kevkei

Having watched enough episodes of "Paramedics," I realise that none of those are really out of the realm of possibility.

That show was good for two things:

1. Lists the places of where not to get sick.

2. A good example of what EMS is not.

I've given up caring about it, it's not like it comes out of my pocket! :wink:

What level are they looking for? PCP/ACP?

Both actually. Preference would be for ACP's. We are actually having a continuous hiring process with the current competition being open until Dec 31st.

I don't know what the process is for out of province applicants and what they are doing about equivalency.

.... Sorry, but there is no reason in an urban environment to not go to a cath lab.......

Sure there is. We assume that each and every patient will get into the cath lab in an expeditious manner, but the reality is this isn't the case 100% of the time. You can never ensure there is always an open and available cath suite.

Our system is unique, we will either transport directly to the cath lab, or alternatively, for some patients we will thrombolize prehospitally.

We basically identify the indications, rule out contraindications, obtain consent, initiate treatment O2, IV, (12-lead previously done), ASA, Nitro, Clopidogrel (Plavix), Enoxaparin IV and SC. We will have also contacted the coordinating Physician to determine the best treatment method (cath lab, or lysis) looking at the whole picture (patients age, PMHx, geographical location, time of day, duration of symptoms, cath lab availability, etc) If there is an anticipated delay in door to balloon time, we administer TNK.)

If anyone is interested, I can forward a copy of our worksheet/consent and the flow chart. I don't want to post it because it's too large, and I can't link to it because it is on a secure site.

There have been great points made about excited delerium and I think it is inumbent upon people to have a better knowledge and understanding of what it is, how to identify it and how to treat it.

...hence the need for PROPER chemical restraint and proper restraint period, as well as mitigation strategies targeting the co-morbid factors.

Excellent comment, although it should be expanded upon that the 'proper' restraint or agent of choice should be benzodiazepines. Other hypnotics or sedatives (Haldol, etc) don't mitigate the massive sympathetic response that these patients are experiencing.

It is also a good point about these patients, we need to initiate prompt and aggressive intervention as you are right, they get to a point of no return. Once this happens, it's too late.

And PS - I live in the most expensive "cost of living" city in Canada (generally speaking).

Of course, that's because the world revolves around your 'city'

Kevkei, please use my entire quote in your response instead of just the one that you want to use to try to prove your argument. I said that there were myriad reasons for people not to be able to move somewhere else. See text above this paragraph to show what I meant.

I didn't think I needed to as the original reference was right above it. I'm not trying to prove an argument, rather I was using the example that I quoted to make a point that this is a position many people will use. My comments were generalized and not directed at you specifically so I didn't see a need to elaborate or provide the entire quote.

If you don't like it, we can step out into the parking lot ....

(and have a beer, I'm buying!)

its' more and more clear.

I have a hard time feeling sorry for someone who complains that the cost of living is too high. If you don't like it move.

If everyone followed that advice, they would have no employee's left.

The problem as I see it, speaking from first hand experience, is staff feel undervalued, under paid and can't afford to survive.

Calgary and Edmonton are the two fastest growing cities in the country, which subsequently compounds increases in call volume and service demands. They are also the two hottest economies with the highest increases in consumer price index (inflation, cost of living increases.) What the City of Calgary is offering doesn't even keep of with the inflation.

The result is that new staff can't afford to establish themselves (vacancy rate at all time low while rent and house prices at all time highs.) Add to this, people that have been employed for a number of years can't even afford to stay.

So in order to make ends meet, I have to sell my house, up-root my family and leave family and friends to go somewhere where I can afford to live? (Which by the way is at least 2-3 hours away to get out of the economic market). I also have to leave a department where I have dedicated 12 years of service, through no fault of my own?

At the end of the day, something will need to be done to offer incentive to attract new employees in addition to incentives to retain existing staff to keep them from leaving. From what I understand staff turnover and attrition is at an erronious level these days. If you want to talk about service delivery impacting morbidity and mortality (in the event of a strike), what about a system that can't possibly sustain itself into the future?

Any training about Excited Delerium or Cocaine Induced Delerium included?? VERY curious :-k

Yes and these patients scare the crap out of me. We have had a few in custody deaths recently here associated with this and subsequent police intervention. Sad part is it is significantly misunderstood and neglected.

We use Ativan or Versed (Midazolam). Preference is the Versed as absorption is faster, generally the dosing we use is 5-10 mg deep IM, or if you have access, 2.5-5 mg IV. Ativan is 2mg deep IM or 1-2 mg IV.

Secondly. How in the he!! has EMS failed to be declared an essential service in Alta.? I'll be the first to admit that BC politics are loopy as can be but at least we got that one right.

I would suspect that just as a strike vote is a bargaining tool, so too is the fact that we aren't declared essential. From what I understand, if declared an essential service, yes it removes your right to strike but it also changes how they would rule in arbitration and it could benefit the bargaining units. Take for example, maybe we get compared to RN's when it comes to salary (not to suggest that would be the case)?

It would definately make a big difference salary wise for private and rural services.

I guess part of the problem is the perception if what is an acceptable wage as demonstrated here Big Bucks for Basics

If people are happy making $9.50 an hour and a $0.50/hour raise is enough then I can see why there would be outrage when people making $30+/hour want a 10% raise.

Based on past history, tf it gets to a strike vote, the intent is to use it as a bargaining tool not to walk off the job.

A few things to consider:

2) the list of non-union EMT/EMT-Ps is long, and i expect they will receive calls from the City this week to check on their availability in the event of a strike.

I disagree that the list is long. People are having a hard enough time solving their own problems these days (recruitment, staffing, etc) let alone helping someone else.

Another thing to consider is Edmonton EMS isn't far behind in their contract talks. What will happen with them?

Calgary EMS will today fire up the engine on the first ambulance in Canada specially designed to transport obese patients.

Oh really? I guess they neglected the fact that we have had ours for a while now?

Depends how much BSA is involved.

Over 10%, you shouldn't even be thinking about irrigation.

Sure you should, you need to stop the burn process.

I'd really rather we did not get into names on this topic. Who was involved is really irrelevant to this forum. It is the professional issues involved that are the important topic of discussion.

Naming names is just going to get this topic closed, and rightfully so.

I wholeheartedly agree, which is why I said something about the original post, which had gone unchecked until now.

Lets drop this unfortunate "fau pax" by 8151 as an error in good judgement.

Because it isn't a 'faux pas', all you have to do is look at the individuals post history which you will quickly find is severely lacking in anything productive. As for myself, I believe that one can speak for another when you can comment on their professionalism and character.

I'll bet it was CCEMS, Mike G.?

I'd like you to qualify that statement. I know of who you are referring and can speak on his behalf.

Welcome to the world of medicine where very little is black/white! This is the type of question that seperates the good from the not so good. I agree with what has already been said and I don't like giving things to cover your bases. I have to be pretty confident it is cardiac (>80%) before I'll start to look at NTG and ASA. You can do this with a thorough history, assessment and physical exam.

If you don't know what it is, what do you think it might be? (differential diagnosis). Are there false positives and/or pertinent negatives?

When you have your list, go through and rule in what you can and rule out what you can. You are left with a working diagnosis, which if you have done your job right and well, you can treat.

Very few cardiac patients will present like a textbook. Many will present with atypical symptoms (especially females, diabetics and the elderly - sounds like a lot of our patients doesn't it?). This is why understanding anginal equivalents is so importanty. More importantly, these symptoms have ususally been going on for hours, days or weeks so how effective is ASA going to be?

I would lean more towards a conservative approach. Assuming you have done a good history and exam, start with your basics. O2, IV, position the patient, etc. Then re-evaluate and ask, has there been any change? If I feel it is cardiac related, if there are no contraindications and looking at the entire patient (vitals, etc) I may consider a trial of NTG and then re-evaluate again. Has there been any change? If so, was it mild, moderate or significant? If it is mild or moderate, I'll probably repeat again after reassessing. (If it was significant, I'd be cautious and would probably raise a red flag.)

When repeated, go back and reassess again. Was there any change now, if so, mild, moderate or significant? If you see positive results, you are probably on the right track and then I would consider giving ASA. If not, I would with hold the ASA and probably hold off on giving any more NTG.

From a pharmacological perspective, dextrose is dextrose regardless of it's form.

From a technical perspective, you are administering an IV medication via an oral route. I doubt the pharmaceutical company approves IV D50W for P.O administration.

The pizza is a good ideal. We all too often load patients up with simple sugar (carbohydrates ) which will plateau and then fall off. You should also remember to add complex carbohydrates as well as protein to the mix to maintain a decent BGL.

I am not meaning this in a hostile way, I am genuinely curious.

As someone who is both a Paramedic and a Nurse I don't understand the role you are describing. It sounds like community nursing to me.... so why do we need community medics? What do they bring that community nurses don't?

Easy, because community healthcare has failed. Either those that are supposed to provide the services do or we have to pick up the slack.

The industry trend is that more and more people are relying on calling EMS to try to access these services. Because we respond to 911 calls in a timely manner (where as community health providers do not, working Mon-Fri office hours).

Hi all. We are looking at setting up a Community Paramedic program in our region and I am looking for information on similar programs in other areas, such as protocols and procedures. We are looking at doing in-home assesment of CHF, wound care and dressing changes and such. Any info would be helpful. And yes I tried to google the info with no luck.

Have you looked at Nova Scotia?

Nova Scotia Community Paramedic

Nova Scotia EHS

How about the International Round Table on Community Paramedicine?

There are a bunch of resources and articles Here.

He was outside, running the pump.

Don't assume you know the situation.

I didn't assume that I know the situation, but if you do, perhaps you could describe how he had any trace of cyanide in his system? What was the causal factor (source)?

Fire tactics and strategies have been fine tuned to make the job safer. It's still a dangerous job. Don't think for a minute it isn't.

Unfortunately, proper nutrition, cardiovascular health, and physical conditioning haven't evolved as quickly.

Shayne

Shayne, I agree that it is still a dangerous job. What I think I (we) am saying is that it typically isn't the dangers of the job itself. Failure to use PPE won't protect you from many of those dangers while PPE in others makes no difference.

On the flip side, many of those dangers are avoidable and you can mitigate others (those tactics and strategies). There will always be the unavoidable and unpredictable events.

The last firefighter who dropped on a scene around here had a cyanide level of 66. ER got him back and he's currently in rehab.

So maybe it's not always lifestyle. Most of the time I'm sure it is, don't get me wrong. But I think there's a subset of patients who go down for reasons that are chalked up to overall health but aren't.

Had he been wearing a B.A, this wouldn't have been an issue. Again, it's not the dangers of the job itself.