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Hey isn't that copyright infringement ? (sorry folks an inside joke) Yes this would be a bumpy ride as one would not only be taking the authority away from the GOD's but also affecting their pocketbook, that said it could be a more cost effective delivery not paying the rather large sums of cash for the one monthly (if that happens) or the lets grab a beer or lunch "meeting" to comply with the medical control issue for the paper audit. In my personal experience in Industry EMS and in services rural the signature on a piece of paper just amounts to a very expensive "Notary Publics" er John Henry. I am frequently instructed to contact the receiving MD in a rural facility who in many cases is only receiving an information / notification and cutesy patch of incoming. Perhaps restructure a fee for service in that regard for the receiving MD ONLY ... I mean fair is fair after all. Kiwi it work's pretty much the same way here for on line advice because the comms problems with cell phone are a large complicating variable.

Oddly enough input from the grunt providers has not been "requested" just the new white middle manager shirts in fact for EMS AHS. So let the MDs and RNs ++ make the decisions but tighten the purse strings ? Gene even this dumb grunt can see your talking out your hat, Gene your talking latitude/unencumbered to provide care but not funding it ... sheesh more circle talking/scree running DOWN the mountain is more like it and don't slip Gene Z because it hurts your ass !

Mobey: Well that certainly would be a good baby step in your area, if I can recall, ALS was not even funded prior to this. So perhaps the introduction of ALS and down the road with an increase in population and call volume it will provide stats to step up to a full ALS service ? Or will this FLY CAR stay as a permanent feature ? A better question may be just how effective can or will a single Paramedic be if (highly probable with a good dispatch system) arrives at Joe's Farm and to prior to arrival of a gut wagon, to find an arrest or AMI or an MCI ... and then must wait for a means to transport ? In fact not having a way to transport and we are back to a delay or a very serious lack of educated help on scene dang difficult to do CPR and ALS interventions of this I do have some experience in austere and industrial type settings. That said a very advantageous position to treat and release but that said if permitted to operate to full scope of practice as in the UK, perhaps this is why our brothers and sisters in the UK are called "Super Medics" cheers and thanks for the input ALL.

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. Margaret Mead.

This quote from another thread: I have some mixed feelings on this FLY car concept as of late. Agreed a great concept in some instances/situations but implementation on broad scale may NOT be the best idea in the long run for the future of Pre Hospital Care delivery. Does it improve or delay timely care ? What level of care (ALS or BLS) should the operator be ? Is this tiered response effective when one cannot transport when required ? In what geographical locations is it best applied urban, suburban or rural ? Who drives the unit back to ER or Hall ? This is a "work alone" situation on some calls, so should there be a safety mechanism in place for the practitioner ? Could it be a waste of resources ? Should it be operated under EMS (stand alone) or Fire Based services ? Does it actually lower cost of ALS delivery (dispatch triaged) or increase the cost per call ? Who is going to carry kits, monitor and my helmet ? (its all about ME ) Any thoughts pro or con ?

I am very much enjoying the exchange of ideas on this topic still laughing about Happi's new moniker for CUPE in BC. <insert knee slapping noises> This whole "practice under DR. Standing Order's or Protocol the current Medical Tradition" so why do we need that autograph ? Does it really make a tangible difference in a court room ... like really ? Knowing that the world revolves around MDs it may be very difficult to ever change the dominance of this group. That said in todays day and age, quite realistically just WHY do we NEED to have signed orders and approved local protocols in the first place ? A conversation I had the other day with a very knowledgeable individual (ps a AB CUPE guy) his point was this: Why does a regulated Health Care Professional require confirmation from an entity (MD) that highly likely have never stepped on foot in an ambulance. To practice in most jurisdictions as a Paramedic/RN/RRT ++ do have a very clearly defined scope of practice. If a Paramedic or RN makes an error in medical judgement providing care and just to qualify "NOT practicing beyond legislated scope". Does the MD stand up to support us, and putting his licence on the line ? In most courts we are judged by a group of peer's not MD's if a legal case ensues from a result of action or inaction. * WE are held directly responsible. * We are held directly accountable. * Its OUR licensure, livelihood on the line. Perhaps WE as regulated health care professionals do not legally require the MD sanctioned signed orders in the first place are we being duped ? After all we are issued a "practice permit" by the applicable governing body's and government. In fact the present advice of the regulating body's is to carry our own malpractice insurance, so compare a Paramedic/RN/RRT "oops rates" to the medical profession, divesting from MDs could just result in way lower insurance rates ? just throwing that out there. I know this is a diametrically opposed position to present medical tradition, and a touch radical but most likely the MDs (those receiving that phat paycheque to sign off) would come out of their skins if they ever heard drift of this challenge. Yet once again I will be placed on ANOTHER "government to watch list" but it does make some sense to move forward into a new future of Health Care Delivery to my way of thinking and the Health Care Professionals would stop following the "cook book" Soo .... any spare room in that Northern BC bunker guys ? cheers Yup: I know completely off topic, perhaps I need to start a different thread when my symptom's of a serious hangover subside but I got on a roll.

So a release of intel, or did did some one just switch on a light ? te he ... maybe letter writing does work I guess ? I had some personal mental controversy in posting this news brief in this thread ... (it could be the rhum I drank with a buddy last night ) but this Alberta step forward is looking like we are now walking up a scree slope, 2 steps forward one step back. I wonder what is the next move going to be, perhaps stop the Health Care "centralization" initiative as well I still have airmiles to donate to the send Stephen Duckett’s one way ticket back to the land of OZ ... sorry aussiephil if your reading this Ok a for using a word that I had to goggle to just START reading this post. te he

Am I complaining ? like again ? Just my hood but we do not have a tangible crisis Fire vs EMS, moreover just poor government management and intervention in EMS "restructuring" this is far more a pressing issue. Frankly any improved EMS delivery of service would be an advantage for my community BUT the local Chief has sworn up and down that NO Ambulance will have a bay in HIS Fire Hall. This fossil is not a team player or interested in improving Health services to the community, in this instance he is just protecting his own turf.(very old school) Ruff ... answer the question please: So is EMS health care or public safety ? cheers

I am for EMS running Fire Departments, EMS has far more call volume logic dictates they should. If one looks to the media justification by IAFF it is very much based and dependent on the argument that Fire Services provide a "faster" response time. The clock does not stop when a Medic contacts the patient it just starts the health care clock, and very rarely is it mentioned the huge cost differences operationally. Quite difficult to transport patients on the ladder truck I have found. So is EMS health care or public safety ? First off in Kanukistan AB we have very few FIRE Medical based services and where they do exist have a huge $$$$$ tax base, the rural Volunteer Fire services do not have the funding to even consider this option (besides we do not have a lot of igloos fires) Looking to my personal geographical data (this small town has 4 fire trucks with an average call volume of 30 calls a year) and zero ambulance for a population base of 4000. The closest AMBO is 20 minutes away (only 3) another community and in that area there is 12 fire trucks in their own hall. So 3 Ambos to 16 and then throw in the call volume ... seems to be some inequality here ? Could this be a reason for some controversy ... well it is. Quoting the past EMT member ... asy: "The Elephant sits where it wants too" IAFF is a huge international organization, long time established "terms of agreement" with "trustworthy" political figures. Perhaps the reputation is deserved ? cheers

Reinvent the wheel when one just needs new tires gezz Comrade Gordon Campbell : look east and just see how well restructuring is working in AB ... do we need a G 13 to get provinces to "STANDARDIZE" themselves ? Oh good the same rhetoric we heard about in AB from Liepert, so get all the HSAA, IAFF and RN Unions fighting over turf wars and then reappoint a HSAA union with multiple disciplines to be thrown into a brown paper bag ... yea thats right we have so many Paramedics working in Health Care Centers today .<insert cough> Just where did that Liepert go ? He did such a great job appointing a "Super Duper Duplicating Health Board". Thats right a new portfolio the Minister of Resources and bowing to big oil business, giving prime resources away at rock bottom prices ... ps a cardinal sign of a looming election is my bet, buying big oil votes. Time for a change in Government I would say ... when is the next election in BC ?

Just to present another side of this complex story ... the money. In AB the cost of an Ambo is directly billed to the patient unless a transfer to a higher level of care directed and required by the MD OR the patient is an in-patient. With the soon to be introduced new and improved Alberta Health Act one must wonder what is in store. It does not take a rocket scientist to understand that the elimination of an AHC monthly bill, resulted in huge numbers of "procedure's" becoming deregulated. Almost the same as a USA based HMO, if a resident in AB does not have additional coverage ... well time to open the bill fold. A huge point in this AB transition (and cost) why did the municipalities notjust receive improved funding, the system of Ambulance Services did actually work at one time and strangely enough more ALS services on a Provincial Basis than every other province, instead the Stelmach Government introduced even more white shirts, more bean counters and duplicating infrastructure. ... again FAIL by this government. In BC, a standard basic user fee, now with a possible introduction of private services will we now see better improved services, will new regionalized services implement more ALS providers ? quite the taxpayers risk assessment there in my opinion, or will the BC taxpayers see a rather large jump in user fees ? So in the long run instead of improving BCAS and addressing the real issues so why burn the whole house to the ground instead of doing some remodeling. I am now under the impression that Campbell is going to use paint and just "Flip that House" No matter what the spin is put on Pre-Hospital Care their remains a huge gap and diverse in the way Ambulance is funded, and levels of care which bring's me to the real point or query.. so how can we standardize care with vastly different economic based delivery methods ? New political math maybe ...

Shucks no ones perfect .... so I fixed it and gave Sniffaliss a neg ... my bad ? On topic ... there is no easy way to deal with the end of a life and providing that information to family. I typically use the phrase: I am very sorry there is nothing more that we can do.

Agreed but his spirit lives on. I will bite on this one again ... just what type of message does one send to a patient when one straps on a lid during a ground transport, maybe some NASCAR stickers would go well, yeah think ? That said the vast majority of Paramedics/ EMTs would need to get the jumbo size would they not ? Just where can I order an orthopedic hat ? cheers

I should casually mention that EMT City is a great venue to communicate and a most excellent means of blowing off steam the contributing membership do understand my flamboyant nature on occassion and sometimes gets the best of me with my passion for this Profession. I have authored to date more than 1800 posts that my on screen persona and yes frankly on occasions get's a bit snarly (I blame dustdevil for this) The latitude to express oneself on this privately owed website is something we all have come to enjoy, as things out there in EMS land are not so seamless as we would like them to be. So get to the point turnip ! My personal opinion changes substantially when I have positive realistic input and as a professional I try educate myself to current dynamic situations, situations do change and hence so should ones opinion based on that valuable shared information, as in Evidence based medicine applied. Some professionals forward tangible information to my queries and others prefer to use a rolled up newspaper on a puppy technique. This does not typically result in myself cowering in a corner like a beaten dog (just saying) many times the use of literary licence <medical terms applied> to draw attention topics that are very dear to my heart and are quite typically understood now intended to stimulate an open active constructive dialog. It has lately come to my attention that some readers / voyeurs are most seriously challenged by the concepts of figurative and the literal speech and lets not to forget the constitutional rights to freedom of thought and speech in America to that end I must state: May GOD BLESS AMERICA ! I applaud RUFFUMS to recognize this, I was yanking his chain to get a response, I bring to the readers attention the term POSTAL that I have used prior in this thread and being a true pacifist no ill feelings intended. I am member of Amnesty International this a very successful "modus operandi/tool" has been implemented with great success in other campaigns yet unrelated to EMS, so POSTAL in my world means "writing letters" well enough said back to the thread. cheers

Reproduced with the permission from PAC

I should state before I continue in this debate that I did hit send before pre-reading and the comments were a rough draught and this rather large oilfield bed truck was bearing down on me, so apology for lack of clarity. SEND became a safety issue. I will proceed and continue to debate just why IMHO it is folly to proceed with a few provincial regulatory body's to head up and set standards for the entire country. More preamble: I should mention that EMT City is not only a great way to communicate but a most excellent means of blowing off steam ... as the membership clearly understands this from more than 1800 posts I have made that my on screen persona, as my personal opinion changes substantially when I have positive input as a professional I try educate myself to current dynamic situations, some professionals forward good tangible information and others prefer to use a rolled up newspaper on a puppy ... that does not result in myself cowering in a corner like a beaten dog (just saying) many times the concept of literary licence is implemented to bring attention topics dear to myself and are generally intended to stimulate an active constructive dialog. But some readers / voyeurs are challenged by the concepts of figurative vs literal, I applaud RUFFUMS to recognize that I was yanking his chain to get a response ... as I do respect his onion being a turnip. I must bring to the readers attention the term POSTAL that I had used prior ... being a true pacifist and a member of Amnesty International this a very successful modus operandi/tool and implemented for great success in other unrelated to EMS letter writing campaigns. enough said back to the thread at hand. There is nothing simplistic other than the concept of labour mobility, the most serious question remains is the Profession of Paramedicine actually labour or a true Profession and once again as we all know that HEALTH is a Provincial mandate under the Canada Health Act "guidelines" then interpreted by the Provinces. So taking that one baby step further look at the huge level in delivery of Pre Hospital Care standards as some provinces have very high standards and others do not. If we look to a bell curve do you honestly believe that most provinces/ territories will come up in higher educational standards or that the math/ economics of the situation will dictate a lower level of qualification ... if one would believe that standards will rise ... IMHO I know this will not be the case. That said ACoP is really an unofficial arm of the AB government and must follow the regulations set forth under legislation, legislation changes almost overnight here proof in point: http://www.health.alberta.ca/services/EHS-legislation.html Now that is IF the current conservative government in AB survives the next election, their is much malcontent and it appears that the topic of Health is top of the political heap of problems right now. Following my fuzzy logic does one wish for what we have right now in EMS in AB under the direction of AHS like for the rest of Canada ? I would disagree its not a cusp its now a back molar with the compliant regulatory body's provincially ... I personally have observed that their IS a process to gain licensure BUT employment is very dubious based on the multiple entities .. and just today this announcement by the BC government. http://www.canada.com/vancouversun/news/westcoastnews/story.html?id=4900475d-7b4b-4f49-9927-e18632fdf1e2&k=37713 It appears that Comrade Campbell is now following the AB lead ... possibly introducing even more opportunities to promote a "EMS private delivery service model". Oh I do agree, but another question in these harsh economic times, is restructuring during economic downturn is cost cutting or very expensive (check out AB Health Care budget)and could this just (as we have seen in AB) a means to Union Busting ? http://www.canada.com/vancouversun/news/westcoastnews/story.html?id=4900475d-7b4b-4f49-9927-e18632fdf1e2&k=37713 "The AIT agreement was a legislated and signed document by the provinces to decrease trade barriers, best read the entire document first and foremost please. This is not clearly a one way street the destination being the very lucrative Oil-Patch industry in Northern BC and Alberta. So tell me it is't so and I have 30 'medics' and names doing just that, this very minute. Those that have actually gone through the process of reciprocity and we are richer for this in some ways, but damn near none are working on the Streets of Alberta PERIOD! but yet again your duped into believing there is not already avenues open ... say like taking a program in that province ?" Is it fine well then perhaps I should do the same, live in AB and work in BC or SK the present AB conservative is quite concerned in residency now, and I do have responses in hand from AB Labour Minister in that regard. The Back Door approach: Just a recent observation, BC will now accept the US REMT-P registry and grant licensure. Now with AIT agreement then allow's that individual to challenge the AB exams ... taking 3 writes to eventually pass and then go on to work in Oil Patch. To then reside in lands far away with (and admitted by that individual to never to work in the public system) It appears this back door approach is very effective means of just working the system, with absolutely no intent of contributing to Canadian society ... Is this the professionalism you are referring too ? Two questions there: COPR The funding targets three prinicpal areas: the creation of common scopes of practice (national) the creation of a national examination, and the creation of a process to evaluate foreign Paramedic graduates. A better question is should Standards be sacrificed based on the "marketplace" ? May I dare say I am favor of the first 2 objectives but the stakeholders are not JUST the regulatory Body's as they most obvious now biased because of Government involvement and at the mercy of the government whim of the day to further that parties objectives ie retaining political power. The best thing for the Profession is the participation of each and every member, and not just my tiny voice in the wilderness as the Profession is currently under siege in standards as the term "barriers" are not artificial they are realistic tangible STANDARDS. Are there any assurances that the highest common denominator will win out ? ACoP approve no AHC approved increase in scope and other members of this board will agree with the least amount of Education .. could this be the way that we will follow in the future more toys in the kit ? To that end I will prove there are no artificial barriers, coming from a CMA approved program. "..I am fighting for improving standards(as this is what it will amount too) and believe it or not this IS the real agenda..." Firstly this does directly impact on my life. Correction from poorly written above statement: I am fighting for improving standards, inclusive of 3 areas yet to be addressed and I believe the future of Paramedicine: Critical Care Paramedic the definition and scope of Practice. Remote Practice and Clinic Paramedic the definition and scope of Practice. Wilderness EMT/PCP endorsements(ie Ski Patrollers, Mtn Guides, and remote and austere settings) Lets get these clearly identified before we proceed shall we ? Perhaps this Economic Development grant would better be served by funding Education for present and future Paramedics to improve levels of care to the community, instead of supporting other programs that favor those that have yet to become citizens of Canada, you know like helping Canadians better themselves before importing workers for big industry and then exploit them ? Harsh economic times should have some influence or would some believe to foster the economic myth that Canada is a bottomless pit of support to the rest of the World ? ie Charity begins at Home or so the saying goes ... the USA does not hand out "Green Cards" willy nilly so why should Canada ? "Here is why it matters, the most its the present taxation laws, so buddy from wherever commutes and when he files his taxes (in his/her province of residence) the income tax earned then goes into THAT provinces coffer's even though the income is not earned there. But herein lies the problem, that individual is using the infrastructure of hospital, the roads and the like, not contributing to the very province that is providing employment. Its not a matter who or where they are from ... but the tax money goes someplace else --> hence the reason why with the massive amount of transient workers (in this example) Alberta has lost out and now has become a have not province." Your understanding of taxation laws is delinquent, and you have complicated with provincial agreements in reguards to health. So perhaps go to the local post office and take another look at the General Form, and look to the very major recent controversy about transfer payments to AB. In the past economic history ALBERTA has paid far more than there fair share and has supported CANADA ... when the shoe changed feet ... well best do your homework is all I will say at this juncture . cheers and to be continued

Just an Idea .... get a Lawyer to look at the agreements signed with your school, let it quietly slip from someone elses lips as they DO have an legal agreement to educate you, students do have rights and or is there not a impartial faculty member not available in the entire Institute to explain your concerns too ? If policy is "coined" ask for the written policy document the school must have provisions for uncontrolled "circumstance". And if your Liaison for field practicum is not answering either phone or email (I believe there is a distant on line involvement) then this should seriously be questioned if undue delay in tangible response sounds as if you are responding in a timely manner but others ... are not. That said on the flip side you could take time off or perhaps investigate another school to transfer your present credits if you need a short sabbatical. ps Good thing I did not apply to teach in that facility ... to hear of this conundrum just confirms some of my initial spider suspicions that less than stellar understanding of the human / student condition. cheers and keep us posted ... quite obvious EMT City supports you

Oh Lone Star .... and just who did you get that forward from ? BUSTED ! Virgins look like Susan Boyle .... Bhwaa Haa Ha.

A bit of puke just got brought up into my mouth ... just what HAS this waste of money, the 14 hired middle management consultants accomplished other than screw every thing up they touch and escalating costs in delivery and in fact a decease in level of care ... good grief man ... you must be living in Saskatuwan ! Let AcoP set national standards foe reciprocity is a seriously recipe for disaster and over my dead body,(BTW) are you insane ? Allowing the current council (best look again) of ACoP to put their fingers in a national requirement's and dictated by legislators is folly for the Profession. MARK MY WORDS ! So just how will a grant from immigration and economic development (federally) have any positive improvement to raise standards for Paramedicine all they wish to do is fast track ! NOW this after the same federal ministry put the cart before the house (to the tune of 700,000 CND) and funded the Brendin Institute to fast track for free FT MDs to become Paramedics, and this when no CMA approval OR ACoP involvement ? I am smelling something very phishy here ... I have been doing my research homework into the very political nature of this "situation" and the more I find the more gray hairs I am developing. With many current ACoP approved institutes, CMA approved with presently over prescribed classes should we not intelligently increase support to those with a proven track record FIRST ? no rocket surgery their is there ? The projections in need of ACP and PCP should have a serious needs assessment and way before throwing taxpayers money at anything and is NOT truly in the best interests of the Profession, that said has good progress not been made with AIT agreement already ? Now all when AHS is trying to use ACP fly cars and a tiered response (to lower costs) btw a tiered response did NOT work in Edmonton it increased costs AND a longer response for ALS to scene, besides being redundant. Talk to the "Paramedics" that are redeployed on a daily basis for this idea and see what really is happening ... THEY are QUITING ! The dust will NOT settle until a Association of Paramedics with the goal to promote the profession becomes the major stakeholder. ACoP in my rather informed opinion as a self appointed historian, their track record is an abomination in legislation advancement and fiscal responsibility alone ... I will take my 30 years watching and actively participating against any one that has a couple of years and believes that propaganda that ACoP spin's is stellar ... ask any current member their opinion and you will be shocked at the overwhelming disgust. BTW Just who advanced the ACoP in the first place .... hint initials P.P. and presently residing in Ottawa, sure hope he is watching this cluster F. ACoP has no National mandate from any group ! So get real PLEASE, well other than the "Association of Regulator's" (an extremely fledgling group in other provinces) so should we sit back and take that risk of our future and thats its all a bed of roses ? Want a real change and improved EMS services in AB ... throw the Alberta Conservatives to the curb where they belong, just look to the current "throw money" to decrease surgical waiting lists ... its a short term fix with the aging demographic population. AND just who actually caused this a very short time ago with AHS policy ? I a flabbergasted with the short term memory lost of Alberta voters ! Heres what I think ... an election is coming soon this behavior by Conservative government it is predictable, Ralphy did it with the gas rebate just last go around ... sheesh. And if Anyone .. I mean Anyone can not see the smoke and mirrors of this "transition" with real goal to control Paramedics as Labour Group, then look to BC and see the how new government legislation has positively improved EMS services ps the paint still drying on the walls of more like graffiti ! So I pose a question just how will reciprocity improve Paramedic Standards or Level Care to taxpayers ? As they are THE REAL STAKEHOLDERS !

What I am saying that this is a realistic study and a positive, athis fter Wang et all jumped on the "airway adjunct" bandwagon and poorly peer reviewed studies did overall negatively affect our profession. cheers Just pleased to see that a new direction should be promoted instead of emptying the bathwater, get those Paramedics into ORs or ERs to practice their skills and improve success's. Its almost the same as Olympic athletes, practice and training ... who would a thought EH ?

Bhwaa haa ha .... if one reads the comments after the news article it becomes very apparent that the picture of the FF is in Toronto (the kinda crest gives it away) and the article is about Winnipeg Fire service ... it just keeps getting better if one takes the time to read the informed commentators . cheers

It was explained to myself I believe it was Dr. BEB (?) that after Viet Nam that this "golden hour concept" was developed on a napkin in a bar in an attempt to bolster political support to employ the plethora of unemployed pilots in the US. Although there is merit in rapid transport to surgical facility the myth persists at infinitum. In fact while doing some research into Occupational Health and Safety requirements primarily for Oilpatch in Northern Alberta. I came across the "Golden Hour" in the actual legislation and guidelines (somewhat ancient in fact)I did forward this study to the regulators ... so in perhaps 20 or so years when they re write the legislation there may be a evidence based medical "perspective" to assist the new revisions. While flying fixed wing in very Northern posts the ongoing "inside" joke was we were dealing with the Silver 6 .... hours of Trauma. Quite hilarious but sad in the same sentence that every little small hospital here do not have a Trauma Team on standby. The advent of advance life support and carrying volume expanders ie albumin, access to blood products and the newer pentaspan and hyper tonic saline "permissive hypotension" in addition to traction splinting, medications, protecting airways +++ and all the other goodies that we now have available. This said more current and timely study's should be undertaken to prove to the overseers (ie the MDs as they are study oriented) and the real worth of advanced care providers deployed in the rural vs urbal areas. cheers