chevy

I am just finishing my didactic component for my ALS program This is followed by a number of days in the local ERs, a week in the OR for intubation hands-on and 400 hrs on-the-road as third-man jumping ALS calls. All good stuff, but my home area doesn't see very much trauma, especially GSWs (although that is changing, hence the need to get ahead of the game) and I feel that I need some extra time practicing my new skills in this area. Does anyone know an ER in a major city that would take me in for a few training days so I can increase my chances of working cases that come around infrequently on my home turf? If so, do you have a contact that I could follow up with? Willing to travel just about anywhere in the Jan-April timeframe. Many thx..

[quote="BEorP That is a valid point about the ACS part of the study not being completed yet. Wasn't it also OPALS who showed no benefit of ALS care for cardiac arrest outcomes or was that someone else?

Algonquin in Ottawa

Not sure how it's relevant to a discussion on BLS and 12 lead given that during my BLS training we were taught to apply and interpret 12-leads for purposes of bypass decisions (Thanks to all who pointed out that Cath Labs are not always accessible from where they work - this is an urban luxury I'm afraid). To answer your question - Nothing (the $15.5K in tuition gives one indigestion though). I start my ALS training in Sept. - takes about a year in these parts.

I thought the title PCP would give it away. The second "p" is for Paramedic for which I competed for 50 seats against 1000 people and worked my glands off for 2 years fulltime. I will not mention the 6.5 years of university I had before that. You think you are the only one with book-learn'n here? If you are going to make snarky remarks, at least get your facts right beforehand. Chevy. B.Sc., Paramedic

Dust. Not sure where you are working but bypassing a hospital by interpreting a 12 lead and ending up at the right destination in the first place does not save 5 minutes at the hospital by spending 10 minutes in the field. Getting into an ER, having them do an ECG, deciding to transfer and then getting that done is a time period that is measured in hours, not minutes - at least in our part of the world. Actually the 12 leads don't consume any time worth arguing over. The vast majority of the time we do them enroute. We have to attach the 4 pads for regular monitoring so the extra 6 pads take another 10 seconds. Push the Button, look at the results. Redirect if necessary. My opinion is that if I'm going to attach a cardiac monitor, then they get a 12 lead as there is no downside, aside from losing a few more chest hairs. In the past 3 months, we have seen an 8 year old and a 26 year old who were diagnosed by Paramedics as having coronary artery blockage by virtue of ECG findings and these patients were immediately brought to the right facility instead of just the closest or less busy ER. Learning to do a STEMI bypass by reading a 12 lead strip is not brain surgery. Based on success with the trials here, many other services are starting to teach this skill to their medics, both ALS and BLS. I see a time soon when it will be come as common as testing blood glucose is on a reduced LOC patient.

More and more PCPs are going straight to ACP. Rather than "Zero to Hero" its more like "No Job to Job". Services demanding experienced ACPs are getting squat 'cause there are not that many available. The response is to take the green ACP and get them the road hours/calls asap. (it's calls that count - not hours!) The writing is on the wall for PCP programs. Within a few years, I'm betting that Ont colleges will do a 3 year ACP program and PCP programs will go away. Let's face it. Unless you want to work rural jobs, no one wants PCPs anymore. As for the arguement that experiennce between PCP and ACP is beneficial - sure it is. Take any profession - engineering, teaching, medicine. If anyone in an education program could take a year or two in the field before they return for their final year would this make them a better practioner? Sure it would. Why don't they then? It's because its faster/cheaper for employers to ramp the newbies up to speed than to hold out only for experienced people and todeal with two levels of employee. Basic economics. my 2 cents worth.

Point 1: BLS medics ARE being taught 12 lead interpretation for diagnosis purposes Point 2: In some areas, this knowledge is being used to bypass the ER and go straight to the Cath Lab with great results As we are an evidence-based profession: see 17 Jan 2008 New England Journal of Medicine http://content.nejm.org/cgi/content/abstract/358/3/231 it's conclusion: "Guideline door-to-balloon-times were more often achieved when trained paramedics independently triaged and transported patients directly to a designated primary PCI center than when patients were referred from emergency departments" From real life: 2 weeks ago, male with CP meets us at door. We get him to lie on the stretcher asap. Take 30 sec's to place 12 leads, run a strip. Clearly a STEMI. Call the Cath lab - from the hallway outside his apt. Leave lights/siren, bypass the ER. Patient gets catheterization done BEFORE we get our paperwork complete. Thats what I call making a difference.

Company policy against phone/texting while driving. Maybe, but it's commonly ignored.

Speaking of driving safely, how about yapping on the cell phone and texting while driving? I'm working for a private service as sumemr gig and many of my partners do this. Drives ne nuts, especially when we have a pt. on board.

I have had the fortune of observing a local ER doc a number of times in this situation. He "goes with the flow". He always readily agrees if asked to join in prayer. If people are holding hands, he does so. He bows his head in respect and doesn't say anything. He offers a few non-religous words of encouragement post-prayer depending on the situation (" It's good to have such a strong family, good friends" etc) He then departs. It seems to give comfort to the family and patient that the care providers are involved. I have no idea what his personal beliefs are but I have seen him do this with many faiths and I plan to model my own methods on his as I also believe that we have to treat the whole patient.

My family and I are visiting the UK in July for 2 weeks (1 week in London and 1 up north towards Manchester to see some in-laws). I was thinking that it would be a great experience to see how the EMS system works in the UK versus here in Canada (Ontario specifically). Would it be possible to do a ride-along in London and if so what would I have to do to make this happen? Cheers...chevy

My opinion is that, unless the scene obviously has sufficient personnel, to stop (if safe to do so), state your "cert level" and ask if the crew needs a another set of hands. If they say no, leave. I am not implying that you stop everytime you see a crew by the side of the road, but if there are obviously multiple patients (multi-vehicle MVC) and only one crew, then maybe it's a good idea. We are taught to use anyone and everyone at a scene if an extra set of hands is required to do exactly the sorts of things you mention (and also how to get the unwanted "rescue randy" out of the way). ..chevy

I have to agree with the masses here. Would a pilot be allowed to fly with a disability that prevented him/her from seeing properly? EMS requires manual labour. Allied services may or may not be there to help when you need them. If you are only 2 people, your problem has just become the patients problem and that goes against the "first, do no harm" rule which should never be compromised. In Ontario, we just heard that the minimum lift load for a 2 medic crew is going from 195 to 205lbs. (Stop eating people!). As an average sized male, this is not a big deal for me but for some of my classmates, this is going to be tough. ALL of my slight classmates (male and female) have been working their butts off to overcome their genetic disadvantage because they know that the patient really will rely on them to get the job done regardless of their size and there is just no excuse that will fly if the job doesn't get done. My point is that is doesn't matter if your problem is genetic or created by other factors, certain realities must be faced, if you can't overcome them, then this profession (paid or not) is not for you. It seems that this gentleman really is interested in healthcare. Perhaps he should consider a role in dispatch or a non-lift profession (perhaps Respiratory Therapy) where he can bring his enthusiasm to bear in a way that keeps him and his patients safe. Stay well.

To add...We are taught that for a hip or tib/fib Fx. The max should be 10% to a max of 5 lbs. The point is to restore the limb to as near normal anatomical alignment as you can, reducing impingement on neuro/vascular structures. The force required will vary by pt. We practice alot with the Sager (fiddlely bugger, with all that velcro) although the pro's tell us that they seldom use it. That being said, one of our instructors used one a couple a weeks ago on a broken femur resulting from fall off a roof. Happy politically correct seasonal greeting inseted here. :bigsmurf: