WolfmanHarris

What about serum lactate and CBC for sepsis screening and early intervention? I don't know a lot about lab results but that's the first that comes to mind. Could be especially useful in an environment that begins to move away from transporting everyone.

Here in Ontario I'm really not sure. There are some exciting things in development that I hope come to fruition, but the legislation and regulatory environment makes these less than guaranteed. 1) Self-regulation. The Ontario Paramedic Association will soon submit an application to the Health Professions Regulatory Advisory Committee (HPRAC) for the Creation of a College of Paramedics. Self-Regulation will open the door to setting our own standards for education and a more adaptable scope of practise. 2) Community Paramedicine. With a publicly funded health care system finding efficiencies and novel ways of providing service is theoretically easier to justify since the system as a whole saves money. Many services are starting to explore various solutions to shift away from the transport everyone paradigm. The early stage programs mirror a lot of what's been reported in various publications: visits to frequent callers, referrals, follow-up visits, etc. My service is exploring a few different options and have four staff devoted full time to developing community Paramedicine. The options being explored are an Expanded Scope of Practice for Paramedics, treat and release of nursing home patients with follow up by NP or MD the next day (traditionally we have transported 100% of these patients), and selecting experienced ACP's and sending them to Physician Assistant School and utilizing PA-Paramedics in the field. The PA-Paramedic program is probably the most interesting. Details are still scarce at this point but it creates a new step in our career path. Also exciting is that the University has apparently agreed in principle to recognize the three years of College training an ACP has as meeting the usual prerequisite for two years of University in any discipline. 3) Longer injury free careers. We have had tracked stair chairs for three years, we have a very open policy for requesting lift assist, power cots have hit all the trucks and power lift is on the way in the new year. We've been aggressively pursuing no-lift policies and equipment where possible and promoting health and wellness across the board. Our service is far from the only one embracing this shift and I think that's going to be a huge career extender. 4) Longer careers. I think has already started. Since the download to the municipality in 2000 and the enhanced education requirements we have seen dramatic increases in pay and benefits. We have a great defined benefit pension. As services grow and embrace new ways of providing service new job opportunities are created away from the Ambulance which help alleviate burnout and extend careers. All in all I think the medics in the earlier stages of their careers are no longer entering with an eye to FD or PD and have a long career in mind when they sign up. I can easily see reaching retirement while still being with this employer.

Once again we see why Fire just isn't the natural home for EMS. More funds coming in from Ambulance? Let's spend it on the Fire side.

We often get frustrated by the wide gamut of persons under arrest we get called to assess by PD but this (as I try to remind myself constantly) is why. PD where I work is extremely diligent at this. I'm also consistently impressed with how they handle mental health calls. We're dispatched automatically with them and during certain hours (not enough but a start) they have a mental health team consisting of a plain clothes officer and a counsellor.

Rural should not be an excuse for the kind of care being provided in NJ. (Haven't been or worked there, just going on the descriptions here.) Ontario has wide swathes of rural areas and remote areas in the north. Rural areas are still served by professional Paramedics exclusively usually with volunteer fire departments serving as first responders only. In remote areas the Professional EMS services may have extremely prolonged responses so many have set up community first response teams where locals trained to an FR or EMR level first respond until EMS can arrive. In some of these remote areas HEMS will also be utilized for more routine calls then they would otherwise be called for in Southern Ontario.

Demand for service in general and my region specifically is outpacing service growth even without the negative impact of economic austerity. I may make great political sound bite to call for across the board belt-tightening in tough economic times, but some services can weather that without impacting the general public better than others. With approx. 90% of costs of EMS (here at least) being wages and benefits, cuts would only result in less unit hours. Whether this is realized by cutting overtime, delaying hiring, or actual lay-offs the only end result can be delayed responses and increased staff burnout. Thankfully I work in an area with a vibrant tax base and growth as well as a regional council that has so far been very supportive of funding growth in Paramedic services. However, even with planned growth call volumes are increasing and the time per call (including turnaround) is still increasing. This trend is not expected to reverse with the aging demographic and immigration so increasing funding is only part of the solution. My service is currently exploring major projects in Community Paramedicine that will initially start transporting low acuity patients to Urgent Care Centres and expand to programs that will see more treatment in place of LTC patients with follow-up in the home and eventually better treat and release within the community. These solutions are novel and potentially very effective but can only exist on the foundation of a strong core EMS system. Detroit and other severely economically depressed areas cant pursue better solutions for their patients when they can't even reach their true emergencies in a manner the public expects. In the short years I've worked we have had a few days where call-volume has severely depleted our available units. While we are station deployed, our posts are hierarchical and as stations are emptied lower priority posts are moved in to cover these area. Below a certain number of units low priority calls (non-emerg IFT, non-emerg 911) are held and at six available units or below we switch to mobile deployment covering one of six major intersections in the region. I can think of perhaps a half dozen times when I've been working that volumes have depleted us to the point we go mobile though certainly on a regular day I can find myself extremely far from my home station covering busier areas. With the way our mutual aid agreements work we can call neighbouring agencies in not just to handle calls (this is done regularly in border areas of the region since the closest Ambulance regardless of service must legally cover the emerg call) but will actually start posting them in our area. I know of this happening once and it was combined with a call-out to begin upstaffing spare vehicles and the movement of medics assigned to HQ onto the trucks.