kevkei

Consider the fact that all of us that have responded to calls have participated in CISD after the fact, whether formally or informally. Any time you talk about the call, debrief with your partner, share with a spouse, etc, it is a form of CISD. In a formal setting, the danger with CISM in general is too much emphases on CISD. It is meant to be a debriefing or a means to decompress and share feelings. It is good to understand what it is not. It is NOT counselling, it is NOT therapy, it is NOT a critique of the call, it is NOT the end. Too many times it ends during the CISD and there is no follow up. In the end, it can potentially do more harm than good. Yes CISM is a good tool to have available, provided the tool is used properly and within its limitations. Unfortunatley, too often I think it is misused. This is a great research topic and I am impressed it is part of your curriculum. Too many programs miss out on the soft skills that we use all the time - compassion, empathy, the grief process, common sense, etc.

I'm not a LEO hater, just want to reiterate my comments were based solely on the incident with the EMS crew. My only position is that people have to be able to justify their actions, period. I agree with your comments regarding what impacts their decision making process and it becomes a dangerous balancing act. However, usually the common man principle would suggest using a little more discretion and tact when the general public is around, especially in this day of recording devices. It is seldomly about what the facts are but rather the "perception" of the witness, in this case(s), millions of viewers. In the incident with the EMS crew, I think he demonstrated that he didn't think at all about the bigger picture, including his initial actions after the initial high speed response (which I'd suggest was quite excessive, probably double the posted speed limit at times). Then an attempt to interrupt patient transport and care to arrest one of the crew members. Tact and discretion don't seem to be in his vocabulary. In that case, there was no 'perp', there were no risks to him or his partner, nor the public. The danger was was that his actions escalated the whole thing. I think he demonstrated that he lacks the ability to use good judgment, was not an example of what he was trained. He made a poor decision and subsequent poorer decisions after the fact. Again, based solely on his first incident with the EMS transport.

You did miss something, I said I had lost any care of the "GLORY" of the job. Meaning the thrills of 'saving' lives, driving lights and sirens, respect of the public, etc. The things people 'enjoy' when they first start in the industry or when they think of the 'glories' of the job when looking into the industry.

Going back to the EMS incident, I think he needs to review the use of force continuum. A 'C' clamp choke hold and baton/asp can be considered deadly force, which isn't acceptable for a passive (marginally active) resister.

Where did I say I have personally lost my care in my job? I am one of the most caring, dedicated and professional people I know when it comes to this job. I have been a part of and experienced almost every aspect of our industry top to bottom, inside and out. I speak based on first hand experience from a labour as well as managerial experience. I commented on being naive because caring is what sets us apart from most other jobs. Do nurses not care when they take job action or strike and walk off the job? How about us? I worked through a strike that involved staff walking off the job, partly because our department publicly promised that service levels would not fall (was a bold face lie, they were running half of the number of units). Perhaps it should be said that it is management that doesn't 'care' and puts the public at risk. The sad reality is that as long as the powers that be are able to hold a gun to the head of this profession (patient's lives, safety, well being, that we care and only want to help people, etc), we will never be in a position to truly negotiate. We will have to reluctantly accept whatever offers are made. There is no requirement for them to negotiate (opposite is true, take it or leave it attitude). They don't need to bargain in good faith as they know the Provincial Government can step in and demand you return to work or Legislate you as a 'temporarily essential service'. As we are not typically deemed as a truly essential service, we are powerless in going to binding arbitration. Another ploy that works to the advantage of the employer. An "imposed contract". Sounds fair to me.

Happiness, that in and of itself is the problem. Government, employers, supervisors, etc all count on the fact that we like to help people and will effortlessly hold it over our heads and very frequently use it as a bargaining tool or tactic. How can staff 'help' the people we serve if you feel overworked, overutilized, understaffed, undervalued, and underpayed? After 16 years of doing this line of work, I have lost any care for the glory of the job. It is just that, it's a job. I work to live, not live to work. At some point in time we as a collective have to stand together and say a loud and resounding "NO". It's like battered wife syndrome. As long as you feel it is acceptable and you deserve what you get, you will never get out of a pattern of behaviour. Like you said, we make constant sacrifices. Missing special events, working important holidays away from your family. It's a wonderful feeling telling your kids "sorry daddy can't be home with you Christmas morning". I'm still reminded by my daughter of the times I haven't been there. I think your perspective is admirable but is a little naïve.

An interesting but simple concept of 'suspended animation'. Clinical death is not the issue, it's biological death, right? If you can slow or halt cellular metabolism, especially in highly sensitive tissues, what can be accomplished? Think of the increased prevalence in prehospital hypothermia....

How about the simple perspective of a systems compliance accurately documenting whether bystander CPR was or was not done? A simple oversight by a crew not documenting or forgetting to, it can have a statistical impact....

The simple answer is yes, this would be a diagnostic '6' lead as it is done in diagnostic mode. I'm assuming that this was brought up as simple trick for doing a 'quick' look. I employ it frequently. It isn't meant to replace a 12 lead, it's simply half of the 12 lead from your four limb leads. Most importantly it gives you a good view of the inferior portion of the left ventricle through II, III and aVf, which to some is important relating to nitrates - but you also see lead 1 and aVl which combined covers the lateral aspect of the LV. I find it's helpful if you need to do a lot of prep on the patient, such as remove clothing, shave chest hair, wipe and clean skin, etc. (this can easily be another 3+ minutes). Since we stratify either to PTCI or prehospital thrombolysis with STEMI, it can help get the ball rolling in deciding which arm we will utilize. Since a common order is placing the limb leads first, maybe doing an initial set of vitals (SpO2, NIBP, EtCO2), further history and physical exam, then decide to do a 12 lead.... What's the harm in a quick peek? I don't think it's lazy at all or poor use of equipment, I think it's an example of thinking outside of the box and using the technology to your advantage. JMHO

Bill 60 See "5 Schedule 18 is amended in section 2" on page 4 of the PDF. Health Professions Act See - Page 159 - Part 10 Profession‑Specific Provisions Schedule 18 - Profession of Paramedics It appears they are amending the HPA to allow the inclusion of PCP, ACP and CCP as titles able to be used, not to replace previous titles EMT, EMT-P, etc. (Formatting and emphasis mine)

Yes to the Maxeran (metoclopromide), with Acetaminophen P.O. Maxeran treats the nausea but also increases the bioavailability of the Acetaminophen and has a synergistic effect.

I say this with all due respect as I have never taken issue with comments before and I know it is probably a comment that wasn't really thought through but to say that you 'didn't pay much attention' is a demonstration of a lackadaisical attitude of where mistakes happen. It's great that you are protected, but what about everyone else that could potentially be exposed to the patient? Hospital admin staff, general public in the waiting room, family members, etc. Our goal wherever possible should be to isolate the source while also protecting ourselves.

Here it is. I stand corrected, it's not specifically a 'HEPA' filter (based on info from our inservice.) It's a FLO2MAX Isolation Oxygen Therapy Mask brom BLS Systems Ltd. FLO2MAX

Thoughts on this: We are carrying the NRB masks with inline HEPA filters, can also be used in conjunction with a side stream mask (without the side port openings).

Actually, the trachea is somewhat to the left of midline on most of the population (Hence the BURP method Backwards-Upwards-Rightwards Pressure) And no, you don't 'have' to sweep the tongue to the left. One of my best tricks I learned was using a Mac blade like a Millar. Instead of sweeping the tongue, control it like with a Millar blade by staying close to a superior approach (close to the palate). I've found this especially helpful in the patient with C-spine precautions. The goal is to isolate and control the tongue, however you do it is up to you in a clinical (street) setting. I will admit though, you can run into push-back in the theoretical setting (class, exams, etc.) The whole sweep to the left idea is to allow for the passing of the ET tube with your right hand. If you have the tube in your left hand, it would make sense to sweep to the right, except as has been stated, a standard Mac blade generally won't work.

To take this idea a bit further, and to correlate it with your subject of cardiology, how does cAMP effect the myocardium? For example, administration of Glucagon can act as an inotrope as well as a smooth muscle relaxant (Beta II).

After thoughtfully reviewing the Youtube video from Ron Paul "Ron Paul about the Swine Flu People die from the Vaccines not from The Flu" a quick question. 1. When was this video made? It ws posted to his website on Sunday May 3, 2009 to be exact. Swine Flu Shot? No than-you Since this was over 6 months ago I think it has next to no credibility. How has his perspective change? Since H1N1 has changed in that time, I bet so too has he. Are there any more recent links to substantiate his perspective in this May blog? 2. Has Ron Paul received the H1N1 immunization? A couple of quotes to consider from the Youtube link. 1. At 1:10 mark, he states "this is not to downplay the seriousness, some people have died and some people might die yet" - How does this support your position? Where does he state in this video that the H1N1 immunization is unsafe? He is quoting incidents from the 1970's. 2. At 2:34 mark "All I am askind people is to do is step back and think for a minute rather than rushing and panicking and taking advantage of this..." - Is that not what we have been and are trying to do here?

This is a comment that ranks up there with explosives having been use to bring down the world trade centres on 9/11. Measles, small pox, the list goes on. Here's a statistic you can quote. The prevalence of adverse responses to immunizations (life threatening, Guillain-Barré, etc) is significantly less than the mortality rate of H1N1. Meaning, a statistically significant margin (ratio)of more people will die from H1N1 than will develop Guillain-Barré syndrome. I wouldn't give any of your sources the time of day unless it is peer reviewed and published. Until then, even if there are some valid points, still a special interest group. Always be concerned with the minority, whether the extreme left or the extreme right. Where I think a bunch of us are is right in the middle. It's up to us to discern what makes sense and how it will apply to what we do.

This e-mail was sent today from the Alberta College of Paramedics.

I kind of laugh that the recent fatality in Ontario with the adolescent kid, on national media, a local infectious diseases specialist repeated that a persons odds statistically were more likely to be killed in a motor vehicle collision (not be involved in). Since most of us either drive or ride in a vehicle quite regluarly, we take action to protect ourselves right? Supplemental restraint systems (airbags), seatbelts, etc .... These are all things to improve safety, increase odds of survival, decrease morbidity and mortality, etc. By arguing against H1N1 immunization or refusal to get it, I feel these people are a part of the problem. The only way people can pe part of the solution right now is to build up immunity to this strain through exposure either through direct contact or through immunization. The reality is it is currently a pandemic and it's prevalence is only increasing. I agree with the statements made about fear mongering but it's frustrating when we as an industry are a part of the problem again as suggested by the many debates here and other sites on this issue. I guess it's the fear of the unknown? When was the last time the media said anything about West Nile or mad cow disease? It's not like these things have gone away, just fallen out of the media spotlight. 'Swine flu' (Actually H1N1 please, otherwise you are part of the problem of hysteria ) Has proven to be different other than just a flu, hence the specific batch. This alone is significant as the specificity is nearly 100% and early indications are that the efficacy is just over 80% for those being immunized. By my book, those are pretty good statistics.

I have a question relating to these areas that are 'saturated' with HEMS providers. What is the system or process utilized to activate these services? Is there a central agency (dispatch centre), does the ground provider/hospital decide who they want to activate, etc? I understand that it probably varies throughout the country, but it might help in better understanding.

Sorry, I guess my link is password protected. I have attached the document. AHS has postings on their website as well. Immunization Clinicians Immunization Clinicians 2 Briefing Room Oct 30th.pdf

Hey, tniuqs, here is some info direct from AHS. AHS Briefing Room - Oct 30, 2009 Call for AHS EMS Paramedics in AHS Influenza Immunization Clinics (Chris Portas) We are building a list of paramedics willing to work in AHS influenza immunization clinics delivering vaccinations and related duties. These staff will be orientated and active in a very short time frame. We will be working in the order below of staff profiles to assist in the clinics. Special consideration may be given to staff who have given flu immunization in the past. We will work with operations to minimize impact on frontline resources.  Pregnant females or the possibility of being pregnant will be strictly excluded  Currently this is a paramedic only position Order of priority in staffing call out 1. Modified worker/light duty 2. Casual and part time 3. Full time

How can you say this? Is it based on standards and scope of practice? If that were the case you could put anything into an "Epi-pen" style autoinjector, where would you draw the line. The autoinjectors used in WMD (generally nerve agents only - Atropine and 2PAM) are 1 1/2 inches long and are 18 gague needles, not remotely similar to an epi-pen (1/2-3/4" and 22-24 gague). I think these are nothing but blue sky statements. As I stated in a previous post: Well, first the H1N1 vaccine would have to be classified as a WMD. Then they would have to develop a transport medium that would be compatible with autoinjector use (nothing at all kike an epi-pen). The use of autoinjectors at a BLS level (from my understanding) is for self rescue only, not for the general public. Even if for the general public, generally the acceptance would be the benefit of use vs. non use and even then, limited to nerve agents. The better argument would be to have Cipro autoinjectors for anthrax exposure. Have you ever seen an autoinjector used on a live model? The only exposure I have had is with an intoxicated swine model exposed to Sarin gas (nerve agent). It's not a pretty picture. Imagine using this to immunize the general public???? I'm sure a general order will be forthcoming!

I believe AHS - Edmonton probably (can't confirm), City of Edmonton EMS for sure did, utilized Paramedics to immunize EMS and Fire staff against seasonal influenza. Forgotten resource, most definately. The biggest problem is what do you do when already short of staff and unable to fill staffing vacancies?