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That don't look like no man to me ! Sooo just how much for the tickets ? What were we talkng about all I want is a Date now, she is hot! And I know she wants me. :wink:

It appears that I stand corrected, do you have the link to the complete study? For debate sake, this is a very small study of only 33 patients and with an additional treatment of: This in itself after 2 hours of evaluation of PEF raises some queries as to the validity of the study, I still remain rather sceptical. The conclusion drawn was: This effect was not significantly different from that of nebulized salbutamol. (but fails to mention of efficacy of IV roids in this abstract) with or without "anything" nebulised. 2 variables in a study with a proven treatment medication do you see where we can prove with this study ? Just perhaps (HS Mangat, GA D'Souza, and MS Jacob) are looking for more grant capital ? cheers

Could this help you out ? http://www.paramedic.ca/Content.aspx?Conte...ContentTypeID=2 http://www.collegeofparamedics.org/acp_dow...cy/aocp_EMT.pdf Sometimes a letter for comparison, from other places can make a difference. cheers ..... EH! LATE ENTRY: Even if one does not "have the time to write their own letter" you already have a couple letters posted here that are most consise, so why just not cut copy paste the examples that your others, a form letter may also help you in your fight. ps I was the ass that voted the wrong way.... hey it ain't my country, not my place cause we have our more than our own troubles here.

Is it possible that one could look across the very poorly defended northern boarder, contact Paramedics of Canada for their standards OR even the UK OR OZ. Why reinvent the wheel when it is so easy a caveman can copy them ! cheers

More evidence based medicine from Ventmedic/ ERdoc / Kevkie, we are lucky to have thier input and take the time to "explain" as racemic epi as this has great potential for rebound, and restricted to post extubation stridor where I have worked, seldom sucessful usually a stopgap anecdotally. Nebulised lido, is far to under-utilised in EMS, IMHO. Have used it many times with good results, but it has raised eyebrows . I have never located ANY studies on Mag Sulfate for nebulised or IV. for the asthmatic in-the-field delivery, I believe just another EMS urban Myth. Mag sulfate does work well for soaking of sore feet after a forced march ..... just in passing. cheers

Lets put this ALL into perspective for the United Nations of so called Paramedics shall we ? dean83: your avatar states you are from Alberta yet the title of PCP does not exist here and although the gap training "allows" for AB EMTs to "assist" with asa and nitro this currently falls under the legislation of the Health Disciplines Act, and under a little phrase called "local medical authority" LOTS of strictly BLS services do don't have that latitude, your suggesting that this is across the province and it just aint true, in that sense your blowing smoke and we have been waiting (some of us longer that others) to advance into the future with the Health Professions Act ... maybe then with just a FEW Medical Directors we CAN standardize care. btw EMT does NOT = PCP ..... BC PCP does NOT = Ontario PCP ! PERIOD. Dust / mobey : With a new government incentive's the hint of upgrading and standardizing to the Advanced Care Paramedic or in Alberta / EMT- P maybe a possibility. The capital purchase of the 12 leads may even be another hint in that direction, I am so hoping so. Unfortunately in some cases as in Mastattas the services providing care (do not have to follow the same rules i.e. taxes ... because they don't PAY taxes) and based on a special interest group's of which I absolutely disagree phylosophically) Yes, a very different topic but this manager may be projecting the possibility of 24 hour Paramedic service. I would wish them good luck with that, perhaps the manager should "not" be sacked maybe just smarter than the average bear, inside information or better funding available ? A Logistic comment: TO door for balloon angiography is not a serious "REALITY BASED" concept in rural Alberta, northern Ontario, rural BC or damn near anywhere other than high density populations .......whereas Throbolytics are very viable option to advance Paramedicine, internationally and perhaps positively influence MANY lives. That said many many rural ALS services do not have Throbolytics on the cars let alone ALS providers, and in some cases even with Paramedics that are very capable, their GPs/ Medical Directors will not even consider this option .... well just YET. Some provinces are much closer than others in passing. If you are from AB and reading this PLEASE review the provincial Stroke protocol on the ACP website, just might be a good idea. Your kidding yourself, unless the difference to door is minutes and just look to availability of Cath teams "after hours" a newly study just released, hope the link works for you. http://www.medicinenet.com/script/main/art.asp?articlekey=88872 Your scaring me you as can not treat ANY arrhythmias, as PCP/ EMT A or B. You can not support BP with pressers your so in over your head ! Is doing a 12 lead enroute a bad thing NO but choosing to go outside your protocols and administer drugs .... hope you have another job.... like would you like fries with that burger sir ! The plastic AED or SAED in my very critical opinion HAS held back the advancement and development for Paramedics IN North America .... PERIOD, as without these plastic brains Advanced Life Support would have been far better funded IMHO. So chew on this for a second all those EMT-B and EMT-A and PCPs. You are not trusted to interpret V-fib or V-tach ..... that little plastic brain has to do that for you so please get real, but now you wish to interpret 12 lead without the proper background, education +++ Besides bedside cardiac enzyme markers are far more accurate indication of possible infarct, as ECG changes can be late signs, (well discussed in another thread) no one has mentioned this and this option could be a far more cost effective means to provide improved care the the Chest Pain patient ? Comments svp? Yet on the other side of the WORLD the voice of true reason and hopefully the future in the "COLONIES" the studies done in the UK are "bloody brilliant" WE in north America are so arrogant to believe that we are superior..... I am personally hold my head in shame ! CHEERS: Andy show us the way !

You sure? There is a lot of Torontonians to laugh at !

EMSdoc: Thanks for your positive input from Doczilla's request we are honoured that you fellow's would take time out of your busy days to comment intellegently and list studies, and links as these are read by many. In regards to your comment re capnograhy as the 2 types available to most EMS providers are Mainstream and Sidestream. JMHO that the sidestream is a superiour device as it is multi-rolled applications for intubated and spontaneously breathing patients as a tool to further evaluate possible impending ventilatory failure/ and monitoring the consciously sedated patient, sidestream it is far less subject to fogging as most have a hydophobic filter in line (very advantageous when moving ventilated patients from warm enviroments to cold) as well far less expensive sampling lines as opposed to the Mainstream variety as the cost of the cable and the high risk for damage is potentially huge. And which as mentioned can go unsevicable due fogging (a trick I use is put a artificial/humidivent between ETT adapter and Mainstream adapter to reduce fogging) My personal opinion of colorometric CO2 detectors (having used far too many of them) is they are a waste of money (they can give false positives due to the entry of CO2 into the stomach during BVM with/ without OPA) Ascultation in my opinion is far accurate than this device, and in many of these outlying clinics CXR is readily available just my opionion again this is the platinum standard .... realistically not in the circumstances that you are familliar, but colourmetric make for pretty ornaments on the base chistmas tree during the holiday season. P3: I see your point in oversaturation of ALS providers but in our "hood" its the quite the opposite in fact the local GPs in many outlying areas, many just doing locums as well. I would suspect would lack the experiance in ETT intubation themselves with/without paralytic's let alone good oversight as most remote areas lack an OR and ERs are more akin to clinics ... We live in very different worlds but perhaps for debate sake we should include this type of astere and remote settings that of having to intubate in a logging camp or worse a patient on a logging landing ... and BEFORE loading into a 206 long ranger or A-star. The lowest common denominator portion of your commentary not only 'irks" me but I find this methodology (when it comes to a socialist type government that regulates all aspects in the delivery of health care) is a true tragedy and becomes quite unacceptable, why when transport times on the Lower mainland are very short and other areas are > 6 hours .... it makes NO logical sence to me either ! Rock_shoes as you can clearly observe from some past posts this becomes somehow ego of subordintate level's and perhaps even some union propaganda that negatively impact the education of the taxpayers that deserve, correction have "rights" to this level of care. I am SO on board with your idea to shift experianced providers from major centers and do locums in remote areas, it is a win win situation for everyone. But as you also can see that education of your collegues maybe the first hurdle to overcome, then perhaps lower the silly barriers of reciprocity.... I digress ... sorry, but I write letters to my MLAs too. cheers fight the good fight my friends !

OMG it IS true! Spenac ..... You have way too much time on your hands ! try : http://en.wikipedia.org/wiki/ Davy_Crocket_ (orthopedic_coonskin_hat_nuclear-protection) I just ordered one from eBay LMFAO and I bet I am the first kid on the block to have one !

Firstly: LMAO @ Brutane, I am so plagerizing that ! 8) Doczilla a query: Have you reviewed the OPALs Trauma Study the ALS vs BLS outcomes in survival and morbidity ? I certianly would like to see that study viewed from your critical perspective, in fact I am not even aware if ground in Ontario even has access to Paraylytics and as it is not mentioned in the study. I believe it is the realm of the CCP in Ontario only, but not certain, it could fit into this thread without too much of a stretch persay and thanks for getting us/me back on topic. :roll: Your most realistic commentary and presentation of these concepts indicates real insight of the field setting, thanks we so need THIS type of oversight and perspective. After my first readings and review of this new OPALs study, the presumption is made that ALS has failed to decrease mortality in the trauma patient and this too becomes rather curious as there is a from the 'surgery' side of things. For some reason the OPAL group is bound and determined to put Paramedicine back into the funeral/ambulance transport medium as the first OPALs study in out of hospital survivability of the cardiac arrest patient proved conclusively that time to ALS intervention and outcomes was the biggest factor, although it took quite a bit more wasted tax dollars to prove that point. Could a finger be pointed sharply at the MOH/ Medical Direction in itself ? A failure to recognise that they may be the responsible party a failure to provide the medications needed ? That in regards to no volume expander, your only as good as your tools. I do believe they are still making kool-aid out east, that said far too many "in most parts of Canada" "just have" N/S on car. :oops: and most places in Alberta as well. Although we in the vast majority of cases we do carry paralytics, and please correct me if I am wrong there Ontario types! I do need a safe place to go fishing on my holidays .... well NOW... :shock: CMAJ • April 22, 2008 • 178(9) Ian G. Stiell MD MSc, Lisa P. Nesbitt MHA, William Pickett PhD, Douglas Munkley MD, Daniel W. Spaite MD, Jane Banek CHIM, Brian Field MBA EMCA, Lorraine Luinstra-Toohey BScN MHA, Justin Maloney MD, Jon Dreyer MD, Marion Lyver MD, Tony Campeau MAEd PhD, George A. Wells PhD, for the OPALS Study Group cheers and still laughing at Brutane !

Funny thing you ask, I did ask if anyone at the service was a member of any type of EMS professional forums ..... got lots of blank looks. The manager stated (You mean like facebook ?) :shock: So I advanced your CV to that service there dusty . :shock: Good Luck with that .... te he he.

Quite unfortunately in the provice of BC ..... everyone calls themselves a "PARAMEDIC" there is no title protection.

So in 12 years none of your patients have aspirated ? And none have suffered Hypoxic events ? And your service area are always 5 minutes from the ER ? Maybe just me reading your comments incorrectly but HOW can one have an educated opinion when one does not practice to this level of expertice ? cheers

This was my reply a tad more politically correct, I think. Commenting on hiring the process really was quite pointless IMHO. cheers

Shane; It is quite true, the rates are going up across the board, it could be a result of the law "supply vs demand". And with the "hint" of the Alberta Government that a decision will be made by June 15th regarding the managing of EMS services and funding formula. In the interum I am not going to look a gift horse in the mouth .... if you follow. Alberta Health release for your review: cheers and we shall see if the government advisors DO have there acts togeter and quite soon.

According to the the regs we deal with up here; 2005 CPR and AED Gidelines the LAY vs Professional Rescuers. The theory here is that teaching Lay persons that more idividuals will actually "TRY" doing at the very "least" compressions. So do you a lay person when your not getting paid ? I'm with Dust: vs_eh : If the OPALs (bs studies) continue then this could really help the ACP to go back to the Funeral/Ambulance driver dark ages.

Quote dust; When I initially read the reply I missed this paragraph completely. I did have a brief opportunity (picking up a truck from a garage) and a one on one discussion with the manager, I did ask the manager about the validity of staff opinion in regards to budget, capital purchase, wages, shifts worked, things like that, and in passing presented in a non threating manner, presented "just" as dumb question is all. The answer was that S/HE knew what type of equipment the staff needed because S/HE worked on the road as well, so S/HE would know IF the staff actually needed that new ETCO2 monitor or the like, no mention of the other issues at all. The discussion never got around to issues that clearly border on the concept of the introduction organised labour, could this just be an appeasement / lip service to the current staff, I do believe so now. Backgrounder: The very real possibility of complete reorganisation and or regionalization exists as the government may be very soon stepping in with all ambulance operation's in the province, a strange but timely release by the government. This just one day after my "interview" I believe that if this occurred that this small show would be swallowed up in the blink of an eye. That said : Yes dust this is one of the biggest concern's that I had too, I follow the Chain of Command and then ask questions but allowing and encourage subordinate level of education and experience to have an "equal say" in patient assessment and treatment is going to sewer any concept of progress. Let alone the democratic hiring process that I was subjected. I truly find this absurd, this is a social political correctness "experiment" no more no less. Further Observation: So after my little "ride along" with a "possible syncope NYD" I was frankly shocked at overly poor assessment of the "Veteran" Paramedic that I was assigned, I was completely silent in that call. Odd because if I were in the same position that of a "potential evaluator" of a future staff member (and had input) I would be including and asking him/ her for any input... i.e. "Like do you think I have missed something here or any suggestions ?" Is this hypocrisy or am I now being too hyper critical ? Cincinnati Score and good neuro assessment did come to mind. 8) The whole concept of a team approach was a sham, little or no discussion with the EMT (driving) and an experianced provider in the back of the gut wagon too and absolutely no dialog initiated at all, nice concept but a big fat FAIL in my books. On a personal note any form of rejection should with a rational thinking man have that individual to take a look at themselves and ask WHY ? I have and sought assistance an have considered all options even the Troll's .... and just where did he go anyway back under a bridge or in a coffee house ? I was actually very relieved with the e-mail follow up, as it was a forgone conclusion that I would be not a successful candidate within the first hour of contact nor would I even wish to provide services. I will be considering this while I am at working as a project manager starting in a few days. :wink: And thank you for the objective and astute input of all respected members that have taken the time to voice their opinions in EMT city, I can wholeheartedly say that I would never "FIT IN" and Thank DOG ! CHEERS ALL.

A term that is used here primarily as a part time position that is none scheduled. PRN I think is the term my friends in Louisiana called it ? An employer has a opening or someone books off for illness or whatever they then give you a call to fill in the blank.

Another point for a "paper" presentation sake would be that Lido is CLASS 1b, and Amnio is Class 3 so different mechanisms of action. A time frame could be introduced as well, Lido has been around for quite some time where as Amnio has not .... I bet the next NEW standards will change the fuzzy warm protocols that we all must "consider". :roll: Just what ever happened to Procainamide its still classified as 1a ? cheers

And this becomes quite apperant after your post, thanks for your positive input it confirms some of the concepts of the tradtional hiring practices, based on an evaluation system that is proven. cheers

"emtannie" Yes about equal to 20 watt/seconds for the candidate as well (in most cases) I highly suspect. I have absolutely no issue of passing out my C.V. to someone I KNOW ! In fact it is quite diverse and stimulates much conversation in most cases, yet it this arena there were absolutely no questions by the staff on any issue of the CV .... quite odd. Te he .... Yes agreed in most cases, thing is that I am on staff with 4 other major players my employability (sp) is not threatentened in the slightest I hope! Very good point (s) :shock: NO say it isn't so :roll: I think you have underestimated this "social type interview" interaction these concepts are very often key motivating factors ! Sex does sell .... unfortunately for me if I were scantily clad on the hood of a sports car .... many would be looking at the new VW BUG in the next booth. :oops: OR running away screaming ? Did I mention that a huge shift pattern had just been implemented ... from the old 4 on (24sa) and 4 off, to 2 on (24s) and 4 off ? Therefore changing the revenue base from 16 shifts per month to 10. Personal economic factors have not been introduced? my bad? Could it be that a series of rejections of possible candidates could result in more possible overtime and a reliance on core staff to improve their paychecks ? Despite the management sheduling issues / and difficulties arising from this situation. A quiet underlying disagreement with Staff vs manager OR Manager vs Owner ? One will never be certian, would it not be a true waste of my time or any other possible candidate if this is the case ...... ??? Another good point's here: SO just who "runs the show" anyway and traditionally paramedicine in most cases is similar to a paramilitary chain of command. SOMEONE has to be the leader, can one imagine at a major MCI and the Incident Commander being given 12 options on how too, perhaps mass confusion would be my bet ? As in every team there must be a leader well thats is my silly theorum. Could the Manager be intimidated as well ? But as who would really know the dynamics in this very small snap shot of this operation and behind closed management/ ownership doors ? Just sour grapes or fair plausable concept ? I dunno really and perhaps not even fair to introduce this idea at this juncture and raise false suspicions. I do not have the bigger picture .... or do I? As squint introduces yet another "twist" related to provincial health care politics and forshadowing of the government recient releases .... hmm the plot thickens. Really ? :wink: . Most operations buck any change this is just my observation but in passing thing is change is inevitable. That said Change for Change Sake is not a good idea either. Oh my spider senses were tingling from the get go! :shock:

A few interesting tangents that you propose, I submit that you maybe reading into a tad more emotion into this senario, than I. Yes, I have used some literary licence to amplify my position regarding this type of hiring process. If you indeed are the owner of an EMS Operation then your statement about coffee type interview does contradict this type of group social interview cant have it both ways can you ? and in passing the vested owner of this hypothetical company was not present either which is curious in itself as in most reputable smaller size operation's that I have worked for, the owner is very involved. So whats your take on that ? My question posed is that of hiring based on a "the social interview" and based on a possible a perceived impression (quite aware of working with many other partners in my history) My point is opposed to merit, proven experiance, past + continuing education with the reliability of an mature medic and in "addition" a degree level program above the required prerequsites. This is not "a better than anyone else" or "chest beating" situation, moreover the most qualified candidate, besides the 'hidden problem" that you are eluding too which is just plain silly, seriously, that made me laugh. I do have some difficulty having my personal information to people that really have a no idea who they may be as without specific permission requested this becomes a breach of trust in my humble view and to do this during the interview could be constrewed as "pressuring" the candidate. I have already answered your query of padding one's resume I believe you missed that point, quite unacceptable and considered fraud in a professional C.V bottom line in my view, but just to reiterate that is professional suicide. No point in responding to the : Medic Troll: I believe that you may be guilty of drawing a conclusion without hearing / seeing all the cards, well just yet. I have been known to do some forshadowing and perhaps have yet to tip all my cards just yet :shock: I do enjoy the old adage: the opera ain't over till the phat lady sings. :oops: In response to your comment about the internet as clearly stated by JPINFV and thanks for that :wink: As most that know myself on this site, I am quite capable of debating fairly intelligently of most concepts that I philosophically and idealistically believe in.. cheers thanks for your perspective as a Private EMS owner.

Complete work history, personal and professional goals, past employers, address, marital status, contact #s the works. NO information that can not be easily be substantiated as that would be just stupidness on a resume! But not even name tags worn by the staff ? Yet intros to > 10 ppl @ start of interview, no designations worn as to who was EMT or Paramedic, quite "atypical" of most service's.