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Best advise is not take advise from forum idiots. Check with each state office and even ask to see the answer in writing. In other words no the rules, regulations and laws that affect EMS. I doubt there would be a problem but some states have some stupid regulations. That was my reply to the exact same question you asked in another post. When you ask a question be patient rather than asking it multiple times.

The fire based ALS first response works well when run correctly, so get over it. It's not crap, since I work in a fire based system and see firsthand how well it can run. My case is that if there was a fire based first response, they sure as shit wouldn't have cancelled themselves and turned around, there would have been three or four to do the job, and their medic would have actually have been able to assess and treat the pt, something that didn't happen otherwise. You see, we solve chaos. we don't throw up our arms and say "oh forget it, there's no way". You can call us bucket fairies, hose monkeys, or whatever cute, jealous nicknames you can conjure up, but it changes nothing. We're here to stay, so get over it. You see, over here, the amount of volunteer coverage and participation has shown a steady downward trend. More and more volunteer companies are being replaced by paid depts, typically fire based EMS depts. So, as you can see, your ill conceived volunteer FF plan can't work. The trend is quite the opposite. Many local gov't have seen the benefit of using idle units to augment the EMS response, and also the cost savings of dual role personnel. And yes, having an ALS first response is an answer to the "what if" scenario, but "what if" is a reality, and both fire and EMS calls and call volume can't be accurately predicted. If you can see the future, let me know so I can play lotto or make some good investments. The reality is, in addition to the usually bare minimum staffing of EMS in most places, you can do one of three things: You can put more ambulances on the road, along with the cost of apparatus, two new employees, complete with salaries, medical benefits, paid days off, and pensions to pay for. You can add a fleet of ALS chase vehicles. This again requires the hiring of more employees, with all salary and benefits due, as well as a vehicle and ALS equipment. Or, you can give an existing FF a pay raise, maybe 20-30% the cost of a FT employee, ALS equipment, and send the engine to help, which is more idle than EMS txp units in the first place. There's also the added cost savings with scheduling and OT reduction with dual role personnel. Which option is the cheapest? I'm afraid that you've misunderstood. We don't get this type of storm, maybe every 10 years or so. We typically get an inch ot two or three as a rule. This year we got not only one storm of the decade, but two. My point was that we almost never have to deal with this type of situation, let alone twice in two months. Pittburgh has experience handling snow, something my area does not. A city that gets a fair amount of snow, on average, ought to be proficient in accessing pts and victims in case of emergency. We don't have the plows, dump trucks, and other vehicles available for snow removal that Pittsburgh ought to have. VDOT doesn't factor snow removal into it's budget. All we had was our chains and 4X4's with plows attached. No help from the state whatsoever. No plowing until the storm was almost over. My daughter's school was closed for literally two weeks this month, no exaggeration. This was their first day back. Stafford County actually had to hire construction crews from NYC after the last storm to remove the snow from our county's streets. We don't budget whatsoever for snowstorms, and we lack the quipment for effective snow removal. Pittsburgh does not. So again, what's Pittsburgh's excuse? I'm willing to bet that Pittsburgh gets more snow than NYC on average, and we managed to get to our pts. Oh, about the fire based thing, the article made mention about including first response in the future, and some were trying to draw the FD in on the blame for not responding or something. The discussion was going to go fire based at some point, so why wait? The thing is, the crew didn't even try. They asked the pt to come out to them. Who does that? Now, if you get to their residence, see that they are ambulatory and fit to walk, and there's absolutely no other way out to the bus, then assist them in ambulating to the rig. Don't be lazy and say "come out to us". If there were so many of these urgent calls in the lineup, then the abd pain would have naturally been a low priority, and wouldn't have even been dispatched. Let alone several times. Sounds like a cover up. FDNY EMS conditions bosses have attempted to give me poor pt care direction, and I've repectfully disagreed and went on about my business. What's important is who the courts will find at fault.

I would disobey if its a bad order yes. Wouldn't you? I don't think this was a MCI either. It was a failure to plan. This snow storm didn't exactly sneak up on them. Even with 12 hours lead time, you can increase staffing and get things in place for operation. Where was the inter-agency coordination? Why was there no plows working to clear the street? No 4x4s available with the agency, the FD, or the city? No firemen available to help carry? I know some of that is addressed in the article, but its all questions we need to think about. Like I said, they need to issue an official report, and release the details, due to the publicity of it.

If your employer cannot tell you where to obtain the required uniform, then your employer sucks. If you are not employed, then you don't need a uniform.

Thanks for the input folks. Basically what I am looking for is general information. As I stated, I remember reading a short news brief in a trade magazine, I believe it was Fire House, in which a paramedic was terminated due to poor patient reports. I am looking for a few articles such as this simply to use as examples as to the consequences of poor documentation for a presentation I am tasked with. Once again, appreciate any input.

http://www.canada.com/news/national/Dying+officer+thanked+paramedic+rescuers/2426743/story.html

Yet again a thread on this forum turns away from what the real meaning is, into the quest of two people this time to feel sublime and righteous. You both still have no idea, the ACTUAL topic is not about either of you. And if one is to look at someone demeaning their peers, they should take a look at themselves. Have a great day.

This was a little more than tonsilectomy ... What kind of cop WOULDN'T have a vest on? Unfortunately they don't make them for tracheas ... This was an extreme situation that doesn't happen every day. DUH, I think we all know these medics SHOULDN'T have done what they did. Great thing to point out there rock ... I only hope I have the same courage to do what they all did, should I ever be faced with that situation because I know I couldn't live with myself if I ran away. Yup.

Oh yes, uber grumpy ... and weren't you telling me last week Phil, that you still hide outside of booze stores waiting to ask people to buy your bottle for you because you're not yet legal?

Sounds like the voting is over and I didn't see it until now ... I would however have voted for emtannie, because she put up with my grumpiness at school for two weeks

This was the first (and last) episode of this show that I'm going to watch. First of all, I don't understand why they run when going somewhere (except to the bathroom, because I've been there!). Secondly, that flight medic's uniform ... Why is it so tight on her and why is she showing off her chest? There's one in every bunch I suppose ... People like that are usually the office pin cushion. Anyhow, I found it pretty cheesy ...

No doubt hey? Bigger/more usually costs more ... more octane in fuel = more $$ ... more property = more taxes ... more insurance on your car = more $$ ... more french fries and an extra patty on a monster burger = more $$ Regardless, if someone takes up more than one seat, they should pay for more than one seat and of course have that seat beside them to use. I don't think anyone here was saying fat people should pay more for a plane ticket simply because they're fat. One seat per person, if you use more you pay more. If they're such nice people then why are you posting potentially embarassing pictures of them? For your amusement? Or are you supposed to be teaching us something here? And no, sitting next to a black/asian/jewish/whatever person is not offensive, that was you being a tad ridiculous. Being sat ON by someone who is too big to fit in their own seat IS offensive.

It appears as though some people feel we should be punished for the unhealthy eating habits of others. I guess they won't mind trading seats with me on an aircraft, when someone is sitting halfway onto my chair due to their sheer size.

That's a ridiculously huge person ... not sure if it was just Canada or the USA also, but within the last year it was made 'illegal' to charge a severely overweight person for two seats, should they exceed the posted size (or however that works). It was supposedly discriminatory and unfair. Sure it's sad and I'd hate to be that person, but do I need to be punished for someone's unhealthy habits? So tell me ... is it unfair that I lose partial circulation in a hip because the juggernaut beside me is too big for one seat? If you can fit in one seat, great. If not, one should be paying for two or find another method of transportation more suited for one's size. Fair amd comfortable for everyone.

Doesn't mean it's right to prove it infallible either. Also, one doesn't have to be out of control with their drug use to incite something otherwise preventable ... could have been the first time in a long time or one excessive night. Point is, when it comes to illegal drugs, even a little bit is too much. I've seen several people out of control who were drunk and "just hitting the bong". Just like the last drunk/stoned driver I saw who caused a 4 car pileup. Meth heads aren't the only idiots out there.

... and then there was the time I watched The Green Mile from beginning to end in the middle of a night shift without getting paged out ... only because I've seen it 5000 times already.

Sleep ... eat ... goof off with the cops ... never had a naked pillow fight, but there's a first time for everything ... study ... talk about what kind of call you WANT to get ... get excited when you get the call you wanted to get ... get mad because you got blood on your pants on the call you wanted to get ... stick things to co-workers cars ... fill station mailboxes with random crap ... clean - NO ... watch 5 minutes of the ending of a movie you keep missing the ending on ... go for coffee ... fret about whether or not you'll get off work on time ... have "meow" night on the radio ... dream about days off ... think about how nice it would be at that time to be jumping out of a plane ... help your partner play tricks on their spouse ... go up to their house and ask for random things from the fridge because you "need them for a call" ... I dunno ... I think a lot of us are ADD. Whatever amuses us ...

I think camels are Egyptian aren't they? Or Saudi Arabian? Dunno ... don't think they're Aussie. Whatever.

Freak is correct pretty much all the way through here ... thing is, with the province taking over funding and everything else now for EMS, a lot of people are looking at leaving. It didn't work in BC (as we can see), it won't work here long term either. Yes, and our trucks aren't modified kangaroos with dingos and didgeridoos for sirens

I know ... it's really too bad. But hey, at least those people know what their future is, whereas the rest of us have to lead a relatively healthy life not knowing how we'll go.

No worries I figured I made an ASSumption out of myself ... frequent occurence lately.

Well, the way I took that person's post was that all Nova Scotia ACP's are automatically licensed here as EMT-P's ... which of course is NOT the case, I might have been making a poor assumption as to how the post was meant to read. ACP's from that province or any other province for that matter cannot just come to Alberta and say "hey, give me a 50# so I can be a paramedic here too". Their education is reviewed for reciprocity, and if approved they may challenge the exam here. As for doing your EMR then ACP then oilfield then EMT well that's great, but why don't you try getting some real ambulance experience in between as well? If you do end up in the patch, you will certainly see that there are many people misrepresenting themselves as EMR's, sometimes even EMT's. I will give two examples and tell you why this bothers me. For instance, I did a couple weeks up north early this year in between full time emerg jobs. There was a 19 year old bimbo up there who told everyone she was an EMR. When I asked her what her reg # was, she told me she couldn't remember. Ok fine, we can look it up online if I needed to put it in a PCR. I asked her when she wrote the ACoP exam, she said she hadn't yet. Okayyyyyyyyyyy .... so I asked why she was calling herself an EMR to which she replied, "Well they gave me this temp number so I'm an EMR". Upon completion of an ACoP recognized course in Alberta, one can apply for temporary registration at that level. What that temp # allows that person to do is practice at that level ONLY IF they have the approval of the medical director for the service they are working in, and ONLY IF they are DIRECTLY SUPERVISED by someone of equal or greater PERMANENT registration. They have a certain amount of time to write the exam, if they go over that time the temp # is revoked and cannot be re-obtained. Same goes for if they fail the exam, they cannot reapply for temporary registration. So this little girl kept telling me I was wrong and that she knew what the temp # meant and that she was an EMR. I went to the ACoP website and printed out the information for her and told her that if she would have read the letter she got from ACoP, this is what she would have found. I also told her that if myself or another one of the EMT's or the paramedic, or even one of the EMR's told her she couldn't do something at the EMR level for whatever reason it was, by law she had to stand back. She made a smartass little comment and stomped away, didn't talk to me for three days which was just fine by me because I really didn't care for talking to her anyhow. The second example I mentioned is a guy from BC who came out to the site I was on. He also misrepresented himself as an EMR "because he took his program at the Justice Institute of BC and that ACP was going to be forced to recognize it within 18 months" and blah blah blah blah blah. I said ok fine if that's the case, however you still don't have an Alberta registration number therefore you are not an EMR in this province. He constantly argued over that, said he didn't care what anyone thought or said, he was an EMR. Didn't even believe me when I said that he could be prosecuted over that and would then never be allowed to register in Alberta. He carried his little box of some symptomatic relief drugs like Benadryl, Tylenlol, Advil, Pepto-Bismol, etc etc, things like that which he stated that BC EMR's were allowed to give out. I didn't care to research that #1 because I don't really care, and #2 because EMR's here cannot administer those meds. I simply told him that if I found out he was doing anything outside the scope of an advanced first aider, I would report him. My reg # is my livelihood, and I will not have it risked because some moron has a chip on his shoulder about having to take an exam in order to practice at their level here. I plan on having a long and productive career doing emerg in EMS. Now here comes a run-on sentence because I'm actually saying this while I type it ... If everyone who is registered at one of the three levels here in Alberta has to go through the gears and jump through the hoops and pay the money and take the exam and wait for results etc etc, what makes anyone else think they shouldn't have to? If that is what is required to work in the province of Alberta and you want to work here, then just shut up and do it. Seriously. We hear enough complaining at work. There may be better ways out there of doing things than how ACoP is functioning. For now however, that is the way things are and that is what we must do. If everyone who had a good idea brought it forward to ACoP instead of just bitching behind the scenes, perhaps more effective changes could be brought about. That's all I have to say about that ... (said in a Forrest Gump voice)

As for NS ACP's, they are ACoP licenced. My 2 cents your mileage may vary. Sleep

Hi 911Laurie, The 2 main texts we used were ... Mosby's EMT Intermediate Textbook Edition 2 Emergency Care And Transportation Of The Sick And Injured (9th edition) Published by Jones & Bartlett I would recommend contacting PMA prior to purchasing any books to verify they were used in the most recent courses, so ya don't waste your $$ Also, ask if you can even take the review course there if you took your EMT at another school. I wouldn't see why not, but of course methods/information vary from school to school.

The only 'problem' you might run into is if SC requires I99 for their EMT-I's. Having just gotten my EMT-I in GA, I know that I'm only educated in the practices of the I85 cirricula. I've thought about 'crossing the border' into SC as well, but that will have to wait until I'm healed up and got wheels under my butt again... What neck of the GA woods are you in? LS

More and more we see articles posted in here that fire based EMS is used as a cash cow in order to justify fire departments staffing levels. We see examples on a weekly basis almost of fire department requiring EMT training to become a fire fighter, and examples whe. You might work for a good organization, good for you, but in the majority of these examples it is a cost cutting exercise by government. spare me the self idolizing BS. Laziness is not mutually exclusive to people outside of fire departments. There will be a lazy hose monkey out there somewhere who will make the same decision. As a volunteer hosemonkey myself, i'll call myself whatever i want. What you wont ever be able to call me however is a scab. "What if's" work both ways, say this patient died because those fancy ALS smokeys were at an actual fire (heaven forbid!) would you then sing a different tune that first responding fire should not always be relied upon and that there should be more ambo's on the road, or would you then maintain that the system is fine, just we you were busy and the response was delayed? The preferred method, funded by closing those fire stations sitting on their asses doing nothing The second preferred option, funded as per above Why should the smokies get anything extra. paramedics do more work, as regularly shown by fire departments own data most calls are ems, with more responsibility, more continuing education re: articles from IFFA (or whatever its name is) claiming increased standards for EMTS would add too much fiscal burden and less wages. Why should you have a pay rise at all, your unproductive, sitting around on your can and free to respond to calls anyway, right?

No. The caller was in too much pain to walk to the ambulance so it was canceled. I haven't read who canceled it but that shouldn't matter. Thats a red flag. The crew should not have accepted the cancelation. No excuses.

I don't see how anyone can try and absolve or justify EMS response. I know you can't base your facts off the media, but it sure sounds like a case of a medic not wanting to get his feet wet. I have been in a stuck ambulance before... I hiked the 1/3 of a mile to assess the paitent and situation while they worked on the ambulance. Why didn't these workers? Even more so if the house was in sight?!? I hope a report is made, and avialable for review. Sounds like it will be a good training document.

46Young, you have made a number of posts telling us how wonderful your workplace is, and I am glad you love where you work; however, the situation being discussed is not in VA, is not staffed with the equipment sufficient to handle that amount of snow in that period of time, and emergency services were dealing with more than twice the normal call volume. The snowfall on February 5 was the largest in at least 20 years, not something that the city is used to handling every winter. They were not facing these conditions “every year,” as you put it. To compare your service to the one in Pittsburgh is like comparing a service in Florida to one in Yellowknife. What is handled on a regular basis by one service is not something that is necessarily handled by another service somewhere else, so you can’t use that as a comparison. I am willing to bet that the majority of people on this site have extricated patients during difficult situations, where weather and distance to the truck were factors… BUT.. in this situation, the weather was beyond the normal winter storm, AND they were dealing with higher call volume. It is pretty easy to be the armchair quarterback and give the “I could do better,” or “my service could do better.” And, the “Fire-based, of course” comment…. Not necessary… based on some of your other posts, this was put in just to incite discussion completely irrelevant to this thread.

What an absolute load of crap! If the issue is lack of resources, then resource it If the issue is not chains on the trucks, put chains on the trucks If the issue is someone not doing their job properly, council them or get rid of them. How on earth is this a case for making Average Life Support bucket fairies the answer to that age old question of ambulance getting bogged in snow and someone maybe being to lazy to take a walk, you know, because this is obviously a scenario that plays out every day of the week. I know, seeing there are lots of sick people and stuff all house fires, lets get rid of half the professional fire service, replace them with volunteers, and use the money saved to double the ambulance on the road!

Where I work, in Northern VA, we maybe get a decent snowstorm every ten years or so. This region is certainly not facing such conditions every year as Pittsburgh does. The thing is, we had no issue in reaching pts during both of our snowstorms, which both dumped around two feet each. All our units, ambulances and apparatus alike, have on spot chains, Z-cables, and heavy snow chains. We carry shovels on our pieces. We had 12 or so 4WD utility vehicles, each equipped with plows and also two FF's, to be johnny on the spot with any access issues. I've driven in many a NY snowstorm in mini mod's, with no chains or anything, and managed. Having chains made it a joke to get around. You need to know your first due, to have the foresight to know that you won't make it up a particular hill or bridge, and react accordingly. We had suppression units routinely doing ALS assessments (and tx if necessary) and bringing pts out to the ambulances, either by carrying or by ambulation if appropriate beyond doubt. Not bad for a dept that hardly ever gets even one storm, let alone two that were each around two feet. What's Pittsburgh's excuse? Maybe lack of available units, since restricted access resulted in repeated cancellations, rather than sending another unit from a different direction? FBEMS ALS first response really helps when conditions are poor, and also when units are scarce, which is the intention of having ALS first response in the first place. I've seen this firsthand through two storms, and things worked great. The concept works well if applied properly, with competent individuals. The alternative, of course, is working with the bare minimum, and getting jammed up on occasion, where sometimes preventable injury and death occur. I'm willing to bet that there wasn't four feet of snow on the ground when the first 911 call was made in this incident. Since snowstorms in Pittsburgh are a given, the plows should have been out, and I can't see there being more than 6 inches or a foot down at the time, at least up to a block away from the residence, which is within walking distance. If you can't manage through even a foot of snow with a monitor and a couple of bags between two people, then you're physically incapable of working period. I've had to carry pts on a scoop or reeves a block or more to the rig with just my partner, as plowing from previous storms blocked any other egress (in NY). If I can carry someone a block or more in a foot of snow, you can't walk with just a couple of bags? This particular situation makes a great case for ALS first response (I'm talking about fire based, of course). You get three or four physically capable individuals, ALS capable as well (how capable varies from dept to dept, but still), and additional resources if needed. Speaking of additional resources, to get someone out of a house during a snowstorm it's real simple. You can use either a reeves or a stokes. Use 4-6 people to carry. Wrap the pt in blankets, and don't forget to cover the head. If a car ejects a pt down a steep enbankment (such as I-26 in North Charleston) a stokes and some ropes do wonders in getting a pt out. Imagine what a stokes will do on the horizontal? Get a utility truck with a plow if you need to. I find it hard to believe that the city of Pittsburgh has no such thing.

Brent, I think you need to read the rest of the case.... Ambulances were called off several times, by the caller, and by medical direction.... this isn't just a case of the medics not wanting to get wet. This situation was a whole lot more involved than that...