BEorP

Hey guys, I'm curious about the possibility of trying to do some short term industrial paramedic work in Alberta. Not sure whether this is possible or whether they would be looking for a longer commitment than a few months, but the hurdle before that would be to get the ACoP EMT certification through the equivalency process from my Ontario PCP. Can anyone explain to me how the gap training works? I see that they have a number of modules online and I also see where they specify what Ontario PCPs need to complete, but how does it work for the actual clinical aspects of these modules? Is this training offered through an educational institution or employers or somewhere else? I see a confirmation of training form on the ACoP webpage but it looks like that is for people trained before 2004. Maybe I'm just missing it... I appreciate any insight you can offer.

What education is required to become an EMT-I in Iceland? I would suggest that you either consider a PCP program or look at the equivalency process here: http://www.health.gov.on.ca/english/public/program/ehs/edu/equiv.html If you goal is to work in Ontario, then it is probably best for you to focus on getting the AEMCA first.

Where are you from and what is your current education and level of practice like? There are other ACP programs (not flight) in the Toronto area that may be worth considering. Is your ultimate goal to work in Ontario or just to receive the education?

Take a look here: http://www.ornge.ca/Academy/Pages/Courses.aspx They say that they want PCPs and also that you need to have the MoHLTC aeromedical certificate which is an Ontario thing, but it never hurts to get in touch and ask. Maybe if you give us some more info on why you're wondering about this and we can help provide other information.

Hi Victoria, Thanks for posting about this. It is definitely interesting research that you're involved in. I have a few questions/comments. 1. It will never replace GCS so i wouldn't try to market it like this You are clearly working on something that could have a big impact on patient care. When I arrive at a car accident where there is another crew coming to back me up and they want to know the condition of the patients, I am quite likely to include a GCS to help them understand what we're dealing with. This is just one example of many where the HCS will not be practical and will not be replacing GCS. 2. Can it be used in a moving vehicle? This will be a huge issue for EMS. If this is something that can only be done on scene and takes 5 minutes, it will not be nearly as useful. If it is an extra assessment I could do on the way to the hospital then sure, why not? (if someone wants to pay for it!) Five minutes may not be long for in hospital use, but with scene times for sick patients hopefully being less than 10 minutes, it isn't something we would have time to use. Sure, there are the odd case of someone who wants to refuse care and we could use it to assess them, but generally if we can't use it in the moving ambulance and it takes 5 minutes it isn't going to work for us for routine use in my opinion. 3. Is this really able to detect mTBI? I was excited by the claims of detecting mTBI. This is where it could be hugely beneficial and could even be integrated into a return to play protocol for amateur or professional sports. mTBI is a huge issue that is just starting to get more attention so this is what really excited me about the HCS. I am curious as to how you have or will validate it for this use prior to marketing it. I don't claim to know all of the science or understand any of it, but I tried to do a bit of searching on PubMed to see what there was to support the use of EEG to diagnose mTBI. The recent review that I found (http://www.ncbi.nlm.nih.gov/pubmed/16029958) mentioned: "QEEG diagnostic discriminant testing reports and commercial marketing make claims that they can identify MTBI. The Thatcher mild head injury discriminant makes counterintuitive claims that the EEG changes are unaffected by drowsiness, sleep, or medications well known to affect EEG. That diagnostic discriminant failed to show good accuracy when evaluated by Thornton or in civilian injuries tested by Trudeau. Other diagnostic discriminants have been reported, but have not been prospectively verified. It is unknown what these various diagnostic discriminants will show when used on patients with other disorders on the differential diagnosis of cognitive or emotional problems. These claims still need impartial corroboration and prospective validation." Obviously this is not my area of expertise, but from this article it seems like at least when it was written there was not much support for this. One thing we do not need in EMS are more fancy techy things that haven't been actually shown to do anything for our patients. Zoll has done well with the Autopulse, but please don't be Zoll. Thanks again for posting this. It sure is an interesting area of research!

They let you in?! JK... too bad I'm not around there anymore!

Bernhard's advice is very good. I have done a fair bit of academic writing and still wish that I could improve on it further. I think one of the big things you need to look at is whether your problem is with your actual writing in terms of grammar or flow or whether the base of the problem is simply trouble setting up the paper. If it is a grammar and flow issue then it really just seems to be practice in addition to having someone proof your work to give feedback. If it is an issue with actually setting up the paper overall and planning it out to get everything across that you want to say then send me a PM with your email and I will send you something I sent a friend recently who was having trouble with that basically showing how I do it. It might be a strategy that you could adapt for your own use.

It sounds like you did fine. Fractures are nothing to worry about when someone is in cardiac arrest in a scenario like this.

It is a difficult question to answer. Yes, I think that any type of education is important. But I think that only because I believe education is important in general. The problem is, I can't really tell you how a better educated provider (especially when we're talking about education in general rather than medical-specific education) would provide better patient care in the EMS environment I worked in. With protocols being such a big part of most North American EMS systems, it seems as though it leaves very little space for an educated provider to be a better provider. When it comes down to it, we're all giving the same drugs in the same doses based on the same indications. In a very protocol-focused system, I can understand how paramedics become disheartened and do not bother to do CME on their own since they know that nothing that they read can actually change how they will care for patients. Sure, you could give an example from a friend of a friend of your partner's where the paramedic had been reading medical journals and had just read an article on some obscure and difficult to detect life threatening condition that they identified and saved the patient. I highly doubt that this happens routinely. This certainly may be different in systems that are distinct from where I worked that allow providers more flexibility and I would be interested in hearing about it. Hopefully this is seen as contributing to the thread and not derailing it, but I have two questions: (and I'm specifically mentioning paramedics rather than EMT-Bs because I do see that there could be more of an argument to be made there that a number of courses are essential just to get the basic knowledge) Under what specific circumstances would someone with an MA in history provide better patient care than a paramedic who has no university education? Under what specific circumstances would someone with an BSc/BS in paramedicine provide better patient care than a paramedic who has no university education?

The master's is in disaster management. No plans for ACP... I'm in medical school now.

Thanks for the info. Do you have a link to the EMR protocol? Or do you have a copy you could email me?

It isn't about scope of practice or skills, it is about education.

I did most of my master's degree at work... I love rural EMS!

Thank you all for your comments! Since BC is a provincial service is it safe for me to assume that every PCP has access to it? Are there any other analgesics used by PCPs in BC, Alberta, or the rest of Canada?

Hey guys, I'm just trying to gather some information on Entonox use in Canada. I believe it is used in Alberta, but is anyone else using it? For those of you who use it, do you find it to be easy and effective? Might anyone be able to email me a copy of the medical directive for it? Thanks!

Sorry... should have been more clear! My question was directed at the first part of the quote about the new provincial directives. I didn't mean to get you going on how things with the ACoP have gone!

What changes are you expecting to see with that?

Unfortunately, the MAC seems to think that with two years of education PCPs are only capable of giving about eight drugs...

It looks like you've been given some good advice already but I just wanted to slip some more in. As you continue to get more information from the forum and to ask more questions, I would ask you to please try to be more professional and respectful. This is an open forum that anyone can read and judge our profession by. The last thing we want is someone coming on by and reading a thread where members are calling other healthcare professionals "dicks." And then doing it again. If you find the physicians at your hospital challenging to work with or find that you would prefer to work more independently, say that, but don't start name calling. Remember as well that one of those doctors you work with could come across this thread if they happened to be searching online for info on becoming a flight medic Don't forget as well that whether we like it or not, in North America we are generally quite dependent on our physician medical directors for our ability to work in EMS. Although you may be able to "intubate, push meds without having to call a MD first," you will still be working under the direction of a medical director who has approved specific protocols for the things you can do and who you will need to answer to if you deviate from these. Welcome to the forum and best of luck with everything! Keep asking questions.

If you've got the time, and are weird like me, write down every single possible question that they could ask you and come up with a solid answer for each. If you're unsure of common interview questions, Google it. You will likely find that you start pulling certain key life experiences or concepts into many of your answers. That is a good thing because then even if you are somehow surprised by a question, you can probably pull a coherent answer together from what you did practice. If you can practice with someone, that is great, but even if not, just going through these questions on your own and answering out loud will be helpful. Do not rehearse word for word. That isn't the point and will just make you sound fake. Focus on just getting good at answering the questions, even if this means using slightly different words each time. And of course, for any interview always have prepared questions for them. I like to have a few ready before hand and then only ask the one or two that really seem to fit with the types of things we have been discussing during the interview. This makes it sound less scripted and more like you actually just put together a really good question on the fly (jokes on them!). Don't forget all of the basic interview suff either... be on time, dress nice, firm handshake, eye contact, bring current resume (or other applicable paperwork), and send a thank you note of some type. Good luck!

My knowledge of GTA EMS is a few years old, so this may not all be accurate now. To give you something to go on in case no one else has more up to date knowledge, I figured I would tell you what I (think I) know. If you're looking at the GTA, that would include the City of Toronto, Peel Region to the west as you have mentioned, York Region to the north, and Durham region to the east. The job market is tight in Ontario these days, but these services are always hiring due to their growing populations (especially in Peel) and normal turnover (still lots of competition, but at least I don't see any of these services not hiring for a year). I don't know what is it like in your state, but in Ontario you will need to test with the Ministry of Health for equivalency and then separately apply for jobs. In the GTA, you will need to do the centralized testing process (assuming they still do this). This makes it a bit easier to apply to a bunch of GTA services, but it also means if you blow the written or your scenarios then you're out for a year. I suspect (and have no real evidence to back this up) that you would have a much easier time getting recognized as an ACP in Peel than Toronto. I have heard that Toronto is pretty happy with their number of ACPs and have even slowed down on training their own people (and Toronto being Toronto, they like people they train themselves). Peel on the other hand seems to be putting new hires through ACP school within just a few years of getting hired (likely a greater need due to the growing population and EMS service). I don't know whether there is a set time they would want to see you as a PCP before going ACP. Again with the disclaimer that I'm not in Ontario anymore and am a bit out of the loop, in Toronto as a PCP you would expect to work with another PCP. Toronto actually does their own system of levels where PCP is "level I" and then PCP with IVs is a "level II" and then ACP is "level III." Generally "level IIIs" work with "level IIs" (ACPs don't like working with just a normal "level I" PCP since they can't start lines for them). I don't know whether this has changed since I left the area, but I believe there was talk that they would finally get rid of level IIs and that they had stopped training them. Since you would likely be working PCP/PCP in a setting with lots of ACPs, you would probably end up doing more low acuity calls (or at least having ACP backup on much of the high acuity stuff). Due to the high numbers of calls though, there will surely be some good stuff that you get as a PCP crew in Toronto. Unfortunately, with the PCP skillset our treatment is generally to drive fast. In Peel, I suspect that you would work PCP/ACP (again, just a guess based on old bits of information). If this is the case, you have basically just been turned into a very over-educated driver since your ACP partner will attend on anything remotely serious. Not really a great situation if you got into the job to provide medical care! You could also consider the Ottawa Paramedic Service... not as big a service as Toronto, but definitely an urban centre. This is probably true for EMS anywhere, but there are often a lot of organizational stressors in Ontario EMS. Just be aware that it will not be perfect, though it could still be a very good experience for you. Where in Australia are you from? Sorry, I don't have any knowledge of the equivalency process other than hearing that it is challenging. I wouldn't see an Aussie paramedic having any trouble with it though.

Congratulations on your acceptance! Looks like someone else has taken the foot pain question. We don't generally stand around for three hours so if standing still is the only thing that causes you problems you should be okay. I would check with your doctor as well, not just for piece of mind, but also because this Ability Works consulting company is doing lift tests for most Ontario EMS services now. If you don't pass their test, you don't get hired. I don't remember them asking any medical history questions, but before spending two years in school it would be good just to be sure you have your doctor on your side if you have any problems in the future. But no, probably not a big issue. PCP can go right to ACP in some of the programs but it is very rare in Ontario. Unlike in the US where many people on a forum like this will say don't work as an EMT-B and go right back to EMT-P school, Ontario is a very different system. So no, not impossible to go right to ACP school but rare and could make it difficult to find work as an ACP. All of Ontario is very difficult in terms of finding a job. Very, very difficult. When you get a job, you are correct that it could easily be five years before you get a permanent spot. And remember, this is for the lucky ones who get hired! Part time casual isn't terrible. I mean, it is a job and it pays well. But remember that you'll be working when no one else wants to and largely based on late call ins. You might not know you're working tomorrow until 9pm tonight when someone calls in sick. And you will work most weekends, a lot in the summer, and then not a lot over the winter. It can be quite difficult to try to schedule life around this. Also, your shifts may have no consistency, which can make the shift work more challenging. The pay is something where Ontario is very distinct from our American friends. The pay in Ontario for paramedics is very good. You can expect to make somewhere in the $30-$35 an hour range as a PCP and slightly more as an ACP. Is there anyone who should not or cannot do the job? That is a tough one and open to debate. I think that most intelligent and physically capable people can learn to do the job if they want to. I mean, there are skills like scene control that you will need to learn, but I think most people are capable of this with practice. The job is incredible. Keep in mind though that paramedics (at least in Ontario) do not usually last to retire at 65 and many get out after 5-7 years for various reasons. Given this, and the job market, you must have a plan of an alternate career if you are looking to become a paramedic in Ontario right now. You might need it while waiting for a job, or after you can't do the job anymore, but you'll need it at some point. PM me or post in this thread if you have further questions and I'll do my best to answer them.

Would you be able to share your protocol for this or direct me to a thread if it has already been shared? Thanks!

While I applaud your efforts, the first thing I would say is tread very carefully. You mentioned it in your post so you clearly understand the need for it, but it never hurts to emphasize it. This type of thing, not matter how tactfully you approach it, will rub some (many?) people the wrong way. My main thought after reading through your list is that it may be better to focus on one specific issue for which there is significant literature that your current practice is not what is best. Transporting cardiac arrests may be the best one, but I don't claim to be familiar with all of the literature out there. Asking for protocol changes without evidence seems like it is just asking for trouble. This could be perceived as you (new, cocky paramedic [in their eyes]) thinking you know better than the physician-accepted best practices that have been put into your protocols and that you are better than the other paramedics who have worked under these for years. (It seems like it may be more likely to be interpreted this way when you talk about "conservative" protocols since this makes it seem like you are simply seeking more latitude or skills rather than a shift to evidence-based practice.) If you are able to approach it as wanting to be able to practice in line with what are the best practices based on solid evidence so you can provide the best patient care possible I think you may be received more positively, but you will need to only propose changes that have a true solid backing in the literature. The next thing that I wanted to comment on is how you plan on getting your message to the medical director. I don't entirely understand the presentation that you are proposing or how exactly you would be presenting it to a medical director you have never met. Though I appreciate your desire to be formal with this, I think going too formal (as in a presentation) risks being perceived as arrogant or something similar. An approach that I might use if I were in your position would be to try to meet the medical director (for example at a recertification or something... hopefully there is at least a bit of an opportunity for some face time with the medical director even if you work for a large service) and even just talk to them to show them that 1. you're not an idiot and 2. you're not an arrogant prick. Making these two things clear from the start is important. This could be done even just by asking an intelligent question after a presentation they give or maybe asking a question about a unique patient presentation on a call. After that initial in person casual meeting, then I might follow up with an email saying how it was nice meeting them in person and I was curious about [insert name of protocol you'd like changed] since I have noticed a lot of literature that seems to point to [whatever] as being the best treatment. I would take the angle of being curious about the reason for our protocols given the evidence to the contrary rather than specifically asking for a change. Now, if your medical director is receptive then the answer may be that you're right and things should be changed. This is just how I would approach it, but of course there are many ways that would work. Just keep in mind that many medical directors have big egos and unfortunately even just asking them questions to try to improve your own knowledge can be perceived as you challenging them if it is not done carefully at least initially until they know the two key things about you. The last thing I will say is that don't assume that just because you have a protocol that does't line up with the evidence means that your medical director doesn't know better. Especially in your situation where there is some other body that needs to approve the protocols, maybe the medical director has wanted to have field pronouncements since the day he got hired but knows that the other medical body would never approve this. These debates happen all of the time behind the closed doors of base hospitals without most of us ever knowing. The best example I can think of of a case where a known best practice was not used by a medical director was a clinically validated field pronouncement protocol that the medical director knew about that was not in use. How do people know he knew about it? Because he coauthored the paper on it. So just remember there is a lot more at play here. Your medical director may be on your side on this but it may not be worth the fight against other regulators for him. Please don't let this dampen your enthusiasm. Anyone in EMS who is thinking is a good thing, even if that means questioning. I just know from my own mistakes at times that anything where you might make anyone in EMS feel at all threatened is something that you need to approach very carefully. Best of luck!

Dwayne, sorry if I missed this somewhere with all of the "distractions" that made their way into the thread, but let's just say that this lady was having another CVA and you got her sugar up and alerted the team. Would she actually have had any real chance of receiving tPA? Based on the overall heath you describe along with bystanders not being sure she was seen in her usual state of health recently would make me think that no doc where I brought stroke patients would give much thought to tPAing her. Since the glucagon was already out, did you consider administering that and then following up with dextrose once you obtained some type of access?