BEorP

I'm sure the (stupid) Paramedic who stays on scene with a major trauma pt as he attempts and fails to get IV access is doing worse than a BLS ride to the hospital would have done. BUT... Don't forget that often ALS crews will get the pts who are more likely to die regardless of what is done for them. AND... Without Paramedics an unconscious hypoglycemic pt would need to be brought to the hospital just to get D50 and some food. Why not just do this in the field? (just one example of an important ALS treatment that can actually fix the problem) PLUS... Without Paramedics, there would be no ACLS. (That one should be self explanatory.)

I think in Ontario (this based on the average PCP salary and the one fire service that I know about) Paramedics usually make more for the first four or five years, but after that the fire salary has increased to above the Paramedic salary. If you are considering coming to Ontario keep in mind that you will need to either be a firefighter or a Paramedic, you can't be both (we do not have Paramedics on firetrucks). EDIT: In terms of social status of Paramedics in Ontario, I would say that they are generally well respected and thought of as health professionals. (This is due mainly to the fact that they have a minimum of two years of postsecondary education but many have more.) Firefighters are also well respected in Ontario because well, you know... they save lives (sorry to throw sarcasm at you when English isn't your first language). But seriously, I would say that both professions are seen as respectable. In the United States you will find that firefighters are considered to be better than Paramedics.

An important thing to add if you're riding out in an actual city (no offence) and have a good chance of getting a call while on standby is to be sure you don't sleep through the Code 4 response that may follow. You look really stupid if you just wake up as your preceptor opens the back door. Not that I would know...

Hopefully I didn't miss a thread on this already, but it seems like we now have a number of Aussie members and I am hoping to find out more about EMS there. What is the basic requirement to work on an ambulance and what are the levels of Paramedics (or EMTs or whatever the term may be) and education required for each level? What is the pay like for medics? What is the scope of practice like? Do medics provide independent care or is a lot of communication with medical direction required in order to administer drugs or perform skills? Is there an equivalency process for medics trained outside the country? (just curious :wink:)

Since we're students and get stuck in the back you might as well take advantage of it by getting some sleep on the bench.

I would also add that, IMHO, if grandma wants to go to the hospital then we should not hesitate to haul her across town.

Do you keep drugs with you while you're off duty?

In my relatively small time riding out in Toronto I have already come to hate BS calls. That being said, I don't see almost any complaint an elderly person can come up with as being BS and do enjoy most of those calls. If you have the flu, a toothache, or menstrual cramps then it's no reason to call an ambulance. But is it really that much of a pain to take an old person to the hospital because they feel weak or fell out of bed? I don't think so. If that is becoming too taxing on an ambulance service then maybe they need to get more trucks on the road or try to educate the members of the public who are actually using ambulances for BS (see above). As has already been pointed out, it sounds like a good idea on the surface, but when people call 911 they expect an ambulance that will bring them to the hospital. If they just wanted an appointment with a doctor they could have made that themselves. Although I am just a student so I haven't been on the road as much as those of you who are employed as medics, my classmates and I have done a few calls for elderly falls when all the pt wants is some help getting back into bed or up off the ground (I don't know if this is standard or just something we happen to have come across). They really have no medical complaint of injury. Will the MD or NP come and pick them up off the ground?

1. If there is a rank structure, an MD should automatically be given a higher rank than most members. 2. Rank structures are everywhere but that doesn't always mean they should be followed. There is a campus response team that I am involved with at the university. I am just a regular member, outranked by our supervisors and executives. When on a call though, I really don't care what someone's "rank" is if the pt outcome will be better if I take charge. I'm not saying to ignore rank or that I would ever disobey an EMS supervisor with a real ambulance service, but I am saying that if rank is just handed out based solely on seniority in a first aid organization then sometimes it must be ignored when someone has more medical knowledge.

We are taught to do 10% of the pt's weight to a max of 15 lbs of traction for a femur.

I was recently working on my resume also and left out the part about the campus response team. I didn't think it mattered since it is just a bunch of first responders going to mainly minor calls. When I had a friend who is a supervisor for the team and also was a Toronto EMS medic review my resume he suggested that I add that in since it was at least some type of practical experience (although minor). But since we will be competing for jobs, leave it out :wink:

Well, although I can't provide a source for this, I would say with confidence that all hospitals (and most EMTs) can read medical information from paper and that not all hospitals can access electronic information.

I don't know how much it costs, but to me it seems like the low-tech method is the way to go for this. Using something like the Vial of Life (which is free, http://www.vialoflife.com/) would seem like a better alternative. The other thing that the electronic can't do that paper can is have an actual copy of a valid DNR. That being said, any way of keeping your medical information in an organized fashion will surely help everyone deliver the best care possible to you.

Although you make some good points... most people who I associate with in day to day life aren't bleeding and Hep C positive.

I believe I recently read somewhere about something related to this (not car accident specific). If I remember correctly, it said that when you zone out in a class but then are called on by the instructor, you can actually remember what has just been said (even though when it was said you were not consciously listening) so you can answer the question. I don't know if this is the kind of answer you were looking for... and I will try to find where I read that when I am awake.

From Essentials of Paramedic Care Canadian Edition Volume 1: CN I (olfactory) - have the pt identify a variety of common odours (eyes closed, one nostril at a time) CN VII (facial) - assess the pt's face at rest and during conversation (note anything abnormal) - have the pt try a variety of facial expressions (have the pt puff out their cheeks, raise their eyebrows, frown, show the upper and lower teeth, smile) - have the pt close their eyes as tightly as possible so you won't be able to open them (try to) CN IX (glossopharyngeal) - tested along with the vagus - listen to the pt's voice (listen for hoarseness, a nasal quality, or anything abnormal) - have the pt swallow (note any difficulties) - have the pt open their mouth and say "ahhh" (watch for the soft palate and uvula to rise symmetrically) - test the gag reflex with a tongue blade on the posterior tongue

Don't worry Dust... I will soon be starting UTLS (Universal Trauma Life Support) and we will allow the scoop for SMR. I think I will be the best person to head up the organization since after I attend the paramedic academy I will be: BEorP, EMT-P, PHTLS, AMLS, PALS, ACLS

If I remember correctly, BLTS (or ITLS I guess?) doesn't like the scoop for SMR... not too sure why though.

Ok well here it is so we don't need to go through it again... speaking generally of course: Canadian paramedics have lots of education. US EMTs do not. When comparing skills and drugs to education, US EMTs can do a lot more than Canadian paramedics.

Ah so your protcol is very different than ours... in that case you'll need to just politely need to explain to this EMT that they are a tool and then also that not every pt who is confused with a hx of CVD is having a stroke.

If you say you already know about education differences, then what do you mean when you ask about "higher standards"? It seems that you will just open up a discussion that has happened many times.

Do you not have a directive in place for who goes to a stroke centre that maybe you could show this other EMT? If it's anything like ours then the other EMT should take a read of it before giving you a talking to. The provincial directive in Ontario requires that to go to the stroke centre the pt have new onset of (at least one of) unilateral arm or leg weakness or drift, slurred or inappropriate words or mute, or facial droop AND can be transported to the stroke centre within two hours of "a clearly determined time of symptom onset or the time the pt was 'last seen in a usual state of health.'" Based on our directive, even if the person was having a stroke (which it doesn't look like they were, but let's humour the other EMT) they would not be transported to the stroke centre since the onset may have been too long ago.

If all your assessments were done correctly I don't see the need for a stroke centre. What signs and symptoms of stroke did the senoir EMT think warranted a stroke centre? Also if the pt was last seen normal the previous night is there even any potential for thrombolytics to be used?

Since this topic is still going... It's a good thing you have a badge. I bet bystanders would never respect someone who shows up with just a professional appearance and that big truck with "Ambulance" on it.

Be careful dust, if you piss off all the basics and want to come home to work you might not have a driver