Saved by the bell ?

[tniuqs]

Did anyone actually read the link to the news article in MacLeans magazine ?

It is about upgrading Hose Monkeys on Big Red Trucks to the EMR or PCP level then calling them FF/Paramedics (because the Firemen have better response times in Toronto and Winnipeg )and the propaganda by the IAFF not only is this very misleading but very obviously a budget grab for the cash, no brains just chest pounding that this "model" is innovative in some way. Besides the fact that this is not even close to a solution for rural Canada as most Fire Halls are volunteers.

(Funny thing I live in a community of 2500 closest Hospital about 30 mines (direct) we have a 3 million dollar Fire Hall averaging 30 calls a year and NO ambulance ? ... weird EH, 3 24/7 Ambulances in this area and over 12 Fire Apparatus staffed 24/7.

My points are quite elemental:

If the wait for Ambulance (Toronto and Winnipeg or Prince George the only services reviewed) Response Times unacceptable for a medical call then why the hell not fund more Ambulances to reduce response times, well if thats the real goal besides decrease operating costs over all. One ambulance is far less expensive than a Crash/Rescue or a Pumper with minimum of 4 men and still not have the capability to transport the patient to a definitive health care facility. If you do pull a PCP/EMT off that Pumper is 3 men safe to respond to a fire no your putting that Pumper out of service bottom line, ps I know that some FF services do run 3 men on a Pumper ... so one would be down to 2 men ... sheesh.

Then the "other" options in delivery of Emergency Health Care, ALS Fly cars, Treat and Release, Triage by a "Paramedic Practitioner" and/or all level's PCP up to be trained to work in the ER departments whats so wrong with that cross training idea ?

(oh yea that would be RN "turf wars" what was I thinking)

I was lambasted <insert gasp, sniff, ha ha> for suggesting that EMS providers become cross trained to Fire Fighters WHEN the need arises to "assist" with fire call's.

(It appears this is not a 2 way street either .... rather curious NOT!)

Fact of the matter the call volume "actual fires" is way down (as legislation building codes +++, heck I say put sprinklers in every new structure) and medical calls way, way up? This FF/Paramedic integrated service sadly ignores the real issues and is a band aid short term fix with ageing population, over crowded in walk-in clinics and Family Practice MDS retiring (mine is) there are better ways, really.

Then there is the battle of the sexes ... their remains in the Fire Hall macho "hero" mentality that women can not do the job and the last bastion of male dominance in the work place, tell me it isn't so and I will eat my fur lined hat!

cheers

Edited December 13, 2009 by tniuqs

[vs-eh?]

On this particular occasion, they listen to her breathing...

Oh really? They are stating in the article that TORONTO FIRE is auscultating this patient's lungs? Really? Seriously? With what? Wow...

Man...I'll comment more later.

Edited December 13, 2009 by vs-eh?

[Kiwiology]

Maybe they bought a stethoscope for two bit from the Johnny n' Roy store eh?

I have to agree with the frozen turnip, fund more ambulances and don't get the fireys to plug the gaps, I don't see a problem with firefighters having some base knowledge say EMR or First Responder to be able to render immediate aid at a scene before the ambo's roll up but that should be it.

The term "Ambulance Officer" is pretty common here too, it's widely known but I think the public are confused by the whole "Ambulance Officer" / "Paramedic" / "Advanced Paramedic" thing, we also have people with patches that say "IV/Cardiac", "Intensive Care Paramedic" and "Primary Care" but as I understand those are going away.

Personally I feel quite viscerally that the term "Paramedic" for the BLS level (if we are being purist and talking no manual cardiac interventions, IV fluid or parenteral medications) is inappropriate. As to what to call this level, eh, you tell me because its going to become "Ambulance Technician" and then we'll have two "Paramedic" levels. Was this deliberate on-part of the services to distinctly separate the two because the Paramedics levels are in-line for an expanded scope of practice so as to avoid public confusion, could be, wouldn't surprise me in fact but I'm not sure. Personally I hate the term "Ambulance Technician" but you'll be hard pressed to find an alternative from me!

[celticcare]

Maybe they bought a stethoscope for two bit from the Johnny n' Roy store eh?

I have to agree with the frozen turnip, fund more ambulances and don't get the fireys to plug the gaps, I don't see a problem with firefighters having some base knowledge say EMR or First Responder to be able to render immediate aid at a scene before the ambo's roll up but that should be it.

The term "Ambulance Officer" is pretty common here too, it's widely known but I think the public are confused by the whole "Ambulance Officer" / "Paramedic" / "Advanced Paramedic" thing, we also have people with patches that say "IV/Cardiac", "Intensive Care Paramedic" and "Primary Care" but as I understand those are going away.

Personally I feel quite viscerally that the term "Paramedic" for the BLS level (if we are being purist and talking no manual cardiac interventions, IV fluid or parenteral medications) is inappropriate. As to what to call this level, eh, you tell me because its going to become "Ambulance Technician" and then we'll have two "Paramedic" levels. Was this deliberate on-part of the services to distinctly separate the two because the Paramedics levels are in-line for an expanded scope of practice so as to avoid public confusion, could be, wouldn't surprise me in fact but I'm not sure. Personally I hate the term "Ambulance Technician" but you'll be hard pressed to find an alternative from me!

Rightyo, BEN, there is a public education plan over the next few years as Technician is introduced to explain the new levels and its talked about during first aid courses. There will be ONE paramedic level and an intensive care paramedic level. The majority of public are aware that someone who works in the ambulance are often called paramedics and don't know the skills. When I was with WFA, there wasn't issue from the public as they saw they were getting an ambulance and people aren't stupid, majoriy of people know that there are different levels for everything. Please get your facts right before making comment about New Zealand EMS unless you work in the service.

Scotty

[Kiwiology]

...There will be ONE paramedic level and an intensive care paramedic level. The majority of public are aware that someone who works in the ambulance are often called paramedics and don't know the skills. When I was with WFA, there wasn't issue from the public as they saw they were getting an ambulance and people aren't stupid, majority of people know that there are different levels for everything.

Scotty

OK lets split hairs, two levels with the word "Paramedic" in them then.

Weren't you the one who told me WFA changed there patches to brand everybody a "Paramedic" because the public didn't get the whole Proficiency / IV-Cardiac / Paramedic thing? You're contradicting yourself.

[celticcare]

OK lets split hairs, two levels with the word "Paramedic" in them then.

Weren't you the one who told me WFA changed there patches to brand everybody a "Paramedic" because the public didn't get the whole Proficiency / IV-Cardiac / Paramedic thing? You're contradicting yourself.

They changed the term to Paramedic to give one title to all staff, remember the uniforms changed a few years ago, and yes the public didn't fully understand the different terms, but then education has changed and ambulance is no longer this behind the scenes little group that no one understands any more. It has come to the fore with introductions of shows like Rapid response and Emergency Hero's etc as shown on our tv networks.

And in reference to fireys having skills skills, it is standard to be advanced first aid/EMR here in NZ. The resistance to them having the skills doesn't come from fireys, it is from other health sectors against fire having the skills/gear to deliver care.

The term technician has come in to show we have a technical skill base and knowledge and move away from officer as it is still the regimented military standards. Same as nursing has moved from the "stripes" ranking and we are gauged on our level of practice with our portfolios of practice, like I am level 2 RN but working on Level 3 which would have been a couple of bars on epualettes.

The public would understand that an intensive care paramedic would have more skills than an average paramedic, and perhaps its just Auckland, but you speak to alot of people, they know that an advanced paramedic/intensive care paramedic is that - a higher level of advanced life support than an average paramedic. If you read the basic scope of practice for ALS in the ACLS course guides - Manual Defib, Cannulation, LMA and meds are the basic skills to be certified at ACLS level - so does that not make ILS practitioners competent in ALS and then Intensive Care Paramedics, are further skilled in extra skills for Trauma as well as Cardiac Advanced Life support. Just putting it out there

Scotty

[Kiwiology]

They changed the term to Paramedic to give one title to all staff, remember the uniforms changed a few years ago, and yes the public didn't fully understand the different terms, but then education has changed and ambulance is no longer this behind the scenes little group that no one understands any more. It has come to the fore with introductions of shows like Rapid response and Emergency Hero's etc as shown on our tv networks.

I'd be very interested to see if WFA has had any negative problems with just labeling everybody "Paramedic" when in fact you could be National Cert, ICO-IV, ICO-Cardiac, ALS-A or ALS-B (notice they still seperate the two ICO modules?).

I am surprised WFA agreed to the new national terminology having labeled everybody "Paramedic" for what, five years, to change to "Ambulance Technician" seems like a step backward but WFA seem pretty onto it and I've heard most of there staff are ALS-A or above, not sure what their vollies are like.

And in reference to fireys having skills, it is standard to be advanced first aid/EMR here in NZ. The resistance to them having the skills doesn't come from fireys, it is from other health sectors against fire having the skills/gear to deliver care.

I don't think the Firey's should have anything about First Responder (the new PHEC) not because I am anti-Fire (in fact the opposite, I am quite pro-Fire and think NZFS are bloody fantastic, love them to bits, dad, uncles, cousins and random friends in the Fire Service not withstanding!) but rather we shouldn't be asking the Fire Service to plug gaps in ambo's capabilities to respond to what must be it's core business, emergency response.

And let's not even start thinking about this "response target" game, we all know that these "response targets" are largely clinically insignificant and do not have any evidence to support them. Just look at the driver training thread to see what problems the "clock-stoppers" cause, look at the UK!.

Lord help us if we see the day my Nana calls for chest pain and two fire trucks roll up and eight Firefighters in all their getup with jump bags come barreling through the door just as the ambulance is pulling up outside.

Obviously out in the sticks the Fire Service has the capability get involved in first or co-response and I think this is a good move.

The term technician has come in to show we have a technical skill base and knowledge and move away from officer as it is still the regimented military standards. Same as nursing has moved from the "stripes" ranking and we are gauged on our level of practice with our portfolios of practice, like I am level 2 RN but working on Level 3 which would have been a couple of bars on epualettes.

I understand in the UK and US the term "Technician" is used as it relates to Ambulance Technician and Emergency Medical Technician but I still don't like it. I think it implies too much of a "technical" skill base and sounds like somebody who spends there day cleaning and fixing the ambo. Many AO's I've seen feel the same way and while there may be a wish to delineate "Ambulance Officer" as a practice level to avoid confusion (remember "AO" is the generic term here for all ambo's) time will tell if this causes any problems.

The public would understand that an intensive care paramedic would have more skills than an average paramedic, and perhaps its just Auckland, but you speak to alot of people, they know that an advanced paramedic/intensive care paramedic is that - a higher level of advanced life support than an average paramedic. If you read the basic scope of practice for ALS in the ACLS course guides - Manual Defib, Cannulation, LMA and meds are the basic skills to be certified at ACLS level - so does that not make ILS practitioners competent in ALS and then Intensive Care Paramedics, are further skilled in extra skills for Trauma as well as Cardiac Advanced Life support. Just putting it out there

You know I think "Intensive Care Paramedic" is better than "Advanced Paramedic". Most people don't understand what "ALS" is but nearly everybody knows "intensive care" is when you are really sick.

Edited December 15, 2009 by kiwimedic

[HERBIE1]

I'd be very interested to see if WFA has had any negative problems with just labeling everybody "Paramedic" when in fact you could be National Cert, ICO-IV, ICO-Cardiac, ALS-A or ALS-B (notice they still seperate the two ICO modules?).

I am surprised WFA agreed to the new national terminology having labeled everybody "Paramedic" for what, five years, to change to "Ambulance Technician" seems like a step backward but WFA seem pretty onto it and I've heard most of there staff are ALS-A or above, not sure what their vollies are like.

I don't think the Firey's should have anything about First Responder (the new PHEC) not because I am anti-Fire (in fact the opposite, I am quite pro-Fire and think NZFS are bloody fantastic, love them to bits, dad, uncles, cousins and random friends in the Fire Service not withstanding!) but rather we shouldn't be asking the Fire Service to plug gaps in ambo's capabilities to respond to what must be it's core business, emergency response.

And let's not even start thinking about this "response target" game, we all know that these "response targets" are largely clinically insignificant and do not have any evidence to support them. Just look at the driver training thread to see what problems the "clock-stoppers" cause, look at the UK!.

Lord help us if we see the day my Nana calls for chest pain and two fire trucks roll up and eight Firefighters in all their getup with jump bags come barreling through the door just as the ambulance is pulling up outside.

Obviously out in the sticks the Fire Service has the capability get involved in first or co-response and I think this is a good move.

I understand in the UK and US the term "Technician" is used as it relates to Ambulance Technician and Emergency Medical Technician but I still don't like it. I think it implies too much of a "technical" skill base and sounds like somebody who spends there day cleaning and fixing the ambo. Many AO's I've seen feel the same way and while there may be a wish to delineate "Ambulance Officer" as a practice level to avoid confusion (remember "AO" is the generic term here for all ambo's) time will tell if this causes any problems.

You know I think "Intensive Care Paramedic" is better than "Advanced Paramedic". Most people don't understand what "ALS" is but nearly everybody knows "intensive care" is when you are really sick.

Many places still use the "Mobile Intensive Care Unit" label on the side of their apparatus. To me, that is about as clear as it gets, and the titles of the providers becomes irrelevant.

It's about the level of care provided, NOT which initials you have on your license. I can't tell you how many times I see captions on pictures that describe "firefighters" providing medical treatment when the people are clearly EMS providers.

[tniuqs]

Well thats all well and good (in NZ or OZ) but the "terms" of reference and titles are used in legislation and clearly define scope of practice in Canada. In many cases government or the whom ever is funding pastes labels on the trucks and the level of care under the term now as "Emergency Paramedic" this blurs the lines to the extent of bamboozling the public, the term PARAMEDIC includes variances in education from an EMR to Critical Care ( from an 120 hour F.A. Course to 4 years) is this the way to go ? ...

Not my idea of standardization, then throw in the concept that FF/ALS is even near to possible instead of funding more ambulances (the Winnipeg Fire Service believes that the Ambulances should be staffed with just drivers only) at there beckoned call ... then quite shocking that the FF "medic" is by break down only EMT level ...

The biggest trap that EMS runs into to divide and conquer btw and continual change in the alphabet soup is IMHO shooting us ALL in the foot, besides it costs tons of funding to change the terms, and amendments to legislative documents and if I have to go into the "timeliness" of politicians to address real issues well no point me going on a <rant> again.

In the case of the EMT / PCP this is a technical provider ONLY ... I see A ... I do B as after all this IS the truth.

Confusing this with the Primary Care Paramedic (well look to the REAL definition of Primary Care by the World Health organization) you may be "shocked" as by definition : http://www.who.int/topics/primary_health_care/en/ so this is a mis namer. In passing only has the "PCP" level or term accepted in "some" provinces one does not see this world wide but it does seriously complicate issues when one throws the Fire service banging on the hero, life saver chests (as in the article)

The 'I' in Canada does NOT indicate Intensive Care its Intermediate the EMT with IV skills. On that note is there a true ICU truck out there in the real world ... come on really, chest tube inserion, doing invasive procedures like Central lines, xray capabilities, Swan, Real Transport Ventilators, ABG machines. The term of ICU is clearly understood by the public as in "damn sick" anyway the myth in most cases as soon as the patient arrives in ICU the "medics" drop back behind the curtains, the rare individual that can go from street level and actually assist in an ICU is like having an ER specialist MD work in ICU as an attending intensivist.

Advanced Care Paramedic providing ACLS is pretty clear and should become the STANDARD on all trucks in Canada (I can only hope in my life time)that said in a duel role and part of every "urban" Pumper mixing Pre Hospital Health Care and Public Safety is asking a but much and then forget the rest of Canada with this model, is beyond cost effective and or realistic as besides the densely populated urban centers there does exist the "ROW" the rest of the world where ALS rural does make a huge difference in positive outcomes, ie volume expanders, chest decompression, clot busting drugs, 12 lead, anti arrhythmic's, pain relief medication and at least 40 other true life saving drugs and procedures, so throw that individual on a Pumper and you put the pumper out of service if the medic has to transport Laws here are quite clear any medication or invasive procedure and one CAN NOT hand off to subordinate level of care hence the model proposed by IAFF is way expensive.

True Critical Care Paramedics are still a rare breed,(the CCP program is not done in 3 weeks as in other countries) typically this pertains to Flight side and required for long distance critical care transports, we do have quite a few of those types of inter facility transports in Canada.

In this article the IAFF in Toronto, Winnipeg and Prince George Fire Dept's (and 3 different provinces and all with their provincial statutes) where the training for medical varies greatly. Point being without having the capability of transport, the basis of debate by IAFF by many is the "fastest response time" and the focus arrest situations ONLY, biggest point being the clock STOPS upon arrival HUH ? but very typical Modus operandi of Fire departments justifying budgets ONLY !

Point being again if the statistic's show conclusively that more EMS is needed to meet with medical calls and fires are markedly down why the hell would one provide funding to the Fire Service "to fill the gaps" when the clear problem is medical. An analogy would be going to the store to make an Apple Pie and purchasing Potatoes or in my case Turnips.

The OPALs studies (use search engine) besides being very dated, quite flawed (it compares apples to kumquat's) and the funding provided by those that were anti ALS.(they believed the cost outweighed level of care/ proper assessment) Many of the commentators in this article are seriously mislead and in vast majority of cases the only study "conclusions" Hence the drive for IAFF to use this as an impetus or push to fund their departments do they really care about an improved model of delivery of care ... not a hope.

The concept of ALS Fly cars, Treat and Release,(increasing scope as done in London UK) Triage by a Higher level of education, redirection to facilities to clinic or available Family Practice MDs, then have the Paramedics actually work in the ERs ... but that becomes a "turf war too" with Nursing staff.

This throw a FF/Medic on red trucks is simply a band aid fix and short term and totally forget about the real issue, improved Pre Hospital Health care.

That all said IF one can be a FF/MEDIC ... why not train the MEDIC (staffing an Ambulance) to go to FIRE, in the rare case where more staff is needed to pull hose, just saying this is not a 2 way street.

Oh and read the comments in the article.

cheers

[rock_shoes]

The concept of ALS Fly cars, Treat and Release,(increasing scope as done in London UK) Triage by a Higher level of education, redirection to facilities to clinic or available Family Practice MDs, then have the Paramedics actually work in the ERs ... but that becomes a "turf war too" with Nursing staff.

You’re absolutely right about the Nurse/Paramedic "turf wars" that are coming here in Canada. I do think that now is the time to have them. I can't speak for every area, but in BC critical care transports have normally fallen to specially trained paramedics. In the past few years nurses, the BCNU (nurse's union) specifically, have actively pursued taking over all such transports. At the same time as they attempt to take over paramedic jobs the BCNU is claiming the existence of a severe nursing shortage. So which is it? Is there a nursing shortage or are there so many RNs they need to seek other work? The truth is we don't have a shortage of RNs. We have a shortage of care aids and LPNs. As much as I will always be a proponent of education the fact of the matter is you don't need a BSN to wipe someone’s a$$.

A level of paramedic qualification sufficient to provide critical care transports does exist here in BC as it does in other parts of Canada. Given that fact which option makes the most sense? Using nurses who will be completely unfamiliar with the transport environment initially or using paramedics who have functioned in the transport environment from day one.

Just as an example. I’ll tell you a little story about the CCT unit based in Trail which is meant to serve the south kootenay region here in BC. The Trail CCT unit is staffed by one RN and one Paramedic (with additional CCT education and endorsements). In between transports both the Paramedic and RN work in the Trail hospital. Because the RN is not qualified to work a street or house call the CCT unit in trail cannot respond to anything but an inter-facility transport. That’s right. You could have a MI in trail with a CCT unit right there and you will still be attended to by a BLS crew until you reach the hospital. Because the RN cannot drive the ambulance (or run a transport ventilator) every transport the Trail CCT unit does requires them to use the crew from whatever community they respond too as their chauffeurs.