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I have heard conflicting stories but doing that is not a good practice for certian... sad thing is in the end that if there are infected ppl then our tax dollars get spent the wrong way again. Wait for the 2000 page document to investigate it too, it will be out in a month after the next election .. am I sounding like a pissamist again .?

Perhaps just a shock and awe situation ? I dunno but they are keeping a lid on it which makes me rather suspitious. First Question I have to ask were these so called 5 .... forgien trained RNs and LPNs ? The real point being that using one syringe to draw up meds, lets just say Ancef from a multi dose vial then loading a 100 ml med bag ... pretty insignificant risk really, as Dr. Purdy eluded too, I may be way off base here but lots of speculation going on especially by the NDP ... well just me GO for IT but they just may look like fools in the end if they can't find any infected people wandering the streets in HP BUT as many other issues need to be addressed with a much higher priority ! Wait a bit to see if there is ANY if at all infections are proven, the outcry from the community is more fear driven, I think How many real cases HIV or Hep C issues have already shown up ? Usually these are the triggers that indicate ... like MRSA in Vegitable Ville. Honestly the dental drills are a way bigger issue, transmitting any disease. Firstly we should be getting the MDs to wash their HANDS and Stethascopes ... so ask yourself do you wash yours tubes beween every patient or just hang them around your neck, OR do you N95 ALL your high temp patients = SARS. What cleaning agents are used by your service ? Just saying infectious disease control issue's are a biggy and best point a finger to EMS as we are very poorly edjumicated on this issue ourselves as a group, talk about monkeys. Oh yea ever find a dried blood in your rig, or on the cot .... tell me that never happens ... or your humidifier water bottle changed out last month ....... just saying. cheers Late entry: Ever try to do a Lumbar Puncture with a Plastic Syryinge or put Albumin 25% in a plastic container, OR Nitro in a Plastic bag incompatibility issues guys and gals.

Yes and No ... sounds skizo dosn't it, the money is there just more effective strategies are needed, more cost effectivlely is all, besides WTF are they doing with the Oil Royalties CA$H anyway ? Of course we need more beds in hospitals and more RNs and Mds as well, my point is unless one "imports them" from wherever this in my opinion is not the answer as world wide there is a shortage .. shifting the Health Care workers from abroad is not an answer as they are needed in their own counties. Ok now for the RANT part ... Up in Mooseville this falls directly in the govenments lap ! The Conservatives were the ones to cut back and not only hospital beds and "restructure" back in Ralphys days. The cut at the training institute level were idiotic and now there is fall out big time. I was asked by a patient when the ER was stacked up like firewood, one day WHY is there a shortage .... I pointed over to a 3 year old sitting with her mom ... because in 20 years that little girl/boy will not have the tuition nor the placement seat available. My point is that longer term goals are neede to fix the system but change every 4 years with the sweep of an election and it is a mess and after 34 years and counting our government has failed us <end political rant> Improve funding for Training LOOK to the Future make Texas "North" the Training Center for North America. Now: Honestly there is a huge number of patients that are NOT emergencies they should be going to there Family doctors offices .... a huge amount of abuse out there, go to a clinic, its not a 711 its an Emergency Room. <big breaths squinters> ah better now. So in the interim how can we help out we as EMS can spearhead this ...Hey Look to the Brits don't reinvent the wheel, Yes across the big pond they have been forced to adjust we should to now with the scares in High Prairie and Stelmachs own riding Vegetable ville just lately "Strike when the Iron is HOT" Write a letter to your MLA ... don't just spin your wheels in EMS forum sites get political, so many great writers in EMT city and CPW that are truely in touch with their communities, stop bitching DO something. I Love ERDocs ideas statiscal based medicine the concept applied in utilization, and bed management (hey ERDoc want a job up here, we have great beef and beers eh! Mobey we do have friends in the FF department, I can't remember where but a Inspector for a FIRE department shut down an ER west of Cow Town somewhere Cochrane I thing ??? ... to bring public attention to the very issue of overcrowding in the ERs. Kudos ! Ok some options worth bouncing of some noggans here so please gimme some input, I am composing a letter to the new provincial transition for EMS or whatever it is called. 1- Treat and release is one very viable option: (I don't think this will be an option in the US, due the legalities and "sewage" (sp) liability issues. 2- ALS "fast cars" used to triage patients in the field. (Ft McMurry wants to put Paramedics on Crash Rescue .. just plain ass dumb thinking I say) 2 (be) or not 2 be, Let us suture/glue/ and put together information sheets and have a family member sign off for care, many times patients just want advice or then the "Off Work for Medical" so not rocket science here. You know how many visits to ER on Sunday night occur for that exact reason .... use the clincal call center concept implimented in London Ambulance Services I will give Stephen Hines a call and I will put him up at my place. (he knows good beer too) 3- Computer network with bed availability and the Hospital needs to "ask politely" for a diversion not the other way around, this would put pressure on the Hospitals to solve their own problems or break there pocketbooks by Shifting the load to another facility more prepared ... lift a few wallets and see how helpful they get. 4- Here's a Stop gap but very viable solution for rural a good PA program and fast tracked through the HPA, and more seats for the NP programs (for we old farts in rural areas) as for you US types we have not established that level here BUT have quite a few ex medics that are now PAs in the US. again dont reinvent the wheel, borrow it and put winter tires on it. 5- Get EMTs and Paramedics OFF the bloody Fire Trucks and integrated services period Make a choice guys and gals its Health Care OR Fire Protection... Operate EMS out of the hospitals not this huge mix of integrated, private, municiple, volunteer services this is a cluster we have right now and continue to promote ... sheesh reorganize the right way not the political/financially correct way, to line pockets. Through government decree we are essential services now capitalize on that ! (oh yea Working under MDs Controls, working with the RNs) 6- A provincial communications EMS network up and running asap. 7- Cancel STARS contract put them directly under PFCC just way too many fingers in the pot they suck the life blood out of other lottery fund's "Because Helicopters Save Lives ??? .. cough, splutter, bullshit, Rapid Responding MEDICS DO! its just a transport media ONLY" So Put stonger regulations and control over their dispatch center, expose the contraversy this is a privatley run social club now, point is it IS far more advanced than PFCC dispatch , so capitalize yes on that network after all its non profit under the societys act therefore we Albertans own it don't we... Oh YES we DO we pay for it. Greg Powell is going to put a hit on me now ! bring it on brother ..... 7- (bee) Use all the "registered STARS sites" in the bush and network with a mutual aid agreement regulation, OH+S after all is under government control. (You know HOW many EMRs, EMTs and Paramedics out there are 10 minutes from a wreck and NEVER even know that a crew is responding from 'hours away" change the software on the STARS dispatch today. 8- Relax OH+S regulations a bit put in regional clinics in the more remote oilfield areas and far more independant from the Prime contractor control's and "oilpatch" dictatorship. Change the 40 minute rule to Hospital to 20 minute to remote ALS health center ... this would save millions for the Oilpatch alone and free up a thousand EMS providers ... you just do not need an EMR/EMT on every drilling rig, just look at the TRI total recordable incidents stats ! ps this concept too would provide better care to the workers, ANd take pressure off the understaffed rural hospital, besides getting rid of the Ma and Pa EMS industrial gut wagon non compliant with current regulations. This would put a lot more bodies back in the system. Last but not least: Get me a job as a Deputy Minister for Health Care. cheers

Agreed: I did very much enjoy what I perceive was a touch of humour in the above comment, good one zilla ! But here in lies part of the problem the tactical PATCH ! I am presently on Standby to transport a Trached Patient an LDT fixed wing interhospital facility transfer but does that make me a Critical Care Paramedic with Flight designation, although I might be ... I try really hard not to get full of myself well .... some days. :shock: BTW: Before I make points for debate only, I must comment positively on some excellent in-depth information provided with chbare and zilla's experiences and commentary, agreed preventative pro active medicine is a part but in the purest sense of the word "tactical" as this implies up close, in your face, on the two way firing range all sexy, level 3 underwear, all nomexed up, with a 3M glow in the dark "MEDIC" stencilled ones back, read on svp. Unfortunately when the real preparedness is in depth knowledge is understanding of the types of injuries, ballistic injuries, blast effects, flash burns, bio terrorism AND treatment that you may have to provide .. its is not running around doing the duck and weave, seriously if one has to ask about what is needed in an field pack or vest this could be a clear S/S by the wanker types, or perhaps just an innocent "help me to learn" comment from the OP. Honestly I though Dust would jump all over that concept AND I do see way too many puffy chested out types when the truly prepared just chuckle to themselves queitly. When we should as elders educate ? as was chbare obvious goal ... besides, I do enjoy poking the bear, hey maybe zillas intent was to stimulate too ... the bugger, hey zilla could be a little old lady knitting and using google ... j/k. :shock: Great Spirit don't fail me now! Remember SOMEDIC ... a poser only and busted. I truly hope you see where I am going with this, as many departments and services use this "sexy" carrot in recruitment posters and for public relations for civilian side ONLY, They have no intention to put medics in harms way, we have observed this with Ottawa-Carlton when all they wanted was more warm Paramedic bodies to do transfers .... lots of BS spewed with this category of Tac Medic ... I digress. I do not believe I suggested this at all Dust but then how can you call them Tactical then ? Goes really without saying that any truly professional organisation, may be it the US military (or the civy look a likes) albeit many of those encounter single treats only. The Brits (ps their Medics in most cases are contentious objectors and restricted to no weapons at all and other of your other allies some restricted by the Geneva Convention and adhered too, carry defensive weapons ONLY) yes zactly most of these entities have huge infrastructure and support system's behind them CAS, Medivac, Field Surgical Facilities, but there are OTHER models out in the real world as well, like Independent Close Protection Support Teams moving dignitaries about in hostile environment's in "official" war zone's or "unofficial" and please do not to forget the mercenary Explosive Ordinance Disposal Team medics whose primary role may be top cover or reach out and touch some one a sniper background is the first choice of First Aid with many of those, these I would IMHO only call these True Tactical Medics and its almost sad but no yellow ribbons for them when they get back home either, just a steak and a good bottle from a friend if they get back in one piece. It all boils down to the definition of a term but then again so does the term prostitution and extortion .... I know this ex wife ... oh never mind I am forced to quote a very good friend of mine with a ton of field experience in very hot zones: "We always have a plan ... then the shooting starts" and the plan changes really F**** quick. Could term "Tactical" be extended to it could those that support at Oilpatch Blow outs or Woodland Forest Fire and just in passing "suppressing firepower" does not really help a whole hell of lot, in that environment the term stratigic redeployment, or rapid extraction is oft time jargon "coined" or the basic RUN AWAY just saying there are many applications of this broad term "Tactical Medic" just saying this is my humble opinion only. Must disagree with that one what if you do not have tactical superiority .... then what ? Personally I like the SKED myself takes way less effort, skid not carry ... and a heads up, just saying EMT- B or P stands for Ed's Moving and Transport as this is MY prime directive. Just to provoke some discussion: The new and very serious threat in civilian terrorism is bring a bit of havoc, place a small IED and injure a few, then bring in the support teams .... to then BLOW the infrastructure to istsy bitsy pieces ... this is one of the oldest and one of most effective forms of terrorism ... call 911 and you get a busy signal, a very effective means to an end with these spineless bastards ... opps got a bit emotional there, my bad ? :twisted: Close support of a team packing a ton of crap just slows one down and a stray round puncturing an O2 tank is a touch unnerving to say the least and then packing a ton of kit, that may or may not be deemed essential in a 2 way firing range, this all depends of the primary role of this or that team, hey perhaps look to the Falklands experience.. the Brits, and superior casualty survival rates too, minimal kit could be packed in that hike in the barrens. Thing is in the real world there are many are definitions of TACTICAL ... just my 2 cents, well more like .14 in today's market place, with the price of Oil dropping like a freaking stone, why am I paying my blood for gasoline ... now thats terrorism ... ok way off topic I am just bored :oops: cheers

Thanks for the information zilla, about the new Battle Dressings. I am a curious, rather a black and white statement is it not, care to shed some insite ? I would assume you are suggesting that tactical EMS should not Armed ? Or that one should stay and play in a hot zone ? Or have a big Red Cross on them ..... ? Just wondering is all.

Richard ... I bought a "Cloaking Device" its pricey but very effective ... 8) Sorry man some days I just have no control over me fingers :oops: The only thing in your hand's should be firepower, IMHO Tactical EMS and unarmed is just stupid man, like taking a knife to a gun fight. ALS kit no way no O2 either your not going to get fancy ass in a hot zone "may be a Trach and MS... just saying extract to safe zone and DON'T look different from the other team members, cause when you take out the medic the bad guys have the upper hand. http://www.medekit.com/controller/Catalogu...?clksrc=catlist cheers

I can't find the literature but does it not generate a exothermic reaction ... moreover a chemical cauterize, I hear a story about a field medic using the powder in the wind and it got in his eyes, dont know if this was the reason they put it in bags ? Is not Hemcon a shell fish by product ? ... hey its all about recycling these days .... just saying. Oh yes there is the shell fish challenged folks too . OH crap I think I was given the cheap stuff ... argh !

I think I have to agree, chbare and do appreciate the input. I was given a "sample" pack I think its the exact same deal that the troops will recieve, in it is the "quick clot foil wrapped dressing" but in addition to rolls of gauze with a pressure dressing incorporating a Tourniquet called the "H bandage"of all things interesting. cheers

Zilla Whats your Take on this ?

I am thinking more like Pandoras box, I am wondering myself just how much teeth the AIT agreement will have, "the labour Mobility part" but Yes prostituting oneself is something I just don't do, working in Industry if they don't have all the goodies/ drugs/ tools .. I go home PERIOD, I spit on ACPs that do not do the same thing. Yes quite an obstacle to overcome, maybe govenment grants and mobile training busses? Hey if STARS can do it with their simulator RV.... just saying offer improvement in education not a "change of shirts" and an effective and tangible means to deliver it to the rural areas. Yea if you look to NS right now with a threatened strike. Government there is looking to retired RCMP cause THEY know how to drive L+S ? And use tazers too..... :oops: You have to wonder what goverments think or really know about what we actually do in the back of the gut wagons ... I find it disgusting their lack of comprehension ... there is another group that SHOULD recieve an Education, if just more of us would get off the couch and run for office ... just saying. Yes and No, You have some very strong members of PAC in the lower mainland, the stats in back injury in BC were instrumental in having us declared part of PSO legislation allowing you to pull retirement CPP benefits @ 55 y/o .... Another way that has been successful is starting an Association under the "societies acts" non profit and here one only needs 5 members to get a grass roots organization to get it up and running, this in fact was the way the ACoP got its start in the door ... way back. It is a repeatable model, but personally go with PAC a unified National voice ! GOOD ! If reciprocity is a go then use the Institutions that have good reputations as your next door neighbours ... we have a plethora of Great Schools to choose from .... that tool is "in situ" already, why reinvent the wheel? I never could speel Thanks for the correction :twisted: WCB setting standards in Health care delivery .... go away take it out of their mandate. I like the hot chicks screaming part on the Roller coaster ... oops outside voice agin my bad ? :oops: OH YES now thats a huge worry right now, the concept is good, but the plan is not (i think its a secret) Good grief, Yes indeed there its going to be very rocky road ahead, new rumour is that some changes to the action plan, but honestly I remain very skeptical as without a proper Communications network "provincially" in place and implemtation of THAT expected to be in 2 years. US marines say if you cant communicate you cant shoot (ps they own the sunni triangle of death now) This IS the back bone of any first responder system, and absient as is unified standing orders, nor Provincial Medical Direction ... nor standardization on car, check out the AHC website on requirements for BLS and ALS under Ambulance Service Act.... its a joke ! My advice go carefully and Listen to the Grunts on the ground and in the air ... but absolutley no venue for that right now .... sheesh, just more Government minions introducing yet another layer of government, funny thing no means to discuss this, we are on a US sponsored EMT City website ... just goes to show you .... but sincere thanks to admin and Ak the ugly one hiding in the sand box .... come out and drink akflightmedic you coward afeard of GOOD beers eh! :twisted: Rock Shoes my friend: Its easy hey if Dion can do it ANYONE can .... LMFAO! ps I know a great pot hole lake just up the road from Merrit off the Smashahalla ... bring worms or flys and a bottle ...... I have the boat. cheers Thing is it just the 2 of us yaking here trying to shed some light in the dark corners ... WHERE is the rest of the GANG ... sure would like to hear what they have to say about this thread ... YOU ?

So whats the next step to change things ? Well I had an Industrial A ticket in 1979 ... yes really, the course has not changed ... IS there a statute of limitations act ? :twisted: Honestly WCB dictating levels in health care delivery in Industry was accptable but today its is just assine. No man fight the good fight ... apathy is what slays us all. As I have said over and over Title protection is the key .... define the terms ... yea Alberta's being the stick in the mud nationally agreed but there is good reason its not an ego thing honestly, but changing all the legislation for a little PCP title that will just amount to confusion with the public is not a smart thing to do ... we have way more important issues on the plate today like our Government finnall declaring us essential sevices ... and introducing more options in delivery than reasonable and using the divide and conquer technique to divide labour... at least BC has one collective Union ..it just the top that needs to be change out ... not through attrition but by "dismissing" a couple. Now thats just plain sad, like there is no auto wacks and MCIs on the Smashahalla that desparatly need ALS intervention ... Merrit is on one of the busiest Highways in BC .... and great fishing too, I love Merrit ! Does not your friends and your Family deserve ALS. Make definate plans ... get involved become a Paramedic Alderman ... one Paramedic Guy in BC did that, didn't he ? cheers will look for you when I go fishing in the spring.

Good I like to bite but then I like to chew before I swallow. Well the EMS Educators involved with PAC evaluations, it looks like they may disagree with you just a bit on that one. A True vs False PCP ? ... again my point ... legislation enacted with title protection, funny thing that BC jumped on the PCP title isn't it ? but BCAS left out the EMR level ? Was that to quietly mislead the public .... IMHO YES. Monty Pythons skit "Confuse a Cat" comes to mind. IMHO: Whats holding you back is the all government minions in BCAS Licencing and the Justice Institute. Its called application of the peter principal in political science, say hello to Lisettt Robinson whose latest comments were: From a fly on the wall, there is aways some practicing good listening skills. Yikes....is this going to be your new Regstrar ? Lord help y'all, looks like the Lawyers will have to settle this one in a court room, tick tick tick ... AIT and labour mobility is comming right quick. GOOD THING.... um so when is that deadline like we have in AB .... in a calender year? Or will EMP Canada pick up the torch and continue to blow smoke .... there is no national accepted EMR couse, they are lieing to their graduates. Not from the information provided to me ... to work in BC I am forced to take a OFA "bridging course" to work in the bush WTF is that, I have flown out of your province, Intubated, Cardiac, Septic, neonates, and Poly traumas ... so suck my 3/4 of my brain out to lean how to secure a patient on a Stoke's litter that will not fit into a Jetbox OR an AStar .....Good Grief MAN .... Hey, I would rather have a bottle in front of me than a frontal lobectomy. Agreed but I would not hold my breath .. or you may encounter the same syndrome as mobey ... I so enjoy teasing mobey it makes my life so worthwhile, just wait till I work with him on Car .... :shock: cheers ps no personal attack intended just friendly exhange of concepts, and data and most pleased you came back to attempt to justify the BCAS position rock_shoes btw who provided this EMT city link to you ? are you still in the STOKE ? LOL.

This too shall pass, you can't kill yourself that way its the autonomic nervous system that will take over ... some days I just cant help myself AND did you read bleeps post ... just aint going to change dood, any time soon. Ah the media ..... now your getting it, why not contact ACCESS TV .... take them for a ride along, yea its community TV but every bit helps, ever see the episode with a very svelt RRT on "night shift workers" ? Ok I will bite ... so just what is the difference .. because there is a bit more education does that mean that the EMT A can explain more about why the patient is dieing ? Sir your in V Tach but I can't do a damn thing, or I will raise your feet because your in shock, many of the myths in BLS are a crock and disproven but we still teach it in the schools and examine to that level too .... just saying. Hey mobey, I have worked with quite a few EMT-Bs in the US that would give any EMT A a good run for the money, don't underestimate the US system quite yet, nor the many true proffessionals (EMT- that work in that system either ... there is lots, dust is just pushing them to improve themselves. cheers

Please apply universal sign for Choking... I hear the sound of hells bells !

Short answer YUP. Paramedic F.A. (first aid level) ..... a very serious issue indeed, to my way of thinking. Agreed! I am going bald too. In BC the PCP level does not even guarantee IV therapy, that is an additional endorsement yet on the other hand an Alberta EMT DOES, in BC even with some ACP in the urban centers trialing Hypertonic Saline + thats smoke an mirrors I say. Hell even some of the Members misrepresent them selves as PARAMEDICS in EMT City from BC .... Oh I am so "happyness" and WTF is an EMP thats is another bs title too, honestly when I dare to challenge the BC types with these issues that ends the convo in a heartbeat ... why because they know I am calling there bluffs. No title protection under legislation in that socialist province, when BCAS is the only authority and no regulatory body other than government minions to look to the future development and only one training enity this = retarded growth for the proffession as little to no input from the tangible membership other than union involvement, just say union in BC and THAT = "held at ransom at the ferry terminal" sheesh. At least at ACoP we are "considered" a democracy well in theory anyway, but apathy in the Canadian culture reins supreme, funny the tools are there for improvement of the proffession but no one picks up the hammer but we prefer to bitch instead of becoming the real forefathers and Mothers .... can I say Fore Mothers here ? :shock: Sometimes MILFs would be a better term in the ACoP office .... (a double meaning) Ok so I am a but twisted. 8) Public perseption is everything! Query: Do you actually believe that the general Public is aware of the "levels of Care" until they actually are riding on the ferno ? Short answer NOT a CLUE. We get a big fat "F" in PR. Honestly the public at large is still expecting Gage and Desoto, besides the media for the last 100 years has said Ambulance drivers RUSHED the (fill in the blank) to the Hospital .... lately they should add: to wait on a cot against the wall for hours ....CHEMS is a mini Traige before triage ONLY, a joke actually Unfortunately IMHO BLS will now become the "standard" of care in the province of Alberta as well with the municipalities and informed local representatives now becoming imputent (ie no control over the purse strings) the introduction of Stelmachs new "Beauty Eh" plans to put prehospital care under the health care new improved "umbrella" may seriously backfire for those in rural areas that in past HAD ALS care. Lately without real forward prgress or a "realistic plan" Stelmach has just introduced another Level of Beurocrats ONLY. Not Reueters------ this just in from Stelmach .... "availability of Trained staff is at an alltime low" I declare BLS is now the new standard ... ! Tell me that isn't a very realistic possibility and I will buy all of EMT city a beer. That said: I do see one very positive move that being a Provinial Communications for First Responders a Network just reciently announced ... at no cost to EMS .... sweet, about damn time too. All services on the same nework that sure would have helped on Black Friday, Pine Lake or the Jasper/Hinton Train derailment... yes that will piss off a few Services that for years developed their own,perhaps hurting them in the pocketbook that said it is the way to go IMHO. It sure would be like walking in the snake pit in the movies to introduce that concept ... yikes. I think its called AFRRCS or something ... they sure need a new name, blimey what a mouthful. A move in the right direction I'd say .... :cheers: Just look to the $$$$ numbers bottim line and that will put into perspective our real importance in the general scheme of things and realistic monitary value of the AHC budget we as the providers of prehospital care are about 5% of the health care dollars designated, not a very big wheel at all and very easy to keep lubed up and with the attempt to divide labour too. If one has worked in this massive system they will understand that nursing indeed runs that circus and we are not even in the center ring, well in this snapshot in time. Now do a little comparison for those Alberta Doods and Doodettes SO ever hear of STARS ? Does even the members of ACoP themselves have knowledge that AAA operates 12 to 14 fixed wing aircraft DAILY with more call volume per year that STARS has done since its inception .... thats right ladies and gentlemen of the rouges gallery. PUBIC RELATIONS is the Key to the LOCK of education of the MASSES. Now in the NWT on the other hand, a vocal and public community with TRANSPORT becoming a HUGE issue to those community's ... go for the good there fortsmithman !!! < ahem, stands down off soapbox> cheers

I hear what your saying but build a better mousetrap, contact PAC and or Eric with Paramedics of Manitoba .... he rocks on, check out his blog. cheers

I too initially belived that these titles should go the PCP, ACP, CCP route so that the Public is somewhat less confused as to the level of care they were recieving but now I agree that the Protected Under Law of Titles of "EMT" and "Paramedic" should not be changed ... this is not a Ego thing at all. But mobey when you graduated your opinion will change please trust me when I tell you. The public has a right to know what level of care they are recieving, or not recieving, as one continue in their travel's in your upward journey you will see the importance of this. The title has very little to do with Pay, unless there is a Union agreement in place .... apples and oranges dood. At this snapshot in time one would have to change Legislation .... HDA and HPA .. so I am afraid your barking up the wrong tree, your dealing with a huge conservative government majority that cares little about the "ambulance drivers" well accept for we cannot strike now with the latest "moon dance". In the NWT there is no regulatory body nor title protection therfore anyone in EMS can call themselves a Paramedic .... AND they DO ! like the cooks helper with a BC OFA 3 in a camp in snowshoe, Do you want that kind of stigma as its very hard to live down after the wankers piss off the RNS, when one is a registered Paramedic .... of this I know. The multiple levels of this and that titles ie EMT A, EMT B, EMT I, EMT D ..... yes is stupid silly it in itself but defeats any standardization of care. Check out the PAC website under AIT tools to see where YOU fit in the National CBO for national reciprocity, I think some will be very shocked in fact. cheers

Annie: Contact Paramedic B. Goulet in Edmonton ERD she was involved in the PAD study, tell her I sent you. http://content.nejm.org/cgi/content/full/351/7/637 Just me but I hate flash boxes ... I am the "elective" kinda welder .... cheers

Query: Vent ... I do not know the VAP protocols perhaps its the abbreviation but always great advice from yourself. The newer subglotic suction ports are a great idea, wish all ETT tubes had them, well in a perfect world. For those of you that believe the ETT is fool proof for micro aspiration, (hence the long term effects of ventilator acquired pneumonias) So take an used tube and place 8 to 10 cc of air in it ... make a circle with your fore finger and thumb, around the cuff .. you will notice small wrinkles ... thats the problem the cuff does not occlude in the manner of a perfectly round shape like in the books. One of the biggest problem's I saw working in ER was exactly as Vent describes ... these are low pressure cuffs not like "Old RED" ! A MOV (Minimal Occluding Volume) should be a technique that is taught and not a certain volume or pressure (for the field) the incidence of tracheal stenosis with longer term transports I suspect would be far lower, this very easy technique and should be standard practice .... IMHO. cheers

R/ r911

This Aiway Registry is a good idea IMH estimation, but what about those forgotten few, the remote practtioner and those in hostile enviroments, most of those Medics have years of experiance ... and usually why they are hired in the first place. But the # of ETI is rather low ... is there anyway of going back and checking the books ... I am talking way back like 25 years to prove reliability and experiance, honestly if the registry starts say in Jan of 2009 would those individuals be viewed in the same light as a 1st year Grad as that would not really be a fair comparison. Wang SHOULD have a baseline for a good comparative study .... look to the ER Doc first THEN minus paralytic's, in the cold, in the wet, in the dark, in a bathroom, on the floor ... hey this is begining to sound like a Dr. Suess book. Horton Shoots a tube .... I digress. cheers

I have said this over and over: 1- Rescue airways are reactive medicine, not Proactive medicine do you see rescue adjuncts in ER? 2- Using technology/invention over training and education is a backward step. 3- Lets compare ETI with the Doctors first pass success rates, for good measure shall we ? (I have worked in hospital too, not as good as they make out to be, especially rural areas) Funny thing the OPALS studies are oft time quoted: ALS vs BLS (and poorly presented) but without the availability of paralytics for the Ontario ACP the success rate was 73 % on first pass. hmmm interesting isnt it ? So give us the same tools in the tool box is all I am saying, retrain those that are in need dont lump the rest of us with the failures. The OPAL studys also strongly suggest that the ACP makes a huge difference in outcome studies in the comprimized breathing group (proactive paramedicine) Just look to the education proccess to explain the rather obvious differences. ps I have all the tools in my toolbox btw, take them away from me so that I can not perform to my full scope and for my good of my patient and I will find another job. cheers

Zactly: Correct the underlying "root cause" do not punish the patients, I like the way you explain that concept. Badges pfft ... take away the registration #

ONLY the rich ones, and mostly politicians .... the common asian women gets the unpolished rice and rich in B1 and then there is all that roughage. Thats why there so hot! lol

Firedoc: love you man but the assumption that most are dehydrated and malnourished is well just that, we must look to evidence based medicine to guide us in treatment guidelines not wrote protocol, and statistics. The geriatric patient is often far more complex than "well, their just old" they must be this or that. Then the patient is evaluated in ER with all the blood workup, that evaluation of that now may falsely lead the ER MD or bloodwork results fowarded to the GP and could falsely indicate that that individual is NOT suffering from malnutrition hence no action taken and a negative feedback loop is generated ... the revolving door senario and now Paramedics have caused this Iatrogenic disorder .... following ? cheers