WolfmanHarris

FAIL! While the delegation from a Physician to a physician extender such as a Paramedic is a key component of how EMS is practices in North America, if you have limited your scope of understanding to your protocols, you are a skill monkey, not a medical professional. Since you're not a medical professional I'm not sure you're qualified to judge on what makes an effective EMS system. Plus if you actually believe that FD should take over so MAST only needs BLS for transport and that LA has a great system to model from I question your perspective or lack thereof. I'd suggest you make an attempt to educate yourself and remain open to seeing where you are in error.

Please folks if they're looking for a department to copy, look no further than the beacon of light that is (your) Nation's capital. DCFD. District of Colombia Fire Department, where our motto is: "It can only get better from here."

Holy Shit Dust! I had to do a double take or two to make sure it was actually you. The word FAIL!.... appeared not at all. Fire Service .... not called Firemonkeys "monkey"... did not appear at all. Actually it was a very good summary of the stance of a lot of people on here. We should sticky it as an EMTCity primer.

Ow! The ladies must love when you roll up in that hot rod. I don't have a picture handy, but I drive a 2001 Chevy Venture mini-van that used to belong to my mom. Her business used to be advertised on it and I couldn't get all the letters scraped off entirely, so it's kinda marked. It also has a small Ontario Paramedic Association sticker in the window. I worry about my whacker tendencies though as the dome light inside has started flickering sometimes...

Actually I think I might get those. My business partner and I were talking about the best way to improve our first aid teaching business and both thought light were the way to go. I mean since we're already repairing and upgrading his old trailer to carry equipment we might as well replace the old electrical the make sure the tail lights work right. Don't know why you'd want them on your car though...

I don't disagree in terms of ASA and how often we get CP calls over anaphylaxis, my argument was more in terms of training and education that epi's an easier starting point than ASA in terms of contraindications, conditions, etc. If you've got them giving ASA and they have to do such complicated things as remembering NSAID allergies and making sure there's no active bleeds and being cautious if there's Hx of asthma and no previous ASA use than why not give them an epi-pen and show them "pointy end comes from here. This end goes into fleshy part. Don't stick yourself, their wallet or anyone else. Dispose of safely." I've shown eight year old how to do it on themselves... Anyways, like Richard said, New York's weird and NYC even more so.

Hey Squint, I think you might be suffering from something I was when I first read OPALS. The conclusions of OPALS seem very threatening to EMS providers as it seems to conclude that we're somewhat irrelevant and that the grand experiment of EMS will come to an end and we'll all go back to be Ambulance drivers. And yet, that hasn't happened? Why? There may be many reasons for this, but unlike you and Fiznat I have not read the entirety of the study. I did just download it and it's on my reading list for the end of the week. Either way, I think we need to look at this study as we would any other study as part of the ever evolving world of medicine, interesting. If we're not challenging and reexamining our role in medicine and how we do things we're stagnating and not doing ourselves justice as medical professionals. Think of it this way, if every physician resisted with fear and unease the concept of delegating medical acts not only would we not have EMS, but would nursing, RT or any other part of medicine look anything like it does today?

Weird. Sorry Richard, not picking on you, just found the whole thing confusing. If I was introducing meds into a BLS system I'd have put epi ahead of ASA (if I had too). It seems to me there's less room for mistakes with the epi for anaphylaxis than there is for ASA. I mean I keep a list of NSAID's above my computer and in my pocket on rideout/lab just to keep pushing memorization of them in case of allergy. On the flip side, I kinda like that at the state level they are maintaining a tight grip on scope. I get worried when I hear about BLS providers getting too much of an ALS scope with little to no further education through medical direction.

If this is a department issued vehicle shouldn't they be providing the appropriate warning and signalling devices for it? If you're having technical troubles remember that the costs of professional work on a vehicle is usually tax deductible for the business/department but "sweat equity" is not and it may be more advantageous for your department to take this vehicle to the garage for proper work. Improper light set-ups and alterations to the electrical system may prove hazardous if not done correctly and could negatively affect the department's insurance coverage. (What doesn't really) Or did you put FD on the side of your POV? A quick google search found a great deal of info on strobe boxes and light set-ups and took less than 30 secs. I don't support POV lights. A quick read over at Policeposers.com will find pages and pages of reasons why I don't. I'm afraid you may have difficulty finding a sympathetic ear in the case of the latter as the majority of the active membership here seem disinclined to whackerdom. However, there are many electronics and custom car hobbyists on the internet who may be better able to answer your questions.

You have to ask yourself then are you in this for the medicine and patient care or for the job? Either is fine, but just be clear on your motivation. If you want to keep your job secure above all else, than by all means resist change that might push EMS into a realm that's uncomfortable for you. You may also find the IAFF a useful resource for tactics. There's nothing wrong with self-interest. If you're interested in the patient care, than recognize that we've got a lot of growing to do in EMS in terms of education and our delivery models. If that means integrating PA's, NP's or other advance practice providers into EMS to help pull us away from "you call, we haul" than welcome that. Yes this might mean that we as Paramedics find ourselves in a system that we might not instantly recognize, but that's not necessairly a bad thing. Yes Basics and other BLS providers (myself included) might find themselve on their way out of EMS long-term, but that doesn't mean you can't increase your education. Realistically we're all interested in both to varying degrees. As far as Physicians on Ambulances, look up SAMU in France. Physicians are a big part of EMS over there, though that is changing. Traditionally BLS is provided by FD and hospitals have SAMU units that have a physician on board and handled ALS. Unfortunately a shortage of Physicians has resulted in them training RN's to take over ALS pre-hospital roles.

So now I'm really confused about the NYC system. As a Basic you can give neulized albuterol but not an epi-auto-injector for anaphylaxis? (Not even talking ampules here) What about ASA or NTG? What's the rationale here?

Seriously. The 40hr First Responders I train can recognize anaphylaxis pretty quick and thanks to Sabrina's law are expected to be able to get a patient their own epi-pen if the patient is unable to. If an EMT-Basic isn't already qualified to use this piece of equipment, then let's drop all the pretenses and call them Ambulance drivers. I know Basic education sucks, but I'd expect that giving them the epi autoinjector to use should not be a huge deal.

CTV News: Hospital Goes on Code Orange I first heard this as an interview with the ER chief who declared it on CBC Radio. After the ER got overloaded and ground to a halt he met with some other staff and decided that this required contribution from around the hospital to solve. He declared "Code Orange: Medical" and made sure the OR knew that it wouldn't affect them so continue with scheduled surgeries but it forced administration to take an active role in solving that problem.

So I was studying spinal trauma tonight and was using the ITLS text when one of their pearls caught my eye on manual in line stabilization. This threw me for a small loop as I'd always been told to apply gentle traction to relieve some of the weight of the head. So I dove into Bledsoe's "Essentials of Paramedic Care" and found my problem. It seems the wrong term has been injected into my education somewhere along the way and has stuck. But I knew I hadn't just heard it in one place. I've heard "gentle traction" used over and over by different instructors and providers and to prove I didn't imagine it I grabbed the Red Cross EMR text "Emergency Care Manual" and found on Page 225: So after this I'm left with one key question: what does traction mean? Does it have different meanings in different circles? Where might this problem of terminology have come from? - Matt Edit: Scratch that. I'm even more confused now. I reread ITLS and they don't mention any sort of force applied superiorly during manual stabilization. Anyone got any insight on which one to go with. My protocols are non-specific so I'd be looking for reasons for or against based on patho. I'm at a loss myself.

*Holds breath*

Good to know. I know the job market's tight, but I don't know if I'm so desperate to work somewhere that actively holding their company back. Odd that they can get away with it though with the way the private are being kicked to the curb these days by the municipalities. Royal City's gone, Windsor-Essex was consolidated, Lakeshore's been gone for awhile down Northumberland way. Thames and now Medavie in Muskoka are still around but both have excellent reputations. And didn't Sun Parlour used to provide for another community too? If I was a private EMS contractor in Ontario I'd be doing my best to convince my community that I could provide the highest service possible better and cheaper than they could in house.

We do 100 clinical hours in hospital and 450 hours on Ambulance in a two year college program. That's for BLS in Ontario. And the Aussies have got us all beat by a long shot.

Does this exist within EMS in the states or is this just "Ambulances" with EMT's running IFT's who are never within shouting distance of an emergency. Because in that case a lot of the private transfer services don't have AED's. But they aren't considered ambulances under the law and their are no regulations on them or their staff.

Didn't realize that even existed? So without an AED (and I'm assuming it wasn't an AED vs. manual defib question) what exactly do these providers do in an SCA? And yes our BLS providers here have LP12's or Zoll's with SAED, 3 Lead ECG, NIBP, SPO2, 12 lead and usually the ALS options that we just don't use without an ACP partner. (ETCO2, manual defib, pacing) I've only seen stand alone AED's with first responders and public access, never in EMS.

Ummm... as a government contractor they should be required to give access to certain stats provided they don't violate FIPPA or PHIPPA. Do you have a firm time limit for putting these together? Generally information requests have a long turn around time, especially when through government to a contractor. Any questions on this though should probably go through: Information and Privacy Commissioner/Ontario 2 Bloor Street East Suite 1400 Toronto, Ontario M4W 1A8 1-800-387-0073 Fax: 416-325-9195 info@ipc.on.ca Regarding Cric, keep in mind that its' an auxillary protocol under Ontario ALS standards. Now I could be wrong on this, but doesn't that essentially make it optional for the service and BH. This service might decide that it doesn't want to utilize some of these protocols and the County might take issue with some parts. So it might actually be in your best interest to draw attention to the possibility of phasing in cric, central venous access and IO. Think like a politician. These things scare them and knowing they have options might make it easier for them to swallow and feel like they have some options.

And I'll fix the jury through bribery. (Gotta keep the bases covered.)

Alex have you considered keeping your list relatively succinct within the body of the letter but then attaching an appendix which takes each ALS intervention and breaks it down in more detail so that the councillor's don't have to do the basic follow-on research themselves. Further, for the sake of disclosure, I'd attach at least the abstract of OPALS Study and other studies related to ALS. At first glance some of it may seem to shoot you in the foot (namely the SCA stuff), but since if they research it themselves they'll stumble on it quickly you can head that off at the pass. Provide a further appendix that has official (though non-binding) quotes from various suppliers on the equipment costs including comparisons from different suppliers/manufacturers. I think your letter is excellent, but I've been in front of a committee trying to convince them to spend money and change how things are done and I found the most effective approach was to anticipate their questions and have them all answered ahead of time in as much detail as possible. They may not read it, but it's there in front of them if they're looking for it. Finally, if you get the chance to go in front of the council on this, prepare a presentation which expands on the high points of this and consider bringing in some experts to talk the talk. For this I'd suggest contacting the regional base hospital for a representative to talk about how ALS works on their end, perhaps a local ER doctor who can speak from the other end and maybe a representative from the OPA. I'd be wary about approaching the union as they view things from a different perspective and may be in favour of ALS but may stall the discussion in terms of contract negotiations and pay. I'm really interested to hear how this plays out. Best of luck and let me know if there's anything else I can do to help. - Matt

Oh and I meant to add initially, good luck! It boggles my mind that we as a province have taken so long to spread ALS into the rural areas and that so many areas are still waiting. In my opinion these are the areas where ACP's can do the most good.

If your service is already using the LP12 or the Zoll E for PCP's there shouldn't be a huge cost then would there? I mean nothing that would end up under capital expenditures.

Why do we want to take one under-trained, low requirement job and replace it with a lower-trainer even lower requirement job? If someone's lost their job and doesn't have more qualifications than a hundred or so hour job, they might just have to go to McDonald's until they can take the few weekends to become a Basic. Now in terms of the plan itself... who are you hoping to help? Giving cities and counties an out to pay less for a service they don't care about or understand doesn't help anyone but the politicians who can tout out those savings and how they've managed to cut costs without cutting services with the remarkable thinking. I don't see how this helps providers at all. Also I've never known a government to get rid of something in bad times only to bring it back when it gets good. Once they're allowed to save money by putting totally untrained people on the Ambulance, why would they be inclined to pay more in good economic times?