WolfmanHarris

Umm... no smashing. Just a one week impound and one week suspension. Minimum fine $2000, maximum fine $10000 and up to six months in jail. There's only so much you can do on a reverse onus law.

If it's against the law in your area you could always call it in. With the new "street racing" laws (harsh penalties including roadside suspension and vehicle impounding for >50km/hr over the posted limit) the news has reported a few cases of on and off duty Police and Fire being busted. When I'm behind the wheel of a service vehicle I drive the posted limit unless responding L&S to a call and I don't touch my phone. Not only is it dangerous and potential career suicide if I get into a collision, but I'm representing my service to the public. I don't always follow the rules on my own time, but I sure as heck do at work.

Help it go viral then. I posted this to my Facebook weeks ago and pass it along through MSN. Might change the perspective of one or two people.

Eww... reusing sheets. Never seen it once. After every call bed gets stripped and wiped down with virox wipes. The only difference I see between medics is some (like me) make the bed ahead of time, while other just leave the sheet folded on the end and unfold it when it's time to move a patient onto the bed. I have also seen some medics give the bed a less thorough wipe down then I prefer, but I've attempted to create OCD in myself for these things to ensure I don't get complacent on decon down the line. Or then there's Toronto which just uses disposable sheets.

I've gone through three different approaches to replying to this and have decided my best response is this: Please go search FD and EMS and you'll find a great many threads that intelligently discuss the many issues that exist in this area. Take the time to gain a further understanding of both sides of the issue and then try coming at this again. I understand you're still very new to EMS, as I am and at this stage it can be easy to get caught up in rhetoric. The best lesson you can learn early in your career is critical thinking and not just clinically. If after you've done and you can better understand where some members here are coming, you still feel inclined to toss around threats, then so be it, at least it will be from a better informed position. - Matt

Here are three of the vehicles from my service. The SUV is one of our older Paramedic Response Units, I don't have a picture of the new one's but their markings are similar to the District Superintendent car also attached. The type 3 Ambulance that makes up most of the fleet is a Demers Mystere. The interior layout of our vehicles are getting a massive change in the nest year to two years as they move to implement the recommendations made by Dr. Levick's consultation. When implemented we should be the first service in Ontario to have a taillift or ramp system and to do away with the squad bench.

All of the above depending on the day.

I suppose one could argue that delaying treatment was potentially unethical, but if I can be a utilitarian for a moment, you maximized the potential good for the patient with the least harm. Either way, I applaud the effort to break the cycle that can occur in some patients, especially poorly coping diabetics. Recently I had to do a similar thing with an NIDDM pt. who's BGL had tanked. He was known to my partner, on scene PD (happened to be closest when the call came in), and the FD lookie-loos/scene obstructors (sorry I had particular issues with FD on this day) and it was apparent he was having issues with daily living. 1.0mg Glucagon SC later we were in the truck about to transport; my partner had returned to the home to chat with the wife and ensure she was taken care of and understood what was going on and my pt. began to come around. He wasn't fully lucid, but was already trying to convince me he was okay. I decided to walk the line on this and rather than seek clarification from my patient on what seemed to be a developing refusal, I played dumb and said, "Excellent sir, you had us worried for a moment. We're taking you to the hospital now to get checked out." I didn't encourage enunciation of his desire to refuse, nor did I say he had to go to the hospital. On route he became fully lucid but didn't quite verbalize a desire to refuse despite his repeated efforts to demonstrate he had control of his faculties, I continued to play dumb. At the same time I realized that this patient was an ideal candidate for our Community Referral by EMS (CREMS) program and could benefit from homecare. But to enroll him I needed to obtain consent from this obviously proud, independent elderly gentleman. I could have asked in offical parlance for his consent, instead I said, "Sir, would you mind if I made a call to someone who could help ensure that we wouldn't need to come and visit you as often and interupt your morning?" He agreed. My point is that sometimes we have to walk a fine line to advocate effectively for our patients and as long as we continue to respect the autonomy of the patient and act in such a way to do no harm then you should be comfortable in your ethics. Cheers, - Matt

Unfortunately Mobey's pretty bang on, which sucks for you. Ontario has the best Primary Care Paramedic (BLS) education in the country. It's incredibly competetive to get in: there were more than five hundred applications for 45 spots in my PCP class, of those 23 graduated two years later and maybe 50-75% are employed and of those almost everyone is working part-time until they have seniority to move into a full time spot. The flipside though, is that Ontario has a strong, entirely third service EMS system, with excellent education and very very good compensation. You could always come to Ontario for the PCP schooling and move to Alberta where EMS jobs remain plentiful. Now you mentioned Ambutrans and Toronto. I'm not sure if you're aware, but the IFT industry in Canada and Ontario in particular is a fucking joke. There are very few "good" IFT companies out there. Most take old retired ambulances and staff them with underpaid PCP students, grads who can't get hired, or first aid trained attendents. You have no medical interaction with the patients you are transporting as they must be stable, non-urgent patients or else they are transported by EMS or ORNGE (air ambulance service). Ambutrans, Ontario Patient Transfer, etc are not EMS, they are just horizontal taxi services. Not that the public can tell the difference half the time. Pay for these companies is usually low, around a third of what I make in EMS and there are usually no benefits. There are tonnes of Canadians on the board who can help you out from all areas of the country. We've got Mobey and Squint representing Alberta, Happiness holding the fort on BC, ArcticKat on Saskatchewan, umm... I don't who's in Manitoba, I'm in Ontario, screw Quebec , OwleyMedic is out east. Just let us know what else you're looking for. Cheers, - Matt

Youtube recommended this one to me today, thought I'd pass it along.

Just got home from work. Sleep now.

You know with all the FAIL's that make up the EMS news feed, I'm not going to fault a human interest story or two.

Are there not enough choppers falling out of the sky, now we need them crashing while still on the ground? This industry is in horrible need of regulation.

After following the IAFF and IAFC and their statements about EMS for months now, I'm beginning to feel that, in the USA anyways, the eventual domination of EMS by the Fire Service is becoming less of an if, then a when. As a group they have a much more unified vision and know what's good for them while the rest of us argue about every little issue they move with one goal. Maybe the answer is to try to work within that and try to place competent forward thinking providers as high up within the fire service as we can. In the end I don't care what it says on my shoulder if the service is well educated, committed and patient centered. Of course this might be just as impossible a mountain to climb as fighting the IAFF, but I'm not so sure the current strategy of no strong central voice and fractured infighting, and limited action is working too well for you folks.* I don't know, I'm just spit balling. *You Folks = EMS in the USA. Here we have tonnes of our own problems, but so far resisting the fire service isn't at the forefront. In fact recent changes in Alberta may be end up knocking fire-based EMS back on it's heels quite a bit.

I know ArcticKat's service has been doing Troponin tests in the field for quite awhile. Can't tell you much more then that but if he's hanging around I'd love to here what sort of results they're seeing in terms of catching developing MI's AND whether they've seen in changes in door to balloon time. Any other services out there doing these tests in the field? Right now my service is involved in the STREAM trial on pre-hospital thombolysis (done in conjunction with early PCI). If the results of that trial are positive I'd be very interested to see if we trial these tests down the line. We've been pushing cardiac research and care big time in the service and it's paid off huge. Our patient contact to balloon times throughout the region we serve are beating (slightly) the times for the ED three floors down from the cath lab. (100th STEMI bypass patient for the service just last week; looking forward to receiving the case review in my e-mail in the next few days.) It's a really exciting time at work.

I'm consistently baffled by how we handle cardiac care in different EMS systems. With my service 12 leads are both a PCP (BLS) and ACP (ALS) tool. Further to that we are required by protocol to use our own interpretation rather then the machine's when activating a STEMI bypass. That's great I couldn't agree more. But, our directives for NTG and ASA are based entirely on symptoms of cardiac ischemia or typical angina pain and the 12 lead is NOT used to rule in an otherwise atypical presentation for MI or rule out in the presence of an RVI. I asked our Base Hospital rep about this and was told essentially, "be patient, we're not quite there yet." Then in the Toronto EMS just south of us, the biggest EMS service in the country, 12 lead is an ACP tool only and they are required to follow the machine interpretation only for STEMI bypass. My biggest problem with EMS in Ontario is that our medical direction has not kept pace with education in all areas. Of course if our direction doesn't allow us to exercise judgment our education becomes wasted as medics atrophy and rely entirely on protocol. It's a Catch-22 in order to demonstrate to medical direction that Paramedics should exercise more judgment we must show that ability, but as long as we have restrictive directive, how can we exercise that judgment?

We've just started using Siren at work. It's been customized to the service but I have issues with it: - Medications database seems to be missing a lot of common drugs making manual input way more useful. - The sections are just in a weird order that throws off work flow (hard to explain) - Certain information is in awkward places (like why is time call received the only time on a different page) - Weird bugs that delete info after you've entered it - Comment boxes are too small, but the lists to choose from leave you selecting "Other: Comment" all the time and running out of space - No spot for narrative, so you either don't have one (not required for us) or like I do you use the generic comment box - Refusal section is clunky and the signatures field is too small for pt.'s to use. Should make it full screen. I can't remember the name of the program the service I was a student with used, but even with it's issue it was better then Siren. They're trying to fix all the complaints the medics have, but there are only so many things that the company can tweek for us within the program. In other words, while I don't know the others, I certainly don't recomend Siren at this time.

So for quite awhile I've been listening to the podcast for the Merck Manual of Patient Symptoms and have enjoyed them quite a bit. So today I went out and picked up the book and have been flipping through it for the last little bit. While not designed for Paramedics, it's an excellent resource that I would highly recommend for a few reasons: - Organized by symptoms; this is how our patients present to us and without the benefit of a final diagnosis this is often as far as we get. By looking up the symptoms you get a broad overview of possible diagnosis to consider beyond the top five approach of most Paramedic texts. - Recommendations for physical assessment and history taking - Overview of patho and etiologies - Information on DI and lab tests; allows the medic to gain further information on what will be done in hospital - Red Flags; maybe the call wasn't BS afterall eh? The book is small enough to toss in your gear bag for referencing at work. At less then $30.00 it's well worth it. (and well you're at it, the podcasts for it and "ICU rounds" make good listening during the commute.) Cheers, - Matt

I saw a great, very tasteful Fire Department calender awhile back that was done for public education and fund-raising. January had all the FF's lined up in front of a nice clean fire truck. They were striking this neat pose called umm... standing and smiling and were dressed to impress in umm... clean uniforms. The rest of the calender included shots from trainings, public events and incidents topped off with a picture of their sponsored kid's soccer team after their championship game.

My condolences to the family and the service. A few thoughts: 1) I'm going for a run tomorrow morning. 2) Partner's fresh dead and probably more likely to be cardioverted. 3) If it's anything like codes here there was probably a bunch of FF's holding bags and doing CPR and a cop taking notes. Plenty of help to push on the chest and bag and with the spare pads you can always swap from one arrest to the other. The code summary will be totally useless after, but you could manage. Actually, FD would probably have an AED on their truck too.

Medium wouldn't be fitting me any time soon. So unless I wanted a bulletproof belly top...

Why an over the shirt vest? Does he wear it all the time? If you can predict a hazard well enough to put on the vest, maybe you should stage until PD arrives? I've looked at purchasing a stab vest for under my uniform, but not too seriously yet. One thing that the cynical part of me thinks of pretty quick whenever armour comes up, is do the people that scream for armour buckle up when in the back? Do they secure all their equipment? Do they wear their hi-vis vest and a helmet when working roadside? Do they wear appropriate PPE (N95, gown, goggles) as required? Sure I don't want to be stabbed or shot, but it's way more likely I'll be in a collision, or catch an infection then it is I'm assaulted and I'm going to control those risks first. I may still buy a vest long-term, but it seems this topic comes up way more then mask fit testing, appropriate use of gowns/goggles, or post-exposure prophylaxis. Question for the Alberta providers: I know Calgary EMS was providing vests to their staff prior to provincial takeover. As EHS takes control, any word on how that may be changing?

You see Chris, in some parts of the world we have publicly funded health care. That means hospitals depend on a share of the public purse to provide their funding; that is an allocated share of the total tax revenue is ear marked for them. If due to tax evasion the public purse has less money available the government is left with two options: deficit spending, or cost cutting. (or both) This commercial is showing how the end result of that might be bad and how the individual tax evader should feel both guilty and worried. It's less of a joke and more of an announcement that serves the public; Public Service Announcement if you will. Or maybe your local trauma/resus room looks like that? /sarcasm.

My bad, I was channeling my trauma arrest protocol I think. PCP penetrating trauma TOR specifically requires asystole on 3 lead, no pupillary response on a >16y/o VSA.

Seriously how hard is it to recognize life/death? I know a hundred hours isn't a lot of time but we're not talking an issue of obviously dead (non-salvageable) vs. workable arrest, we're talking alive vs. dead. For f**k's sake if we can't get this one right every arrest is going to be worked, head attached or not. Word of advice for determining death: 1) Are they awake? If so, not dead. (Good so far? Let's move on.) 2) Are they moving? If so, not dead. (Still with me?) 3) Do they respond to yelling or pinching? If so, not dead. (What we call verbal and painful stimuli. Technical I know.) 4) Are they breathing? If so, not dead. (Now this get's complicated; make sure the airway is open first.) 5) Do they have a pulse? If so not dead. (Now, make sure you've not checked with your thumb AND actually know where the carotid is. TV not withstanding, the wrist is probably not your best bet.) 6) Do they have injuries incompatible with life? (Note that this part comes after everything else. The bad boo-boo to the head with the gross stuff coming out may mean dead, but not until you've checked all of the above.) If so, consider the following: - Do they have a pupillary response?(That means, do they change size when you shine that light you carry around at them) - Is their monitored HR zero? You know, Asystole? (That's the dramatic flat line that usually cues commercials on TV.) Hopefully this list may help you. (Whoever "you," future defendant may be.) It's obvious you're likely too stupid/ignorant to continue in a career where people's lives may be affected. It is my hope that with this list your inevitable failure and exit from my profession will not cost anyone their life. Please ensure you collect your burger king application on the way out. Kind regards, - Competent, Professional Paramedics. Edit: Edited for spelling/grammar. Also, apparently I get snippy when I type with an eye ache. (Yes I said eye ache. Long story.)