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We've carried it in our flight program for 3 years now with decent success (mostly anecdotal, with no evidence of harm). It is now being rolled out to our group ACP (Paramedic) crews. There is design to put it out to the PCP crews in the future if the initial introduction to ground is successful.

The lidocaine comment was a little facetious. Yes, it has use but as was mentioned, 2nd line for the most part. That said, I have had good success with it.

I found this with a quick search - gives a basic explanation well enough: http://www.swgeneral.com/assets/1/7/EMS_Calculating_Drip_Rates.pdf But I have to be honest, deeply learning and understanding the math - concentrations, drip sets, etc - will serve you far better in the long run...

Sure, you could take them. But be warned about becoming a bit of a badge collector. The greatest asset you can acquire is some experience. Seeing one person with experiencing an MI is not the same as seeing the next person with an MI. Only a bit of time and volume can teach that. I don't...

Obviously one had to take into account other factors and medications when determining analgesia requirements, anticipated effectiveness and risk. With regard to the remembers pain I was reflecting on a recent clinical rounds I attended where an anesthesiologist mentioned that the perception of...

I would hardly call a total of 10mg of MS extreme. But I do have to agree with the addition of a sedative to common analgesia when the occasion demands it. Someone mentioned burns and this is certainly a good case, as is other areas where the pain is extreme or manipulation will cause pain to...

I understand that most PEA protocols would have a bolus of some volume to account for the possibility that the issue is one of preload/straight-up hypovolemia. I'm just saying that if D50W is given, the benefit may be derived from the osmotic pull and subsequent repletion of intravascular...

It seems unlikely that a cardiac arrest would have a solely hypoglycemic etiology, even given the possibility presented of a prolonged QT. I wonder if some of the anecdotal effect of D50W administration might not be due not to the sugary-goodness but rather to what is essentially a fluid bolus...

Here we run a CCP/CCP model for all critical care transfers withing the province. Our CCP training above ACP (Paramedic) is 2 years. During our program we complete the post-RN courses in crit. care nursing from a well-respected post-secondary institution here. The rest of our program is...

Different here, pre-hospital and air is provincial so one service for about 4m. They don't want to spend money. Having worked here I can see it both ways. Sure a town should have ALS but will they be good? ALS here is targeted and in higher volume areas so pretty good for skill maintenance etc.

Sure, and that's fair. Expansion has to come with training and experience. Of course, people are aware of scope creep; adding protocols without the requisite training is foolhardy. In our area it works and provides for needs of areas without ACP(ALS). For instance, a town of 30,000 people...

In BC it's long been a tiered system, and one that we would never trade. Having ALS everywhere is useless, IMO. Our PCPs have a scope including epi (drawn), ventolin, IVs, D10W, N/S, ASA, Ntg (if Rx), nitrous, and glucagon. It works fine and many towns don't have ACP (medic) - only urban...

Miley Cyrus

Ah, that makes sense then. We do have EMRs in smaller communities but the majority are PCP. It's been a big change. When I started our scope was about the same as what's been discussed here for EMTs.

Never occurred to me that they couldn't check glucose. Up here the EMTs (PCPs as we call them) start IVs, defib, blood glucose, starting a 12-lead cath lab trial, give neb ventolin, ASA, narcan, D10W, glucagon, nitro (if previously prescribed), epi for anaphylaxis. For a hypoglycemic pt they...

Different in Canada. National standards exist are being reworked (apparently) to maintain relevance for the Critical Care Paramedics. Most systems use RN/Paramedic, maybe some use MDs on flights. Where I work it is solely CCP/CCP for both fixed wing IFTs and scene/HEMS work; our training is...

We use LP 15 on the street and Zoll Propaq X series flying. We had the older Propaqs by Welch Allyn for years and while they had their failures (usually due to not being plugged in) they worked ok and were used hard. The EtCO2 was fine.

I think it's distressing to hear a new medic being told to be careful erring on the side of the patient. Now, my particular bias here is that in Canada no one gets stuck with a bill, so there is that. Paramedics love to play mini-cardiologist, Snarff. Yes there is a ton to them and even when...

To me the point is the 12 lead is almost irrelevant. Sounds like it was somewhat convincing for ACS and with the S&S it seems like a good call. I think the real point is that for a new medic, on their own, with 4 months of experience, it's not the wrong call to err on the side of the patient.

I'd say if anyone gives you a hard time about the helicopter tell them to pound it. Does the closer cath lab hospital do PCI? Or not without surg backup? If they do and depending on actual time for helicopter arrival/load/transport/unload that still may be an option. The patient himself, as...