kevkei

So what then, it's a cheap shot at me? If so, then pick the fight with me not the rest of the country. And while we're at it, make sure not to bring a knife to a gun fight. Since I have taken the time to write out a lengthy response and to do the footwork for someone else, would you like to question anything else I have said?????? Apologies, missed those posts as I was typing and researching.

The question you asked is simply about Provincial reciprocity. Unelss things have changed, there were only 2 programs out of the U.S that ACP would allow for complete reciprocity. One being in California and one being OHSU (Oregon Health Sciences University). That being said, the best case scenario is you will probably have to complete an ALS practicum and probably an EMT-P refresher program. Very seldomly, if ever, has ACP allowed 100% reciprocity other than with OHSU. The last time that happened as far as I know was ~10 years ago. (I bed Dustdevil could give a better idea of the headache ACP will cause) My short and blunt answers were because is it too difficult to do a forum search here or on ACP's website?ACP - Substantial Equivalency ________________________________________________________ Substantial Equivalency (From the link above) Within the Province of Alberta, the practice of Emergency Medical Technician is a designated health discipline under the Health Disciplines Act. The College has been designated under this Act to administer the Emergency Medical Technicians Regulation and act as the self-regulating body. There are three areas of practice currently defined in the Emergency Medical Technicians Regulation: Emergency Medical Responder (EMR); Emergency Medical Technician (EMT); and Emergency Medical Technologist - Paramedic (EMT-P) Equivalency reviews are conducted by the College's Registration Committee. The fee for an equivalency review is determined by College Council and is subject to change without notice; fees are non-refundable. The current fee schedule is: $300 EMR equivalency; $400 EMT equivalency; and $650 EMT-P equivalency. Preparing Your Equivalency Submission Equivalency submissions must be mailed directly to the College. Email and fax will not be accepted. Approved applicants may apply for temporary registration. Applications for equivalency must include: Completed application form. A detailed course outline with learning objectives and time lines for didactic, clinical, and ambulance components. Be sure to include the number of hours and/or weeks for each program component. Examples of sufficiently detailed learning objectives include: Methods used to deliver the material (eg. lectures, home study, lab, computer managed learning) Bibliography listing of the texts used as well as copies of all printed resource material (eg. Bibliography; Egan; Fundamentals of Respiratory Therapy, Mosby, 1985.) Methods and pertinent documentation used to evaluate the student's competence in each component: didactic, clinical and ambulance. Minimum competency requirements for instructors and preceptors. Confirmation of Program Completion Original certificate or certified true copy; or Official confirmation of current attendance. Copies of additional EMS related training or instruction, such as BTLS or CPR. Cross Referencing In order to assist the Registration Committee in determining equivalency, a cross reference to the Alberta Occupational Competency Profile (AOCP) is required. The cross reference documents below contain only the main headings of the competency profile. Please review all the of the sub-competencies contained in the profile to accurately determine your level of equivalency. EMR Cross Reference Document EMT Cross Reference Document EMT-P Cross Reference Document Privacy Policy | © Alberta _______________________________________________________ So in short, have you done a cross reference of the ACOP document for EMT-P's? Have you looked at the skill set and compared with your program? This should give you an idea of what to expect. Even in Ontario where some would argue have the 'best training programs' for ACPs (EMT-P), you are required to bridge gap profiles and upgrade prior to being able to register. Even then, it is a 'restricted' license. Agreement on Internal Trade (Labour Mobility Within Canada) "Depending upon which province you are applying from, you may require additional training to achieve full scope-of-practice in Alberta. Please refer to the following documents for comparisons of registration categories:" "Please allow 4-6 weeks for processing of your application. Following successful completion of application process applicants will be sent a letter with instructions on how to complete the online Alberta Jurisprudence Exam. This exam is a mandatory requirement. (See, you still have to do a registration exam...) Upon passing the exam, applicants may complete registration with the Alberta College of Paramedics by following the steps outlined in the New Practitioner Registration Package."

Simple answer, NO. Perhaps when hell freezes over. (You'll understand if and when you understand who and what ACP is).

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA !!!! Touche! Quebec is backwards in many ways, EMS being one of them. xlq, lighten up a bit, sheesh. When it comes to the law enforcement community, the RCMP as a whole gets poor grades. Obviously Dust even in his locale and limited experience here has picked up on this. There are many reasons why due to the ineptness of the RCMP that the fallen four sacrificed their lives for nothing. Kind of like the ultimate sacrifice of the 'heroes' of 9/11? What did that accomplish?

Hey, you said it was a sweet deal? Welcome back, long time no see.

According to the CMA, BCIT isn't accredited for a CCP program. I know that BC has CCP positions, but I can't find a link to a CCP program in BC. I do know that NAIT's Paramedic (ACP) program out of Edmonton includes the CCP didactic in their base curriculum as well as clinical requirements for practicum. This is partly why the AIT and provincial mobility has been difficult as there are still gaps in the Alberta competency profile.

Yep, we had a few go through thumbs in the initial training/orientation.

I agree 100%. I've seen more complication errors with the BIG (usually the operator) and better success generally with the EZ.

There's no fooling, BC is an absolute Provincial model. Here, each health region will be responsible for determining how they want to deliver service and by whom. There will be 'inter-regional' cooperation but the boundaries of each region is (will be) pretty specific. As Stated before, there are still different service providers, not everyone is employed by the Province.

CTAS stands for Canadian Triage and Actuity Scale. CAEP (Canadian Association of Emergency Physicians) CTAS Info

That is actually how they were trying to sell the idea. Their proposal was that they were going to increase the ALS coverage, especially in the rural areas. The problem is where are you going to find the Paramedics to do it? As for copying the BC model, there are still 6 health regions that are each responsible for their own operations, so there won't be a common link across the Province. This is supposed to allow for each region to accomodate for their unique needs. Or so they have said.

Dust, I generally agree but that isn't what I was suggesting. You still need to do your initial critical interventions to cover off the ABS's and use an acceptable method to identify the critical threats. After you have done that, invest some time (maybe 2-3 more minutes to get additional and specific information. (This will account for 5-10% of most systems call volume). The telehealth part can cover an additional 15-20%. This is why I suggested talking to the other services above. AMPDS itself even allows for this, anyone familiar with the 'Omega' protocol? If we as practitioners think that everyone that calls 911 should have a Paramedic at their door within the industry standard, are fooling ourselves. We don't walk into the ER and expect an ICU intensivist to see each patient within 5 minutes of arrival. We should change out method of thinking. As for a recipe for disaster, I'd say the Dallas system was doomed to fail. There are many places around the U.S and the world doing these things, doing it well and with little to no liability or negative outcomes. Looking at their evidence changed my perspective as I had thought, how can this be done? Well, it seems that it can be and their is significant cost avoidance and resource allocation to respond to those cardiac arrests, FBAO and major trauma even faster.

Not that you need me to tell you this, but for the purpose of others offering their perspective. There is a way to accomplish this, develop your own system to do what you want it to do, not what others tell you should be done. - Have competent, medically trained people (Paramedic) do the call evaluation and dispatch. - Follow the principles of telehealth to hear and treat (triage), take your time - not all patients need an ambulance at their door <8:50 90% (actually, the majority don't) so take the time to do a proper evaluation on the phone. There are only a few true critical threats where time sensitivity is an issue. - send the appropriate resource in the appropriate method, if you need to even send it at all. - establish appropriate response time benchmarks depending on patient disposition. - too many systems base how they respond on equality for all patients, which is intuitively wrong. Too many people buy into the fact that when someone accesses 911, we have to respond L & S as quickly as possible. That we need to stop the clock, the sooner the better. This is a fallacy, we have an inherent issue in wanting to not tell someone that they can wait. I did some public consultation with different groups and found that they were quite receptive to these kinds of changes. Does your local are have any type of nursing telehealth system? Have you talked to them at all about the 5 w's and how they do what they do? Is there a way that you can leverage some of their resources or partner with them?

I agree, you have to steal from Peter to pay Paul. There is and only will be a net deficit of practitioners. Specifically that you can only be employed with one title within AHS. Can't work full time in Edmonton and casual in Parkland. Can't work prehospital and for CHEMS. I can however work casual there and full time here. Hmmm! I agree here too. They will find themselves in a whole world of hurt I think, they are aware of the shortage. That will be defined in the future. Who says the clinic would need to see the patient that day? There is a lot of potential being looked at for modifying and expanding the EMT and Paramedic scopes of practice. You will probably eventually see Physician Assistant become a reality as well, coming from the Paramedic pool (adding to the existing shortage). I will admit, over time I think there will be huge potential to what we as EMS providers will be able to do. In hospital, out of hospital, critical care, urgent care, community care, etc. Keep in mind, I do say this knowing full well what the future is looking like and the cold reception coming from AHS. No, the agreement on internal trade (AIT) would still require for provincial registration and testing, it makes only it easier to transfer your education. Remember that this was supposed to be for trade unions, but EMS ended up getting included. If that is what AHS is saying, 1000 ready to move here, I'd push all of my chips forward and call, 'I'm all in.' Logistically improbable, if not impossible. Because we already know BC and Ontario have an overabundance of ACP's or Paramedics. Sounds to me like a good bargaining position when their threat falls through. Say to their face 'good luck with that.'

I don't know what you did or used before, but using AMPDS typically increases L&S responses to the average of 75% of all incidents. IT is an okay product if you want to try to mitigate the risk of call evaluation and dispatch but you have to accept risk of L&S responses. A 01C1 (Abdominal pain) is a medium priority L&S response because of a 1-3% chance it is a AAA (lacks specificity by 97-99%) If you want to provide the best service and most appropriate resources, and if you are comfortable accepting some risk, there are other alternatives that would be better. I agree with Dust that what’s nice is it is a pretty prepackaged product that the masses are using, but not a great product. AMPDS, ProQA and SSM are the ‘be all end all’ for ‘best practice sites’ (Fitch anyone?). If you would like some good contacts to review, try looking at: - any of the NHS ambulance trust services in the U.K London Ambulance Trust - Metropolitan Ambulance Service in Melbourne Australia MAS - or a contact closer to home Mecklenburg EMS Agency in Charlotte MEDIC 911

Basically with the transition, it will go one of three ways (but really two) - direct delivery (by Alberta Health Services) where they take over existing providers (City's of Edmonton, Calgary, Private's etc) - contract delivery - where services are contracted to provide EMS. If the City of Edmonton would have contracted, staff would have remained with CUPE for at least 2 years or the duration of the contract to provide service. Where integrated services are being exempt is that AHS is contracting with said municipalities to provide EMS. Bascially AHS is paying the integrated services and they run and employ how they see fit, but with AHS oversight. Until their actual employer changes, they remain with the same bargaining unit. The oversight by AHS has been you can't use EMS to augment fire, which is why the hiring numbers are up. Strathcona 20, plus 2 more, St Albert 24, Leduc 16, Lethbrige 16+.... The rules are being more clearly defined. As for people jumping ship to integrated services, I did and have the benefit of controlling my destiny, not what is directed by AHS, the Gov't, etc. I still get to be a Paramedic, I get to stand back and let the dust settle and then decide what I want to do for the next 15 years. Is it the best scenario? No, but at least I'm in control. One other point, don't assume that after the 2 year contract period that all integrated services will give up nor will AHS automatically take over service delivery. Unfortunately, the reality is the integrated services were the ones that wanted to keep delivering but all the other major players wanted to give it up. An no, it's not a money maker here. Our City council had to increase our budget $250000 to hire additional staff, this resulted in a tax increase to the taxpayer. Just my 2 cents worth. Until all dispatch is consolodated, you won't see much of this. There will be more regional cooperation but I don't think you will see much of units being drawn our of an integrated area to cover somewhere else. Really, they don't know because they still have no idea of what the system(s) will look like or how they will run. This isn't totally true. Nothing is changing for me here at the moment or even in the near future. We have been directed that it will be status quo, with some modification of duties (if you are on the ambulance, don't expect to do an interior attack). What AHS said is that the resource needs to be capable of responding to another incident within 90 seconds. Even this is going a bit far as we have the staff and resources to man up to 5 units. We only have a contract to provide 2 full time ambulances.

And I understand that, but you assume everyone is calculating their UHU with the same formula and I can tell you that not all of them do. Plus, if you add other job related factors, the UHU isn't fully accurate anyway. A more important benchmark is time on task. For example, if it is common for a system to deal with diabetics and you treat and release, but you are assigned to the incident for 1.5 hours, this isn't included in your UHU. To illustrate, if a crew works a 10 hour shift, they transport 4 patients with a total incident time of 4 hours (1 hour per event) this would equal roughly a UHU or .40. But lets say for another 2 events, they treat and release 2 diabetics for another total of 3 hours (1.5 per). Add to this time to refuel, restock, respond to a couple of other events but cancel en route for another 1 hour (cumulative time of 8 hours). Then they do a 1.5 hour fire standby, help perform rehab, do pre/post entry vitals on fire crews, etc. Now we have 9.5 hours of the entire shift. Somewhere in there, they get a 15 minute lunch break 3/4 of the way through the shift. Last but not least, they get a late call on the way back to their station and work 1 hour of overtime. Statistically, they had an UHU of 0.4 for the shift but ran ass ragged all day. So who really is the busiest system in the States? It's all a guess my friend because stats can be collated to reflect whatever the beholder wants.

Not really, you'd have to assume everyone is calculating the UHU with the same format and including/excluding the same variables. It's like stats for response times, cardiac arrest survival, etc.

I also have Ketamine available but our MD prefers Etomidate for RSI. Not trying to stir the pot with you at all as I do agree it is something to consider and be cautious of.

I thought adrenal suppression was associated more with continuous or repetative use of Etomidate? I know research has suggested that in single use it may decrease cortisol levels but wasn't thought to be clinically significant. Have you seen anything indicating otherwise (I've been looking and can't find anything) as I'd love to see a reference if it does as we have been discussing it here as well. I've seen the article from Journal Watch, so in bacteremia I can see the issue, but for RSI in say TBI? Truly and clinically, cortisol can be given at a primary care centre based on lab values. Considering risk vs benefit, what would be viable or preferred alternatives?

Would it have happened if the EMS crew were first in or arrived alone? As for me, if our dispatch says PD isn't responding or will be delayed to what sounds like an unsafe scene, then I don't go in. Luckily our dept has a policy in support of this. I've been on plenty of scenes where they were initally thought to be safe or where they became unsafe where PD has drawn weapons, Tazered, etc... And no, I don't think a ballistic vest would have helped their egos, nose, lips, hand, or head

How about dimenhydrinate (Dramamine, Gravol)?

I'm flattered that you noticed I had been gone..... a while. Short version, new job (won't tell you yet what I'm doing, will be good for a few laughs though), new baby, training, moving, the list goes on. Not much free time to get on here and keep up to date. What have I missed?

Yeah, it's all good....! Been too busy with lot's of changes, you'll learn soon enough I guess. I'll try to get you updated. Isn't that interesting? We'll I'll search it out and maybe reply..

Hey all, been gone a while, may be back a little more often. Some recent changes but can talk about that later. Looking forward to trying to catching up with y'all.