akroeze

Well to be quite honest I got completely demoralized after talking to some people in the know. Apparently the municipality a few years ago commissioned a study on the implementation of ALS. The numbers were even better than the ones I came up with and they unanimously voted against it. Frankly, it makes it difficult to go ahead with something that could potentially give you a black mark in some people's mind when the odds are like that.

You'll fit in here very well. Welcome

Not ignoring anyone's posts here but my time is limited tonight. I do want to address some things however. All this information I quote as far as scope of practice etc is based on the service right next door to us which is under the same base hospital. They do crics, they carry all the drugs, they do every optional procedure. I'm going with the idea that BH would likely have this service also do all the procedures/drugs. Those saying I should quote call statistics.... I don't have access to them. I am not employed with them and thus don't have access to their data since they don't make it public. As much as I'd like to. Any Ontario folks know of any services that DO break down some statistics about how often they do ACP level skills?

If it isn't too much trouble could you identify the mistakes to me? Proofreading your own work is far inferior to someone else doing it as you made the mistake the first time because odds are you thought it was right

Do you believe the police should bring every person they arrest for public intoxication to the hospital or call an Ambulance?

You're right.... I was trying to simplify it but in doing so became inaccurate. I will correct that part for the next draft. Thank you. I want all forms of feedback as this IS such an important issue.

The first draft is up! I eagerly await feedback from you folks. My goal is to have this mailed out this e-mailed out to all of the council by this Sunday evening. http://home.cogeco.ca/~rkroeze/ACP.pdf

They utilize LP12s with 3-lead, SpO2 and NIBP functionality. So really the initial cost would be paying for 12-lead and ETCO2 functions to be added to a number of monitors.

Dose anyone out there have a good link to prices? I'd like to price out how much it would cost to equip an ALS truck (rather, upgrade an existing truck with the stuff needed to be ALS). That and increased hourly wages will be the only real expenses of note as far as I can figure.

What he said, 12 leads are within the scope just this service doesn't have them. It definitely isn't going to be a focus at all as I firmly believe that all PCPs should have access to 12-lead as well. That and there is no cath lab in the area therefore no STEMI bypass would be implemented regardless of EMS 12-lead capability. So i think I will focus on a few key cases in order of most attention given in letter to least: -Pain Control -Seizure Control -Dysrhythmia Control

Explain the rationale for avoiding IO in favour of EJV?

Yup! Just google "Narcotic Equivalency" and you will find lots of charts. There is even a web site that is fill in the blanks: http://www.medcalc.com/narcotics.html

Hi all, The municipality I live in is in the process of reviewing their EMS service. Specifically we are currently having EMS provided by a contracted private company that provides care at the Primary Care Paramedic level. I plan on writing a letter to my city counsel making the strong argument for the implementation of an Advanced Care Paramedic program here and would appreciate the help and expertise of you folks here. I will quote some info about the place: "At 2,458 square kilometres, Chatham-Kent is the twelfth-largest municipality by area in Canada and the largest in southwestern Ontario. Over 59,000 of the 110,000 residents live in the former City of Chatham." In the main community of Chatham they have 2 trucks 24hrs/day in 12hr shifts with an additional truck 0800 to 0000 in 8hr shifts (1000-1800 coverage only on Sundays). The surrounding communities all have one each of which there are 4 with 24hr/day coverage in 12hr shifts. Finally there is a first response truck staffed by a medic 24hr/day 12hr shifts in one other community. So in summary: -6x24hr trucks -1x16hr cover 6 days per week with 8hr on Sunday -1x24hr first response truck There are two destination hospitals, one in the extreme north end of the municipality with the other being in the geographic centre. The furthest point from a hospital is basically 50kms with the majority of it being 80km/hr roads. The Primary Care Paramedics: -2 year college diploma -Semi-automatic defib -3-lead monitoring (not 12-lead) -ASA -Nitro (Chest pain, Cardiogenic Pulmonary Edema) -Salbutamol (MDI and nebulised) -Epi (Anaphylaxis, Status Asthma) -Glucagon -Gravol (anti-emetic for IM admin only) -Glucose gel -King LT airway in arrests only Some (not many at all) are additionally certified in: -IV initiation with protocol for fluid bolus if needed -Dextrose IV -Gravol IV So with this in mind, what are some examples I can use in this letter? Things that come to immediate mind are seizures and pain control. I'll post a link to the draft of the letter when I have it written so I can get your input. I would really appreciate your help.

Are these protocols available online somewhere?

In fact IO tends to be quicker for gaining access than IV. I guess crotch is advocate rectal D50 in all cases. :shock: How did we ever manage to treat patients who are hypoglycemic before he showed us the light??

That reminds me of a saying I use from time to time: I don't see colour, I only see black and white!

Just out of curiosity, are you this dramatic and exaggerating in real life?

You would guess wrong.

They'll appreciate it as much as a perforated bowel.... I mean, we're talking doomsday scenarios here so it can go both ways

All except this one

So you're saying that you're unwilling to change your views on something?

I don't have any protocol for it and that has been a problem to me from day one. The two things that bother me most about my cardiac care options is I have nothing for rate control and nothing to bring pressure down. Sure I have Nitro but that is pretty much playing with fire and I don't know if the doc would be for it anyway since it would be SL spray and not a drip

I doubt you'll find many that will say yes.

Now that is funny

I agree with the poster though! Spreading ribs isn't that hard! And really, hard is it to sew something together? We should be able to do CABG as long as you can prove you got your sewing badge in Scouts.