Lithium

Well, I honestly don't see the big deal. Technically speaking, according to the ambulance act, a 'paramedic' is one who is designated by a physician to perform controlled medical acts in his/her absence through standing orders and protocols. (yes, there is a difference in the legalities between offline and online medical control, but we won't go there) So, those who are saying that PCPs are not 'paramedics', well, you're wrong. The Ontario symptom relief package and cardiac arrest protocols are all delegated acts. Therefore, PCPs are paramedics. I really don't have any qualms with a PCP calling them self a paramedic, so long as they are working (same goes for ACPs and CCPs). But this does bring up another issue, because in Ontario, once your shift is over, you are no longer a paramedic. That's one of the things the Ontario Paramedic Association is pushing for, but again, not related to this post. As vs-eh already stated, part of the Ontario uniform standard is epaulettes with the word "paramedic" highlighted with a number of stripes to designate your status. Generally, it goes like this: PCPs get one bar, ACPs get three and CCPs get three with 'critical care paramedic'. However, I believe Peel and Hamilton are on the right track, because they rely more on wording then striping. PCPs gets "paramedic", ACPs gets "advanced paramedic". So, for those who are truly concerned about the public knowing who has more education, there you have it. peace

Alright, maybe I'm not done ... akroeze, you admitted you have little exposure to ACPs. I'll simplify it for you, generally, PCPs have acces to five medications. ACPs around 18. See the difference? If you have more things to consider, it's gonna take you a lot longer. Case in point ... when dealing with cardiac patients. Is this a rate, rhythm or volume problem? Do I need to slow them down or speed them up? If so, how do I want to do that, pharmacologically or electrically? Rhythm, again, pharm or electricity? Volume, too much or too little? Do I diurese them or top them off? Secondly, if it's inducing ischemia ... do I want to manage that before or after, perhaps if I correct the underlying problem it will disipate? How do I want to manage the ischemia? Nitro, or try jumping straight to morphine? If I'm gonna be using electricity, then perhaps a bit of sedation, but I don't wanna snow them. These things take time to consider and formulate a plan, and I'll be damned if I'm gonna be deactivated or decertified because you or anyone else thinks I'm spending too much time on scene. It's my license and my career. peace

See, my issue with develloping a national registry for Canada, would be trying to get the provincial bodies who already regulate EMS licensing to trust us. Then again, if we're testing according to tha national scope model, I can't see a problem with this. peace

akroeze, again, it looks as though you won't understand why it takes an ALS provider that extra time until you are one. There's multiple people on here (oddly enough, usually ALS providers ... hmmm) stating they can understand where that extra time comes from. What about if I said that when I was working air, that oft times we would spend 50 to 60 minutes preparing our patient for flight? Would you find that a little much? Because honestly, that's around average for a CCP transfer. JPINFV, yes, I COULD do something for that damaged cranial nerve. Any idea what that would be? Report my findings to the receiving facility. If you don't look for something, you won't find it. Hammer, yes, I can percuss chests, and if you wish, I would be more then willing to show you how :wink: but what's this with pelvic exams? :shock: Remind me to get in and out of Hamilton as quickly as possible. Dust, thanks for the defense. I think Im pretty much done with this thread ... it's gotten way off track for me. peace

I have explained it, you just don't seem to be able to accept what I'm saying.

And I guess you won't until you're an ACP yourself.

Oh Hammer, it happened to me once about 6 years ago, I was on a PRU, layed down ... next thing I know I have a supervisor who happened to be acting OPS manager waking me up. Not a good thing ... never again. peace

You can, but do you? There's the difference I would think. Plus, were you taught how to properly percuss a chest for instance, or administer a spirometer and understand how to interpret the findings? I wasn't until I took the CCP program ... 678, no worries. However, if you look closely, it seems to me that this is turning into another bls vs als discussion. How do I say this without offending anyone ... Yes, again, if there is a critical error noted in my primary survey, I will initiate rapid transport. However, if not, I'm not going to rush. I should mention as well, that in my area, our average transport time is only 10 minutes without lights and siren usage (and only 9 minutes and 30 seconds with haha), and I'm not a huge fan of performing initial assessments in the ambulance unless our scene prevents patient privacy (ie. shopping mall etc.) So, as you said, you are not the only one who finds me spending 25 to 30 minutes overall on scene (from arrival to departure) a little much, but as others have pointed out, such as Dust and Rid, they don't see any problems with it as they both understand what is involved. peace

Didn't you ride with an ALS crew? We're not saying that EVERY call should be half an hour on scene. But also please don't think we rely solely on those mnemonics to perform our assessments. The ACR will list those same mnemonics, as that is what the MoH wants to ensure was assessed. For instance, even though that most calls are medical related, I still perform very throrough and detailed PHYSICAL assessments. No, not the typical "okay, can you squeeze my hands?" thank you!" and then have the gall to document and report that there is no deficits. I'm probably one of the few ACPs in Ontario, who on every respiratory call, will perform a complete physical chest assessment. Have you ever seen an ACP, or PCP for that matter percuss a chest? No. Why not? Beats the heck out of me ... chest percussion to me is as essential as a stethoscope. However, I won't do it in the back of the ambulance, purely because I can't hear as well. Secondly, since I'm disrobing the patient of most of their clothes anyways (and yes, women can leave their bra on) I do it in the privacy of their home, which I guess 'prolongs' my scene time. Also, what about spirometry? I've 'acquired' ( ) a spirometer, and routinely use it on these patients as well. All it takes is a few extra seconds and all I do is ask my local ER nurse for a few of those disposable mouth covers and bingo, another assessment tool. So, this patien is complain of dyspnea, you ausculate and find the lungs are pretty clear, maybe a little shallow, SPO2 is 98% on RA, what would you think? Now, after percussion, I tell you their chest sounds a little dull and their expiratory flow is diminished ... now what do you think? As well, I really like to sit through my calls and think, absorb what's going on and try and put it all together. How many cranial nerves are you evaluating when you speak to your patient and shine a light in their eye(s)? How many of them aren't you evaluating, what does that tell you, what doesn't that tell you, and more importantly, how does it relate to the patient in front of you? peace

Apparently you do. To me, that sounds almost like a classic case of an anxiety induced stress response. There could be a multitude of factors in your life that can lead to these, but what I picked up on immediately based in your post is the fact that you claim to be a 'whatever' type of person. I don't believe anyone can be like that in this life unless they're pharmaceutically enhanced. To me, it sounds more like you perhaps repress everything, and it's now just starting to catch up. If your employer has an employee assitance program, I would advise you check it out. peace

WOAH WOAH WOAH peoples! If you actually read my post, you would see I clearly stated that I would encourage anyone capable of going straight to medic to do so. My anaology of Mt. Everest is based on the attitude of most Ontario medics as demonstrated by vs-eh. (no offense intended buddy) What I was trying to impress is that within Canada, or atleast Ontario, anyone going straight from BLS to ALS will encounter probably one of the most uphill struggles they ever will have to climb in their life. If they can accomplish that (meaning dealing with their colleagues whilc concentrating on their new-found knowledge and responsibilities) then any call they can come across shouldn't pose much of a problem. Again, I reiterate, I would encourage anyone to go straight into ACP, ALS or 'paramedic' school ASAP. peace

Thanks Dust for clarifying a bit, but 678, you can think that's a long time if you like, but in reality it's not. Now, don't get me wrong, if the patient is critical (ie. severe trauma, arrest etc), you can bet your butt we will be off scene in under 10 minutes and I'll have most of my assessments and interventions performed enroute. But in those calls where there is nothing seriously wrong, I will take my time to figure out what's going on. peace

Like others have mentioned, I can't sleep on night shifts (or any shift for that matter). There's been a few times where I'll relax and close my eyes, but thats in one of the comfy chairs in front of the TV. If I were to lay down on a bed and close my eyes, I'd be fast asleep, and I'm such a heavy sleeper, there's no chance the tones would wake me up. I have to be awake for my entire shift, if not, I'm not at optimal performance. It's a pain, but it's what I've come to know. To prepare for the shift, I just stay up as late as possible, then the night of my first night, I force myself to do all the mundane tasks around the base. Usually that includes a very thorough, comprehensive inventory of the ambulance and all gear inside. So if our checklist says the trauma bag is only suppose to have 5 band-aids, and there's 7 inside, well 2 are coming out! This usually kills a few hours after midnight, and the call volumes are generally less which provide the time. I've tried sleeping on nights, but like I said, I'm such a heavy sleeper, and it usually takes me 30 to 45 minutes to arouse all of my faculties completely, it's just not gonna happen. The thing I dislike, is on my days off between night shifts, it really screws me up. I find during those 2 weeks or so, I really have no social/family life. peace

The opinions on this are varied. Personally, if you're capable of going straight to ALS, I would advice you to do so. Just be prepared to rustle some feathers along the way as well. When I was in ACP school but still working my normal PCP shifts, if I happened to be with an ACP at that time, I found they were rather helpful on calls. If it was an ALS call, they often elected to allow me to run it from a theory portion, and they would perform any of the necessary delegated acts (electrical therapy, med administration etc). Of course if I was way off-base with treatment modalities, I was reverted to just 'driver' and we talked about it after the call was finished. Anyways, like I said, be prepared to receive some flack from your colleagues. Going from BLS to ALS with no experience is similar to attempting to climb Mt. Everest without oxygen. Few have accomplished it, most would tell you it can't be done and you have to be a little crazy. :wink: Best of luck either way. peace

Just because it's along these lines, if you wish to convert mg/dL to mmol/L divide the mg/dL by 18. So ... 80 mg/dL would be 4.4 mmol/L peace

I'm honestly glad you felt bad about this. Not because I'm a sadistic person (well ... perhaps? haha) but mainly because it shows that you are genuinely concerned about your patient assessments, and to feel like you missed something so crucial shows that you still have room to grow and perfect your technique. If it's any consolation, I can't recall off the top of my head any incidents where I 'missed' something that was crucial (but rest assured, there has been a few of those moments). However, many incidents come to mind where I was completely off base and wrong with my field impression. (ie. 36 y/o F whom I believed to be having a hemorrhagic stroke, was actually treated at the hospital for a catatonic shizophrenic episode with accompanying lower GI bleed :shock: _, well i guess not really treated for the catatonia, as that was previously diagnosed ... anyways) If you think you're unsure sometimes as a PCP, just wait til you make the jump to ACP. My average scene time as a PCP was 16 minutes, as an ACP its closer to 25 or 30. Your assessment skills will become more enhanced over time and you'll be sure to leave no stone unturned. peace

Well, I occasionally find myself reading a few blogs floating around out there in cyberspace about EMS professionals all over the world. Something that I've seen more then a few of the people write about (however so briefly) is how they 'dress' their patients for the ER before arrival. Basically, they admit to carrying 'johnnys' in the ambulance (I guess the johnny is the gown given to admitted patients?) and once the patient is ready for transport, they'll have them put this on. To be honest, I've never seen this in practice up here. It makes sense however, since most medical and perhaps some minor trauma cases can be in the ER for a few hours at the least and will be asked to change into the robe for assessment purposes. What are your thoughts? Would you request your patients to take off their tops (ladies can leave their bras on) and put on the hospital gown? And yes, I do realise there are certain consequences that can arise from this ... peace

HAMMER! Ooo la la, are you 'available' my lady? :wink: peace

Yes, I've seen that video before a few months ago. I have mixed feelings about it. No, it doesn't really portray EMS in it's true form (come on, shocking someone on a wet roadway? no thank you haha) but it does get people interested. I think that was the point however, to stir up interest in young people to research EMS as a career. On the same note, are the people who respond to such a stimulus really the ones we want attracted to this career? I don't really think so ... because not every call is a severe traumatic arrest. When they find this out, that most of EMS is totting non-acute people to the hospital because they don't have other means, are they going to stick around? Plus (and no offense to our American friends) are the people in their last years of high school who truly want to set up a life-long career for themselves going to take this profession seriously, whey they find out all that is required to get in at the entry-level is a few hundred hours of night courses? Even up here in Ontario, I wish the program was longer (similar to the joint program between a college and university which is 4 years long and you graduate as a PCP with a Bachelors degree). Anyways, those are my thoughts. peace

Actually, a very good idea. I find with these age groups, the kids are usually pretty timid at first, but if you ask them to start going through stuff, they open right up! But as Anthony mentioned, one thing I've always found quite helpful is to perform skill-related demonstrations on the kids. Pull out the O2 masks and turn on the oxygen for a bit to get the hissing sound, apply the cardiac monitor daisies, lay themd own and strap to a backboard and get volunteers to let you apply this stuff to them. Not only does it spark their interest and let you talk about it in a controlled, no stress environment, it also gives the kids a heads up incase (heaven forbid) they're ever involved in an incident where we really need to do these things. peace

Get yourself a medic student! I love having ALS students during a code, then I can pluck myself in the jump seat (conveniently located directly below the a/c i might add ) once the patient is intubated and monitor my students progress while ventilating... haha... are you SURE you want to give atropine to this PEA arrest at 120? peace

See, that's the whole issue. I for one, would love to be able to develop and implement a body similar to the National Registry for Canada. In my opinion, it would assist with reciprocity quite easily, and for those of us who want to move between provinces, would provide a way to do such that. Then the issue comes up, who is this organization responsible to? Each province? No, that would complicate things because each province (err, state) has their own ideas of what a PCP, ACP and CCP can do. Quite frankly, if I could attain licensing in Alberta as an ACP, I'd be there in a heartbeat. So, I would have this organization responsible to the CMA. Each test following CMA standards for the PCP, ACP and CCP. Any Canadians out there agree? Disagree? More input from our fellows of the south, you already have this organization, how would you tweak it? peace

Hello all, I'm curious what our American friends think about their National Resgistry organization? As you may or may not be aware, up here in Canada, reciprocity between provinces is a HUGE hurdle to jump over for medics looking to move outside their province of original training. It's become a little easier with some programs now being granted CMA (Canadian Medical Association) accreditation. This just means that, that specific program has met minimum requirements and teaches that paramedic level to the national scope. Anyways, if you could let me know what you think of the registry in general, how the exams/practicals are, if it truly is beneficial for moving between state to state and any other issues you can think of ... Thanks! peace

Even simpler for your heart-valves analogy ... I learnt it as: You always TRY something before you BUY something. (tricuspid before bicuspid) Tri before bi. peace

Don't forget the endocrine system, and especially the renal system! Acid-Base balance, fluids/electrolytes ... love that stuff. And if you can describe the three phases of cellular respiration in detail, you're ahead of the game peace