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.)

In America, almost always yes. In Canada, it varies with location, but generally yes also.

If you want to be a paramedic, go ANYWHERE except the United States. I recommend The Netherlands.

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.

Ahhh... but you miss the point.

The question is, can we really determine that is the case on the telephone? Case after case tells us the answer is 'no.'

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

^ My grandmother is much more likely too call me if she is having chest pain than to call 911. If 911 would send a doctor, she would still probably call my cell phone.

Honestly, I would rather have her call me than anyone else.

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.

I personally feel that the Sager is clumsier, but that may be my lack of experience with it. I prefer the Hare. The other problem I have found with the Sager is that we were told to apply 20% of the pts body weight in traction. We applied this device to a "casuality" during a MCI drill and found that anything close to 20% damn near pulled the leg out of the socket. We kept tinkering with it and found that in average about 7-8% was what the patient could tolerate and which also provided sufficient traction. Any thoughts from those who have more experience with this device than I do. I would appreicate it. Thanks.

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:

As an aside Rid, I know you hav alot of experience and knowledge in the area of EMS, hospital emergency care, etc. But I have also noticed a trend in your posts whereby you use alot of terms like "all, none, the vast majority, more than half, always, never" without supporting these with any quotable source. How can you say that most hospitals have a no outside device policy. We have three hospitals here in my home town, one of which is a level 1 trauma center and it is already making great use of the medictag. One of our hospital based Rescue squads has purchased a medictag for each one of its responders and since many of them are also firefighters and would seem more likely to become injured than your average emergency first responder, each responder is required to wear the device around their neck at all times while on duty. Unsubstantiated generalizations are ALWAYS bad.

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.

Do you worry like this when you are off the job. You touch doors, windows, shake hands, pick things up in stores and set them back down, pick fruit everyone else has touched, read magazines everyone else has touched, go to the bank and use the same pen everyone else has touched...but all of a sudden because we arrive in an ambulance, everything is "contaminated".

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.

Ok, I need to hijack this post for a few replies. How exactly is the best way to test out a patiens cranel nerves (specificially I, VII, and IX) prehospitally?

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

I'm still trying to figure out where they got this grandiose notion of being an "international" standard.

Was there a UN vote on this that I missed? :roll:

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

About the only good method I have found is to scoop them onto it. But if you're going to do that, why not just leave them on the damn scoop?

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.

We can not determine whether or not the onset was too long ago in this situation, adn if he was presenting with stroke symptoms it would be negligent according to our protocols to transport to a facility without CT scans and other stroke equipment. I did explain myself to him, but hes very stubborn. WE'll see. Monthly meeting tomorrow night.

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.

He was saying that since we can't diagnose, that confusion was reason enough...

He was last seen at baseline the previous night due to the fact that they were both asleep until the time of call. THe stroke could have had an onset (if it was a stroke) while he was asleep, which would indicate use of thrombolytics.

FYI, i completely disagreed with the EMT in question, I was just making sure.

We asked the patient if he'd ever had a stroke, and after a few minutes he said yes 5 years ago, however we asked the wife and she said no.

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.

We are dispatched to a residence for an 80 year old male presenting with AMS. Arrive to find pt seated on bed, slightly disoriented. We get a brief history from his wife, stating that he had failed to turn off his alarm clock at the proper time, and he awoke in an awkward position, seeming confused. Last seen at baseline the previous night, seemed to sleep normally. History of CVD, nothing else, according to wife. We consider stroke, so we do some stroke tests, which find strong and equal hand grasp, equal smile, negative facial droop, negative slurred speech, and negative arm drift. Assessment of vitals finds bp of 130/84...pulse 68, skin warm dry and unremarkable, 12 resp/min, rales in lower left lung, SP02 93 on RA...NC on 4LPM based on o2 sats. Pupils PERL. These s/s were constant throughout transport. We didn't call ALS or transport to a stroke center due to the fact that he was requesting transport to his PCP's hospital., as he just seemed confused. He was unable to remember the year or who the president was, hwoever did answer personal questions well. Negative headache, neg chest pain, no SOB no discomfort/pain.

Would you have called ALS? Would you have transported to a stroke center?

I ask because I was told after the call by a senior EMT (i'm 17) that we made the wrong call, and I was wondering what you all thought?

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...

In fact, in my home state of IL, an EMS employee, private or public, has the AUTHORITY under the IL Compiled Statutes to order bystanders, media and lookie lous of the scene and to have them arrested if they do not comply. I have said it once and I will say it again...Dust- You do know alot...You dont know it all. Dust off your imagination and realize that there is a whole big world out here that you have never even scene let alone know the rules of. Tonight when you go to bed, just quietly say to yourself..."Sometimes I am wrong." Then go vomit if you have to.

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