1. #1
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    Default fun and games with BCAS

    The Pictorial, Sunday, March 7, 2004
    Peter Rusland ~ Staff Reporter

    John Limer painfully lifts a bandaged right hand, describing the insult to his third-degree injury.

    "The ambulance blocked my cab and said we couldn’t go to the hospital until we signed a release form saying we refused an ambulance, and that was totally false." In fact, Limer called a cab to take him the short distance to the Cowichan District Hospital while waiting in agony for an ambulance after Tuesday’s dawn heater fire in his folk’s place on Mary Street.

    Liner’s Dad, Tom, said the cab was called rather than waiting for an ambulance to arrive from Chemainus. "It took a long time, John was squirming from the pain." Limer was treated fir burns and smoke inhalationg by North Cowichan Firefighters who called for an ambulance at about 6:23 a.m., according to B.C. Ambulance Service’s Records.

    "An on-call crew from Chemainus responded because its full-time crew starts work later in the morning," BCAS director Dave Maedel said. Chemainus’ ambulance was called because Duncan’s full-time crew was busy transferring a patient while the station’s on-call crew was handling other local emergencies, he said.

    A local paramedic said if both Duncan crews are busy, another local crew should be scrambled and waiting for duty at the Red Rooster restaurant near Chemainus or at another spot. "An area the size of Duncan shouldn’t be left uncovered," said the paramedic, who asked his name be withheld for fear of disciplinary action from Ambulance Service brass for speaking out. But Maedel said it’s hard to write an ironclad policy about cross-coverage. "That decision’s left up to our (Victoria) emergency medical dispatchers and hey make the decisions based on call volume, time of day, and a whole series of factors."

    Tom Limer says overtime should be paid for part-time drivers to do transfer work. Meanwhile, Tom Limer’s glad he took the cab to CDH.

    "We thought we’d take a cab, it’s cheaper and faster"

    Ambulance rides cost $54. If a patient is treated by paramedics and refuses a ride, the tab is $50. Tom Limer figured the cab ride cost about $10.
    "The disappointment was not being able to leave without signing that release form."

    ---------------------------------

    It seems like this type of thing has been happening more and more lately (or maybe that it is just being publicized more).

    Over the last year I have heard a number of firefighters from other department’s who have commented on similar things happen. IE,
    ~ BCAS taking longer to get on scene (anywhere from 10 minutes to 30 minutes).
    ~ I have read an article about BCAS changing the dispatch shifts around so that there are half has dispatchers on during the busy evening hours.
    ~ Paid crews doing PT transport, leaving on call crews to cover calls .
    ~ Limited availability of ALS crews (which I have run into myself).
    ~ And then there is the call I heard about (third hand, so I am not sure of how accurate it is), that was a cardiac arrest across the street from a fire hall (which the guys were there re-certing their FR), and the FD wasn’t even called in favour for a 10 minute response time from ambulance.

    Has anyone else seen any noticeable changes when working with ambulance crews??
    "No one ever called the Fire Department for doing something smart..."

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    We have experinced delays here on the north end of the Island as well. The full timers are out on routine transfers, and no one bothers calling in a part time crew to cover the station. There has been delays on more than one occasion. The other thing that is bothersome is that at night there is only one full time paramedic at the station, and a part timer is called in from home(or wherever). This makes a delay equal to calling in a part time crew, why even have a full timer on duty? Dont get me wrong the paramedics that cover our city are great people and do a great job it's just that the system is flawed. Things ran a whole lot smoother when the Fire Dept ran the amblance(and alot cheaper too).

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    This a topic that has been revisited over the years.
    Bcas has been historically understaffed and will contiue to be until government increases funding. A successful system should not be staffed 2000 + pt timers and a handful of full time. Delays will increase with call volumes going through the roof as we have seen over the years.
    As for smooth transitions, it might be a pain in the keester watching someone do the same work up you have already done, but lets imagine for a minute that someone might have missed somthing? Now we all no that never happens but the extra redundancy helps when the recieving phys. note all injuries have been exposed in the back of the bus because it was to cold in the ditch. It comes down to CYA.

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    CYA is the name of the game ....... cross all your t's and dot all your i's and you will be fine.
    To the world you might be one person, but to one person you just might be the world.

    IACOJ-WOT proud

    GO WHITE SOX!!!!!

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    Originally posted by bluewater
    lets imagine for a minute that someone might have missed somthing? Now we all no that never happens
    Oh, I agree that is where is an importance of double checking. That's why we have two FRs on the PT, that's why we check and re-check pulses and resps. That only makes sense. I fully understand why they would double check a pulse, etc, after getting on scene. However, I was always told that BCAS (and ER staff) uses our initial assessment, along with their findings to help treat the PT. (The example I was always give was, if we get a pulse of 90 when we get on scene, BCAS gets a pulse of 84 prior to transport, and the ER staff gets a pulse of 65, they can tell that something is going downhill).

    I think we have all been through some great PT care transitions. I know I have seen, first hand, some near textbook perfect transitions were our information is relayed to the BLS unit, who relays it, as well as their information to ALS, who relays it all to the ER. When it works, it is a thing of beauty. However, it doesn't always have that smooth transition.

    However, lets consider that maybe our transition from handing the PT over as an FR to a BLS crew would be smoother if we educated, or trained, a little more closely. Also, let the FR course better explain the roll of each level of care, and maybe give a brief orientation as to each level's protocols, and how we can assist them.

    In my opinion, it is all about education and training. The more we know down here at the bottom level as FRs, the easier we can make the transition for the PT and BCAS crews we are working with. I am not saying "Lets all train as ALS" but it would be nice to get a general idea of what the other levels are doing. Yes, the FR program does have an ambulance familiarization chapter, and it does include a visit to a BCAS station so that we can have some time to poke around with their equipment. HOWEVER, in my opinion both the chapter and visit are largely in adequate.

    One comment I have always got while trying to explain to other places about our system, is that ALL BCAS personnel are called "Paramedic" despite of their training (which as the term "Paramedic" usually only applies to the highest level of training, after the EMT-B, EMT-I, and EMT-A levels)

    Perhaps rolling the FR program into the BCAS system and making us the first level of training.

    Example:
    FR III (which could be called EMT-FR)
    BCAS Paramedic 1 (which should be, in my opinion EMT-Basic)
    BCAS Paramedic 2 (which should be, in my opinion EMT-Advanced)
    BCAS Paramedic 3 ALS (which can stay EMT-Paramedic)

    This would put everyone on the same page, and with the same basic protocols from top to bottom.

    These are, of course, just my thoughts....
    "No one ever called the Fire Department for doing something smart..."

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    Realizing that these are just your opinions, I can take them with a grain of salt.
    Paramedic one is anything but basic. I find that insulting.
    There are very few differences between the new p-1 and the old ema 2.
    In dicussions with Manitoba als attendants there are basic protocols here that I can run that they do not have access to such as Entonox.

    The everyone is a paramedic thing has been around for years and will not change in the near future due to legislative issues.
    As for First responders increasing there knowledge base have at 'er. But most time it comes down to the simple fact there is only so much room in the back of the bus and each agency has protocols and guidelines they must follow or be in violation of there licence level.

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    Blue,

    I apologies for the mistake. I wasn't trying to say that Paramedic One was only "basic." I certainly didn't mean any disrespect towards yourself, or any other BCAS Paramedic 1's reading these forums. I have to admit that from a firefighter, and first responder, point of view, we get told little, if nothing, about how BCAS works and operates and was just trying to make sense of everything.

    I am certainly not an expert in this field, and I, like many others, understand things better when it is layed out as simply as possible. In the popular system within the United States, and some places in Canada, the term "Paramedic" seems to apply to the highest level of training (from what I understand, and I certainly could be wrong). So, when trying to understand the BCAS system with their first level being called Paramedic One, etc, etc, up the ladder (with all of them having Paramedic in their titles), I was a little confused as to where everyone fits in; not so much with P1, P2, P3, etc; but how it all fits into the "grand scheme" of things.

    If you could shed any light, that would be great.
    "No one ever called the Fire Department for doing something smart..."

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    Firefighter26,

    Maybe I can clear up some of your misconceptions and/or questions. In the province, we formerly had EMA I/II/III. In 2001 the Paramedic Association of Canada cam out with national competencies of Primary Care Paramedic, Advanced Care Paramedic and Critical Care Paramedic.
    Our Paramedic 1 or Primary Care Paramedic is about an 800 hour course which includes all of the usual splinting, spinal, AED, patient assessment etc. In addition they can do pulse oximetry, blood glucose testing, traction splinting, learn lots of assessment and pathophysiology, and can administer basic emergency drugs including oral glucose, glucagon, entonox, narcan, nitroglycerin, ventolin nebulizers, epinephrine, cholopheniramine, and hopefully shortly IV's and ASA. The course also includes lots of exams as well as in hospital and on ambulance practicum time. Advanced Care Paramedic is a 64 credit diploma and takes roughly 3000 hours of training and includes full ACLS, invasive procedures, transcutaneous pacing, ECG interpretation, advanced airway interventions, and lots of drug administration and pathophysiology.

    As for the bigger picture I'm not exactly sure what you mean. If you mean in terms of response, when someone calls 911 the call is prioritized using the MPDS system and the severity determined. According to the MPDS algorithm certain units are allocated based on the problem and/or severity which can range from a BLS ambulance responding routine for a minor problem all the way up to BLS & ALS ambulances, first responders and/or police for major incidents.
    Right now are system is maxed with severe hospital delays delaying crews up to 5 hours in some cases. As well our call volume is increasing by about 10% per year. Next year we will probably do about half a million ambulance calls in a province of 4 million. Hopefully this has answered some of your questions. In my area the relationship with the fire departments is strained at best as they are gunning for a takeover since their call volume is drastically decreasing. It's unfortunate that they like to do things like lock us out of the building to slow our response and then slander us in the media about how they beat us every time. I hope your rant above does not indicate you are one of those unprofessional types.

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    Originally posted by snowmedic
    I hope your rant above does not indicate you are one of those unprofessional types.
    I am certainly not one those types of firefighters; nor is my department. I am sorry if I came off as ranting. In fact, our department (myself included) does everything it/we can to make the job easier for everyone. Whether it is making sure that there is a place for BCAS to stage the ambulance nice and close to the scene at an MVA; to moving furniture before BCAS gets on scene so that it will be easier for them to get their stretchers into living rooms or bed rooms. (in fact, because we know our district better than the BCAS crews, which come in from another town, we make sure to stage trucks or personnel at points, such as intersections and long driveways, in order to direct BCAS to the correct location - we even try make sure that our trucks are not blocking access so BCAS can get their ambulance up nice and close).

    I am sorry to hear that the FD in your area is giving you troubles. I have always believed that, ultimately, it is patient care that should be everyone's priority (not call volumn).

    Half a million calls province wide is a lot to have to deal with. While I know our department certainly doesn't want to "take over" the duties of BCAS, most of us would certainly jump at the chance to be able to better assist (either through responding as FRs, increasing our level of training, or broadening the range of equipment we have available) during calls.

    What I find interesting is that your single post (which just happens to be your first post, so welcome to FH.com), had more useful information than most of the ambulance familiarization section of the FR program. Overall, I would like to see the relationship between FDs and BCAS grow closer together so that we can all be on the same page, either at a routine shortness of breath at 3:00 in the morning or at a five vehicle MVA during rush hour.

    The questions is, how do we get there???
    Education? Workshops? Training? Joint courses/ventures? Ride-a-longs?

    If it is possible, I would like to know where I can get more information about the MPDS system that your dispatch uses to determine your level of response and when FDs are called as FRs (it would be good information to take back to everyone else); and also, from your BCAS point of view, what things we can do as the fire department to help things move forward (communication is a two way street, and it seems that we -firefighters and paramedics- rarely get a chance to talk outside of the emergency scene, so I think we should both take advantage of it when we can).
    "No one ever called the Fire Department for doing something smart..."

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    If you are interested in getting the MPDS determinants for first responders you should probably go via your chief. If you are doing first responder work in your department he will likely have a list of the types of calls that you attend. In general they are time sensitive, life threatening calls such as SOB, cardiac arrest, choking, and basically any other ABC problem. The major issue in my area right now is that several departments are demanding to be sent on all medical calls (even routine) and will respond Code 3. So if you fall off your bike and twist your ankle and call 911 in my neighbourhood you'll get an aerial rescue truck responding with 4 guys. My opinion is that this is a tremendous waste of money and in addition as a taxpayer, I want my fire department available to fight fires and perform Hazmat, rescue etc when I need them.

    Riding third in your area might be a possibility, you'd have to ask your local crews if they are willing to take any of your members out. A good way to build a relationship might be to propose some joint training. When I did my training at the JI we had an extrication day where the JI footed the bill for some cars and my course hooked up with a local fire department for a full day of live auto ex scenarios. I think the FR3 course is a good course for what it's meant for and you can never go wrong training on the basics.

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    I will have to run that by our Chief to see what he thinks. As FRs we were told that there is a "check list" of criteria for when we will be toned out. However, I don't recall any of us ever seeing it.

    As for some joint training, I think Auto Ex would be the best place to start because that, next to medical calls, is pretty much the only time we interact. I am not sure what level of extrication training, or awareness, BCAS gives its paramedics (something I have often wondered but never had the chance to ask because everyone is usually to busy when we "get together").

    I am working on scheduling a large scenario Auto Ex practice for this summer (if I can get an interest of some of our surrounding departments), so I will have to make a note to stop by the BCAS Station in Mill Bay to see if they are interested in sending anyone to attend (they don't necessarily have to bring their ambulance, just show up).

    In the last half of 2003 we had an RCMP officer stop by the hall while in the area, and he joined in on a rather interesting Auto Ex practice (the full blood and injury simulation kits), and she said that she learned a lot about what we do, as firefighters, at car accidents (like cribbing and deflating tires). She suggested that the next time we do a scenario such as this, to give her a call and she would see if some other officers would like to come out and see what we do and how we do it (I actually put together a basic booklet on auto extrication to give them, but I haven't out the finishing touches on it yet).

    On another note, what is your opinion on radio use between BCAS and FDs?

    Some examples would be during highway MVAs to let you know that traffic in a certain direction is shut down to let you zip around the backlog to get to the scene quicker. Or, in our case, to give BCAS better directions (in our district, we have a lot of dirt driveways with 3-4 other driveways branching off of them. We usually leave a firefighter or non-essential truck to direct BCAS in, but sometimes manpower can be limited.) Ideas? Comments?

    I know of a paramedic we worked regularly with who carried his own scanner/radio to listen for things like I mentioned above.
    "No one ever called the Fire Department for doing something smart..."

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    Radio use may be possible, it depends on whether your department uses digital or not. In Vancouver the very busy ambulance channels are digital while in less busy areas they are not. I worked in a previous area where we had RCMP and fire channels programmed into our portable radios. It sounds like you're on the island so I couldn't speak as to the SOP in your area you'd have to ask. Something like a tactical channel would probably be best as dispatchers from both services tend to get their nose out of joint when people start using their airspace to have their own conversation

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    Originally posted by snowmedic
    It sounds like you're on the island so I couldn't speak as to the SOP in your area you'd have to ask.
    Yup, you got that one right. About 15-20 minutes North of Victoria on the TCH (you've probably heard of the Malahat -propane tankers, forest fires, and our regular assortment of MVAs - , that's us).

    Originally posted by snowmedic
    Something like a tactical channel would probably be best
    Our radios just got reconfigured (change all of our radio frequencies around, doublexed our main channel, and give us 2 tactical channels), so we one of our tactical channels might be way to go (however, our "Tac2" channel is also the same frequency has King County dispatch in Washington state.. and it comes through, at times, better than our own dispatch in Duncan).

    Who would someone get a hold of to discuss radio use between BCAS and FDs?
    "No one ever called the Fire Department for doing something smart..."

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    Most of your questions can probably best be handled at an interagency level i.e. get your chief to get in touch with the BCAS Unit Chief from the station that you normally respond with. I don't know what the policy is on reprogramming our radios as they are all set up for a province wide network in case we do calls outside of our own area. Same goes for training. A previous station I worked at was 2 blocks from the firehall and we used to wander over often on Tuesday night fire practice and help out with things like first responder skills or equipment familiarization etc. It worked out quite well, the only problem was we couldn't stay for beer after, being at work and all that.

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    Originally posted by snowmedic
    [B]A previous station I worked at was 2 blocks from the firehall and we used to wander over often on Tuesday night fire practice and help out with things like first responder skills or equipment familiarization etc. It worked out quite well [B]
    I think that we need more of this type of interaction between our two agencies. I would be willing to bet that you had a better working relationship with that FD then the one you spoke of earlier.

    We work a fair bit with Mill Bay FD, so I try to head down to their practice nights (Wednesday), or drop in for their duty crew (Sunday) once or twice a month to get that interaction and familiarization between the two departments (as well as scheduling some joint training sessions).

    That may work fine between FDs, but what kind of things would BCAS crews be interesting in "stopping by" for? We do, every so often, what I call a "rapid fire night" were we will run 5-6 scenarios in one night, in rapid succession (and often at the same time). These usually range from shortness of breath and other medical scenarios, to multiple vehicle MVAs (with entrapments), to the odd vehicle fire or chimney fire scenario. (it usually takes me two weeks to organize all the required patients and resources).

    Once I am done planning this joint Mill Bay/Malahat Search and Rescue scenario, I might be able to come up with something the local BCAS crews can join in on.

    If either of you have done some joint FD training, what did you find the most interesting to you from a BCAS point of view? (I am just trying to get an idea of what things we do that other BCAS crews might want to come by to watch/participate in… for example, I can't see an afternoon of building search being to entertaining or appealing; were as, an afternoon of extrication would).
    "No one ever called the Fire Department for doing something smart..."

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    Default Nosy American with a question

    If the call volume is going up 10 % a year, why does BCAS rely so heavily on part-timers?
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    Due to the vast area covered the government feels it is most prudent to cover smaller call volume stn.s with part time.
    Most stns in the north with the majority of them only doing 50-400 calls per year it would be impossible to staff at full time levels.
    The 10% increase I believe is being shouldered by the metro areas of the province.
    Hope that helps.

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    I don't have the exact stats but yes, I'm willing to guess that most of the increase in calls is occurring in rapidly expanding urban areas. Funding increase has certainly not kept up with the increased demands either, at least as long as I've been working.

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    We solved the problem of having to go on a "RED" with a private operator in our community. We (the fire dept.) now run the ambulance service, we have 2 fulltime crews on 24/7, no callbacks and if we have to go on a Red we call in our volly fire fighters. We keep the level of srvice to ALS on all three rigs and if need be we roll our squad with a BLS crew.
    The way to solve these ambulance problems that most communities experience is to intergrate it into the fire service. Its time the provincial and the federal govts. stepped up to the plate and started training fire depts. to at least a BLS. level if not to an ALS level.

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    It would be easy for bcas to lower our call volume, all they have to do is raise the user fee I heard a rumor that alberta was planning to go to a provincewide ambulance service, has anybody else heard that one?

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    Ameland, it is in the works as we speak. It will not be a provincial ambulance as BC has, but it will be administered and run by the regional health authorities. It will address the need for ultimate patient care. In many cases you have an ambulance driving through one juridiction past an ambulance station of another provider to get to a patient. The future says the nearest ambulance will take the patient no matter who they are or where they are. In some cases we as a provider of extrication have waited for an ambulace for far too long when we could have one out of our jurisdiction in mere minutes. Its called the territorial thing, but ultimatly the patient is the one who loses the most in this situation. Oh well the political wheels turn on and on and on........ you get the picture

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