vs-eh?

WOW...PRPG is drunk.

It is actually quite disheartening that articles like this even have to be written. Most of this is common sense. Again (for the millionth time I know) will reference the program that I took for PCP (BLS). http://postsecondary.humber.ca/07651.htm Multiple research papers... Several presentations... In depth A&P, pharm, advanced assessment, etc... People are weeded out... Breadth education... This is all to practice at the most minimum level in Ontario in the 911 environment. I dare say that I am thinking that a lot people currently thinking/doing their EMT-B education (for lack of a better comparison) would be hard pressed at doing this kind of education. The sad thing is that there is a fair percentage of these EMT-B's have a higher procedure set than I do as a PCP. That is sad. I read about EMT-B's going to EMT-P with little to no road experience. I wholly disagree with this. Basic's from what I have read for the most part do not function in the 911 environment and work somewhat exclusively in the "transfer" area. How can you expect to move into ALS medicine without practicing BLS on real patients on real scene calls. I don't get it. I think another problem is with the medical directors that EMS services have, because in the end they dictate your scope. I have talked to and read about EMT-P's who didn't do an in hospital OR field intubation prior to being "signed off" as an EMT-P. The drug lists that some of these same paramedics have which include some ridiculous drugs like flumazenil or being able to do RSI and have never heard of "BURP". Come on. Are your medical directors aware of some of the education that people are getting? They are comfortable with this? I tend to wonder if this influences the litigious nature of the public toward aspects of American EMS. When I did my ACP education I did not really learn anything new. PCP education encompasses so much of ACP that there could be an argument to the move to the "zero to hero" in Ontario. I would disagree, but I could see a year being added and well....I haven't changed my patient assessment since doing my ACP. I just get the feeling that EMT-B's have the "well I can do this, no problem" attitude, without having proper education and clinical/field experience. Listen to Rid, listen to others, listen to Dust (yes, yes, I said Dust, he has his moments - damn you on that niacin flush ). Get educated, get experience. The opportunity to "save a life" will always be there...Although few and far between.

Apparently our flight guys and their base hospital physician swear by it.

Why was the monitor still on after this length of time? Once the patient is pronounced, get your final strip or end-tidal waveform and turn it off. At the very least should a family member walk in and see a rhythm, well, you'd see how issues might occur. Maybe it was the epi...Or maybe the patient was STILL ALIVE!!!!!! Dun dun dunnnnnnnnn...

1) If you are restricted to having only 3-lead capability (like me, booooo), you can at least get a better picture of the ST segment by putting the monitor in diagnostic mode. Do this by pressing and HOLDING DOWN the "recorder" button (print the strip button). You will see it say DIAGNOSTIC on the screen, keep holding for a diagnostic view in the lead that you are on. I'm not sure if you have to be in manual for this. 2) You can analyze in manual mode. A lot of people don't know this. You simply have to be on the PADS under your lead options. And of course have the defib pads on. Anything else that may not be common knowledge?

It is a good thing you aren't in Ontario.

A few things... - Are the education requirements changing? Or is this simply a national minimum scope of practice for each level? There will always be regional/state/county differences I assume in overall scope. - AEMT looks like it is approaching PCP in Canada. - The vent thing for EMT's? I don't agree. - Venturi mask? I have only seen one outside of the classroom environment in close to 3 years, in all levels of practice. - Pt. assisted med? Again, this must be an American thing. I still don't understand what that truely means. In theory yes, but I assume this is only for "symptom relief" meds....i.e. NTG, puffers....Not, "yes sir, let me help you to take your senokot, or something..." - MAST/PASG? I have never seen one, and I assume they aren't used anymore. AEMT - IV appears not to include bolus or first time use of certain meds i.e. NTG. If not you eliminate I'd say 75% of it's uses. - IO? meh, no point really unless you are working with a paramedic. Beyond that there is minimal (read < 1%) usage. - Narcan. I have never only seen narcan given once. Never prehospital. And even if it somehow is required it is better to give it IM or SQ not IV...IV is for the controlled hospital environment or to reverse PAI using a narcotic. Support A+B prehospital and let the hospital sort it out.

http://www.michener.ca/ce/csu_paramedic.php Not a Masters...but... How many EMT's or paramedics here have a full university bachelors (i.e. 4 year) undergrad? How many have more? Probably not many...Here though it is pretty common to have this as an ENTRY to the field. As I have said in past threads, a 4-year degree means very little now. People go back to school and do there 2-years of BLS..."to get a real, good paying job". Yes, we get paid well here... Even though I did not finish my undergrad, I took a number of 4th year courses (in 2nd and 3rd year) and submitted "long" (20+ pages with 30+ references) on a number of topics. Forensic osteology and evolutionary studies, man....I shoulda stayed in that....I could have been in Africa or something....

So here is how it breaks down here... We use the Alpha/Bravo/Charlie/Delta/Echo system that many of you may be familiar with. In all of these I'm speaking from an ambulance perspective... A - no L+S B - no L+S C - Too much of a catch all priority. 75 year old with elbow pain, but has a hx of heart? Ummmm charlie...however stroke is often a charlie too, so...It is up to the crew if they want to run it or not. I'd say 80% of the time, they don't. D - L+S and tiered to fire and police. Crews normally would run this, whoever there are exceptions. If the crew is likely to get there pretty soon anyway, they may not run it. E - L+S and tiered to fire and police. Probably hard pressed to see a crew that doesn't repsond L+S to these. Comments... - We are basically dispatched on a "closest car" system, regardless if a BLS or ALS crew, with some exceptions. Chest pain and a BLS car is 5 minutes away, ALS is further, it will likely go to BLS with no ALS backup. 99% of the time it's not needed in our system anyway. We don't double dispatch here, unless it is an echo and a BLS crew is closer. I'd say 50% of the calls that BLS units get are Charlie or higher, 95% of the time ALS backup is not dispatched/required/asked for... - Fire usually gets there < 5-6 minutes, I think there are like 80ish fire stations here. Fire functions in a FR role only - AED, basic BLS stuff, O2, etc...They don't do vitals or anything (out side of general impression of a radial pulse). Basically they are there to assist us, imho the system works well like that. No real infighting about tx because well all ambulance (regardless of scope) are the higher medical authority. - At peak times there are upwards of 20 paramedic response cars in the city, a mix of BLS and ALS. Normally they are only dispatched to Charlie+ calls, but they can go to anything they want. They augment response times and treatment in some cases. - It is pretty rare that police attend to "normal" higher priority calls, they maybe dispatched, but they are too busy to attend a 98% of the time obvious medical. Psych calls they are often requested and many times a crew has to "stage" and wait for police depending on the call details. ANy kind of violent trauma call (shooting/stabbing) etc...they are there pretty quick and many times before us. Cardiac arrests/obvious deaths they have to attend. Whether a pronouncement or "obvious death" they have to attend and 99% of the time they are left with the body after everyone leaves. They wait for the coroner and such...

I can't read .... BUT IF I COULD!!!!! Honestly JEMS is a pretty good journalmagazine. It takes profession medical opinons and references (much like yourself Ace844) from "real" medical journals. But to answer the question, no. The only time I look at "real" medical journals is when I am writing a paper or something.

All alpha's aren't alpha's and all echoes aren't echoes... It would be interesting to see a study based on dispatch priority and what ended up being the chief complaint in EMS opinion and hospital opinion. Hmmmmm.... A classic examples...The alpha "sick person" that is the pre-arrest CHF'er. The echo choking that is the guy that has had a vitamin suck in his throat for 2 hours...

Oh and I admit, reports are rarely detailed. They don't need to be. "78 y/o male, post-arrest, VF shocked twice, 2 rounds of epi/atropine with a ROSC, 500ml fluid on board, pressure of 60 with a rate of 110, setting up dopamine, be there in 5." "68 y/o female, CAOx3 c/o CP consistent with ischemia, pt has hx of heart, 12 lead shows ST elevation in V2-4, IV established, ASA, NTG, morphine on board with some relief, eta 7 minutes." These are standard reports en-route. Keep in mind, we don't give a report to the ER for every patient we bring in, on the one's we feel that are warranted.

Again, you're joking right? Come on, you guys aren't reading this saying to yourself "Well self, that seems like a reasonable report to me...What is the problem..." Gimme a break...2 BROWN 2 PURPLE, SOME WEIRDO RHYTHM WITHOUT A PULSE.... 25 year old male receiving O2 via plastic mask, he has those cardiac stickies on his chest, the rhythm looks normal as I remember from class, I couldn't start one of those IV things, the thing that tell you the blood sugar said low, he got a white box with a needle and some powder, I mixed it and injected it into his arm, GLUE-KA-GONERS or something, I took a prick from his finger again, it said 6.4, I dunno what that means but we are hear now at the hospital. he is saying stuff now,PHEWWWWWWW!!!!! :roll: Ummmm no dude, I guarantee you no paramedic here would given a report like that. And I doubt your experience in London was typical of the service, in fact I can say with confidence that it isn't. Telling you the colours of the boxes they gave, following a ROSC and report to the hospital? LOL. Come on. They also got a bag with silver foil around it DOPA-something, there pressure was 60 something so I gave it. I hope I did my drug calcs right. 120drips per minute with a 10gtt set right? :wink:

You're joking right? I hope you are. So he gave 4mg of atropine, 50mEq of bicarb and 25g of dextrose? Hmmmm leads me to believe either you aren't reciting the report accurately or the colours of the boxes are different here. Either way. This just reinforces the impression of colour coded medics that other countries have of the US (yes, I'm generalizing). ABSOLUTELY RIDICULOUS. This "medic" would be laughed out of the ER if she/he gave a report like that here. I am flabbergasted.

As Rid said, maternal physiology changes...While the patient is more tachy than would normally be seen, boarderline tachycardia is not uncommon in the 1/2 trimester, neither is absolute/relative hypotension. Were these dizzy spells related to the pt lying down and getting up? Is the pt generally a small/average/large woman? Grav/Para? Anxiety? The things Dust mentioned?

http://www.city.toronto.on.ca/ems/operations/eru.htm That's what I work on. During peak times there can be upwards of 20 in the city, 3 or 4 are usually always ALS preceptor units.

Heh, Asys you're awesome bro. I agree wholeheartedly.

The Ambulance Act of Ontario basically states that no one can become/continue on as a paramedic if you have been convicted of a crime of moral turpitude for which you haven't been pardoned. Pretty broad, I have never heard of a paramedic here that ever had a criminal record of any kind. DUI? You're screwed. Too many points on your license? You're screwed. College's require criminal record checks prior to admission, as do the services. Pretty sure that here it would encompass all of the above.

Can't really call it a debate now can you, when basically only one side is presenting their case. But, don't worry my creationism friends, Bush is handing you "Intelligent Design" to offer your children in school. Teach them well and let them lead the way... Progressive thinking George, kudos...

Ummmm...But I have lives to save.

At least give an example on which you base your faith to this "long-winded" poster. Man, I wish you commented when this thread was at its high point... If you read the thread in it entirety, comment, please. I'm open minded...but apparently YOU'RE not.

Wow, that is brutal man. I feel for ya, and all the medics in the 'peg. I am amazed they are able to keep medics working under conditions like that.

I thought Vasopressin was given as a one time dose of like 40 units? What's with the repeat dosing and stuff? This is from ACLS - Vasopressin (Class IIb) 40 U IV bolus (administered only once). If no response to vasopressin may resume epi after 10 or 20 minutes. Then epi q 3-5 after. So me reading that it seems that if you decide to go with vasopressin, you a) don't give more than one dose ever, and wait 10-20 minutes before starting with the epi. Doesn't say anything about giving drugs concurrently and such.

Of coarse you can, I have never said otherwise. The point is this, you cannot even challenge creationism/belief in a higher being. It is all based likely on what we created as a species thousands and thousands of years ago. Why teach/preach something that is the definition of a hypothetical with no real current evidence to offer otherwise. There is nothing, zip, zero...But the naive learn this and speak of it as fact, too many people. BLIND FAITH PEOPLE. These are all getting to be moot points. We live in the Matrix. A higher being creates and destroys the universe every nanosecond, but makes me believe that we live in continuity. My cat created and controls the universe. You must believe in these examples. You have to, they are not prone to any type of disproof. Why would an omnipotent, omniscience, omnipresent higher being "care" about us? Why? We again are imposing supposedly HUMAN characteristics on to this being. It is not a human, if it does exist. Things on this earth, which is all we know, and now "testable" by imposed rules of the "laws of nature". People will argue that "God" created these laws, but anyway... You can at least prove/disprove certain things with what we have like the theory of gravity, geo/helio-centric theory, darwinism, lamarkism...these have gone through the scientific method and have been proven/disproven. As much as they can be....but again paradigms shift, but unless this higher being starts smiting peeps, I doubt it will roll into the realm of the current accepted theory. But honestly I hope it does, I think everyone, deep down, hopes that a higher being will reveal itself in our lifetime and show us the error of our ways. But this has been going on for thousands upon thousand of generations. You have to go with what you know.

MI_EMT - These people with "more education" who get flustered or suck at scenario's would likely be the exception around here. I have already mentioned how much education we get at the BLS/ALS level around here, and those that "suck" at scenario's are weeded out quickly. Of 60ish people out of 1500+ that applied in my class, only 25+ graduated after the 2 years. We thin the herd, and likely not enough. This "logically thinking" student who wasn't doing simple initial ACBC interventions either isn't being educated properly, or can't handle the scenario environment, which I can see. I know plenty of good people who are good on the road, but when a scenario rolls around they freeze. Scenario's are easy though, beat the sheet basically, well maybe not be you feel me. Especially oral boards. LOA? airway? breathing? breath sounds? pulses? mechanism if any? Hx? etc.... I don't disagree that having a degree would definitely be an asset for climbing the "corporate ladder". A lot of jobs require a degree, any degree, for the sake of having it. Showing that you acquired the education, that you can work at that level, regardless of field of study. This is Ontario though, college and university are separate entities, and vaguely comparable outside of the fact they are both post-secondary educations. Theory vs. practical again, loosely. The standard of education now, for the majority of "decent" jobs is a university degree/college diploma. Why should we be exempt from having such an education? I would honestly be embarrassed if my patient asked me what kind of "training" I had to do this, and I said "oh about a month....". I probably wouldn't even be doing this job if that was the case. I couldn't disagree with you more. But anyway...