rock_shoes

Dear god why? Are you saying that you actually transport dead people, not workable codes, but dead people to the ER? Why?

We do this in my area as well. The nearest coroner is over 2 hours away so we transport to the hospital morgue. Then the coroner can come when it's at least a 2 for 1 and save themselves a trip.

I think it's a great idea to put kid's through some testing prior to putting them on stimulant medications. All in all these medications are way over prescribed. More often than not ADHD can be controlled through behavioral methods. Having been on Dexedrine for ADHD myself I can assure you these medications aren't the cure all many would have you believe. The side affects can be terrible.

I had my first MVA sunday morning and I had a DOA. So now my director wants to put me through a CISD, due to the fact that it was my first mva and there was the doa he is afraid that the next mva i will second guess myself in the patient care aspect of the job is this normal

Sounds like a "knee-jerk" reaction on the part of your director. Appropriate help from a mental health professional should be made available to you if you need it. There is no justifiable reason to force someone into a CISD for a call like this. So you were exposed to a dead body on the job. Big deal. It's not exactly an unusual occurence in EMS.

Im just so glad all I can do is an oral airway and bag em.

Play Safe :wav:

Why are you satisfied with an OPA? Please tell me you're kidding. Intubation ,provided the requisite education has been received by the caregiver, is a far superior method of securing an airway. I realize intubation opens up a pretty big can of legal worms but the fact of the matter is we aren't lawyers. Our concern should be for our patients.

Please don't take this as an attack. That isn't the intention. I just believe that improving the standard of care to the highest level possible is the best course of action.

The best use in EMS is as a quick drug reference. Anytime you come across a drug you're unfamiliar with you can quickly look it up and have all the indications, contraindications and, just as important, drug interactions.

Firstly and MOST Importantly agreed lots of bilateral heads up butts, the only fast tracking I can see is a serious court challenge (from either side of the rockies, I could really care less who funds this challenge from BC or AB really) get sleepy government officials moving, use solidarity for Paramedicine as the rationalle.

No question that BC and AB are the two biggest proverbial “sticks in the mud” when it comes to the formation of a national registry.

Never even suggested anything negative re: Quality of ACPs ... ever. Yes, Quite aware of the Durham finals and kudos, thing is place these all these folks in a sim @ the RAH or Uof A with ABGs, XRAYs, Labs plus ER MDS running the model's and one may find some very different outcome's and not sour grapes at all just a frank reality, heck Parkland won it last year. My counterpoint is that this just rationalization, and I see some pride as well, all awesome PR never the less, congrads to all the teams that recieved funding for this event.

That being the case we would have to send you a Critical Care team rather than an Advanced Care team. :wink:

I have DO have the new improved BC version,

BC ACPs have to patch for Narcotics.

No information on Pacing.

No mention of Amnio, or Vasopressin.

No Paralytics.

No Beta Blockers.

What is with your Hypoglycemic guidelines D 25 why ?

heck your still carrying Fluazamils, why? for mixed ODs. maybe best avoid that item.

Come on man I have all these options in Industry in AB, like today! Perhaps best keep to your skill set.

AND I do to have very serious issue with ANY PCP in administering ANY IV meds... Narcan is NOT without complications.

Like I mentioned before current licensing protocols don’t accurately reflect the state of practice. I do recognize that. Even by licensing protocols though morphine is not a patch it’s part of the standard drug list. So is D50. There are also allowances made for use of chemical restraint.

Here is the "problem" I have > than 20 years on the Road and Air, so just where is this credit thing factor in ?

Just how does your idea factor into this statement :3 months of paid or not. This does is addresses lack of ALS providers nor is it anywhere near cost effective. This 3 month deal is a union dictated "ideal" dude. I can work without supervision in the US and the majority of provinces and territories across Canada but have to have my hand held it is nonsense!

It isn’t really designed for the experienced ALS provider. It’s designed for the “fresh out of school” ALS provider (For whom I think it’s actually 6 months). For someone just out of school I still think it’s a great idea. Yes 3 months is long for someone who has been in the game for a while. There should probably be a competency based method of shortening it up for the experienced out of province providers. Just remember the amount of beurocracy we have to deal with here.

I dare say YOUR opinion will change when you get YOUR ACP ticket.

You may very well be correct on that. We shall see when the time comes.

Yes quite aware, its the lobotomy part I have some difficulty with is all, sheesh workplace BC affecting the provision of advanced health care ? Since when did they have input affecting Health Care, it is simply not within their juristiction or mandate.

WCB has a habit of sticking their nose into things they shouldn’t while ignoring some things they should be taking care of. I don’t like it either. I’m sure the other provincial equivalents can be just as much of a pain in the rear.

Even though I have active practice permit Alberta ACP/CCP level + other areas of Health Care AND have done many Medivacs OUT of BC, for years Flying. I have to still have write a $500.00 exam based on protocols that are about 10 years behind Alberta, I have current ACLS, PALS whatever.

I agree with you on the poor system of reciprocity. Credit should be given for experience. Unfortunately reciprocity sucks in both directions. If I want to work in Alta. once I finish my upcoming PCP course I will have to go through their also nightmarish reciprocity process. The only way to get around those issues is a national standard of practice with a self regulated national licensing/registration body. Just don’t be too quick to judge ACP practice in BC. The ACP’s we do have are excellent. We just don’t have nearly enough of them. A team of three women from BC did just take home the national title not too long ago. What are antiquated in BC are our licensing protocols. Fortunately they aren’t really used in practice. The switch has been initiated to “Treatment Guidelines”. Under treatment guidelines any procedure or medication that falls under your scope of practice is available for your use at any time without having to fit it to a rigid protocol. A good example would be giving someone with a severe allergy the benadryl before they go anaphylactic as opposed to waiting until you have to give epinephrine first (protocol is epinephrine then benadryl). You just have to be able to provide sound reasoning for your decision.

Then I have to do a 3 month "mentorship" before I will be allowed to practice on the ground and restricted to a only major community ie VAN, VIC, Killona (lol) or the LOOPs ...I have no choice of where I wish to work.... ah canadian democracy in action.... MEH!

I think you already know we disagree on this one so I’ll leave it at that. Personally I don’t see what the problem is as you would be paid your full ACP rate during this period anyway.

The biggest problem in BC is "top heavy" organized Labour, odd that Alberta ACPs are providing care to MANY industrial site's on the sly, as there are NO government regs in Private Delivery of Health Care and odd that Oilpatch DEMANDS that Level of care .... WCB should be burned to the ground and start again. Maybe perhaps time to consider a change for the public at large TOO?

No disagreement from me on this one. WCB will only recognize an OFA ticket or an EMR license currently. Join the 21st century for crying out loud. To work in the patch in BC as a PCP or ACP you need to do a 1 day “Bridge to OFA” course to be recognized. Then you can work to full scope if you have a medical director willing to sign off on you.

Submitted for your consideration.

Well I don't know about Dust but I say this subject is exempt. I'll even let it slide that she's dressed up like a fire fighter.

Seriously, folks... is "better than nothing" the best your community deserves?"

Precisely. Unfortunately in some of the far flung regions of my home province "better than nothing" is the best that is provided. Remote stations in BC are so close to volunteer it hurts. Responders are on pager and paid a 4 hour "call-out" when an ambulance is called in their area. Many of them are driver only/EMR crews (EMR is roughly equivalent to EMT-. BC Ambulance is simply unwilling to provide a higher level of care when the call volume is 30-40 a year. In reality these outlying areas need some kind of "paramedic exchange program". Send medics from the busier centres out to these low volume places for a block every so often (Full timers in BC work a 4 days on 4 days off rotation). Think of it like a working vacation. Most likely these medics will get some time to de-stress but if something does happen the people in these outlying communities will get the experienced crews they deserve.

hi im 17 from manitoba, i want to go to Alberta for paramedic school. If I get my paramedic license there am i alloud to be a paramedic where ever i want in canada if its available? like can i get my license in BC but work full time as a paramedic in montreal if i wanted?

It is possible to work as a paramedic in province's other than the one you took your education. However if you want to work in a province other than the one you were originally educated in you will have to go through that provinces licensing or registration process (varies by province). My suggestion would be to take the best program available in the province you wish to work. The reciprocity process is a real pain and not worth the hassle if you can avoid it. You can pretty well forget about Quebec as they just do their own thing regardless of what the rest of us are doing.

I think the point is that a paid professional crew would have shown up with the ambulance. They wouldn't have shown up off duty in POV's because professionals know how to switch off at the end of their shift. They turn off the pager and they don't sit around listening to a scanner waiting for the "big one" that will land them in the paper and make them local heroes. Yes dispatch was also largely at fault. A professional crew would probably know their response area well enough to realize when dispatch gives bad directions.

Fantastic. More of my tax dollars confiscated for the benefit of the most useless element in our society.

If it saves one junkie, it's a failure in my book. That's a code some poor medic student needs to finish his ride time.

Don't worry it won't save any junkies. They'll just re-up after they take the naloxone and OD when the naloxone wears off. It will probably increase the number of dead junkies actually.

Our nearest trauma surgeon is actually over 4 hours away running hot.

I'm guessing you guy's do air-evacs for cardiac and major trauma patients then. It's definitely interesting working outside the major centres. Much longer transport times etc.. At this point in my career I would like higher call volume though. Realistically the rural and remote areas are the ones with the greatest need for experienced medics because they have patients under their care for the greatest amount of time.

Admin is there anything you can do to stop people from ruining a good thread with such absolute garbage? I guarantee you Dust has plenty of experience and has made the progression starting as an EMT. Why do some people find it so difficult to accept a voice of experience? Remove your head from your rectum and join this century. My apologies for the personal nature of this post but I'm sick of these trash posts destroying what should be an exciting and interesting thread about bettering how we care for our patients.

Be aware of the behavioral based interview that is becoming more popular with EMS agencies. Don't be afraid of it. If you know what to expect it's actually easier than a standard interview. Use the STAR (Situation, Task, Action, Result) technique and you'll be golden.

Isn't that a big contradiction? :?

I think he meant Alberta College of Paramedics when he said ACP. EMR has a national profile making it similar in scope to EMT-B south of the border although Alta. EMR's are more restricted in scope than say BC EMR's. Needless to say the lower level of education as an EMR is the reason I'm making the move to PCP(Alta. calls them EMT's hence all the confusion) so quickly. Why they don't call it the Paramedic College of Alberta and save everyone some confusion I don't know.

hmmm interesting........

well, type ones really are easier to hose out when needed

but type 3's are smoother, easier communication (very important on county roads etc).

either way, if it's not a high top/van unit, i'm happy,

Having used both I have to say I don't think type I's ride any worse than type III's. Both type I and type III ambulances are built on a 1 tonne frame with 1 tonne suspension. I think the only reason our type I is shorter inside is because it's a 4x4. The overall height of the 4x4 isn't any greater than our 2 type I's in spite of having more ground clearance and larger tires. Having looked a little further into it I've found the same style bodies as those found on type III's can be fit to type I's. As far as I'm concerned that just about completely eliminates any advantage for a type III. The only remaining advantage I can see is maneuvering in really tight urban areas.

I'm currently taking my EMT course through Alberta Health and Safety Training institute in Calgary. It's an accelerated program, they cram it all into 3 months of class work. It has been the MOST intense three months of my life, but I have loved every minute of it. I highly recommend the school, but only if you are able to be entirely, 100% devoted to the learning process. I would recommend taking a leave of absence, or quitting any job you're in and tell your friends and family you'll see them in three to six months.

The amount of time you spend practicing is incredible. We spend literally 25% of the course practicing skills and doing injections/IV's. The course is difficult, their standards are high, but it offers an amazing learning opportunity. Others may disagree, and I suppose it all depends on your preferred style of learning.

Just thought I'd throw in my two cents.

Sounds a lot like taking the PCP course in BC. Very few have any love for the Justice Institute though. That level of intensity only works well for a select few. Unfortunately it's the only option in BC. There are only 2 providers of PCP courses (the Justice Institute and the Academy of Emergency Training) and both offer these shorter more intense programs.

What is a "rual" area? And when you say "real area" what kind of real area are you talking about?

I work part time at a service that is 90 miles to hospital with no air support and only 1 ambulance. We have some patients that it takes about 2 hours response time, then it takes well over 3 hours transport time to the hospital. Most response times are closer to 20 minutes. Nearest mutual aid is an hour away. We are primary for over 2000 square miles, and mutual aid for another 4000+ square miles.

I would call your area remote not rural because there is no hospital in the same town as the ambulance is based in. That said the nearest trauma surgeon to us is just under 2 hours away running hot. Our rural car does respond to places more than an hour out due to the size of our response area. There are two remote cars out in the far-flung regions but they have a difficult time retaining enough staff to man the cars so at times where going out over 2 hours.

I couldn't understand what the original poster was trying to say either. I'll discuss rural EMS with you mobey. I work at a rural station in BC. We have one of less than 10 4x4 cars in the province at our station.

Or you could just threaten to remove their ability to intubate in the field for failing to live up to their end of the bargain

Restriction of licensure for failure to maintain competency? I like it.

WOW big question.

It is osmosis. basically it is the movement of fluid from an area of lesser concentration to an area of greater concentration.

Just imagine dropping a tablespoon of salt into a glass of water. Over time the salt becomes equally dispersed throughout the water (this is your hypertonic saline). Now drop a piece of fruit into that saltwater.

The fruit is hypotonic (less salt), through osmosis the water leaves the fruit to get to the higher salt concentrated water. Now the solution becomes isotonic (or equal salt concentration throughout the water.

Now apply that to the human body.

Our tissue is filled with low sodium water. If we fill our vascular system with hypertonic saline (more salt), osmosis will draw the fluid from the tissues into the vascular system in an attempt to become isotonic.

Confusing hey?

Actually that makes a lot of sense to me. A good scientific explanation works for me because I spent a couple of years taking engineering before I moved towards EMS (What was I thinking making that switch :shock: ). The human body is always striving to maintain equilibrium. By giving a patient hypertonic saline we are throwing the system out of equilibrium. The bodies own actions to regain equilibrium have the effect of increasing blood volume in the vascular system. I could see this having a lot of benefits should a patient need surgery after being brought in as it will reduce the amount of fluid in the bodies tissues.

The more I learn about the science behind the primed study the more I look forward to seeing the results. It would have been better if the action of the solution had been explained properly at the same time as the inclusion criteria was presented.

Thank you! That was my point why can't we do it to provide a baseline prior to TX and it is useful for other providers to continue the continuity of care. THANK YOU!!!

BLS use of glucometers has already been discussed in another thread. Any further discussion of the topic should take place there. This was a good thread and unfortunately it's original intent has likely been lost to all of this.

Back on topic. Could someone explain how exactly the hypertonic saline has an enhanced affect over normal saline. The way it was described to me is that the hypertonic solution draws fluid from the bodies organs into the blood-stream. What is the action that causes this to happen?

Use the search function, my friend. You will find out why you are about to get the responses that are coming next. I can sum it up for you in 3 words, education, education, education.

ERDoc said it perfectly now let's all leave it at that. This has been a good thread and I really don't want to see it veer way off topic with this.

That is great to hear. What defibs are you guys using?

Right now we are using Lifepack 500's that have been re-programmed to work with our current CPR on BLS cars. All the ALS crews I've seen are using Lifepack 12's. Some BLS cars are starting to get the Lifepack 1000's now.