WolfmanHarris

Saw it last week, but thanks for reposting. Always makes me smile.

I'm going to leave aside "professional courtesy" in terms of Law Enforcement showing leniency to EMS providers. The courtesy is their's, their prerogative and certainly not an expectation. For my part, as a Paramedic, professional courtesy involves going the extra mile for a fellow medic, cop or FF or their family. I have rarely found myself in that position, but as an example, I recently picked up the 12 y/o son of a co-worker who I'd never met. The child had a complicated medical history and the parents had arranged a sitter for the night for a rare getaway. The sitter had to stay with the three other children when we transported and the child would have been alone in the room waiting for their parents. My professional courtesy was to stay in the room and keep them company until the parents arrived. This is something I wouldn't do for the average Pt. but is that extra mile I would go for a colleague. I'm afraid an example doesn't make a great definition, but I don't have a clear concept of it myself I guess.

Not only did the OP leave something that could cost him a job to the last minute, but I do believe it took more time to join the city and post than it would to have found some options online. I assembled the following top 5 list in 30 seconds. These are the top 5 hits from typing "Paramedic CE" into google: 1) http://www.ems-ce.com/ 2) http://www.emcert.com/ 3) http://www.ems-ceu.com/ 4) http://www1.emsjane.com/ 5) http://www.emsmedic.com/ Can't speak to the quality; but with potential unemployment staring you in the face, who cares?

Wow, that sucks! Did your state suddenly drastically increase the CE requirements without any notice?

But the continued risk of a much larger, less responsive vehicle rushing to calls with L&S? Besides, while the science is certainly there, dispatch is still incredibly fallable. As a result I've ended up at a more than one VSA that came in as a "not responding normally" or "drowsy." The failure point here is almost impossible to fix since we rely on information from the public; L&S to scene may remain a dangerous reality of our job for quite some time. Now as far as L&S to hospital, I couldn't agree more that there is little to no need. I'd say less than 5% of calls in my area go back L&S.

Not sure what your timeline is, but consider that once the equivalency process is done, the hiring process for EMS Services in Ontario is incredibly competitive. Toronto EMS hires Paramedics once a year at the PCP level only. ACP's are sent for education from within ranks only and currently Toronto is over staffed on ACP's thanks to their new deployment plan. Toronto conducts hiring through a centralized testing process and that window is closed until next year. Peel Region hires through the same centralized process, though I believe they may do some of their own competitions as well. Durham Region hires through centralized as well as their own hiring. They have significant preference for those who attended school or precepted in the Region. York Region has been hiring multiple times in a year for the last two years. The largest hire of the year is currently going on but there may be some smaller hires later in the year. Ottawa hires through the Eastern Ontario centralized testing process. To the best of my knowledge this is only done once a year and that window is now closed until 2012.

I will have to check chapter and verse to back this up, but Ontario's PHIPA (Personal Health Information Protection Act) does grant a Pt. unrestricted access to their medical records; with the caveat that Health Information Custodians (HIC's) may require payment for administrative costs and some other reasonable restrictions. Until I have the chance to copy and paste the relevant sections, here is a link to the law: Ontario e-laws A document for public consumption created by the Ontario Information Privacy Commissioner. FAQ's Brochure

Any time we come across a Patient, we notify dispatch that we're stopping at a potential call. This immediately generates a run number. If it turns out there is nothing for us, it gets recorded as a "No Pt. found," but there's still a unique run number. Heck everything we redeploy to cover another station it gets a run number (and we can do that dozens of times in a shift).

Agreed. Were it not for the STREAM trial the transmitting would just be a gimmick and if thombolytics ever make it into our scope permanently it will be entirely gimmicky. What I'd love to see would be point of care troponin tests.

Depends on whether they're interpreting your 12 leads or just using them to inform the cath team in prep for a STEMI. We transmit our 12 leads to the cath lab as part of our STEMI alert but all interpretation is done in the field for STEMI. If a Pt. is being enrolled in the STREAM thombolytics trial (which is also new for 2010) the Paramedic does interpretation for enrollment, but for the purpose of the study it's confirmed by the on-call cardiologist who randomizes the Pt. to one of the two study groups.

Thinking back on 2010, my service had quite a few enhancements: - Ferno tracked stair chairs fully rolled out - LP15 deployed on all vehicles - CPAP - Initial trial of Opticon (three vehicle trial; full roll out expected in 2011) - Initial trial of Stryker power cot (three vehicle trial; unsure of full deployment) - Initial trial of LUCAS 2 (5 vehicles as of Dec 2010) - Deployed dog harnesses for transport of service dogs to comply with the requirements of the Ontarians with Disabilities act (I kid you not) - Implemented voluntary, non-disciplinary, anonymous, Pt. safety report ("Close Calls") That's all I can think of off the top of my head.

And since we're on the topic of AV blocks. I vote tell you the answer, (far better to look it up yourself; which is why my gear bag is stuffed with printouts from journal club and textbooks) but to point you in the right direction, look to the relationship between the P-wave and the QRS. Also, once you've gotten a good handle on it, youtube "Diagnosis Wenkebach." Edit: And sorry, no 3 lead on PCP trucks in BC? No PCP 12-lead I'm used to, don't like it, but I'm used to seeing it. But no 3 lead at all?

Ya I feel like I don't have enough info here. Were it a basic 911 call and I was starting my ACS protocol then ya, I'd upgrade to L&S (called code 4 here). Were my 12 lead to show a STEMI we'd bypass, otherwise L&S into the hospital since that Pt. will be getting stat bloodwork as well as follow-up 12 leads and in the event a non-STEMI is found may still end up heading to the cath lab or being thrombolyzed. However, as a CCU to CCU transport, what's the Pt.'s Hx? Course of tx in the sending facility? Mainly my question when deciding to go L&S is, is there a time sensitive treatment that will be done for my Pt. immediately upon arriving? Is my Pt. decompensating or critical and in need of resourced beyond what I can provide immediately? Generally I am very reluctant to proceed L&S to the hospital without compelling reason. The increased risk is not worth the time saved.

I just rinse in between calls during the winter. Hot water from a hose takes off all the snow and ice and most of the dirt and salt.

I was the truck every shift as call volume allows. If we get back to base after end of shift, I won't stay later to do it, but on the flipside if the crew I'm relieving didn't get a chance, I wash it at the beginning of the shift. In the winter I try to rinse the truck off every time it hits a station to keep the dirt down (and the back-up camera clear). We do a deep clean of the interior every Sunday. Everything out, wipe every nook and cranny. I mop out the back of the truck and the floors in the cab every time it's my turn to clean (driver cleans while attending Medic does paperwork then switch for the next call). Stretcher and monitor gets wiped with virox wipes after every call before fresh linen is placed on it. Severely contaminated equipment is pulled from service and sent to logistics for decon. I never do an exterior detail or wax.

I thought I had.

This is the only topic he's posted on. If you don't want to engage any further on this, let the thread wither and die. It seems like the OP has never entered practise and is thoroughly soured on the profession. I imagine this will be the extent of our interactions with him or her and there's no need to antagonize ourselves further with an endless, repetitive barely cogent argument. There is nothing to be gained on either side, be it individually or for the profession as a whole.

Doing it on the cheap can be hard. The most obvious EMS related things are often pretty whackerish (like a REALLY big keener) and aren't particularly useful. I'm not sure what your price range is but here's a few that to come to mind: - Subscription to JEMS. It's not great for education, but a good trade magazine and helps keep them studying and reading. - Gerber Hinderer knife. Great multitool with window punch, seat belt cutter, O2 wrench. I actually find this one useful. One of the major gift companies will do engraving on the blade for a decent price. - If they're new EMT's looking to move on to Paramedic school, consider a good Anatomy and Physiology text. (This may be too expensive) - Stethoscope. Opinions on what you need/ should spend money on vary. I have a very expensive one I got as a gift from my wife, but there are plenty of passable ones for a decent price. - Going in a different direction, consider a gift card for coffee. (Starbucks, Tim Hortons) Caffeine is the life blood of this industry. If I knew your price range a bit better I could offer some other suggestions.

Afraid I couldn't afford it this year. I'm still waiting for another TFT contract at work, so my income's been cut in half for the last couple months as I wallow on casual. Have fun guys!

Thank-you for clearing it up. I for one have no issue with this program. I trust that those selected to be involved with the organ recovery project will have an appreciation for the delicateness of the situation and will handle it with compassion and understanding. Nowhere did it say or imply that anything but the best efforts would be made for the patient or that the family would be pressured or compelled; certainly not anymore then they would in hospital when the staff ask about organ donation. If I happen to suffer an untimely death while my body is otherwise still suitable to best used to aid others, I would hate to think of it going to waste. I have made it clear to my wife, repeatedly, that I wish as much of my body that can be used to aid others as possible. This is not the right choice for many people for cultural or religious reasons, but for many their hang-up is more a discomfort with facing their own mortality.

Holy crap, never realized how much I've come to depend on ECG until now. I won't worry too much about it though, plenty of non-STEMI's out there. I know this was a college scenario so we're working on a piece of fiction here, but I'd be curious about initial HR, RR and BP. On all my SOB calls I've gotten in the habit of adding ETCO2 into the mix to take a look at the waveform. Dive back into the Hx. Some people have a weird perception of pain. Yes the crushing CP occurred following ventolin administration, but did anything feel out of the ordinary in the chest prior to that? How did the lungs sound after the initial ventolin treatment? Were I to hear increased wheezes or crackles then I'd start considering CHF. Given his history, I am inclined to lean more towards cardiac ischemia brought on by the asthma and ventolin treatment. Of course this is where it gets a bit stickier. Has the Pt. ever had asthma complications with ASA usage? Under my Medical Directive NTG is contraindicated when the Pt. has no prior NTG use w/o a line established. I can tell why this one was used in school for you. Forces the student to make a decision and operate in that grey area where so many Pt.'s fall.

I found this picture online and unless I'm mistaken, that's a Ferno #30. I sorta assumed these were all long gone. Murder on the backs. Anyone else still using these? At my service we're gradually rolling in Stryker power cots (and anxiously awaiting the power load system) as part of a service wide transition to "no lift". We already have tracked stairchairs.

Even if response times had any bearing on clinical outcomes (they don't), L&S rarely make a statistically significant difference in response times. L&S are about public perception/relations and faulty call-taking resulting in not having reliable information on what you're actually responding to as well as being a legal necessity for moving through traffic in violation of traffic laws (clearing intersections, driving on the shoulder). Note that I'm not talking about driving recklessly, just driving with L&S. My service recently completed a 6 month trial of opticon and has received budget approval to install the system on all of our Ambulances. The pilot project showed a 58 second average decrease in response times in our most urban and congested areas. This system is tied to our L&S and engages automatically.

All of our Ambulances have a toughbook mounted in the back with a terminal in the cab. These computers have Ontario's Ministry of Health Locator program. It's not ideal. It will display your current location and very accurately pull up any address in our catchment, but beyond that, the closest we get to guidance to the call is it starts zooming in as we get closer. I've gotten the hang of it, and within my district I never have any problems, but when I head south it can get pretty clunky. We're technically allowed to put our personal GPS in the truck, but it's discouraged. I only use it if I've taken OT outside my area as a back-up. I had a bad experience with a partner who was really uncooperative with giving directions so I bring it just in case. Ottawa uses Microsoft streets and routes to supplement MOH Locator on their computers and apparently it's a pretty good program. Peel Region Paramedic Service has one of the large Garmin's mounted in their cabs along with the laptop.

Welcome to the city Brian! I'm a PCP in Southern Ontario. Been on the job for a year and a half. Look forward to hearing more from you. - Matt