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kevkei Is is so good to see you are back.

Kev: 1- Where are they going to find all these dual trained FF/Paramedics and I believe EDM and FMM is hiring too, which ups the numbers ... I dont think anyone in AHC has done the math ... HellsBells made a terrific point. 2- If they do find enough Paramedics it will be at a sacrifice from the "RURAL" areas hence decreasing the level of care to other important Albertans where ALS is making a bigger difference in positive outcomes. (hey everyone wants greener pastures, cant blame them really) 3-And really no clear answer from Liepert on exactly HOW paramedics can improve scope and provide care for the community ... find a open clinic on a saterday night ... in Edson or High Level ? BRB my Sheep is needing a popcorn for this movie. Baaaa !

Dust: Yes ACoP regulates Paramedics, (even those that are cross trained) and EMTs and EMRs, if you chose to stay in health care (only) your new employer and paycheck has become the AB government, private service, municipal, hospital based or Fire based. Some integrated services are embracing this and some integrated services are saying "well there's the door" ..... and good luck with that. Best part is this Dust : Me either, thats the whole freaking point !

YUP: Bucket Fairies are Public Safety/ Cross trained Paramedics are now classified Health Care Workers .. the F/F are jumping ship because they want no part of this newly reclassified "health care restructuring" can you blame them ? I can't, they are way ahead, really. Appears that Integrated services will be far more stable AND one get's to hold a mattress down on night shifts, just let the IHAS's guys and gals do transfers cause they get paid crap, and who cares ... really. JAB! The reason and why the leap is not rocket science .. the IFFA is the biggest Union in North America, government will not screw with them, hell, we are the EMS dumb asses and just as like Bryan says we lack solidarity. cheers ps got a spare bed ? I can cook ! but no nookie ... LMAO.

WRONG cost of living is way higher, well except for Hongcover (BC) If you saw my heating bill alone you would freaking fall over. And WRONG ... you think I was just visiting in Texas ... Ha Ha I was applying for jobs ! WRONG ... I am a Mercenary Health Care Worker, hell all Our Canadian Trained MD's work in the US. cheers And Hellsbells makes a damn good point .. and how about the Paramedics moonlighting in industry .. we are Legislated there No Medic... No worky ... OH+S man says and they have a bite better than there bark. NEVER UNDERESTIMATE the TRUE POWER of properly organized Professionals ... hey we didn't start this we were forced to ... comply.

Yes agreed the topic is worth a new thread. NS is whining and they should, they get paid crap. Quebec is going to the table and the press .... just no one understands what they saying/ parl'e ? BCAS took a strike vote, but there messed up with only PCP in areas were ACP should be. SK is starting to look really good, maybe Toba ... they have great beaches . AB: CUPE is doing everything in the power (including TV advertizements) and good one's too. Posters and Billboards appearing everywhere, join HSAA .. have hospital weenies negotiate terms ? WTF! Government dictating just what Union WE are suposed be members of ? WTF where did the right to organize labour go ? Private Operators not investing in Staff, Education or Capital purchases, since the anouncements. Medics on integrated services are jumping to Fire side like rats jumping ship. Dispatch centers are disapearing and lots of pple looking for jobs, good news for stimulating the economy. The Minister of Health is saying to increase scope of practice for Paramedics but no mention of more beds opening up or just who is going to take care of the insurance rates when they sky rocket. Then MOH appointing MDs that want to back to the dark ages, take away RSI and ETT. ACoP gets caught telling stories out of school, going to get spanked, allowing OOP Medics working without due process or registration. Past Medical Directors in rural areas AINT happy. All this and Mobeys right too ... no drop in level of care ? How stupid does Stelmach think we are, sure hope he doesn't get chest pain, would love to me the Medic on that call. This IHAS is news to me ... no transfers till one signs on the dotted line ? I just wonder how that will work out ... NOT ! stand your ground, your worth your money. All this on APRIL FOOLS DAY ... Well: I am sitting back with my sheep, drinking beer .... party at squints place, saying I told you so. A Concept without A real Plan .. way too fast ... and the wrong people calling the shots.

BEorP: A question: do your protocols allow for Entonox for chest pain ? as some areas do, others not. Decreasing pain/ anxiety can reduce endogenous catacholamine release, therfore reducing HR. Heck one day (just anecdotal) we converted an SVT with Fentanyl alone (an applause heard from the crowd .. that in an ICU) Multiple leads not a bad idea to develop a working Dx, but correct me if I am misunderstanding something but is LA (left arm) not a ground lead ? with Lead selection settings on the monitor in Lead 2. If selected in Lead 1 LA would be a positive lead .... get my point ... one could be really confusing the situation, unless one has a very good handle on 12 leads (ps thank God for the colours/letters/numbers) With no Line, Chest Pain and a Tachycardia ... probably best do this while enroute an idea to place some defib pads as well (the if I waste 80 bucks then I will not need them concept) this wards of VTach spirits too ... Then again you may just bottom pressure not disagreeing yes`a judgement call, I personally would look to LOC over B/P (pt has alread had one spray in the senario)... no pt weight, no size mentioned (I have seen many small elderly females with Normal B/P 90/60) just saying. <snip> There is FAR more than one study to clearly indication that Trendelenburg is absolutely useless, if pt did have a component of CHF you could be making things far worse, then that could really change outcome. Besides someone c/o of CP will rarely want to lay down, let alone head down. Umm HUH ? sorry, not even close to a rational physlogical explanation, (tricking ?) I believe your trying to explain postural hypotension in a round about way, in fact, if one finds a 10% decrease in Systolic pressure (Sitting vs Supine) this can be a clear clinical indicator that the pt. has a fluid related problem. DRY! Your welcome, google is your friend. cheers

In late: But I agree with AZCEP ie the BBB (notching S wave) or possible indication of some type of LV Hypertrophy, question is this new BBB ? but the tachy cardia is still unexplained. I would do a wee fluid challenge, as the elderly can frequently be dehydrated, get a line in asap. 12 lead absolutely and maybe do a bed side troponin if you have that capability. If you don't have a line, 12 or bedside stuff ... get going to ER, if the pt has already taken Nitro check the expiry dates, and if her BP and LOC are ok let her try another spray ... cheers

I Hate the crunchy noises when doing an NTI. cheers

As you may know Dust, I have many friends that work in very remote deployments. I have contacted a friend with Cougar (another medic/ crew chief) but to my best knowledge the medic has yet to be identified ... but you are absolutely correct my very good friend, the issue that I find so hard to swallow is Remote Medics are really not recognised for their contributions to the ever evolving world of EMS, many times they are far more advanced and experianced than working on a "Power Truck" downtown anywhere, a remote medic works without a partner, often hours or even days from a Hospital, self reliant and moreover have great pride in what they do.

ST. JOHN'S, N.L. - The fuselage of a downed helicopter that claimed the lives of 17 is lying on its side on the silt and gravel of the Atlantic Ocean floor, but it is largely intact, investigators said Saturday. The probe into the crash took a step forward as officials confirmed they found the Sikorsky S-92, owned by Cougar Helicopters, and recovered various debris, which included parts of the chopper and personal belongings. After wading through deep, murky waters, a remote-controlled camera confirmed they had found the fuselage. Mike Cunningham, lead investigator with the Transportation Safety Board, said investigators hope that same camera will determine whether any bodies are still inside the helicopter. "It's certainly quite clear how important it is to (their families) and it's just as important to us," Cunningham said. Police released a partial list of the dead, who represented the white and blue-collar workers from Newfoundland's offshore oil industry. One was a drill hand, another was a medic. "We see this accident as something that we're all in together," said Hank Williams, Cougar's base operations manager. "We're hurting." The helicopter crashed Thursday with 18 on board as it ferried workers to two of the province's offshore oil platforms, located about 350 kilometres east of this port city. The lone survivor, Robert Decker, was in the Health Sciences Centre in St. John's in critical but stable condition."We continue to pray for his full recovery and have complete trust in his medical team," his family said in a statement. "To the family of Robert's co-workers and friends, you are in our every thought. Since our world changed on Thursday morning, there hasn't been an hour pass or a prayer said that hasn't included you. We feel your loss, we share many of your questions but at this point we have no more answers than you." The only body recovered so far was that of Allison Maher, 26, from the small Newfoundland town of Aquaforte. Investigators are hoping to begin lifting the wreckage on Monday or Tuesday by luring straps through the openings of the fuselage and hoisting it aboard an offshore supply vessel. "We want to ideally bring everything up in one piece," Cunningham said. Officials said they have recovered pieces of the helicopter, including doors and the interior bulkhead. The helicopter is believed to be sitting 120 to 150 metres below the ocean's surface. After the wreckage is pulled from the ocean floor, it will be brought back to St. John's for further investigation. Investigators would remove the data recorders for a thorough inspection, Cunningham said. "We look at everything through a microscope," he said.Transport Canada's aviation database had reported the pilot of the helicopter declared a mayday "due to a main gearbox oil pressure problem." The gearbox is located on the top of the fuselage under the main rotor head and serves as a link between the engines and transmission. "It is like many components on an aircraft. It's very important," said Charles Laurence, another Transportation Safety Board investigator. "There's no backup system for a gearbox." Cunningham said the gearbox would be examined as the investigation unfolds. "We totally dissect everything that we can and certainly that is going to be an area that will be examined," he said. So far, investigators have retrieved the upper and lower parts of the main entrance door, the aft cargo door and one of the emergency exit doors, which is still intact. The lower part of the main entrance door was locked, but its upper part was in an open position, Cunningham said. All aircraft have been restricted from flying within a 20-kilometre radius of the crash site. A partial list of victims in Thursday's helicopter crash off N.L. Here is a partial list of names of the 17 people who are presumed dead in Thursday's helicopter crash off Newfoundland and Labrador as released by the RCMP. Only one person has been confirmed dead by the RCMP: Peter Breen, 55, St. John's, N.L. Gary Corbett, 46, Conception Bay South, N.L. Wade Drake, 42, Fortune, N.L. Wade Duggan, 32, Witless Bay, N.L. Colin Henley, 38, St. John's, N.L. Ken MacRae, 47, Greenwood, N.S. Derrick Mullowney, 51, Bay Bulls, N.L. Burch Nash, 44, Fortune, N.L. Paul Pike, 49, Bay Roberts, N.L. Allison Maher, 26, Aquaforte, N.L., confirmed deceased. Tim Lanouette, 48, Comox, B.C., first officer. Thomas Anyll, 46, Langley, B.C.

An excellent point my friend and every area is very different absolutley agreed ... but logically the next question would then be: Just WHO knows what is in the "best" interests of the people ... the government either federal, provincial, municipal ? .... or the hospitals ? unions or paramedic association(s) "of very loose sorts" should we let the MD's ? those who have never worked in the back of a truck call the shots either? Or matbe the hospitals boards that we all know are run by bean counters only. Involvement of Fire Deptment should be extracation or when one needs more hands ... not just because they carry a 'flash box" or O2 to every trouble breathing call to boost their response stats, send another gut wagon not a 50 ton sprinkler system ... sheesh. A side note .. yah know if we made sprinkler systems mandatory in EVERY new building, heck go one step further and retrofit all building's 10 years old ... most likely many funds could be released to provide improved level of services to EMS / Healthcare overall, we would not need anywhere near the vast numbers of FFs on a nation wide basis. In our "hood" recent events are now seriously challenging what is the best system for EMS with a new "transition concept" (all warm soft and fuzzy) but no tangible plan, well unless complete privatization is the goal (and ye gads sure looks like that in my crystal ball right now) ... sorry to digress but we in Alberta are very shortly, like APRIL 09 face a supossed huge overhaul/ transition and all that I have witnessed (so far) has resulted in a COMPLETE standstill for any development to improve EMS (and many fire based EMS services are witnessing a huge jump by medics to fire side ONLY) ... the devide and conquer technique of union busting and fracturing a system that once was a fairly effective model, well this has all been stopped DEAD in its tracks ... or maybe completely derailed now with the threats of cutbacks with the downturn in the economy. cheers ps there is no perfect system .... but there is lots of dumb ass systems out there.

You gave birth ? OMG and you didnt even look pregnant when I saw you last .....

Cheers, keep hacking !

Yes we noticed .... hope everythings good with you, I have been learning way more about cardiology. cheers

I heard the penis are free .... but Condoms cost $120.00 ! I can just hear the inflight safety talk now ... In the event of sudden inflation, please contact the attendant for assistance, we take cash and visa only .... and Mobey were NOT flying North West to EMStock now, but hey do they have a girls gone wild flight ... direct to Midlotian, count me in. cheers and laughing

Just FYI; http://www.viasyshealthcare.com/prod_serv/...l&prodID=54

Firstly: Thanks for the info on the 3000 ... and the first time I have seen one, many improvements over the 2000 .. btw it (the 2000) had a terrible rep for exhalation block failures (Like I said I had one crap out on a LDT flight ... so just a bit personally jaded) when exhalation block fails it can inflate a small weather balloon. krumel ... do you know the cost of the new 3000 ? as the only drawback from LTV for EMS tansport is that its worth about 20 + G here. Unlike the LTV (a turbine powered .. oh yea ) the old Oxylog 2000 required a compressed Oxygen source for the drive mechanism (a venturi device) one can get higher flows on an FiO2 of .4 than 1.0 has this changed ... I did not see that in the literature, (dont think so) so your duration could be limited by amout of O2 on board, not a battery or plug into inverter. The LTV has a turbine and can generate much higher flows if required, Ti % and Slope can also be adjusted with the LTV and one can hear the turbine "step up" which is very, very cool. With the LTV 02 can be blended internally with a 50 psi source OR just 'T'ed" in for those with minimal oxygen reqirements (most helpful on very LTD flights or trips on board regular airlines on repat returns across the big ponds) when going from on board tanks, to truck, to portable's, a very nice feature indead. I sure would like to do some bench testing on the 3OOO do you have any links to dealers / reps in Canada ? It appears that Draeger is trying to compete ... thats all good. cheers and thanks ps the reps seldom change the lock outs from factory settings especially in the CV 4 ... the access code is usually 012345 or 12345 .... te he my bad ?

Could you please explain that acronym ... as I may wish to use it in future posts ... just saying. ps contact PM. LMAO!

A Yugo must have eaten my post ..... wierd.

Vent:

Once again the RRTs agree, Carevent, Autovent or for that matter the Oxylog (the OZ demonstrated a large percentage of exhalation block failures, I personally had one @ 28 Thousand feet ) none of these vents I would suggest any operation in purchasing. The inspitation time on any Volume ventilator and not fully compreheding the interactions can in itself be a very serious concern, And as if I would ever put this on a child .... NO way. My question is this ... Why with the increased use of CPAP or Bi Level support (my vote) in EMS do companys spend so much on a device that is SO limted, and old technology in the first place, instead of purchasing one ventilator that can do it all ... my personal favourate is LTV for transports as pressure control ventilation is becoming more of the norm with adults and Paeds. The scariest thing about this whole thread is handing over a ventilator to an EMS provider without proper the background or theory of operation ... Yikes. cheers and sorry for the late reply ... looks like vent had it covered six ways since sunday anyway.

Mobey : Funny Thing Dude, we live in a different world. My first post got eatten by the internet gods ... ps I have chains, 4x4 and have more "gak" than this yo yo's kit bs kit gimme a call and will give you a hand up ... ps medicnorth has chains too and has a frozen moose in da fridge ... my nieghbour a gennie and fuel till the spring. cheers HEY and if the shit REALLY hits the fan .... no taxes .... ho hoo.

To Al and Happiness: Ok ... an old communications Prof once said to me: If you continue to think the way you have always though ... you will continue to get what you have always got. Question : IS IT ENOUGH ? (ps for your patients !) Oh Yes I too have climbed up the single rungs of the ladder, St Johns, Instructor, Industrial C, B, A, AA, EMT-A then on to a real ALS Paramedic and mentored and supervised along the way in Edmonton with the intoduction of an ALS service and implimenting some of the best in instructors in N. A. (we were ahead of our time, and Bill Coghill (isourus) acomplished this, using ..... ALS Paramedics from Chicogo, New York, Tuson, and Texas in the early 90s ... I have been a lucky man bottom line, as well I persued a few other enhanced venues too ... that said: We must be proud of what we have accomplished (so far) the forefathers/mothers and for Mo Fo' ers (ok got to throw in some ha ha ) of what we have accomplished ... BUT we must accept that this ladder "effect" is something we have to overcome besides no MD resident is unsupervised unless by a Fellow or a Chief Resident , and no matter just what the students "learning type" it may be, internet, an audible learner, a visual learner, or interactive with an instuctor lecturing. There is no "Zero to Hero" ... there is only one goal .... to advance the profession and yes have certianly have GREAT pride in the PCP level (you should).. but never forget this : (ps I bet $$$ Dust will agree) The more you learn the more you don't know. AND not only are you worth any other public safety officer wages ... YOU in BC are worth the investment of further EDUCATION to provide improved services to yor patients .... So STAND YOUR GROUND ! cheers ps While recently improving my personal understanding of LBBB and silent MI ... I would be most interested in promoting improved education at the JI ... contact PM any time.

Iatrogenic Roids ? This clown deserves to die a slow death, although I know a good proctologist that could save his ass ... (always a joker in the crowd) A Forest Gumpism comes to mind ... Stupid is as Stupid does !