BEorP

I agree with this in general as well (though I am one of the paramedics who did not go work where I rode out and went to school). Certainly, this should be a big factor in deciding which college you go to if the choices are between the colleges that all have strong reputations (maybe even the biggest single factor). The only thing I would add is that I would suggest being careful not to allow this to push you to an inferior program just because of the geographic area. But if you're comparing two high quality programs and one is where you ultimately want to work, definitely go for that one.

Sorry I can't help you with any of your questions, but I just wanted to say that you should keep us updated on whether you end up getting a contract and are looking for paramedics! Good luck!

Welcome to the forums! I assume you are referring to CMA accreditation? We could have a long discussion about this, but I'll give you my quick answer: it doesn't matter. If you are applying to work in Ontario, it will make absolutely no difference whether the school had CMA accreditation (since all are accredited by the Ministry of Health, which is what really matters). If you are forced to leave the province to find work, it may make the transition easier, but it is certainly possible to become certified in other provinces after graduation from a non-CMA accredited program. From the list you have there, I'd say that most of those have good reputations and will prepare you well to be a good paramedic. If you want more specific thoughts on some of those programs, send me a PM. Good luck!

Still not sure whether I will make it back from Australia in time for this, but I'm being optimistic and have registered for Day 2. Hope to see lots of you guys there!

I have a BS in paramedicine and used to think that it was no better than any other BS degree in terms of benefits for a paramedic career. My views have shifted slightly in the past year or two and here is my advice now: If you don't plan on making a lifelong career out of paramedicine, do a degree that will give you career opportunities outside of paramedicine (such as a STEM degree as previously suggested). If you know that you want a long career in paramedicine but you have management aspirations, do some type of business or management degree. If you know that you want a long career in paramedicine with a clinical or research focus or even just want some added knowledge, go for a BS in paramedicine. Even though a BS in paramedicine is unlikely to change how you do the job on the road, it can teach you a lot and the specific degree in paramedicine can give added credibility with some audiences for things like research (particularly on an international paramedicine stage where BS degree paramedics are more common). Good luck!

I don't have a source to back this up, but I remember asking a similar question in paramedic school seven years ago. There weren't many services in the area that had 12 lead capable monitors at the time, so I wondered whether even without moving the leads around if you saw elevation in leads II and III that that would be diagnostic of an MI as elevation in two contiguous leads on a proper 12 lead is. The answer I was given was absolutely not because a 3 lead ECG lacks the "diagnostic quality" of a 12 lead. They said basically that you shouldn't think much of elevation that is just seen on a 3 lead ECG. So in response to your question, I would say that I think doing the leads individually will likely not be helpful (but this is going off of just what I was told many years ago and nothing that I have read myself). I know we probably don't want to be sending people off to other forums, but the other major EMS forum has a section where a proper PhysioControl rep will answer questions. They might be able to get you a proper answer from PhysioControl on this, along with the actual scientific justification.

As ERDoc says, it is amazing that some still hold the belief about witholding analgesia in abdo pain. It was just a couple of weeks ago that we had a lecture on abdominal and GI emergencies and the professor described this misconception that pain relief impedes diagnosis is “the biggest rubbish that ever escaped into medicine”.

I think that was from me! I'll need to try to get my hands on Egan's. The reason for my question was that I've read many various things from people like yourself who are obviously experts in this that make reference to the hypoxic drive theory largely being a myth. I've also read a bit about the importance of alleviation of hypoxic vasoconstriction as you mention here as well. What I haven't come across though is a nice review article or something similar that in a single document from an irrefutable source that outlines specifically what is wrong with the theory as it is traditionally taught. I was hoping that there was something that in a single PDF would pick apart the traditional hypoxic drive theory, but I guess I might be asking for something that does not exist. Maybe the chapter in Egan's is the closest thing to that that I will find! Thanks for the info!

I have written a number of articles for paramedic publications. I think that sometimes the idea of being "published" can seem like a bit of an intimidating prospect at first. It really is something that most of us who can communicate coherently on this forum are completely capable of doing though. I'm certainly no brilliant writer, but my ramblings can still make it to publication. If you have an interest publishing, think of what you want to say and jot down some initial ideas, then get on Google to make sure no one has said the same thing, and then start working on it. Look at submitting it to a non-peer reviewed publication like EMS World in the USA (or Canadian Paramedicine in Canada or Response in Australia). EMS World also has the ability to publish articles as online-only, which is a good stepping stone if you've got something that is worthy of being shared but maybe wasn't quite able to make it into the print edition. If you're not sure whether your idea is something that would be worthy of publication, many of the editors are happy to read a brief outline of what you plan on writing before you spend the time on it to let you know whether that is the type of thing they would consider publishing. If anyone has any urge to try this and want any type of assistance, send me a PM. It can be a really enjoyable process to put something together for publication and then it is a nice feeling to see it in print and an even better feeling to hear from random people who have read your article and enjoyed it.

There are so many good things that can be said about CAP lab and that those of us who have been will keep repeating. I think that this point is one of the biggest things that makes CAP lab such a great learning experience though. The doctors there really are interested in teaching paramedics and have respect for what we do. Despite their incredible knowledge and experience, they still somehow manage to teach in a way that is not at all condescending. Rarely do we ever have learning opportunities in EMS where we can get such an amazing learning experience, especially without egos getting in the way.

Excellent case. Thanks for sharing!

I'm also interested in this... I don't want to put a damper on your enthusiasm, but I don't see how it could get much easier to put on than the LUCAS 2 (though maybe that is why you're the engineering student and I am not!). Even the LUCAS 2 though would be more difficult to use than simply having a lay person push hard and fast in the centre of the chest for a few minutes. I have difficulty imagining a device that would be easier than this simple task of doing compressions manually (again though, not an engineer!). If I were able to dream of the one thing that would make these devices easier (having only played with them on mannequins), I think that the place where the most improvement could be made in a dream world would be with the actual application to the patient. The fact that something has to wrap all the way around the patient is what is probably the most difficult aspect of application for paramedics and what would be an insurmountable challenge for lay people who are under stress and have never seen one of these devices. If you can design an automatic compression device that does not need to wrap circumferentially around the patient, maybe you'll have something. I just don't quite see how that will be possible, but it would probably be the best improvement you could make in my "dream world" where anything is doable. I would also suggest that you clarify what your objective is. In your initial post, you mentioned freeing paramedics up to do other things. Now it seems like your focus is more on lay people, so I am a bit confused. Is this something that you are just writing up as a project for school about things you would hypothetically do, or do you actually plan on building this new device? One last thought (again not wanting to damper your enthusiasm, but wanting to ensure you have all of the important information), there is no evidence that mechanical CPR devices actually improve patient outcomes from cardiac arrest. It seems like a great idea to have these "perfect" compressions done for a while arrest and allow the patient to be moved with CPR ongoing and all of this, but at this point we don't have any reason to believe that these very expensive devices actually do anything good for patients in the end. Just something to keep in mind! Good luck with your project!

Thanks, Dwayne. It is just a slight possibility that this point and I don't even have an offer or anything so I have no idea on any further details of what it might end up being, but I appreciate you giving the general info so I at least have an idea.

Are you trying to design something to do compressions specifically? If so, how will your device be different from the existing Autopulse or LUCAS?

I may have the opportunity to do some type of international remote paramedic work and was just wondering what wage I should be expecting. This would likely be somewhere in SE Asia or at least this general side of the world (certainly not in the Middle East). I know this will vary based on a huge number of factors, but any guidance would be appreciated on what to expect in general. I would only be working as a locum, holding down the fort for no more than two months (possibly over Christmas if that matters). I appreciate any replies. If you're not comfortable talking wages on the forum, a PM would be great. Thanks!

Couldn't have said it better... especially the last part. Often, we might not be 100% sure on all of the details so it is better not to say anything other than what you know for sure, which is that you don't know but you're focused on them. It may sound like a cop out to them (or even to ourselves), but it also happens to be the truth. That being said, just for the sake of discussion I will mention a call that I was on as student. A driver who had been drinking was involved in an accident that killed the driver of another vehicle (pronounced dead on scene). Our patient (the driver who had been drinking and had gone into oncoming lanes) was repeatedly asking about the other driver and the attending paramedic did eventually tell him that he had died. This paramedic had actually pronounced that patient dead before this, so there was no uncertainty about the information in this case. In this situation, the patient's reaction was not positive, but he seemed to settle down a bit at least knowing that was he feared had happened had really happened. Maybe sometimes the uncertainty is worse for the patients. I'm not saying that I would take the same approach, but this anecdotal example at least makes me reluctant to say it is never appropriate to answer the question directly in some cases. How you identify those cases, I'm not entirely sure, so I'll probably default to the "I don't know" and "we're focused on you."

That was my thinking as well (immature being the key word). I would love to be a student in paramedicine with an instructor who could respond well to challenging questions in class, but too many of us in our industry take those questions as some type of personal attack and respond negatively. By having the discussion one on one, you show that you are genuinely interested in it and not simply trying to show up your instructor. I do agree with Dwayne that it shouldn't be that way, but I think that in many places it is. We've put ourselves in a bad spot by putting people into management and education roles based solely on their time on the road and not their actual education in management or education.

The other thing I would add to this is what there will always be cases where protocols/medical directives/clinical practice guidelines aren't perfect. Many of these are hypothetical situations that won't be likely to commonly arise in real life, though it can still be frustrating to see these. If you work in a system that allows you to use your judgement in these situations, that is wonderful. Unfortunately, many systems do not allow this. If this is the case in your system and the protocol says they need to hold it and that is that and the medical director or whoever writes the protocol wants it to be that way, then there isn't much discussion to have. Yes, what you suggest may be reasonable, but if it is not in line with the written guidelines that you need to follow then there's no sense in discussing it with your instructor who obviously didn't write the protocols. I'm not sure which province you're in so I don't know how it works with your protocols, but if on the other hand the medical director or whoever authored the protocols would support your solution and you know this to be true, then I would ask you what benefit will come from arguing with your instructor. Do it their way in class and then do it your way in real life. I'm not saying that we shouldn't take a close look at our protocols and ask questions about them. In fact, we probably should be doing more of that and taking our questions to the medical directors who write them. The key thing though is that those issues need to be taken up with the people who actually wrote the protocols. A paramedic arguing with an instructor (or for paramedics working on road, a supervisor) about a protocol that was written much higher up serves no purpose. So I guess what I am saying is that you should definitely be having discussions in the appropriate setting and challenging the views of others with your supporting evidence, but that this isn't always appropriate if it is simply a protocol issue. Besides, discussing and debating things where there is actual evidence and not simply protocols to fall back on is much more fun!

Talley and O'Connor is also worth considering: http://www.bookdepository.co.uk/Clinical-Examination-Nicholas-Talley/9780729539050

It is an incredible opportunity that most long term forum members will have seen me going on about each year for the last few years. It is not everyday that someone offers a learning opportunity like this to EMS providers. Do not miss this chance for an enjoyable day of great education. It is also great to meet 'zilla and the other forum members who make it out. If I can sneak into the country again, I just might make another appearance!

Well done!

What do you mean about getting more creative? Sometimes I feel like we think we have more of an obligation to convince everyone to come to the hospital than we really should. I've certainly had my fair share of calls where I have been extremely persuasive in getting patients to agree to come to the hospital. Now looking back on some of these instances, it seems like we've bordered very closely on coercion rather than just convincing. If the patient is competent, they have a right to make an informed refusal no matter what the consequences will be for them.

A competent patient has the right to make an informed refusal of care. Unfortunately, we're slow to recognize that in EMS as a whole. It puts us in a bad position when we get put on the line for patients informed decisions, but all you can do is document and remind your manager that it is the patient's decision.

Thanks for the case! I'm a bit late, but curious. You mentioned in the initial post that the ECG showed sinus tach with a narrow QRS and no T or ST changes. Not that it is something we're normally looking for, but was there any PR segment depression?

Interesting stuff, thanks for that. I managed to dig up the study, which is available here. The most important line from the abstract seems to be: "Based on testing and stability assessment, 88% of the lots were extended at least 1 year beyond their original expiration date for an average extension of 66 months, but the additional stability period was highly variable." I haven't had a had a chance to actually read the paper, but I didn't see any mention of 10 years in the abstract. Still, an average extension of 66 months is all you might need! Let me know if you need the full text to prove your point to anyone at work.