The Argument for ALS Level Care

[Christopher.Collins]

I used this link when I had to purchase and equip an ambulance for one of my classes. I hope it suits your purpose.

http://www.savelives.com/homepage.html

This is a great site and company. They are based in Old Saybrook, CT which is a neighbor to my hometown. The owner and his staff are all Firefighters and EMS'ers that know the demands of what we do. Very nice people and very proffesional. Actually rumor has it the company was started out of my former chiefs home garage.

[spenac]

This is a great site and company. They are based in Old Saybrook, CT which is a neighbor to my hometown. The owner and his staff are all Firefighters and EMS'ers that know the demands of what we do. Very nice people and very proffesional. Actually rumor has it the company was started out of my former chiefs home garage.

Thanks for the heads up. We will scratch them off as we don't deal with FF's.

:twisted:

[BEorP]

There is convincing evidence that if a seizure lasts more than 5 minutes the person will begin to suffer damage to the neurons in the brain.

If I were a county counsellor (which I am not) I would want to see a citation when someone says that there is "convincing evidence" of something as serious as this.

I've added some comments below in red:

Advanced Care Paramedics additionally provide

-Advanced airway management in both cardiac arrest and non-arrest patients (i.e. Intubation)

-ETCO2 monitoring (measuring carbon dioxide levels being exhaled)

-Removal of airway obstructions by direct laryngoscopy

-12-lead ECG interpretation As I mentioned previously, this is not exclusively an ACP skill even if it is something that is currently not done by PCPs in your region.

-Needle thoracostomy (treating certain types of collapsed lung)

-Intraosseous and external jugular IV access (more ways to get access if an IV can't be established)

-Manual defibrillation There are PCPs in the province who do manual defib, but I understand that the vast majority of time this is ACP only but you may want to add a note of what the benefit of this is as you have with other skills.

-Synchronized cardioversion (for life threatening abnormal heart rhythms)

-Transcutaneous pacing (for dangerously slow heart rates)

-Cricothyroidotomy ('tracheotomy') You probably already know this, but I believe that there are some places in the province where they have ACPs but can't do any form of cric.

-Treatment of cardiac emergencies according to internationally recommended standards of care

-13 additional drugs (Adenosine, Atropine, Diazepam, Diphenhydramine, Dopamine, IV Epinephrine,

Fentanyl, Furosemide, Lidocaine, Morphine, Naloxone, Sodium Bicarbonate, Midazolam) Again, you may just want to ensure that you're not implying that having ACPs means that you will have everything you list here for sure since not all services will carry all of these drugs.

[WolfmanHarris]

Alex have you considered keeping your list relatively succinct within the body of the letter but then attaching an appendix which takes each ALS intervention and breaks it down in more detail so that the councillor's don't have to do the basic follow-on research themselves.

Further, for the sake of disclosure, I'd attach at least the abstract of OPALS Study and other studies related to ALS. At first glance some of it may seem to shoot you in the foot (namely the SCA stuff), but since if they research it themselves they'll stumble on it quickly you can head that off at the pass.

Provide a further appendix that has official (though non-binding) quotes from various suppliers on the equipment costs including comparisons from different suppliers/manufacturers.

I think your letter is excellent, but I've been in front of a committee trying to convince them to spend money and change how things are done and I found the most effective approach was to anticipate their questions and have them all answered ahead of time in as much detail as possible. They may not read it, but it's there in front of them if they're looking for it.

Finally, if you get the chance to go in front of the council on this, prepare a presentation which expands on the high points of this and consider bringing in some experts to talk the talk. For this I'd suggest contacting the regional base hospital for a representative to talk about how ALS works on their end, perhaps a local ER doctor who can speak from the other end and maybe a representative from the OPA. I'd be wary about approaching the union as they view things from a different perspective and may be in favour of ALS but may stall the discussion in terms of contract negotiations and pay.

I'm really interested to hear how this plays out. Best of luck and let me know if there's anything else I can do to help.

- Matt

[akroeze]

Not ignoring anyone's posts here but my time is limited tonight. I do want to address some things however.

All this information I quote as far as scope of practice etc is based on the service right next door to us which is under the same base hospital. They do crics, they carry all the drugs, they do every optional procedure. I'm going with the idea that BH would likely have this service also do all the procedures/drugs.

Those saying I should quote call statistics.... I don't have access to them. I am not employed with them and thus don't have access to their data since they don't make it public. As much as I'd like to. Any Ontario folks know of any services that DO break down some statistics about how often they do ACP level skills?

[WolfmanHarris]

Ummm... as a government contractor they should be required to give access to certain stats provided they don't violate FIPPA or PHIPPA. Do you have a firm time limit for putting these together? Generally information requests have a long turn around time, especially when through government to a contractor. Any questions on this though should probably go through:

Information and Privacy Commissioner/Ontario

2 Bloor Street East

Suite 1400

Toronto, Ontario

M4W 1A8

1-800-387-0073

Fax: 416-325-9195

info@ipc.on.ca

Regarding Cric, keep in mind that its' an auxillary protocol under Ontario ALS standards. Now I could be wrong on this, but doesn't that essentially make it optional for the service and BH. This service might decide that it doesn't want to utilize some of these protocols and the County might take issue with some parts. So it might actually be in your best interest to draw attention to the possibility of phasing in cric, central venous access and IO. Think like a politician. These things scare them and knowing they have options might make it easier for them to swallow and feel like they have some options.

[BEorP]

Did you end up finalizing it and sending it on out?

[akroeze]

Well to be quite honest I got completely demoralized after talking to some people in the know. Apparently the municipality a few years ago commissioned a study on the implementation of ALS. The numbers were even better than the ones I came up with and they unanimously voted against it.

Frankly, it makes it difficult to go ahead with something that could potentially give you a black mark in some people's mind when the odds are like that.

[rock_shoes]

Frankly, it makes it difficult to go ahead with something that could potentially give you a black mark in some people's mind when the odds are like that.

I don't understand how advocating for a higher level of paramedic care in your home community would leave you with a black mark. Regardless of whether or not people agree with you it's difficult to fault someone for trying to make improvements to a service. Perhaps there are more politics at play than I am aware of?

[akroeze]

I don't understand how advocating for a higher level of paramedic care in your home community would leave you with a black mark. Regardless of whether or not people agree with you it's difficult to fault someone for trying to make improvements to a service. Perhaps there are more politics at play than I am aware of?

The powers that be that run the local company are so anti-ALS it isn't funny. They practically froth at the mouth when spewing out anti-ALS comments.