pond life

I think BC PAramedic do deserve greater pay but you should not be asking yourselves (or us) this question as we have a vested interest in a positive answer. Why don't you poll the citizens of BC from local papers, tv channels and local internet sites. Also do a seperate poll involving the fire dept, police and nursing community. THEN you will have an unbiased repose and reflection as to the appropriateness of increased salires. To win such a request from your employer you need outsiders on your side. Mike

Hi all, I can confirm that the police, fire and ambulance all do training blue light runs. It would be unwise to let the newbie out on theroad without first being assessed that s/he is safe. And this must be done by a driving instructor. Another option would be to get the instructor on the first shift of each newbie. However this has proven impractical as the instrucotr can't be expected to be in different ambulance stations across 3 or4 counties on the same day. Everything we do or use in the ambulance service in the UK has to be assessed by a trainer first - driving on blue lights is no exception. My concern would be letting a person loose without safety oversight on theior first few blue light runs - red mist tends to creep in and that's never a good thing. Mike Cornwall. England

All becomes clear. There is a lesson to be learnt for me here (other than learning about correct placements) - and that is not to go for 19 years and wonder if I understand something - it's better for me to ask the dumb a*se question and everyone chuckle - oooh he should have known that - rather than continue in ignorance. Thanks guys - I have been educated. Mike

I was taught that V1 & V2 remain in the same place and all the other vector leads as changed over to the right side. Now you got me wondering if I misheard my lesson in 1989 and am off to confirm what I thought I know but obviously don't. cheers Mike

In England our response times begin when the 999 (911) operator puts the call through to dispatch and the phone starts ringing. The call takes has 30 seconds to pick it up...!! It's called 'call connect' over here. Mike

Certainly will post it to the group. Won't be implemented until April 2010. We are to test it out this summer to identify the glitches in the system. cheers Mike

In England we have to get to Category B calls within 19 minutes. I am currently seconded to a University and being paid by the department of health to come up with alternative indicators other than a response time. I am initially looking at clinical outcomes, patient experiances, clinical interventions and time to definitive care on Cat B calls. I have one year to achieve this and if it works then the whole of England will be affected by the change in service mesurements on thier performance. Mike

It is possible to give Salbutamol (ventolin) (?albuterol is it in the US) by nebulisation in an unconscious or failing respiratory effort patient by using a T-piece. Not sure if you use them stateside so I will dig nout a pickie for you. Mike

I only know the US system slightly from ridealongs in Seattle area but if this were in the UK I would approach this slightly differently. This is a holistic call in which you are meeting not only the clinical needs of the patient but the social psychological needs of the family and possibly even the nurses. I would ask the nurses if they believe the patient has deteriorated in their opinion. I would ask the husband and any other relatives what they would like to see achieved here. Noting that certainly one option is to take to the ER however there are other options available - ie treating in the community or admission to a community hospital. When the husband comes back with 'the ER please' I would be taking him to one side and asking if he is finding it more difficult to cope at home with his wife's failing health are there any other issues here and if there's anything I have not been informed about (possible facing up to spouses deathe etc). If I could gain the trust and co-operation of the nurses and relatives alike I could then begin base line obs including temperature, urine dip test and other assessments to identify the source of the pyrexia. It may be that the patients immune system is low and has chest infection or pneumonia - in which case I would assess CURB65. At the end of the day if there are no red flags I would opt for a treat and refer for the patient (rather than treat and release). If appropriate after my assessment I would take to ER but may also consider alternatives such as BLS transport to a ward in a community hospital or I may prescribe Pen V if appropriate with a follow-up with an acute care at home team. If I went down the road of non-conveyance I would sit down with the patient and be specific of why the patient is not going to ER but will ensure a good safety net is in place. Mike Bjarkoy Paramedic/Emergency Care Practitioner Penzance. Cornwall. England

Hi Scott33 Wehn you do come over let me know and my wife and I will put you up in our cottage in cornwall and you can do a few ridalongs on the RRV in Penzance. It will give you insight into ECP work and the impac that a fluid treat and release policy can have in reducing ER admissions. my NHS email address is mike.bjarkoy@nhs.net if you have problems getting hold of me on our usual discsuion forum routes. cheers Mike

Oi, hertzvanrental - I have a body of a budda and can get on my minal with a stepladder but do have to use a zimmer frame to stay on it. Surfs up dude. Nice part of the world (Cornwall) except for the Cornish...! Mike

Hi all. Does your system allow you to employ a treat and release or refer system on your payient contacts? Mike

Work in Sussex = dodgy... I visited Burgess Hill the other day and did two red calls on the RRV. My Manager in Cornwall happened to phone me in the middle of one of them - confused the hell out of him. ha ha ha..... Mike

IMHO No. Glucagon will work on the reserves already insitu. Otherwise Dextrose 10% IV should be administered. As has been already stated, carbohydrates is probably the key to the treatment here. The glucose needs something to work upon. I used to give Glucagon IV and had a few incidents of vomitus (the patient not me). The only other time I would IV Glucagon would as (again) has already been stated for beta blockade OD. Mike

3 times a day, 2 hours a session... ooh how rude. Seriously though, you don't stand a hope in hell. Well there is one way which I will give you at the end of the post. Here is my experience of this visa thing. Back in 2002 I applied for South King County Medic One in Seattle. IMHO one of the best EMS systems I have come across. Anyway very long and expensive story (£10,000 in flights, car rental hire etc etc later) I went over there about 4 or 5 times to go through the testing process which was challenging and fun at the same time. This took a few months at during this period of time I had 2 (not one but TWO) immigration lawyers working on my problem - getting a green card. Option one - student visa, is a no go because the the education for medic one is not a degree and therefore didn't apply and once I had completed the course I still wouldn't be eligible for the following reason... Option 2 - H1B green card requires that ANY job is filled by an American and only if there are no other US citizens available for the job can an alien apply. As there were a lot, I mean A LOT, of medics apply for one of 4 jobs the INS said that there were Americans that can fill the position and therefore they get it.. every time! Option three - exchange visa - this is OK for a short while but will not allow you to actually be employed in the US even after the exchange has finished. Option 4 - already been mentioned but is not as straight forward as it seems - marry an american. Even if you do this INS can still refuse you at interview. Option 5 - USAIR immigration lottery which is cool as long as you are anything else other than British because they are not eligible. I am South African (by birth) and tried that route and guess what - no joy but spent a lot of money trying. Option 6 - get a green card in an existing company. I had this option to be a director of a Plastics company in Florida - the problem, is that the green card is not trasnferrable across professions - hmm. Option 7 - and this is the only way I know for certain that you can get in. Ready for it - it'll cost ya.... Sell your house in the UK ad invest in excess of $150,000 dollars in a US company - my immigration lawyer gave me an option of 230 companies I can buy into!!!!! You then name your wife as the director of the company. You automatically get a green card as a spouse of which you can do with as you which. One thing you cant do is enter as a specialist - doctors and nurses, athletes and scientists are specilists - EMS workers are not. So at the end of the day - sell you hour, buy a business and put it in the name of your spouse (bad move) and hopefully you will swim and not sink. I was not prepared to take that chance - I regret in some ways not doing so. But my scope of practice now is greater than it would have been in Medic One. All I need now is a social life... Cornwall is as boring as sh*t. ooh and can I have a look at your picture - I'll place it on my computer as the background wallpaper... Mike xxxxx