kevkei

I think that this is one thing that is commonly missed. Each service, municipality or location has their own needs and factors. What works in one area is not guarenteed to work in another. How about thinking about what is in the best interests of the people that utilize the service?

We make the payment and then submit for reimbursement. Comes seperate from our regular pay (otherwise it would be taxed as income).

That show was good for two things: 1. Lists the places of where not to get sick. 2. A good example of what EMS is not.

I've given up caring about it, it's not like it comes out of my pocket! :wink:

Both actually. Preference would be for ACP's. We are actually having a continuous hiring process with the current competition being open until Dec 31st. I don't know what the process is for out of province applicants and what they are doing about equivalency.

Sure there is. We assume that each and every patient will get into the cath lab in an expeditious manner, but the reality is this isn't the case 100% of the time. You can never ensure there is always an open and available cath suite.

Our system is unique, we will either transport directly to the cath lab, or alternatively, for some patients we will thrombolize prehospitally. We basically identify the indications, rule out contraindications, obtain consent, initiate treatment O2, IV, (12-lead previously done), ASA, Nitro, Clopidogrel (Plavix), Enoxaparin IV and SC. We will have also contacted the coordinating Physician to determine the best treatment method (cath lab, or lysis) looking at the whole picture (patients age, PMHx, geographical location, time of day, duration of symptoms, cath lab availability, etc) If there is an anticipated delay in door to balloon time, we administer TNK.) If anyone is interested, I can forward a copy of our worksheet/consent and the flow chart. I don't want to post it because it's too large, and I can't link to it because it is on a secure site.

There have been great points made about excited delerium and I think it is inumbent upon people to have a better knowledge and understanding of what it is, how to identify it and how to treat it. Excellent comment, although it should be expanded upon that the 'proper' restraint or agent of choice should be benzodiazepines. Other hypnotics or sedatives (Haldol, etc) don't mitigate the massive sympathetic response that these patients are experiencing. It is also a good point about these patients, we need to initiate prompt and aggressive intervention as you are right, they get to a point of no return. Once this happens, it's too late.

Of course, that's because the world revolves around your 'city'

I didn't think I needed to as the original reference was right above it. I'm not trying to prove an argument, rather I was using the example that I quoted to make a point that this is a position many people will use. My comments were generalized and not directed at you specifically so I didn't see a need to elaborate or provide the entire quote. If you don't like it, we can step out into the parking lot .... (and have a beer, I'm buying!)

If everyone followed that advice, they would have no employee's left. The problem as I see it, speaking from first hand experience, is staff feel undervalued, under paid and can't afford to survive. Calgary and Edmonton are the two fastest growing cities in the country, which subsequently compounds increases in call volume and service demands. They are also the two hottest economies with the highest increases in consumer price index (inflation, cost of living increases.) What the City of Calgary is offering doesn't even keep of with the inflation. The result is that new staff can't afford to establish themselves (vacancy rate at all time low while rent and house prices at all time highs.) Add to this, people that have been employed for a number of years can't even afford to stay. So in order to make ends meet, I have to sell my house, up-root my family and leave family and friends to go somewhere where I can afford to live? (Which by the way is at least 2-3 hours away to get out of the economic market). I also have to leave a department where I have dedicated 12 years of service, through no fault of my own? At the end of the day, something will need to be done to offer incentive to attract new employees in addition to incentives to retain existing staff to keep them from leaving. From what I understand staff turnover and attrition is at an erronious level these days. If you want to talk about service delivery impacting morbidity and mortality (in the event of a strike), what about a system that can't possibly sustain itself into the future?

Yes and these patients scare the crap out of me. We have had a few in custody deaths recently here associated with this and subsequent police intervention. Sad part is it is significantly misunderstood and neglected.

We use Ativan or Versed (Midazolam). Preference is the Versed as absorption is faster, generally the dosing we use is 5-10 mg deep IM, or if you have access, 2.5-5 mg IV. Ativan is 2mg deep IM or 1-2 mg IV.

I would suspect that just as a strike vote is a bargaining tool, so too is the fact that we aren't declared essential. From what I understand, if declared an essential service, yes it removes your right to strike but it also changes how they would rule in arbitration and it could benefit the bargaining units. Take for example, maybe we get compared to RN's when it comes to salary (not to suggest that would be the case)? It would definately make a big difference salary wise for private and rural services.

I guess part of the problem is the perception if what is an acceptable wage as demonstrated here Big Bucks for Basics If people are happy making $9.50 an hour and a $0.50/hour raise is enough then I can see why there would be outrage when people making $30+/hour want a 10% raise.

Based on past history, tf it gets to a strike vote, the intent is to use it as a bargaining tool not to walk off the job. I disagree that the list is long. People are having a hard enough time solving their own problems these days (recruitment, staffing, etc) let alone helping someone else. Another thing to consider is Edmonton EMS isn't far behind in their contract talks. What will happen with them?

Oh really? I guess they neglected the fact that we have had ours for a while now?

Sure you should, you need to stop the burn process.

I wholeheartedly agree, which is why I said something about the original post, which had gone unchecked until now. Because it isn't a 'faux pas', all you have to do is look at the individuals post history which you will quickly find is severely lacking in anything productive. As for myself, I believe that one can speak for another when you can comment on their professionalism and character.

I'd like you to qualify that statement. I know of who you are referring and can speak on his behalf.

Welcome to the world of medicine where very little is black/white! This is the type of question that seperates the good from the not so good. I agree with what has already been said and I don't like giving things to cover your bases. I have to be pretty confident it is cardiac (>80%) before I'll start to look at NTG and ASA. You can do this with a thorough history, assessment and physical exam. If you don't know what it is, what do you think it might be? (differential diagnosis). Are there false positives and/or pertinent negatives? When you have your list, go through and rule in what you can and rule out what you can. You are left with a working diagnosis, which if you have done your job right and well, you can treat. Very few cardiac patients will present like a textbook. Many will present with atypical symptoms (especially females, diabetics and the elderly - sounds like a lot of our patients doesn't it?). This is why understanding anginal equivalents is so importanty. More importantly, these symptoms have ususally been going on for hours, days or weeks so how effective is ASA going to be? I would lean more towards a conservative approach. Assuming you have done a good history and exam, start with your basics. O2, IV, position the patient, etc. Then re-evaluate and ask, has there been any change? If I feel it is cardiac related, if there are no contraindications and looking at the entire patient (vitals, etc) I may consider a trial of NTG and then re-evaluate again. Has there been any change? If so, was it mild, moderate or significant? If it is mild or moderate, I'll probably repeat again after reassessing. (If it was significant, I'd be cautious and would probably raise a red flag.) When repeated, go back and reassess again. Was there any change now, if so, mild, moderate or significant? If you see positive results, you are probably on the right track and then I would consider giving ASA. If not, I would with hold the ASA and probably hold off on giving any more NTG.

From a pharmacological perspective, dextrose is dextrose regardless of it's form. From a technical perspective, you are administering an IV medication via an oral route. I doubt the pharmaceutical company approves IV D50W for P.O administration. The pizza is a good ideal. We all too often load patients up with simple sugar (carbohydrates ) which will plateau and then fall off. You should also remember to add complex carbohydrates as well as protein to the mix to maintain a decent BGL.

Easy, because community healthcare has failed. Either those that are supposed to provide the services do or we have to pick up the slack. The industry trend is that more and more people are relying on calling EMS to try to access these services. Because we respond to 911 calls in a timely manner (where as community health providers do not, working Mon-Fri office hours).

Have you looked at Nova Scotia? Nova Scotia Community Paramedic Nova Scotia EHS How about the International Round Table on Community Paramedicine? There are a bunch of resources and articles Here.

I didn't assume that I know the situation, but if you do, perhaps you could describe how he had any trace of cyanide in his system? What was the causal factor (source)?