blindsideflank
Forum Lieutenant
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I apologize if this thread is a repeat. If it is, then I hope that you can link me to old threads, or that this can be the thread that ties old ones together.
I work in a province (thats Canada eh?) that is not progressive with its scope of practice. My fear is that this company/service is holding back EMS. We have PCP's that have 20 plus years experience that are great paramedics and are paying thousands of dollars taking pharmo/patho and anatomy courses online with the simple goal of learning more. There is little support to further the PCP education/scope of practice and our tiered response system limits the number of ALS paramedics hired. Not to mention the burden our system puts on somebody trying to obtain that licence level (school plus a long mentorship and being forced to move to the one urban setting they want you at.)
EMS seems to be as useful as it is not... make sense? In other words we are helping with emergencies (or think we do, see ACLS) but most of the time we taxi patients when we have the opportunity to actually help patients and the medical system through earlier treatments and symptom relief. Our service does not seem to support this and I worry that it holds our profession back.
So I ask as an ACP with nothing to gain from expanding the PCP scope, what is there out there for PCP's to build upon?
I hope to present something to our medical director. I hope to discuss my concerns and the possibility of expanding our scope, whether its through a new level (ICP, but im sure the beauracracy is insane), to endorsments. I even believe that many paramedic would be willing to pay for some of their own education if you set prerequisites.
Many are doing courses through Thompson Rivers University that have been made ACP prerequisites, but they are doing them for "fun." It would maybe be possible to ask them to complete A&P, Patho and Pharmo on their own time before obtaining training for an expanded scope. I beleive people would do this despite a raise in pay (if that could not be provided). It would also provide better care in rural areas where, ACP's are not staffed.
My first push will be for gravol, as it is used by PCP's in other provinces. I have found this training program online
http://www.lhsc.on.ca/About_Us/Base...drinateCertificationLearnerPackageSep2010.pdf
http://www.lhsc.on.ca/About_Us/Base...PPCPDimenhydrinateQuestionsandQuizMay2012.pdf
I dont believe gravol would require further education before adding it to the scope, as it is in the PCP scope in other areas
Other drugs i would like to see used in very limited roles are zofran, pain control (morphine? probably not toradol?), versed/ativan (remember i said rural areas do not have ACP's), atrovent (we neb ventolin only), CPAP (is coming to our ACP's soon), prednisone or dexamethasone (this helps the hospital more than us), Tranexamic acid (also coming to ACP's soon), Mag (for bronchospasm, i know personally that this has been huge for me),
other possibilities include chest decompression (maybe just on trauma codes as per ITLS), PALS and ACLS education (we currently dont have monitors for PCP's and I know the data regarding some ACLS practices is weak or non existant). I started a thread earlier questioning if PCPs should give epi q5 on all arrests after a defib to bring closer alignment to ACP/hospital ACLS practices. The consensus seemed to be that chasing unproven practices to be like the big dogs was not appropriate.
There has been a study in our service going on with PCP's transmitting 12 leads and i am awaiting the results of that.
so I ask for your thoughts, what you service does, and anyone with experince with ICP's. Ask away, and tear me apart, I want to hear it before I contact our medical director. feel free to leave any links to GAP training like the gravol link above
I work in a province (thats Canada eh?) that is not progressive with its scope of practice. My fear is that this company/service is holding back EMS. We have PCP's that have 20 plus years experience that are great paramedics and are paying thousands of dollars taking pharmo/patho and anatomy courses online with the simple goal of learning more. There is little support to further the PCP education/scope of practice and our tiered response system limits the number of ALS paramedics hired. Not to mention the burden our system puts on somebody trying to obtain that licence level (school plus a long mentorship and being forced to move to the one urban setting they want you at.)
EMS seems to be as useful as it is not... make sense? In other words we are helping with emergencies (or think we do, see ACLS) but most of the time we taxi patients when we have the opportunity to actually help patients and the medical system through earlier treatments and symptom relief. Our service does not seem to support this and I worry that it holds our profession back.
So I ask as an ACP with nothing to gain from expanding the PCP scope, what is there out there for PCP's to build upon?
I hope to present something to our medical director. I hope to discuss my concerns and the possibility of expanding our scope, whether its through a new level (ICP, but im sure the beauracracy is insane), to endorsments. I even believe that many paramedic would be willing to pay for some of their own education if you set prerequisites.
Many are doing courses through Thompson Rivers University that have been made ACP prerequisites, but they are doing them for "fun." It would maybe be possible to ask them to complete A&P, Patho and Pharmo on their own time before obtaining training for an expanded scope. I beleive people would do this despite a raise in pay (if that could not be provided). It would also provide better care in rural areas where, ACP's are not staffed.
My first push will be for gravol, as it is used by PCP's in other provinces. I have found this training program online
http://www.lhsc.on.ca/About_Us/Base...drinateCertificationLearnerPackageSep2010.pdf
http://www.lhsc.on.ca/About_Us/Base...PPCPDimenhydrinateQuestionsandQuizMay2012.pdf
I dont believe gravol would require further education before adding it to the scope, as it is in the PCP scope in other areas
Other drugs i would like to see used in very limited roles are zofran, pain control (morphine? probably not toradol?), versed/ativan (remember i said rural areas do not have ACP's), atrovent (we neb ventolin only), CPAP (is coming to our ACP's soon), prednisone or dexamethasone (this helps the hospital more than us), Tranexamic acid (also coming to ACP's soon), Mag (for bronchospasm, i know personally that this has been huge for me),
other possibilities include chest decompression (maybe just on trauma codes as per ITLS), PALS and ACLS education (we currently dont have monitors for PCP's and I know the data regarding some ACLS practices is weak or non existant). I started a thread earlier questioning if PCPs should give epi q5 on all arrests after a defib to bring closer alignment to ACP/hospital ACLS practices. The consensus seemed to be that chasing unproven practices to be like the big dogs was not appropriate.
There has been a study in our service going on with PCP's transmitting 12 leads and i am awaiting the results of that.
so I ask for your thoughts, what you service does, and anyone with experince with ICP's. Ask away, and tear me apart, I want to hear it before I contact our medical director. feel free to leave any links to GAP training like the gravol link above
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