ukcanuck

In the UK we are not allowed to "land out" at any none reccied sites. That limits us to lit pads wherever they happen to be. There is talk about doing night scene jobs using NVGs and pre reccied sites to meet up with crews but most crews/pilots/flight people just don't see the point when you look at risk vs benefit. There are untold wires and stuff that ruin the crews day as we are a very populated little island. You can afford to run several critical care support cars with what you would pay to do night heli ops and most crews are never that far from a hospital. Except maybe the scottish highlands but then they call out RAF SAR.

Hi there just came across this thread today but wanted to add that bougies have been used here in my service in the UK for several years. We believe in optimising first time attempt and so recommend you use one on every tube. Adult down to ped's - and they make ped tubes A LOT easier IMHO. If you don't it is up to you but most do use bougies on every tube. Personally I set up with a bougie and if I get a grade 1 then pass the tube but anything less gets a bougie then tube. It is not about showing whether the paramedic can intubate w/o adjuncts but rather actually doing it first time for the patient. We are also looking at disposable McCoy blades with the little flipping tip which makes a difference to the grade of view. We use them on the critical care team I have association with and the flight system I am part of. We set up with the McCoy on, bougie ready to pass once view is achieved, and the rest of kit for tubing and LMA out ready in case of failure. Plan to fail and you never will. If you have the ability to sway your service to using them then do. It should make a big difference to your first time success rate - that sounds like a study to do foe someone I will try to dig out some research we used when we started recommending this method and post it.

Hey there all, My reciprocity application and portfolio have been approved by the EHS and I am sitting the ACP registration exam for NS in the near future. I would like advice as to what text books, educational materials, tips and hints for the exam would be good to review. I have a large selection of text books already and don't want to buy the wrong ones obviously. Also anyone know of any websites etc would be greatly appreciated. I will be asking both the EHS and MSOP for advice but figured asking people who have done it would get me a better usable answer. ANY help would be geatly appreciated and rewarded with good karma thanks

Sorry but had to write something about this "the questions is do people pay 'significantly more'" my NI last month £330 if I was in BC (Canada) £49 for a family of three or more how much are people in the USA paying for health insurance with the following benefits - 'Free' Primary care consultations if you can get a doc, get an appt after managing to get the receptionist on the phone and convincing her that you do need to see a doc and you might get an appt same day at their concenience not yours no cover out of hours really poor service by out of hours and no walk in clinics for the vast majority of the country - 'Free' Specialist consultations huge wait time for anything not life threatening and that is after convincing the GP that there is something wrong with you that antibiotics or antidepressants will not make better - 'Free' Investigations do you really want to get into the wait for CT/MRI or any appt time for anything such as a holter monitor, stress test or tilt test to name but a couple - 'Free' Emergency Department treatment yep in dirty depts that must see you in four hours whether you went there with a sore toe or severe MI. No private options or even hospitals with ERs that specialize in caring for those who can and are willing to pay more for more - 'Free' Emergency Ambulance treatment and transport, taxi - need I say more about the abuse put onto that part of the all great NHS they are busy doing matty taxi because it is free and a taxi charges so there are no ambulances for real emergencies don't even go there - 'Free' none emergency Ambulance transport if you meet the mobility / disability / vulnerability criteria why should they - most can pay and all are attending out patient clinics or appts for the most part they have means of getting around when they don't go to hosp they can make it to bingo so why not hospital?????? - 'Free' emergency inpatient treatment as long as you meet the criteria don't need ITU/CCU beds as they are all full god help you if you are having twins as your SCBU will be full and you will be either transferred out or one of your babies will be - have fun - 'Free' elective inpatient treatment yep again - you can wait in line with people who have not paid tax into the system - mmmmm sounds good to me - subsidised dental care if you can get one at all some people will travel hours to find one and even then it is £15.50 per visit - free optical care for under for under 16 (19 if still in secondary education) and over 60s as well as free opthalomology services provided by medical opthalmologists ( as above) for all ... plus the various time frames for investigation and treatment yeah really long and even longer 14 and 62 day rules for cancer invesitgation and treatment but no active radio treatment for cancer on the weekends or even into the evening so even if you are Dx with the big C the treatment is slow and not enough of course the incidental find rate in Canada and US is sooooo much higher than in the UK and the 18 week rule coming in at present for treatment http://www.18weeks.nhs.uk/public/default.aspx replacing waiting time time tagets for referaal to consultation and consultation to treatment yeah have to wait and see how the stats people twiddle with those stats to make it look good plus the various provisions within other social secuirtty benefits for meeting the costs of healthcare ( i.e. free prescriptions for people on low wages / recieving tax credits ) yep people who pay more get the same as people who don't pay or pay a lot less - sorry call me a pure capitalist but this is not right plus the contributory Social Security benefits Graduated Retirement Benefit; retire at 68 - fantastic Incapacity Benefit; Job-seekers allowance (contributions based); Maternity Allowance; only good thing listed have to give you this one Retirement Pension (category A & ; Widowed mother's allowance; Widow's pension. Widow's payment. you forgot to mention inheritance tax and as most house prices are so high most average people have to pay 40% tax after they die on money that they have already paid tax on :? apart from that, the fact that the NHS is falling down around our ears, not enough beds, not enough staff, not enough resources, crap workinh conditiond, poor conditions for patients and evrything done by the lowest bidder it is fantastic staff are great but the NHS runs on GAG - goodwill, ambition or guilt - on the part of the staff just my opinion having worked bothy sides of the pond be safe and watch out for the bean counters they might get the electricity meter and turn it off :wink:

The only reason you got a hot answer - sorry - is because it is a VERY large issue over here and it gets peoples noses out of joint quickly. No offense taken and none meant in the answer. Easy answer to your question is that the £20 is only when we go disturbable and get a call. If no call then no money and the service has got free cover out of you. Seems easy as you got your break anyways but it comes down to a principle issue in that the service knew this was coming and just figured we would all cover the breaks without getting paid and get stood down at the high priority base so the figures look better. Also the £20 solution is only in my service - even though the agreement is national each service have different solutions and not all of them are as good as ours some are no pay at all and others are a lump sum annually. The gov't refuses to pay us for our meal breaks and so we are in the situation we now have. Also throw into the pot that the vast majority of the calls we get when we are on break are the calls that have not been covered by other crews so they end up being lower grade headache and abdo pains. I just wish that the system would go back to paid for 12 hours respond for 12 hours eat when you can - as unhealthy as it is for you but most of us knew that when we joined an oldtimer once told me that you are a poor ambulance person if you can't get a coffee some where and a bite to eat when you need one in your shift we will have to wait and see what happens as it gets interesting as just in my service we merged with two others so we now have three solutions to the issue just in one service - like I said anyone want a swap please!!!!!!

From the coal face that is facing this PR and having to deal with it We don't like the fact that we have to have a thirty min break in the middle of out shift when we either agree to respond and get £20 if we do get a call (about US$40) or we can go undisturbed and get thirty mins down time. Fact is we do not get paid for our meal breaks now which is a detail being missed by the press. We work 11 1/2 hours in 12. Before the current agreement we worked and got paid during our meal breaks. 12 hours paid and 12 hours worked that seems fair. The gov't brought this in and I for one would rather work for 11 1/2 hours eating as I go and go home earlier. But I am not about to work while I am not being paid. If the system wants the cover they should pay for it. The NHS wants us to give them free cover so they can get more out of us without paying. The NHS runs on the GAG principle Goodwill by staff Ambition of staff or Guilt felt by staff It is not as clear cut as the article makes out that the crews are standing down while death and mayhem is going on but the crews are just as uncomfortable but where do we draw the line in the sand about what we do in our time. Unlike most adverts we see for the states we do not get time off for CME or extra courses, most extra courses have been cancelled, leave is being refused, vacancies are not being filled, and we are expected to more and more in time let alone out of time. Pressure is put on staff to become staff responders (responding from home while off and getting a call out rate) to show committment to the service to get ahead and meanwhile we are going to more and more inappropriate calls because the gov't refuses to bill the punters when they call because they can't find their remote control. Its great over here in the NHS anyone want to swap ?????? please........

Too true tniuqs I have a mate who is a paramedic whose wife is a nurse and he can't get a look in for a ticket but the nursing board are falling over themselves to get his wife in and working. I would love to go back to Albt and work for a service but in all truth the whole APL system for ACoP is so long winded, expensive and paper driven that I will look elsewhere before even thinking of trying it. Consequentially the ACoP is losing the interest of paramedics who are working autonomously If the diferent colleges would at least think about setting up a easier and yet robust selection procedure then I would expect that most of the vacancies would be filled by UK paramedics. Queensland in Oz is quite happy with the response to the recruitment drive they held in the UK recently and I believe that they and other services from down south are planning to do it again. Canada and the US for that matter need to tap into the supply and pick off the ones they want before we all learn how to say "G'day mate" Any hints or tips for dealing with ACoP would be greatly appreciated

Guys and gals Thanks so far for the info and tips on where to go So far after some months of e mailing and contacting I have found that ACoP is not really receptive to anyone outside of Albt that thinks they can do the ACP skills and Ontario means that I have to go back to PCP level to go back up - I'm too old in the teeth to do that. I have just found Nova Scotia to be receptive and might go that way. Immigration is not an issue into Canada as I am Canadian and worked BCAS for five and a half years part timer but on full time hours - you full time part timers from BC will know what I am saying (greetings region 2) Talked to friends there and they know of only one of the CMA accredited guys getting through all the hoops to work ALS(ACP) let alone the outside guys. Whether it is Canada or the US does not really matter but my partner has her heart set on the american dream and really wants a warm state - too many dark wet dank wnters in the UK The NR will not let you test until you get a state licence hence the request for either a course to get one or a state that likes outsiders. Also there appears to be more choice when it comes to types of places to work in the US compared to Canada. In Canada it is either a fairly large municipal or city or you are stuck in the middle of no where. The industrial side that is very open in Albt doe snot appeal to me as I did it for a few years in BC. Staring at trees for 12 hours a days gets to you after a while esp when the trees start talking to you. I am also 50% of the self loading baggage for an air ambulance service and would like to have a pop at that and the US has more flight systems than Canada so the primary target is US with Canada as a secondary colder target Please keep the ideas coming if you have them as there are several guys in my service wanting to jump and several are already going to Oz or New Zealand Cheers

How about 60,209,500 people in the area of colorado, $2 per liter for gas, $500,000 for a house that is only 950 sq feet, that is not any where near London and is considered a cheap area for housing, ripped off at every turn by anyone incl the govt (we even have to pay a tax just to have a TV), a retirement age of 68, and you have to pay for everything even to go out on the river for a paddle. Professionally I also think that it will be a step forward at the best and the same at the worst - so all added up family wins on the lifestyle and I can't lose with work I would not be a good Dad or spouse if I didn't do this Any ideas or suggestions

So here is the rub - paramedic in the UK, PHTLS/PEPP instructor, AMLS, training officer, and a few other alphabet soup type courses. Want to move to the US and am willing to do the training to prove myself. Looking for a full time paramedic course (have already followed the 12 week course thread) that is available that will lead to NREMT-P. OR does anyone know a state office that will recognize outside training to gain a state ticket that will let me sit the NREMT-P. Again willing to prove everything via portfolio or examinations. Already have ideas on how to get around immigration but need the ticket to get things going. ideas on a post card please Thanks in advance

COD was MI and opinion of coroner was that PHT or PCI would not have saved pt. There was no evidence of adverse reaction or complication to the PHT. My service has a cardiac care nurse who coordinates the cases and follows each one up as a quality control to ensure that it was an MI and to follow any adverse reactions. He also gets feed back from the ER/CCU. Didn't make me feel any better but I put it into context that I have treated trauma pts where I have decompressed their chest gave them fluids drove really fast to hospital and did all the trauma stuff and they still died due to their injuries this was just not as obvious as a FUBAR pt Still advocate PHT unless you are around the corner from PCI but even that has a complication and death rate To be honest I am surprised that you guys aren't doing it considering that it is common for RSI in the field over there and I would put that down as a risker skill set to perform well. If you are good enough to do that then you are good enough for PHT for sure!!!

Do you mean results, numbers of patients, or personel experience? I know that my service has done 50 this month and we limit to STEMI within a set guidelines. I have done several with only one adverse during which the pt died but the PM showed he would have died anyway due to the extent of MI and heart disease

I find the debate as to whether to use pre hospital thrombolytics interesting. It is considered standard of care even if you are less than 10 mins from the ER over here. The papers, which I don't have at hand but if you want them I will dig them out, showed that for every min delay in re establishing flow cost the patient 11 days of life. It also increased the incidence of LVF/CCF which has a worse life expectancy than cancer over here. This was put into place after many studies and many high level conferences. It may have had something to do with the fact that in my area we serve probably the best part of 1.5 million and there are two cath labs about 1.5 to 2 hours apart. Neither are really set up for emergency admits for acute MI. Using PHT means the patient gets care faster as getting the pt to the cath lab would be hard within rec time frames. They are only just starting to use thrombolytics/fibrinolytics for CVAs at one hospital out of eight and that is the local neuro centre. I would be very wary about using it pre hosp for CVA as it is best practice to completely r/o a bleed. PHT is widely used throughout europe all with good results - so apart from the fact that you would be able to get the patient to a PCI suite faster than us why wouldn't you do it? It is solving the patients problem.

NTG contraindicated for inferior wall MI? Ok so I am new to forums like this - NTG is not CI for inf MI just a huge caution due to what it does to them in the vast majority of case No NTG, but okay to use Morphine? They will both have similar actions on the RVI. Morphine is easier to titrate, so you will have fewer negative effects, but you still have to be careful. quite agree to this - which is why it would be preferable then fire and forget NTG Prehospital fibrinolysis isn't widely used in the States, but for those that are able, it might be a good consideration. Depending on how long it will take to get this patient to a PCI facility. PCI is not that available over here esp for emergency cases. Most of the cases they do are pre planned and it takes some time (weeks) to get most pts in for an angiogram. It is pretty well nation wide that pre hospital thrombolysis is performed Atropine would be a consideration, as mentioned previously, but I would shy away from it. The lower doses of Etomidate may very well reduce blood pressure, but if we can get the rate up with TCP, the situation resolves itself, right? by using TCP would you actually increase the pressure as well as the rate or just the rate that dying and ineffective muscle is moving - not sure. i know that the rate will hopefully go up after capture but will this also bring the pressure up. In patients with functioning myocardium it should but will it in this case. The pt is already not pumping enough out due to dying/dead muscle will he have enough reserve to pump harder when we pace him? Another head scratcher :? Will this extend the MI to the point of no return if you have a distance to travel for thrombolytics or PCI I like watching threads like this as it makes me think quite laterally as most of the people on here are based over that side and have a different take on the world. I used to operate over there and had top swap views rapidly when I came over here - very different helth care system

Have to admit this is the type of call that makes you think at two in the morning Over this side of the pond we would give atropine, r/o contras for pre hospital thrombolysis, assess the effect of atropine and then give tenectaplase with heparin. I would be expecting some arrythmias and BP fluctuations with the TNK but most pts stay the way you found them with TNK. I would also consider small doses of NS to help with pre load. Would also try legs up but would watch his breathing effort carefully. NTG is contra'd several times and is not good for inferiors and our MD would want to have a one way and only he gets a cup of coffee type chat with you. I would titrate the morphine in due to BP. I would disagree with TCP as even etomidate has some effect on BP at these low levels and even the most burnt paramedic does want to cause pain and suffering. Solve the MI and you should solve the brady and hypotension. I think doing 12 leads for RVI and post MI are great but would you really want to be shifting this particular pt just to do a 12 to prove that he is having an MI. With the inf lead st elevation you can look for st depression in V1-3 with large r waves and the post is almost a cetainity. Statistically it is almost a dead certainty. Really enjoyed watching this thread. Thanks [/font:1aa72e5e7f]