Call Volumes

[FarNorthMedic]

Most base hospitals require their ACPs to maintain current ACLS, PALS, NRP for certification, but, how many ACLS meds are carried on an Ontario ambulance? Ooo, so we have Epi 1:10000, Atropine, Lidocaine and perhaps Sodium Bicarbonate. WOW! What about adding other more pertinent medications? Beta/calcium channel blockers, wider variety of antiarrhytmics, more options for pain management and patient comfort.

EXACTLY!!! I couldn't agree more!

And then, what 'advanced airways' in Ontario is common practice? Naso/Orotracheal intubation and seldinger cricothyrotomy. The latter is even rarely used. Not to mention digital intubation, lighted stylette, gum bougie ... but who actually uses those regularly? I understand their more of a rescue airway, but I don't buy it. I would much rather see the addition of RSI into the provincial protocols.

There is a problem throughout the works when a PCP can't even use the LMA as opposed to an oral or nasal airway. I say LMA because it is not a controlled act as it does not pass the larynx. Better then an oral or nasal airway any day of the week, and still no push for it.

From my BHP....."Before we touch IVs we need to worry about advanced airway procedures".....well.........?????

I think ultimately the aim is intubation but if you put up an oral airway verses the intermediate a/w the answer is clear. Oh wait lets just put an inflatable cuff on the oral airways........?!?!?!? :? Now where with the vomit go

I suppose my point is that I truly see the day when paramedics in Ontario will be entering school, graduating three of four years later with a degree and at the ACP level.

Again agreed. Just more clinicals and even a longer probation period as a third would help this "BLS before ALS" issue.

[xlq771]

There is already a cuffed oropharyngeal airway (COPA). here is a photograph of one:

http://www.adair.at/eng/museum/equipment/s...ay/object01.htm

[FarNorthMedic]

I know

I was being sarcastic with it. I think they're pretty useless. If you're going to inflate any cuff in the oropharynx it should be preventing aspiration not aiding it. If you have a patient with one of these "toys" in and the patient starts to vomit you will cause damage if you rip it out. If you don't have a 10cc syring readily available to deflate the cuff the vomit will look for an easy place to go

[Acosell]

Back to the original topic, my base does between 700-1000 calls a year. In the last 24 hours I've done 4.

[ParamedicGA25]

In Morgan county Ga we get about 2 calls a day

[Capman]

Approximately 4,000 calls a year with 4 bases of operation and 9 ambulances. This area is still considered super rural. About 400 - 600 of these are long distance ground or Air transfers. Some days the service does 5 runs and some days it does 20 runs. When events such as concerts or fairs come to town, we have done as many as 30 runs a day, though numbers like that only come around once or twice a year.

It's a comfortable number for me and from the employers view, it's enough to generate funds worthy of making the service feasible to them.

[mobey]

The loss of skills or getting "Rusty" is a very real concern with low call volumes.

I used to work for a company that only did about 200 calls/yr. You could easily sit around on a 72hr shift and not do a call. When I was hired on I was asked to help reeducate the BLS staff whom had been there for around 10 + years and had completly lost ALL pt. care abilities.

Unfortunatly they used the "good ol' boy system" and I was not accepted and ended up leaving.

In a service with low volumes I believe it is imperative that you continually study (EMTCity helps), and even volunteer in a facility to keep yourself exposed to patients.

[shannon710]

Rural sounds great to me right now. I work for a very busy county EMS in Fla, and we have already had 16,000 calls this year county wide. We have been running non-stop 24-7!!!! It keeps your skills sharp,but makes you very tired. :flower:

well, as far as busy counties, we have one sole ambulance company in our county with 64 trucks in the fleet, we average anywhere from 10-12,000, yes THOUSAND calls a MONTH and 9-11,000 transports monthly, and thats our "slow season" before the snow birds come!! We have some down time on a 12 hour shift, but generally just enough to eat a few bites and regroup for the next call.

[JakeEMTP]

With 64 trucks though Shannon, that's only 10-12 calls over a 24 hour period on average, per truck. Pretty normal around here.

[shannon710]

we generally have about 35 trucks on the road during peak hours(with planty in reserve and some down for maintenance at any given time), less at night, we average around 400 calls per day and around 370 transports, and our shifts are 12 hours, not 24, imagine 10-12 calls in a 12 hour shift.