A new BCAS?

[rock_shoes]

Hello,

What specialized paramedic positions are we talking about in BC? The only thing that I can think of is air ambulance off hand. But, I am not sure. For the BCNU that seems like a small target when compared to pushing for NP and things like that.

Air and Ground CCT, ITT primarily. Though the number of such positions is relatively small there are two very important things to remember about them. Firstly they are highly desirable positions often seen by the public as prestigious. The BCNU would use the status of these positions as a public bargaining chip (believe me after some of their recent shenanigans nothing is below the BCNU). If you want to see tears of gratitude just watch the ITT come in to transport a sick infant to BC Children’s. Secondly, and frankly more importantly to me, the demand for CCT crews is set to rise dramatically in BC. Healthcare funding cuts have resulted in service centralization the likes of which no one has ever seen before. The more services are centralized the greater the demand for specialty transport teams.

The push for Nurse Practitioners has also resulted in the squashing of Paramedic Practitioner movements by the BCNU. The two things can realistically be developed together and without one being at all detrimental to the other. NP’s working primarily in hospital and clinics. PP’s working primarily out of hospital and in public outreach. Kind of like a general surgeon vs. a cardiologist; different, but still related, specialties with similar levels of education. For whatever reason the BCNU has chosen to take paramedics on as a foes instead of as friends. It’s really quite unfortunate as the two professions could truly do wonders working together.

As for Paramedics working in different areas in the hospital. This is a good think. For example, when I work in Halifax a few years back Paramedics staffed the Triage Desk in the ED. Or, having a patient holding area staffed by Paramedics in the ED. Thereby freeing up crews waiting to transfer care of their patients.

I wholeheartedly agree Dave. In my experience Paramedics tend to triage patients more quickly than most RN’s. One of the determining factors seems to be that Paramedics are used to having to make their own decisions without direct physician orders. Also for whatever reason “drug-seeker” sensitivity tends to be a little higher with paramedics.

Being exposed to treatment and management of patients within the hospital only could improve one's clinical skills and knowledge base. IMHO.

Again, agreed. I’ve actually been very fortunate in having hospital staff accept my assistance wherever possible and they have become excellent learning opportunities. My current station is one of the few that is actually attached to the local hospital. As a result I end up spending much of my time between calls in the emergency and medical imaging departments. Being a true local who was actually born in the hospital my station is attached to, has afforded me opportunities not allotted the majority of paramedics.

There is a shortage in nursing. For the most part the shortage is in special care area (NICU,ICU,CCU,ED) due to the time required to gain the skills and knowledge necessary to be proficient in these settings.

That’s exactly it. Specialist nurses like the ones who make up these groups are the ones that would have to be used to provide CCT and ITT transports. They don’t have enough of these nurses as it is. On what planet does it make sense to stretch a resource already near the breaking point even thinner?

Edited March 17, 2010 by rock_shoes

[DartmouthDave]

Hello,

Personally, I am indifferent as to who dose intra-facility critical care transport in BC.

What I want is actual ground critical care transport resources available in a timely fashion. In reality, what happens now is the sending facility sends staff with the BLS crew. In fact, this week we have had three admission to the ICU all brought in via BCAS with accompaning hospital staff. This is wasteful. You tie up a ambulance crew AND hospital staff.

As for flight. I find the BCAS flight temas older, relaxed and expereinced. Response times tend to be slow (from my point of view) due to limited numbers of crews and planes. The same for ITT.

But, I would like to add that nurses are capable of filling this role. There are excellent systems that use nurses. But, in BC, the logical solution is to build on the system that is already functioning. Not intend for a 'flame war'. Just waving the flag that is all. =)

The NP vs Community Paramedic. There is room for both. But, I think on the Paramdic side of the house doing two jobs (EMS & Primary Health Care) wouldn't work well unless the station is very slow. The example I like to cite is Long and Brie Island in Nova Scotia. Even there, their scope is limited when compared to NP.

So, to sum up, Community Paramedics can work in a few selected areas. Also, considering the educational background for a NP is a Master Degree it would be hard to match this with suplamental training in addition to one PCP or ACP training.

As for Paramedics doing Traige. Yes. Can they do it better and faster than a nurse? I say that that is an individual issues that transcends one profession. I have done triage. Sometimes, you need to wear two hats; being the charge nurse and triage. Trying to sort out bed issues. Trying to move a patient to ICU. Dealing lots of other crap....to put it bluntly. If all I had to do was triage was I would be moving a light speed!

As for 'Dr orders'......

I think that beyond the typical standing orders (...CP, SOB, ect...) that one will find in any good ED (..that in many ways mirror EMS protocols..)

Paramedics won't find a greater degree of freedom becasue at the end of the day the DR is the 'most responsible' provider.

Cheers

[rock_shoes]

Personally, I am indifferent as to who dose intra-facility critical care transport in BC.

Fair enough. I’m not for a couple of reasons.

Firstly, such a switch is a serious blow to those of us who have worked very hard actively pursuing the career path currently necessary to obtain such a position. It’s a matter of saying “if you want this job you must do this,” then pulling the carpet out from under us as we near our goal and saying “just kidding. Now you have to do this”. It’s a cruel, unjust thing to do to dedicated hard-working people because another interest group, though potentially qualified to do the job, carries a bigger political stick. Most of the nurses I know are caring compassionate people who only want the best for patients. How the BCNU, which is currently black-balled by other Canadian unions due to recent actions, sprang forth from such an otherwise wonderful group is beyond me. I absolutely do not hate nurses. I hate the blatant attacks and take-over bids put forth by the BCNU. Being a “team player” is damn near impossible when your own team-mates are gunning for you.

Secondly, and I think most importantly, a paramedics role in BC has always been defined as the provision of care on a scene coupled with the provision of care in transport. When selecting a profession to draw on to provide specialized care in transport it only makes sense to draw on a profession whose programs have been structured around the provision of transport from day one.

What I want is actual ground critical care transport resources available in a timely fashion. In reality, what happens now is the sending facility sends staff with the BLS crew. In fact, this week we have had three admission to the ICU all brought in via BCAS with accompaning hospital staff. This is wasteful. You tie up a ambulance crew AND hospital staff.

You and me both. If BCAS deployed an appropriate number of ACPs and CCT endorsed staff many of these issues would disappear. Underfunding and poor communication between BCAS and the health authorities are the primary cause. I do have hopes that falling under the PHSA will help to knock down some of those barriers. My pessimism is a direct result of how paramedics in BC have been treated under the BC Liberal reign.

As for flight. I find the BCAS flight temas older, relaxed and expereinced. Response times tend to be slow (from my point of view) due to limited numbers of crews and planes. The same for ITT.

I’m guessing you would prefer to continue seeing those experienced, relaxed, professional crews (in a timelier manner of course). Just one of many symptoms indicating current flight crews, though effective, are not available when needed. The limitations are in staffing and resource allocation not the quality of personnel. If you have been able to produce quality personnel capable of providing the required service it makes far more sense to me to step up production over moving to an entirely different product. It actually comes down to economics when you think about it.

But, I would like to add that nurses are capable of filling this role. There are excellent systems that use nurses. But, in BC, the logical solution is to build on the system that is already functioning. Not intend for a 'flame war'. Just waving the flag that is all. =)

No worries. I’m not the type to flame someone for spurring good discussion. I know you speak with the best interests of patients at heart.

The NP vs. Community Paramedic. There is room for both. But, I think on the Paramdic side of the house doing two jobs (EMS & Primary Health Care) wouldn't work well unless the station is very slow. The example I like to cite is Long and Brie Island in Nova Scotia. Even there, their scope is limited when compared to NP.

That’s the thing. BC has a number of communities with low enough call volumes to make excellent use of Community Paramedic initiatives. I wouldn’t expect community paramedics to have a SOP rivalling that of a NP. I’m thinking more in terms of providing in home IV therapy or conducting fall hazard assessments on an elderly person’s home.

So, to sum up, Community Paramedics can work in a few selected areas. Also, considering the educational background for a NP is a Master Degree it would be hard to match this with suplamental training in addition to one PCP or ACP training.

It’s becoming less and less of a gap all the time. Most new grad ACP’s will have completed a minimum 3 years of university education. Some because of other past university programs, many because of the educational path they have chosen. I don’t think an additional 2 years of education to produce a Paramedic Practitioner is unreasonable. In fact I think it would be prudent to put paramedics with 5 or more years of education on the street serving the public.

As for Paramedics doing Traige. Yes. Can they do it better and faster than a nurse? I say that that is an individual issues that transcends one profession. I have done triage. Sometimes, you need to wear two hats; being the charge nurse and triage. Trying to sort out bed issues. Trying to move a patient to ICU. Dealing lots of other crap....to put it bluntly. If all I had to do was triage was I would be moving a light speed!

Fair enough. I’ll be the first to admit there is often more going on than meets the eye. Kind of like being told your hand-off report was painful by a triage nurse when you haven’t slept a wink in the last 30 hours and she stole your crew report leaving you nothing to reference as you muddle through. I’m sorry. I don’t necessarily get to go home after 12 hours like some people. But that’s another story .

As for 'Dr orders'......

I think that beyond the typical standing orders (...CP, SOB, ect...) that one will find in any good ED (..that in many ways mirror EMS protocols..)

Paramedics won't find a greater degree of freedom becasue at the end of the day the DR is the 'most responsible' provider.

Cheers

Dave you work in the Yukon correct? The majority of nurses working in a southern ED actually have next to nothing for standing orders. It’s bewildering actually. You have a 4 year RN with full ER certifications and she can do very little without physician’s orders. It’s not right and it’s certainly an area that needs to be addressed. Even working as a PCP I’ve stayed with an admitted patient on multiple occasions because by license I’m able to give another dose of nebulized ventolin etc. and the RN has to wait for orders (frequently there is no onsite physician). It’s absurd. A BSN RN is more than capable of making those type of decisions.

Regards

[DartmouthDave]

Hello,

I should change my profile. I worked in the Yukon up until the summer of 2008. Right now, I live in Northern BC. Just haven't got around to it.

Fair enough. I’m not for a couple of reasons.

Firstly, such a switch is a serious blow to those of us who have worked very hard actively pursuing the career path currently necessary to obtain such a position. It’s a matter of saying “if you want this job you must do this,” then pulling the carpet out from under us as we near our goal and saying

Regards

I think it is reasonable for an ED have SOP to keep things moving. Without waiting for the EP. It is simple supply and demand. The EP can only be in one place at one time. IMHO.

Cheers

[tniuqs]

I am very much enjoying the exchange of ideas on this topic still laughing about Happi's new moniker for CUPE in BC.

<insert knee slapping noises>

This whole "practice under DR. Standing Order's or Protocol the current Medical Tradition" so why do we need that autograph ? Does it really make a tangible difference in a court room ... like really ?

Knowing that the world revolves around MDs it may be very difficult to ever change the dominance of this group. That said in todays day and age, quite realistically just WHY do we NEED to have signed orders and approved local protocols in the first place ? A conversation I had the other day with a very knowledgeable individual (ps a AB CUPE guy) his point was this:

Why does a regulated Health Care Professional require confirmation from an entity (MD) that highly likely have never stepped on foot in an ambulance. To practice in most jurisdictions as a Paramedic/RN/RRT ++ do have a very clearly defined scope of practice. If a Paramedic or RN makes an error in medical judgement providing care and just to qualify "NOT practicing beyond legislated scope". Does the MD stand up to support us, and putting his licence on the line ? In most courts we are judged by a group of peer's not MD's if a legal case ensues from a result of action or inaction.

* WE are held directly responsible.

* We are held directly accountable.

* Its OUR licensure, livelihood on the line.

Perhaps WE as regulated health care professionals do not legally require the MD sanctioned signed orders in the first place are we being duped ? After all we are issued a "practice permit" by the applicable governing body's and government. In fact the present advice of the regulating body's is to carry our own malpractice insurance, so compare a Paramedic/RN/RRT "oops rates" to the medical profession, divesting from MDs could just result in way lower insurance rates ? just throwing that out there.

I know this is a diametrically opposed position to present medical tradition, and a touch radical but most likely the MDs (those receiving that phat paycheque to sign off) would come out of their skins if they ever heard drift of this challenge. Yet once again I will be placed on ANOTHER "government to watch list" but it does make some sense to move forward into a new future of Health Care Delivery to my way of thinking and the Health Care Professionals would stop following the "cook book"

Soo .... any spare room in that Northern BC bunker guys ?

cheers

Yup: I know completely off topic, perhaps I need to start a different thread when my symptom's of a serious hangover subside but I got on a roll.

[Happiness]

I’m guessing you would prefer to continue seeing those experienced, relaxed, professional crews (in a timelier manner of course). Just one of many symptoms indicating current flight crews, though effective, are not available when needed. The limitations are in staffing and resource allocation not the quality of personnel. If you have been able to produce quality personnel capable of providing the required service it makes far more sense to me to step up production over moving to an entirely different product. It actually comes down to economics when you think about it.

So I live on Haida Gwaii as most here know, and I to say these guys who do the plane thing are the best. Maybe because I live so remotely we are on the top of the list but in 14 years I have seen on one instance of a pt waiting for days for a plane and it was weather related. Last weekend I had a crew come in on 70-80k wind gusts to see a lady that phumo. They ended up staying the night as the pt went from a priority 1 to stable (thanks timmy and little guy lol).

Now with that being said the problem is not the fact of our training (and yes squint I know you think I'm undertrained)it is the fact that our islands do not have a hospital that has any surgery capabilities. In most cases our level of training is good but the fact that the pt is so far from surgery that maybe the reason that they die.

Now I do have issues with the EMR training and the length of time that BCAS lets a person train with the experienced. 10 calls riding 3rd is not enough. When I did the PCP training I already had many years experience but I got training in a bigger centre and in the hospital and it was the best. It is to bad that they do not require this with EMR as you learn so much in those situations and to learn on the job is the best.

cheery ohhhhhhhhhhhhhh to you all

happiness

[tniuqs]

and yes squint I know you think I'm undertrained

I have never said that period.

Under the remote situation you operate in it is a big fat fail of BCAS not to have at least a full time ACP, minimum and not to forget a possibility of a CCP rotating into the Health Care center too, so have Comrade Campbell put his money where his yap is and try something new.

Happi you said it yourself about those guys you love (as in your story) why should the good people of Haida Gwaii NOT have that level of care as the other communities in BC... hey don't you pay PST like the rest of the province ? I bet those guys would be happy to do teaching when they are on island.

They ended up staying the night as the pt went from a priority 1 to stable (thanks timmy and little guy lol).

Other places base flight services in the outlying areas THEN bring patients into major centers, BCAS Air Ambulance system the opposite way, trying to get into a tight spot in a bad weather situation.

Lots of ways to skin a cat.

[tniuqs]

Columnist's attacks on paramedics irksome

Editor: Re: It’s the Falconization of healthcare in B.C. (The Times, March 17). Why does Tom Fletcher have such a passion to belittle paramedics and give out misinformation?

This is at least the third time in the past few months or so that he has specifically targeted paramedics in B.C.

What illegal strike action did paramedics pull?

Is Tom still going on about the “sick-off” that he assumes was an intentional act, or does he actually have something substantial to show his thoughts are more then mere accusation?

Also, I’d dearly like to know how paramedics attempted to disrupt the Olympics. Was it the info line paramedics did at the Whistler test events (where people were just handed information, nothing more)? Or was it the fact paramedics showed the public the mixed up priorities that the test event was given full-time coverage (for a handful of people) whereas the city the event took place in, received less coverage itself?

Paramedics provided all requested coverage during the Olympics, and we even have a nice memo from our COO thanking us for stepping up and ensuring peak service levels, both at the Olympics and in the communities that suffered coverage because of it. So what disruption are you talking about, Tom?

Tom has written numerous times about the inflation of paramedic overtime. He’s right; a lot of money is spent on it. What he doesn’t tell is that it is BCAS who prefers to do it this way, because paying overtime is still cheaper than hiring enough full-time paramedics to ensure proper staffing levels.

Funny how Tom believes every single problem is the union’s fault.

Lastly, a perfect example of Tom not knowing what he’s talking about is the union’s offer to extend the current contract for another two years. Get your facts straight, Tom, it was one year — not two. And your comment about “senseless fighting” is misleading.

Only weeks ago the union and BCAS were so close to actually working out a mutually beneficial contract. It was the best progress both sides have made with each other in a long time. It was the government that stepped in and ripped it all up, then froze negotiations.

Why don’t you explain why they did that?

Here, I’ll help — because any contract, even one that aims at improving the service, interferes with the government’s plans of getting rid of BCAS as a direct government service, and Mr. Falcon can’t have that.

Jason Angulo

Coldstream

[DartmouthDave]

Hello,

Tniups, I agree in principal with your desire for community based paramedics programs within some of BC smaller communities. However, the model that you propose (CCP/ACP in Community Health Stations) isn't pratical for two reasons.

First, the focus of training is the provision of emeregncy care not community health and primary health care. When I was in the Yukon most communities have health centers that were staffed by RN and NP with a focus on community health. They knew the primary health care side of the house very well. They basic emergency care as well. Enough to manage until a transfer was arranged. Enough that they could maintain their skills within a small quite community.

So, in turn, it would be unrealistic to expect an ACP or a CCP to be at the top of their games with emergency care while simultaneously being at the top of their game with primary care. The provision of health care has specialist for a proven and valid reason.

If specialization wasn't needed...well then...lets disband the ITT. Heck, we will just 'show' the ACP and CCP from the adult side of the house how to do it. Or, as a matter of fact, why train CCP. After all, they ground ACPs can just do it all, now. This point may be over the top. However, what I want to say is 'Primary Health Care' is complex to master and isn't something that can be a side project any more than being ACP(f) or CCP or in the ITT can be.

Second, suppy and demand. BC has many problems with EMS. One thing that is good is sending ALS to ALS calls. This keeps a small cadre of well trained staff (..could be a little bigger...an other issue...). This keeps the provides well tuned. As opposed to an ACP that may tube 3-4 times a year, for example. To have an ACP or CCP sitting in a small town waiting for something to happen or muddle throught primary health care is a misallocation of resources.

Now, at the PCP level there are numerous community paramedic programs that work well (Long Island, NS...for one). Yes, this is a good idea.

IMHO...

Cheers

[tniuqs]

Hello,

Tniups, I agree in principal with your desire for community based paramedics programs within some of BC smaller communities. However, the model that you propose (CCP/ACP in Community Health Stations) isn't pratical for two reasons.

First, the focus of training is the provision of emeregncy care not community health and primary health care. When I was in the Yukon most communities have health centers that were staffed by RN and NP with a focus on community health. They knew the primary health care side of the house very well. They basic emergency care as well. Enough to manage until a transfer was arranged. Enough that they could maintain their skills within a small quite community.

So, in turn, it would be unrealistic to expect an ACP or a CCP to be at the top of their games with emergency care while simultaneously being at the top of their game with primary care. The provision of health care has specialist for a proven and valid reason.

If specialization wasn't needed...well then...lets disband the ITT. Heck, we will just 'show' the ACP and CCP from the adult side of the house how to do it. Or, as a matter of fact, why train CCP. After all, they ground ACPs can just do it all, now. This point may be over the top. However, what I want to say is 'Primary Health Care' is complex to master and isn't something that can be a side project any more than being ACP(f) or CCP or in the ITT can be.

Second, suppy and demand. BC has many problems with EMS. One thing that is good is sending ALS to ALS calls. This keeps a small cadre of well trained staff (..could be a little bigger...an other issue...). This keeps the provides well tuned. As opposed to an ACP that may tube 3-4 times a year, for example. To have an ACP or CCP sitting in a small town waiting for something to happen or muddle throught primary health care is a misallocation of resources.

Now, at the PCP level there are numerous community paramedic programs that work well (Long Island, NS...for one). Yes, this is a good idea.