Tactical Spork

For the Bagram folks:

Have a EMT City meet and greet at the Green Bean or something like that. Sounds cool to me. I am back in the 'world' right now, but if all goes well I will be back in KAF in Jan. so perhaps then.

Dwayne, Was it the KAF role 3? Depending when it was, I might have some info. PM if you want. I see your point, I think we just differ on timeline. My view is just wait until you get to the hospital, then sort it out there vs. doing it in the field. Great discussion. TS

Hello all, I have a question for the group somewhat related to the topic at hand. My question is related to chest tubes and hemothorax management. I am looking for people's views on clamping the chest tube if it is putting out a lot of blood (say >1500mL post placement, or >200mL/hr to use classic textbook numbers). For discussion sake a thoracotomy is not an option as the patient is being transported to a trauma facility (via ground or air depending on your background). Looking forward to the feedback/discussion. TS

I guess there is a way view US Netflix in Canada. I should look that one up online. I bet it would cost extra but if you get a ton of extra content then perhaps it would be worth it. Kind of related, but have you ever noticed how EMS is featured in movies? Sometimes it is less than favorable. As mentioned Mother, Jugs, and Speed come to mind. Bringing out the Dead comes to mind also. Not sure my feelings on that one, as I thought the book was quite good. Dwayne do you get Mongolian Netflix?

I wonder if Mother, Jugs, and Speed is on Netflix? I think getting paid a percentage of your call would be a bad idea - for ambulance calls. I should mention that for a few industrial contracts I did get paid a day rate, and a percentage of the invoiced cost. Now, I see that as different as I am there to provide medical coverage so a company can make money be it drilling, mining, or whatever.

Should EMS wages be call based? No. First, from a Canadian perspective I think many of the medics trying to make a living on pager pay in British Columbia would disagree with this premise. From a broader context call based pay, to me anyway, sounds like a volly squad setup. If you are at work then you should get paid. Yes, I will agree, to a point, that this can cause 'friction'. You run your ass of while the other guy sleeps all night without turning a wheel. This happens. As for rural vs. urban, low vs. high call volume it doesn't matter. Base salary on a person's skill regardless of call volume. A skilled person is of value to their patient as well as an organization. Be it a guy sitting on an industrial site for 24/7 waiting for something to happen - if something does happen they will be happy to have a skilled provider. To having an experienced person doing 911 calls. I think what this boils down to is EMS education and training. If you have an ALS provider with training comparable to an associates degree, well, then you will need to pay them regardless of the setting they will be employed in.

A nice podcast summary of current tourniquet research: http://phtlspodcast....ity-trauma.aspx Among other studies, it also mentions the one below.

From my point of view, the main issue with EMS education is the lack of time. In a degree program, you measure a student's progression in years, whereas in EMS you measure a student's progression in months. With time, you can 'guide' or correct a student's behavior. They have time to learn and mature. I know the topic of 'degree' or 'college' prepared EMS providers has been discussed in other threads, but I do think that is the key here. Regardless of the ratio of mature, immature, heroes, sand-baggers, to joe average they are still out the door before you know it. Especially at the BLS level, but there are still a few ALS patch mills out there. Of course, it would be hard to convince someone to complete an EMS degree program with the current salary options in EMS. Of course, as you raise education requirements income tends to follow (as well as the quality of patient care).

Hello all, I enjoyed reading the posts. I thought I would add my thoughts. First, a few pages back, the consensus I gathered from posts was that you should apply a tourniquet to slow, but not stop blood flow. From my experience I would recommend against such practice as typically you are applying these devices to control deadly uncontrollable bleeding that cannot be stopped by other means. I think, from a practical level, halting deadly bleeding yet maintaining distal flow in an attempt to maintain tissue viability would work, from a theoretical point of view, but in field application this would be almost impossible to achieve. Also, one could argue that such end tissue perfusion would eventually produce hemodynamic instability over time. This doesn't fit with the life over limb concept of tourniquet application as the blood supplying the tissue isn't coming back, so to speak. Typically, the distal flow theory of tourniquet use is sometimes advocated for when there is significant post-injury tissue at risk. For example a mid-thigh GSW with arterial bleeding, or perhaps some sort of crushed a extremity. Anything other than a straight forward amputation would be another way of saying it. The concern is distal tissue death. If anything these are the cases where a loosely applied tourniquet will actually promote blood flow and loss through the venous side. After all we all put tourniquets on when starting IVs to 'puff out' the venous side. Well the same thing is going to happen to that messy extremity trauma. It will promote blood loss. I am a KISS guy. In trauma I see all blood loss as bad with the goal being to stop it. Yes, over a prolonged time-line there is an increased risk of tissue/nerve damage or death, but in my humble opinion that is outweighed by risks of blood loss and death early on. It wasn't that long ago when the math added up differently: you had your head jumped on for applying a tourniquet for that very reason. I never understood why, as after all, many of these complex extremity injuries have surgical-tourniquets applied in the OR to help facilitate surgery as it is hard to see your work if it is covered in blood. Look forward to people's thoughts. TS This is a certified 100% troll-free post

FYI, The JIBC School of Health Sciences is exploring the possibility of delivering the Advanced Care Paramedic (ACP) Program at our Victoria and Kelowna campuses. We would appreciate your participation in this short survey which will help us in establishing potential applicant numbers for these locations. Your responses will be treated in the strictest of confidence. http://survey.jibc.ca/survey/30997/123e/ If you have any difficulty in accessing this survey please contact acp@jibc.ca Spork

I think one of the main issues is experience. Typically, from what I have seen, it is the new guy who gets in over their head, or gets burned. You know, the new guy who really, really, really wants to 'break in.' To the point that common sense is pushed to the wayside, and red flags are ignored. That inexperience also plays out on the clinical side, also. I am not saying you need to be the trauma god to work in the industrial setting, but some level of experience is required. People working the patch right out of school, in my view, is wrong. It happens all the time, of course. The way I see it, from my experience anyway, is once you gain experience you know what type of project work well for you. That fit within your ability, if you will. Also, with experience you know what type of income such a position will generate. Now all you have to do is find such a job, for a company that won't farm out to newbies for a lower rate!

Best of luck. A lot of solid advice so far. Just expect firm answers from potential employers, and don't leave any details (travel costs, day rates, duration) out. Assuming something is the fastest way to get caught. For example, I ran into a medic who was going out west to work. Somehow he seemed convinced that he didn't have to get registered in Alberta to do this, nor did he seem to believe me when this was pointed out. The company had a special 'deal' with ACoP to deal with this. LOL. He even paid for his flights out west, just to find out as you guessed, that he couldn't work. A week or so later he was back in town. The last I heard he was trying to do international work for free to 'break in.' That is not the way to do it. Needless to say, if you approach this line of work with a direct goal then you should be ok. Be it for academic reasons, to fund your endless summer, or whatever. Just keep in mind no money is free, so it might be ok now. You might not miss the night shifts, but long rotations in/out have their own unique issues. Just keep asking around, and making those contacts. Soon enough you will get a feel for who is good, and who to stay away from. Personally, I deal with a few key companies that I have a relationship with. If I do consider trying something new, I am very critical of their operations. If I have any concerns I just walk away.

Are you going to U of A, or U of C? Your plan will work. Back in the day, I did that very plan. To answer your questions, I would have to say it depends. Sometimes a company covers specific costs, while other times they don't. It depends on the contract, as each one can be specific. I think your best bet would be to work with a few companies so you develop an understanding. They know what you are looking for, and you know what to expect from them. Just be up front with things as it is business. I can think of a few specific times where I let that point laps just to get burned in the end. The other issue you may have is fitting things into your schedule. Depending on your course load time might be of a premium. Perhaps you might only be able to fit work into your reading week, for example. Of course, you can always take your textbook on the job as you will have plenty of study time . Yes, the majority of you time at work will be just waiting for something to happen. Bring your textbooks. A few people who frequent this site work in the industrial setting so, I am sure, you will get lots of useful input. Feel free to PM me if you have any additional questions.

I could tell you how that handle came about, but it is my understanding that the 'mission' is still classified. Might be out on Wikileaks though... I know, perhaps I could write a tell all book. How about 'Blood on my Spork?'