WolfmanHarris

Good thought. Lord knows the job market in Ontario is incredibly tight. So much so that it seems more and more services are turning to geography as a way to thin the applicant pool. (i.e. Waterloo and Peterborough not considering or not giving equal consideration to non-local applicants) I've got all my ACoP stuff printed off and waiting for if I don't get a job this time around. Ditto for NS, NB and SK.

And I thought they smelled bad on the outside.

How hard and how much of a time and monetary commitment is getting your NR? What's the downside to studying a bit more and a bit longer?

Maybe this is an Ontario thing, but none of the cops here wear a badge unless it's a dress uniform. (if that) The RCMP is a clear example of trying to do too much at once. You cannot be a national investigative and security service while still attempting to do small town and remote policing and do both well. Not and attract the best candidates and keep them. Besides, how can you practice good community policing if most of your constables are being rotated out of these small towns to the jobs they actually wanted after a couple years? The brass at the RCMP are not doing their people justice.

The quicker I leave the room and wait outside the door for PD the more I trust myself to do the right thing. Also if I assume I will get caught (and why not, I rarely got away with anything as a kid) the short term gain is not worth it.

Nah Quebec is way more like the 17y/o who moves out but still calls home for money. "Sovereignty Association" is a bigger crock than "distinct society." Scuba, I'm not sure what the quality of your education was, but a quick google of EMT-I programs showed me that they're pretty short. As a result you're probably lacking a good foundation in A&P, pharm and patho. (Nothing personal, don't actually know you.) This might not be a problem in Quebec as their system still lacks ALS and a is lagging in education standards, but you might want to consider restarting.

I'm going to need to go looking to verify this, but apparently you're not supposed to bother checking for a pulse until the 2 minutes of CPR is completed regardless of the rhythm as NSR and even a palpable pulse might not yet be adequate CO. (I have some doubts on that as I feel like if you have a palpable carotid you must have fairly adequate CO) I saw this to an extreme recently. VSA Pt. in the local ED, witnessed arrest. Physician performed CPR. Halfway through a cycle the pt. regained conciousness and started saying "Why-are-you-pushing-on-my-chest-?" RN asks if they should maybe stop and the Dr says, "Not yet we have to complete two minutes." Still scratching my head on that one.

Fracture - in this case meaning broken up into multiple parts. For one EMS system to have excellent benefits and good pay, and another to not due to having a different model means that EMS is fractured. Now if we all enjoyed these benefits regardless of what model the service was provided in, than it would be inconsequential and more a matter of semantics. For example, I come from a system where every service save three are third service municipal. The three that are not municipal are direct private contracts from the municipality to run their EMS system. Wages and benefits are comparable from service to service (Wages b/t $28-38/hr and benefits for all FT employees.) If I move to a different area of the province I don't expect to have to work as a FF, nor do I expect a pay cut or raise that isn't comparable to the increase or decrease in cost of living. This is a non fractured system. Though talking with you is causing more and more deja vu. Tell me again how awesome LA Co is as a system again?

You say backbone, I say appendix. The fact that they take the same training is part of why education is lagging so much. How can you justify a 2 year or more education when the volunteers are doing it for free and couldn't possibly go to school for that long? But we've been down this road more than a few times.

Complacency and sticking ones head in the sand in the face of the many issues that face EMS and leave us in a somewhat precarious position as a profession is of no help. I don't think anyone is saying they hate their job. Were that the case I doubt they'd be online posting on a forum such as this. EMS (especially in the USA) is fractured, with far too many stakeholders, with their own agendas (not all of which are actually geared towards EMS) pulling it in various directions. You're correct, Fire is not alone in creating problems for EMS, but it is one of these stakeholders and significant for its overarching goal of promoting and maintaining the fire service. This fracturing more than anything else is what holds back education, wages and the establishment of EMS as a separate specialized field. What you call whining, I'm sure others would call advocacy.

That's almost exactly what I was talking about. Except it's on an Aussie ambulance with the much nice internal arrangement. (Foreward facing seat).

I give up. Without knowing the specific make/model it's impossible to google effectively. Little help from anyone who knows what I'm talking about?

Spen, I think Rich may be talking about the style of Ambulance that was popular for awhile around here with a single rear hatch that openned like the back of your minivan or SUV. They didn't last long as the pistons kept failing injuring patients and crew (from what I understand; before my time.) I'll go hunting for a pic. - Matt

You're absolutely right and I knew better too. Blame it on poor editing and a plethora of acronyms in my day to day life.

Maybe they voted without reading the thread and understanding what was meant. I didn't vote until I'd read the whole thread and it turns out I thought you guys were talking about something else. Now I learned something disturbing in this thread. I had no idea that there were services out there that not only ran L&S to all calls, but transported all calls L&S. I don't understand why this is happening? Could someone in this sort of system enlighten me as to why you're dispatched this way? If priority dispatching is not used, does that mean that all responses are L&S or is another system in use that I'm not aware of? Crotch is right that we shouldn't be using dispatch CAD software to patch over not having enough resources. I still think we need something to determine how we respond to these calls. I doubt the public would accept an abandonment of L&S entirely, regardless of the evidence, heck I doubt many services would get behind it, so how can we best limit dangerous and unecessary L&S responses, if not by priority dispatch? And for FYI: We use a priority code dispatching system who name escaped me. Something with cards in the title. Technically it has four codes, but the lowest two are never used with 911 calls as far as I can tell. Code 4- Emergent (Lights with sirens as necessary to clear traffic, intersections) Code 3 - Prompt (No L&S) Code 2- Scheduled (IFT's. Some services rarely if ever do these no due to private IFT companies) Code 1 - Deferrable (Like urban legends. I've never heard of anyone actually get dispatched priority 1 outside of a disaster) Once we've made patient contact and are transporting, we assign a code for dispatch and a CTAS level (Canadian Trauma Accuity Scale) for the receiving facility. They're coded in reverse with 1 being the most severe. Usually only CTAS 1&2 will warrant L&S and I've had some CTAS 2's that did not. CTAS 1 - Resuscitation (arrest, pre-arrest, post-arrest) CTAS 2 - Emergency CTAS 3 - Urgent CTAS 4 - less urgent CTAS 5 - Non-urgent

Base hospitals have self-reporting lines as part of the QA process that allows Paramedics to report their own errors and work with Base Hospital to address any underlying issue.Beyond that I couldn't tell you much as I don't yet work for a service, so don't know the exact policies. If I made a mistake I would report it. In fact I think we need to copy the airline industry and start making it part of our culture to report all mistakes and near-misses in order to be constantly searching for ways to prevent them. I haven't yet made a medication mistake outside of class, and the one's I've made in class that I've caught I've always verbalized and attempted to fix as I go. If and when I make a medical mistake in the field, I intend to report it.

Despite Alberta's insistence on using backwards titles , their EMT is equivalent to a PCP under the Paramedic Association of Canada's National Occupational Competency Profile (NOCP). EMT-B will not be recognized as equivalent under the NOCP.

My preceptor's current partner is probably around 400lbs. He's a very nice guy but has provided some great reinforcement for my motivation to get healthier. I carry around 30-40 extra pounds right now that I've been working my ass off to lose. It's never posed a problem on any call as I'm young and my cardiovascular system does a good job compensating when demand goes up, but I'm not going to be young forever and I know that if I don't pick it up and lose the gut, that time will be even shorter. Obesity is going to be to North America, what AIDS is to Africa. A preventable condition whose spread is hastened by ignorance and poor decisions.

I think its a matter of projecting both confidence and competence. If you have any reservations about exposing a body part, the patient will pick up on this and feel uncomfortable. I've seen fellow students who approach every patient interaction with an approach that's a variation on "Umm... okay, ma'am what we need to do now, if that's all right with you, is lift up your shirt so that we can take a look for any problems, is that okay?" Even when the patient agrees, they often seem hesitant. For a variation on this, watch the various ways that students ask male patients to move their penis and testicles out of the way of the pubis rest on the sager splint. "Umm... sir I need you to get your... friends, out of the way so we can put this on you."

I have never not exposed an area being assessed. Only debate is whether I can pull the clothes out of the way enough or whether I need to undress, cut, etc. What drives me nuts is when people only listen to each lobe of the lungs once and when I listen I find their A/E so diminished I listen carefully for a few breaths to make sure I can hear any adventitious sounds. If you need to take the time to listen, don't rush. I used to see this with my First Responder students until I got in the habit of going to Value Village and picking up a dozen or so old t-shirts and pants per course so that they can actually cut them if necessary and I can get them bloody with moulage. Same with buying enough guaze and dressings so that they actually open them up and use them properly. Practice the way you intend to practice.

I actually feel like this a lot sometimes. Two years of school, and most of the time bed, oxygen and blanket is all I can provide. Gotta get that student debt paid down so I can go ACP.

The problem with DCAP-BTLS, is there's a box, that corresponds with a mark, on the testing sheets for any scenario I've done for school at for hiring. So in order to get good grades, you start beating the sheet whether you like to or not and before you know it, you've developed a habit you need to break. Verbalizing and thinking useless crap that you already know.

Interesting take. Is this based on an ethical standpoint of ethical egoism, or do you just have not sense of ethics whatsoever? Honestly, approaching life in this way is the cause of a great many issues and yet when this results in a lady dying on an escalator with people walking by, everyone is up and arms convinced that they'd never do that. Bullshit.

Oh well Spen that's just my surprise birthday gift being dropped off at work by my Aunt who lives near by. Seriously, in that case I'd hand it over to management and suggest that they allow the crew to suggest a charity. Also suggest to management that they issue a press release about the donation, asking the public to send any compliments or concerns about the service to their professional standards division (or equivalent). If the county has a policy that would prohibit donating this, then I'd suggest the service use the gift for an upgrades to the crew room at the base.

Ethically I don't know where I stand on this and what ethical principles may be at work here. As long as the gift is of limited monetary value, given in good faith without any expectation of consideration and not requested the issues I have become just a bad slippery slope argument of "what if's?" that aren't particularly helpful. Personally, I'd find it difficult to accept most gifts from a patient as I don't feel comfortable placing myself in a situation where I can be taking from them. If a patient were to ask what they could give my partner and myself, I'd recommend a donation to PAC's Paramedic Benevolence Fund. If they show up with a gift I'd suggest they donate it in the name of the EMS Service. Now there are some exceptions: if someone brings in some cookies to the station, I'd thank them and spread the wealth. I'd consider it rude to emphatically reject a small, thoughtful gesture like that.