BEorP

Johnboy, you're obviously intelligent and able to make reasonable points in the discussion. It really negatively impacts your ability to get your point across though when it seems like every other post you are just insulting other members. I am quite interested in your perspective, but it would be much easier for those of us reading through this thread to follow your line of reasoning if the personal attacks were left out of it.

Interesting... I hadn't realised that there were issues with the Pedi-Mate on Stykers. Do you have a link to any details from Ferno or Stryker? I'd like to be able to pass it along.

It is so nice to see you online again, Rob! It is incredible to see the number of people you have impacted through this forum... do you remember when you helped me with my resume to get my first EMS job? That was back in fall 2007... seems like ages ago now given all that has happened since then. I'm so glad that I had the opportunity to meet you in Dayton (was that in 2008?). Thank you for everything!

Very interesting thread and one that I thought was worth replying to. The problem is that I've been sitting here for a while now trying to figure out what I have to say about it. My feelings are definitely mixed. I like the general idea of the initial post, but I also know how easy it is to become jaded when working in a system that does not endorse those views and would rather just have you fit patients in protocols. In my short EMS career, I managed to get myself into trouble a number of times over doing what was best for the patient. I never went outside of my protocols, but I sometimes followed the letter of the protocols (e.g. "paramedic may" is not the same as paramedic must) rather than the interpretation that the base hospital endorsed. The danger of this is that whenever you are tagged as someone who does not fully respect the sanctity of the protocols, you can be labelled a "cowboy medic." This is not a good label to carry with you. I guess what I am saying is that even though I am proud to say I advocated for all of my patients, sometimes at my own expense, I look back on it and sometimes wonder whether it was worth it. I wonder whether more good could have been done by trying to change the system to allow for more flexibility and to encourage better patient care by all providers rather than just improving my own care for a few patients. I also wonder whether I would have enjoyed my time in EMS more had I not been constantly going through audits and "discussions" about my actions on calls because of my patient advocacy. I do not mean to sound burnt out, but I do know how it can impact an EMS provider to seemingly constantly being up against a base hospital or EMS service and it is not fun to say the least. I guess this will really depend on the system you work in and how they view providers like this. Even with my mixed feelings though, I am proud to have advocated for and provided the best care for all of my patients. The other important consideration or danger with this idea of "clinical judgement" and then protocols is that not all EMS providers are like the members of this forum. In fact, I would bet that most of the people who come on here to discuss things like this are probably in the top 10% of EMS providers. Do you truly believe that the bottom 10% have the clinical judgement to make decisions without simply trying to put a patient into a protocol? I certainly don't. But then this creates problems for all of us, because in the eyes of some base hospital systems, we are all treated like those bottom 10%. In some ways this seems fair, because as much as we might want some extra leeway in our protocols, we probably wouldn't want it for a bottom 10% provider treating our mother. Taken even one step further, do you think that the average EMS provider has the clinical skills to assess a patient and then consider protocols rather than assessing a patient with protocols in mind? When you're working in an environment where you were trained to follow protocols and get in trouble if you deviate from protocols (even for the good of the patient), it is understandable that people can regress to this form of assessment. The last comment I have on this would be that even when we consider the top 10% of EMS providers, they need to be aware of their limitations. As much as we as EMS providers may hate to admit it, the protocols are written by smart people. This by no means means that they are always right or account for every unique patient presentation. The risk though is going outside of the protocols or treating a patient based on your assessment or whatever we want to call it and then being wrong when the protocol treatment would have been more appropriate. This would be terrible for the patient and the idea that thinking paramedics are better paramedics. The obvious way to prevent this is what we're all doing right now in addition to other research, reading, and continual education. I do not mean to sound negative about the idea of the thread. I really do think that it is great for EMS providers to be able to truly assess patients and treat them accordingly (while being in line with protocols or through a physician patch). I guess I just wonder how this could practically be something that is taken up more widely or how one provider can help to change things. And maybe the answer is that systemic change is not the goal, but rather simply the satisfaction of knowing that you have always provided the best patient care possible while accepting any flack you get for that. In that case, keep it up.

Did anyone else listen to the 911 tape that they link to in the article? The caller stated (even after being asked to double check by the call taker) that the patient was conscious (although not alert). Who knows whether this is accurate or not, but it doesn't seem to be in line with the impression I got from reading the article that he just dropped and then got over an hour of CPR before anything changed.

I recently left EMS to attend medical school. I have a four week rural placement in a few months and the school seems fairly flexible about who I do it with in terms of what type of healthcare provider (the skills they want us to demonstrate at this point are fairly basic). The main thing is that it needs to be in a rural location (and in a developed county like Australia). As much as it would be great to branch out from EMS and do something more "medical" in a hospital, I miss EMS and hope that it will be something that I am involved in for my entire career so this could be a great opportunity to get exposure to a system somewhere else. As I further consider my options, I was just wondering whether anyone has suggestions on where I might like to try to go. Australia and New Zealand are obviously high on the list due to their strong EMS systems (and proximity!). Any other suggestions of places to look for an EMS service that would offer a quality rural placement?

I don't see how such a large expenditure can be justified for something that has not been shown to benefit patients. Don't just listen to what the Zoll reps will tell you about increased cerebral perfusion or anything like that, read the literature. If it doesn't help the patient, why spend so much money on it? And if someone were to respond with the EMS provider safety issue then we would need to look at why cardiac arrest patients are even being transported. In case anyone is interested in reading a good review of the lit: http://www.thecochranelibrary.com/details/file/985305/CD007260.html

I think it depends on what we're talking about being an "EMS Chief" and "managing an EMS agency." If we're talking about the top person, I think that this can be done by someone who has an understanding of EMS even if they have not actually worked on the road. Yes, EMS experience would make it easier for them to do their job, but I do not think that it is absolutely essential. Good management and communication skills are much more important. There is a very good EMS Chief/Director in Ontario whose background is actually in dispatch. She has never worked on an ambulance, but she does a very good job of running the service. If we're talking about an Operations Manager type position though then EMS experience is critical. Not extensive experience necessarily, but some.

If you're considering the joint U of T program, please send me a PM. The short answer to your question is that you should absolutely finish your degree. Not only does the job market in Ontario suck right now, but you will also be a better paramedic with that additional education (or at least a more knowledgable one). How many paramedics do you know who retire at 65? Not many make it that far. Your degree may prove to be useful at the start of your time in EMS when finding work in EMS will be a challenge at at the end of your career in EMS when you need to move to something else (since this will likely be long before a normal retirement age). Durham is a good program. I believe that they are one of the two CMA accredited PCP programs in Ontario and this accreditation does make mobility within Canada a bit easier. You can definitely go to other provinces after attending a non-CMA accredited program though. There may be more hoops to jump through, but nothing impossible. I know a number of people from non-CMA accredited Ontario programs who are working outside of Ontario (mainly out east). In terms of going to school where you want to work, yes this is generally true. I would say that it applies even more outside of large cities though. In smaller services, they may only have a handful of students ride with them and as long as they don't screw up, they may be the first in line for the jobs. Still, I do agree that it is generally better to go to school where you want to work. Durham, being a decent program and located in the GTA would not put you at much (if any) of a disadvantage when applying to Toronto EMS though compared to Humber or Centennial. Most of the older guys in Toronto likely went to Humber or Centennial, but they definitely hire Durham grads these days. Most of all though, do not leave university without a degree. EMS may seem like fun, and it is, but you need to plan both for the difficult job market and the long term reality that people don't last in EMS. And if the U of T program interests you and you have questions, send me a PM.

This should help to understand the complicated equivalency process: http://www.health.gov.on.ca/english/public/program/ehs/edu/equiv.html The wage for a PCP will be in the low to mid $30s an hour with a few dollars more for ACPs. Shifts are typically (but not exclusively) 12 hours with some type of rotation to get 14 in a month. The exact schedule varies depending on the employer.

I understand your concern and it is refreshing to see that there are still people who are about the patients. That being said, autonomy is one of the major principles of medical ethics. If this patient goes home and dies in their bed and that's what they wanted then that is excellent. I commend you for at least questioning it while at the hospital to ensure he wasn't being discharged home unwillingly when he would be unable to manage, but once you found out he was competent and wanted to be left at home there is not much more for you to do. A couple other quick points. On the quote above, with a phone in reach he is far from helpless. He knows our number. Maybe I missed it, but I don't recall seeing any mention of family or friends. For all we know, he is going to immediately be calling a family friend who will be coming by to assist him but he is just too proud to admit it to you. And to end off with a quick personal anecdote... a couple years ago I was called for an elderly lady who had a syncopal episode while having an evening drink on her porch with a friend. There wasn't any obvious cause of it and of course it could have been anything from no big deal to her needing a pacemaker. She did not want to go to the hospital and was adamant about that. In the course of ensuring that she understood the situation, I explained to her that we couldn't say for sure whether it was a serious problem or not but that it could be and she could potentially die from it. Her reaction? She smiled and said, "Yes, that's fine. I'd be happy to go right here." Would you have felt guilty leaving that patient there? I sure didn't. Is this just something in your region/state that DNR means do not treat and you simply leave a patient who is still alive but in distress since they have a DNR?

With the CAP Lab less than a week away now I just wanted to see if we can confirm who will be there for sure. I will be there for Dec 9th.

double post

Physicians are prohibited from participating in executions in the AMA's Code of Medical Ethics. See: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion206.shtml "An individual’s opinion on capital punishment is the personal moral decision of the individual. A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. Physician participation in execution is defined generally as actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner."

Will voting help me get into this residency program someday?

Wow, great to see all the interest! I'm looking forward to seeing everyone.

I've registered for December 9th. I hope to see some of you there!

This is an incredible learning opportunity that is not often offered to EMS providers. I encourage everyone who is able to make it to come out for a day. All of the docs who help to teach the various components are very knowledgeable and eager to answers any questions that arise. I definitely plan to make it out there again this year (for my third year in a row). Get your Canada jokes ready...

Just an update on this, apparently the MAC will be revisiting the issue... http://www.cfra.com/?cat=1&nid=75646

I haven't heard any further updates, but initially the "word on the street" was that Ottawa PCPs could not do IVs because they did not complete a Medical Advisory Committee (the committee of the big base hospital docs in Ontario) approved course. They certainly cannot be the only PCPs in Ontario who were doing IVs after having completed a course that was not "MAC approved" but it doesn't seem like anyone else has lost the skill yet. I'm surprised that this didn't get bigger than it did...

This CTV story is a bit misleading. At least for the time being, many Ontario PCPs (outside of Ottawa) are still doing IVs.

I'm just wondering if anyone has heard from Dust lately or if anyone knows that he planned to be offline for a while. It seems odd for him to be inactive for this long so I'm just getting a bit concerned. Hopefully he's just away on some type of adventure! Thanks!

Incredible! Thanks for that. This is why I still find time to read the forums when I can.

I don't entirely agree with this statement. In the GTA, you will definitely have an easier time finding work if you are a grad of Centennial, Humber, or Durham. This is, of course, not only because the reputation of the programs, but also because they have produced medics for these services for many years so they know what they are looking for (and many students will have precepted there). I do not have any evidence to support it, but I highly suspect that Centennial, Humber, Durham or even any of the other more established programs (Fandahswe, Conestoga, etc) grads would generally have an easier time finding employment than some of the smaller and newer programs (Lambton, St. Clair, St. Lawrence) since people know them to produce good medics (plus the person interviewing you might be alumni of your school or have other medics from your school who they like). Of course, the most important thing for getting hired on at a smaller service may be just making a good impression by precepting there and doing well, which you should be able to do even if you don't go to the school in their area (although it will be more challenging to coordinate, and if you go to a GTA school I would definitely recommend riding out there... that is too good an opportunity to pass up). Anyway, to the OP: If you hadn't mentioned that you already had a degree, I would have said to go to Centennial without even considering the other programs. The ability to fairly easily turn the paramedic diploma from Centennial into a strong university degree (that impresses potential employers) is a huge benefit of this school (yes, you can go and get a paramedicine degree from U of T after going to a different college, but it isn't as easy). Admittedly, I don't know much about Niagara and what Dust mentioned about all of those schools being good is true. That being said, I can say with confidence that Centennial will prepare you to be a good paramedic who can truly think critically (not just in the buzz word sense of the words). It will be an exhausting and frustrating experience at times as it seems to consume your life for two years, but you will likely look back on it and think that it was worth it. PM me if you have any further specific questions on the program.

Sounds reasonable enough. I just wanted to be sure this wasn't your entire thesis or something since it would essentially be wasted. As an assignment for a class though I can understand. I will try to find some time later today to answer by email.