follow up question on ontario paramedic schools

[irish_emt_in_tx]

Such hypocricy Dust, it was you that said in another thread that the workplace is there to employ, not educate, and everything needed to operate in the EMS environment was supposed to have been learned prior to being employed. If it is not learned in school and should not be taught in school, but should be learned at work but it is not the employer's job to educate, then where is it to be learned? Make up your mind.

[Dustdevil]

Error :roll:

[vs-eh?]

A few points...

1) I don't do 8 calls a day (offload delay *cough* ummm this guy has chest pain and is a CTAS 2 *cough* why are we waiting here for 20mins before being triaged *cough*). Maybe on a response car, but not normal ambulance...

2) Ummmm, how many PCP or ACP programs have CCP's teaching them? I would wager zero (rarity would be the main thing). Maybe flight does, but those boys and girls I'm sure make much better money in the air than pointing to a chalk board. I agree that your "certification" level does not equate into quality of education. At my almamador, there was only 1 person who was an ACP and they were not in active practice at the time. In fact, 2 of the main instructors had only about a year of road time as a PCP BETWEEN THEM before they started teaching. There is more to teaching then experience. Plus, my school required (as I was leaving) the instructors who were full time faculty to have their Master's, etc.... (I believe). Just because you are an ACP/CCP does = you would be a good instructor.

3) If you are in a service that runs PCP/ACP crews and your PCP partner cannot do an adequate assessment/their job then problems arise (FYI for my American friends 98% of the time in the Ontario (crews are ACP/PCP, ACP/ACP crews are usually only in larger centers, and even then normally only Toronto). This is an issue that I hear every once in a while at work with people who work part time for a "provincial service" (sorry guys). Because there aren't generally a lot of PCP/PCP cars, the impression is at times that people sometimes can't/don't adequately assess a "ctas 1/2" patient, because they are used to their ACP partner running that call. I have heard this from multiple sources.

4) ALS "assistants" do exsist in some services *cough* Level 2 in Toronto *cough*

5) Ummm, for those who are graduating from a 2 year program in PCP (as I did) I think there should be a hefty ACP component. People always say "Well, I don't need to know this shite so WTF yo am I learning this, I failed this exam, OH NO!!!111!!!!" Having a substantial in depth ALS component to your 2 year diploma makes transition to ACP much easier in my humble opinion. Yes, not everybody wants to be an ACP/CCP (especially CCP, 18 grand? Jesus...) but knowledge equals power, knowing is half the battle...G.I. Joe...When I did my ACP didactic I'd say 80%+ of what was taught was simply review of my PCP (I hadn't been out of school that long). The remaining 20%ish was perhaps a little more in depth/ finer points....

[Lithium]

Hmm, interesting points vs, but realize to that since you work for the centre of the universe ( ) that a lot of the situations are specific to Toronto.

I'm well aware of TEMSs 'level 2', and quite honestly, I think that should be the minimum level of care on any transport ambulance in the province. The only difference I've been able to find between those level 2s and fully certified ACPs is their ability to use advanced airways and administer medications. Beautiful system, I love it

What services do you still consider to be 'provincial'?

[_radar]

Yes Dustdevil, I have been reading long enough, and my head is firmly where it needs to be. I have been on this forum long enough to see you double back on many things that you have posted. Myself not being retired as you are, I do not have the time, at present, to go and look up and quote everthing you have double talked on. What I can cite quickly enough at this point is that Dallas/Arlington is nowhere near Halifax or, as your profile read not too long ago, "Just south of Winnipeg". And your spelling, such as labour instead of the American labor, is also recent. And just to let you know, that spelling is European, where I come from, not Candadian. When I get time, I will quote you on your double backings in PMs.

To all other posters, sorry to have hijacked the thread. Will not happen again.

[Dustdevil]

I have been on this forum long enough to see you double back on many things that you have posted. Myself not being retired as you are, I do not have the time, at present, to go and look up and quote everthing you have double talked on.

In other words, you can't. And it certainly has not happened in this issue. My stance has remained consistent for many years.

And your spelling, such as labour instead of the American labor, is also recent. And just to let you know, that spelling is European, where I come from, not Candadian.

Wrong again. I have spelled labour with a U since before you were born, when Australian and South African relatives influenced me and I began spelling many, many words English style. This is not a recent affectation. But, if you can figure it out, you are welcome to use the search function to check my posts if you like. Be sure to come back and admit to everybody that you were full of $hit afterwards.

When I get time, I will quote you on your double backings in PMs.

Like any intelligent professional, I will change my views on issues when presented with evidence that supports a better way. And when that happens, I make a big deal of it, so nobody misses it. But hypocrisy or "doubling back" is something you won't find. But again, have fun trying! We need more people making arses of themselves here.

And speaking of hypocrisy, try using spell check next time you go criticising other people's spelling. Your illiterate rambling gave me a headache. :roll:

[EMT City Administrator]

Hijacking a tread is NOT ALLOWED even if it followed up by an apology. Bickering is to be done via PM's as no one else cares to read it.

Get back on topic.

Admin

[vs-eh?]

Hmm, interesting points vs, but realize to that since you work for the centre of the universe ( ) that a lot of the situations are specific to Toronto.

I'm well aware of TEMSs 'level 2', and quite honestly, I think that should be the minimum level of care on any transport ambulance in the province. The only difference I've been able to find between those level 2s and fully certified ACPs is their ability to use advanced airways and administer medications. Beautiful system, I love it

What services do you still consider to be 'provincial'?

Unfortunately here, any service outside Toronto is generally considered "provincial". Retarded I know.

In my opinion the "level 2" position in Toronto is antiquated. When it was instituted (mid 90's I think), PCP was only a year long, no SR, and ACP's working only with ACP's (as I recall). In order to broaden ACP coverage and to bridge the PCP-ACP gap, this position was initiated. There are still ACP's today that basically REFUSE to work with a "level 1". Often they pull the "optimal crew configuration" card which is a Toronto policy that basically states a ALS car should have (common and most often) a 2/3 configuration or a 3/3 config. It is quite common to see a level 1 and 2 working together (which would be a BLS car) and have a 3/3 config on another car. The two 3's COULD be split up creating 2 ALS cars. But no, people will bitch about working with a "level 1". OH NOES!!!111!!!! THIS LEVEL 1 CAN'T START AN IV ON THIS ARREST AND BESIDES LEVEL ONE'S ARE IDIOTS ANYWAY...Grow the f_ck up. In my opinion it looks terrible for a level 3 to refuse to work with a 1/ask for a level 2 to attend a call simply so the 2 can start an IV. In the end, level 2's are IV starters for the most part. Yes, they can do IO's, cardioversion/pacing, blah blah blah, but ONLY with they are working with an ACP, because it will be the ACP who is wanting it done. 99% of the time level 2's would function as any other PCP would in the "province" :wink: . The 2 year program now in a good school generally encompasses a large part of the ACP patho/scope anyway...I think people need to get their head out of their asses and wake up...

Another point to be made is that provincially the new PCP scope of practice (IV, bolus, first time NTG, D50) basically 99.9% of general practice would meet or exceed the "level 2" position. It was asked in a CME about 6 months ago, if TEMS would be getting this new scope (as KW region does for example). The short answer? No. Why you ask? Because of the level 2 position, it would generally exceed it. Then people will bitch about getting an enhanced scope and not being paid for it, "Why am I doing a level 2's work but not getting the same wage?" LOL, these people amaze me. Also no doubt some level one's will "refuse" to adopt a new scope, blah blah blah. Seriously amazing, and they would get away with it. People, we get paid well, and yes I agree that enhancing scope of practice to an extent deserves a potential pay raise, but come on. It's not like they are giving us RSI and corresponding hardcore QA/QI, this is a PROVINCIAL MOH PACKAGE JUST LIKE SR WAS! IF YOU DON'T LIKE IT BE ON A NON-EMERG CAR AND DO TRANSFERS ALL DAY!!! THIS IS PART OF YOUR JOB!!!!

This also goes with getting new drugs/equip. People bitch about not being compensated for STUDIES! You think people won't bitch if we anded say fentanyl or ummm I dunno 12 LEADS HERE! Man, it bothers me. Instead we (IMHO) waste money on electronic ACR's and shite when that money could have gone to 12 leads and more drugs, but no. You add 1 or 2 procedures and your initial cost will swell because people will bitch about not getting paid. I GUARANTEE THAT IS WHY WE DON'T HAVE THESE THINGS!

I would like to see here:

- 12 leads

- fentanyl along with the morphine (better hemodynamic profile and better for blunting sympathetic flow with PAI or ICP issues)

- a rate control drug i.e. metoprolol or more likely diltiazem or something

- gravol and benadryl. For the love of god why on earth don't we have this?

- an alternate airway as a rescue device for BLS/ALS for failed intubation. LMA or CT. Somebody said LMA's are like 10 bones or something? Like seriously, why don't we have these...

But ya, that was a bit of a tangent. What were we talking about? Oh ya college. Ya...College was fun... :twisted:

[kevkei]

Who do you think is the better medic? The guy who works for Toronto, does 8 calls a shift, but never sees a truly acute patient? Or the medic who works for Thunder Bay, does 1 call every 3 or 4 days, but every patient is at least a ctas 2?

Sorry, but quality isn't any better than quantity. In Edmonton, I will see at least one CTAS-2 every 4 days and in between see 6-8 others a day (1,3,4,5). You need patient contact to become a better caregiver. You also need a strong background, the right personality, good training (each institution has something to offer to different types of students, so one is really no better than others) and experience. Experience takes years if you only see 1 patient every 3-4 days, regardless of their acuity.

[Skuter]

Hey gang. It's been a while but I'm back.

As far as students riding with ACP/PCP my approach has always been to let the students do everything within their future scope of practice (i.e. BLS, SR etc.) up to the point that ALS interventions are required. I also make them babble a lot about what is going on in their mind. Furthermore, once the ALS interventions are completed, on-going patient care and monitoring can be done by whoever is closest to the BP cuff and the "record" button on the Zoll.

In my mind a "skill" (eg taking vitals, hooking up ECG, and SpO2) is something that can be learned with practice -- just like putting the puck in the net. The challenge is learning to think like a medic.

Also, I have found that most students are lacking is the ability to communicate with effectively patients, allied agencies, concerned family members, grumpy triage nurses etc. This is a skill that can only be learned on the road and it does not matter where you ride out you will always have to deal with grumpy triage nurses!!!

Skuter