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These are from a book called Disorder in the Courts, and are things people actually said in court, word for word, taken down and now published by court reporters that had the torment of staying calm while these exchanges were actually taking place. ______________________________ ATTORNEY: Are you sexually active? WITNESS: No, I just lie there. ___________________________________________ ATTORNEY: This myasthenia gravis, does it affect your memory at all? WITNESS: Yes. ATTORNEY: And in what ways does it affect your memory? WITNESS: I forget. ATTORNEY: You forget? Can you give us an example of something you forgot? ___________________________________________ ATTORNEY: Do you know if your daughter has ever been involved in voodoo? WITNESS: We both do. ATTORNEY: Voodoo? WITNESS: We do. ATTORNEY: You do? WITNESS: Yes, voodoo. ____________________________________________ ATTORNEY: Now doctor, "isn't it true that when a person dies in his sleep, he doesn't know about it until the next morning?" WITNESS: Did you actually pass the bar exam? ____________________________________ ATTORNEY: The youngest son, the twenty-year-old, how old is he? WITNESS: He's twenty, much like your IQ. ___________________________________________ ATTORNEY: Were you present when your picture was taken? WITNESS: Are you shitting me? ________________________________________ ATTORNEY: So the date of conception (of the baby) was August 8th? WITNESS: Yes. ATTORNEY: And what were you doing at that time? WITNESS: Getting laid ____________________________________________ ATTORNEY: She had three children, right? WITNESS: Yes. ATTORNEY: How many were boys? WITNESS: None. ATTORNEY: Were there any girls? WITNESS: Your Honor, I think I need a different attorney. Can I get a new attorney? ____________________________________________ ATTORNEY: How was your first marriage terminated? WITNESS: By death. ATTORNEY: And by whose death was it terminated? WITNESS: Take a guess. ____________________________________________ ATTORNEY: Can you describe the individual? WITNESS: He was about 20, medium height, and had a beard. ATTORNEY: Was this a male or a female? WITNESS: Unless the Circus was in town I'm going with male. _____________________________________ ATTORNEY: Doctor, how many of your autopsies have you performed on dead people? WITNESS: All of them. The live ones put up too much of a fight. ________________________________________ ATTORNEY: ALL your responses MUST be oral, OK? What school did you go to? WITNESS: Oral. _________________________________________ ATTORNEY: Do you recall the time that you examined the body? WITNESS: The autopsy started around 8:30 p.m. ATTORNEY: And, Mr. Denton was dead at the time? WITNESS: If not, he was by the time I finished. ____________________________________________ ATTORNEY: Are you qualified to give a urine sample? WITNESS: Are you qualified to ask that question? ______________________________________ And the best for last: ATTORNEY: Doctor, before you performed the autopsy, did you check for a pulse? WITNESS: No. ATTORNEY: Did you check for blood pressure? WITNESS: No. ATTORNEY: Did you check for breathing? WITNESS: No. ATTORNEY: So, then it is possible that the patient was alive when you began the autopsy? WITNESS: No . ATTORNEY: How can you be so sure, Doctor? WITNESS: Because his brain was sitting on my desk in a jar. ATTORNEY: I see, but could the patient have still been alive, nevertheless? WITNESS: Yes, it is possible that he could have been alive and practicing law. The above episode was published in American Law Jounal few years ago. A young lawyer friend of mine showed it to me when I was in BC. In fact, he had a copy of it on the wall.

I also question why ACoP was chosen over PAC. Time will tell if they can get it right. From my point of view, if in the end, they do manage to set a national standard I will be happy. I still remember the days when it was easier to work abroad then, say, move between Alberta and BC for example. To qualify that I should point out that time the standards of training varied wildly across Canada. The only other comment I have to make - and I will direct this at nobody in particular - is as a profession we should support our members who meet the standard to practice regardless of what setting they work in, or where they came from. To me it seems a bit narrow minded to say stuff like I support paramedics, unless they work for fire departments, or are foreign trained doctors, and so on. If I said women shouldn't be paramedics, or a certain ethnic background then people would be up in arms, yet if I make broad generalized statement that seems to pass as fair game. To me the latter is just as unacceptable as the former. If someone is trained as a paramedic, and is working as one, then by definition they are a member of our profession. They are just working in a different setting. After all we can't pick on one individual, just because we disagree with how they wish to practice, yet turn around and embrace other areas (hospital based medics & community medics, for example). Cheers

First of all met me say I really admire the work Canada has done over the last decade; specifically Rob Theriaut, Mary Beth Gibbons and all the folks at the Ontario Ministry of Health, Canadian Medical Association and Paramedic Association of Canada. I think you guys have one of the best systems in the world and that you darn Kanuckistaniadians are a bloody smart bunch in putting together the NOCPs. It was just the other day I was watching a webinar with Ben Maartman and Dave McLean (BC/AB respectively) who have become the unoffical "champions" of the AIT movement. They are talking about a "national" regulator and a "national" scope of practice, well hang on .... HMMMM I seem to recall Canada having a NATIONAL occupational competency profile .... maybe, just maybe that should fit the bill? I must dubiously question the Alberta College of Paramedics' goals in putting together the "Alberta" comptency profile when a very, very comprehensive document exists in the "National" competency profile; thus creating a double standard, lets say Ontario creates one and maybe British Columbia too; then you have a quadrupile standard and before long we are calling you the United States! While I am sure there a bunch of legislative and financial issues at play here I cannot comment on as I'm not familiar with the inherent structure of the Canadian system. Looks to me to be another case of a bunch of jurisidictions (provinces in this case) wanting to stray from what should be an inherent national standard to ensure consistency. Now if you ask me, and nobody did, should this whole kerfuffle not just be as simple as updating the NOCP? If Alberta and British Columbia want to let thier PCPs start an IV why shouldn't Ontario? Lord knows they have the education to back it up, in Ontario at least; can't speak for the rest of Canda, if Alberta lets people register who have not graduated from CMA accredited courses lord knows that Quebec and the Neuf's are up too. Oh, and can somebody PLEEEEASE send me some mayple syrup eh?

Unless a physician brings the emergency department, a radiologist with an x-ray/CT machine and a diagnostic lab tech with him on the ambo he is no more use than a properly qualified Intensive Care officer. Europe, parts of South America and Isreal use doctor (nr RN) based ambulances; SMUR/SAMU in France as an example. Germany uses prehospital physicians (as does Quebec in Canada) because the legislative arrangements do not permit Paramedics to perform restricted interventions; look at the Canadian definition of a "Paramedic" it is any ambulance attendant who can perform one or more controlled medical acts. I don't think physician or RN based ambulances are required nor I venture a guess do they provide better ouctomes for thier patients; anedcotally they may because a physician or an RN might be able to use thier extra knowledge and training to perform a better assessment but I don't have any evidence for this. As for who should lead the paramedic profession; well, paramedics; not firefighters or anybody else and that includes doctors. Ambo's should draw upon the resources that are out there in thier subject matter expert colleagues such as cardiologists or paediatricins but they should not be "led" or "overseen" by a physician. Legislative arrangements, education, a definition of praxis and both an industrial and clinical leadership body is what is required. I would propose the definition of a "Paramedic" be a health professional who provides emergent community based health assessment, treatment, referral or transport as required to ensure patients recieve the right health services for thier individual circumstance. This includes a variety of tasks including responding to life threatning emergencies, unscheduled care requests and health promotion and prevention activities. There can be subspecalties in Paramedicine just like in many other professions; be they neonatal transfer, critical care transport, intensive care (ALS), speciality rescue (high angle, caves, swiftwater etc) etc etc but they all fall under the title of "Paramedic" just like you can have a private, commercial or airline transport pilot but he is a still a "pilot" just like all you Canuckistanadians have a 4 (or F in Ontario) endorsement on your drivers license; doesn't mean you don't still have a "drivers license". Ambo's need to stop letting the bull take charge of them and take charge of the bull; need to get out from being owned by doctors and firefighters. There is one service provider here that has thier thumb so firmly up thier arse I wouldn't mind being owned by the Fire Service right now.

So in the real world: No this is a myth perpetuated by EMS and uneducated "others" NEVER withhold O2 as hypoxic drive patients are in a scant few ~ 5% of all COPD patient's. Firstly highly likely a respiratory arrest is from another cause, Hypoxia will kill your patient far faster than acid PH imbalances ... if the COPD patient is in extremus their WOB thats "work of breathing" and O2 requirements are far, far higher than the average. Tripoding, accessory muscle,(forced exhalation) and pursed lip breathing are clinical observations indicative of the level of distress. .... counting breath rate is very elementary. After experience in the field this will become crystal clear. Yes but this is a far slower process that the EMS myth promote's ... if you have pulse oximetry the "targets in Hospital Care are SpO2 > 88 % < 94 % or serial Blood Gas ... a bit beyond this scenario discussion but worth mentioning. ps Patients are really going to die on you, despite any book or proper treatment ... its just the way it is, as a CNA im sure this is not a new concept. cheers

Don't run around trying to catch someone screwing up. Instead go out and catch them doing it right. Then reward them. Steve

I'm really getting sick and tired of all this 'fire bashing'! If Firefighters were such 'terrible drivers', there would be more fire apparatus wrecks. If EMS were such 'great drivers', we wouldn't be hearing about all of the ambulance wrecks... Driving a fire truck (which is more top heavy than ambulances), also deals with shifting weight (can't put 'load locks' on a tank of water). This forum is rife with so many misconceptions (usually perpetrated by those that have never performed firefighting duties). Those of you that know me, know that I fought fire for 15 years AND worked full time EMS for 12 years. You also know that within the scope of practice for the level I was at, I was pretty damn 'smart', and damn good at both professions! In my opinion, the energy spent whining, crying and bitching about what 'fire does', that energy would be better spent elevating EMS to the status of a 'respected profession'! Furthermore, if EMS wants to shed the 'bastard stepchild' image, maybe it's members need to stop acting like one! Fire and EMS have always been inextricably intertwined, and with the 'tough times' because of the poor economy, that bond will be further strengthened. Deal with it!

Speaking of movies, I recommend lifting any "pr0n in the stations" prohibitions. It does wonders for morale.