NREMT-P transfer to Alberta Paramedic?

[Siffiliss]

geeze people, calm down. I wasn't trying to insult anyone. It was meant as a joke in response to the Toronto medical students who said they didn't know better because of watching shows like e.r.

If you want to take cheap shots at me for whatever reason it is you don't like me or put me down for not accomplishing some things for reasons you have no idea about, or just want to call me names... then you got issues. I have never put anyone down on the forums here in such immature ways or at all. Grow up!

I really don't care what you've done or haven't done for whatever reasons you say you have ... I honestly don't give a crap. I guess you found yourself about as funny as that <enter foul language here> comedian on Fox hey? Take your own advice and grow up Or perhaps, just think before you speak.

I am looking at a transfer to Canada, primarily the Yukon to undertake a contract there nursing and EMT. I am mainly writing in response to Aarons pathetic miniscule comments.

You have come back to this site and already have caused nothing but disharmony. Wouldn't it be best to actually complete your NR and EMT-P before actually ripping into individuals and people from other countries who actually have qualifications, certification and oh surprise surprise, are actually working as paramedics. You have insulted others from another country which is bluntly, pathetic and again, I reiterate my point, when you actually pass EMT P and actually register, then talk, otherwise keep your mouth shut and its people like you that make me very happy I am bypassing America and going to Canada!

Fortunately, Aaron is a rare breed of ignorance.

Celtic, if I can help you with information at all let me know, as I have a couple of EMT friends in the Yukon.

Edited April 16, 2009 by Siffiliss

[tniuqs]

They learn EMS by watching tv shows.

Now I understand what you were talking about, that was in the National Post (the link provided) cause serious stoopid knee jerk reactions from many that do not understand that the media loves embelishing they know nothing about it, and appears some in our fold did not do a follow up either.

http://www.nationalpost.com/news/story.html?id=1419824

I would have attached pfd but I am puter challenged, so have included for all, the media got the story from it was Edmonton and not TO, compare the medis release and its alarming conclusions and then read the real McCoy ... got to love the National Post as a source of medical information ... sheesh.

Letter to the Editor

Positioning prior to endotracheal intubation on a television medical drama:

Perhaps life mimics art

Sir,

Pulmonary resuscitation skills, including the ability to intubate the trachea, are expected from Canadian trainees in anesthesia, medicine, surgery and emergency medicine. However, following an audit by educational directors from Canadian Critical CareMedicine programs, we identified common recurrent deficiencies. Inadequate positioning of the head and neck was especially prevalent prior to intubation attempts, and improving thiswas seen as a simple but important first step. The optimal position involves flexion of the lower cervical spine; extension of the atlanto-occipital joint and raising the ears anterior to the sternum.1–4 This should align three airway axes (oral, laryngeal, and tracheal), optimize the glottic view, and increase the likelihood of endotracheal tube placement.1–4 We found that only less than 50% adequately positioned the head and neck.

As part of ongoing nationwide efforts to ensure basic resuscitation skills5 we explored all potential causes for the inadequate positioning, and this included trainees’ prior experiences. Many trainees reported limited supervision or hands-on training. Remarkably, however, when asked how they had therefore learned, after “trial and error”, a surprising number answered that television medical dramas had been an important influence. Almost all had seen intubation on television, and “ER” was by far the most common source. While nobody is suggesting this is the only reason for suboptimal head airways skills, we thought it would be interesting to review “ER” for the adequacy of positioning prior to intubation attempts.

We therefore assessed these three components in the 41 intubation attempts that occurred over the 42 episodes that comprised the latesttwo seasons of “ER”. Fourteenwere excluded due to inadequate view, and 5 more involved cervical-spine precautions which precluded optimal positioning. Of the remaining 22, none (0/22) achieved more than one, let alone all three, components of optimal airway positioning. In terms of individual components, the lower cervical-spine was flexed in 0/22, the atlanto-occipital joint

extended in 1/22, and the ears level with the sternum in only 3/22 cases.

While few would suggest that medical dramas can be held responsible for physician performance, it has been previously suggested that they can significantly influence beliefs.6,7 Of note, the producers of “ER” retain numerous medical experts. This suggests that either optimal airway positioning is poorly appreciated, or not understood to an important aspect of successful intubation. Diem et al. similarly studied cardiac arrests on television dramas.6 They argued that the unrealistically high survival means families will be misinformed unless physicians educate the public. Presumably in terms of pulmonary resuscitation, physicians themselves might be similarly misinformed without comparable educational efforts. Our audit highlighted the perils of leaving pulmonary resuscitation to the inexperienced or unsupervised. It also highlighted the need for deliberate and comprehensive resuscitation education.

Conflict of interest statement

There are no conflicts of interest.

References

1. Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with

recommendations for management. Can J Anesth 1998;45:757–76.

2. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult airway society guidelines

for the management of the unanticipated difficult airway. Anaesthesia

2004;59:675–94.

3. Barash PG. Clinical anesthesia. In: Airway management. 5th ed. Philadelphia: Lippincott

Williams &Wilkins; 2006. p. 595–642 [Chapter 22].

4. Miller RD. Miller’s anesthesia. In: Airway management. 6th ed. Churchill Livingstone,

NY: Elsevier; 2005. p. 1617–1651 [Chapter 42].

5. The Canadian resuscitation institute. http://www.criedunet.ca/. Accessed February

10, 2009.

6. Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles

and misinformation. N Engl J Med 1996;334:1578–82.

7. Turow J. Playing doctor: television, storytelling, and medical power. New York:

Oxford University Press; 1989.

P.G. Brindley!

Critical Care Medicine, Unit 3C1.12 University of Alberta Hospital,

8440-112th St, Edmonton, Alberta, Canada T6G 2B7

C. Needham

Department of Anesthesiology and Pain Medicine, Edmonton,

Alberta, Canada

Edited April 16, 2009 by tniuqs

[MI/MEDIC]

Just heard back on my file, 100% reciprocity in Alberta.

[tniuqs]

Just heard back on my file, 100% reciprocity in Alberta.

So just walk in and jump on a truck no exams, no restricted licence in any way ?

Good luck with that.

[chbare]

I would suspect some type of testing would be in order. From kilometers per hour, to kilo-pascals of oil pressure, to SI units of lab reports, there are differences between the United States and Canada. I suspect there is reciprocity after testing and perhaps additional course work or orientation?

Take care,

chbare.

[mobey]

Sheesh.... even interprovincially we have to write exams on highway laws, local governance, protocol's and scope etc etc.

Something does not seem right. I'd call back.

[MI/MEDIC]

Sheesh.... even interprovincially we have to write exams on highway laws, local governance, protocol's and scope etc etc.

Something does not seem right. I'd call back.

I shouldnt say 100%, still have to write ACP in June.

[chbare]

I shouldnt say 100%, still have to write ACP in June.

Got it.

Does Alberta ACP ~ to the US paramedic? I understand, some levels of PCP in Canada receive several hundred hours of education, yet operate at an intermediate-ish SOP. Not that I disagree with this model of education.

Take care,

chbare.

[WolfmanHarris]

This is where it gets complicated because in this case ACP does not equal Advanced Care Paramedic but Alberta College of Paramedics, which is usually shortened to ACoP up these parts. The reason for this is Alberta likes to be different and bucks the PCP, ACP, CCP trend of the rest of Canada.

That's not to say their levels are pretty close to the NOCP, just substitute EMT-A (Emergency Medical Technician - Ambulance) for PCP and EMT-P (Emergency Medical Technologist - Paramedic) for ACP.

Education is comparable, with one major change. While BLS is two years in Ontario and ALS is one year. In Alberta BLS is one year and ALS is two years. Just a difference in whether or not you front load the extra theory or not. At least that's my understanding of it.

Welcome to Canada MI/Medic. Here are a few things you may want to know:

1) If you don't like hockey it's best to save the money and stay out of any restaurant or bar with a TV between October and umm... well counting the juniors and international games and exhibition and training camp, let's say September.

2) Quebec... probably just better for you to find out for yourself. Let's just say one of the best and worst parts of Canada at the same time.

3) Tim Horton's. Good coffee, great spot for lunch. You'll find them everywhere. (Except Brighton where I'm on night shift tonight)

4) Not sure how far north you are in the US, but just in case: "all season tires" aren't.

Okay I'll stop there before it gets too off track. Anyways congrats and good luck the move up!

- Matt

[kevkei]

That's not to say their levels are pretty close to the NOCP, just substitute EMT-A (Emergency Medical Technician - Ambulance) for PCP and EMT-P (Emergency Medical Technologist - Paramedic) for ACP.

Actually, part of the reason ACoP is difficult is their goal was to meet AND exceed all of the NOCP's, which is why interprovincial movement was always problematic.

MI/MEDIC, you might want to get a ton of help if you are going to write ACP in June. The written and scenario's are fun!