vs-eh?

Where I'm from you probably wouldn't be allowed to even enter ambulance preptorship, let alone practicing autonomously. Why is RSI even being discussed? *shakes head* Honestly do the doctors that allow you to practice even care? Are they even aware? *shakes head*

10 "live" combined? You said OR/ride time, so I assume this is both in hospital and during ambulance practicum. Is this an absolute requirement or just a "we'd like to see"? I should stress that 20 minimum tubes are required in hospital prior to starting ambulance practicum. If you don't get the 20? You go back. Most anesthetist's generally (for the first few anyway) allow you to tube patients that are evaluated with a grade 1 airway +/- edentulous. I assume that is the same everywhere. Teeth for an elective surgery are an anesthetist's number one priority right? How do you "prove that you can" do an intubation, without having standards? Sedate and intubate a member of your service? I personally think we should have a minimum number of tubes required per year to. It is a shot in the dark. However, most that are educated now you know have X education and at least have 25+ intubations behind them (minimum).

http://www.emtcity.com/phpBB2/viewtopic.php?t=3992 How many intubations did you do in the OR/ER under an anesthetists or ER doc's watchful eye prior to precepting? How many intubations are you required to do during preceptorship? Have you read/are you required to read any advanced airway texts (Walls manual, etc...)? I think the above 3 issues should be corrected prior to you worrying about RSI...

I know it is fictional. Even if it was posed in a more realistic scenario, my answer would still stand and still be the correct answer. But since you want a creative answer...Mine would involve a jetpack, a rusty spork (yes, spork), and the Canadarm (space shuttle arm). It basically writes itself. No need to go into details...

http://www.conestogac.on.ca/jsp/cecatf/health/acp.jsp Which equals 18 months or so minimum as a PCP in a service prior to applying. This is pretty much a standard (minimum).

You would probably concede though, given that I have not shown a detailed brakedown of the PCP and ACP education, that your comparison to NW Arizona is strictly seen from a procedural point of view. I am assuming this. I think a lot of people simply look at it this superficially. They see a collection of procedures, and in turn infer that "standards" are not being met in comparison. I think a lot of people on this forum see EMS level as simply a set of procedures, a "what can I do", and that seems to define them. If an EMT-B sees/or thinks that they should/can do an IV, that "sets them apart", makes them "more educated". Or if an EMT-P administers Lopressor that they have "an edge", perhaps in a greater educational scheme. This is flawed thinking. It is also ironic considering the vast majority of calls require only BLS. I sure most would agree that an educated BLS paramedic with a limited scope is far better FOR THE PATIENT, than an under-educated BLS paramedic with a greater scope. Hmmmm? I would wager that NO PCP will be able to use every piece of education or procedure that they were educated or instructed on. I was shown the how's and why's of cardioversion and pacing, EKG interp, pretty in depth pharm, started 50+ IV's in clinical, etc...etc...Could I physically/practically USE those as a PCP where I worked? No...No PCP can...Sure as HELL helped when working with ACP's or doing MY OWN assessment though. Sure helps when I updated a ACP crew that the patient was in a 3rd degree block with a good report, knowledge of pharm, etc.. prior to their arrival and they had a mental picture already of what to do. THAT HELPS! It helps that paramedics with more advanced scopes can rely on those that may not currently have them, but who KNOW them. Thinking and knowing > doing. PS - ACP's can do EJ's generally. Not a central line but you know...

http://www.marketlabinc.com/files/products...dium/ml3028.jpg Ours is the sexy blue non-latex material, and I think it has writing on it. Perhaps describing its sexiness (I have never cared to read it)... I have never seen a person use a glove...Ever...

Absolutely ridiculous scenario... Potentially even more ridiculous are those that wouldn't wait the 4 mins for proper extrication equipment to get there. Way too dangerous... What is better, one or two patients? Remember the priorities people: 1. Yourself 2. Your partner 3. Your vehicle 4. The patient Shite happens, too bad. Heroes that you read risking doing stuff like this without proper safety components will eventually be the one's you see dead, adding more patients to a scene, and being read of in a newspaper by paramedics saying "Why the hell did he do that?" What do I win for the correct solution?

I see posts all the time for people trying to justify either for or against for EMT-XYZ should or should not be doing X procedure. Why educational requirements should be this or shouldn't. Why should I have to do this or that... Why!? From what I have seen, people here do not generally dispute Ontario's educational requirements. Nor do they dispute the fact that generally (especially on a BLS level) they are light years ahead of current American standards. It should be noted though...I am speaking for Ontario only, not Canada as a whole. There are differences in education at all paramedic levels across the country, as well as differences in scopes of practice. Some could be seen as better, some worse. This should not be seen as representative of the entire country, just as a California or New York State perspective should be seen as what it is for the entire country. However, generally speaking, Canadian EMS education exceeds that of our American neighbours. I don't think this is ever disputed... I will again offer an outline of both PCP and ACP education and reference a single program for a general comparison. I will then give the general scope of practice and pharmacological intervention. Then pose a question... *Note* I will leave out Critical Care Paramedics (CCP). They are a "rare" paramedic and generally do not function in "normal" EMS in Ontario. By normal I mean 911 land, what the average person would see as what ambulance is. They do exceed ACP scope and education substantially though in Ontario. PCP (Primary Care Paramedic) http://postsecondary.humber.ca/07651.htm - 2 year college diploma - Approx. 800-1000 hours of didactic, ~ 100 hours of clinical, and 350-500 hours of ambulance precepting. Typical hour totals range from 1200-1600 Scope of Practice - BLS airway interventions with rare services using alternate airways (i.e. CT and LMA) - SEAD, 3/12 lead monitoring (though generally not formally allowed to interpret, although it generally wouldn't matter). Not all services have 12 leads. - Minority of services allow PCP IV starts, some only with ACP partners. - Basically the general scope of what is considered BLS by most standards Drugs and standing orders (all drug admin is done at the paramedics discretion and nothing needs to be "called in") - NTG spray (for ischemic CP or CHF) - Epi 1:1000 (for anaphylaxis, asthma, or croup) - Glucagon (diabetic problem) - ASA (ischemic CP) - Salbutamol (SOB) I think some services may carry glucose tabs or something. Some services allow PCP's to administer D50W, but again very rare (by rare I mean like a handful). Generally speaking the above 5 drugs are the PCP drug list. ACP (Advanced Care Paramedic) http://www.conestogac.on.ca/jsp/cecatf/health/acp.jsp - Approx. 1 year post-diploma - 300-400 hours didactic, 160-240 clinical, and 480-720 precepting. About 1000-1400 hours... - Obviously they are banking on a solid didactic foundation Scope of Practice - intubation (including lighted stylet in some rare services), rare services have alternate airways, surgical airways (needle/surgical cric), chest needles, ETCO2 (some waveform, some not) - pacing, cardioversion, manual defib, 3/12 lead interp. - IV/IO (ped) Drugs (Can be used for all applicable drugs indications - i.e. amio is used not only in an arrest but also for stable VT or some afibs, etc...) *Note* ACP's on land basically NEVER hanging any infussing medications (other than dopamine). - Adenosine - Amiodarone - ASA - Atropine - D50W - Diazepam - Diphenhydrinate (rare in services) - Dopamine - Epi - 1:1000, 1:10,000 - Fentanyl (this is basically an either/or situation now; either fent or morphine) - Furosemide (not under standing order here and very very rarely used) - Glucagon - Lidocaine - Midazolam (including use for PAI with an analgesic) - Morphine (see Fentanyl) - Naloxone - NTG - Salbutamol - Sobium Bicarb - Xylometazoline (for nasal tubes) Given the above outline for those that were not aware, my questions... Why do you think Ontario paramedics have a generally equivalent or lower scope of practice/drug availability compared to American EMT-B's and EMT-P's? I am using my impression based on what is said on these boards. Grain of salt perhaps, but still... Do you consider Ontario paramedics (especially PCP's) overeducated for what they can generally do? Would you come to Ontario and (assuming you could) enter into EMS education with it's current standards and corresponding scopes? Would you still do it even though following 2 years of PCP education, the job outlook was poor? By poor let's call it a < 20% chance of getting a job as a paramedic. This is mainly because I see a lot of people who seem like they should be entitled or seen their education as justification for doing certain things. This is all under the guise of "for the patient" of course. This hopefully will give some a bit of a perspective...

You simply make new mandatory standardized minimums. You give a "warning period" of 1-2 years. Following that time, all entry into the field (at said level) requires X education. Period. This has happened here with the PCP program. In the fall of '99 it was a 1 year college diploma, in '00 a 2-year requirement. Done. There is no difference in scope of practice, nothing. PCP's here with a 2 year college diploma are at the same scope as their one year counterparts, and as their 25 years on counterparts (with obviously a much different education). There is no "ranking difference" either for education. It is simply what the requirement is now. Ontario has a population ~ 40% of Canada's total at ~ 12.5 million. This isn't some small area that is "trialling" something. This is how it is. It also holds some of the largest EMS service's in Canada. I don't know what sparked the move from 1 to 2 years college. But I can tell you it has not had an ill effect. The PCP market is FLOODED today. I would say the big influx started about 4 years ago, well after the educational increase. It is extremely competitive and difficult to get a job as PCP today. Two year diploma? Means nothing (and that is mandatory for BLS)... I truly get the sense that EMS education is somehow feared by the masses in the US. It can work (as shown just 6 years ago here). Start trimming the fat, increase minimal mandatory education and perhaps you will start getting the pay and respect that you desire.

Scenario - 123 Main Street. Bravo (This is a call priority) - Psychiatric You are called to a downtown street corner for a MALE mid 40's wearing a "funny hat" and "5 OTHER PEOPLE" who appear to be "preaching" on a major downtown street corner. They are saying things like (referring to the man in the funny hat - call him F-MAN) "F-MAN is the one true god, observe his hat!" "Tell me who could make a hat such as this?" "I have seen him do many many things to help people, these people forget, and he has told me not to tell you specifics, but I tell you I have seen miracles and happiness come from this man!" F-MAN says "Thanks, my followers" They are not harassing people, being fairly benign (say as benign as Jehovah’s Witnesses knocking repeatedly on your neighbors door), but they are "acting strange" and "they appear that they have mental problems"... So what do you do? Do you respect these people? Do you respect a person that is asking his mother to preach to God with him in their apartment? The mother feels scared (for no other reason than she is "scared" because he is acting "strange"). He is not being violent or anything, just chanting, asking for God, etc... Do you respect these people? Do these people go to the hospital with you and/or the police? These people are "psych" no? EDIT - DUM DUM DUM DUM DUM!

Lol...Mormon's... PS - This is pretty funny if you haven't seen it and I invite you to "google" this religion. The hilarity will ensue...

If people are inserting this divice... http://www.vitaid.com/canada/lma/proseal.htm or this device... http://www.tempe.gov/fire/training/Power%2...tube/sld001.htm wrongly (with any kind of regularity) in your service (NEW YORK CITY)... YOU MY FRIEND HAVE WAYYYYYYYYY BIGGER FISH TO FRY! Remind me NEVER to go to New York. I hope this was a joke. An endotachael tube is not the same (nor is it a blind insertion generally) as the above mentioned devices.... This is not a valid comparison...

Nobody on the yes side has voiced an opinion... I find this interesting...

With all due respect Asys...They aren't going to be breaking any trachea's with an LMA....At least without a HUGE amount of effort...

Sorry man... LMA is not a "secured airway" (an endotracheal tube is). In a can't intubate/pseudo can ventilate situation I am sure that 2 nasal's and an oral is just as good with good manual airway management as an LMA. An LMA doesn't require pauses in CPR? I.e. 30:2? I find that hard to believe... And apaprently it doesn't... http://circ.ahajournals.org/cgi/content/fu.../24_suppl/IV-12 Hmmm... I guess an argument could be made that most/all out-of-hsopital cardiac arrests do not have an empty stomach but...

Hmmmm... Ok...This poll (as of right this minute is 3/3 50%/50%) Now considering I haven't voted and I assume my Ontario friends are of the "Nye" vote, and I will assume the OP is too... Those who are in favour please voice your opinion... Because as far as I am considered it's 100% NO. Express your opinion...

Now with the poll up... Those who think they should, be them basic's or paramedic's...please voice your opinion. A poll means NOTHING without a response to it. A 3 hour CME? Good Lord! A solid 120 + 3 (OR DARE I SAY 6) hours has EMT's doing a scope of practice which ALS PARAMEDICS here would be scoffed at for suggesting? Yes, I know that PCP's place LMA's here (rarely, and in all honesty it's not that difficult, even under an anesthetist's concerned eye). PCP's have near ONE THOUSAND hours of JUST DIDACTIC not including clinical and precepting. Let me repeat 800-1000 hours DOES NOT include ambulance time (350-500 hours). However... You have to draw a line. I think the line drawn even at your 120 hours is far beyond the thin red.

Do it... And extrapolating this from a purely procedure vs. education issue (EMT-B vs. PCP). PCP's should probably be able to do everything an EMT-P or CCEMT-P does...At least procedure wise... And then ACP's should be able to do what a doctor can do (anything that is simply a physical procedure). CCP? Perhaps Jesus could weigh in? A line has to be drawn somewhere. Jesus?

Yikes... $9.50 US is ~ $11.15 CAN....Is this considered a "good job"? "GOOD DRIVING RECORD TO DRIVE" does that mean people can have a terrible driving record and not drive? All things considered I think Taco Bell likely has better pay and skill sets. Have you seen that mayo gun? Don't mess...

It does paramedicmike. Thanks.

Now when people say "degree" in the USA, what can/does that mean? In Canada, generally speaking, a degree is a 4 year university degree. You can get a 3 year degree (university) but they are falling out of favour or simply not available in Ontario (not 100% sure for the rest of Canada). Now in Ontario, entry into EMS (Primary care paramedic) requires a 2 year college DIPLOMA. College's, unless affiliated with a university, do not (to my knowledge) offer degree's. They are certainly not (again to my knowledge) less than 4 years. There is a distinct difference between college and university education, generally speaking, in Canada. I have seen people who ask for education in the US quote this AAS (or is it ASS) "degree" in paramedicine. This is generally 2 years (college I assume). Can you get a "degree" in 2 years in the US? I assume you can't get a "degree" in philosophy (undergrad) in 2 years. For example - http://www.michener.ca/ft/respiratorytherapy.php RT requires a 3 year DIPLOMA here. However because this school is associated with a university, a fourth year is available, and in turn a diploma and a degree. Also ACP's (similar to EMT-P's) now upon entry into the field need 3 years of education (normally 2+1) to become an ACP. However I just have a diploma and a post-graduate diploma (I guess) for this. Just asking...

Ummmm... Carlos Nieto did it on Third Watch and he worked for FDNY while he was in school. Third Watch is the most accurate representation of any EMS show. Shame on you Dust for making people think they can't reach for that rainbow. References cited (and yes I know wikipedia isn't a good reference...GOD!...) - http://www.anthonyruivivar.net/ http://en.wikipedia.org/wiki/Third_Watch PS - I would wager to say that a significant, if not the majority of people who have entered EMS since the advent of the 2 year PCP (entry) college program do have 4 year university degrees (not in EMS). This was either done prior or since being hired.

Yes, we all need more information for any one to comment without gross speculation on this case. Please (if you are going to do so) present it in a case study format, including what you did. Rarity in EMS? I personal have never seen it. If you are looking for standards of treatment in EMS? http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-67