WolfmanHarris

Not actually the shortest orientation I've heard. My preceptor when he switched to working NHEMS had a couple of hours with the boss and a day of Base Hospital. Unfortunately he showed up to find the office closed. But a door was open so he let himself in, setting off the alarm. Made a quick exit, called one of the staff he knew and had just started talking to them, when they said "Hang on Chris, apparently the alarm's going off at the office." Quick explanation and about an hour late they got started. Of course it goes on from there, apparently they double booked the education staff for that day, so rather then review with him, he was left in the room with the directives to review for a test later. Fast forward two hours and they check on him and find out they gave him the wrong directives book. Swap books, told to review those. Check in again, do the written test and sent on his merry way with a, "You'll be fine." Glad to see HQEMS isn't making NHEMS look too bad.

So I just finished my first week with York Region EMS, which is only week one of a three week new hire orientation program. I was chatting with some friends at other services and it became clear that how the various services handle orientation varies widely, from the multiple weeks of training to one week to as few as 2-3 days. What's included in them varies greatly as well. My question is topic is two fold: What does your service provide for orientation (for Fire EMS services please include only time spent on non-fire orientation)? What do you think should be included in a comprehensive orientation program? Here is a breakdown of my orientation schedule with explanations where required: Week 1 Monday - Welcome - Meet and greet (coffee, fruit and snacks provided; chance to meet all the bosses and supervisors as well as a chance to meet other recruits) - Service overview - Introductory session for driver training (CEVO3) Tuesday and Wednesday - Base Hospital Certification (not sure how much of this happens elsewhere; but the Base Hospital provides medical direction and is separate from the service, so they come in for two days of protocol review and testing as well as some info on ongoing research programs) Thursday - Bariatric unit/supplies overview - Bags familiarization - Stair chair familiarization (new ferno tracked) - N-95 fit test - Driver training classroom session - Regional intranet/HR/payroll computer system familarization - Computer mapping software training Friday - CBRN Basic Certification (from Government of Canada program) Week 2 Monday - In vehicle driver training (skid pad and road) Tuesday - Area familiarization (drive around the region and find all the stations, hospitals, etc) Wednesday - OFF for Provincial Exams Thursday - MCI day Friday - Code of Conduct - PHIPPA - Allied agency interactions - ACP equipment familarization - Infection control - Pandemic planning - "Respect in the Workplace" (HR Comes to visit) - "A Day in the Life" (covering all the little details of what to do. I.e. how to sign in) Week 3 Monday - Talk from the coroner - Coroner's Package training (the paperwork we have to do on a death) - Radio system - Mike phone system - Hospital info - Payroll Tuesday (most of this day is getting us caught up with the various small CME's the rest of the service has done recently) - Obstetrics review CME - Documentation CME - CTAS review CME - Clandestine labs awareness - WHMIS and OH&S Wednesday - CUPE Local 905 - Draw for Seniority - Court/Inquest Appearances - "Attendance Awareness" (Not sure either, but it looks like HR) - Community Referral by EMS Program - Offload delay - Continuous Quality Improvement (CQI) Thursday - ePCR training Friday - Crime Scene Preservation from YRPD - Special Operations from the EMS Special Response Unit (SRU) Following three formal weeks of orientation, as new hires we then also have to: - Ride third crew member for three shifts - Complete a driver probation log for 20 shifts, during which we can drive to Code 4 calls (L&S) but not back from them. (Due to not having an experienced person up front along with us) - Be on probation for six months

We've got this great forum where people from all over the world discuss EMS and we tend to learn from them. Heck I'm not in the same country and I know NJ EMS is broken. Main points that come to mind are that NJ is a volunteer dominated system where just about every rural "First Aid Squad" has an Ambulance and some undertrained, over adrenalined firsr aiders playing at pre-hospital medicine. ALS is few and far betweeen.

That was essentially my reaction. Not that I wasn't a fan.

I'm afraid that's the product of the Provincial Labour Relations Board, which in the lead up to the strike at the behest of the province initiated an essential services order to determine what percentage of the staff would be forced to continue to work as normal, regardless of the strike. This is especially strange because prior to this the Province resisted making EMS officially an essential service which would have compelled them to go to arbitration, rather than ignore them. The Labour Relations Board made the strike largely meaningless by declaring more then 90% of the Paramedic staff essential. Their picketing can only be done in their own time and the impact to the service is limited to behind the scenes such as not completing paperwork. In fact the real kicker is that the public and government aren't really affected by this job action, those who are include: the medics who are without contract and forced to use their spare time to fight for a fair contract; the BC Paramedic students who cannot continue their education on the road, as training is a non-essential service; the Paramedics who are missing any scheduled CME for the same reasons; unionized support staff who will not cross the picket lines and must accept decreased pay in order to support their Union brothers and sisters; and management who is caught in the middle trying to run the service and work with their striking Medics. That being said, CUPE needs to step it up and overcome these problems, not let it cripple their job action and hurt the Paramedics of BCAS.

Might be a reporter error here. I've taken some expired IV bag and drip sets to practice setting rates, clearing lines and the like. If anything, some commitment to maintaining competency is a plus, or at least less negative.

Talking with a colleague, apparently the official opinion of the Sunnybrook-Osler Centre for Prehospital Care (Medical Driection for Toronto, Peel Region and others) is that NIBP is more accurate than manual, assuming a stable environment free of extremes, movement and when perfectly tuned; however, this does not reflect the reality of EMS and thus they should be primarily using manual BP and not relying on NIBP. Can't support this with a link I'm afraid as they're not my medical direction and I don't have a copy of their policies.

Agreed that swine flu was overblown but consider this. The "benefit" of SARS for Ontario is that so many medics were on quarantine and then reverse quarantine wearing coveralls, masks, goggles and gloves all shift, even in the base, that wearing mask and goggles on any febrile respiratory problem is pretty much standard across the board now. We need to keep in mind that the flu still kills a lot each year; not in general populations, but certainly in those high risk demographics we spend a great deal of time around. I'd also rather have the CDC, WHO and Health Canada jump the gun on severity of a disease outbreak and have to backpedal, then be playing catch-up when the bodies start piling up.

I'd treat it the way you do any time you've transported a febrile patient. Take off your N-95 and gloves, wash your hands, clean the truck and put it back into service. If no PPE, then feel and appreciate the pucker feeling you're getting in the nether regions, learn from it and start looking up transmission rates and mortality rates for H1N1 and compare it to the other flu strains out there. Gain some perspective on the call. Regarding a specific plan of action with regards to your own post exposure protocols, talk to your infection control officer, medical director and hospital staff to lay out a plan. See what testing or follow-up you need and consider taking some time off while it gets sorted out. I'm not sure if you can transmit asymptomatic, but it wouldn't surprise me (since you seem to be able to with everything else) and you need to limit your exposure to other crews and patients. Might be time for work quarantine if time off isn't an answer; that means N-95 all the time on you at work. (Ontario medics will remember this from SARS; I won't as I was only 18 and not a medic at the time) Good luck! - Matt

I'm really glad you've found something that interests you. Looking back to when I was 16 I can recall some of the motivations and interests I had that ended up leading me here (yes I know I'm only 24, but 16 seems so young.) I also teach a great deal of people your age course in lifeguarding, First Responder and others. So please realize that it's from experience that I say this; I have my doubts that you are ready to function in an EMS environment. At 16 most people's sense of responsibility for themselves, let alone others is underdeveloped at best. I find it very difficult to instill in lifeguard candidates the seriousness of their job in such a way that they aren't horribly negligent after months of working without jumping in the water. I have a hell of a time convincing 16 year old First Responder students to put down the AED and pick up the book. There are exceptions, but they aren't likely to be asking others to answer the question about whether they can certify. They'd have looked it up and know for themselves. Once again, not a dig, what we've seen from you so far is about what I expect from a 16 year old. And that's okay. Now is the time to make the right choices about whether EMS interests you and is a potential career for you. Step one, take the credit Basic course you're in. Enjoy it, get the taste of EMS-lite, then move on and keep studying. Put down the sager splint and oxygen tank, take your fingers off the siren button and put down the galls catalog. Go study biology, chemistry and all the other subjects and start looking for an associates degree of higher that leads to a Paramedic license. This is the path for success and unlike some of us, you get to learn about it before you've taken missteps. Still get as much exposure as you can to EMS and learn how interesting this field can be. But get an accurate picture of what's involved and an accurate sense of the responsibility you're taking on and the maturity it requires. It might take longer, but the deferred gratification will be far more worthwhile and make you a far better provider then the quick and easy road. Welcome to the City. Welcome to EMS. Use the resources here and around you, be a sponge and learn what you can. Best of luck! - Matt

I wouldn't knock him too much Dust, he not only works for TEMS which is not only a solid service, but renowned for it's animosity with Toronto Fire. My guess is he was playing to his audience south of the border by making a connection to the bucket brigade. That being said, as a result of this and other studies done in Ontario our medical direction (Central East Prehospital Care Program) requires us to take our first baseline pressure manually and to use our judgment on whether subsequent NIBP results are reliable. Generally I stick to manual BP, but that's largely because of the bumpy roads causing time-outs. Two large services though have pulled NIBP as an option. I prefer having it as a tool to use when/if appropriate then having it taken from the truck; but if medics keep relying on it I may lose that option. (Hopefully not though, the medics at my new job all seem very on the ball so far) Something to consider (though after some quick searching, I can't find corroboration) is that apparently the NIBP adds significant weight to the LP12. I know I'm tempted to ditch NIBP if it means less weight to carry. Other then that, good article summing up some of what I've read before. +5 Dust for a Canadian source.

Umm.. compared to what? Edit: My FAIL. Didn't notice there was another page of replies. Pardon the redundancy.

Come on and be nice to the kids. PCR's are far from basic. The one's here were written by a committee that hasn't worked on the road in years, they were then adapted to ePCR for the service by a company that's never even been near a call and finally tinkered with my management with no computer skills. It's a wonder we ever complete them. Better to test the kids on something simple, like medical math.

Anyone watch the season finale of "Southland"? (Awesome show by the way) The two cops got called for a lady who orders chicken nuggets every day for 15 years and they're out and the guy who flags them down b/c his car broke down and he's late and need a ride. Both hilarious, neither a surprise. In fact: Burger King Call Taco Call Burger King Again McDonald's Missing Shrimp And these are just one source and only the one's related to fast food.

Then why the heck would we give them FD applications if we want them to be an elite medic? That's like creating a great cop by getting them a security guard job.

Taser, asp and a good sized good van to toss all the captured loot. I may not be collecting all that crap like they are, but that doesn't mean I won't take it.

Vent, JP, does this discussion not seem eerily familiar to you guys? I mean more so than every other time we've gone over this? I still agree that's a start, but I think the best route is a 3-4 degree as the only level.

Yes most calls do not require ALS skills. All require proper assessment and a good knowledge to realize when they're not needed. You know what 120 hours gets you in prehospital medicine in the rest of the developed world? Not working in an Ambulance. You're on the right track to a certain extent, we do need to get rid of all the extra levels, but we don't need rebranding. We need a single four year degree to be a Paramedic and a post-grad diploma to do flight and land CCT.

If I'm going to take on zombies I'm going to want "The Lobotomizer" from the book "World War Z." In the book the Marines invent a nice little combo entrenching tool, carcass decapitator. I'd take that, an M1 carbine (purely out of my long term interest in owning a Garand. But for this I default to the larger magazine in the carbine.) and a pistol to be named later. BTW, read "World War Z." Excellent book! Only problem is by the end of reading it, you start planning your own little Zombie survival plan while trying to fall asleep, or while on a long bus ride, or sitting in class.

We actually accept American passports at the border too you know. Even Mexican. Now New Zealanders, they have to scuba in from off shore tramp steamers and then scale the wall. Either that or fly Air Canada.

I'm definitely up for it!

Guilty. Great story there too. Gonna take a few beers before I share it. Ever had road rage?

Welp. I have seen way worse videos online. Can't say I hate this one.

This is an EMS forum. Come on! Who hasn't. Guilty!!! Better question, have you done it?

Not guilty. Ever committed a crime?