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Jennifer Goyer
New member
Username: Army

Post Number: 1
Registered: 01-2003
Posted on Saturday, February 01, 2003 - 11:42 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I FEEL THAT WE ARE TURNING INTO WHAT THE ORGANIZATION WAS NOT ALL ABOUT. AFA IS GREAT BUT AEDS IS GOING TO FAR UNLESS IN METROPOLITAN AREAS. WE WILL FORGET HOW TO DO BASIC FISRT AID BECAUSE WE EXPECT THE FANCY EQUIPOMENT TO BE THERE WHEN WE NEED IT. wE SPEND ALL THIS MONEY ON THE EQUIPMENT AND MOST OF THE TIME IT SITS IN THE TRUCKS COLLECTING DUST AND WHEN WE REALLY NEEDED THE MONEY FOR SOMETHING ELSE WE DON'T HAVE IT.
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Melissa Ying
Intermediate Member
Username: Mying

Post Number: 18
Registered: 11-2002
Posted on Saturday, February 01, 2003 - 01:01 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I'm sorry, but no.

The organization is about improving the health, safety, and quality of life for canadians by providing training and community service. It doesn't say anywhere in there that it's only about standard first aid or being stuck in an old definition of what first aid is.

AED is a very simple piece of equipment to use. And it saves lives. You know, once upon a time CPR was only to be used in hospitals and never for first aid, too.

You will be seeing AEDs in more and more places. They're already in a lot of pools and airports. They are a first aid measure. It won't be that long before we are teaching them as a part of Standard First Aid for the public.

AEDs are, if anything, even more important the farther out of the cities you go where your response time from fire and ambulance is longer -- or your fire service doesn't have defibrillation. I am not from a metropolitan area... I know what I'm talking about. My division then was kicked into high gear to get our first AED after waiting 45 minutes for an ambulance for someone having a heart attack. We had our AED before 12 months after that event had passed. And we were not a wealthy division, and our branch even less so.

Sure when you look at how much you actually use it, it's not much. But when you need it, you're going to be awfully glad you've got it, and so is the person you may save using it. I've seen people saved with AEDs. They are so relieved to have had suffered cardiac arrest somewhere where someone was there, with an AED, fast enough to make the difference. The sooner the AED is applied, the better the chance that it will work.

Absolutely do not get caught up in the new equipment and forget your basics. The basics are the foundation of any new skill, and obviously every time you practise those new skills you should be practising and reinforcing the basics upon which you are building.

The reality is, we are not the only event first aid providers out there. As event first aid providers, we serve three major purposes... we are bringing in the money that keeps community services alive, provides our own uniforms and training and meeting halls; we keep ourselves busy and give ourselves a reason for existing; and we are important ambassadors for the public first aid training courses. We are St. John. We should always be the best we can possibly be and do the best we can possibly do. We should strive to provide the best possible first aid care we can... not only because if we don't, we'll lose business, but because if we don't, we'll lose patients we could have saved.

From a financial standpoint, sure, prioritizing is important. And sometimes a division has other things they need to attend to before AED is viable. Sometimes, though, people need help from others in determining what the priorities are, and not everyone will agree. And sometimes, what people really need is to be working harder to find more money. It's out there, and there are people in SJA who know how to find it.

What do you really need the money for that you aren't getting? Let's address that.
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Jennifer Goyer
New member
Username: Army

Post Number: 2
Registered: 01-2003
Posted on Saturday, February 01, 2003 - 03:58 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Sorry i was on a thought that was on my mind for awhile. No offenses taken hopefully just spitting out words
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Don Tai
Member
Username: Dontai

Post Number: 13
Registered: 12-2002
Posted on Saturday, February 01, 2003 - 04:06 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

It's pretty clear to me that AEDs do save lives. If you're in doubt, search Google for "AED Save Life Canada" or see below.

What's not clear is widespread AED use in SJAB. Here in Toronto we can usually have EMS on site within 10 minutes, and Toronto Fire within 4-6 minutes. Toronto Fire always have AEDs on hand. I think only ALS ambulances in Toronto have AED units, but I might be wrong. Is this the reason Toronto SJAB have no AEDs?

For a heart attack, every minute without an AED reduces the survival rate by 10%. If the EMS response time in your area exceeds 10 minutes, an SJAB AED might save someone's life. Your hard earned CPR skills may be of little use in resetting the person's heart rate, but at least blood will flow to the brain, prolonging life.

Financially, an AED program is expensive. First there's the machine, at $1,500 (I think). Then there's training courses for the instructor, who can then teach everyone else. Then there's recertification every 3 months for everyone. That's a recert 4 times a year for everyone, and it all adds up.

The Heart and Stroke Foundation (HSF) says that 6,500 people in Ontario have a heart attack yearly with a survival rate of 5%, which sucks. That's 18 people per day, 0.74 people per hour, 5.9 people for an 8 hour SJAB shift, for the whole of the province of Ontario. It's not likely to see a heart attack on your duty, but you might be standing beside someone who does. Does your group have the financial means to prepare for this scenario?

With unlimited time and money anything and everything is possible. For the rest of us we need to spend our scarce resources for the maximum benefit. Only you can decide how to spend your money best.

If you've taken care of your uniforms, your basic/advanced training is done, you all have stethoscopes, BP cuffs, flashlights, jump kits, O2 kits, radios, bikes, and an ambulance or 2, then go for the AED.

Don

Reference: Do AEDs save Lives?

Without a doubt AED use have saved lives.

Here's what the Heart and Stroke Foundation of Ontario says about AEDs.
Mike Colle, a MPP in Toronto has introduced Bill 51, the Portable Heart Defibrillator Act in Ontario. The bill, introduced Dec 2000, still requires more legislative readings and has yet to pass into Ontario law. Here's the summary:

Summary: Requires that portable heart defibrillators be made available and installed in significant public buildings, including privately owned buildingssuch as shopping centres, arenas and stadiums that have significant public access.

There are some liability issues not yet sorted out with AED use (see HSF report). While these issues are addressed in the bill, until this bill is passed AED use may be in a legal grey area.
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Melissa Ying
Intermediate Member
Username: Mying

Post Number: 19
Registered: 11-2002
Posted on Saturday, February 01, 2003 - 04:21 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The issue of AED training was already covered in another thread on this board... Don (Tai) you may want to check that out for clarification of the current certificate maintenance and recertification requirements, hopefully it will clear some things up for you. :-)

In addition, each district now has at least two people available to instruct patient care providers in AED, so hopefully nobody is going to have trouble getting training.

I for one would move AED far above bikes or a second vehicle in my list of priorities. Each division is going to have different needs though.

A common misconception is that if EMS is only 10 minutes away, then no AED is needed. This is not true. Think of it this way. Imagine there are one hundred people who go into cardiac arrest amenable to rescue by defibrillation all at the same time. After one minute has passed, ten of those people are not coming back. After two minutes, a further ten. And so on. Wouldn't it really suck to be one of those first forty people in a place where EMS is "only" four minutes away?

There is room for some variation between municipalities, but safe to say, all BLS ambulances in Ontario have defibrillation on board, usually semi-automatic or manual with cardiac monitors. ALS ambulances have manual defibrillation with cardiac monitors, allowing them to better time the administration of shocks, and change the voltage.

Unfortunately, the cost of an AED still runs closer to $5000.

To Jennifer: it's okay to vent. :-) And in a public forum you're going to get responses to your ventings. Obviously something's bothering you: I for one am interested in helping you with whatever that is, if I can.
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Rick Patterson
Senior Member
Username: Rick_patterson

Post Number: 77
Registered: 10-2002
Posted on Saturday, February 01, 2003 - 10:47 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The basics are always good to have right down to the lowly triangular bandage. I have seen Divivisions that frown at that insignificant little piece of first aid equipment but it is so handy. At the youth level we need to set those foundations of knowing the basics and knowing it well so that when they become adult members they will be able to use the toys as well as the staples of first aid.
I apologize again if I sound like I'm soap boxing it but I really believe in this organization ( and yes I do have my down moments with it to)
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Paul W. J. Irwin
New member
Username: Pirwin

Post Number: 1
Registered: 02-2003
Posted on Wednesday, February 05, 2003 - 10:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

SJA has a very capable group of people. We have those with qualifications in First Aid, and those in Para Medicine. Those who wish to attain certification at any of these levels can do so with SJA in Canada. We have hundreds of First Aid Instructors across the country, and operate a school that is soon to announce an Advanced Para Medicine program, in addition to its Primary Care program. I am proud of that. We have so many qualified people who work towards the mission of SJA.

Having the basic knowledge is a must. Having the courage to use it also helps.
I would encourage any member who wishes to attain a level of certification that they feel comfortable attaining, to do so.

I know there are even members of our SJA Family who do not have Emergency First Aid certification. I would encourage all those who are part of the SJA family to try to have at least a basic knowledge of First Aid. It is part of who we are, and what we do. On top of that, you get liability coverage! Not a bad deal. Well, I don�t have to sell you the idea.
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Tyler Mancuso
Intermediate Member
Username: Tmancuso

Post Number: 28
Registered: 10-2002
Posted on Wednesday, February 05, 2003 - 10:33 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

As far as I am concerned whatever better cares for the patient, the better.

AED's are great devices, saves lives, minimal training. What about carrying epinepharine... we don't yet but i see it coming, should we??? YES.. up here we wait 45 minutes for an ambulance, what happens if a patient has an allergic reaction... EPI PEN :-) the US has de regulated them an you no longer need an Rx for one, why don't we

What about nitro and ASA? and maybe ventolin? Again, very simple drugs, we can help administer if the patient has their own, so we have to know the protocols, why not provide proper training, and carry them...

If it is going to better the care of the patient, and with the appropriate training, why not. Yes were not paramedics, but this is something that may save a life with very little adverse side effects.

At one time Oxygen had to be licenced, I remember the exam we had to do and it was not easy, now its de regulated, and theoretically anyone can use it without direction. AEDS are headed in that direction.

Collecting Dust, if it saves one life, its worth it!

Thats just my opinions....
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Mike Rumble, RPN
Senior Member
Username: Mrumble

Post Number: 50
Registered: 11-2002
Posted on Thursday, February 06, 2003 - 12:11 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Actually, in St. Marys, we carry an Epinephrine by way of EpiPen in our mobile first aid post. Provincial Commissioner's Directive 9/98 states Epinephrine (Ana-Kit/EpiPen) may be included in Mobile First Aid Units labelled "for administration by a physician or his/her delegate". You may wish to look into this option if you're concerned about a slow Paramedic vehicle response. I will point out, however, that EpiPens don't have a long shelf life and it can get costly to replace them (the counter-argument being, of course, it's worth the cost when you need the drug).
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Tyler Mancuso
Intermediate Member
Username: Tmancuso

Post Number: 29
Registered: 10-2002
Posted on Thursday, February 06, 2003 - 08:38 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The only problem is, it is highly unlikely to have a physician on scene, we discussed carrying it as per that directive, however we looked at the fact that the cost vs. likelyhood that a physician is on scene is unlikely.

It is too bad, we could not get a standing order for epi. When it boils down to it, contraindications to administering it is nil
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Paul W. J. Irwin
New member
Username: Pirwin

Post Number: 3
Registered: 02-2003
Posted on Thursday, February 06, 2003 - 08:59 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

An order from an M.D. is a call away by phone or radio to the local Emergency Department of a hospital, if you have that equipment available to you. You can make the arrangements in advance with a simple Base Hospital program. You can also call an SJA physician. We do have them on call, as far as I am aware. Ask the powers that be for that information.
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Paul W. J. Irwin
New member
Username: Pirwin

Post Number: 4
Registered: 02-2003
Posted on Thursday, February 06, 2003 - 09:06 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Also... I have recently been made aware of a pilot BLS program that sees the first five front line drugs in a kit with a Physicians standing order for trained members. I understand that it was not signed off by an SJA Physiscian, but one outside of SJA, as a base hospital program. Inquiries would need to be made to confirm this information.
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Tyler Mancuso
Intermediate Member
Username: Tmancuso

Post Number: 30
Registered: 10-2002
Posted on Thursday, February 06, 2003 - 10:24 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Paul,

would you by chance have any contact information on this.... Up in the north here, this would be a good program due to the delay in ambulance response times...
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Paul W. J. Irwin
New member
Username: Pirwin

Post Number: 5
Registered: 02-2003
Posted on Thursday, February 06, 2003 - 10:28 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Get in touch with the local Base Hospital Physician program. If you have connections from within the SJA Family to them, use these contacts. If you have a good relationship, your relationship with local EMS may also be an advantage to you.
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Chris Thomas
Intermediate Member
Username: Cthomas

Post Number: 17
Registered: 12-2002
Posted on Wednesday, February 12, 2003 - 11:43 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The more skills that we have and are authorized to use the better. The term First Aider in the dictionary refers to: One who gives emergency medical treatment administered to an injured or ill person before professional medical care is available.

The term Paramedic in the dictionary is this: A person who is trained to give emergency medical treatment or assist medical professionals such as doctors. The term Paramedic is widely recognized in many countries other than North America for any person properly trained person to give any form of immediate emergency medical care at any level. In cetain countries a person with no more than first aid and C.P.R. may be known as a Paramedic. Now, the Ontario Ambulance Act refers to a paramedic as. "paramedic" means a person employed or a volunteer in an ambulance service who meets the qualifications for an emergency medical attendant as set out in the regulations, and who is authorized to perform ONE or MORE controlled medical acts under the authority of a base hospital medical director, but does NOT include a physician, nurse or other health care provider who attends on a call for an ambulance; ("auxiliaire medical")At the current moment St. John generally goes by no more than Standard or Advanced first aid but we are slowly climbing towards the minimum requirements for Pre-Hospital Emergency Care and are advancing into the controlled medical acts and base hospital programs therefore before long SOME of us will basically be Paramedics as defined above. Therefore it depends on how far your training goes and whether or not you are licenced to carry out controlled medical acts to be considered a Para - Medic. The definition may change but this is currently what the term means. Also generally Paramedic are graduates of an AEC or A-EMCA program but not nessicarly.
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Justin Mausz
New member
Username: Coop

Post Number: 2
Registered: 11-2002
Posted on Sunday, March 09, 2003 - 12:42 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

My name is Justin, in addition to volunteering for SJA, I also work part-time for a Event Medical Response company whose standard of care is Symptom Relief. I have also just completed a 5 month stint as a student with Toronto EMS through a co-operative education program.

I wish to clear up some of the misconseptions surrounding Symptom Relief and Paramedics. I'll start with Paramedics.

For the majority of Southern Ontario, Paramedics are graduates of an approved two-year college program and are divied into three categories: Primary Care Paramedic, Advanced Care Paramedic, and Critical Care Paramedic. Upon completion of the A.E.M.C.A Program, graduates apply to an EMS system (i.e. Toronto EMS) and once accepted, gain standing as a Primary Care Paramedic (PCP). The skills of the PCP include Symptom Relief, IV access, Semi-AED, Mannual defibrillation, 3 and 12 Lead ECG interpretation as well as all of your regular skills like oxygen administration, spinal immobilization, basic airway management, etc.

The program itself is very difficult to get into and also very difficult to pass. The program is heavy into the study of physiology, biology, pharmacology and anatomy. The actual classes for skills development take up only a small portion of the course, the rest is about learning the human body inside and out. This program will soon (within one or two years) be moved to a 4 year university degree program to come out as a PCP. You're still looking at an additional year to 2 years of college training to up-grade to ACP or CCP. Critical Care Paramedics currently work on the Air Ambulances or on ambulances that conduct transfers between hospital Intensive Care Units.

Now for Symptom Relief...
Symptom Relief is the administration of 5 or 6 (depending on the services) front line drugs to counteract life-threatening conditions. These include the following medications and conditions:

-Epinephrine: for anaphylaxis and severe asthma (injected) and for severe croup in children (administered via a special oxygen mask called a nebulizer)
-Ventolin (salbutamol): for minor-to-moderate respiratory distress associated with Asthma and allergic reactions. Nebulizer form.
-Asprin (ASA) 160mg: for suspected heart attack (Myocardial Infarction - MI).
-Nitroglycerin: for treatment of stable and unstable angina as well as treatment for Congestive Heart Failure (CHF).
-Glucagon: treatment for symptomatic hypoglycemia (low blood sugar).

The dosages for these medications are determined by the patient's weight and/or age. Epi-pens are, for the most part, not used and the medication must be drawn up out of the vial and injected. In some cases, dilution is necessary before it is administered to the patient.

Something else to understand is that it is not simply a matter of following a series of protocolls. The best advise I've heard has been "Just because someone meets your protocoll doesn't mean they should get the medication". There is a huge need for appropriate judgement.

With medications, of any kind, we are balancing that medication's medicinal value with its toxilogical effects and with that in mind, extensive training must first be obtained in their proper use - training that SJA does not currently provide. In order to fully understand these medications and the conditions they're used to treat, you must first understand the human body from the cell up. Training begins with cellular biology and eventually progresses to understanding how these medications affect: the heart, the central nervous system, the pancreas and endocrine system. You would also need to learn the pathophysiology of the conditions themselves, again something that is not currently taught by SJA in Ontario. SJA training includes an appropriate level of anatomy and a very basic overview of physiology (usually how the heart and lungs work), however if SJA wants to expand their current level of care to anything beyond AFA, they will need to seriously re-evaluate the training process.

Symptom Relief medications, as with any medication, not to be taken lightly. It is important to have a solid understanding of the human body and a very thorough patient assessment process. SJA's current 'chest pain' protocol, in my opinion at least, is still insuffecient. The contraindications to administering nitroglycerin are still seldom discussed. Things like checking a blood pressure and a pulse before hand to make sure that the BP is above 100mmhg systolic and the pulse is between 60 and 160 are not taught and these things are critical. Members are not taught to ask the patient (regardless of gender) if they are currently taking viagra or have any current bleeding disorders before they advise them to take their medication.

Something else that SJA does not have is cardiac monitoring (ECG) capabilities. This includes having a defibrillator that has the capabilities to monitor ECGs as well as pulse oximetry. Some of the medications I mentioned above can be harmful if the patient has certain changes in their ECG. Training to interpret ECGs is even more extensive than the training that would be needed to perform Symptom Relief.

The defibrillators themselves are also different. The defibrillators/monitors we use at my work are the same machines used by Paramedics on the road. They are different from AEDs in a few ways. The voice prompts (at least on the machines at my work) do not exist. You have to be fully trained on the cardiac arrest procedures before you have to use the machine. There is an extra button, the "Analyze" button that must be pushed for the machine to begin analysis of the ECG to determine whether or not it can be safely shocked. We are also able to select the joule settings for defibrillation. If a PCP is taking over care of a VSA patient from a Firefighter, that Paramedic should obtain the last time the patient was shocked and at what joule setting the patient was last shocked. The Paramedic then attaches his/her machine and manually selects a higher joule setting. (ie. if the Firefighter shocked at 200j, the Paramedic will select either 300 or 360j depending on what type of machine it is).

In summary, I am not opposed to SJA having symptom relief in the future, however, I do feel strongly that the current training is largely insuffecient for the addition of these skills. This makes me kind of a 'bad guy' within the organization, but I stick to my beliefs. There is still a lot of confusion surrounding exactly what symptom relief is and what needs to be learned in order for it to be used safely. As far as SJA personnell squeezing themselves into the definition of what a "Paramedic" is, I'd ask you to look at it from the Paramedic's perspective. The Paramedic has put through literally years (at least 2, usually 4 to 6) of work to be called a Paramedic and SJA wants to call someone who has taken an assembage of First Aid courses the same thing. All I ask is that you look at it from their perspective. I am not a Paramedic...I'm in fact an EMR. At organizations like the one I work for, the term EMR has a different meaning than it does in SJA.

This post is not intended to offend anyone, only to educate.

Respectfully,

Justin Mausz
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Tyler Mancuso
Senior Member
Username: Tmancuso

Post Number: 47
Registered: 10-2002
Posted on Sunday, March 09, 2003 - 03:17 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Justin, I agree with some of your post, including the aspect that the training is insufficient, as it totally is. For example you were mentioning the "chest pain" protocol. It is in my opinion totally insufficient. We have adopted additions to the protocol, including the assessment of pulse and B/P prior to administering (oops I mean "assiting") nitro. A good history goes a long way.

This is what needs to be changed, and a symptom relief program introduced, meeting the required training level for use. Do we really need to know the cellular function of the drug, likely not, however do we need to know the pathophysiology of the conditions, the drug affects, contraindications, dosages, methods, etc. certainly...

Just wondering, do you have to be a paramedic to work for the Event Medical Response Company your are employed with? or what type of training are you required to have to be employed? (i.e. sx relief training?)
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Justin Mausz
New member
Username: Coop

Post Number: 3
Registered: 11-2002
Posted on Sunday, March 09, 2003 - 05:37 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Well, Tyler, you bring up an interesting point - is it really important that we understand how the medications function on a cellular level? Yes and no.

To quote many a biology or physiology teacher that I've had "everything comes back to the cell." And it's quite true: the cell is the basic unit of life. Cells make up tissues, tissues make up organs and organs make up us.

A couple of examples:

In order to understand the effects of Asprin in preventing further damage during an MI, we must understand it on a smaller scale.
Asprin is a platlet aggrigation inhibitor, which essentially means it's a blood thinner. Platlets are those tiny structures found in the solid componants of the blood that aid in clotting. They band together (via 'stickiness') and cause the blood to essentially become more viscous (thick). A heart attack results from a blood clot in a coronary artery, therefore, the logical step is to reduce the clotting of blood...or to inhibit the 'stickiness' of the platlets.

Epinephrine is another matter entirely - and a bit more complex. It's actual classification is: A natral catecholmine with alpha and beta effects, also called a sympathomimetic. Now essentially what that means is that epinephrine works to mimic the functions of the sympathetic nervous system. But to truely understand the medication and understand why it's effective, we need to go into a little more detail (only a little).
Epi is a hormone, in fact it's a hormone found in our bodies in the form of adrenalin. It is produced in the adrenal gland and part of the "Fight or Flight" response to stress. There's a little problem though that threatens to make this hormone (and medication) completely ineffective - it can't penetrate the membranes of our cells. But, nature created a by-pass system. When Epi is introduced into the circulatory system, it exerts its effects on what are called "Target Cells". These cells are specially outfitted with structures called receptors on their cell membranes. These receptor sites take the Epi molecule into the cell where it can work effectively. These are called Adrenergic Receptors.

Now, do you need to be thinking about what's happening with your patient's cells every time you give a medication? ...probably not. But, you do have to learn the material. This is material that is taught in college to Paramedic students and its material that I had to learn for work, and there's a very good reason for that. They don't want to set people loose with all these medications if they're not willing to sit down and get trained properly on their use. It communicates to students that there are no short-cuts when it comes to effective patient care.

The other reason all this physiology is taught is because the protocolls for administering symptom relief medications allow for certain levels of judgement. As I mentioned earlier, not everyone who meets your protocolls should get the medication and understanding how these meds work will aid you in making appropriate decisions.

As for the Event Medical Response companies, most of them do require current A.E.M.C.A certification before they'll hire employees. Parkview EMS for example only hires Paramedic Students, Paramedics or higher qualified individuals. There are a couple other companies out there that do transfers as well as event coverage, I'm not sure what their hiring policies are. From what I've heard, my company will only hire Paramedic students or Paramedics now. (I was hired on before that policy came into effect).

Take care

Justin

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Tyler Mancuso
Senior Member
Username: Tmancuso

Post Number: 48
Registered: 10-2002
Posted on Sunday, March 09, 2003 - 09:27 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

You forgot to mention:

The Actions of Epi:

results in the accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors

affects both beta(1) and beta (2) adrenergic receptor sites.

Just thought that would be important information when using it to save a persons life

:-)
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Dave Wakely
New member
Username: Harrypotter

Post Number: 1
Registered: 03-2003
Posted on Tuesday, March 11, 2003 - 05:20 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Tyler,
I'm not sure if you are being sarcastic but as long as it sounds that way here we go. beta 1 and 2 effects are VERY important they give you a hint as to the protocol in case you forget ie a HR over 200 is a contraindication to nebulized epi(Since beta 1 tends to do what???)

I have to suggest several several things:
-If you don't understand the drugs you shouldn't give them (if a asthmatic has midsternal chest pain and SOB what do you treat? should you give ASA? Ventolin? Nitro?)
-SJA is not renound for stressing the essentials, if you've taken an O2 course you've been beeten over the head with hypoxic drive, something like 1% of COPD patients develope this(i spoke to one RT who had never seen it in his 10 + years)
-SJAB does not have the current factilities for sharps disposal; lets face it most of the time SJAb can't even keep our trucks washed would you feel comfortable giving sharps to every one?
-SJA people will forget the protocols; it is not a job thus people have other things to do, people will forget the protocols.
-To increase the duty of care you would need to pay; in addition to the cost of the drugs, drug kits, sharps, sharps containers and neb masks a MD would need to authorize the use and that would increase his malpractice primiums.
-SJA members as a whole tend to panic. I've attended as second in and as a responding ambulance to SJA first response calls and in genral they are a mess(not speaking down to SJA they do thier best to control situations which they are not accustomed to)

Just for the record a Paramedic as defined by the ambulance act in a EMCA who is employeed by a service and is capible of performing the acts listed in schedule 1.(not an exact quote but close). Chris you may want to look into riding out for a couple shifts on an ambulance before you dismiss paramedics as first aiders with a couple of drugs.

I am niether in favour of or against SJA getting SR but if we get it, checks need to be in place; I can't count the number of times members have told me they weren't comfortable with the Defib. Some people are not ready and some never will be for SR. I would love to develop a program that would see our members become skilled and ready for performing controled medical acts that require more brains then your average game boy to do.

Be careful what you wish for

Dave Wakely

First do no harm
Second Make sure you get lunch
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Tyler Mancuso
Senior Member
Username: Tmancuso

Post Number: 49
Registered: 10-2002
Posted on Tuesday, March 11, 2003 - 09:12 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Dave,

I don't know how your division is, but ours for instance is highly trained (probably over and above the requirements) each level two member completes 80 hours of anatomy and physiology (just under the time and content of my degree nursing course), cover one hundred and sixty hours of practial and theory based training in emergency care (bypassing MOH first response by a long shot), then they do their level 2 testing.

Speaking for the Sault division, they are ready for Sx Relief tomorrow. EMS that responds to our scenes has no problems with scenes being a mess, as they are usually the most orderly scenes the would see, 90% of the time the patient is packaged and ready to go before they get there (i.e. boarded, extricated, etc.).

Our vehicle is highly maintained (to MOH policy) contains sharps containers (and we have proper disposal routes - directly across from our office is a hazardous waste depot) So thats not a problem, and with respect to protocols, i don't know how ems works up there but ours have pocket guides when in doubt of the protocol and must be carried by every paramedic. We have something similar i designed, that has all the bts protocols pertaining to assessment, PCR, Abd Pain, Allergic reaction, AMS, Amputations, burns, chest pain protocol, diabetic emergencies, seizures, hypoperfusion, spine/head inj, and MCI. It also includes our AED algorythms. So in other words a SJA version of the EMS Field Guide. All wrapped up into a little laminated and bound pocket guide (even has tabs organizing the guide and everything (yes i had too much time on my hands)

What SJA needs to do is expand their training, prepare members for duty better so EMS does not see our scenes as a "mess". This is easily done, we do mock car crashes, etc where it is as real to life as it gets, and this certainly prepares them for the unexpected

I will admit, it takes a lot of time and deication from the instructors and officers, as well as the members to get to this level, however it provides a higher level of care prior to EMS arrival.

I agree that SJA needs to 'get with the times' our oxygen course totally needs work (which they are doing) and needs to put more focus on things that might actually happen, but with time it will happen. Just think a few years ago only Paramedics had Defibrillators, and now everyone has them, so in time this will happen with other things such as sx relief... hey i can go across the bridge tonight and buy an epi pen for my first aid kit, as its de regulated in the states... Eventually that will be the same here too.

Maybe this type of program should be district or even division specific, based on the training levels, competency, etc???

Just a thought.
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Dave Wakely
New member
Username: Harrypotter

Post Number: 2
Registered: 03-2003
Posted on Tuesday, March 11, 2003 - 09:35 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Congrats to everyone in your division for meeting those standards.

In Mississauga we have ten new members a meeting and multilevel training programs in the past have failed to identify and correct weaknesses. Some of our level 2 people are amazing and some inspire awe for entirerly different reasons. As far as field guides go I think if you have to read up on it on a call you probally shouldn't be doing it(crazy call me but reference books are genraly utilized only to clairify protocols by those with more than one set of protocols)

Your RN A and P was only 80 hours? The RNs at humber need like 240 (five hours a week for 3 semesters)

I do agree that training needs to be improved, the problem is we always have so many new members our training officer is going to develop ulcers.

I really would love to see it work but I am not sold on the idea. If the proper checks were in place(training with high standards and 100% chart audit) I think it could work.

Other food for thought is politically SJA getting SR is threatening to paramedics, cause now the only thing BTS2SR members wouldn't be able to do is cardiac monitoring, so more of them will go around claiming to be paramedics. It's no joke considering toronto SJA acted as scabs during the pride parade.

Submitted respectfully (except for the scabs)
Dave
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Tyler Mancuso
Senior Member
Username: Tmancuso

Post Number: 50
Registered: 10-2002
Posted on Wednesday, March 12, 2003 - 08:10 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Yah,

our BScN Program's A&P Course is three hours a week, 2 Semesters lecture time (there is a three hour lab but its only a dissection lab)... Let me tell you, it needs to be longer so that we can absorb the hundreds of notes each day :-)

PS I think provincial should already be doing the chart audits, etc. I am going to be pushing that in my new position that at least our district begins auditing each and every PCR! Not only is it quality assurance but can help in training needs, as they are usually only filed away without even going over them.

With respect to the training, we have seperated the training nights for Level ones and level twos, then everyone is on the same page (more work, but it works!) New members attend a BTS Course, do their level 1 then proceed to the level one training sessions until ready to take the level two course, then they attend the level two training sessions, and once a month we get together for a joint training session. Worked well sofar!
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Marika Beaumont
Junior Member
Username: Marika

Post Number: 6
Registered: 11-2002
Posted on Wednesday, March 12, 2003 - 08:14 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I have been in both adult and cadet divisions in SJA since 1985. I would be terrified to see most of the symptom reducing drugs available for administration! We work hard to get people adequately trained but we need to stick with the more basics. I agree we should be able to use AED's but there are too many risks and uncontrolled variables in a volunteer organization to start taking on medications. Not that I have any strong feelings on this :-)
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 55
Registered: 11-2002
Posted on Wednesday, March 12, 2003 - 01:04 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I agree with Marika. I'm sure you've met members that still hasn't perfected how to tie a St. John tubular sling yet. So to start getting into medications... could be dangerous.

Even if we limit them to BTS 3, 4, 5.... members, I've seen BTS-2 members that could use a bit more BTS-1 training.

I say until we can perfect our basics with 100% of the membership, we can continue to use the resources of EMS for medications and more serious injuries.
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Jennifer Goyer
Junior Member
Username: Army

Post Number: 6
Registered: 01-2003
Posted on Wednesday, March 12, 2003 - 02:36 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Justin what u said in the memo on March 9th is exactly how i felt when i started this discussion. There are people who buy a stethascope and bp cuff and they think they are paramedics but they only have standard first aid. Defiantly SR can be a dangerous course especially for the volunteer aspect. andjohnson u don have a good point for i have seen people like that and i agree with that. Paramedics go through extensive training for two years with everything drilled into their heads and they have the hands on experience. As for the volunteers there are some people that have some experience but that experience is sometimes different in the back of an ambulance then it is in a first aid truck. If people can prove that they are able to do BTS2 with out problems and maybe then go on to SR if able to.
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Gordon Siu
Junior Member
Username: Erdaemon

Post Number: 8
Registered: 04-2003
Posted on Monday, April 28, 2003 - 03:36 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

There are some good discussion here:
Certainly more training is fun and good attraction for recruitment. However, throughout the years, there have been two main problem:
1) Members like to play around with the fancy gadgets, not necessarily doing well with those skills, but also neglect the basic techniques as mentioned by others here.
2) Members realize that EMS is close by, thus neglected the mastery of basic skills, by providing basic life support. Thus, the so-called "bandaid-patrol".
For those involved in training, the point should be clear that no matter what level we are training at, the skills should be reflective of that level. BTS2 doesn't mean the member can only perform level 2 skills, but should also competent in all level 1 skills as well.
For the case of level 1 providers only, there are still a lot of room for improvements. Patient assessment and documentation are some examples that are very simple, yet frequently overlooked.

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Gordon Siu
Junior Member
Username: Erdaemon

Post Number: 9
Registered: 04-2003
Posted on Monday, April 28, 2003 - 04:10 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Now that some brought up the paramedic discussion
here's from the National Registry explaining how most US EMS works
http://www.nremt.org/about/ems_learn.asp
The american licensed EMS structure looks like this in most states: MFR-> EMT-B -> EMT-I -> EMT-P (aka Paramedic)
Emergency Medical Technician are often the minimum requirement to operate EMS vehicle with medical authority.
EMT-P or Paramedic on the other hand further expand the definition of ability to carry controlled medical acts. All licensed paramedics carry out ACLS protocols, pain management, and treatment for certain medical and traumatic conditions. With other accreditation, paramedics may provide more procedures like simple sutures, NG tube insertion, operate ventilator, 12-lead ECG interpretation. More recently RSI (rapid sequence intubation) and administering thrombolytics. Note that EMT-P might be working with flight nurse or physician onboard on air ambulance, thus their scope of practice might be significantly expanded like assisting in field cesarean section.
Recent article actually state US army are now upgrading all combat medics to be cross-trained as RPN. Thus reinforcing the idea that BTS members should also have knowledge of basic nursing skills.

One point to clarify, often when we say symptom relief, the medications are often in simple dispensing forms, i.e. MDI, auot-injector, tablets, etc. Whereas in advanced prehospital care, emergency medications often are parenteral administration, via IV, IM, SQ or ET. Thus typically the training involved in symptom relief program are shorter, since the risk involved with administering wrong dose is relatively lower.
However, the provider still must prove competence in assessing the patient needs and determine the appropriateness of medication administration.
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Dave Wakely
Intermediate Member
Username: Harrypotter

Post Number: 18
Registered: 03-2003
Posted on Monday, April 28, 2003 - 06:04 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Gordon,
One point to clairify, Currently symptom relief medication comes in nebules, Amps, spray and pill form. Another point to clairify is that MDI's are on the whole misused. The training involved in SR medication is less because the medications are in most cases will not cause harm.

Are you arguing for or against first aiders giving SR medication?
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Roger Scott
New member
Username: Pcab

Post Number: 3
Registered: 01-2004
Posted on Saturday, January 10, 2004 - 07:50 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The Paramedic Association of Canada has developed a National Occupationl Competency Profile with input from pre-hospital care providers and other stakeholders from across Canada. CMA Accredited pre-hospital education programs are now assessed based on the NOCP at four levels:

Emergency Medical Responder
Primary Care Paramedic
Advanced Care Paramedic
Critical Care Paramedic

The PAC has determined that symptom relief drugs may be administered by Primary Care Paramedics based on the appropriate level of education in those programs. The EMR level does not include symptom relief.

St John Ambulance remains a first aid organization at heart. Its all well fine to promote advancement, but lets keep it in perspective. If the Canadian Medical Association (CMA) endorses the PAC NOCP, that seems a pretty strong endorsement. If you don't have PCP training, you shouldn't be administering any meds (unless you have training in another health discipline and it within your scope).

Note: contrary to a previous post, initiating IV therapy and interpreting 12 Lead ECG is not within the Primary Care Paramedic scope in accordance with the NOCP, but there remains some provincial variations based on each province's legislation regulating EMS.

Providing medications safely requires appropriate training.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 101
Registered: 07-2003
Posted on Sunday, January 11, 2004 - 12:42 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Justin:

"This program will soon (within one or two years) be moved to a 4 year university degree program to come out as a PCP."

I know it has been a while since this discussion happened but this is the first and only time I have heard of this. Do you have a source on this info?
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Justin Mausz
Intermediate Member
Username: Coop

Post Number: 28
Registered: 11-2002
Posted on Monday, January 12, 2004 - 01:45 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Centennial College offers a joint program with the University of Toronto for a four-year degree program.

Students compete the first two years at Centennial studying paramedicine courses and earn their diploma, they then have the option of transferring into the degree program at UofT for the remaining two years studying anatomy/physiology and biology to earn a Bachelor of Science in Paramedicine graduating with PCP status.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 102
Registered: 07-2003
Posted on Monday, January 12, 2004 - 04:00 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Oh wow! I'd never heard of that! Thanks, I'm definitely going to research it...

but is there really an advantage to having that? It doesn't gain you any more pay/skills or anything does it?
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Justin Mausz
Intermediate Member
Username: Coop

Post Number: 29
Registered: 11-2002
Posted on Tuesday, January 13, 2004 - 01:56 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I'm honestly not sure what sort of advantages it will give students. I'm also not sure what I'm going to do - whether or not I'll transfer into the degree program when I'm finished the two years of diploma study.

Paramedics in Ontario are aiming to become a regulated health profession (similar to the Registered Nurses) and develop a college of Paramedics for self licensure. Having a degree in the field would probably be very helpful if Paramedics were to become regulated. I can see the degree program becoming the standard of care down the line - it would just suck to be the person who's in the last two year program ever and graduate with a diploma when preference is given to the degree holders.

That said, if the job market is anything like the way it is today, so long as they do well during ride outs and the entrance testing, very few people will have difficulty finding a job.

Ultimately, it comes down to whether or not you want to get a degree while studying something you enjoy - degrees can be very useful down the line, especially if you eventually wanted to teach in that field.
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Tim Gallant
Intermediate Member
Username: Tim

Post Number: 30
Registered: 03-2003
Posted on Tuesday, January 13, 2004 - 06:24 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Hello everyone,
does anybody know of any places where one could obtain thier CCP.(in canada)
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 103
Registered: 07-2003
Posted on Tuesday, January 13, 2004 - 06:15 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Tyler,

Again, I know it has been a long time since the comment was made but is it possible to obtain the file you use for that pocket guide? I'd be very interested in lookin at it!
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Michael Lawrence, RN
Advanced Member
Username: Spud

Post Number: 36
Registered: 10-2002
Posted on Tuesday, January 13, 2004 - 08:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Tim,

The only place in Ontario that I know of... and please someone correct me if I am wrong, is through the Sunnybrook Base Hospital Program in Toronto. You need to be an employed PCP/ACP with a service before getting accepted. As to specific other requirements, I believe you also have to be an EMCA in Ontario. I am unaware of any other CCP programs (unless they are done in house by services in larger areas such as BC or in Alberta).

hope that helps.

Cheers,
Michael
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Roger Scott
New member
Username: Pcab

Post Number: 5
Registered: 01-2004
Posted on Tuesday, January 13, 2004 - 09:21 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

There are no CCP programs in Alberta. Sunnybrook and Women's College Base Hospital Program Flight Paramedic Academy is the only CMA accredited CCP program in Canada right now. There remain a number of "Level III" (the old accreditation criteria) paramedic programs that have yet to undergo accreditation under the new NOCP criteria. NAIT (in Edmonton) was a Level III and has just been re-accredited at the ACP level. We chose ACP rather that CCP because there are some competencies which we instruct at a simulation level but do not require clinical practice. Further, we felt that a new grad paramedic is better served at the ACP level and intend on making CCP a post-diploma option in the future.

For more information on CMA accredited programs visit http://www.cma.ca/cma/common/displayPage.do?pageId=/staticCo ntent/HTML/N0/l2/accredit/official_list.htm#PA

Roger Scott
Paramedic Instructor
Northern Alberta Institute of Technology
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Roger Scott
Junior Member
Username: Pcab

Post Number: 6
Registered: 01-2004
Posted on Tuesday, January 13, 2004 - 09:42 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Re: Degrees

There are a number of initiatives in different provinces right now that do/will provide a degree option for graduate paramedics. Athabasca University in Alberta has offered a BSc completion option for EMTs and Paramedics (using the Alberta definitions of those two terms PCP and ACP for comparison) for several years. Medicine Hat College offers a Bachelor of Applied Health Science - Paramedic Degree. Their program offers a number of exit points allowing a student to graduate prior to degree attainment. Lakeland College in (Alberta/Sask) offers a Bachelor of Applied Emergency Services Administration desgined for EMS, Fire, Police or corrections. It is a Post-Diploma program. A disadvantage to the last two programs is they are Applied degrees which pretty much means terminal degree as more coursework would be required for someone wishing to do post-grad (Masters). SAIT offers a post-diploma degree of Bachelor of Health Science in partnership with Charles Sturt University from Australia. There some Canadian Universities who may not recognize that degree as equivalent to a Canadian degree when considering going on to Post-Grad.

The commonalities between most pre-hospital care degree programs is they add more to a paramedics education. Most paramedic programs tend to be technically oriented. Degree programs offer a broader based education including liberal arts, more sciences, leadership/management etc. Advanced education can only serve to strengthen the profession.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 104
Registered: 07-2003
Posted on Wednesday, January 14, 2004 - 12:09 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I did some more reading. From what I can tell you go for four years. When you are done you have a Diploma from Centennial College for Paramedic and a Bachelor of Science with Honours. They just managed to pack two separate courses of study into four years.
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Henry blais
New member
Username: Hblais

Post Number: 4
Registered: 12-2002
Posted on Sunday, July 25, 2004 - 08:33 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Don: Good research. Did the government pass the Bill 51? Can anyone clarify this?


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Don Tai
Senior Member
Username: Dontai

Post Number: 74
Registered: 12-2002
Posted on Sunday, July 25, 2004 - 11:22 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Bill 51, the Portable Heart Defibrillator Act in Ontario has not progressed in 3 years, and has been sent back to start the whole process again. It passed its second reading on June 28 2001. The bill was killed just before the last election. Mike Colle, the Liberal MPP spearheading the bill is still in office, and may yet revive it, but he's part of the Finance Office now and may be distracted.

Here's what I think happened: The government did a first and second reading, got public input, then proceeded to rip apart and defeat every clause in the bill, ripped apart the title, and then told everyone to go back and restart the bill from the beginning, not even letting it get a 3d reading. "the government then defeated every section of the bill, including the title of the bill, gutting the bill after spending all that taxpayers' money going to Ottawa, among other places, and didn't even let the bill go back to the House to be considered for third reading...
". I think the reason they defeated the bill and every single section, was because the bill overstepped the boundaries of what the Ontario government can implement. Please read the link and the bill as it's interesting.

Note that there is still no legal requirement to have AEDs in public places, nor is there any future plan. There also exists no protection from civil liability for a first-aider who uses one without standing orders from a medical doctor as well as documented training on the specific AED used. Use of an AED is still considered a delegated medical act and should be treated as such. SJAB has very strict guidelines on AED use and we should follow them to the letter.
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 19
Registered: 04-2005
Posted on Friday, April 22, 2005 - 06:08 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

What are peoples thoughts on SJAB providing S / R Medications ? I have heard it talked about by many people from all over the place, I'm just curious to peoples opinions.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 246
Registered: 07-2003
Posted on Saturday, April 23, 2005 - 01:21 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I have mixed feelings on that but at this point don't really want to get into it.
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 31
Registered: 08-2004
Posted on Saturday, April 23, 2005 - 10:17 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Adam,
ABSOLUTELY NOT. SJA members who do not hold professional health-care qualifications, lack the knowledge, experience and assessment skills to perform these acts safely. SJA lacks the appropriate medical oversight to do this either.
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Steven Boa
Junior Member
Username: Xlq771

Post Number: 9
Registered: 02-2004
Posted on Saturday, April 23, 2005 - 11:22 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Would it be possible for St.John ambulance to get an outside agency to conduct Symptom Relief training for members that have MFR/EMR or higher? For example, Fire Management Inc., out of Petrolia, ON has a 16 hour course that they have so fire services with MFR's (80 hour version)in that area can provide Symptom Relief. They teach the drugs Ventolin, ASA, Nitroglycerin, Epinephrine 1:1000, Glucagon, Gravol, and Benadryl. The medical director is Dr. J.C. Fedoruk, former Base Hospital Medical Director in Windsor, and the developer of the MOH Symptom Relief program for Primary Care Paramedics. More information can be found at www.firemanagement.net

Why would SJA lack the medical oversight to have MFR providers trained to do Symptom Relief? SJA owns two Paramedic schools in Canada - the Maritime School of Paramedicine, and the Atlantic Paramedic Academy. Both schools run PCP and ACP courses that exceed the NOCP. How could the organization have these schools, if the medical oversight was unavailable?

As for MFR/EMR doing Symptom Relief, in other provinces such as BC, AB, and MB, EMR's must be trained in, and have delegated to them Symptom Relief in order to be eligible for registration with the province as EMR's. In both BC and MB, EMR's must also learn IV Maintenance. Then again, in all of those provinces the EMR course must be longer than the 40 hour program used in Ontario - 80 to 120 hours. They also have tougher standards for the courses - large amounts of homework, most theory learned at home so classes can be devoted to more practical skills, etc.

I think MOH is to blame for the province having no set standards for first responders beyond the few teams they have in the north. Other provinces regulate the training and scope of practice for EMR's. In those provinces SJA must comply with all regulations. I communicated with a member of the Steering Committee of the proposed Ontario College of Paramedics. I was told via email that they want to exclude anyone lower than PCP. Some paramedics are afraid the province would staff ambulances with EMR's in order to save money. Personally, I think EMR's in Ontario should operate in the same environments as in other provinces - Industry, Fire Services, Patient Transfer Services, Special Event EMS (such as SJA) and MOH EMS First Response vehicles. Like other provinces, EMR's should transport under limited situations - MCI/Disaster, Transfer Services, and delayed EMS response ie. 5 minutes to the hospital, 25 minute EMS response.
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john Docherty RRT
Advanced Member
Username: Jpdocherty

Post Number: 35
Registered: 05-2003
Posted on Saturday, April 23, 2005 - 12:37 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steven
Although there are many who would agree the St John Personnel be allowed to deliver Symptom Relief ther are a few road blocks in the way. The Ambulance Act for one, It states that in order to perform controlled act (medication prescription) you must be a PCP,ACP,CCP as out lined under the Act. Or be a member of a College as described under the Regulated Health Professions Act ie College of nurses, Ontario College of Respiratory Therapists to name a few OR be delegated the controlled act by a college. That is how Paramedics are able to deliver medication in the province of Ontario. We are delegated the cotrolled act by the base Hospital Doctor in our area and we work directly under their lience. I as a Paramedic cant go and work in Toronto with out Toronto base hospital granting me permission to perform their medical acts S/R and SAED. It is posible for Paramedics to hold certificates from multiple base hospitals which isnt that uncommon.

As for St John we can use AED only if we meet the St John protocols and have a card signed by the Provincial Medical Officer. I as a paramedic cant put on a SJA uniform and perform AED on duty without the appropreate credentials my Base Hospital certificate wont cover me.

These Laws that I speak of are Ontario Laws and NOT applicable in other provinces, so moving to manitoba I would have to start all over again to become registered to practice.

If you can convince the provincial Medical Officer to certify SJA then its posible to deliver S/R, but good luck its his licence that you put in jeopardy, but im sure he would be open to discussing it with you.

Just some thought on the subject.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 248
Registered: 07-2003
Posted on Saturday, April 23, 2005 - 12:43 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

And the thought of a St. John member with a 40hr course and then 16 hours extra being able to inject somebody with epi or give nitro... that's scary.
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Dave Wakely
Senior Member
Username: Harrypotter

Post Number: 47
Registered: 03-2003
Posted on Saturday, April 23, 2005 - 01:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steve,
You speak of the NOCP's but the NOCP clearly states: "The EMR competency profile does not
include controlled or delegated medical acts."

NOCPs allow paramedics to give drugs not EMR's furthermore I could not find reference to AB, MB, or BC allowing/requiring EMRs to give drugs. EMRs do operate in all the industries you listed but they have other jobs to do. By and large your EMR alone will never be enough to get a good paying job. If they wanted a medical person they would hire a nurse or a medic. Hydro employes medical team at the EMR level but they are all trained in confined space, hazmat and fire supression.

Keep in mind if you give drugs to a patient you may be required to come with the paramedics to the hospital. Once you have performed a controled medical act it is the paramedics who decide if they are willing to take responsibility for something that happened prior to thier arrival. Unless a transfer of care agreement is created the paramedics will call you to task. EMR's do not transport patients, neither do paramedics... an ambulance does. If you are going to operate an ambulance you must meet the requirements of the ambulance act, including being an ambulance service and employing paramedics. The reason we(SJAB) can operate in disasters is that we are part of the regional/provincal/federal disaster plans.

Dave
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Steven Boa
Junior Member
Username: Xlq771

Post Number: 10
Registered: 02-2004
Posted on Saturday, April 23, 2005 - 05:08 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

John - The RHPA allows Physicians to delegate acts. Being a paramedic is not a requirement, otherwise SJA, Fire Services, or other agencies would not be allowed to use AED's. Only MOH ambulance services and MOH paramedics are bound by the act. Fire Services are under their own act. Patient Transfer Services are not regulated at all, and yet they do AED and symptom relief.

If you, as a paramedic, relocate to any province that has signed the Mutual Recognition Agreement, you go through a reciprocity process to get certified in that province. You do not have to start over.

If the SJA Medical Director is unwilling to delegate symptom relief, SJA should consider replacing him with a more progressive medical director, such as Dr. Fedoruk.

Dave - The NOCP allows EMR's to use an AED, which is a controlled/delegated act in Ontario. The NOCP clearly states that provinces and training programs may exceed it.

The references I made to other provinces are as follows:

BC - Health Emergency Act, Emergency Medical Assistants Regulation, Schedule 1 (authorized acts) and Schedule 2 (licence endorsments for acts allowed with extra training), Order In Counsel OIC 1181/91

AB - Health Diciplines Act, EMT Regulation
- Alberta College of Paramedics EMR Continuing Competency Profile
- Alberta College of Paramedics Alberta Occupational Competency Profile for EMR

MB - Emergency Medical Response and Stretcher Transportation Act
- Transfer of Function Protocol, Manitoba Health Emergency Services

Pearson Education Canada/Brady Books textbook, Emergency Medical Responder, 2nd. Canadian Edition, has just been released by them. It is the second edition of the textbook that SJA says that it uses for the MFR/EMR program. Chapter 5 covers Pharmacology and Symptom Relief by EMR's. ISBN 0 13 127824 X

An MFR with only 40 hours instruction should not do symptom relief. However, those with the 80 hour EMR course (the only course that actually complies with the NOCP) should receive the training to do symptom relief. Most areas of the province do not have fast EMS response times. Waiting 15 or 20 minutes for an ambulance is not providing the best care for the patient.
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 32
Registered: 08-2004
Posted on Saturday, April 23, 2005 - 05:37 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steven,
I might suggest not mentioning specific positions or names on here, even Dr. Fedoruk.
I have been told about many concerns (even from the Ontario College of Physicians) about Dr. Fedoruk's willingness to certify ANYONE. This has been ONE of the motivating factors for creation of a Regulatory College for Pre-hospital Care. Just because you can find someone to certify you, doesn't mean it is a good idea.
This has already been borne out in the realm of event coverage and non-emerg transfers, and means that the average medic on the street will INSIST you accompany a patient you have administered drugs to. This means that you are then not present to cover the event you are contracted to cover. It is the reason why, when working for one of the Private providers I work as an ACP for, we do not do any of our Expanded skills as the local land crews will not accept patients that have been given drugs that they do not carry. Be careful what you ask for........... ever been to a Coroner's Inquest?
These recurrent and incessent ramblings about increasing scope, without proper education and training, along with the unrealistic expectations of some members are part of the reason I decided not to return to the organization.
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Robert McKay R.R.T.
Junior Member
Username: Mckayrob

Post Number: 7
Registered: 06-2004
Posted on Saturday, April 23, 2005 - 06:50 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Hey everybody. Lots to read and lot's talk about here.

I am the Acting Superintendent in North Bay. I am also a Registered Respiratory Therapist. As other health care professionals have mentioned, it is a scary thought that St. John members want to provide SR services. This is not a job. This is not something you spend two, three or four years of your life in school for. St. John Ambulance can be a a very good launching point to other careers, but it is not the place to be administering drugs. There has been lots said on the time spent learning anatomy, physiology, pathology and such when becoming a health professional. My A&P courses totaled around 250 hours. And my course focused on Respiratory illnesses. I do not know everything there is to know about drugs, diseases, etc. How can somebody who has a 16 hour course (on top of MFR) even begin to think they might be qualified enough?? Not even close.

AED's on the other hand are becoming more and more available for use in public. I am disappointed that the legislature in Ontario hasn't yet put forth proper legislation towards proper AED manufacturing, training and use. but, I do believe they should be available. My brigade will soon be getting training (by the city)for SOME of our members to use the AED's that the city is buying. This training will not be offered to all of our members because not all of our members have the proper skills to use move advanced equipment. You may say they AED's are not "advanced", but I disagree. Knowing how to push buttons on an AED and knowing why you are pushing the buttons are very different things. You must also know what is happening when you push that button.


(Message edited by mckayrob on April 23, 2005)
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Michael Lawrence, RN
Senior Member
Username: Spud

Post Number: 52
Registered: 10-2002
Posted on Saturday, April 23, 2005 - 09:34 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I would like to echo the sentiments of some of the members who have posted before.

St. John Ambulance is not, nor will ever be an Emergency Medical Service. We are community service volunteers who provide FIRST AID to help our commmunity organizations provide fun, exciting, and safe events in the places we live. We also provide assistance, where and when able, at specific community disasters/emergency situations.

Yes, we are increasing our ability to respond while on duty with a higher standard of care with the 40 hour MFR, but we are not EMR's (as defined by the Paramedic Association of Canada's NOCP guidelines). We are ensuring that when we send out our volunteers they all meet one common standard that the communtiy can expect.

I think that Robert said it best... for those who are very much interested in the field and want to do more... go to school and become a paramedic, nurse, doctor, RT, physiotherapist, or any one of a number of disciplines involved in the health care field. You can still belong to St. john and maintain/practice your first aid skills while contributing back to the organization all of the education and experience you have gained professionally.

Just my two cents,
Michael L.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 250
Registered: 07-2003
Posted on Sunday, April 24, 2005 - 01:30 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Just thought of another way to look at it. We can apply the same arguements for SR in SJA to other skills. Why isn't SJA starting IVs? It's a monkey skill! Even a monkey can start an IV, there realistically isn't much to the actual starting of one. Or intubating, that's a relatively simple skill so why aren't we doing it in SJA. Wouldn't it be in the best interest of our patients??
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Dave Wakely
Senior Member
Username: Harrypotter

Post Number: 50
Registered: 03-2003
Posted on Sunday, April 24, 2005 - 02:32 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steve
In AB EMRs must be supervised when performing any delegated act except defibrilation(section 10.1 of the aforementioned act)

In MB EMRs may administer epipens, ASA and oral glucose (I could not find the act you mentioned but you can find the info at MB EMS website)

In BC you are right the board may decide to change the standard of care when needed. That does not mean that they do, simply that the mechinism is there.

As for the textbook, I have the mosbys paramedic textbook(I'll save you the ISBN) that mentions insulin, haldol, Etomidate, dobutrex and many others that paramedics don't give. If the EMR book had a chapter on space travel would that make you an astronaut? NO. A chapter on SR does not a provider make.

As for calling for the replacement of our medical director with some one "more progresive" why stop there? You saw a code on ER once lets go find a Doc willing to commit professional suicide and you could be running full ALS codes on your next duty.

Dave.
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Michael Lawrence, RN
Senior Member
Username: Spud

Post Number: 53
Registered: 10-2002
Posted on Sunday, April 24, 2005 - 08:19 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

As one of the monkey's who starts IV's several times a shift at work, I take a little offence to your comments Alex - it is not always easy to start an IV (ever tried on a cancer patient post-chemo, or someone with no blood pressure, or a child, or someone dehydrated???)

I understand your point, that it is still a task/skill that has a limited number of steps involved, but it is an art sometimes and does require a fair amount of not only dexterity but experience to decide which catheter to use, and which vein would be the best clinically for the patient.

Cheers,
michael L.
PS. Can anyone spare a banana????
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 33
Registered: 08-2004
Posted on Sunday, April 24, 2005 - 08:53 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I agree with Michael and Alex,
I think the point is that while any skill can be broken down into steps that can be quite easy to learn. It is the knowledge of risk/benefit, knowing when it is appropriate to utilize that skill, and the art and experience of it's application, that is important.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 252
Registered: 07-2003
Posted on Sunday, April 24, 2005 - 12:02 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Michael,

I understand and meant no offense. My point was it doesn't take a highly educated person to do it. You can take Joe off the street with no medical background and teach him to do an IV in a day. If he does them all the time he will be able to get the most difficult ones. All without any medical training. So if it's this easy to learn why aren't we teaching our SJA members to do it???

I'm trying to illustrate the point that just because you CAN do a skill doesn't mean you should
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Robert McKay R.R.T./R.R.C.P.
Junior Member
Username: Mckayrob

Post Number: 8
Registered: 06-2004
Posted on Sunday, April 24, 2005 - 01:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The same thing goes for intubating. It may look simple, but it's not. Whoever is intubating needs lot's of background knowledge in the how, why, what and so on. I have seen many Residents, who have been properly trained, not intubate properly. It is a skill that must be performed fairly often to maintain competency.

These skills that have been talked about, there is a reason they are CONTROLLED MEDICAL ACTS. There is legislation to make sure that the people performing these acts are doing a proper job. Most of the people that can perform them belong to a college of some sort. These colleges regulate who can and cannot perform these acts.

If somebody wants to do a certain job, then go to school. Take the proper courses. And join the proper college. Then get a paying job and keep up your competencies. St. John is not a school to further a career. St. John Ambulance is a volunteer service to help our communities by providing First Aid at public events. Sometimes I think that having the word Ambulance in the title makes people think that it is more than that.

That is my opinion. It may differ from yours. That's ok.

Rob McKay R.R.T./R.R.C.P.
Acting Superintendent North Bay Brigade
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john Docherty RRT
Advanced Member
Username: Jpdocherty

Post Number: 37
Registered: 05-2003
Posted on Sunday, April 24, 2005 - 01:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

How bad of an idea is it to give S/R to SJA memebers? Lets try this little test, on your next meeting night have two members without any coaching place a patient on a stretcher and load it in a vehical and then unload it, lower it and assist the patient off the stretcher.Remember NO COACHING just do it. Then think of giving them a needle full of epi. Some skills require a lot of practice even if they seem simple. S/R is a bad idea for SJA. We got ASA isnt that enough?

Oh yea I hate it when people only read part of a post befor responding to it, dont be nit picking very unprofessional
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Adam Prieur
Senior Member
Username: Beanmedic

Post Number: 46
Registered: 01-2003
Posted on Sunday, April 24, 2005 - 01:40 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

We got ASA?
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john Docherty RRT
Advanced Member
Username: Jpdocherty

Post Number: 38
Registered: 05-2003
Posted on Sunday, April 24, 2005 - 02:28 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Adam
I refer you to Provincial Commissioners Directive #09/98 Issued 01 Dec 1998, on assisting with Medications
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 253
Registered: 07-2003
Posted on Sunday, April 24, 2005 - 02:34 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Just wanted to clarify. We are not allowed to CARRY ASA, we are allowed to recommend a casualty takes their OWN ASA if they are having chest pain.
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Steven Boa
Member
Username: Xlq771

Post Number: 11
Registered: 02-2004
Posted on Monday, April 25, 2005 - 11:54 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Why isn't SJA a part of the province EMS system? In most countries, SJA is EMS. Even here in Canada, the organization owns two Paramedic schools. The organization has the expertise and resourses to be part of the system, so why not formally join it? Why not apply to the province to have SJA designated as a First Response Service?

SJA has the expertise and resourses to increase members knowledge level to the point where they can be trusted to competently perform symptom relief, so why does the organization not do so? It doesn't take that long to learn the required anatomy and physiology to perform symptom relief. Saskatchewan Institute of Applied Science and Technology's Primary Care Paramedic program is accredited at the highest level (6 year) by the CMA as not only meeting, but exceeding the PAC NOCP for PCP. The students they train are eligible for AEMCA certification under the Mutual Recognition Agreement. The entire course is only 570 hours long (396 hours in class, 174 hours clinicals), and students come into the program with only SFA and CPR. If this school, and others like BC's Paramedic Academy can run the entire PCP course in a short time, SJA should be able to train members properly to provide symptom relief. Even a limited program would be better than what is done now. Even limiting the program to ASA and Oral Glucose, with patient assist on Epinephrine 1:1000, Nitroglycerin, and Ventolin would be an improvement. The protocol for doing full Symptom Relief and Patient Assist are not that different. The required background knowledge is the same.

Why did SJA Ontario only adopt the 40 hour MFR course, instead of the full 80 hour EMR course that is used outside of the province? If a member relocates to another province, the member would require retraining, as the course must comply with all PAC NOCP requirements in order to be eligible for reciprocity under the Mutual Recognition Agreement.

Isn't Mosby's Paramedic textbook a US Advanced Life Support Paramedic text? I know some Ontario colleges use it for their PCP programs, but it really is meant for the ACP level. Mosby's EMT-Intermediate text would be more appropriate for the PCP scope of practice. Even better would be Pearson Education Canada's Essentials of Paramedic Care, Canadian Edition, which was specifically written for the PCP and ACP levels.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 254
Registered: 07-2003
Posted on Monday, April 25, 2005 - 12:05 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I'm sorry but Steven you seem to have a grudge against something here... what does your last paragraph have to do with SJA?

I ask the same question as you do for the second last paragraph only slightly modified "Why did SJA ONtario adopt the MFR course?"

IMO we don't need it, the ONLY skills on that course I have ever used are BP and O2 and I managed just fine without my MFR. But we have had this debate a lot.
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Michael Lawrence, RN
Senior Member
Username: Spud

Post Number: 54
Registered: 10-2002
Posted on Monday, April 25, 2005 - 02:25 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steven,

A couple of things... I am glad to hear you are so enthusiastic to enhance your st. john training... but if you are really interested in pursuing higher training/education, apply to one of the many community colleges that offers paramedic training in the province and become a paramedic yourself.

Second, Ontario Council adopted the 40 hour course as this was what was passed on down the line from National. Why not the 80 hour course??? What advantage does the 80 hour course have other than meeting the NOCP requirements for EMR... as far as I am aware the province of Ontario wouldn't recognize us any differently than now. Also keep in mind the HUGE time committment to train every volunteer in the province to the 80 hour program. It is hard enough for some of us to get everyone trained to 40 hours... remember we are all volunteers, including the instructors - they don't get paid to teach.

Again, as for symptom relief, I understand that you may believe it to be simple, but it is more complex. Truly though, what would the advantage be for symptom relief, with the exception of epi for anaphylaxis (and maybe the odd ventolin for the really, really bad asthma patient -who probably has it on them already) none of the drugs are life saving... they are "Symptom" relieving. Just taking the required amount of A&P and pharmacology is not enough. You need to practice your knowledge frequently by actively providing patient care to a wide variety of clinical situations in order to learn/develop your critical thinking skills - st. john duties do not offer enough clinical experiences.

Just my thoughts.
Michael L.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 255
Registered: 07-2003
Posted on Monday, April 25, 2005 - 02:40 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Think back to all your years in SJA. How many times have SR meds been applicable? I've been in for going on 6 years now. I volunteer probably 250-300 duty hours a year. I can think of 4 times in 6 years where I would have actually used SR.

-1 for an anaphylaxis from a bee sting but even that one was iffy... he recovered without one with O2 before the medics arrived

-1 for an asthma attack

-2 for chest pain (both with ho Hx of Nitro therefore just ASA)

Don't get me wrong, I've dealt with LOTS of emergencies... but those are the only ones where I feel SR would have been beneficial to the pt. I have had many diabetics but they all did fine with just a sweet drink and something to eat.
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Dave Wakely
Senior Member
Username: Harrypotter

Post Number: 51
Registered: 03-2003
Posted on Monday, April 25, 2005 - 07:03 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steven,
"In most countries, SJA is EMS"
-In some countries SJA works with EMS in a transport capacity(normally in a 3rd service model with the notible exception of Australia)

"SJA has the expertise and resourses to increase members knowledge level to the point where they can be trusted to competently perform symptom relief"
In recent years divisions have had a tremendous amount of new blood. Larger divisions are struggling to find MFR instructors to meet the new standard. How do you expect divisions to find instructors for SR?
"It doesn't take that long to learn the required anatomy and physiology to perform symptom relief"
I agree... the mouth is here - ASA, Nitro and ventolin go in there. The arm is here Epi and glucogon go here! In a procedure based system (such as in many US states) you learn protocols, BUT the PAC established the program minimums to teach an understanding of WHY things are done, without such an understanding you are not a safe practicioner. The bottom line is EMR is included in the NOCP because the PAC wanted to draw a line in the sand for fire department training. The 80 course is now standard across my region (which includes 4 paid and vol. FD's). The 80 hour course makes for a good assistant in the BLS world. (**please note I am not saying ANYTHING bad about a fire service I could not take an 80 hour course to be a firefighter**) This 80 course makes them good at First aid, as in comes before medical aid. Medical Aid as in the paramedics, nurses, RTs and doctors that follow the first aid.

Mosbys is a required text of several PCP programs. Although PCP's are trained to function at the PCP level they are trained to understand ALS procedures. 570 hours is a year of full time class, in addition that program requires ride out hours. Most paramedic students have more than 570 ride out hours by graduation(in ontario).

Steven I challenge you to argue the risk/benefits of SR drugs(see why risk it in the pt care focus area)

The US does not have Advance/primary care paramedics.

Steven, just out of personal interest what division are you in?

Dave
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 20
Registered: 04-2005
Posted on Monday, April 25, 2005 - 07:48 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I have spoken to a few paramedics on this topic who are and who are not with SJA. I think from what I have heard from them is that it is possible for SJA to get involved with S/R. Maybe not be able to admin all the same meds as EMS. However, Epi for example may be possible. As well as others.

Also from what I have heard opinion on is some hard working EMS people may feel that SJA is trying to take their jobs away from them and don't want SJA to do the things that they can do as EMS. Over the years SJA has gotten bigger. We can now Administer Oxygen, provide airway management - which last i heard it is a regulated MEDICAL ACT. We perform AED which is another medical act while on duty and requires a sign off from the Doctor.
What I am trying to say is that in another 10yrs ANYTHING is possible.
I for one am not a so called "Wanna-bee" Paramedic that some people may call SJA volunteers...

As for the USA Paramedic quote from Dave. Stating the US doesn't have Advanced care and PCP ?? I believe that in fact they do, thay are just under a different title. EMT-B (Responder) EMT-I (Primary Care) EMT-P (Paramedic) EMT-P'd in Florida provide the same services as Ontario P-3's. EMT-P may be just another title and not the same title used here on Ontario or Canada for that matter.

As I have said, I have asked the opinion from some Medics in my area, majority...(Experienced) feel it would be useful in situation such as a child with a Bee sting suffering a reaction - EMS ETA 25 Minutes. Like to wish that patient GOOD LUCK!

The point of fact is that OVER TIME anything and everything can and will more than likely happen, Act;s can be changed, just because it's in the Medical Act right now doesn't mean things can't be changed in 10yrs.

SJA - From how I see it, give or take a couple years...10-15... will trained EMR's to the PCP scope or atleast close to it. Think about it, 20yrs ago we never had PARAMEDIC... we had High School grads or not ... driving a van with F/A training...that was it.

I see the point that we are volunteers. Maybe this could all come into play in 10yrs and only interested people could take part in the training...with a selection process in place.

I think it is GREAT to see everyone;s replies posted, it's excellent. But I can almost pin point the people that accept change easier than others, anything can happen... you can't disagree with this...anything can happen. It's simple.

Have a good one all,
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Steven Boa
Member
Username: Xlq771

Post Number: 12
Registered: 02-2004
Posted on Monday, April 25, 2005 - 08:16 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I would like to start by saying that I am sorry if I have offended anyone with my posts. That is not my intent.

I am new to SJA, as I am in the process of joining either the London or Woodstock branch (I have not decided yet which), and I have tried to get out to meetings at both branches. My employement gets in the way, so finding time is difficult. However, I am not new to EMS. I am a New York State and NREMT Emergency Medical Technician EMT-Basic. The US EMT-Basic level is just above the EMR level in terms of knowledge, skill set, etc., and all provinces that formally certify EMR's accept the US EMT-Basic level for reciprocity at the EMR level. I am nowhere near the level of knowledge that paramedics have, and I certainly have a lot to learn, both about EMS, and SJA. I am in the process of academic upgrading, so that I can get into a paramedic program.

Some things about EMS in Ontario, and about SJA just don't make any sense to me. In another topic thread, there is a discusion about whether SJA should backboard patients. In the US, this would't even be an issue. Failing to provide the patient with the care of your skill and certification level , whether First Responder, EMT, or Paramedic will get your certification revoked, and get you and your ageny sued. Backboarding is a First Responder skill. Symptom Relief is another issue that doesn't make sense to me. Schools outside Ontario can train PCP paramedics in for less time than Ontario schools. These schools not only teach how, but why the paramedic does a given procedure. If they didn't, the CMA would never accredit the school. The entire SIAST PCP course is only 570 hours total length, including clinical and field placements. They spend 396 hours over 13 weeks in the classroom, and 174 hours in clinical and field placements, before they graduate. Surely if this school can train a PCP in such a short time, SJA can train people in symptom relief. The way to decrease the risk of harm to the patient is with training. Yet it seems to me that SJA is not willing to increase the training level.
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Robert McKay R.R.T./R.R.C.P.
Junior Member
Username: Mckayrob

Post Number: 9
Registered: 06-2004
Posted on Monday, April 25, 2005 - 08:18 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I would like to respond to a few comments by some people.

Steven Boa:
The schools you talked about have one big thing that St. John Doesn't. Tuition. They are paid schools with people who get a salary to teach. Our Brigade divisions are volunteer divisions. The ability for us to educate everybody to the level of EMS would be very costly. Since the main funding for our supplies comes from donations, it is very unlikely that we will see that kind of training in the near future.

Adam Guerin:
While we do provide airway management. We do not provide the type of airway mangement that is a regulated medical act. As far as airways are concerned, the act says that only a regulated health professional can intubate past the point of the larynx. That means that the use of an oropharyngeal airway is not a regulated medical act. There are even some longer airways (Combitubes, Laryngeal masks) that we could technically use under this definition. But, even with those, without regular use, familiarity with the equipment diminishes. And the use of those items would increase our insurance.
I have said it before and I will say it again, use St. John as a starting point for a medical profession. But, go to school and become a healthcare worker. It is very rewarding.

Thanks,
Rob Mckay RRT/RRCP
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 23
Registered: 04-2005
Posted on Monday, April 25, 2005 - 08:22 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

From what I have seen, I am in my 6th year almost entering my 7th with SJA. SJA is slowly increasing the level of training and will keep doing so over time. When I joined the Brigade, we trained nothing at all to what we do now... thing shave to change over time, we must keep up with the times. People need to accept CHANGE in life.

I agree with your input Steve Boa, thanks for your thoughts.
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 36
Registered: 08-2004
Posted on Monday, April 25, 2005 - 08:24 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The role of SJA in Canada is First Aid, not MEDICAL AID. Adminstering meds is medical aid. Automated defib is now consodered a first aid skill and hence relevent to SJA.
As for the comparisons of levels of pre-hospital care. While Canada and the US may have levels that compare in terms of scope of practice, they differ greatly in terms of education and knowledge. For that reason, US EMT-Bs are NOT eleigible to write the EMCA.
Yes medical practice changes, but it is beyond SJA to push this.
And as for how things develop over the coming years......actually I really disagree. If a regulatory College for Pre-hospital care is developed then there is no way SJA members will move beyod first aid as they would never be able to maintain licensure with the college, just through volunteer activites.
20 years ago we did have Paramedics, trained even before that in the MoH's Kingston Program and then in Toronto, and on Air back to 1977.
And that is just on the ALS side... >http://wx.toronto.ca/inter/it/newsrel.nsf/3257dc890938d23b85 256dde005a446b/c0d358fa82ca21eb85256e9a004cc450?OpenDocument<
As for Airway management, if it doesn't go past the glottic opening, it is not a controlled act, so using an OPA is OK, intubation you need delegation for. Oxygen administration, while generally a drug, requiring a prescription or delegation, is exempted for emergency use.
Please, know what you are talking about, before posting.
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 24
Registered: 04-2005
Posted on Monday, April 25, 2005 - 08:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks Robert for your input. But I am not really interested in going into a Health care career and don't see myself studying it in school. Yes it is rewarding, I tip my hat to all. I am in the process and working towards employment with Emergency Services, just not EMS as my interest is elsewhere.
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Mike Rumble, RPN
Senior Member
Username: Mrumble

Post Number: 158
Registered: 11-2002
Posted on Monday, April 25, 2005 - 08:54 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I wanted to comment on the ASA point made above: like Alex pointed out, we do not DISPENSE ASA. This seems to be a common misconception with the PC Directive mentioned. We RECOMMEND a patient take THEIR OWN ASA. However, I might point out, that same PC Directive does give SJA authority to carry an EpiPen in Mobile FA posts "for use by a physician or his/her designate."
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Dave Wakely
Senior Member
Username: Harrypotter

Post Number: 53
Registered: 03-2003
Posted on Tuesday, April 26, 2005 - 01:29 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Adam,
If you look at the training sylabus from MOST US EMT B,D and I programs you will notice very little theory. EMT-P tends to be a much longer course because they have to back teach the things learned at a lower level here. Dr. Bledsoe(considered a Leading expert in EMS) discribed the level of knowledge in ON as a pyramid. Lots of knowledge builds a base which we can make decisions. In the same article he described the US system as an upside down pyramid where they teach only the very basics to everyone but advanced providers resulting in bad decisions being made by lesser trained personel.

25 years ago Ambulance service was in it's infancy(and didn't give any drugs). St John was responsible for training lots of driver attendants of the day. Since that time EMS has grown from FCC, EMCA and finally to AEMCA. St John still offers first responder courses and still isn't an ambulance service.

Steve to clarify SIAT says the hours listed do not include rideouts (as per thre website). Why does anyone argue for less training for people in medicine. The doctors used to be trained by the local barber we moved on. You will notice that average life span has increased since the time of barber-surgeon.
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 25
Registered: 04-2005
Posted on Tuesday, April 26, 2005 - 07:31 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Dave, thanks for posting that informative information, I wasn't aware of all of the USA EMS stuff...interesting key points.
Thanks,
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Steven Boa
Member
Username: Xlq771

Post Number: 13
Registered: 02-2004
Posted on Tuesday, April 26, 2005 - 08:12 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Dave,

The SIAST Primary Care Paramedic program consists of 396 hours classroom instruction over 13 weeks, followed by a practicum of 174 hours, for a total of 570 course hours. Course # EMER 163 is the field placement on an ambulance. Course # EMER 165 is the clinical placement in a hospital. The website address is www.siast.sk.ca/siast/educationtraining/appliedcertificate/h ealthapplied/pcparamedic.htm
Please read the length of the program section. Sandy Peach is the contact for the program at SIAST. She can be reached at the phone number listed on the website, which is (306) 798-1429 if you don't believe me.

In choosing a paramedic school, I have all but eliminated Ontario schools because of some of the things I have been told by the program directors. I have been lied to by one, who told me his program is CMA accredited, when the CMA says the school has not even applied for accredition. I asked one program director why the program is 2 years instead of 1 year or less like other provinces, and I was told that the paramedic unions wanted the program increased by a year so that they can negotiate better contracts with their employers - they can't justify $20+ an hour for someone with a one year certificate. I was also told that some advanced paramedics want to be considered doctors, just as a dentist, or eye doctor is. All of this literally destroys the credibility of the colleges in question, and by extension paramedics in general. The government is never going to grant paramedics request for a College of Paramedics if they act like that, or insult other agencies. How many paramedics have called SJA scabs, or firefighters, or patient transfer services?

SJA stopped being just first aiders when they start using oxygen, or backboards, or traction splints. They have become a first response agency. A first aider is specifically defined in legislation (OHSA, Regulation 1100 I believe) as someone trained in Emergency First Aid or Standard First Aid, as defined by WSIB Ontario. Go beyond this, and you stop being just a first aider.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 257
Registered: 07-2003
Posted on Tuesday, April 26, 2005 - 08:59 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steven,

I find it ironic. Before you seemed to want us to get all the training we can and eseentially be Paramedics and now you're putting them down? Which is it?
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Dave Wakely
Senior Member
Username: Harrypotter

Post Number: 54
Registered: 03-2003
Posted on Tuesday, April 26, 2005 - 11:01 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Steve.
First let me catch the point that causes me the most discomfort. SJA as scabs. In the unlikely event that SJA transfers patients in an emergency manner(or responds to 911 calls) while EMS is in a work to rule position they are scabs(replacing union workers attempting to effect change with their employer). It is not name calling it is fact. Most brothers and sisters in trade unions would not haphazardly call someone a scab. By your own admision you have a lot to learn about SJA, there may be a history with which you are not familiar.

Second, let me apoligize. Upon closer review it appears I was wrong about the SIAT program.

Third, first aider as defined in WSIB is for the purpose of work place safety legislation. One could argue "the minister" is defined as the minister of health as per the ambulance act and therefore no other provincial cabnet members are ministers...logic wins out you can not use an isolated definition in an act to define a general term.

As far as the credibility of paramedics, having a two year program gives credibility it doesn't remove it. Why do you find it so hard to learn more? what if in that extra year you learn something to help your patients?

"I am nowhere near the level of knowledge that paramedics have, and I certainly have a lot to learn, both about EMS, and SJA"
I agree whole heartedly. How do you expect to gain the level of knowledge in half the time? With half as much training you may be a safe paramedic (ie. not kill anyone) but you probally won't be a great medic either(at least not for a little while). WHY DON'T YOU WANT TO LEARN? If you truely wanted to be a paramedic you would be looking to take the MOST in depth course offered! I take pride in my profession and would have gone to school for ten years if I needed to in order to do it! I would go so far as to tell you if you have no intrest in learning as much as you can you might as well stay home and save you tuition dollars because if you do not have the interest now it is only going to go down hill. And I for one have no interest in working with or having as a provider someone with such a poor attitude toward education.

"How many paramedics have called SJA scabs, or firefighters, or patient transfer services? "
I think your asking who has made fun of SJA, FF and transfer services? I don't really know where this came from but can you clarifywhat you are talking about?
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 26
Registered: 04-2005
Posted on Wednesday, April 27, 2005 - 01:43 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I agree with Dave, why wouldn't someone want to take the absolute best program offered instead of a shortened up version. I for one am not a Paramedic and I don't for see myself ever becoming one, I have the up most respect towards paramedics though and I am sure glad to have such well trained EMS in Ontario.

On note of the quote though regarding EMS making fun fire fighters, SJA, transfer services, I'm not sure where this came from but I know for a fact that there is stuff like that mentioned, in the area where I live I don't think it is a huge problem, our local fire fighters are good patient care providers, the local SJA Brigade has a great rep, as far as the local transfer services go...for majority it is staff half with SJA volunteers and fire fighters... I can only speak for my area...
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Melissa Yingbull
Senior Member
Username: Mying

Post Number: 97
Registered: 11-2002
Posted on Wednesday, April 27, 2005 - 07:46 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Apologies, but I feel this needs a response
...use St. John as a starting point for a medical profession. But, go to school and become a healthcare worker.

Or don't and that's just as good.

The purpose of St. John Ambulance, at its beginning, was to train lay men and women to provide qualified first aid care, and thereby increase the number of first aiders in a given community, whether or not they were on duty. My great-grandfather wasn't ever in professional health care during his 20+ years as a "Johnnie" in the UK. He, like most of his contemporaries, did it because they enjoyed learning, drilling, and providing good care, and they felt it was their civic duty to do something. The explosion in membership around the time of the world wars speaks to that. Regular joes and janes, bus drivers, teachers, housewives, engineers, plumbers: they joined St. John, they manned highway first aid posts, and hauled marathon swimmers out of the lake. They did it because it was social responsibility, and it meant they were ready for the next war, on the field or the homefront, and because it meant they were ready for the accident at work, and it meant less strain on the municipal systems. The primary focus was never the preparation for health care careers, that's just a side effect.

If St. John were nothing but a springboard for healthcare careers, it would lose much of its purpose and value, and all of its attraction for long-term membership. JMHO, of course.

It's great that SJA helps people pursue their healthcare careers, and it's great that SJA has such resources in its HCP members -- and I have heard that there are plans to at least facilitate certification for such members, we all just haven't heard the official word yet. But. It is folks like Mr. Guerin who fuel this organization, and who give it its purpose, and who have my utmost respect.

You may now return to your regularly scheduled on-topic back-and-forthing. :-)
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 27
Registered: 04-2005
Posted on Wednesday, April 27, 2005 - 07:57 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks Melissa for your constructive input.
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 28
Registered: 04-2005
Posted on Wednesday, April 27, 2005 - 08:19 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

On another note. The mentioning of Paramedics calling other service providers scabs... I can't say I agree with this being okay no matter what the situation, last I heard we were all uniformed to serve and protect. Some people may need to think about this for a second but to me it's as clear as day.
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Robert McKay R.R.T./R.R.C.P.
Junior Member
Username: Mckayrob

Post Number: 10
Registered: 06-2004
Posted on Wednesday, April 27, 2005 - 10:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Melissa,

I was not trying to say that SJA is only good for starting a health care career. I am a healthcare worker. I joined SJA after I finished school. I joined to provide first aid. My point was that SJA is FIRST AID, not medical aid. Providing SR is getting into medical aid, and I do not agree that SR is something that SJA should get into. I was trying to say that those members who wish to provide that kind of care should also think about moving into health care.

For those members who say that since we provide oxygen and other types of advanced care, I say that we are providing Advanced First Aid. I hold firm that we should not push SJA to becoming a medical aid service. My brigade does not perform many advanced care services, but that is due to lack of available resources for training. If my members felt competent enough to backboard, it would be there choice whether to backboard or not. Personally, I would not. Mainly because the Paramedics' response time here is very quick and I would rather have them provide those services.

Adam,
I completely agree with your statement on calling people scabs. Also, how can an unpaid volunteer be a scab? They are not taking anybody's job. Food for thought?

Rob Mckay
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Adam W. Guerin
Intermediate Member
Username: Adam

Post Number: 30
Registered: 04-2005
Posted on Thursday, April 28, 2005 - 12:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Just to add. A number of Divisions do still lack training aides do to lack of training resources... the new training module AMFR is going to try assist this issue and bring a way of standardized training across the board so to speak. It'll all take time but I am sure something will work.
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Dave Wakely
Senior Member
Username: Harrypotter

Post Number: 55
Registered: 03-2003
Posted on Thursday, April 28, 2005 - 01:31 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Adam,
Scabs are scabs. The idea of contracting a security company to replace police officers is as silly as SJA replacing paramedics. The ambulance collective bargaining act has taken away most of paramedics rights to take meaningful action against the employer and SJA would be further subverting this. We are not all uniformed to serve and protect. SJA is uniformed to provide first aid services not medical transport.

This is an ugly argument that I for one am not really interested in having. Lets let sleeping dogs lie and walk away from this one.

Dave
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Adam W. Guerin
Advanced Member
Username: Adam

Post Number: 31
Registered: 04-2005
Posted on Thursday, April 28, 2005 - 02:17 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Who said ANYTHING about SJA replacing Paramedics ?????????????????????????

I am sorry but I don't agree.

And when I put on my uniform I am stressed to serve the community, If I am on the way to or from a duty and stop at a house fire, MVA, or someone yelling help as there friend in the river drowning, I will act to serve, and indeed protect who and what I can.
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Adam W. Guerin
Advanced Member
Username: Adam

Post Number: 32
Registered: 04-2005
Posted on Thursday, April 28, 2005 - 02:21 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I think some of us see things in a different perspective, I see it as serving and helping out when someone needs it most, I personally don't care what uniform someone may wear, we are trained to HELP.
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Paul W. J. Irwin
Senior Member
Username: Pirwin

Post Number: 112
Registered: 02-2003
Posted on Thursday, April 28, 2005 - 03:14 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Members may well recall that during a union action in recent years, SJA Ontario issued a memo offering direction to any Community Service Unit that might have been approached for services.

Should any Community Services Unit ever be approached under such circumstances, I would recommend that direction of such requests be made to the appropriate person(s), such as those in your Ontario Council Office.
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Adam W. Guerin
Advanced Member
Username: Adam

Post Number: 37
Registered: 04-2005
Posted on Friday, April 29, 2005 - 01:01 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Kinda brings back the memories of our Divisions assisting Toronto EMS during the SARS epidemic when SJA acted as Auxiliary EMS so to speak, responded to patient transfer calls as well as a couple Code 4 calls as I recall. I recall some Medics feeling against this and other were all for it. It's a catch 22 situation I guess, we can't please everyone but our job is to help those in need.
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 38
Registered: 08-2004
Posted on Friday, April 29, 2005 - 01:20 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I guess it is a matter of wether the medics are looking at things in the long-term or the short.
As medics are generally patient advocates, and SJA was providing a valuable service, many were supportive. However, those medics with a little more time on the road are more likely to look at the longer term ramifications of someting. If SJA was needed to provide a service, should htere not have been Healthcare funding from the MoH given to Ambulance Services to provide that care. When was the last time you were cared for by a volunteer nurse in the hospital, or were pulled over by a volunteer Police Officer? So why do we accept that pre-hsopital care can be provided by volunteers on a regular basis? Standby first-aid is one thing, but EMS response or transport is another.
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Adam W. Guerin
Advanced Member
Username: Adam

Post Number: 39
Registered: 04-2005
Posted on Friday, April 29, 2005 - 01:54 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Yes I agree with you on this and you've made good points as to why the MOH didn't fund for more Medics. However in the short term effect SJA's role is to provide Disaster Response.

This is a topic of interest though...
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Adam W. Guerin
Advanced Member
Username: Adam

Post Number: 40
Registered: 04-2005
Posted on Friday, April 29, 2005 - 01:56 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Actually to add to this, I have been handed a speeding ticket by an auxiliary OPP officer, in my own car...

;)
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 39
Registered: 08-2004
Posted on Friday, April 29, 2005 - 01:58 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Yes, but unless in the company of a Police Officer, Auxilliary have no power.
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Adam W. Guerin
Senior Member
Username: Adam

Post Number: 41
Registered: 04-2005
Posted on Friday, April 29, 2005 - 02:00 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Actually under an emergency situation auxiliaries can carry power. I have friends with the RCMP.
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Paul W. J. Irwin
Senior Member
Username: Pirwin

Post Number: 113
Registered: 02-2003
Posted on Friday, April 29, 2005 - 03:05 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

An Auxiliary Police Constable or Special Constable, while on duty in that capacity, is by legal definition a Peace Officer. They are acting under the authority of law, and are sworn to an oath of secrecy, as are regular Police Constables. They are even issued firearms from time to time, but not normally sidearm. Case in point; two OPP Aux. PC's were sent to a domestic call by the Duty Sgt. in a community in the GTA. They were issued a shotgun and assigned to the call, which they completed.

As stated previously, the SJA role in the community, outside of regular duties, is to respond to community needs in a Disaster. This is when the normal resources of a community have been overwhelmed by the needs of the community in the given situation. Such services may be under the direction, or alongside, of a community partner agency. These may include EMS, Canadian Red Cross, or otherwise as directed by the Municipality, Province of Ontario, or the designate as applicable. Always ensure that you and your Members are qualified to meet these needs if called upon.

SJA will likely take time to attain the currently proposed levels of training. I would encourage continuing medical education and training without losing touch with the basics. Should a higher level of education be desired by a Member, they are available through several avenues, as have been stated.

;-) "BE GOOD ALL DAY"
Paul
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Simon Martin, A-EMCA, CCP(Flight)
Advanced Member
Username: Als_medic

Post Number: 40
Registered: 08-2004
Posted on Friday, April 29, 2005 - 03:48 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Paul,
Sorry if I offended. My comments were based on my recollections of the Police Services Act, which I last read in school in 1997.
In thinking through this, I have actually changed my views slightly.
In Canada we have a long tradition of community involvement in many services. We have long had citizens, who were volunteers (or paid an honorarium), who provided services, or assisted with services in times of need.
We have Volunteer Police Auxiliary Members who assist their community's Police forces in a day to day basis, but to a greater extent with large scale incidents, that stretch the limits of available resources.
Many communities rely on Volunteer Firefighters for their rescue and fire suppression needs.
Even our Armed Forces relies heavily on the "Citizen Soldiers" in our Militia and Reserves.
Perhaps we need SJA to have a better established relationship with EMS, across the country. If SJA can maintain a constant level of training and competency, could this not be possible.
For this to happen a lot of work would be required and formal, legal recognition would be required (i.e. Ambulance Act) and if Professional Regulation comes along, then registration of ALL qualified members with the College. Realistically I don't think this will ever happen for many reasons. SJA is a fiercely independent organization and having to follow regulations imposed by others (EMS, MoH) might not go over well. That and whenever a unit was staffed, it would have to be with at least two members, qualified to an appropriate level (EFR, MFR, whatever), appropriately stocked (Ambulance equipment, AED etc). Any time this was not followed and you have a MAJOR problem.
Also, many SJA members do not wish to do EMS work. Many joined to provide some service to their community and are very happy working competently at a BTS1 level. So unless you split SJA or each division into first-aid and volunteer EMS.............
Enough of my rambling........
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Paul W. J. Irwin
Senior Member
Username: Pirwin

Post Number: 114
Registered: 02-2003
Posted on Friday, April 29, 2005 - 04:20 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

No offence taken Simon. It must of course be recognized, as you have touched upon, that there is much work to be done.

There are more Paramedics and SJA Members than vehicles. Partnerships in times of need could well include the partnering of Professional Paramedics with SJA Members to better meet the needs of the community in a disaster. Thus a given patient has access to the best in first aid and paramedic care. What are people more likely to require? Why not offer both.

The minimum qualification will soon be based on the new program for Patient Care Services Members. Practice, practice, practice, by all of us, professional and volunteer alike.

Vehicles are of course going to have to meet the minimum standards required. SJA does have a limited number of vehicles, but could have 20 to 50 into most Ontario communities within 48 to 72 hours.

Members can have many roles, and would be required at shelters doing duties just like at duty events. Members who are not qualified to do patient care may well be very busy in other roles, as they have in the past, including Youth Services Members.

People should always be prepared to support themselves for about the first 72 hours after a disaster strikes.

;-) "BE GOOD ALL DAY"
Paul
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Simon Martin, A-EMCA, CCP(Flight)
Senior Member
Username: Als_medic

Post Number: 41
Registered: 08-2004
Posted on Friday, April 29, 2005 - 05:16 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Paul reminded me of a few more things that would be needed.
Driver training; and not just how to drive the unit, but proper Emergency Vehicle Operations.
Proper documentation skills; like how to properly complete an ACR.
Experience; not easy to come by, but with more formal interaction with EMS, perhaps rideouts as part of training might be an idea.
EMS Auxilliary or Ambulance Auxilliary doesn't sound too bad, does it? Adequately expresses a role, without implying that jobs are being taken away. Because if people feel their livlihood is threatened, they are prone to get defensive.
Municipalties cannot afford to provide EMS staffing at events and I think an integrated role with SJA and EMS could work. It did in the past at events like the Molson Indy and the CNE, with SJA staffing units (carts and 100 series units) that were dispatched by Toronto EMS. Just need to take this even further.
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Adam W. Guerin
Senior Member
Username: Adam

Post Number: 50
Registered: 04-2005
Posted on Friday, May 20, 2005 - 02:21 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

lets not forget another well trained volunteer group of individuals who serve and protect in all weather and situations, I am talking about the Canadian Coast Guard Auxiliary. Just another volunteer organization that plays a huge role, and these people training often in everything from medical treatment to jumping from helicopters..
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Simon Martin, A-EMCA, CCP(Flight)
Senior Member
Username: Als_medic

Post Number: 52
Registered: 08-2004
Posted on Sunday, August 07, 2005 - 05:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Adam, While I highly commend anyone who volunteers their time to contribute to their community, please get you facts straight. The Coast Guard Auxilliary (CCGA) is all about water borne vessels. Even Canada's Coast guard (CCG) is not primarily tasked with airborne search and rescue (SAR), but will send helicopters if they are avialable and in the area. Most CCG helicopters are not equipped or staffed for rescue work and certainly not by the CCGA. In Canada, Primary SAR is the responsibility of the Armed Forces and is Provided by dedicated personnel and aircraft at various bases across the country, including CFB Trenton, Gander, Greenwood, Comox etc.
If you'd like to know more about Canada's SAR system and the SAR Techs that do the rescues, read my upcoming article in the October/November 2005 edition of Canadian Emergency News (part of the series I'm writing entitled, "EMS Extremes".
As for the medical side of the CCG, there is so much inconsitency in the services they provide, they won't even talk about the medical traiing they get. Whil they do have a few techs trained basically as PCPs, they are all on the west-coast on the hovercraft. The rest all just do first-aid, at least that is all I've ever seen done when I've been on calls with them.

(Message edited by als_medic on August 07, 2005)
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Adam W. Guerin
Senior Member
Username: Adam

Post Number: 53
Registered: 04-2005
Posted on Sunday, August 14, 2005 - 05:03 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Interesting facts here. Sorry I don't have much spare time on my hands to further more investigate these issues.

Cheers all!

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Adam W. Guerin
Senior Member
Username: Adam

Post Number: 56
Registered: 04-2005
Posted on Sunday, August 14, 2005 - 05:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Last I recall hearing from a friend of mine who is active with CCGA is that they were registered for MFR training. Hundreds of lives yearly are saved due to their efforts. Like anything else I am sure over time the CCGA will upgrade their training if they haven't already. I know the CCG-(A) is interested in the SJA-AMFR-1&2 programs.it's the aspect of being able to afford to train these people. It'll all come together.

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