WolfmanHarris

Hands-down the UK. The United States as a system is perhaps one of the most fractured, lowest standard systems in the developed world. There is a lot to be learned from the UK and Australia. I'm sure a quick search will bring up some examples, we've discussed it a few times.

Thank-god for "offload to waiting room policy." If you're a CTAS 4 or 5 patient, able to ambulate or sit in a wheelchair and can be left to care for yourself, you can take the Ambulance to hospital, but you will find yourself offloaded to the waiting room same as if you came by cab. Not to mention I will if called for, check the "not medically necessary" box on the form and hopefully so will the MD giving you the full $350.00 bill rather then the usual $45.00 co-pay.

That raises an incredibly interesting point. We are very quick to refer back to good systems/providers and saying "while of course if they're going to do the study that way; of course the results suck." But what if we did have a comprehensive, fully stratified study that accurately represented EMS nationwide (US, Canada or wherever)? How discouraging would the results be? Would we find that professional, educated, competent providers were in the minority?

Maybe it was all planned. Show just how poor BC medics are, can't even afford production values.

Here in Ontario it varies between $26 - $38/hr. I haven't been able to reliably compare cost of living between the US and Canada so the best I can offer is that this pay places medics on par with a large percentage of Hospital RN's as well as front line PD and FD. A Primary Care Paramedic (BLS) makes an average of $70k/yr to start before OT based on about 14-16 12hr shifts/month. With OT a great number of Paramedics have ended up on the "Sunshine List" over the last few years. This is the list governments are required to publish online, on paper and to the news outlets of all employees making over 100k/yr. A great many more are making that much but aren't on the list as they collect from two employers.

No shit. That last commercial looked like a high school AV club production from 1995.

Really well done.

I was reviewing some of my CREMS resources today (find the best stuff during an office clean-up) and thought I'd share a few more details on the resources accessed through our program. Remember that these are not provided by the service, we have a referral program that allows Paramedics to facilitate access to a Community Care Access Centre or Community Crisis Response Service. Community Care Access Centre (CCAC) provides: - Information and referral for - Meal delivery program - Adult day care programs - Respite care - In home health care - Nursing - Person Support/Homemaking - Physiotherapy - Occupational Therapy - Social Work - Speech and Language Pathology - Nutritional Counseling - Long-term Care Placement - Short Term Care Placement (for recovery from illness/injury or caregiver respite) - Case Management Community Crisis Response Service - 310-COPE 24/7 access line - As assessed by the phone contact other services include - Mobile Crisis Response Team - Mental Health Support Team - this is specific to situations with police involvement. A crisis worker and plainclothes LEO respond to assist. - Short term crisis beds - Access and referral for long and short term support Both program are free government programs. While there is nothing that prevents them from being used to help/support the homeless, these programs are not designed for them specifically. It's a start though. I may not have gotten in this to be a social worker, but I still think a holistic approach is incredibly important. Not for selfless reasons either; the hospital emerg is not often the right spot for these patients. I can either continue to take them there and bitch, or I can use the resources available to try to make my professional life a bit easier. Same reason I like doing public education and community programs. If I can get even a few more of my patients/their families to keep legible lists of meds/history I won't have to keep bringing rubbermaid containers of pills with me in the truck unnecessarily.

Online EVOC course eh? Aside from a merit badge needed to get hired, do you expect to get anything meaningful? I understand taking a BS course b/c you need it for hiring. I had to get my ITLS for hiring at my job, despite the fact that our education covers it in WAY greater depth then that course. But I still took it with the bunch of pre-service Fire students, showed off during the practicals and sailed through the written. I also had to recertify my CPR, for the fourth time in a year (having taught it dozens of times as well). But I blew through that too as part of the game of getting hired. However, take a quick look under "Ambulance Crashes" on here or Google and you tell me whether you think you're prepared enough to drive safely and professionally that you can half-ass this course? Driving is the most dangerous thing you do on the job, both for you, your partner, your patient and the public and the thing we are generally the least prepared for in school. I'm sure you worked hard to learn all the things that will help you help patients, why not put the same effort into one of the few things that will help save you?

Right, but BCAS is not an essential service, they are operating under an Essential Services Agreement, which is not the same thing. For example, in Ontario under the Ambulance Service Collective Bargaining Act, Ambulance service is only deemed essential during a labour action and then the language actually only deems the vehicles and equipment as essential, not the Paramedics specifically. This means that only once the service is in a strike position are a certain percentage of normal staffing considered essential. This is cart before the horse crap. Were a service to be considered actually essential, then 100% of staffing would have to be maintained, job action would not be allowed, but as soon as negotiations broke down it would go to arbitration. This is what the BC Paramedics are asking for and it is being ignored by the Province because they are under no obligation to do so. There is absolutely no reason why the government would push for EMS to be essential when they can have their cake and eat it too. We can't actually strike but we can't compel the government to arbitrate.

I think being essential when it mean instant binding arbitration is good. This half assed form, where we get to "strike" but not actually with no onus on the employer to negotiate and ESA that seem to increase each time is not. For example, while TEMS' ESA had them at 75% staffing, prior to the tentative deal the City had approached the Labour Relations Board to ask that it be increased. If almost 100% of us have to be at work while striking, then for f***'s sake, just give us the essential service designation and end the charade. Oh and get us out of the same union as sanitation, daycare and whatever other catch-all is in the local. One collective agreement does not fit all.

Every medic in the service got a chance to trial both the Ferno and Stryker stairchairs and give input. The final decision was Ferno, with a custom order to make the handgrips and a few other parts like the Stryker. I don't know if we'll be getting power cots just yet around here, but we've been told either 2010 or 2011 will see the trucks get tail lift systems like the UK. The official master plan for the service includes a transition to "lift free" as much as possible in the next few years, so I'd imagine power cots are under consideration. Already we have wide leeway to request lift assist and are encouraged to do so. Even less heavier pt's where the lift is akward or we feel we need it, we're not discouraged from placing a bystander to help if appropriate. Our SRU carries the bariatric equipment in their SUV and will respond to set up the ramp/winches, lift cushin, etc. for any of the truly heavy patients.

I use the scoop all the time. I prefer it to the LSB. Also any suspected hip or pelvic fx is getting it over the long board. My money is on the Ambulance itself. North American ambulance designs are awful for safety and the idiots that are allowed to drive them in some areas only compound that.

Learned a valuable lesson just now. Research, research, then post. NOT, research, post, research. Straight from NIOSH: Back Belts - Do They Work? Edit: Keep in mind that until I find a better reference take the above for what it is, 12 years old and inconclusive. I'll continue to look but google is full of places selling them and I no longer have access to my old University search online resources.

Aspiration pneumonitis -> death? I'll leave the expert answer to Vent, but my understanding (as remembered without referencing my text's; so I could be wrong), is that aspiration pneumonia has ~25% mortality in hospitalized patients and that severe aspiration pneumonitis has ~70% mortality. I'd say that's bad. Of course even without death, I can only imagine how invasive and risky the treatment of this patients must be in terms of ICU stays. Worst case scenario for you, they aspirate due to poor airway management, Vent's at the receiving hospital and kills you.

So I've been wracking my brain to come up with a ergonomic reason why, but so far with no luck. Anyone who works in a warehouse and does a lot of repetitive lifting wears a back brace as part of their safety equipment to protect their back. I have never seen a medic wearing one or talking about them, so unless I've missed this entirely and everyone is walking around with them under their uniforms, any thoughts as to why we don't wear back braces? Should we?

Tactical Paramedics in Canada are not armed. They are also not part of the entry team. Beyond that I can't speak too much to specifics. Here are some links to Tactical Paramedic teams Toronto EMS Tactical Paramedics Ottawa Paramedic Service Tactical Paramedics

Sorry, you're missing an important distinction. The essential services agreement (ESA) was issued by the government. In 2001 when EMS was downloaded to the Upper Tier Municipalities from the Province, each service was required to establish an ESA that determined minimum service levels that would be maintained during any job action. This is the norm for the entire province. (I can't remember the name of the legislation, I'll have to go looking) In this case 75% of regular staffing. At TEMS right now, all staff show up for work, management then send 25% home on "strike day" and they end up on the picket lines. Once again, it seems that the medic on the street (myself included) wants to be deemed an essential service and end this half and half crap. Not only do I have no interest in seeing a reduction in service for the public's benefit, I don't want to be working my ass off because 25% of the trucks are parked. As for finances, we don't operate a fee for service system, so there is no way to impact revenue in the service as it is 100% tax funded. As for the media, we've been doing pretty well on the PR front. While the public shouts that uneducated, untrained labour (garbage) shouldn't be making $20+hr wages and having the huge benefits they do, they are also saying that EMS should be essential, and that we, the public health nurses and the other professionals caught in the strike do deserve a pay increase. (Though ironically that isn't a big sticking point.) And Dust, these uniform changes have become the accepted way of protesting during labour disputes by Police, Fire and EMS throughout Canada. This is the first instance that a service has pushed back, which is interesting. Montreal PD wore camo pants and pajama pants for over a year, Montreal FD has been wearing TFS shirts and has slapped Toronto stickers over the Montreal logo on all their trucks, Toronto PD wore union baseball caps for months, Durham Region PD the same, BCAS have put "On Strike" on their vehicles and coats while 95% continue to work, TEMS wore yellow t-shirts to protest inadequate numbers of medics on the road. As I'm certain you're aware, things are done a bit differently up here and I'm sure the reaction from TEMS management surprised the medics as much as it did me.

Agreed. Last time this happened with the yellow shirts, the shop stewards were all over this and everyone showed up with them. Sending individual medics home would be harassment, but sending all home was out of the question. So the shirts stayed. I think after this you'll see the medics try again to leave local 416. CUPE stopped it last time and being caught up in a garbage strike (among other unskilled jobs) with all the bad press and incompetent union leadership seems to be pissing a lot of medics off. Of course TEMS staff is still fractured in attitudes with the older trade unions types having a different outlook then the newer guys who view the job as a profession. The nature of the collective agreement makes mass fire and rehiring impossible. The City has a binding agreement that the position is unionized. Labour law makes it illegal to fire somone for legal labour action and despite the awful friggin press from the garbage collectors and an incredibly burnt out Ambulance unit chair, the union has not broken the law. Any of the medics on the street I've talked to want to be deemed an essential service and lose the right to strike in exchange for automatic binding arbitration (like PD, FD, most RN's). The nature of the essential services agreement is such a joke; it deems the vehicle and equipment essential and sets required deployment levels, but does NOT deem the staff essential. Our contract is up next year and I'm hoping we don't end up in a similar position.

I've tried three times now to write a preface for this that summed up my thoughts on these patients without success. So I'll leave it at this. An instructor of mine gave me a piece of advice that has guided my philosophy and outlook on Paramedicine. "It's not about saving lives; it's about impacting lives."

It's really frustrating that we use American pre-hospital research that's potentially based on providers with piss-poor education has an affect on how things are done up here. I received more education on difficult airways then that, and it's not even in my scope. @JeepLuv If it's not too late to get your money back and start again, I'd consider it. At the very least, do your patients a favour and don't touch a tube; stick to an OPA or supraglottic as based on your own description of your education you're not competent to intubate.

The main program my service has instituted unfortunately is not well designed to deal with the homeless. Our Community Referral by EMS (CREMS) program is designed to get more appropriate services to patients who may need them via the Community Care Access Centre, which is a regional department that sets up various homecare and alternative care initiatives. Our program breaks down like this: Common reasons to refer: - Frequent calls to EMS - Mobility issues - Chronic orthopedic issues - Hx of acute episodes of chronic conditions (CHF, COPD, diabetes, asthma) - Impaired hearing or vision - Mental health issues * - Problems with catheters or drains (chronic) - Palliative care - Potential abuse or neglect (in conjunction with duty to report to PD) - Problems with activities of daily living - Hydration and/or nutrition issues - Caregiver distress/respite - Requires assistive devices (walker, handrails, etc.) - Paramedic judgment that community care resources may be appropriate Our basic procedure is to identify the need, obtain verbal consent from the patient (required due to PHIPPA), leave them with documentation for CCAC and call CCAC to leave a referral. Current CCAC clients are not excluded from this program as our contacting them can notify a case worker that their care may need adjusting. Transport is not required with this program, not does transport exclude them from being referred. * Specific to mental health, for acute mental health crisis we have access to a help line where a patient that is not an imminent risk to themselves/others (and thus would be detained by PD under the Mental Health Act and transport compelled), is put in touch with mental health professionals who in consultation with us will arrange a response. Less severe cases will receive over the phone intervention and the patient will be left in their own care and more severe cases will receive an on scene response by a crisis team consisting of a mental health worker and a specially trained, plain clothes LEO who will take over the situation from there. This mid-range response is apparently uncommon as if it is felt they require care that rapidly, they will usually be transported directly to hospital. I can't speak specifics on this one as I'm yet to have a psych case at this service, so I'm going by written P&P and what I've been told.

I could be wrong, but I hope not. The last thing BCAS needs is member giving their services away for free right now. I hope the ESA has forced them to be there, otherwise they need to get the heck away from there. Here some of the private event coverage companies cover Roger's Centre and the ACC so maybe that's what was going on, but I doubt it. I trust Kat to recognize BCAS when he sees it.

I think Kat meant volunteer like "paid duty" for cops. Not a scheduled shift, but one you bid for, meaning you're "volunteering" to take the extra work. That's how events like that are covered with my service.

Style over substance? It's a large company; clean trucks, spiffy uniforms, a slick operations and good PR will convince the general populace for quite awhile that they're being well served. The majority of them won't deal directly with the service and until obligations are missed chronically and the company can't spin it anymore in the media the cracks can be well painted over. Hell works for Fire. Say "9/11" or "Johnny and Roy" enough times and you can convince the public that NYC and LA have the best systems in the world based on that reputation alone.