Canadian PCP va ACP scope

[Merck]

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 centers so it certainly fills a void. Are there problems? Probably. But there's problems with stupid nurses and doctors too. I think overall it works out best for patients.

 

[MonkeyArrow]

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 centers so it certainly fills a void. Are there problems? Probably. But there's problems with stupid nurses and doctors too. I think overall it works out best for patients.

I'm assuming that PCP is primary care paramedic and ACP is advanced care paramedic which would equate to the U.S. basic and medic, respectively. Your PCP have a scope that is envied by some AEMT/EMT-I in the states and therefore the scope expansions as stated by OP. I was speaking strictly of a BLS system with a very limited scope. If a tiered system works for you, more power to you. I am just seeing the potential issues in the suburbs of GA where most of the EMS is fire based.

 

[Merck]

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 here won't have an ACP.

 

[unleashedfury]

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 here won't have an ACP.

My thoughts are if they want to expand the scope it needs to be a transition time. not just hey its Jan. 1st congratulations youre all AEMT's will be training you in house shortly.

a town of 30k won't have a ACP? wow. Everyone and their brother here is trying to get a ALS unit. Apparently they believe that ALS in their own town will bring in more revenue to the dept. Though it was proven wrong when 3 of them shuttered due to lack of call volume.

 

[Merck]

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.

 

[medicasaurus]

I think a key thing with the Canadian experience is that from what I have read, the EMT-B program in the US is a 120-200hr course. This would put the course in the EMR(Emergency Medical Responder) range in Canada. My PCP-IV course was around 800 course hours. Here is a students breakdown of the BC PCP-IV course (https://paramedicblog.wordpress.com/2011/10/26/primary-care-paramedic-student-workload/). So our system would be more similar to a AEMT being the standard with Paramedic targeted response. The EMR level (EMT-B style) here is relegated to working on IFT or Rural/Remote area's.

 

[mycrofft]

all things being equal yea sure more education and why not, but why not just have them become medics?

our didactics lasted ~1 year and I felt like that still wasn't enough time! there is so much to know about paramedicine and medicine in general.
If they are so great and knowledgeable they would definitely make good medics so instead of tacking on skills and education why not just go for the whole thing and become a paramedic?

To me that comparison is like comparing a medic to an MD (just a little more training and schooling right?) theres a lot that factors into it IMO.


Take this with a grain of salt because living in CA, especially in metro areas we don't have to worry about ALS units being 20+ minutes out while BLS just twiddles their thumbs on scene.
I am by no means trying to sound arrogant or elitist but at some point I think the lines become blurred.

What, and have to pay them more???
That aside, I like Merck's comments.

 

[PotatoMedic]

If only we had the BC system.... There are probably faults but I think I would much rather be educated and work up there then here right now... But I can't convince the wife to move.

 

[cprted]

I'm actually not a huge fan of the tiered, ALS only in urban centres everywhere else is BLS only, "one size fits all" model. We have a huge and varied province with some pockets of population that live a long way from any kind of hospital, let alone a Level 2 trauma centre (the province only has one L1).

I think tiered ALS is great for urban centres! Short transport times, even if you have a very sick patient and ALS isn't available, you're in the ED in under 15 (tops!).

Once we get into smaller urban centres, it is hard to justify the cost of a paired ACP-ACP car, but these would be great spots for single-member ALS PRU (Paramedic Response Units). Thinking Vernon, Penticton, Salmon Arm, Duncan, Squamish, Whistler, etc.

Into the hinterland, every town with at least 1000 people should have a d-paired (ACP-PCP) alpha car. Driving 70 miles code three from Princeton into Penticton with an unstable trauma from the fiery rollover on Hwy 3 ... yeah, it would be nice to have ACP on the car. Somehow Alberta and Saskatchewan are able to staff a full time d-pair ALS car in every little cow town, yet we say we can barely afford to pay our people $11 to be on standby ...

Just because people don't live in an urban centre doesn't mean they don't deserve or sometimes need ALS level care. There are lots of calls that don't warrant an ALS response in BC where the patient would really benefit from having ALS. Granny who falls and breaks her hip, that's a BLS only call, but man oh man would it be nice to give her some morphine before we pack her up on the clam. 73yom, hx of IDDM and ACS, feeling weak and generally unwell ... had ALS been on that seemingly nothing call, we might have caught the STEMI in his house rather than an hour after he arrived at the ED ...

 

[Handsome Robb]

When we get calls in our outlying areas they generally tend to be more serious than those in the middle of town. Not saying we don't get sick patients in town but those in the middle of nowhere generally don't call unless they really need help but again that's not always the case either.

I think ALS I far more important in a suburban/rural setting than urban however I think both need ALS coverage.