WolfmanHarris

Looks official on Slave Lake. My little bird was a link on PNN. I hope those gals and guys get some help on pay; worst time of year to be short.

I feel sooooo much better about my "Mighty World" Ambulance that sits on my desk. And slightly less better about driving it around my homework with the L&S on.

Wow. Just wow. When is a fire truck not a fire truck? When it's got nothing to do with a fire service. (Not a great punch line)

Just BLS or BLS and ALS?

I didn't really fall for this patient, but she was an incredibly frequent flier due to narcolepsy and cataplexy combined with being a stressed out 1st year university student. The condition was really screwing with her life, but she was incredibly well adjusted with it. Just a really pleasant person to be around and one the few times her condition had some severe complications I realized that I cared more than was entirely professional. Too many interactions had blurred that line but that was as far as it went.

Look at the rest of the pics in the album. If it's a joke than only the Ham radio guys get it.

Sounds like the sort of thing that while useful, would be so infrequent that when you might need it, you've forgotten it even exists or where it is. Like one crew I saw when they were asked to set up the "Pedimate" for another crew on scene. There was a long "ahhhh. Right."

So a quick google search to make fun of that flashlight created a monster. I'm finding that looking at whacker pics is both horribly disturbing and hilarious at the same time. So rather than totally jack the thread I decided to start another one. So let's see the worst of the worst! [web:ccaf4d5586] [/web:ccaf4d5586]

I popped "Whacker" into Google. I was both entertained, scared and then horribly depressed. It's been an bit of a roller coaster over the last five minutes. HAMsexy Oh wait. This is the perfect vehicle to put your flashlight in. (Look closely and read the side) Or this one. [web:b9de9cc198] [/web:b9de9cc198] Done editing. Gonna cry a bit now; maybe throw up. [web:b9de9cc198] [/web:b9de9cc198]

I know I read that. I barely understand more than one service under the 911 umbrella for the same geographic area, let along multiple volunteer services in a major city.

This is the company that some services in Ontario are using for pre-hire assessment. It still remains to be seen whether it will take off and replace traditional lift testing, be combined with it, or go the way of the do-do. I favour a combination of the two with a PAE (the test they run, can't remember the exact acronym) every couple of years. Ability Works The first service they used this for (Windsor I think) there was some concern from their HR over how well it would predict a candidate's ability. So the results were not binding on hiring and even the candidates who failed were hired. According to the company the 3 candidates who failed all suffered lost-time injuries within 2 years of hiring, one career ending. Hardly impartial research though.

Now I'm more confused than anything about VEMS. What are volunteer services doing in NYC or any other major city? This is an entirely alien concept to me.

So are you in favour of setting a standard? And what would you base it on?

I think more important than weight may be reevaluating lifting ability. I've seen medics who barely passed their lift tests in school when working out daily, letting this slip and picking up poor lifting habits as their strength decreased. That's not to say that weight is not a problem. It's been an on and off struggle (currently on) for me since undergrad. I worry about how it will affect me on the job, not so much in my ability to treat my patients (I am nowhere near bad enough that my weight would get in the way of any procedure), but in how it will affect my back long-term. I also want to be able to set a good example for my kids (when I have them), so I might as well start by setting an example for my patients. I've been working hard to increase my cardiovascular health and drop the extra weight. The question then becomes, how do we as an industry best deal with our own fitness? Is it better to set a weight limit or to set a standard for strength and fitness? I'd pick the latter. Do we want to discipline/suspend/fire those who don't meet a standard or do we want to find ways to encourage such as facilities to work out in the station (available outside of work), gym memberships, etc? On this I think we need the latter with a bit of the former to give it some teeth. But let's be honest, before any of this could work, the members of the service need to commit to making it a priority in themselves. Without that intrinsic motivation it will be difficult to get anything moving and people will aim for the minimum standard rather than seeking to improve themselves. Without support from the staff it becomes another high-handed management down initiative for people to avoid. - Matt

Would it help to avoid being bogged down in semantics if we used the term diagnose interchangeably with "field diagnosis," "working diagnosis," "findings consistent with," "best educated medical guess," etc? That way regardless of whether you believe our assessment and treatment decisions represent a diagnosis or not we can discuss the issue at hand on the same page.

Ukcanuck, your best bets are to go to www.ambulance-transition.com which has a library of all the MOHLTC documents. There you'll want to grab BLS Patient Care Standard, ALS Patient Care Standards (even as a BLS provider all of our SAED and SR protocols come from that document, the Ambulance Act and the new DNR supplement (which I think is up there). That should cover almost everything you'll need to know for reciprocity as far as protocol and medico-legal. I'd also suggest a browse of the Highway Traffic Act for the sections on emergency vehicles. Hope that helps.

So with the way the academic year fell together I have a full month off. I'm visiting family and relaxing but I'm also studying. Mainly going back and reviewing A&P from last year. But I'd also like to break away from the textbooks abit. So... I'm wondering if anyone has any good journal articles that they're able to send my way that they'd recommend for holiday reading? Doesn't have to be EMS related. Anything you think would be beneficial. Unfortunately it would have to be full text (which I know makes it hard) as I no longer have access to my University library account and my college one is not so good on the journal subscriptions. Thanks in advance and Merry Christmas! - Matt

But you're calling for direct supervision. Once again we're in agreement about the need for better system quality improvement. I don't know for sure that we're in agreement on education, but I hope so. Where we're not in agreement is over your solution to the problem and I don't think its for lack of understanding of your perspective. I just don't think it's the way to go for all the reasons listed by myself and others above. If you want to put the management types to work, put 100% PCR audit on every refusal. That will not only increase the accountability by the providers without creating management undermining them on scene, but help establish trending and reporting system wide.

So we're back at not being able to trust the on-scene providers to act in the best interests of their patient's medically. Using a pretty wide brush their to cover up incompetence and laziness when there's better ways to deal with it. If the provider is compelling refusals from patient's inappropriately, they're probably also doing other things wrong and should not be working any longer.

Your point is? The fact that they do this doesn't support your assertion that there needs to be a supervisor on scene for refusals. I think maybe the waters are being muddied a bit from the original topic on refusals with the medical error stuff we're talking about in the DC thread. I agree the FAA has some concepts that could be copied into EMS, but it's not supporting your argument here.

Aside from a vague idea do you know what the FAA does while the plane is in the air? The FAA inspector doesn't call up during a flight to confirm a course change nor do they sit in the tower and confirm the ATC's direction. People are left to do their job's while working because if they're not, stuff goes wrong and people die. The FAA sets regulations, it isn't an all-seeing back seat driver of the airline industry. (Though we do have a lot to learn from the FAA in error reporting) As per wiki (this is what they do) The Federal Aviation Administration's major roles include: * Regulating U.S. commercial space transportation * Encouraging and developing civil aeronautics, including new aviation technology * Issuing,suspending,or revoking pilot certificates * Regulating civil aviation to promote safety, especially through local offices called Flight Standards District Offices * Developing and operating a system of air traffic control and navigation for both civil and military aircraft * Researching and developing the National Airspace System and civil aeronautics * Developing and carrying out programs to control aircraft noise and other environmental effects of civil aviation As per the FAA this is what they do [web:afa635fe8e]http://www.faa.gov/about/mission/activities/[/web:afa635fe8e] If you're going to draw a comparison, do it right and make sure it fits. In this case it doesn't.

Congrats!

I think you're missing the point argued by most on this one Crotchity. No one's really arguing that the supervisor should be kept in the dark, or away from the scene b/c they're all afraid of being found out to be lazy incompetents. What's being argued is that the Supervisor is a blunt instrument that may or may not address this problem, while proper education of the provider and proper informed consent of the patient solves multiple problems. In the end there will still be refusals that should go to the hospital, but like has been said before, people have the right to be stupid no matter how sick it makes them. We can only seek to reduce these and prevent inappropriate refusals. Increased supervision won't solve the problem of lazy incompetent providers, it will only force them to seek out other avenues to avoid work.

I'm not going to say "saved lives" in this post as I believe that narrow a definition is incredibly difficult to examine with the record keeping available. Now if we want to talk about medical errors and the complications or worsened outcomes they cause, that's different. That involves less necessary proof. Take for example Kaisu's recent case, despite the medical errors made by the FD medic in that case, Doczilla's opinion is that the Pt. was likely going to die regardless. So we can't with certainty say that the medical error caused a death, but we can say it complicated the situation. So would having a supervisor present at a refusal result in decreased medical errors. Maybe. But I don't see the supervisor showing up, doing another thorough assessment or anything else medically relevant. So their role becomes to flex muscle and make things look serious. I can see the odd patient responding to being overwhelmed by opinions, but I can also see patients digging in their heels with a crew that they've refused transport from hanging around waiting for a supervisor to come in. Don't you think we'd accomplish more by ensuring that providers are educated in refusals and am able to fully inform patient's of the risks and take the time to try to convince them. The flip side of this being that when the education is there, not only will EMS realize the importance of convincing some patients to accept transport and treatment but will then be able to refuse that transport when warranted. For the life of me I cannot remember where I read the study reference or even if it was a peer reviewed study, but I read somewhere that when Pt. were fully informed of the risks associated with refusal and given time to reconsider, many changed their minds and accepted transport. I will keep looking for that study, if it exists. In the meantime here's a quote from a Jems article (not the best source sometimes I know) I found in the same google search. JEMS article As for medication errors, that's a different situation all together and won't be solved by having a supervisor on scene and perhaps should be left to another discussion as they're very different animals. - Matt

Exams are done and no school until Jan 12. So I'm studying and killing time until I go visit family on the 23rd. Plus I can't take credit, they're all ripped from other sources I remembered.