money locked in so I can evaluate it fully and compare it to the SIAST program.

That's what BC -- and the rest of Canadia and the U.S. too -- ought to be doing. It is the very best of all possible educational systems. Those "minimum patient contacts" will give you a LOT more experiential benefits if you have a solid foundation of understanding in your brain before you experience them. That way, it takes a lot fewer patient contacts to achieve competence, because you learn so much more on each contact.

That is in fact exactly what BC will be doing. I'll let you know how it turns out when I go through the program (probably Sept. next year). My frustration as I said before is that I've now completed a PCP program (because that's what I was told I needed to do) that won't help me gain entry to the program. Had the system been straight with me right off the bat I would have spent my time and money on the real pre-requisites and been ready that much sooner.

Don't get too hung up on the name of the school Dust. The Justice Institute of BC is the name only. The reality of the situation is that the JI is an umbrella for several schools including Fire, Police, and Paramedic academies. It's the same idea as having several faculties within a university. Given the name I would suspect that the Police academy was the founding faculty so to speak.

I've never even been in a type II. Our service hasn't used them for around 10 years. The only ones that are left are use as medical support units (van full of extra supplies for mass casualty incidents).

To be totally honest with you guys, after sitting in a classroom for 8-10hrs, it feels pretty good to get out and run a few miles.

Couldn't agree with you more on that point. It does feel great to go for a run after class. Like I said previously. I firmly believe you need to be fit enough to perform your duties without injuring yourself. It just isn't appropriate to worm that into the academic portion of a program. Then the smart kids get fat and lazy :shock: . Spending some class time developing fitness and nutrition plans appropriate for paramedics is time well spent and any great program will include this. Acting on those plans should be done outside of class time.

Are you there for an education or a workout :roll: ? The whole idea sound absurd to me. Don't get me wrong. I advocate being fit to perform your job, but this "style" of teaching, if you can call it that, just doesn't have any place in ADULT education.

What is your union's stand on reciprocity for foreign transfers?

As far as I know the union has no official position on reciprocity for foreign transfers at this time. Traditionally the union has pushed for "training from within". ie employer sponsored training taking a PCP to the ACP level. As far as I'm concerned if you're competent and willing to work hard you're welcome to come out. I can't speak for the older crowd within the union but most of us who are younger are more than happy to work with anyone who is competent.

You would have to get in touch with the registration and licensing board (British Columbia Ambulance Service). Give them a call as they can answer your specific questions as they are the the licensing body.

BCAS

Actually the British Columbia Ambulance Service (BCAS) and EMA (Emergency Medical Assistant) licensing board are two separate entities. The BCAS is the sole provider of emergency ambulance services in the province of BC. If you want to work in BC they will be your employer. The EMA licensing board is the licensing body in the province of BC. You must be licensed by them if you wish to practise as a paramedic in BC.

I don't know what parts of your training will transfer over but the folks at the EMA licensing are the people you will need to talk to. If you can transfer over be aware that we will be entering contract negotiations in 2009.

I grew up having a stay at home mom and I can honestly tell you there are a lot of advantages to it. The thing you have to consider is whether or not you will be happy long term giving up your career. If you're miserable as a result it isn't worth it because the benefits of you staying home will be negated. I know myself that I would never be happy as a stay at home dad (not that I have any children at this point). As much as I would love any children I have I would be absolutely miserable.

My basis is not religious, although my own moral beliefs indubitably influence my position. There is indeed a dignity to life, no matter how taxed or stretched or contaminated that life may be. That is my position in a nutshell. Do I think it is wrong to bar someone from ending their life intentionally? Is there a difference between allowing someone to stop life-saving drugs and allowing them to take a lethal dose of something? I'm not sure. But where I have serious problems with end of life ethics is where *someone else* makes the decision for the person in question as far as intentional death goes.

These decisions should be made by the patient either verbally at the time or through the use of an advance directive similar to a DNR.

There's a difference between not resuscitating the 98 year old for the 5th time and intentionally administering lethal doses of medication to them. While you as an individual would say that "I would not choose to live and I would choose to actively end my life if put into such and such condition" I do not feel that you can make that judgment for another person.

Again I don’t advocate someone else making these decisions. I advocate the patient making these decisions. Think of it as a part of your will.

And if you say there is no dignity, no lesson to be learned, no value to experience gained from end stage cancer or Alzheimer's or AIDS, I ask you- have you ever spent time with someone in that stage? I mean not just intermittent, brief instances of association... but really spent time with them? People who are put into extraordinary circumstances like that often gain knowledge or self-insight. Doesn't happen all the time... but just saying.

I have in fact done exactly that. While there are insights to be gained I firmly believe that people deserve the right to end there lives in these instances. If these people are going to gain some form of insight they will gain it prior to taking their own lives.

This is an issue that will almost always remain divided. I do not feel that euthanasia is beneficial. I feel that it places life in lower regard than pain. Once you establish that it is acceptable to end life based on certain standards of pain or suffering, you open the way for people to re-negotiate those standards (which they have in Europe in the Netherlands) and you teach society as a whole that it is preferable to end pain, rather than to confront it and bear with it as long as life is granted to you.

Did anyone notice how suicide rates have jumped in the Netherlands since the official institution of euthanasia policies? Just curious...

Wendy

CO EMT-B

You’re quite correct that the issue will remain divided. It’s much like the abortion debate in that respect. You’re also correct that once standards are put in place those standards will be challenged. The fact that something will be challenged does not indicate that it isn’t of value.

On the note of an increase in suicide rates in the Netherlands. Is this increase related or does it come as a result of other extraneous factors?

Just as a side note I also believe people have the right to fight for survival as long as they chose. I’m not advocating that people make one choice or the other. I’m advocating that they be given that choice.

Ed

There is no dignity in end stage cancer, aids, or alzheimers. Who are we to deny these people the right to die with what dignity they can have on their own terms? Having read both Wendy and Mateo's articles, my opinion has not been swayed. Any of the rest of you who read them may have noticed that the majority of opposition came as a result of religious beliefs. Religious beliefs have no place in the political realm. The fact that it is up for debate is a prime example of the very poor job we as human beings have done in separating church and state.

Feel free to try and sway me from my standpoint. I'm more than willing to engage in the debate and don't harbour hard feelings just because of a difference in opinion.

Euthanasia can, and has been shown to, work if the correct restrictions are put in place. In some countries it is in fact a physicians written prescription that allows for euthanasia. Bringing Hitler's version of euthanasia to the discussion is going overboard IMO.

Given that you have a plan to further your level of education to the preferred level ASAP and have in my experience shown yourself to act intelligently with due diligence, I would not call you a hypocrite. I know exactly where you are coming from. I started out on car as an EMR (essentially the same scope of practise as an EMT-. I went through the same feelings knowing that that level of provider shouldn't be accepted on car. I've since completed the majority of my PCP with only four preceptorship shifts remaining. Now as I continue to work I will be completing the pre-requisites for the ACP program (recently changed to a years worth of university credits just for entry into the program) at the Justice Institute of BC. Provided I'm able to complete all of them in time, I'm looking forward to starting into the program September 2009. The point is at this time you are working within the existing system. As long as you continue to strive to improve that system throughout your career there is nothing wrong with that.

Note:

PCP stands for Primary Care Paramedic (roughly equivalent in scope to EMT-I)

ACP stands for Advanced Care Paramedic (roughly equivalent in scope to EMT-P)

There is no solid medical reason I know of that indicates circumcision is better. You just need to teach your kids to wash themselves properly. I still have mine and have never had an infection as a result of it.

Patients have the right to refuse care up to and including refusal that results in death. To be perfectly honest I would make the same decision given the circumstances.

Excellent idea. It's refreshing to see researchers take and entirely different approach when the same old same old just isn't working.

Contrary to popular belief, I don't think dispatchers do these things on purpose. As the calls come in they move cars in to the correct position. Simple as that. Of course I do bring our dispatch coffee and donuts on occasion as a curtesy.