jw-c152

I'd say I've had an unusually busy set of night shifts this past weekend... I don't believe it's because of full moons or other superstitions though. Maybe it was all that turkey being eaten (Today is Thanksgiving in Canada). I didn't work last Halloween, but the year before we weren't very busy at all. Let's see what happens this year (working night shift).

Timmy, in your list you stated "Airway - Advanced Laryngeal Mask Airway" Then you went on to say EMTs intubate. LMA and ET Intubation couldn't be much further from the opposite ends of airway management. The LMA (or plastic vagina as it is known as here - for it's shape!!! Heads out of the gutter...) isn't used very much in the pre-hospital setting (offhand I can only think of 2 services (PCP [bLS]) in Ontario that use this device. I used to work for one of them, and used the LMA a handful of times on VSA patients. I'd say it was better than an OPA but not nearly as reliable as an ETT. That said, I could see an EMT-B being trained in using an LMA... but if an EMT-B is intubating patients then that's quite scary.

I've had the unfortunate experience of smoking a moose in an ambulance... It was not fun, let me tell you! Myself and partner made out okay. Moose did not. Happened in Ontario's Algonquin park when I worked for one of those semi-northern services. John

I'm involved in an organization that does similar Capacity Building missions in 3rd world countries. Check em out... www.dmgf.org It's run by a Toronto medic. All team members are either Paramedics, Doctors, Engineers (Water Purification), Police Officers, Nurses or Firefighters. The team runs pre-planned capacity building missions (training EMTs and Doctors, building schools and hospital buildings, organizing the donation of medical supplies, etc) but also has a disaster response mandate as well. The most recent deployment was to Lebennon following the recent violence there which left numerous citizens homeless. Good luck with your adventure in Nepal. Like Dust said, it'll change your whole outlook on life. Cheers.

Although I have not taken an ACLS course as of yet, I didn't realize this was a new procedure... Heart and Stroke Guidelines (here in Canada at least) for CPR - Unconscious FBAO have had 'chest compressions' rather than abdominal thrusts to clear the airway for over 5 years.... I don't think that concept is anything new.

Our service uses strictly Demers ambulances, but we don't have any of the Millenium model - we only have the Mystere Type III trucks, which I really like. I'm not aware of any service in Ontario that uses the Millenium model... but they definitely may be out there. Cheers.

As far as a national service... The Netherlands is about 41.5 thousand square kilometers. Canada is over TEN MILLION square kilometers with ten separate provinces and two territories which cover everything from the flat plains of the praries, the Canadian Shield, Mountain Ranges, Arctic Tundra, the Badlands of Alberta. Based on size alone a National EMS service in Canada would be next to impossible. Besides, a National services doesn't necessarily mean a Better service. You're comparing apples and oranges.

Wow, my head is starting to hurt from this repeated banging on the wall. This discussion was over a long time ago. Let it die.

Cost

I suppose I might think about the 'what if's on the way to some calls... but for the most part I don't. If i'm driving, I'm more worried about getting us their safely. If i'm passenger, I'm more worried about finding the street in the map book. Usually the extent of my trying to predict what a call will be like based upon Dispatch info is deciding which equipment I need to take with me right away. Cheers.

My service just replaced the Zoll M with Zoll E Series monitors (just 3 days ago!). I have yet to really have an opportunity to use the monitor other than once on a chest pain call. I will say that the quality of the 12 lead was superior to that of our old M monitors - But that could be attributed to the fact that the old monitors were 6 years old. Our service has not installed the NiBP option - all are done manually. So far I'm not overly impressed with the E Series - mainly due to the size/weight and 'awkwardness' of carrying it and lack of storage space. I can't speak off any technical/performance issues d/t only using it once so far.

So you know how you always get a good chuckle when you see a picture in the paper of paramedics or fire fighters giving a dog oxygen after it was pulled from a fire.... You know who did that tonight? You guessed it! Pooch made out okay! Hopefully no pictures in the paper to laugh at though Later.

Wow, Hammer... I take it thinks aren't hunkeydorey out in Steele Town.

They are certified to perform SR/Defib and do everything else a PCP can. The only difference is that they do not have their EMCA certificate. No different than the TO guys you mentioned. The difference is only in the uniform - 1 stripe whereas AEMCA certified gets 2 or 3. I believe the era is coming to an end shortly where 'grandfathered' medics will be allowed to work in the province. We only have 2 as far as I know. John

Durham's striping is actually like this... One bar - Grandfarthered Non-EMCA certified Two bars - PCP Three bars - ACP Like the rest of the province except TO and Air we have no CCPs. But that brings us back to the point earlier in the topic where those One Bar's are still paramedics by law... Cheers.

There are muchos newly graduated paramedics and not too many jobs in the GTA right now. If you're willing to go north you may have a better chance of being hired. The GTA services seem to go in cycles of lots of hiring for a couple years, then very little for a couple years. Perhaps by the time you graduate this will have cycled around again. When I graduated 3 years ago I had a full-time job offer with my service of choice and a part-time job offer with another. I took both, but now only work the full-time spot. Don't worry about driving/direction issues at this point. Even if you have never ever driven Toronto streets you will quickly learn if you are hired there. I wanted to work for TO when I first started school as well. Unfortunately at that time there were issues with Preceptoring and then SARS and other concerns, and the way Toronto treated us as students (after promising us this and that) turned me off working for them. If you want to work TO or Peel, that's great, but go through college with an open mind about other services as well. There's a lot of great ones out there. If you're looking at wages, Toronto and Durham are pretty much the highest right now, but the others may catch up by the time you graduate. Have fun in college, good luck. Maybe see ya on the road in a couple of years. later.

No where in this post have I stated that forcing yourself to stay awake is an acceptable solution. In fact, this whole thread is about ways to prepare yourself for night shift so that you will be rested and prepared to work nights so you do not have to force yourself to stay awake. By actually contributing to this thread instead of posting smartass comments you will be a part of helping ensure people are not driving to calls tired. Thanks to everyone for your thoughts. john

Thanks Nate for the typical American answer.. sue sue sue everybody for every little thing... Very helpful, thanks.

Dust: All of the services I know in Ontario work on a rotating schedule. My service does have a few "Day Cars" which work strictly day shifts. However, the PCP "Day Cars" are primarily transfer vehicles, and the ALS "Day Cars" are hard to get onto due to seniority (which I only have 3 years of). Would be nice to avoid services with rotating shifts, but here it's not possible. john

My strategy seems to work for me... I'm not new to working nights... I'm just over 3 years on but I'm finding I'm starting to get more and more tired already. Thanks for the suggestions... keep em coming. And yes, I do love coffee.. MmmmMMMm Timmy's jOHN

Hey everyone. I'd like to pose a question to you all. How do you prepare for your first night shift? Tomorrow night I start my set of 4 night shifts (12 hours, 8pm-8am). I work in a busy service where I am likely to get no rest/sleep time while at work. To prepare for tomorrow, I will try to stay awake as long as possible tonight in order to sleep most of tomorrow then hopefully I won't be too tired. What do you do? Thanks----John

For starters, place her in a lateral position and insert OPA to help maintain airway (NPA if the OPA won't work d/t the seizure). High concentration O2. Meanwhile gathering some history on the patient. Does she have Hx of seizures? If yes, what meds does she take for them and has she been given anything during this episode to stop the seizure. Other Med Hx and Rx. Is pt pregnant? Any allergies. Anything in the room to give an indication of what could be causing the seizure if no Hx of seizures (ie. drugs/alcohol/etc). Find out from husband how much the pt weighs. Who wants to take it from here?

Interesting... personally, I went to Centennial. We had our problems with the school as you would anywhere, but I think we came out Okay. I certainly don't feel like I didn't learn all the matierial we are supposed to know. As far as ride-outs... I know a lot of students think that riding out in Toronto is the thing to do. I was like that in first year as well. Then some things happened (TEMS FTO's began to refuse taking students, SARS, etc.) and I ended up riding out in another service. I had a great experience in the other service. I was at a station that was running 8-10 calls per shift on average, much shorter offload times. I was in an urban centre that also responded to rural areas, so we had a number of serious MVC's with some good trauma. So just food for thought... Bigger (ie. Toronto) isn't necessarily better. I'm not saying it's not a good place to be a student, but in my experience I came to realize that I may have gotten more out of riding out where I did. I may be a bit biased though... I'm now working for that service. Cheers.

Just thought I'd make a post from another Ontario point of view. Acosell, for this post I'm going assume you're a PCP (like me!) If not, apologies, please correct me. Without reciting word for word, here's the provincial Primary Care Paramedic directive for Hypoglycemia. --Indications - patients who exibit any of these SERIOUS signs and symptoms: agitation, altered LOC, syncope, confusion, seizures, symptoms of a stroke --Conditions - patients who have a suspected BS level less than 4.0 mmol/L -- Contraindications, etc. So, as a PCP in Ontario, you would have to have a patient with one or more of those serious symptoms, plus suspect they are hypoglycemic in order to perform a BGT. I know all Base Hospitals have slight variations in medical directives, but I believe most in Ontario follow the provincial directives fairly closely. So in this case, if your auditor is a 'By the Book' kind of guy, he could rightly say that you may have deviated slightly from the directive. Personally, I don't think it's worth being written up for. Perhaps on that call I would have done a BGT as well, but I can't say. I wasn't there. ACP's on the other hand are different. Their scope is much broader and are not restricted as to when they can check the blood sugar level of a patient. Cheers, Later.

emt123, I believe your question is a matter of symmantics. You are correct that only patients in pulseless Ventricular Tachycardia and Ventricular Fibrillation should be defibrillated. However, I believe your confusion is over the function of an Automated External Defibrillator (AED). When you use an AED it is not your job to interpret the patient's cardiac rhythm. You do not need to know if the patient is in V-Tach or VF (in fact, most AED's won't even show you the rhythm) because the AED interprets the rhythm and determines if the patient should be shocked. Yay for technology. When told by your EMT-B class that you should "use the AED on all breathless, pulseless individuals" what they meant is that you should APPLY the AED to all of these patients. The AED will then decide whether or not to shock. It will not let you deliver a shock if the patient is not in VF or VT. So yes, only VF and VT should be shocked, but as an EMT-B or any other member of the public using an AED you do not need to determine if you should shock or not. Apply the AED, follow the instructions on the front of it and all will be well... Except perhaps the dead guy. Hope that helps a bit. Later.