WolfmanHarris

You know, I've never felt the inclination to watch porn with a bunch of other guys in my workplace. A bunch of girls? I'd consider that, but probably not at work.

Both numbers might be right depending on the operational definition. To hospital? To discharge? 12 months post discharge? 5 years? neurologically intact? Survival from SCA has got to be one of the most varied definitions I've ever seen. What they all have in common though is significant increases in success for bystander CPR performed immediately and early defibrillation. The other thing they all have in common is that most people who suffer SCA stay dead. So regardless of which numbers are correct or which study you look to, yes I believe that access to that AED would have increased the chances. Might not have changed the outcome dead and alive is still an all or nothing proposition.

I'd say the implication of that statement could be interesting depending on which way you take it. Do you take emergency to mean run hot to everything. In that case I'd disagree. If we take emergency to mean maintain a high index of suspicion for potential complications and to assume that a condition is the worst possible until assured otherwise, than I would agree. Provided, it means exercising clinical judgement and not just making everything load and go, doing procedures "just in case" and running diesel therapy wide open. Taken one way, that line is an excellent pearl of advice for a provider, taken the other it throws good sense and judgement out the window.

Would it be taking a spot that could be better used by an ALS provider/student for me to register? None of the skills mentioned are within my scope and I'd hate to take the opportunity from someone who could make immediate use of the practice. Otherwise I'm looking at taking a day or two off to drive down. - Matt

Seriously?! All right let's toss out computer aided dispatch and coding responses. Everything gets Code 4, L&S and while we're at let's blow red lights to make sure we shave seconds off. I know the dispatcher said it was a stubbed toe, but what they heck everything is an emergency. Come on man, pull your head out of your butt. You know you don't believe that anymore than I do. And if you'd read the article you'd notice that the point wasn't the minority of calls are immediately life threatening and the rest are not; it was that 911 is tied up with honest to goodness bullshit. (example: "My keys are locked in my car") Yes not all these require or will get an Ambulance response, but they tie up resources all the same. Don't tell me that the student with dick all in road time gets this better than you. "As 911 providers..." I've taken it to assume you meant EMS providers. I know my cop friend isn't putting the noise complaint ahead of the sexual assault or the officer needing assistance. I know my friend in the Fire Department isn't rushing to the CO check (when the family's been told to leave the house) the way they're rushing to a structural fire. Why, because not every 911 call is an emergency; every 911 call is a request for service from Emergency Services. Yes every call is an emergency to the person calling and as caring providers we must recognize that, but that's not what this is about. - Matt

And their smelliest cargo comes packaged for them for easy transport. No fuss, no muss. Ya I'm with the others on this, asking for more reimbursement as the route to better pay and the like seems real cart before the horse thinking. It also begs the question, why would increased revenue for a service result in increased pay/benefits for staff? Any private company exists to make a profit first and even the best employer is going to relish the chance to make more. And as we all know, EMS is not currently overrun with the best employers. That's not to say that FD, 3rd service, volunteer or any other non-profit model would necessarily see increased pay as being top of their list with increased revenue. Budgets are set within government from the total taxbase and money making departments fund those with zero revenue (for example, parking tickets partially parks or something). How many VFD's out there have a new apparatus every few years with all the bells and whistles while still paying nothing to their staff? Where's the motivation? When they can have new medics in 13 wks (which by the way, I did not know was possible. I knew education was shorter in alot of the US, but did not realize it was the extreme some places) why work that hard to keep them for a whole career? Sure individual services might take turns increasing standards to attract staff, but as a whole, I can't see how it would affect a sea change in the industry. It seems (and no offense intended to my respected elders) that behind the services themselves which see increased education as costing them more money in the end in wages, that the next biggest group against education are those that went through the current education system and turned out "just fine." Those who worry that if education were increased because its needed, then by implication they must NOT be doing well enough.

The ambulance isn't really "gear" like "hey wouldn't it be cool if this monitor had gizmo xyz?" The Ambulance is where we spend alot of our time and where all our patients end up. They're also not particularly safe for us or our patient's. Proper driving, not blowing lights and laying off the L&S will help alot, but we really do need to take a long hard look at safety standards and vehicle design. Fancier lights, louder sirens and foams padding on everything in the back all look nice and are incremental improvements, but I haven't seen any groundbreaking rethinks on vehicles. Personally, if I had ONE thing to chance, I'd agree with you and change the education end of it. If I had five, new thinking on Ambulance design would be in there somewhere. - Matt

Hey man, no one is knocking that FF/PMD isn't a sweet job if you can get it. Man if I could join one of those services in the states that run ALS engines with no transport. No offload delay, no transfers, lots of hands on the engine to help but not as much lifting. Good pay, benefits, 2-days on 5-days off, work as a contractor on the side for more big bucks, bask in public respect and enjoy the fruits of more than a century of hard fought gains by the unions. Sounds like great work if you can get it. Here's the problem, keeping these jobs is at the cost of allowing EMS to make its own gains and establish itself the way Fire did. Fire broke away from private insurance companies by the turn of the 10th century and found its feet as its own profession. It was free to increase its standards for training and equipment and in the process a mature well developed Fire-Rescue system was created. Just stick to that and let EMS do the same and break away from it's tangled roots to find its own place to grow. You're right, private EMS does not, as a rule do well by EMS either. But you may have noticed that no one here has argued that EMS was perfect and that Fire came along and broke it. What is being argued is that EMS is a the cusp of redefining itself, not by the toys we carry, or by cardiac arrests and MVC's, but as prehospital health care. For this to happen, the EMS system must shake off any factor that will prevent this. Whether this be a medicare/medicaid billing that discourages a service from exploring public health issues, prevention or other aspects of primary care. Or volunteer squads which keep us latched to decreased education standards and low pay and no benefits. Each provider model on its own has its problems, the patchwork of providers models only serve to bring these problems together and give us a system destined to stagnant, restrained by all these countervailing stakeholders. The upshot of all this is not, that Fire Departments are evil or that the individual providers are not doing the best they can at MFD. It's that as a system this combined provider model will plateau EMS right here. - Matt

Find a better way to prove it than that. Or be proud of it. Righteous indignation isn't going to get you too far. I like the pants and have been considering buying them. Yes to some they may make me look like a whacker. Who cares. I'll let my actions speak for my competency (which is still developing), take the ribbing that goes with flashy pants, or too much crap on your belt, or whatever whackerish quirk some medics have (and as a student/newbie I expect to be ribbed on anything/everything). Whacker's partially the gear, the junk and the t-shirts worn 24-7 but I'd say its mainly an attitude. Excellence can make up for the little crap and good humour will let the rest roll off your back. - Matt P.S. Remember, there's a fine line between keener and wiener.

I might take the age thing personally if you weren't bang on in the majority of the cases.

Fair enough. Went with the first thing that came to mind.

I'm impressed. Way too often people come on here looking for the quickest way to get into EMS. Good on ya for doing it right. All those extra steps will pay off big time and make you a far better provider.

I'm not doubting you on this, but that's the problem with anecdotal. I just pulled up circuit city vs futureshop on the same model 32" Samsung LCD Circuit City (US) $849 Futureshop (Can) $699 (these are both without any of the random reductions in their mark-up) Looked over at DVD's and they seem about the same. For example "Tinkerbell" is $29.99 in both placed for the movie that will delight your kids and drive you nuts as they watch it again and again... Anyways, I digress. I'll have to do some more checking into this stuff. Don't know why it interests me so much at the moment. Long story short, some of us are lucky and get a living wage from EMS. Others not so much. Hopefully we as a profession can one day help pull these guys up so no medic's making $10 bucks an hour.

I know our taxes our way higher than down there and cost of living is different everywhere, but can someone help me lay out some estimates or purchasing power parity north and south of the border. My fiance makes $10.75/hr in an unskilled retail job. As a PCP (BLS) I stand to make around $30.00/hr working 12's, 16 days/month Gross income is $69120 An ACP (ALS) stands to make around $35.00/hr working 12's, 16 days/month Gross income is $80640 Taxes for combined federal and provincial income tax equals 25.97%. That's without any other deductions such as EI or without any writeoffs and the like. So it's a rough number at best. But based on this I calculate a take home of PCP - $51169 ACP - $59697 This is where I get confused. Everytime comparative wages between the US and Canada come up for EMS, the whole take home and cost of living argument comes up and I'm told that realistically we make about the same above and below the border. This seems hard to believe. Am I missing something? Because from where I stand alot of you guys and gals are getting hosed on pay down there, even after our huge taxes.

It seems that by shifting the patient's being boarded to the unit they'll be eventually staying in the problem of bed shortage becomes a small problem for one department not an overwhelming problem for the ED. Imagine CCU having two patient's in their hall, being seen by their staff who want to find them a proper bed. They have patient contact, the staff treating them are part of their definitive care rather than the ED while they wait. These staff now have a face to the two beds they have to free up, not just a phone call from downstairs. This seems better than keeping a dozen patients in a crowded ED with the staff there responsible for pushing for space for them. It puts the people who know the needs of their department of what they have to deal with in charge of finding the spots on their unit rather than someone from outside pushing them to accommodate.

Thanks for the links there was some excellent insight in there. Up here very few FD's have made an active effort to take on EMS. Some services have a combined admin with two divisions but that seems to be working okay at the local level. City of Kawartha Lakes was an amalgamation of a bunch of small rural towns around the medium sized town of Lindsay. When they amalgamated all the VFD's and EMS were brought under CKL Emergency Services, of which EMS is one of two divisions. From what I understand it's worked well for a few reasons. The townships no longer have to pay for duplicate administration for each VFD. The FF's are volunteer and seem quite happy to stay that way. The Chief of the EMS Division isn't an FF and the overall chief lets him run his own show. Once again, here's what I don't understand (nor do I expect to). I read the Berkley site right through and read their justification for PMD/FF's and how it was based on strategic placement of Fire trucks and response time. My first thought was, couldn't an ALS transport ambulance be placed at each of these same stations, have the same response time and much quicker to hospital time? I know, it seems almost too easy. I've said it before, I like Firefighters. I like cops too. Ditto for nurses and doc's. Heck the garbage-man and my mailman are both quite friendly. It's not about knocking the waterfairies, it's about knocking the people who make the decisions and try to feed these lines of BS to us on behalf of them. And about those FF's who buy the line hook line and sinker. I can at least grudgingly respect those who know they're only doing it to protect they're jobs.

Need to make medevac less of an obscene money-maker to remove the motivation for every Tom, Dick and Hospital to buy a chopper. I wish I could remember the numbers, but Bledsoe had an excellent example with University of Michigan's chopper. With that sort of profit margin... man!

Sorry Dust I should have been more clear. I understand why someone would want to dump the routine calls on someone else in lieu of glory and excitment. I see that crap in school everyday with the trauma junkies who tolerate the calls that involve more compassion and less toys and that barely. There's more than enough medics with this same attitude, they just don't get out transport when they drive an ambulance. The main thrust of my question is how does any organization get approval for an ALS program that sees Paramedics arrive in a non-transport unit, extend their scene time while a transport unit waits outside and then sometimes not even put a medic in the back handing off to a BLS unit. Even more senseless, having an engine and ALS ambulance respond and have the transporting medics wait. I mean someone has to approve this system at a government level and while I don't vouch for the intelligence of any elected official, I can't see how this could pass muster. So... how do these system sell this? What's their pitch?

Okay. I've never understood the areas that have fire based ALS, but not transport.

Don't forget hose jockey or waterfairies. I wasn't clear from your post, does your department transport too? It seems to me that if an FD is providing first response for a transport ambulance, they should only need the first line, time sensitive drugs. If they have time to run all their algorithms for all these different drugs, getting the 12 lead, starting the lines and all that, I'd wonder why a transport unit is taking so long to arrive and take over.

Dr. Tober wrote an excellent, well thought out and reasoned letter there. I have very little to add other than my thumbs up. I hope things go his way down there. Interesting to note that despite all the previous arguments around here about FD holding back EMS training we have a big example of a department wanting EMS but not being willing to do EMS. The medical director provides them with criteria to run ALS engines under his license and they say its "too expensive and too time-consuming for them to comply with." Case in point. This might not be all the departments out there, but its enough and it really hurts the case of any FD that might be committed to running EMS for the sake of EMS. (They may exist out there somewhere and I'd rather not wait for the exception that disproves the rule) Other point of discussion, if he's going to give FD drugs for an enhanced BLS response, why not drop amiodarone and atropine, removing a lot of the need for Fire provided ECG interpretation. Put nitro and ASA on the engine instead? I hate second guessing a physician, but aren't these the frontline cardiac meds. Also what about Salbutamol and Glucagon? In other words why these as the drugs that stay over others? BLS here gets nitro, ASA, glucagon, salbutamol and epi. - Matt

State government eh? Sounds like these straps should get conveniently lost. Replacement seems to be quicker alot of times than convincing someone in an office to send them back and get the right ones. Just toss the straps in an unlabeled box out of the way so they'll still be there when they're needed until the new one's come in.

I come from a family of Master Plumbers (Grandfather, Dad, 3 uncles). A good, actual plumber is a highly skilled, well paid trade. In fact a Master Plumber in the City of Toronto currently charges $100/hr labour due to shortage and demand. I could make far better money in the family business, but chose EMS instead. Sometimes I wonder about that. There's some crappy plumbers out there and hopefully they make money that reflects that.

What provider model does Taunton use at the moment?

That's a good point. I wonder if it would be possible for a department looking to meet a staff training need like this to establish a specialized program, but that remains directly affiliated and run through an accredited college as a combination p/t and distance education. That might also decrease the start-up costs for the department that may only be looking at maintaining their program for three years, and therefore may not want to invest significant funds into equipment and facilities and resist the urge to then turnaround and create a certificate mill to justify the costs of starting the program.