Some Potentially Helpful Links!

A key organization to the field of paramedicine is the Ontario Paramedics Association. This is a great website to check out to learn more about the paramedic scope of practice, the different roles of paramedics in different communities, and interesting news related to the field of paramedicine. Currently there have been reports on four EMS personnel killed, to find out more information there are media releases available through the top right heading “news”. If you are interested in becoming a paramedic there is job opportunities, salary, and other important information available to a potential student. This website is also great for current paramedics who are involved in the OPA to learn about changes to the field, news, different regulations in different municipalities, and about the status of the current issues such as the regulated health care professions and the attempt to become a health care profession under Canadian law.

http://www.ontarioparamedic.ca

A regulated health care professional is a medical professional that is able to perform one or more regulated heath acts. These include communicating and giving a diagnosis that will be relied on by the patient, performing a procedure below the dermis, setting or casting a dislocation or fracture, administering a substance via injection, or inhalation, proscribing, dispensing, or otherwise prescribing any form of medications, ect. There are fourteen controlled medical acts. Of these fourteen, paramedics perform eight controlled medical acts, but are not considered a regulated health care profession. Paramedics perform controlled medical acts under the authority of a base hospital physician. The following link is to the Regulated Health Professions Act, 1991. Can you guess which controlled medical acts paramedics perform? We perform 1, 2, 3, 5, 6, 7, 8, 12.

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_91r18_e.htm#BK24

The ITLS, also known as international trauma life support course, is run by various paramedic services throughout Ontario. The largest of these services is Toronto Emergency Medical Services. The course costs approximately four hundred and fifty dollars, and is a weekend course lasting Saturday and Sunday in Toronto. The course consists of a test portion and a practical portion. A failure of either of these portions results in a fifty dollar retest fee. Prior to the course you will be sent a manual that they suggest you study for a minimum of two weeks prior to the course. This course is a necessity in order to work in Halton, Peel, and York. Most other large services it is not mandatory prior to hiring, and they will send you on the course. This being said, hiring works on a “point” system, the more points you have, the better your chances of getting a job are!!! Visit http://www.torontoems.ca/main-site/careers/itls.html for more details.

The BLS. So important to the field of paramedicine that it doesn’t even need to be referred to by its name. This crucial document is the bible of paramedicine. The framework, regulations, standards… This is the book paramedics live by. You arrive on scene to find a patient convulsing with trismus (clenched jaw) and you cannot insert an oral pharyngeal airway. Crap. What do you do now? You need to secure this airway. You need to ventilate this patient. Who do you call? Not Ghostbusters… the BLS! It provides the standard practice and guidelines and will tell you that you may insert a nasopharangeal airway instead. This document will make or break your paramedic career,

And changes every year so make sure you stay on top of things!  Visit http://www.health.gov.on.ca/english/public/program/ehs/edu/pdf/bls_patient.pdf to read the BLS!

There are various courses offered through the Highland Wilderness Training Institute, there are options such as basic wilderness first aid, advanced wilderness first aid, wilderness first responder, emergency medical responder, and emergency medical technician. These courses are not needed for any job application. For those of you who sometimes cross the thin line between “keener” and “Weiner” this course will be just up your alley, and can certainly do no damage to your resume! If you are looking for employment in northern Ontario, or somewhere that is isolated or has delayed hospital access, this course is for you! http://www.safetytrainingontario.com/HIghlands_Wilderness_Training_Institute/Wilderness_First_Aid_Courses.html

Respect the Dispatch!

Paramedics are a medical profession unlike any other. A call comes in and dispatch sends us on our way with sometimes little more than an address. The information we receive is only as good as what the caller told dispatch, and the amount of time dispatch has to tell us what we are headed to. According to Brad Mooney a supervisor, paramedic, and dispatcher of 27 years, “We can only give you what we get. I would say on a weekly basis we get calls to a child with abdominal pain and show up and there’s someone with a weapon, a domestic assault, or nothing to do with a child or abdominal pain at all. That’s the nature of the beast.” My caution to you is to remember to always be prepared, trust your gut, and don’t blame dispatch!

Asthma Medications

When asking a patient about their medical history most patients will remember that they have had a history of asthma. How many patients can list off  "Advair diskus three times daily, Sabutamol, and Singular, with occasional doses of Azithromycin as needed" not many, the response that I've heard time and time again is "The purple cirlce one" or "the orange one" or "the little square pill". I have compiled a short list of the more common medications with pictures in order to help future paramedics and students with this issue. I hope it helps!

Advair Diskus- Purple circular looking medication. Made up of Fluticasone and Salmeterol, and is used to control moderate to severe asthma when an inhaled steroid alone does not work. (see http://www.rx-pain-relief.com/allergy_asthma.html for more information)

 Mometasone furoate Also known as Asmanex® Twisthaler® is a small white cylindrical tube with a larger base and numbers and a twist function at the bottom. This medication is used to block the action of both inflammatory cells and chemicals that are involved in the immune process. This medication is used for allergy induced asthma. (see http://www.copdforums.com/ for more information)

 Flovent also known as fluticasone propionate, is an inhaler used to treat asthma. This medication is an orange puffer, and is referred to as a controller medication because it is used to reduce inflammation in the bronchi over a long period of time. (See http://www.drugshoponline.com/Buy-Asthma-Medications-FLOVENT-(FLUTiCASONE)-(FLiXOTiDE)-100mcg-1-discus.html for more information)

 

 Singulair is a small square shaped pill taken for long term asthma control. Singulair can be used as an alternative to inhaled steroids, or can be used when a patient is not getting adequate control with inhaled steroids alone. (See http://www.drug3k.com/imagepages/11725/image5.html for more information)

Symbicort is a pink and white tube shaped combination asthma medication containing budesonide and formoterol, given via a dry powder inhaler to help with maintenance and control of asthma. (See http://www.asthmameds.ca/news.php for more information)

Ventolin also known as sabutamol is a bronchodilator used to treat acute exaserbations, or an “asthma attack”. Ventolin comes in a dark blue puffer. (See http://www.canadapharmacy.com/index.cfm/fuseaction/product/name/Ventolin-inhaler/product_id/1891.htm for more information)

Accidental opioid overdose from licit or illicit opioids such as oxycodone, heroin, codeine, and morphine are significantly on the rise throughout the world. North America, Denmark, Italy, Spain, England, and many other first world countries have all seen a dramatic increase in the amount of deaths due to opioid drug overdoses Naloxone is a drug that can be administered for opioid overdoses via intramuscular injection, intravenously, or through a nasal spray. Naloxone has been proven a safe and effective drug for opioid overdoses.  It dramatically increases the well being of the patient, and is very simple to use and very inexpensive. It is so safe that drug using populations in The United States and Australia have been given the drug to administer to peers, which has proven effective in both countries (Irwin, K.S., Kim, D., Khoshnood, K., 2009). This drug is currently unavailable for paramedics to administer... but why? If we can give it to known drug using populations surely medical professionals should be able to follow the drug protocols for this drug! 

References

Kim, D., Irwin, K., & Khoshnood, K.. (2009). Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality. American Journal of Public Health, 99(3), 402-7.  Retrieved December 1, 2010, from ProQuest Nursing & Allied Health Source. (Document ID: 1647955791).

Community Paramedicine

Emergency wait times. They’ve become almost a running Canadian joke. "Prolonged waits in Canada's ERs are now accepted as normal, but the problem is both unnecessary and solvable," says Dr. Alan Drummond, past president of the Canadian Association of Emergency Physicians (CAEP) who is running a campaign to increase the number of beds in hospitals (Patrick Sullivan, 2004). 

Something that could greatly reduce wait times in Emergency Rooms would be community paramedics. What is community paramedicine? “It’s a simple concept: Connect underutilized resources to underserved populations. In this case, we’re expanding the roles of EMS workers to provide health services where access to physicians, clinics and/or hospitals is difficult or may not exist.” (Community Paramedic, 2011). We all know how long ER wait times are, and when a patient has a chronic issue, such as osteoporosis, diabetes, high blood pressure, high cholesterol, or need help but do not qualify for a personal support worker, community paramedics could provide the link between the hospital and the patient. If a community paramedic came to a patient’s home and regularly helped them to monitor their blood sugars, and explain their medications to them thoroughly, what are the chances that they would later be taken to a hospital with hypoglycemia or hyperglycemia?  

References

Sullivan, P. (2004). Emergency MDs call for quick action on ER wait times. Retrieved from http://www.cma.ca/index.php?ci_id=40157&la_id=1

Community paramedics helping those on the fringes. (2011). Retrieved from

http://www.ctv.ca/CTVNews/Health/20110110/community-paramedics-110110/

Opening

ParamedicPeer is going to be a place where paramedic students from all across Ontariocan come and learn about new trends in paramedicine. Resources will be made available to students such as the Basic Life Support Standards, the Regulated Health-Care Professionals Act, study help, and information about possible upcoming job opportunities. New trends such as community paramedicine, STEMI bypass protocols and new upcoming changes to the field will be discussed.