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Maybe its my composition? Basically saying .... if you don't have PPE and correct training for the "job" then don't subject yourself to the possible hazard (s) and if an Operator is not providing the PPE maybe best to go look for another Operator that will. I try not to get into the details in these forums as your passing comments may be misconstrewed, and not trying to be snotty or anything ... really. But it may be best to take a proper recognised tactical course, the weaver stance or squared stance is useless unless are armed yourself. A topic in its own right . Oh yea just my 2 cents but using an "expired" Vest is the same hazard as using "expired" Climbing Rope or "expired" Meds ... I so try to extend MY expiry dates by using my common sense. cheers

Do you like Dunkin Donuts ? I will buy. :twisted: :twisted: I slay me

Firstly: The whole concept of BULLETPROOF is a sham, as the shotgun is very effective tool for finding holes / chinks in lots of body armour and under the arm is a big cop killer, as are head shots. The whole idea is a misnomer and unless one is wearing a level 3 "ceramic plates" type BODY ARMOUR and a Kevlar Lid, so if you have one inkling to wear this level of protection working on a truck. Are you considering or subjecting oneself to a higher than "regular" threat level ? Just saying a bit of false sence of security. If one is working in a tactical support or combat role well that's a tad different and then it should not be issue it should be issue ! period. In passing Combat small arms Schools are even teaching a different stance when confronting a shooter based on this evidence, well that's what I have been told and only when exchanging lead. :wink: Question: So do you have reflective stripes on your BDU ? hells bells ... not me, I don't care to be targeted and running and hiding becomes a bit of a mute point with 3M reflective crap all over. I do enjoy working with larger and slower partners :twisted: If one looks to the stats of EMS LODDs, MVC are the highest on the hit parade, so just what are we doing again ? Playing cop or medic ? yea, yea, I know on a very few occasions one does waltz into the unexpected. Secondly, and more importantly in my mind: Scara makes a very good point, WE are getting hammered at MVC scenes, we are being stupid ! To that end I have done a little sewing on an old trauma MCI vest as my last job site was super high risk with highway traffic or the "importance" of being located from the air. RULE # 1: Treat ALL drivers as Idiots .... cause they are. :shock: The lime green and reflective silver tape appears to be visually the loudest, my theory being if they can see me maybe they will not hit me or will find me ... :shock: That said my Vest is removable if I find myself going into "domestic incident" type call, again just a smaller target. ps I wear running shoes too, believing "discretion is the better part of valour" as the yellow stripe up my backside doesn't seem to affect my ego tooo much. I so hate the sight of my own blood. cheers

So what is holding you back ? The age issue is only in your head man, employers look for life experiance and proven reliability, you are far less of an employment risk that a young pup. cheers

Thats da Man! And one funny fellow when he does't have his game face on. I so miss flying. cheers

Spock So just what happened AFTER you handed over care ? A point of debate to follow. I don't mean to beat a dead Horse here, the point I am pushing IS there any research being done AFTER the Resusitation. This is why I am so skeptical about handing these devices "carte blanche" to every Tom, Dick or Mary. Just saying from a historical perspective with the EOA and we all jumped on that bandwagon, because we did NOT have ANY Paramedics .... to find out later that "higher than unexpected complications" and have them shelved, I still have the 20+ research documents identifying the complications in my files. Its well established that insertion is so easy a Caveman can do it, as an RRT my choice is always the ETT, and in over 24 years I think I have missed one or two, not bragging here just practice makes perfect. Sad commentary: I do see a new reliance / excuse (s) to use these, for whatever reason. :evil: All the other devices LMA, Combi/ King LTare just RESCUE ONLY and as in the example above used in difficult situations, so please send "buddy" Paramedic to the OR or to polish his skills period ! Airway Adjuncts are just that, NOT to be used as a Primary Airway as this is just a stopgap, perhaps leading one to believe that it is mandatory that a more educated and practiced provider be on car to provide improved Airway Management and care. YOU TOO ? :wink: But if they are resusitated then its back to the ETT. Thing is you don't have to change out if an ETT is placed correctly from the get go. 8) And my point exactly, fewer possible complications .... see where I going with this ? Statement: If you continue to think the way you have always thought, you will continue to get what you have always got. Question 1 : Is it enough :?: Quoting it's not a perfect world crap is just self defeating plain and simple. Question 2: Why, Oh, Why, in EMS do we just drop off that patient then wash our hands and never do the follow up research ? This is our biggest flaw and I believe that we can be the forefathers of the future, if we just would try, mindset has to change first I suspect. cheers thats all I have to say about that ... F.Gump.

I was wondering, when dustdevil would put in his 4 cents, AGREED !

There was a small component of sarcasm in my origional comment, if one looks to the quite abismal outcomes ie OPALS study in out of Hospital arrests .... really the conclusions drawn boil down to the response times of the ALS (we knew this before) therefore in rural areas with only BLS providers available in lets say > 98 % of arrests were called DOA, so 98 % of the LT/Combi tubes WERE inserted in cadavaers .... if your following current stats in Out of Hospital cardiac arrests, the cool guy concept really does give false hope to the families in many situations and can endanger more lives .... those of your co-workers. Good points all, but we need evidence based medical studies to prove or disprove your query. We AGREE these Airways have ONLY been looked at the "insertion" criteria, my reasoning in all this comes from more of a historical perspective with the use of the EOA ... which was a great idea at the time (pre ALS in Edmonton Alberta) but the post insertions complications became such huge contraversy within the medical community and they were pulled off the cars, never to return ..... well until the advent of the Combi .... wierd that history repeats itself ? Just my crystal ball working overtime but this may become the fate of the use of the Combi/King LT as a primary airway. Quite odd because one can remove the Mask component with the EOA, the HOLE is still Obturated hence only one other choice for the ETT to go ? In the King and Combi there is a even a greater possibillity of Aspiration .. so best get that SUPER DUPER peas and carrots sucking Portable Suction Device "RIGHT HANDY" :oops: :shock: Having another system comprimised ie "Pulmonary" (in the resusitation period) and rule of thumb = another 20 % AGAINST discharge to door and that's the just the ICU perspective. I personally @ the BLS level ans shot an EOA, did have one patient survive from asystole with no neurological deficits and walked out of the hospital ! whoo hoo. BUT VERY, VERY RARE ! just as an anecdote in passing. :roll: cheers

The studies may be a bit biased however You think ? I think a comparative study from successful ETT to successful "Airway Adjuncts" This should be undertaken and not sponsored by the Company that stands to profit and increase market share, can't think of any company that would openly post studies that could in anyway be controverial .... just not good buisness practice, and not saying that the King Lt is NOT a good back/up at ALL. Perhaps a to door discharge ? I can't for the life of me understand inserting an Airway in a trauma arrest patient without the capability of addressing any of the underlying causes ? for that matter a medical either BUT once again :The patient was rushed to hospital and pronounced DOA" endangering lives of innocent civilians for zero reason ... sheesh. Best look to trauma arrest "BLS" outcomes FIRST, If one can follow my ramblings. just my $00 .0197 @ present conversion rate. cheers

Thats good to hear there fortsmithman so its a cash flow issue I gather. it always boils down to that,but if your a resident and there is no school up there you may be able to apply for a bursary or grant from the NWT government ? .... just thinking out loud here. The NWT really should establish there own registry with the levels defined by Alberta and title protection IMHO ... I am positive that ACoP would share all the already established standards, maybe contact the Paramedics of Canada to give you guys/gals some help with set up support, as they are wizards at lobbying. A Remote or Wilderness EMT program would a very applicable for the NWT, but ACoP has not accepted that concept like EMTs/ Paramedics are not already working in those enviroments right now, like ski patrols, backcountry guides, oilfield +++ !!!! ..... sheesh don't get me started. :twisted: If you are supporting ground for a medivac out and you see a big, alright "portly" Paramedic called Troy. He is the man, so give him a big kiss from squinty :roll: :oops: I will garuntee you will get a good chuckle out of him, he is one hilarious guy. PM me when your headed down, maybe, I can help you out in some way :?: cheers

Greetings and welcome to the Canadian Forums Fort Smith Man ! Soo, are you from Ft. Smith or are you in Ft. Smith ? (as most international lurkers will not be aware that Ft.Smith is in the NWT. and great fishing !) Great to have someone in the "know" up there, I am aware that in YZF the Fire Department has trained thier guys/gals up to the PCP/EMT A level, whoo hoo ! I had the sincere privilege of meeting and enjoying a few beverages with some of the crew last summer, great bunch of nut bars and lots of fun! Are you just using the Alberta Advantage and the abundance of schools available down south to further ALL Ambulance operations for the NWT ? Or have you lowered your standards and relocated ? te he. I certainly hope the NWT government will legislate standards and title protection very soon, as most communities and industry self impose the Alberta model, and honestly this is the first step required for the NWT for a variety of reasons to advance care and put all those with "dubious credentials" where they belong back as the camp cook/ campy. A FA ticket from wherever (just based on the distances/ logistics alone) is completely unacceptable for modern EMS delivery of care wherever you are, just why should NWT citizens recieve less ? And can someone PLEASE explain to me why anyone believes that as a EMR needs any road time before continuing up the food chain? I really dont understand, really ? The only reason that I can fathom is the time and expense assosciated with the upgrade as a volunteer ??? In such an enviroment, I would tend to think that the skill set and scope of practice would sure help out one's community a one hell of a LOT more, as when one gets a MCI "its all hands on deck" and get put to work asap in most ER's or Nursing Stations. cheers

motivationional Hey I made a new word ??? :shock: Proof reading is everything .... LMFAO!

Comanche So just what does THAT mean ? but thanks for that everyone does call me an angle. Whatever, the inuendo could suggest something negative, just dunno and not really following your train of thought. Anyway the simple mathmatical facts are that MANY schools out there are hard pressed with the large numbers of students and available positions. Hospital placements for Paramedics I believe are one of the most strained as many "gas passers" have residents and an O.R. placement's are really tight. The present trend with EDM and Calgary doing such massive hiring these days really complicates the situation, do you take a student and ride them 3rd on a car OR a new employee ? Not really rocket surgery here. I do know that some schools HAVE looked beyond our borders and stepped out into the International arena, sweet. I believe that CCEMS is one of them and have provided opportunities in Baton Rouge (other areas in Lousiana) and what a great opportunity for student(s) with high call volumes and you get to learn other languages...te he. cheers

Hold urine Horses ! Never said any group was useless ... ever ! The concept of "SAVING LIVES" is my bone of contention it is false heroism: Protecting an airway and taking away the pain were some of my biggest motivationional factors to continue up the food chain. We need to UP the high bar is all, improve deployments of available resources and looking from outside that stale government perspective, to prove a better way, bet I can save them all money too ... always the bottom line. cheers A true Hero is one that overcomes a fear of personal injury/ death and risking their own life to aid some one. WE are just doing a job and it is a team approach, just saying ......

Hey would it not be great to work with an ALS service and get payed more ? I bet your lady would like that idea, as would you mobey ! That said Core Knowledge, skill sets are the Responsibility of the Practitioner this situation is a bit anecdotal and quite true of just about any, like maybe working on a transfer car... not disagreeing just a counterpoint is all. cheers

Could it be the smoke and mirrors of the Alberta Advantage ? Seriously just not the panacea that is touted, one must take into consideration many variables before pulling up stakes: 1- Just because that Gut Wagon Show is accepting applications and resumes DOES NOT INDICATE THEY HAVE A VIABLE CONTRACT...ps over 180 industrial shows running these days, many going down the tubes I dare say. 2- There is a slowdown in gas development ... look to the costs of oil and gas ... good indicators. 3- know how many people in foreclosure, loosing homes and their white 3/4 ton trucks...! 4- The boom or bust nature, do you want to live in a Camp when you have a wife and a kids at home ? 5- The day rater phenomenon ... one sideways look or complaint to an employer ... and your history (aka zero job security) On another note it is quite disappointing that the current Government in AB has seriously under funded in the majority of Ambulance services. The true irony exists as for industry vs Public Delivery of care. OH+S regs: 1- - Risk assessment is evaluated as high for anything other than office workers in industry. (ie paper cuts) 2- Sites > than 40 minutes transport to a 'hospital" 3- Sites > 200 men/ women on a site, requires an EMT-P or RN ? BUT nothing in the OH + S regs stipulates the just what equipment is required (a topic in its own right) 4- Industry is also under a serious misconception with a the STARS registry for a remote spot ... meh ! This is NOT DUE DILIGENCE and that this is a very serious gap in EMS ERP (Emergency Response Planning) one has to look to night flying capability/ weather and realistic range from these bases. These Oil companies have been majorly duped into believing that a flying blood clot will actually show up...I digress, but some day this will become an issue , mark my words. note: Industry does have experianced, informed advisors these days... hmmm. Pubic delivery in Standard of Care very Dependant on the municipaliies funding formula: The very realistic situation exists, that of RURAL communities in Alberta. My point being that the Government does not follow there own code ! (I guess its the same as the "pirate code" ... more of guidelines I guess) Sounds like Hypocrisy to me :evil: MANY outlying rural communities far and above exceed the requirements for ALS coverage. 1- Travel to and from the worksites are the highest statistical "risk assessment" ??? These workers live and travel through the communities EVERY DAY! 2- 10 x more injuries in the home than a worksite. ???? 3- But under the Ambulance Services Act (AB) the rural/urban services have far more stringent stipulations and regulations in regard to mandatory equipment. ??? WHY ? End of RANT. Must disagree based on their are no EMT-B's one does need a EMT-A. The oilpatch has had way too many FA freak on site its really too bad because it paints "way too many good people" with the same paintbrush. Quite unrealistic time frames more like > 40 minutes in the areas I have made note the concept of Remote clinics could cut that TO ALS intercept/ intevention in half, anyway your quoting a US standard's and info out of the US, and this golden hour ?? meh! No weight at all in AB !!! Get a trauma patient to a trauma surgeon, MAN their is NONE in outlying communities other than CowTown or Deadmonton. GOOD but lets up the anti shall we? Yes the First Responders make a huge differance to a positive out come .... SAVE LIVES ? dood your watching too much hollywood movies ... look to my signature this is well ..... lets not blow too much smoke, it tickles me arse. I just might have some insight into the regs here ..... GOOD again, because this remote supervision (that is believed to be an acceptable condition for non registered practitioners and is poorly understood @ the ACP level {restricted practice permit} btw not licence. I WILL say that this is very actively being watched and could very well result in investigations and negative outcomes, and is the medical director really aware ? cheers

Comanche So just what does that mean ?

Yes agreed my fur lined jockstrap friend, long time ! :twisted: In the educational facilities there must be a repeatable way to teach a logical approach, in time and with a good Preceptor/Mentor, as NSmedic points out this will become second nature, it will not happen overnight either it takes experiance. The thing that sticks in my craw is a "Trainer" throws the Student to the wolves, right from the get go .... then uses the shred technique to teach the student .... meh. The good Mentor will model first and through example, then discuss the finer points, this is the technique employed by most teaching MD's, a system by system evaluation: C/F, O/A, PMHX, Rx, CNS, CVS, END, PULM, ABDO you get the drift. I can categorically state that there are just too many folks out there in EMS land that really have no medical "logical" some with a deliquent gene yet have great hearts, this can be of paramount significance down the road in their careers. If the student has (albeit harsh) graduated to field evaluation with this serious flaw "ie sans logic" unidentified then it is a failure of the school bottom line, not everyone is cut out for this field. That said reviewing OP commentary I am lead to believe your concern is primarily a confidence issue. I reflect on my First Paramedic Preceptor who always asked these questions: So what's happening here ? Practice "Active Listening !" And for the golden cookie award ask just the patient "What do you think is wrong" many many times they will tell you exactly what the real problem is! Its amazing ! :wink: cheers ps My preceptor was from New York City, Yonkers in fact the son of a butcher and a great human being, but talked really funny. :shock:

Yea yea, you said you would marry me too you snake! Back on topic: I can not tell you how frustrating it has become to open up links on PURELY ALS subject matter in well marked forums to find crap (the last shredded thread EMS research) and the 12 lead thread was simply a lesson in frustration. On three occasions, I did try to keep things on topic or redirect it back to the debate(s) at hand, recognising that things will go astray a bit these are complex topics. Sorry but when Mr. high JINKS started in with the drither again, I completely lost it ! Sorry but some twits only read the last page of the thread. Hey, I am not for censorship or more policing, quite simply ... go reread the rules of engagement or go so off topic as to be just a distruption for the common good in advancing the EMS community at large, can you just imagine what visitors with some education think when they "check us out"? sheesh ! Its dragging all of us down to a lowest common denominator, not basic! Bloody primative when mindless disputes that have NOTHING to do with the Topic by the original posters .... aargh. To that end I propose a "solution" just hit REPORT asap to ADMIN / AK "WAY OFF Friggin TOPIC" it is really sad that this has to come to more moderation, thing is, it is really negatively affecting the site, we lose ALL credibility in the pulic eye .... and they are watching ! cheers

My bad? yes sure hope my kids don't read this; We have established that doing a 12 lead ie Rids comment that buy providing good information to ones Medical control that options for treatment could be fast tracked ...yes hes right but only in a system that has trust in it members of the health care delivery team! Dang I sure hope he is still following, but lets pull this back from the edge of oblivion, shall we Scara ? SOoo if we are carrying and routinely using the 12 lead, even without bedside Troponin (albeit sure would be a cost effective way to advance Paramedicine and the next step up the ladder to delivery thrombolytics in the field, in many areas in the UK this IS the "street level reality" a 20 min delivery is optimal) Heres my point and bit of personal PMHX, I can remeber the day when we carried the Artifact 5, we did ECGs on everyone, were they the patients benefiting NO! We were self taught in many cases and we learned TONES of stuff, it opened our fossilized minds that we could become Paramedics and do more for those IF we only had the tools to do it. Yes to shock that V Tach, defib that V fib, at will not that stupid plastic brain a technological fix that HAS put Paramedicine in the bushes We gained the respect of the ER RNS and MDs. Slowly we advanced, SO do those 12 leads, learn learn learn, takes just a minute and down the dusty road we could gain the respect of the medical community and one MD at a time. cheers

Yes we are there is an bright, shining star and I too could care less if one squats to pee or sprays indiscriminately. Your Leaving ah PRICELESS ! That is the best news in my day appears this has not been a Total Waste of my time. What was the topic again ?

Is now formally declared an acceptable terminology unless it is not permissable to usurp DwayneEMTB the and his highly respected Dean of EMT city status? :shock: From the latin: Occularorectal cranial inversion is a the preferred PC term, I believe ? cheers

Here is an EXCELLENT example of where ACoP falls on its face, the barriers are super difficult for dust devil, to register, sometimes I think a lobotomy would help 8) It so gets MY goat that we can not just kidnap ... ok thats stretching it, so not a kid lol, Import his ass up and his dodge pick me up truck up here! :shock: Whats your opinion on the independently operated Clinic concept, oh man of dirt/dust/ sand :twisted: If we could only learn him to spell Kanada correctly we would be off to the submarine races ! cheers ps hide the women NOW! :oops: