# BC (Canada) PCP additions



## blindsideflank (May 4, 2014)

Primary care paramedics in British Columbia have some changes on the way. An anti emetic  (presumably gravol),  possibly TXA, CPAP, 12 lead ecgs (in select areas,  and cyanide poisoning kits.

Pretty cool for them, any emts out there using cpap in your service? Is it bein used appropriately?

Our critical care guys are now puttin in arterial lines too, but not that exciting.


Bc has a service that really fails to serve the rural areas (tiered ALS response available only in metro areas) and its cool to see the BLS cars get to offer more. Hopefully some pain control one day.


----------



## Medic Tim (May 4, 2014)

blindsideflank said:


> Primary care paramedics in British Columbia have some changes on the way. An anti emetic  (presumably gravol),  possibly TXA, CPAP, 12 lead ecgs (in select areas,  and cyanide poisoning kits.
> 
> Pretty cool for them, any emts out there using cpap in your service? Is it bein used appropriately?
> 
> ...



I just got the email about that. I wish I had had access to antiemetics when I was a pcp. 
Hopefully their next project is making emaccs login more user friendly.


I have been told PEI is looking to add fentanyl to the pcp scope under strict protocols... and allowing pcp to work under the acps license.ex acp instructs pcp to push an epi amp during a code.


----------



## WolfmanHarris (May 4, 2014)

Are the increasing the didactic time for BC as well?

Anti-emetics and benadryl were added to the PCP scope in Ontario recently. IM/IV toradol is currently an auxiliary directive and my Base Hospital has chosen not to implement it yet since the directive is going to be adjusted significantly in the next few months and they didn't want to roll it out only to change it almost immediately.

We've had CPAP for a couple years and 12 lead (medic interpretation) with direct bypass to PCI for some time.

Otherwise the only big things coming down the pipe here are some community paramedicine initiatives that would see us transporting to urgent care for some patients rather than ED and a few other care pathways (especially for LTC patients). Those are held up with the Ministry of Health from what I understand.


----------



## Medic Tim (May 4, 2014)

BC has schedule 1 and schedule 2 pcp. The added meds and scope is for the schedule 2 PCPs . Schedule1 are bare bones pcp ... I don't believe they even do IVs . They also need to go through training before they are cleared to administer / use the new meds/skills .


----------



## ThadeusJ (May 5, 2014)

A lot of the US states allow CPAP to be used as a basic level skill.  New York is in the process of introducing it now.


----------



## blindsideflank (May 5, 2014)

Ontario rocks, I dream of a 2 year pcp program here.

Not fan of toradol, do the pcp's find much use in it? In bone breaks mostly? 

Wolfman do they carry gravel only? Zofran?


----------



## Av8or007 (May 5, 2014)

Ontario is good, but you guys in BC have got the right idea with tx guidelines. Ontario is still really cookbook in regards to protocols.

BLS standards are a relic from the late 90's...

The only anti-emetic is gravol IV/IM and in some cases PO.


----------



## WolfmanHarris (May 6, 2014)

Av8or007 said:


> Ontario is good, but you guys in BC have got the right idea with tx guidelines. Ontario is still really cookbook in regards to protocols.
> 
> BLS standards are a relic from the late 90's...
> 
> The only anti-emetic is gravol IV/IM and in some cases PO.



Standards are only getting worse with the standardized protocols. Thankfully I'm under one of the better base hospitals, but the way some of the other BH's are holding everyone back in ridiculous. Don't even get me starting on MOH EHS branch.


----------



## Av8or007 (May 6, 2014)

To me the BLS standards are even worse. 

1. Oxygen is a medication, not a cure all. O2 is only indicated for S/Sx of hypoxia and or a SpO2 ≤94%. Non hypoxemic chest pain doesn't need o2.

Make pulse oximetry part of the prov equipment standards. The fingertip units are cheap if a service doesn't already have spo2 (which they should).

2. Spinal immobilization for all. Don't even get me started...
----------
As for the ALS, the pain protocol is terrible (for all levels but especially ACP).
Naloxone shouldn't require a patch and what is with only giving one dose of epi for anaphylaxis/severe asthma (when a wilderness FR can give more with an 80 hr course)...

And the icing on the cake - no matter what the directive for pcp's states, King LT sga's CAN be used outside of cardiac arrest as long as BLS airway has failed and pt is gcs of 3.


----------



## ChillbroSwaggins (May 6, 2014)

Av8or007 said:


> To me the BLS standards are even worse.
> 
> 1. Oxygen is a medication, not a cure all. O2 is only indicated for S/Sx of hypoxia and or a SpO2 ≤94%. Non hypoxemic chest pain doesn't need o2.
> 
> ...



Let's not forget some of the ridiculous patch points. I can just imagine the conversation the medical advisory council had when writing our protocols.

"Are our ACP's with 3 years of college education smart enough to administer Narcan under their own judgement....na they're way to stupid. Let's make it mandatory for them to patch and consult with a physician first. That's certainly not a giant waste of time."


----------



## Av8or007 (May 8, 2014)

Or the fact that cric and needle decompression require a patch.

Some of these protocols are so restrictive they are almost negligent...
..


----------



## Medic Tim (May 8, 2014)

I knew Ontario was restrictive but didn't realize it was that bad.


----------



## medicasaurus (May 10, 2014)

We have EPOS in BC now... which is a Doctor on call to discuss treatment options or to determine discontinuation vs transport in cardiac arrest. It is also used to discuss cases of intoxicated refusal and the like. However my treatments are my own and other than to discuss cases (particularly in arrest or refusals) we don't call.

I have called 3 times in 3 months. Twice on cardiac arrest to discuss early transport and possible causes of arrest. Once to discuss an intoxicated head trauma refusing to be assessed. All discussions were professional discussions not "mother may I". It stuns me to think you have to call for Naloxone or for life saving interventions. Treatment Guidelines are awesome btw our latest are here --> bctg.bcas.ca


----------



## Av8or007 (May 10, 2014)

To me, tx guidelines are what ALL Canadian services should be doing for the majority of treatments.
Especially in Ontario where the PCP program is 2 yrs in length.

Ontario is trying to implement some of that community medic stuff - i don't know how that's supposed to work when you can't even (insert one of many issues here, see above)...

Anyone have any ideas why Ont. is so  behind the curve on both the protocols and autonomy fronts?


----------



## AsAlways (May 11, 2014)

Av8or007 said:


> To me, tx guidelines are what ALL Canadian services should be doing for the majority of treatments.
> Especially in Ontario where the PCP program is 2 yrs in length.
> 
> Ontario is trying to implement some of that community medic stuff - i don't know how that's supposed to work when you can't even (insert one of many issues here, see above)...
> ...



Because paramedics are not a regulated health profession in Ontario (no college of our own under the regulated health professions act), and as such the profession is completely controlled by physicians.

As you know paramedics in Ontario are only permitted to perform controlled medical acts because they are delegated this ability by their medical director (an emergency physician who runs one of the 7 base hospitals). Since we're technically working under their license I assume they're very skiddish about what they let us do, since it's technically their license on the line. They'll never face direct action though, as they make the protocols insanely restrictive to cover their *** and make sure they can always point the finger at you for messing up any aspect of them.

Until we get a college and get our own licenses I don't see this changing. Unfortunately that may never happen, as the Ministry of Health inquired into the formation of college of paramedics and has received advice against it (much of which comes from the base hospitals surprise surprise). No final decision has been made but it mostly looks like we won't get a college. The medical directors don't want to relinquish control for whatever reason, and our autonomy suffers despite having some of the highest education standards in Canada.


----------



## Av8or007 (May 11, 2014)

Does BC have a college of medics? The whole tx guidelines thing seems very progressive.


----------



## medicasaurus (May 12, 2014)

We are licensed through the Emergency Medical Assistant Licensing Board (EMALB). The Treatment Guidelines are driven by the provincial ambulance service (BC Ambulance) and are endorsed and supported by EMALB.


----------



## fortsmithman (Jun 22, 2014)

AsAlways said:


> Because paramedics are not a regulated health profession in Ontario (no college of our own under the regulated health professions act), and as such the profession is completely controlled by physicians.



Sounds like what we have in the Northwest Territories,  where it's up to our individual medical directors what we can and cannot do.


----------



## Av8or007 (Jun 22, 2014)

fortsmithman said:


> Sounds like what we have in the Northwest Territories,  where it's up to our individual medical directors what we can and cannot do.



Its worse in a way in ontario, since if there was a med director that was aggressive and progressive they are held back by "provincial standard" to the lowest common denominator...


----------



## Medic Tim (Jun 22, 2014)

fortsmithman said:


> Sounds like what we have in the Northwest Territories,  where it's up to our individual medical directors what we can and cannot do.




Not quite. Ontario has provincial standards for education and licensing. They just have little to no say in it.(from what I am told) there are some variations in protocol but Ontario is quite restrictive when compared to other parts of Canada. 
I may be wrong but the nwt has absolutely no set standards on education or licensing beyond working under a doctors authorization. Most job posting I see for up there require licensure from another province.


----------



## fortsmithman (Jun 22, 2014)

Medic Tim said:


> Not quite. Ontario has provincial standards for education and licensing. They just have little to no say in it.(from what I am told) there are some variations in protocol but Ontario is quite restrictive when compared to other parts of Canada.
> I may be wrong but the nwt has absolutely no set standards on education or licensing beyond working under a doctors authorization. Most job posting I see for up there require licensure from another province.



You are not mistaken.  We do not have any legislation here.  It's pretty much what the medical director says.  Most if not all mineral exploration companies who hire EMTs/PCPs and EMTPs/ACPs here in the NWT require registration with one of the provinces.  My service for example we try to follw that standards set forth by the Alberta College of Paramedics as we are on the Alberta / NWT border.  Part of our service area is in Alberta.


----------



## Afterbang (Sep 17, 2014)

This has been a really interesting read! I'm a PCP student in ontario partway through my second year. I'm planning on continuing my education and finishing my ACP course right away then id love to move back home to work BC! Reading about the differences is pretty cool, id love to hear more info because around here all you really hear about is whats happening within the province. Anyone know how smooth or hard or a transition that is (going form On. to BC.) 

*dont mean to threadjack! haha


----------



## cprted (Sep 17, 2014)

I'm licensed in three provinces (BC, AB, Ont) and I can say once you get your initial license, getting licensed in another province is pretty straightforward.


----------



## Medic Tim (Sep 17, 2014)

cprted said:


> I'm licensed in three provinces (BC, AB, Ont) and I can say once you get your initial license, getting licensed in another province is pretty straightforward.


This ^^^ 
I am licensed in BC, AB, NB and until last year NS. 
Once you license in 1 province, you can transfer it into any other without having to retest (You will most likely have a small test on specific provincial laws and regulations) But they are usually pretty easy. Also be aware that while a license will transfer you may not get full scope and may get restrictions on your license.


----------



## Afterbang (Sep 17, 2014)

sweet thanks for the feedback! All and any info is appreciated


----------



## gnosis (Sep 20, 2014)

I seem to recall getting an email a procoagulants coming down the pipeline as well, but I haven;'t heard anything about it since then. Has anyone heard any news since then?


----------



## cprted (Sep 20, 2014)

Still in the pipeline as far as I know.  CPAP for BLS will be coming out this fall with the AIME update course.


----------



## gnosis (Sep 20, 2014)

Very nice. Good to know.


----------



## jcroteau (Sep 22, 2014)

I wouldn't recommend going straight to acp with no time working as a pcp


----------



## Afterbang (Sep 22, 2014)

could you elaborate as to why? lack of experience that im assuming?


----------



## MedicDelta (Sep 27, 2014)

Afterbang said:


> could you elaborate as to why? lack of experience that im assuming?


Most colleges requires you to have actual working time as a PCP. The Justice Institute of British Columbia for example require you to have a minimum of 1 year experience as a PCP before entering their ACP course. I would also not recommend going straight into an ACP course. It's very technical and experience is nothing but an asset.


----------



## Afterbang (Sep 27, 2014)

interesting. ..my college dosent require pcp experience but its a part time course so you can work at the same time you complete your ACP.


----------



## fortsmithman (Sep 30, 2014)

MedicDelta said:


> Most colleges requires you to have actual working time as a PCP. The Justice Institute of British Columbia for example require you to have a minimum of 1 year experience as a PCP before entering their ACP course. I would also not recommend going straight into an ACP course. It's very technical and experience is nothing but an asset.



As far as I know SAIT, and NAIT only require you be a registered EMT/PCP.  Medicine Hat College has a 4 yr zero to hero Bachelors program for EMTP/ACP, and they don't even require you be an EMR to enter their program.  Why is EMS different from the other medical professions,  RNs don't have to be LPNs and MDs and DOs dont have to be PAs, so why does one have to have experience as a lower level provider in EMS.   In Alberta for those that don't know they call their PCPs EMTs, and ACPs are called EMTPs


----------



## MedicDelta (Sep 30, 2014)

fortsmithman said:


> As far as I know SAIT, and NAIT only require you be a registered EMT/PCP.  Medicine Hat College has a 4 yr zero to hero Bachelors program for EMTP/ACP, and they don't even require you be an EMR to enter their program.  Why is EMS different from the other medical professions,  RNs don't have to be LPNs and MDs and DOs dont have to be PAs, so why does one have to have experience as a lower level provider in EMS.   In Alberta for those that don't know they call their PCPs EMTs, and ACPs are called EMTPs


The JIBC require you to be a certified EMR before entering their PCP course, and before you enter their ACP course you have to have a minimum of 1 year working as a PCP. I agree with the way they do this because you have to be good at the basics before you can move on to the more advanced stuff. Doing it this way also increases your chance for success, in my opinion. Obviously not all colleges are the same though with their requirements. In Ontario you go straight into a PCP course usually with just a Standard First Aid and CPR/AED certificate being required. That's because EMR doesn't exist in Ontario. The reason the JIBC does it the way they do is because of the reasons I mentioned. And I really don't think that's a bad idea. Also, you do have to be an RN before becoming an NP as a side note.


----------



## cprted (Oct 1, 2014)

MedicDelta said:


> The JIBC require you to be a certified EMR before entering their PCP course, and before you enter their ACP course you have to have a minimum of 1 year working as a PCP. I agree with the way they do this because you have to be good at the basics before you can move on to the more advanced stuff. Doing it this way also increases your chance for success, in my opinion. Obviously not all colleges are the same though with their requirements. In Ontario you go straight into a PCP course usually with just a Standard First Aid and CPR/AED certificate being required. That's because EMR doesn't exist in Ontario. The reason the JIBC does it the way they do is because of the reasons I mentioned. And I really don't think that's a bad idea. Also, you do have to be an RN before becoming an NP as a side note.


The JI's PCP program is also an accelerated program, hence the reason for the EMR prereq.


----------



## MedicDelta (Oct 1, 2014)

cprted said:


> The JI's PCP program is also an accelerated program, hence the reason for the EMR prereq.


So is the one here in Nova Scotia with Medavie HealthEd, no EMR requirement.


----------



## cprted (Oct 1, 2014)

MedicDelta said:


> So is the one here in Nova Scotia with Medavie HealthEd, no EMR requirement.


Medavie's PCP is still longer than the JI's by over a month ... not arguing that short is a good thing by any stretch of the imagination.


----------



## Medic Tim (Oct 1, 2014)

EMR is not an EMS license level in NB and NS. The medavie program is about 10-11 months all said and done. I have worked with a few BC PCPs who got their pcp in about 6.

I worked 3 years as a PCP before going on to ACP. I wish I had gone back to school much earlier. My acp program had a mix of experience and zero to hero. The guys with no experience had a harder time on truck and in the hospital as they were still learning to interact with pts. They also had a harder time taking control of a scene and the general everyday "operations".

The problem with experience is that not all experience is the same. Some is good, some is great, and some is horrible.


----------

