BLS 12 leads

[tniuqs]

"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,

Ok maybe I am confused just how many services do have the latitude ?

Odd but most have it listed in protocols, yet not on car ?

ps there is a reason btw.

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.

You may just want to reconsider that statement in 2 regards:

1- What and how do you believe the HPA is superiour piece of legislation? Just because ACoP told you ? the HPA was mandated by Ralphys Government to the colleges not voted on by the ACoP membership, this "vote" occured in the Legislature.

(ps remember the little ACoP Gap thingy under HDA, point in fact as this was to bring the AB EMT level up to Ontario PCP level without sending all the EMTs back to school) ...... almost a pity.

2- Your assuming that somehow standardization, and introducing yet another layer of government intervention will somehow give you a improved scope of practice ? please explain to me just how this will be accomplished ? ... folly in my view. The thing is BLS was quite clearly defined in the HDA as it was pretty much standardized in AB with the old Alberta Health Protocols, was it not ? So how will HPA make anything better for your patient ?

In alberta emts can ADMINISTER ASA/NTG not assist, not all services have adopted this yet, but it is the governing bodies' stand, and why does EMT not equal PCP? last time i checked it did.

In statements in your first paragraph state AB EMT assist/ then down the page you state administer .... am I confused or are you ? It is on the ACP webpage if you really want to know in a release about 2 years ago.... "see approval for of GAP in the on line so called Dialog or communication releases"

And PLEASE check again the on-line protocols/ guidelines from AB, BC, and ONT they are all available for comparison.

I have gone into great depths in other threads to explain why the educational concepts of ie the "pyramid" vs the inverted pyramid, and why the Egyptians got it right a long way back.

cheers

[tniuqs]

First off HUH? look to your underlined comments, things that make sense in evidence based medicine ARE proven to be statistically best treatments.

1- I believe you are just following blindly wrote ACLS protocol, the ILCOR Consensis studies are suggestive that CPR was not being done as effectively as it could be in the fist place.

2-V-Fib still is listed as one of the most lethal possibly correctable arrthymias. Frankly I think your confused as to the reasoning behind the changes, and this does not make for interesting debate.

NOW why would one work a Code when rigor mortus is present ? Just how many initially asystolic patients were noted just what was the criteria, in fact, could it be possibly to include all in a study is my guess, are you following what I am saying here? These statement's that we are discussing in this tread are based on the OPALS study not ACLS Guidelines.

1- The OPAL's 2 study basically came to the same conclusion as all, the sooner the ACLS is initiated on "pre code/ respiratory distress" patients the better the outcome.

2- The out of hospital survival OPALS 1 is based simply on the response time ONLY, PERIOD, BLS or ALS ... sure gets when you boil it down. That's all the first OPALS study really noted.

BUT then budget concerned poluticians (sp?) used this to debate in efficacy of service levels and then their concern was brought the media in to "clerify" the situation ... again sarcasm applied. Why does in hospital arrest's have improved outcomes ... umm cause there is an RN at the desk ?

Further interrogation:

That said if one does have a return of spontaneous pulses, so then just how does BLS treat underlying rhythms or contributing causes ... so do a 12 lead enroute? give more O2 ? and drive faster ? = same outcome's, so who is holding back EMS anyway ?

The thing that holds back EMS is mindless following of wrote protocol's, as this ideology (ok I can't think of a better term) is based on the lowest common denominator, NOT the highest. I can tell you with somewhat of a background that patients will seldom follow any firm rules.

Great to hear, have you used it ? the preliminary research looks very promising unfortunatly I am stuck with blood products to treat hypovolemia these days.

(ps thats is Sarcasm) please note well: I have a cold and I get cranky when I am sick, just saying don't bring a knife to a fire fight when you hear a 50 cal. in the background ..... :twisted:

cheers

[BEorP]

[tniuqs]

Does one really have to introduce intuition into this?

BLS = Combi tube (whatever) O2 therapy, IV access, maybe fluids.

ALS = Intubation, CPAP, RSI, Clot busting drugs, antiarthmia rx, pain control and tropes ..... I don't need intuition to figure that out! Does one need to have a new study to prove the difference between Advanced Life Support so why even try to compare "outcome" studies for the BLS level its a no brainer, well unless your just trying to lower costs at the expense of best patient care.

In fact lots of studies out there comparing Paralytics vs no Paralytics for success in intubation for ALS providers (yes another topic but just an example)

Question for You I will put in Basic terms: ie Your Father is suffering from chest pains, do you want an ALS provider or a BLS provider to respond in the same time frame to location.(and don't go off on a I saw a ACP do this once, please)

In your example you are debating early compressions 30:2 vs early DFib, apples vs oranges, these are simply the new ACLS protocols, and the concensis from ILCOR IN evidence based medicine and applied research, using this as an argument "what we thought in the past was best care" it simply does not compute.

Look to "inclusion criteria" in the OPALs Study, out of hospital arrest outcomes based in initial ecg rhythums ..... you state you are a researcher ... I think you maybe shocked.

cheers

[BEorP]

I am having a very hard time understanding your posts, but I will make an attempt to offer some comments (added in blue).

[tamaith]

i think they should be able to put them on. and not necessarily be able to read them. it may help als or receiving hospital. i agree with mobey.

[tniuqs]

Edited due lack of incentive to proof read, and sorry bout that :>)

Look to the "inclusion criteria" in the OPALs Study, the out of hospital arrest outcomes are not based entirely on initial ecg rhythums. The whole attempt to prove or disprove ALS providers vs BLS providers change outcomes (In Arrest Situations ONLY) its the time to location thats the signal most important influencing factor, did I not say that before?

You're barely making sense here, but even if they are separating patients based on initial rhythm, patients who are obviously dead

Good point, so I introduce the concept that many a BLS level provider may NOT be experianced enough nor confident enough in "Calling Them Dead", because once anyone (say like a FF) starts CPR the first place it is akin to stopping a clown parade, this one of the flaw's in the inclusion criteria to start with in this study.

Question:

1- Have you actually read the OPAL study ?

But before those 2005 guidelines came out, if I had asked you why paramedics immediately analyze the patient, you could have explained the reasons. And those reasons would have seemed to have made sense.

Question:

2-Your Avatar states you are a Paramedic .... analyze ?

[Perhaps] I am the not only one guilty of failing to proof read, or somewhat confused?

This is my point. You do need studies to show the benefits of ALS care so that those who pay for ambulance service will understand why it is needed. Saying ALS will have better outcomes than BLS because more interventions available is exactly what I was talking about when I referred to doing things because they seem to make sense intuitively

Question:

1- Do you need studies to prove that a higher level of training and scope of practice will have any influence in positive outcomes (Best Practice) or are you talking (Economics) ?

2- You still did not answer the first question posed.

Question for You, I will put in Basic terms: ie Your Father is suffering from chest pains, do you want an ALS provider or a BLS provider to respond in the same time frame to location.(and don't go off on a I saw a ACP do this once, please)

cheers