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You doing Med Evac in Robertsons ? Lawn mower engines with rubber band drives ... yikes, cancel my travel plans. cheers

I would need a snow shovel to check that out ....

http://www.chtv.com/ch/cheknews/story.html?id=2245264

EMS rule #5 = Assume all are idiots till proven otherwise .... The point being is anyone can parrot the ACLS paint by numbers cook book (this is a silly what if scenario in the first place IMHO) I am an true idiot to post it appears "WHAT IF SCENARIO" it took an entire page before that came to light. I have personally converted SVT or Narrow Complex Tachycardias refractory to Antiarrhythmic rx x 2 flavours, just with Fentanyl the patient was in an simply an adrenergic response because she had been cardioverted without sedation by a resident idiot prior. On one occasion converted SVT with a 400 mls of N/S ... one HAS to have a history of some sort before asking the wide open question what would you do, its a trap with no escape. ie as I tried to suggest in a previous post .... maybe I should go back to that Mail Older Bride again. cheers

Having just a bit of background concerning "Cabin Cooperation" both Pilots left and right seats are ATR (thats Airline Transportation Regulation/ Licences) multi engine, turbine or fan jet, IFR, night endorsed and passing simulator) so your comparing apples to apples and egos in the cabin ... this is not the discussion in my perspective. Nope comparing Paramedic to EMT is comparing apples to oranges, (generality speaking) what I am looking down the road for (in medical care) maybe furthur afield, ie when I am the one pushing meds IV for pain relief ... I am looking to trends in ETCo2 ... do you thing most EMT are, when SPo2 drop to 91% when cabin pressure assends to 8000 AGL am I going to a NRM ? hmmm. Define the difference BLS vs ALS ... and I'm old and a sucker, I like shooting the breeze with the little old lady transfers thats a part of the ALS vs BLS equation not factored in, just try doing the return trip from Jasper to EDM and not changing out Driver vs Attendant ... we all are aware that ~ 10 % of trips are actually ALS only. Interesting just how did that go with ACoP ? Where you a BCAS ACP ? and you do not have to do a field evaluation by a registered REMT-P registered member before you are hired by Cow Town EMS or even receiving your R0# 05 ? You raise a good question should your expatriate visit to the UK and returning have some priority in the hiring process, sorry to break this to you but presently what you want and what you are about to receive may be very different from the reality of the "New improved AB EMS" Could you explain the SSDD abbreviation? I must disagree the UK system and CND complicated by multiple different factors in provincial Act(s) your a tad deluded. cheers

This is very dependent where the SpO2 or SaO2, some occasions this is a major difference in positive outcomes, sorry to disagree with the above comment and it leads some down a garden path and breaches the vast majority of EMS protocols ... I have yet to directives to titrate O2 to sats of ______ in any EMS protocols. So hypothetical situation, you find a patient with PMHX of Sickle cell and your suggesting that that O2 is not indicated, question: At what PaO2 will cells start to sickle? (documented in EBM) Or that even when anemia may or may not be present (clinically) and SpO2 is reading 92 % do you withhold O2 ? Point being that understanding ODC oxygen dissociation curve (sans shift due H+ or other variables, lets not complicate with 2-3 DPG, or others)[all things being equal] that most EMT-B have very little understanding of what SpO2 and PaO2 fall on the curve? Or the "suspected" hypovolemic patient and SPo2 is 93% do you not use a NRM at higher flows ? Or the patient in moderate respiratory distress, does the Krebs cycle not come into play and assist to prevent an increasing metabolic lactic acidosis ? I asked this very question of JWade in the inception of this ... perhaps you could enlighten the readers ? cheers

Ever Hear of the old story of the Lion with a thorn in his paw ... ? If you can't walk you can't RUN ! Eventually the voters will see that Jello is impossible to staple to a wall, if it continues to stick it is called MUCUS. Comrade Campbell and his forestry cronies did such a fine job when BC was on fire this summer ... good grief what makes the voters so blind in BC ? ps The Winter Olympics remains the playgrounds of the Wealthy funded by taxpayers moneys (of this I do know as at one time I was potentially a member of the Crazy Cancks but my folks could not afford the training in Europe) you think I will purchase anything with the Olympic rings on NOT ... I will not be even watching it on TV I would rather watch reruns of Trauma cheers

None taken .... ahem pick up that case of beer would you I an too old and feeble of mind and I will spare a you a slow death Well this tread sure has got off track a tad, although I cannot disagree with any comments they are valid it is dependent in many cases on the positive and negative experiences it each individual it has matters not the # on the card [although agreed it should be laminated so puke washes off easily] and I could pontificate for hours on this or that situation, I spare you my thoughts, I will say as a fossil I have observed every level screw up and on the other side observed every level do stellar jobs .... This thrread started about hiring freeze in Cow Town .... and the reasons why this is occurring, very soon we will observe the standard PC hiring policy's by AHS HR and it will all become a mute point it will become hiring based on PC only not experience in this area or that .... I will hold my tongue on that topic, as I recently was NOT hired in a local operation because of a "social hiring fit in" policy .... possibly a good thing as mediocrity is really not my persona ... What annoys me with the bigger picture when any major urban area hires the 10 day on 4 day off crowd (insert reg #) wishes to have greener pastures 4 days on 4 days off ... you just cannot blame anyone for this, the old municipal funding formula was directly responsible for level of care in the rural areas ... FAIL. This sucked "experienced providers" insert (reg #) from rural areas into urban ..... so 29 hires for Cow town pulled 29 from 29 separate rural communities ... all wrong in my books. Now this new improved takeover "maintain service level" well we have already clearly observed that this is a lie with BILL 60 and putting an EMERGENCY PARAMEDIC Band Aid sticker on every gut wagon, just as BCAS capitalized on this, we will loose experienced providers where they can truly make a difference not the 15 minutes flip to the foothills ER but 3 hours transports from a rural community where resources are truly stretched to the max not only in man power but in brain power as well. The Liepert "circle talk" of hiring ACPs or EMTs and actually use them in Rural Facilities is fraught with "turf wars" conflict's and a lack of put your money where your mouth is philosophy ..... just where did the money go in Dr. Druckmans Super Boards pockets ? Late entry for uk FYI ... there is always a TEAM Leader in a Team, the higher the reg # thats where the finger is pointed ALWAYS! The legislated level for the "patch" best called remote deployments and there are many flavours from drilling rigs to completions to logging to pipeline to plant turn around to mountian pine beetle and forest fires is the EMR level akin to a First Aider and they get thrown out after 120 hours of training and cant even open the door of a real gut wagon and pull the cot ... because the "program" does not include this The huge fail IMHO is that ACoP and WCB should me mandationg an EMT W for Wilderness level because thats what it is in most cases. No def not - sorry but if you graduate then go out to the oil patch w/o 911 experience then IMHO that is asking for problems, controversial I know but its what I think - no reasearch at all behind it just my opinion Do you need research to understand that a spanking new Grad EMT ... with a whole 40 calls on car then thrown to the wolves and perhaps seeing 2 patients for cold and cough in a month when and IF they ever do get a heavy hit ... no rocket science needed to see the possible out come (and in those cases the Team consists of one "Medic" and an overseer called a Consultant or Safety ) that signs the bills and is duped into believing one call and a Rescue Helicopter is on the way and the liability for the accident is already on his head .... FAIL AGAIN. cheers

Hey Sly: Goggle Bledsoe ... go to "handouts" then open Power Point called "Snake Oil for the Masses".

Agreed unless one has the bigger picture in this situation basically one is shooting in the dark, I find it very curious that mentioned in the "scenario" a PEA (so what was the rhythm prior to return of pulses ?) And without a possible cause or PMHX to the OP you are treating a monitor and talking about hanging dopamine, very curious as well. Cardilogists typically refer to a "stunned heart" and with crazy reperfusion rhythms as stated my kevkie (put your hands in your pockets hold the rx) Then a rate of 80 during recovery quite curious again (thinking Beta Blockers?) typically a resuscitated arrest are far more tachycardic, that said a relative slow but wide complex could be Ventricular Flutter or perhaps a BBB? Quite a stab in the dark without a strip to look at, or proper Hx of incident, akin to buying a mail order bride. A little story, in Hospital, Patient 36 y/o female O pmhx, just delivered first child, some post partum hemorrhage, Ergonovine Malate IM .... then a sudden arrest .... Code Team responded <insert heavy breathing> ECG observed by experianced RNs a very wide ventricular appearing complex and a slow response ~ 80 bpm. Paddles pulled like a gunslinger's in an old duster, BUT some one noticed a tiny little "hick up" buried in the complex ;>) initially appearing to be artifact, NOT ... stat to angio an nitro squirted directly into coronary artery. PRESTO the huge ischemic T waves disappeared and was determined that the epithelium of the coronary arteries was hyper sensitive to Ergot ... go figure. Point being without a history ...

How can one be licensed as BCAS is the "catch all" licencing, regulatory body, tied to education and employer ? Heck as an ACP I can not work in Industry until I have challenged the OFA level 3 from WCB ? So @ 2500 a month (625 a week) then based on a 5 day work week that amounts to $125 CND a day thats about $10.40 bucks and hour but far better than $2.00 bucks an hour pager (before taxes) or is this an honorarium like tax free ? Heck EI pays $400.00 a week and stay at home and watch the Olympics on TV, sure hope the EMRs take basic math in their program. I know Whistler, heck you can't get a beer and a pizza for less than $50.00 and accommodation ? Well unless you have a friend living there with a spare piece of rug so good luck with that too. Then add travel (the rent in Vancouver during this event)is beyond Gorging .... WOW thats a great deal where do I sign up ? Oh and still waiting for a response from MP Stockwell Day and that letter had a different "tenor" in presentation than the response I received from MP Bob Rae (NDP) concerning pandemic preparedness. http://www.emtcity.com/index.php/topic/16779-are-you-assisting-in-innoculations/page__st__50

The death rate from Canada Health website: http://www.phac-aspc.gc.ca/alert-alerte/h1n1/surveillance-eng.php The World Health Organization: Public health significance of virus mutation detected in Norway. http://www.phac-aspc.gc.ca/alert-alerte/h1n1/surveillance-eng.php http://www.who.int/csr/don/2009_11_20a/en/index.html Yup its a government conspiracy this vaccine

Thanks Artickat: So VANOC pressured the Comrade Campbell government to: 1- Legislate BC Emergency Paramedics back to work (even though this was not an active strike) 2- Using the H1N1 pandemic as leverage and not providing priority vaccine to First Responders. 3- Now VANOC did the math to find out they may need more assistance, maybe STARS will come to the rescue. Sure would be a complication if a member of BCAS was legitimately ill. On to EMR in BC are they not part of the CUPE ? So if they are registered out of the province do the EMR have direct reciprocity (otherwise unregistered with BCAS are the legally covered under a blanket malpractice insurance) Will they be receiving the $2.00 per hour standby fee or are they just volunteers, do they receive a wage (as per contract) if they are pressed into staff a unit ? http://www.health.gov.bc.ca/ema/ http://www.bcas.ca/assets/Careers/PDFs/May%2022_EMR%20FAQ.pdf http://www.bcas.ca/EN/main/careers/898/qualifications.html

Dear Mr. Squint: Thank you for your recent correspondence to Mr. Rae about the H1N1 pandemic. The federal government has to be held to account for its reaction to the threat posed by H1N1. The confusion, delays, and sudden drops in availability of the drug require an answer, and question period in the House of Commons is an important venue to hold the government accountable. The federal government has yet to demonstrate that it is treating H1N1 with the seriousness it deserves. While it spends $100 million on partisan ads; it spends a fraction of that raising awareness about H1N1. This has resulted, in large scale confusion about the risks posed by H1N1, a lack of public knowledge about the shot, and little promotion of ways to fight the spread of H1N1. The answers given in the House are less than clear and candid. Further, in 2006 the government budget allocated $400 million to respond to future pandemics, the government has yet to utilize this fund. Mr. Rae would like to see the government use this money for the purpose it was intended, helping and enabling health workers fight H1N1. These are two very simple ideas, both are easy to implement, and they would demonstrate that the government takes this health threat seriously. Once again I would like to thank you for sharing your thoughts with Mr. Rae, I hope you will not hesitate to contact him again on any further concerns that you may have. Yours Sincerely Office of the Hon. Bob Rae 613-992-5234 raeb@parl.gc.ca SIR: I commend you HIGHLY on your comment's regarding H1N1 today on TV ... I am an Albertan, a Registered Paramedic and a Registered Respiratory Therapist who just happens to be ill at home, day 5, and likely due to H1N1 and taking my GPs advice to self isolate myself. My brother returned from the middle east 6 days ago and I gave him a hug, appears now a huge error as I was not inoculated for H1N1, a debated topic at the Alberta College of Respiratory Therapists annual general meeting over a month ago, by the way the Ventilators purchased for this well known and predicted by WHO for this imminent Pandemic are a laughable, (well not humorous at all today) they do not have the capability to deal with the intensive ventilator care required, very sadly. The reason I write is that you are correct, our government here under Liepert as Health minister receives a huge "F" and should resign immediately for his comments today in the legislature, only 125 to 400 expected to die ? Therefore, I have personally extended an invitation to my home (and his family) for milk and cookies ... as for the last 3 days I would have very much enjoyed sharing this illness (oddly enough he has not dropped by, nor returned my call) http://www.calgarysun.com/news/alberta/2009/10/29/11563116-sun.html On another topic as a First Responder please review his Deputy Ministers Comments, ignoring Canada Health's advice. http://www.calgarysun.com/news/alberta/2009/10/28/11550396-sun.html We as professional Health Providers called Advanced Care PARAMEDICS are a forgotten resource (in Alberta) in my humble opinion a huge error and based on some type of turf wars .... appears that Toronto EMS is far ahead, as is the methodology in Sault Ste Marie, making an appointment (brilliant really) yet in Alberta we are amassing large groups of people, awaiting in confined areas. Well as a Health Care provider this is the most effective way of actually transmitting disease, My Grandfather a WW1 veteran and a POW also exposed to Spanish influenza, well he himself would be shaking his head in absolute disbelief. Health Care delivery is a provincial responsibility and I believe that the National Health Minister and Medical Advisors (yes I know a Conservative) are doing their best an excellent internet site, evidence based medicine applied, very unfortunately the Provincial Health in Alberta receives the FAIL here, it will be interesting to do a post mortems on the different delivery methods ... I pray that my children will not be in the statistical analysis. I have a suggestion but this has been basically ignored, we have these units called Industrial Ambulances over 1000 I suspect sitting due down turn in the oilpatch, perhaps use that resources and a call center to inoculate those that wish to their homes .... I would be most pleased to assist in ANY way to assist ... I expect that in another 4 days I will have developed my own immunity, I know of many other EMS providers that would be pleased to assist as well. Feel free to Contact. cheers

http://www.vancouversun.com/business/Vanoc+medical+volunteers+events+threatened+paramedics+dispute/2237886/story.html Vanoc to use medical volunteers if events threatened by paramedics' dispute Comments on the article: Great comment from someone who lives in the area so this highway is notorious for big wrecks (MCI) one bus goes off the road and call the volleys .. so VANOC is going to find 750 lifeguard's, part time Ski Patrollers and OfA level 3 Band aids to provide Medical Services in a couple of months ... Ok why am I laughing ? Just imagine that a Government could be ousted from power by mere Emergency Paramedics standing up for their rights in a democracy ... this just keeps getting better by the minute. VANOC EPIC FAIL a most excellent example the tail wagging the dog, just too bad they are dealing with a pit bull with a cropped tail, VANOC and Comrade Campbell even have trouble doing basic Math: Are the security Volunteer's too?

Awesome Dwayne but lets not forget OUR EMT City hero's too, so many non military Medics that we oft time leave out. Ak. Dust. Rogue. and the others that we will never know their names. cheers

Correction: Dustdevil brought Chuck to Iraq just for a photo Op. For the life of me I have searched in vane for that picture to insert. cheers

And the WINNER in the Arnie vs Chuck thread is PHIL !

I may be wrong but I sense <sarcasm?> back at you bro, so how do you get .90 Fi02 on a self inflating BVM or a JR ? And can one cause Auto PEEP with say "wide open flow meter" or 15 + lpm on a BVM ? I so hope you get that job btw! Great stuff But an RRT Slam is now must be in order (to be fair) ... I can tell you that I took me 3 years I my OLD ICU (note the past tense part) to have in included in respiratory report "include trope levels" and right next to MAP = Mean Airway Pressure, Oh so don't get me going. Many card in hand ACLS ICU RNs would get noses right out of joint pulling ABGs and believing this was a "static" measurement, and that recording MV and SpO2 and ETCO2 were rather important, this @ 04:00 hours was ABG / ie blood work time on a 30 bed unit that only took 2 years to change policy ...argh. NB: Many respirologist ie pulmonary medical intesivists type(s) believe that Oxygenation = MAP, provided CO not affected to drastically. cheers ps maybe we need to invent a Smart "monitor" in line with every BVM and voice activated ? I will get back to you

Great point and moreover "the trooper" actually being aware that there is a "Cop Cam" is highly suggestive he has a cognitive judgement problem, even more magnified when the supervisory Staff in a Media conference to boot are simply doing damage control and circle talking, failing to address the real issue as ERDoc points out so eloquently, a pattern of behavior. cheers

'melclin' Perhaps it is my lack of skills with a plastic brain but searches to these studies is sub optimal, if you could be so kind as provide a link. 1- PC = Presser Control (type) Ventilation with a flow inflating "bagger" and VT is subject to R= Resistance and C= Compliance)If a Paramedic is to use this mode of ventilation best get further training as a member of this website for quite some time the group as a whole (well in this Ventilation subject area) seriously lacking education (I hope that most using PC will recognize that one can ventilate a brick !)and without monitoring devices/ watching chest rise, or belly rise (in the non intubated) and the addition of pulse oximetry and ETCO2 well. if you think this is far from the truth ? It does happen far more frequently than you can fathom and unrecognized besides I have the court cases to prove it. 2 VC = Volume Control Ventilation ... well I have a little scenario on a little course I developed for Paramedics: Called Transport Ventilation in the Flight Environment ... would you guess that based on the 5 to 7 ml per kg that 90 % of Paramedic students FAIL ... when presented with a Patient that is 200 kgs .. HUGE FAIL! This is where I start then titrate PIP > 40 to achieve Plateau pressures less than 32 cmH20 "in the fresh Intubated" and non complicated pulmonary patient. To the OP could you please explain APPV or IPPV (is that intermittent positive pressure ventilation?) I understand PRCV, APRV, PC, VC, Control, PS, CPAP, and SIMV (a few more oldies too)... but APPV has got me scratching my balding head? Comparing 1 PC and 2 VC is like comparing apples to oranges in the first place unless one has volume measuring devices in line as well as pressure ... http://www.lifesavingsystemsinc.com/em100.htm well IMHO is a toy and also should hit file "G" the Carevent ATV has nice colours on the twisty knobs again belong in file "G" for anything more than a transport across the street (I call them the Educated Fire Fighter) as far less extubations enroute. Honestly I have no idea why if these are published studies why one would wish to remain "private" just the drift of the convo suggests that yet just another capitalized approach, inventing another gimmick as in the Smart Bag IMHO should recycled into gargbage bags ! http://www.otwo.com/prod_bmv.htm ILCOR are standards set for those that rely purely on the dummied down for the Paramedic Masses AND so that every RN can get a card for their wallet. Its not a gospel,and its a consensus and vast majority of those with input a cardiologists or ER Mds ... hint: the footnotes are an indicator. Really a rhetorical question, short answer of course the type of airway is a variable and what type of lung simulator are we talking here computer sim or one with mechanical springs, just a query is all. 1- I believe chbare is referring to Vd/Vt ie deadspace ventilation with the use of variable airways, I will not put words in his mouth persay. 2- Quote Ventmedic: "For the OP, it sounds like that researcher is trying to build a better mouse trap with the BVM to achieve lower VTs, limited flow and lower pressures" Agreed Fully, education is the long term answer not another I am too stupid to use my brain and the sense of touch and need another plastic invention. 3- Vent goes into great depth to explain compliance compensation, deadspace ventilation and different strategies in the ARDS patient errors in the CCT situation this is why Respiratory Therapy is now a 3 year degree program and a 2 week course for a CCT patch ... is a band aid fix at best, s if one cannot run an LTV like a piano ... get off the bird ! <snip> Phil: Firstly in a full arrest situation there is no spontaneous circulation/ perfusion ! and if one looks back to the Krebs Cycle and production of Lactic acid there is an INCREASE need for O2, and at the cellular level the production of CO2 is still a dynamic process even during DEAD (to a point) and quote ILCOR guidelines all you wish in that regard but one still has to be returned to homeostasis if one HAS a return to spontaneous circulation, there is research to suggest that acidosis is a protective mechanism at the cellular level ... note research, IMHO the increase in stats we are observing is directly related to the focus on education of compressions ONLY in the out-of-hospital ... to door discharge this is a misnomer. This is not mute at all, the multiple topics here ie during arrest or transporting or the ventilated patient during transport, the concepts for example DHI a "relative hypotension" resulting in PEA and generally is unrecognized by majority of EMS providers, but further compounding this with Oxygenation, Ventilation, and Perfusion with a smattering of Mask Seal and ramblings. Last point you make Phil we actually place a O2 cath down the ETT tube at a flow 0f 6 lpm and do serial ABGs watching CO2 rise and PH drop ... in fact this is used a criteria to establish Brain Death, therefore are you resuscitating a heart or a brain ? <end rant>

Phil: First LMAO Special Olympics, so thanks for Playing under funny stuff Second: Mate your just pissed cause the best Oz has to offer is Crocodile Dundee

Richard B the EMT I'LL Kill you Last !

Paramedics' tough tactics are a sign of renewed militancy.