nsmedic393 - this one is for you

[Nate]

When I saw you replied Dust, I was a little scared!! lol

Maybe my suggestion to anyone that wants to tell me that I can't do the things that I have been trained/educated to do is research and compare the courses! Take a look at the Alberta guidlines and course criteria. Look also at the Saskatchewan criteria. THEN if you must, you can debate that with me and tell me that I should not be allowed to do the things I can!

Neesie

I don't think you should be able to breath, but that is just my view.

[nsmedic393]

Hi Neesie, so nice of you to target me in particular. Most of my coleagues have already answered your questions but I will re-interate my specific point of view.

IV initiation is a skill. A monkey can do a skill. All the reasons you suggested for doing this skill (fluid challenge, D50%) are resons for you average ALS provider. My posts adress the PCPs, here and EMTs elsewhere, that are not allowed to do anything with the IV. For them there is no need to start the IV unless starting it for their ALS partner.

Now you can argue that you NEED to do IVs because you can do things with the Iv but I feel that you are practising outside of your education. My PCP course was bought from a college in alberta so I have a good idea of what education you have gone through. It is not enough to know all the ins and outs of giving fluid or IV drugs.

Also, as everyone else has posted my opinions are listed on previous posts. Instead of arguing about this all over again just read the previous posts.

[Nate]

Also, as everyone else has posted my opinions are listed on previous posts. Instead of arguing about this all over again just read the previous posts.

Eh, I guess I can allow you to breath.

[JPINFV]

Well I suppose this will be the last that I say about this then. I am new here and didn't realize this topic has been discussed already. I would like to mention though that I have been "EDUCATED" in IV administrtation. I do believe that Canadian EMT/PCP is much different than the American EMT. We are educated in the complications that can occur, the treatments and the indications and contraindications involved. They don't just let anyone that wants to do an IV do one. Of course we have to be educated! It is okay that you don't agree with me. It is also okay that emt's in the states don't have the same training that I do as a pcp in Canada...and yes, PCP is just a fancy name for the old emt with a few additions to the education.

If there are any Alberta EMTs out there that care to put their 2 cents worth...please feel free to back me up on this!

Just one other question...do you believe that EMT's should not be allowed to administer D50W as well?

Education and training are two different things. A 5 hour course that goes over the skills, indications and contraindications an education does not make. Furthermore, if this "education" includes giving fluid to hypovolemic patients secondary to trauma, then it's wrong. A good BP means nothing if in the process you cause the patient's hemocrit to plummet.

[hammerpcp]

Well..............Since we are going to debate this over and over again I thought that you all are entitled to my opinion.

Ontario PCP's (sorry Neesie I can't speak for the other provinces because i just don't know enough about their education, although I will take your word that it is sufficient, since your medical director and provincial government seems to think so) are trained in IV skills, initiation, indications, precautions, etc, etc. In fact I damn near perfected the skill while in school only to graduate and not be allowed to use any of those skills or knowledge. If my education is not sufficient to have IVs within my scope of practice then American paramedics should no be allowed to either. *Hiding under the desk*

And nsmedic393 are you beating your chest and saying "I'm the boss" again?

Whats the problem? I don't see it. BLS or ALS skill, whatever you want to call it doesn't really matter. IVs are quickly becoming a standard skill set for PCP's in Ontario, as well they should be. If you don't want to call us BLS medics anymore that is fine. We change our title every few years anyway.....and the public continues to call us ambulance drivers so who really cares.

BTW, D50 is a much safer drug then Glucagon, and we give that out freely.

[Neesie]

nsmedic393 perhaps I went about this in the wrong way. I by no means meant to single you out. I was just reading the posts and you were the first one that I saw saying that we shouldn't be able to do IV's. Perhaps that is my misconception because I have met a lot of Paramedics who think they are God's gift...AND NO I am not saying that ALL paramedics are like that because I have met a lot of paramedics who are awesome and want to help in anyway they can. They don't think they are are better than anyone else. Thank you for the opportunity to voice MY opinion and concerns. If Canada could get their shit together and make the NOCP enforce the 3 levels and not allow any changes to any of them without taking the next level, we probably wouldn't be having this conversation.

As far as you Nate, I think I don't want to even waste my time (or my breath considering I only have the one left that is in my lungs at the moment.) to argue with you. I know what I am ...I know what I have been educated to do. I will continue to do this and know that I am making a difference in my patients outcome. If I don't know 110%, I don't do it!

Just incase you would like to know what I have been educated to do it is as follows:

- cardiac monitoring II lead

- IV administration

- Defibrilation

- D50W and oral glucose

- multiple immobilization techniques and splinting including sager splints

- injections (sub-Q and IM)

- epi, glucagon, atrovent, salbutamol, asa, entonox, O2, nitro

- combitubes and LMA's

- pasg (mast pants)

to name a few!

I am finished with this topic. I never meant for it to become the way it has. I am going to accept that there are many many differences between here and the United States and I hope that all of you will as well. Just because something is different, doesn't make it wrong. Because someone is a paramedic and someone is a pcp doesn't make one better than the other.

Take all

Neesie

[Scaramedic]

A good BP means nothing if in the process you cause the patient's hemocrit to plummet.

Hemocrit, schemocrit oxygen is way overrated anyhow!

Peace,

Marty

:thumbleft:

P.S. before anybody goes crazy on me, I am kidding. Jeez, get a sense of humor! :wink:

P.S.S. Would someone from the Great White North start a thread explaining what a PCP is. I can't really add anything except smart ass replies to this thread. Sorry, once again ignorant American here.

[Neesie]

PCP=Primary Care Paramedic

Canada is trying to change the names to paramedic so everyone is a "level" of paramedics

They took our old EMT and added a few things to it and changed the name to PCP.

There is a lot more anatomy and physiology, meds, injections, and airway apparatuses that have been added to the EMT to make up the PCP

[Dustdevil]

You have to understand the history behind this whole thing.

The whole reason the "intermediate" and "special skills" courses were implemented was for trauma resuscitation. This was instituted back in the 1970's when we still thought that a couple litres of Ringers in the field was a prudent thing to do for the exsanguinating patient. Although that theory was absurd, it did at the time provide not only justification, but necessity for a great many more field personnel to be able to start IV's. After all, the military had been doing it for over a quarter of a century with no more training than a Paramedic.

Those days are long past gone. We haven't believed in isotonic fluid resuscitation for trauma victims since before I left the field. Consequently, both the justification and need for a quickie skills class for IV's is gone. Poof. Kaput. No more. Nil. Nada. Nicht. It died not long after Johnny and Roy left the airwaves. Yes, they still teach it. Old habits die hard. And apparently nobody wants to be the Grinch who breaks the bad news to all the kiddies out there that they can no longer have their toys. Therefore, we are stuck with this culture of entitlement among sub-paramedic providers who believe they should have this little bone of advanced practice, whether they really have any justifiable need for it or not. I want it. I earned it with my extra couple weeks of school. Give it to me.

Personally, I don't see how anybody -- especially a medical director -- is impressed by any such argument from people who can't even tell us why they need it. It always comes back to saying they "need" it so they can give this drug or that. And since giving drugs is really the only true justification for IV's in the field, it is an open and shut case. They don't belong in the hands of sub-paramedic providers.

[Scaramedic]

Thank you for the info Neesie and Dust. I am now somewhat less of an ignorant American.

Peace,

Marty

:thumbleft: