# Medical Services restructuring...



## combat_medic

This is a question I‘m putting out not only to the other medics out there, but with anyone who has had some recent experience with this:

Recently the CF medical trades all banded together to form the Canadian Forces Medical Group, and then separated from the army to become their own branch, like Comms did (lame, I know). As you can imagine, this restructure has created an enourmous hassle, especially for medics who aren‘t in Medical Companys but are in combat arms units or other non-medical units. 

I‘m trying to find out how this restructuring nonsense has affected the medics in these units. I‘ve been getting royally screwed around, and am trying to find out if it‘s happening to other troops medics out there. Even if you‘re not a medic, any insight or experience you might have with this would be helpful. Reply here, or send me a private message.

Oh, and if anyone on this forum was responsible for the restructure, we need to have a little chat    :mg:


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## Michael Dorosh

Our infantry unit had its own UMS with some really great medics; they were disbanded a couple years ago and the medics were told to join the medical company.  Most quit or found work in other cities.  We‘ve had (some) exercises without any direct medic support since then.  We also lost our weapons tech and vehicle tech at about the same time.

In addition from being superb medics, they were also terrific Highlanders; they would carry the C6 if they had to - one of the medic sergeants swallowed his pride and took a Comms course so he could better acquaint himself with the radios, etc.  It was a blow to see them go.


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## combat_medic

Michael; I hear that! I‘m in a similar position right now, and am in danger of getting removed from my unit. Of course, if they try that, I‘m just remustering to infantry. I can imagine that a lot of medics were placed with the same choice; be torn from their unit, leave or remuster. Not exactly fair, if you ask me.


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## Armymedic

Following the topic of medical equipment, in the Equipment site, some of you reserve medics have voiced concern over the restructuring of the medical services....

Let air it out here:

For the reg force (I speak only of 2 Fd Amb in Petawawa, the base with the most med tech posted in the military) that it has been a double edged sword.
On one side, it is good for the personnel assessment (PDR PER) and career development as we are easily shuffled when one of us has to leave a UMS for a course or training, etc. 
Bad side is, we can be easily shuffled around...

Saying that, care to the soldiers is always the priority and the reason we are employed. First line care on a daily basis must be maintained in the units UMS, and generally each UMS is left alone to do that. Exceptions are the occasional Fd Amb parade, base duty, or any other of those things that requires unit involvement (ie sports days, Bgd level activities).

As whether is a good thing, I feel it has its moments.

et vous?


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## starlight_745

I have found good and bad points as well.  Some of the good points are that we have money for continuing ed now.  We have been running lots of CPR C recertifications, BTLS etc as well as training BTLS instructors for the unit.  The MCSP modules are still in the teething stages however they could be good with some modification.  Bad points are we are still chronically short of equipment.  We only have one set of UMS basic panniers and 2 functioning ambulances.  We are also short of big ticket items as well (i.e. cardiac monitor).  One thing I am also finding is the ever increasing time committment as medical resources seem to be more and more committed.  Last year I was employed by the army for 110 days on Class A.  Combined with working full time in civilian EMS and having a wife, I‘m pretty stretched.  Supposedly the reserve med coys/ field ambs are supposed to dramatically increase their ARE to something like 232 positions, but I don‘t see this occuring without a significant investment in equipment and vehicles.  We barely have enough vehicles right now to deploy 2 platoons to the field.


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## combat_medic

Good points: Allowing UMS Medics to go in yearly for recertification (FA, CPR, BTLS etc.)

Bad points: being treated like a second class citizen because you‘re not a parading member of a Med Coy, being denied courses and taskings because no one thought to call you, having your travel claims ignored because since you‘re not a parading member you‘re "not a priority", being constantly told of your incompetance as a medic because you‘re attached out, despite your experience in several MIRs for months on end, and your countless no duff casualties on ex. Being told that your regimental affiliation means nothing, despite the fact you spend your entire career there, not being able to get basic medical supplies because their being used for training, and real casualties are not a priority, having all your phone calls, memos, and e-mails to the Med Coy ignored or unanswered, but getting called every few months by some jackarse who asks you "who are you, by the way?" 

I would say that‘s a pretty good start.


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## Brad Sallows

starlight_745, I am surprised that you claim 110 days Class A.  Are you sure some of it was not Class B, or did your LFA really grant permission to exceed 100?  (Just curious.)  I assume you are in a med unit (Fd Amb).  If so, I am also surprised there is only a UMS pannier set.  I would have expected all med units would have at least one medical platoon set, less a few restricted items (unless you are parading with a detachment of a res fd amb).  Ask your Ops NCO to poll the reserve med units to find out their scales of issue; you may be able to build a case for obtaining a more complete pannier set or at least to draw some official attention to rationalizing any apparent shortfalls or surpluses.  It is still possible that some of the Reg F box ambulances might be transferred to the Res F if the Reg F Fd Ambs obtain more armoured ambulances.  However, if you really have sufficient vehicles to put almost two platoons in the field, I am envious.  We have only enough for a medical section, less trailers.  I would not expect the reserve medical unit establishments to grow to 232 anytime soon, and I certainly don‘t expect the number of derestricted positions to increase suddenly.  Money, money, money.

combat_medic, has your supervisor established contact with the med unit to facilitate your career management?  Under the terms of the Mutual Support Agreement, administration of your pay, claims etc should be the responsibility of your employing unit depending on what arrangements are agreed by the respective COs.

If the medical unit to whose establishment you belong is 12 Med Coy/12 Fd Amb, I state with absolute certainty that:

1) There is a designated I/C within the med unit to assist with career management and administration of detached persons notionally assigned to the "lower mainland" UMS, and

2) In the absence of (1), the DCO of 12 Med Coy/12 Fd Amb is the point of contact.

A letter was circulated to all mainland BC units explaining that arrangement, among others.  The immediate unit supervisor (section NCO? Adm Pl or Coy I/C, 2I/C, CSM?) is expected to maintain contact with the med unit I/C UMS and/or DCO.  You should not have to do this yourself unless within your unit you are reporting directly to the CO, or your supervisor has decided to delegate all that responsibility to you.


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## combat_medic

Brad: I was contacted by someone at the unit who had no idea who I was, what my concerns were, or how to address them. He apparently had no medical or administrative training when he was given the IC tasks, so understandably did not know what was going on. When I told him all the difficulties I mentioned, he didn‘t know they even existed or how to remedy them. He gave me a phone number for someone else in the unit to speak to about this, whom I have called repeatedly and left messages for, to no avail. 

If they‘re expected to get in touch with me, then they have failed that... miserably. In terms of "facilitating career management" they have done the exact opposite. They have made my career as administratively burdonsome to manage as possible, and blocked every opportunity of advancement that I have tried to administer on my own initiative.


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## Brad Sallows

Send me the phone number you were given, via private message on these means.

Unless there is a piece of correspondence between COs stating that so-and-so detached to unit such-and-such is authorized to act independently, there is generally an expectation that information will follow certain well-trodden paths.

Foremost, there is an expectation that someone in the employing unit supervises the medics and represents the interests of the unit medics through the unit chain of command.  The unit staff, not the medics, have authority to deal directly with counterparts at the med unit on matters of personnel administration and training.  If I called Comd CF H Svcs Gp tomorrow to arrange my own training, I would not expect a return call.  (Well, I would, but I would expect it to be a unidirectional conversation with my CO.)  If you know your own training requirements, there should be minimal need for you (or more properly, your supervisor) to consult the I/C UMS.

Push your course requests and employment availability up through your unit chain.  The routing of information from your unit to the med unit is simply a different path than the one to brigade HQ.

I agree it sounds like we haven‘t provided sufficient orientation to the the I/C UMS.


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## starlight_745

Brad

My mistake, yes about 6 weeks of those days was for a course, the rest was class A


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## Armymedic

Cbtmedic,
there is a little saying I tell the people who have worked for me at 2 Fd Amb:

If you want to play ball, first you have to show up at the game. When you get there you have to play by the rules, or find a diffrent ball park to play in....

I think you need to show up.

Its funny though, both reg and res F medic complain about having to work in Fd Amb. Thats kinda neat.


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## Caz

I find this topic incredibly interesting, but I don‘t know anything about the restructure.  Could somebody give me some background?

Thanks!

-R.


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## Armymedic

I‘ll attempt to paraphrase it all, but I‘m sure Mr Sallows, and Cbt medic will fill in where I missed...

CF medical services (medical, dental, physio etc) have been given their own Command status, under direction of a Director General Medical Services. It has been done in response to SCONDVA request in an effortpartly to improve the provision of health services to the mbrs of the CF and also to assist in streamlining medical assest (read save money, and make most efficient use of the few medical personnel we have).

Two main efforts of this is having a core of Garrison care where the health teams are not deployed and offer a consistancey of care to mbrs. The other is the consolidation of 1st and 2nd line personnel so that resources are distributed to where they are needed most. 

For the Army, this means a proposal which does away with the traditioal UMS system, consolidation of records, doctors and 2nd/3rd line tmts in one area of a garrison. For the Med Techs (which are a field resource in the army), they are consolidated in a Fd Amb and doled out to units based on thier requirement for medical assests and firstline support.
In theory, it all sounds doable, but there is a predisositon to all mbrs of the army to want "thier" assests or atleast what they precieve as thiers close to them. Also this new system it doesn‘t help the young medics because they are unable to get attached to thier troops (read earn the trust of the soldiers and get to know them), making it difficult to do the job really well.

Hope that will help.


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## Caz

Interesting... Medical Command...  it looks good on paper, but I have zero experience with it in reality.

Hope they can work all the bugs out for you folks.


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## starlight_745

I think one major problem in the reserves (speaking as someone who spent time in a combat arms unit) is that most units exist only as squadrons/coys.  Therefore most units have only 1 or 2 medics, making training difficult if not impossible.  If an entire UMS in a battalion was the norm, you would have a critical mass of pers able to conduct meaningful medical training under the watchful eyes of the snr Med A‘s and PA/MO.  Therefore, medics must go to the field amb to get training.


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## Fraser.g

They are still working the buggs out but here is my understanding of the new relationship with medics in non medical units.

The short answer is that reserve medics can not belong to non medical units.

The only way that they can parade with another branch unit is because of geographical distance. 

For example, there are two medics that parade with the Sask D‘s in Moosejaw Sask. They are members of 16 Field Amb but their day to day administration is carried out by the gaining unit. This is only because there is not a Det of 16 Field Amb in the city. If one of those medics moved to Vancouver, they could not parade with the BCRs they would have to parade with 12 Field Amb. The other option would be to release or remuster. 

CFMG provides funding for those medics attached to non-medical units to the tune of 37.5 man days a year(if memory serves) the number may be a bit more so that there is not a financial restriction on maintaining medical training. That training is the responsibility of the local Field Amb. Also the course loading and tasking of that member is the responsibility of the Field Amb.

It is the responsibility of the member to ensure that they attend the training exes of the field amb. If they do not participate in that training and maintain their MOCOMP they will be unable to function as a medic and will be given the option of release or remuster.

With all this in mind, I am surprised that Combat Medic is still parading with the Sea Forth. I understand his reluctance to leave the unit that he has called home for so long but under the new orbat he has to belong to CFMG and not 39 Bregade.

I hope that this clears things up.


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## MedCorps

Being a Reg Force guy someone bring be up to speed on this... 

It seems like some of the old XX Med Coys are being converted to XX Fd Amb (ie 11 Fd Amb, was 11 Med Coy) and others are staying as XX Med Coy.  

I am a little confused as to why (I sorta liked the old system, as it was obvious which units were ResF).  Did the role / mission of these "new" Fd Amb designated units change from there role as Med Coys?  If so, what is the new role?  Are all ResF Med Coys going to re-name to Fd Ambs? 

Thanks, 

MC


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## Fraser.g

All Reserve units are officialy at the field amb level now.

They all have the same number but have increased on paper to field amb from Coy level formations.

The easiet way to diferentiate is that Reg force units have single didgets 1 Field Amb etc

Reserve have two 

Victoria has 11 Field Amb
Vancouver is 12
Edmonton is 15
Saskatoon is 16 etc.

The confusion was the delay in formalizing the change. CFMG has been using the new designators for a while and the Land Force have been using the old designators. As of last week, they have been singned off on from Ottawa so every one should be on the same page.

I hope this helps


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## MedCorps

So what is the authorized peace-time strength of a Reserve Field Ambulance? 

MC


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## Fraser.g

Good question,

Right now 16 Field is parading at platoon strength. We have been instructed to recruit 12 Pers a year plus attrition. These target numbers are due to our ability to absorb and train members. Ideally I think (this is my feeling only) that CFMG would like to see us at Coy Strength with about 50% of our numbers employed in the civi health care field.

If any one else has an idea please fire it off.


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## Brad Sallows

The establishment I was using for planning and other purposes for several months is still (last I heard) a "draft"; it lists 135 (might be off by one or two) unrestricted positions (ie. available assuming full funding).  Funding constraints will of course cause that number to be reduced.  I would expect each unit to have a different target strength set which weighs factors including: current strength, available funding, historic attrition, availability of indiv training courses.

It is sometimes worth doing the arithmetic to find out if your higher- or self-assigned goals are achievable.  There is no point shooting for an all-rank strength of 100 if your annual attrition is 15% and you are limited to 10 course vacancies annually for, say, QL3 and BCT.  (Caveats: you can work on reducing attrition, or hope that people will stick around long enough until you get some extra vacancies one year.)  Over-recruiting just aggravates attrition in two ways.  New people leave in disappointment if they don't get courses within a reasonable time window.  Other people leave because the resources which might be used to further their training (and interest) are wasted to recruit and train other people up to the bottleneck course level.

(Number of critical course vacancies) divided by (attrition rate) = sustainable steady-state strength.

By critical courses, I mean the ones required to get a soldier / officer trained to an employable level: BMQ(R), SQ(R), MOC (QL3); BOTP(R), CAP(R), BCT.

For example (just pulling some figures which may be close to reality), if there are 7 serials of QL3 offered annually with a maximum course load of 24 each, the total number of reserve medics nationally should be about 930, or about 65 per reserve field amb.


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## Fraser.g

Brad,

The choke point that we are experiancing is not with the number of QL3 Courses put on the brick each year by CFMG it is the number of BMQ/SQ slotts that the Army and CFMG have agreed on. I have many more interested bodies than I have positions to get them trained. 

Last year we had people that wanted to join as medics but were discouraged at the recruiting center or CFRC becasue of lack of vacancies.

I had put forward the question as to why we could not fund and run our own BMQ/SQ in the summmer and was told that it was an ARMY course therefore only they could run one.

Is your unit exp the same limitaitions.


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## Brad Sallows

The specific bottleneck may vary with time.   Over the past few years in LFWA I found the bottleneck to be QL3; we had no difficulty attracting sufficient recruits willing to endure the entire recruiting process, and between summer ARTS in WATC and local CITY courses within 39 CBG there were sufficient QL2 courses.   I should note there is nothing inherently bad about the presence of a bottleneck in one of the gateway courses; absent unlimited funding, such a restraint will always exist.   It is important to recognize the restraints and plan accordingly.

What must first be established is: how much freedom of manoeuvre does the CO have?   It can vary subtly (or quite overtly) from year to year.   If a unit is assigned all its gateway course vacancy numbers and a list of constraints which tells it how to spend every Class A funded day, there is very little latitude to tailor a unit's training to suit the situation.   Otherwise, it is clearly possible to address different shortfalls from year-to-year - recruits, junior leaders, drivers, collective BTS, etc.   I never saw a training directive (from higher) that was completely achievable given the current state of the unit and the assigned resources, but we always seemed to have difficulty articulating "We can't do all of this" to higher.

If MOC/QL3 is not the bottleneck, that's actually a good thing: virtually anything else you can influence, whereas I have always found QL3 vacancies to be nearly impossible to influence.   (This applies to any highly centralized training, but there is less pressure to take the more advanced courses quickly.)   If you need BMQ or driver wheeled courses, commit instructors and funds to participate in CITY courses run by your supported brigade.

The directive to recruit more civilian professionals is both a bane and a boon.   In the short term the time and expense (lost income) of getting over the "learn to be green" hurdle is considerable for them, so attraction is difficult.   Advantages are that we compete less for recruits with other units, we are less tied to the army's recruiting and training cycle, and the mobility of the target audience should be less than for students.

[Add: it helps to be working from some sort of long-term planning concept - call it a 3 or 5 year plan, if you wish.  Set the end-state (eg. a trained platoon and company-level HQ).  Determine, based on attrition, what you believe your course requirements per year and collective BTS workup/evaluations are to maintain that steady state.  Work to bend and tweak the system to address your requirements, not necessarily all at once...]


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## MedCorps

Are all of the Res Fd Amb NCO posn's MOC 737?  Do they many allowances for Svc Sp Pl? / Dental Pl  / HQ (Sig Ops , MSE Ops, Cooks, V Techs, Supply Techs and the like)? 

Good to see some Medical talk here.. 

Cheers, 

MC


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## Brad Sallows

There are non-7xx positions in the (draft?) establishment HQ and service support elements.  I can't recall offhand how many are unrestricted, but the number is only a few.

(When the 737 change was originally announced, we thought it was to include the R711s.  Then there was official hesitation, and AFAIK reservists are still R711.)


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## Fraser.g

It seems that CFMG is hesitant even to hold and maintain their own vehicles let alone higher cooks, MSE ops, sigs and the like. 
This meens that we are still beholden to the old bregade system for most of our support. So much for seting up an indipendeant command structure.


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## Brad Sallows

Most reserve units with which I had some acquaintance were never capable of much integral support.  (There were exceptions, if a unit managed to acquire and hang onto a switched-on cook or veh tech.)  I wouldn't worry about the non-med positions (particularly if all it does is pull people away from the local service battalion) until I had a very healthy number of medics on strength.


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## Fraser.g

Granted, 
There is little need for full integral support in most reserve field ambs. With that said I believe we have to control our own equipment and have the resources to maintain that equipment at the first line level. 
As of now all our MSE are controlled by and dispatched from the local service Bn. This means that we have to ask them to dispatch our own ambs or ask them for the lift to deploy to the field. If that equipment is tasked for Svc bn use or at the Brigade level then* we* have to adapt and make due not the brigades that we support.

If we are going to be independent in our own Group then we should be able to deploy independent of the units we are supporting.

Yet another two cents.


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## Brad Sallows

If you look into it, I believe you will find the vehicle situation is due to the way 38 CBG chooses to manage vehicles.  By comparison, in 39 CBG the vehicles are not centralized in the service battalions.  However, no-one ever seems to have as many trucks (serviceable) as they desire, so there is still a need to plan ahead and borrow/share.  I don't know when or if equipment will be transferred from army ownership to CF H Svcs Gp ownership.  If it is, you are still going to have to establish between yourselves and the service battalion (or the ASU) a process for maintenance.

It is good to have sufficient ownership to manage "your" vehicle allocation, but you might find you don't really want responsibility for first-line maintenance.  Operator maintenance alone (if done properly) can be challenging if you are deficient in people, tools, or facilities.


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## vr

Heres my question to throw into this topic:

Are Reserve Field Ambulances being transformed into PRL holding units??

The new benchmark for any meaningful medical work is as I read it the QL-5 or civilian equivalency.  Here in BC that is the new PCP course or registration as a paramedic.  I believe there is an equivalency for nurses, but am unsure.  This is the requirement set for many medical supports to training.  The requirement for  supporting anyother training is an SFA ticket and a safety vehicle.  The QL-3/QL-4 Reserve Med A is somewhere in between.  During the recent Bde ex medical personnel had to be imported from back east (41 Bde) to fulfill requirements for support.

QL-3/4 (MCSP/BTLS) Med A's going to Op Peregrine last summer were not permitted any patient contact unless they had the equivalent civilian qualification.  If they had 404's they got to drive the ambulance; no 404's they got a shovel.  It has been my personal experience in training with Reg Field Ambs that those with civilian quals are weeded out for patient care and those who did all the training that the Army told them they had to do were shunted off to the side.  This is especially true for any member wishing to go on deployment in trade.

Much has been made of the delivery of the new Sim-Man trg aid to the Reserve Fld Ambs.  While these are awesome pieces of kit, one of their primary functions is to allow civilian-trained mbrs to practice as part of the PRL.  The operator's course for these is, according to the msg, only open to those with the requisite civilian quals.  This further marginalizes a number of senior, *keen, and available * members.

All would be well if there were plans afoot to bring all Reserve members up to this standard.  Prove me wrong, but at present there are none.  The only recognized standard that the Reserve Med-A will continue to have is the AMFR-2/BTLS which is the standard taught to civilian police/fire personnel.  If the powers that be were to commit to the long-term program of bringing Reserve Med-A's up to civilian EMA standards they would be rewarded by a longer-term committment from the members.  The 15% annual attrition quoted earlier is an extremely conservative estimate.

Lastly the recent long-term recruiting plan put out to the units has made it quite clear that the sole priority will be recruiting civilian qualified health care workers into the Reserves.  Non-qualified applicants will still be accepted but will not be actively sought out.

This is my theory.  Any comments.

As a secondary point, how successful do you think we will be in recruiting & retaining civilian trained personnel.

"There is no art to killing with the point."


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## starlight_745

As a member with civilian qualifications, my opinion is that CFMG will never get anywhere near the number of civilian qualified personnel they are looking for.  Unless they get their act together and start getting better equipment and resources to get the job done, people will not stay around.  As cool as the sim mans are, 30000 bucks would have bought a lot of new tail gate equipment, monitors, pulse oximeters etc.  Stuff for real patient care that is sadly lacking in the majority of units.


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## Fraser.g

Recruiting civi qualified pers is not a problem with targeted efforts but as Starlight says keeping them is going to be a pain. Once they see the state of equipment their parade rate will dwindle until they release. 

We need to be trained to the PCP level at a minimum. If CFMG approached the civi training facilities and block booked two seats per course this would be manageable. The problem lies with the fact that we have no way of holding them once they are trained. There are no contracts in the reserve and so I forsee many pers taking the training and then saying thanks and leaving.

The other possibility is that we use the post secondary education fund to assist members in taking their PCP on their own. Perhaps we could set up class A days for study or in some way assist them beyond the 50% cost of the PSE funding. By the way, that fund is a tentative go but the monies will not be released or confermed until after the election. 

Another thing that would be beneficial to the reserve medics is to get them into practicums in civilian hospitals and local EMS. I would be more than happy to mentor medics in the ER where I work on civi street but we need to work out liability insurance, scope of practice, supervision, not to mention authorization from CFMG.
It is great to teach a member the skills to treat a patient but if those skills are not used continuously they will be lost. This goes for the Regular force and Reserve members of CFMG alike.


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## Armymedic

Retention is our (reg force)  problem too........

Even with the PCP qualified QL 3's, people still are having to wait 3-4 yrs to get their QL5 course, and only then being fully employable in the UMS or firstline medical support roles. 

Also we have to resign people who have 3 yrs in the military who have only been at the unit for less then a yr, because they sat on PAT platoon in Borden for too long waiting for their QL 3 course. 

The good ones are getting out, going back to school, or looking for avenues where they aren't wasting their time waiting for another course.


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## Fraser.g

I think that by increasing our relationship with the civi health care sector we can maintian the skills that will be needed on the present battle field or operation other than war as well as keep the interest and therfore decrease the attrition rate in both the regular and reserve forces.

Grant


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## starlight_745

I think a good example of this type of program is the US Air Force Top Star training run out of St. Louis.  (I forget what the acronym stands for).  It is a two week course where NO/MO/and Med Techs rotate through and each has a different skill set to refresh in.  For example Med Techs do EMT refresher, ICU/Emerg rotations and ambulance ridealongs, Nurses do TNCC/ABLS and rotations etc.  There's not that many people in CFMG so if everyone could rotate through a program like this every couple of years it would probably work, combined with some other local unit level  coned.


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## Armymedic

Problem with sending people off for course is that we are toos short staffed right now to replace them...

With the PCP Bridging, we send 5-7 pers pers course away. Right now we have 14 MCpl-ptes away. Who cannot be backfilled because we are already way short of QL 5 Cpls and MCpls at Fd Amb.

At my UMS we are 50 percent short staffed, with 1 pers on course 1 MCpl posn vacated and 3 Cpl posn vacated, with no sceduled replacements.

So how can we afford to send more away, for whatever course, medical, leadership or otherwise?


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## Fraser.g

The answer to this is reserve back fill into the Field Amb. There are many members of the reserve medical world that are PCP qualified. Why not use them? 

This would serve two fold:

1. Increase the strength of the working relationship between the regs and reserve forces (Total force)
2. Facilitate increased retention in both the Regular forces and Reserve due to availability to go on courses and OJT for the reservists.

We have to start thinking outside the box on all levels if we are going to fix the problems in CFMG


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## starlight_745

I think the problem with using reservists to backfill is that most of the reservists ( or anyone who isn't a student for that matter) who have civilian qualifications can ill afford the time off work to fill a position for say 2-6 months while someone is on course.  I have a helluva time just attending all unit training as well as my career courses and keeping of top of admin such as PER's etc.  Without any type of job protection it would be very difficult for most people I know to backfill unless it was perhaps an operation.


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## Soon to be Medic

I am wanting to join the Regular force being a medic. Should I be qualified? Before entering, if training is an issue.that I have been reading in this forum?


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## Armymedic

You hit the nail one the head:



			
				starlight_745 said:
			
		

> I think the problem with using reservists to backfill is that most of the reservists ( or anyone who isn't a student for that matter) who have civilian qualifications can ill afford the time off work to fill a position for say 2-6 months while someone is on course.  I have a helluva time just attending all unit training as well as my career courses and keeping of top of admin such as PER's etc.  Without any type of job protection it would be very difficult for most people I know to backfill unless it was perhaps an operation.



And just because they are PCP qualified, does not mean they can work as a QL 5 in a UMS. 

So Nurse as needed ( I couldn't resist  ) while you suggestion is valid for filling Pte QL 3 positions at medical company, which by the way there are no shortage of, how do we back fill those QL 5 Cpls, and MCpl positions?

Soon to be Medic,
Quick answer...No. To be PCP qualified thru college its is a 2-3 yr course, paid from your own pocket of course. If you are looking to get in soon, don't bother, because the military will train you to that standard eventually, and you will get paid to do it. Worry more about getting into good shape and reading about biology, anatomy,  and chemistry. Truthfully, being a good medic is not about qualifications, but knowledge and abiity to use it wisely.


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## starlight_745

As long as there is no QL5 equivalent course for the reserves, there is little hope of any type of large scale employment of reservists.  At best I think there will be a few amb drivers and maybe QL3 types to fill out a med pl.  While I have civilian PCP qualification and lots of prehospital experience, there is no possible way to obtain full equivalency at the QL5 level so once reservists are finished QL4 there is essentially no medical training remaining in their careers.  I know 6A includes some but how many sergeants are out doing direct patient care?  The majority I know have thier hands full with administration.  While we're at it can someone outline what is contained in the current reg force QL5 and if there are plans to change the content any time soon?


----------



## Fraser.g

Armymedic said:
			
		

> You hit the nail one the head:
> 
> 
> 
> 
> starlight_745 said:
> 
> 
> 
> 
> I think the problem with using reservists to backfill is that most of the reservists ( or anyone who isn't a student for that matter) who have civilian qualifications can ill afford the time off work to fill a position for say 2-6 months while someone is on course.   I have a helluva time just attending all unit training as well as my career courses and keeping of top of admin such as PER's etc.   Without any type of job protection it would be very difficult for most people I know to backfill unless it was perhaps an operation.
> 
> 
> 
> 
> And just because they are PCP qualified, does not mean they can work as a QL 5 in a UMS.
> 
> So Nurse as needed ( I couldn't resist   ) while you suggestion is valid for filling Pte QL 3 positions at medical company, which by the way there are no shortage of, how do we back fill those QL 5 Cpls, and MCpl positions?
Click to expand...


I have two Paramedic or new PCP Advanced medics who have gone out on several taskings and have been employed at the 5b level due to their skill set. Here in Saskatoon we use advanced care paramedics in our trauma center along side the nurses and docs. 

If they can function there then they can certainly function in a UMS or MIR. All that has to happen is that the area surgion has to sign off on their skills.


----------



## Armymedic

What rank were they?

5b means they worked as a senior cpl or a MCpl position in the reg force...But also as a jr Sgt.

The task you mention must have been a type of range coverage because I doubt that civilian paramedics have the clinical experience to take care of 2 or more jr med techs at sick parade at that 5b level.


----------



## Fraser.g

Nope,
The task was with 1 Field Amb both in garrison working in the MIR and also for NO Duff coverage on Ex. 
He was also going to be on tour working in the 3 VP UMS but was unfortunately unable to deploy due to a leg injury.
The individual that I am referring to works Trauma both pre-hospital and at the level 1 trauma center in Saskatoon.
Not exactly range coverage.
By the way his rank in the reserves is Cpl. but I would put his skill set and knowlage up against any Regular Force Sargent I know.

Grant


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## Armymedic

I think we're getting pissy over nothing, I am sure your troop is good to go.
I had a bad experience with a civ paramedic reservist MCpl who thought that he was civilian qualified meant that while he do everything in the military that  he learned in school, without consulting the MO...

It wasn't pretty.


----------



## starlight_745

Just for my own benefit, could someone outline the current reg force QL5 content or direct me to a link that does?

Thanks


----------



## Fraser.g

Sorry Armymedic, 
Long night shift with multiple traumas all at once.
I agree there has to be a definite scope of practice for EVERYONE in a medical facility. My frustration has been that certain members of the field ambulances and above do not use reserve medics with civi qualifications to their utmost. this discourages them from going out on future taskings and it turns into a downward spiral.
It is my hope that once the PCP program is fully integrated into the Regular Force qualifiactons there will be more use of Primariy reserve and PRL members.


----------



## Donut

Soon to be medic:

The Reg F (Justice Institute of BC) PCP is 13 weeks long, not 2-3 years.  You still need to do the 16 week clinical block in ontario, but taking the civi course is certainly an option, is recognized, and not that long.




DF


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## vr

So what becomes of the non-PCP Reserve Med-A?  The ones who went to Op Peregrine after doing all their mandated training and were handed a shovel or if they were senior enough could drive an ambulance.  What taskings and employment are left for these guys?  GD by the sounds of it.

It is extremely unlikely that the powers-that-be (? new weekly abbreviation) are going to spend the money to bring the majority of currently serving reservists up to a PCP standard.  Are we going to have 2-tiered medical units?

At peace with my bitterness.


----------



## Armymedic

Actuall a bridging program is currently in progress, whith three courses currently underway. At 2 Fd Amb, they load them with 1 MCpl, a QL 5 Cpl and the remainder of the 5 or 6 pers, QL3 medic who are awaiting thier 5s course. 

As for this 2 tier thing...2 Fd amb is desprately short of fit Med Techs at all levels and so employment is not as restricted as you menationed above. Non PCP qualified ptes who can drive..do. Those who don't get tasked supporting the understaffed UMS's as need.


----------



## vr

I was referring mainly to the Reserves where the biblical separation of the sheep and the goats has already begun.


----------



## Donut

I fear we're going to see two things with the move to 50% civi licenced pers among the reserve Fd Ambs:

Those reserve medics without a civilian qualification are going to get tired of being a driver and underemployed, and will get out. (that 2nd class citizen thing)

Those who do enroll with civilian qualifications are going to look at the kit and equipment they have to work with, look at the amount of money they give up to work for the CF, and the amount of time they are expected to commit, and leave.

Someone on this board asked if the Res Fd Ambs were going to become PRL holdding units; not a bad idea if they opened the PRL to trades other then NO/MO types.  RT's, EMT's, Lab & Pharmacy techs etc are already overcommited  in their day to day jobs, and, while many wish to serve, the sacrifices are too much, especially if they have to do CME for two (or more) different organizations.

We can offer incentives to keep them around, Spec pay might help with some, enrollment bonuses etc, but ultimately the CF can't retain and challenge health care providers so long as the only unique opportunities it offers are field time and  "challenging" (read frustrating, demanding, under-staffed, -equipped and -supported) working environments.  Who, really, wants to trade in their Ford with a crestline body for an LSVW?  or their nice pharmacy with no concerns over drug stability at room temperature to handle meds at 40 degrees below zero? or their nice, well appointed ICU/CCU to put up with bugs (have you seen those freakin' camel spiders?!?)  and dust and boredom in Afghanistan?  There's virtually no "jammy" goes to counter those anymore, no jump courses, Air Evac, DCIEM rotations to provide the carrot, just the stick.

We can show up at recruiting venues with our ECS beepin' away, and get the attention, but how long will people stay in if there's no further advancement for them, and the working conditions and pay are both below the civilian standard?  


There's a huge number of bugs in the system that need to be worked out;  we should solve as many as we can before we actively seek out huge numbers of civilian practitioners to join and become disillusioned and bitter.  If we look like morons the first time they walk in the door, they're not going to come back in five years when we say we've cleaned up our act. "no, this time we're serious..."


Free advice is worth what you pay for it.


DF


----------



## Fraser.g

I agree that there is allot to upgrade and improve before we go out and actively recruit for civi qualified pers. Right now the state of the Res Field ambs is abysmal to say the least. 
0 Funding and what we have is being cut back every day
0 Kit comperable to the civi level
0 training other than to the AMFR 2 level
0 Practicums to get hands on experience
0 courses to keep people interested etc.

As for the PRL, it is being offered to any member with health care training. I have a member of my unit who is going PRL as a Phisio Officer,
PCP qualified members are the same as well as Pharm Os and any other allied civi trade. 

One day we may go 50% but at this point it is an unrealistic goal. We have to develop our own infrastructure and nurture those that we already have rather than throw them away or off to the side and hope for a new pre-qualified cadre.

GF


----------



## starlight_745

I agree that we need to focus on retaining and looking after the medical staff we have.  There is a shortage Canada wide in virtually every health care occupation I can think of off the top of my head.  We are not going to be able to compete with the rest of the private/public sector any time soon.  The reserves already has (had I guess) a relatively successful tuition reimbursement program.  Why not institute a health care specific one through CFMG?  For example Cpl Bloggins has spent 5 years in the reserves and attends school for his PCP/Lab Tech/X-ray Tech/PA etc.  and CFMG reimburses his tuition with conditions that he stay in the reserves for another 4 years or whatever.  The constant focus on recruiting on not retention really irritates me.  If a unit loses a senior Cpl/Mcpl that is probably a 50-60 grand investment and will cost at least that to recruit and replace that member.  It sure makes shelling out for a $3500 PCP course look cost effective in comparison.  People that have been in for 4 or 5 years already are likely to stay in if we stop over tasking them and kicking the crap out of them and making them hate the CF.


----------



## Fraser.g

The tuition reimbursement program is back, all we are waiting on now is the final signatures on the budget. At least that was the last I heard from my OR. 
The big problem is that we do not have fixed commitment periods or contracts in the reserve. If we were to have that then the education incentives that starlight might work.


----------



## vr

One detriment to bringing in qualified civilian personnel is the amount of training required.  This relates mainly to physicians & nurses.  One unit in BC had a neurosurgeon interested in signing on and when he asked what he had to do for basic he was told the full BMQ-CAP R, BOTC and anon.  This came down from CFMG.  Well that was the end of that.

There used to be a course called BOTC-Specialist AKA the Chaplains course.  This was for personnel who were to be solely employed in their specialties without wider responsibilities.  I believe that this was done away with.  Something like this is required if the Reserves wish to attract health professionals.  People at this point in their careers & lives are unable to take a whole summer or even half of one to go off on course.  If they then wanted to play Platoon Commander they could then go off on that course but their duties would be mainly clinical.

If the powers that be ( I forget this week's title) are serious about making the Reserves 50% civvy practitioners then they have got to make it easier to get in.


----------



## Donut

We were debating something similar the other night:

Now that reserve medics only need QL3 and a block of time in to be promotable Cpl, does this mean we are taking civi paramedics, giving them BMQ/SQ, writing off their QL3's with a Fd Med bridge, and making them instant Cpls?   

If so, if this is the plan, what does this do the currently serving Cpls, what does it do to the rank of Cpl, and is this a good thing?

I personally am of mixed opinions on this.   We're not going to attract civi health care professionals at the bottom of the food chain, nor should we expect them to enroll as such, they are technical experts in their fields, and deserve to be treated appropriately.   But, at the same time, by effectively making cpl a rank that carries no additional tng beyond basic MOC qualification, we are degrading the rank and adding another useless rank/pay step that gives us no benefit (anyone remember that Cpl used to be a Section Commander rank?!?)   

Do we want 50% of our Cpls to be good soldiers, with a couple of years in the CF and no clinical experience while the other 50% can't come up with a contact or loc rep but can place that ETT perfectly at 0300 inverted in a MVA?   Are we moving to a de facto â Å“streamedâ ? medical service even as we argue that it's not feasible with our current levels of tng and staff?

How are the â Å“non-clinicalâ ? cpls going to get along with a guy with 3 months in the CF, who's uniform still has the shine on it and his boots still don't?   Having MCpls and Sgts driving around Paramedic Ptes and Cpls on Op Peregrine didn't go over very well on Op Peregrine, and I expect the reception to be even worse if this becomes the natural order of things.

So, the topic is accelerated promotion to Cpl of civilian qualified enrollees.   Discuss.   

â Å“I'm a little verklempt.   Talk amongst yourselves.   the holy roman empire was neither Holy, nor Roman, nor an empire.   Discussâ ?


----------



## HCA

I would have to say that my chief concern with bringing in the medical professionals is our lack of kit. We shake our heads in dismay at the poor state of affairs and carry on as we always have.    This is the way it has always been and we are used to it. Unfortunately I don't think it will be too impressive to the health professionals we are trying through our doors.

SO what can we offer them that would bring them in then keep them in?


----------



## starlight_745

The lack of kit is something that I think is one of the easiest to remedy.  To do something like say buy brand new kit to outift all the tailgates in the unit would not cost all that much.  If a unit was willing to cancel a couple class A saturdays of training there would be enough money to kit out at least a med platoon with all the items we're short of.  The consumables are easy enough to get from CMED but kiss any big ticket items good bye like a pulse ox or new spineboards.  I thnk the lack of proper medical kit in most units is a liability waiting to happen at best and a scandalous display of the standard of care for our troops at worst.


----------



## elliott.t

ParaMedTech,

it sounds like your talking about the semi-skilled or skilled enrollment plan that CFRG has in place.

Cheers


----------



## Donut

Elliot, I think I am, to a point, but I must confess I'm not that familiar with CFRG policies.  We're not just talking about a QL3 bypass, but an accelerated promotion for these members.  To the best of my knowledge this isn't being advertised or offered to Reserve types.  Sitting at my station I have three paramedics (one former mbr) around me who have asked all sorts of questions about joining, but probably won't think about it if they're coming in as Ptes.

Our recruiting NCO can't give them a definitive answer as to what their career progression will look like, so they're holding off on applications, and we're still hurting for qualified troops.

What they're waiting for is a clear-cut policy decision at the national level that states what they're going to be offered upon enrollment, and how fast they can proceed up the chain.

On a similar note, do any of the reserve types have any experience with the CFMSS PLA process?  I started putting it together, but have put it aside because it seems a ridiculous amount of paperwork for very limited return only to be told that I'm a Reg F QL3 (maybe).

Doug


----------



## HCA

You say they "probably won't think about it if they're coming in as Ptes." Why not? Pte is a good rank and everyone should have to do some time at this rank to appreciate it. Some of my best experiences were as a Pte. I would say there career progression would be as fast or slow as they work at it. In fact career progression just got a lot easier with the elimination of QL4 for Cpl's. If I remember correctly now if you have your BMQ, SQ and your QL3 as well as two years in your good to go.

We could also debate if this is to fast but for paramedics joining now I can't see why two years as a Pte would be so bad for them or how it would change there role if they were made Cpl's faster. Leadership will still be the stopping point for all pers with or without prior medical skills.

If you have a paramedic that joined up and was also able to get the courses required BMQ, SQ, QL3 bridge, QL4 and PLQ Mod 1-6 there is always accelerated promotions for the exceptional people that occasionally wander in our doors.

HCA


----------



## vr

This situation is already being addressed by some Reserve units.  It seems that QL-3 & most if not all of QL-4 are being written off for pers with civvy quals.  On a recent Reserve QL-6A which is the Sgt qual course there was a candidate who had civvy quals up the yin-yang but had never deployed with a medical sub-unit to the field.  I guess that the unit decided that the civvy quals overrode the need for the mbr to participate in the less glamorous aspects.

Is this the 2-tiered system that we are going to get?  One group of "inside" medics who stay in the tent/BMS/amb and only do clinical work and another group who do the "outside" work.  The ones who set up, run, and defend the facility.  Who, if they're lucky, get to be the "head-holder for a casualty.

The PRL is only required to do 14 trg days a year.  Will these pers be held to the same standard as everyone else when it comes time for promotions & appointments.  In the Reserves we have always used field training exercises to develop and assess our troops.  According to recent statements from senior personnel this may no longer be the case.  So when it comes time for promotions how do we compare the military trained versus the civilian trained member? :dontpanic:


----------



## Donut

HCA, I should have said â Å“they have stated they won't join as privatesâ ? vs â Å“probably won't think about joiningâ ?.  One person I am referring to is an ex-member, who knows exactly what it's like as a Pte, Cpl and an OCdt, others have looked at the pay scale and said no, others have thought about being clinically subordinate to a First Responder and said no.

The end result is that our organization is clearly not attracting enough health care professionals.  Telling them they'll spend a couple of years as pot-wallopers or sentries is not going to do it to bring them in.

So, new MP's are promoted Cpl as soon as they are trade qualified, the reasoning AFAIK is that they carry increased responsibility and are required to work independently immediately;  they, too, need a certain civilian skill set to be effective, the same can be said of the Paramedic qual'd Med A.

In terms of what we can offer them to enroll, I have to say not much, or else we'd be enrolling them now.  

Anyone know anything about spec pay?


----------



## MedCorps

Our Coy CSM gave a brief last week after talking with the Branch CWO .   The brief was centred around the Reg QL5A issue, but spec pay came out in the question from the class... 

As it stands right now specialty pay for MOC 737 is not on the near radar.  

MC


----------



## starlight_745

My impression regarding the PRL is that there are no promotions or career courses within the PRL.  My info may be out of date though.


----------



## Brad Sallows

Well. If the difference between military command and clinical command can't be resolved and the reserve leadership isn't perceived to be capable of treating professionals at junior rank levels with sufficient respect, then the organization is indeed at an impasse.

Pay scale affects a lot of people, regardless whether their chosen MOSIDs draw on their civilian skills.  Stating that won't solve the perception problem, but reserve _service_ is a sacrifice.


----------



## HCA

I would have to agree with Brad on this one. Reserve service is a sacrifice. One that many of our society are not willing to make for a variety of reasons. (Which can debated elsewhere) 
What we are looking for are those few people that are medically qualified and have the desire to serve their country. Now we can do a few things to make the joining more attractive but in the end it comes down to service. There can really be no other reason in the end that senior members like myself and others continue to serve. 

The money is mediocre, the job stress high and the job satisfaction decreasing year by year as the workload increases logarithmically. The main reason I continue to serve is pride in the work I and the people I work with do. 

We need others who are like minded and while I doubt we will find them in the numbers that the forces desires, we will find some. If they want to serve then it will not really matter to them what rank they join at. We as senior leaders will have to ensure the people we work with exercise their military command appropriately and employ their clinical experts to their maximum potential.


----------



## Donut

As Maj Sallows said, it is a matter of perceptions;   we are not perceived as capable of employing health care professionals appropriately.   While I am almost certain health care professionals have a desire to serve (very few are in health care for the money, and it's certainly open to debate if being a member of the CF is somehow less, or more, of a national service then being a RN, Paramedic, RT, what have you in the current health care crisis, but service it is)   it seems that our organization makes if more difficult and less rewarding then necessary for these people to serve two masters.

I'm not debating that service in the CF, much less the Reserves, is a sacrifice;   It does appear, however, that the CFHS are in a unique position in that we are a federally mandated health care provider, as much so as OHIP or BC MSP, and we are not doing all we can to attract the providers we need to meet our obligations to the other citizens who give up their time, family lives, and income to serve.   Relying on an already overworked segment of the workforce to feel some patriotic zeal and give up even more of their lives to face challenges that replicate or exceed their worst civi experiences seems destined to fail.   The game has to be worth the candle, no matter how dedicated you are to playing.

I think Starlight_745 may have hit it on the head in his July 8 post.   If we can't attract them, we need to find a better way to grow them ourselves.


Doug


----------



## axeman

hey para med tech this is the axeman .email me  way_to_evil @hotmail.com  then we can tell lies about the moolitia


----------



## starlight_745

I see grooming the the people we have as the most cost effective way to manage things.  Funding PCP spots, and running more courses and putting forth a good MCSP program in conert with some local civilian health care facilities would go a long ways towards retaining people then we wouldn't have to worry so much about recruiting all the time.  Most units are terribly bottom heavy adding to the burden for NCO's who have to manage all the training and supervision for all the BMQ qualified troops waiting for courses.  The equipment problems in my mind are the easiest to remedy but we need to think outside the box.  A lot of money could be saved if units got funding to make local purchases.  As I said in my earlier post, consumables are easy to get from CMED, it is the big ticket items where we break down.


----------



## Brad Sallows

Another thought on recruiting professionals into the reserve:

My guess is that the number of medical professionals in the leadership - MCpl+ Lt+, but mostly Sgt and Capt - must reach a critical mass which provides a leavening of cultural maturity and interpersonal skills which in turn makes a unit attractive to other medical professionals (recruitment, retention).  I have no idea what this critical mass should be - maybe 1/3, maybe 1/2.  I do not suggest the rest of the leadership lacks maturity and interpersonal skills, but rather that it does not quite operate on the same wavelength.

If that hypothesis is true, then some potential approaches to a solution:

1) Recruit and train up (field and leadership training) the required mass.  This seems to be what we are trying to do.  Is it working?

2) Grow from within.  Train and maintain paramedical skills.  Expensive.

3) Curb non-professional growth by setting the bar high.  Force NCMs to acquire and maintain paramedical qualifications to advance beyond MCpl, and HCAs to acquire and maintain a trade-applicable professional certification (eg. diploma in a field of medical administration) to advance beyond Capt (or perhaps even Lt).  Not popular; likely to result in a contraction of units in the immediate future.

(1) and (2) are most discussed.  I believe (3) (and (3)-like) solutions should be considered.  The medical reserve might have to grow smaller before it can grow larger.


----------



## Infanteer

> (1) and (2) are most discussed.  I believe (3) (and (3)-like) solutions should be considered.  The medical reserve might have to grow smaller before it can grow larger.



Mr Sallows, I think this practice (3) may be required CF-wide.


----------



## Brad Sallows

Are there combat professions in the civilian world we should be recruiting into the CF reserves, or do you just mean we need to slow the pace of rank advancement in the reserve?


----------



## Infanteer

> Are there combat professions in the civilian world we should be recruiting into the CF reserves, or do you just mean we need to slow the pace of rank advancement in the reserve?



Haha, I realized I read into (3) a little incorrectly.  I'm still trying chuckling over the Infantry trying to get American 7/11 employees who've faced incoming rounds to join up an bring experience to the Army.... 

What I was trying to agree with is the fact that the bar should be set high and that the Army as a whole might have to get "smaller before it gets larger".  However, I realized this is not in the context of what you were proposing (ie: civilian requirements) and that I'm firing down the wrong lane.

I'll pull pin on this one ladies and gentlemen....


----------



## Fraser.g

With all the talk about the TCCC and Combat First Responder courses generated out of the states, why don't the medical reserve go about the same track as the US   Regular force as outlined by the 10th Mountain Division LI?

Four stages of treatment and care in a ratio of 100:50:25:2
100% Combat life saver 
50% Trauma Focused Individual Training
25% Combat Medics
2% Advanced Trauma Management Providers

While in the reserve we are lucky if 10% of all troops have Standard First Aid, to train the reserve medics to the T-FIT(including TCCC and C(Ranger)LS) would be a major jump ahead in medical coverage for the reserves.

This would also give the reserves a bonified skill set for deployment to theater and by doing so reduce the stress of repeated deployments on the regular force. At least they could be employed as the Bison Amb Drivers and release the regular force medic in to the 25% and 2% of the above mentioned matrix.


*T-FIT MTPs are:*

Overview                                                                                                                             Introduction

Tactical Combat Casualty Care                                                                             Triage   

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Airway Management                                                                                                   Head Trauma

Thoracoabdominal Trauma                                                                                      Burns

Extremity Trauma                                                                                                           High Altitude Sickness

*CLS MTPs are:*

Combat Lifesaver Course

Preventive Measures                                                                                                   Burns

Clearing an Object                                                                                                        Heat Injury     

Mouth to Mouth                                                                                                            Nerve Agent           

Field Dressing                                                                                                                 Litter Transport

Dressing for Chest Wound                                                                                    One Man Carry

Dressing a Chest Wound                                                                                         CLS Task and Equipment

Abdominal Dressing                                                                                                     IV

Preventing Shock                                                                                                           Dressing a Head Wound      

Splinting a Fracture                                                                                                        Pulse

Spinal Injury                                                                                                                       Respiration

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LPD Med

IMO the above outlined training is very doable and in a relatively short time frame. It would take 5-8 man days for the entire package. 

GF


----------



## starlight_745

I think that we're stuck with AMFR2 from the sounds of it.   I have seen the medical reserve dying slowly more and more over the last 2 years.  Unless there are major infusions of kit, vehicles and some sort of defined scope of practice I know an awful lot of people that are planning on clearing out because they've reached their limit.  I think the medical reserve dearly needs a clear mission, scope of practice and the equipment to accomplish it.


----------



## Fraser.g

You are preaching to the quire here. I commissioned from the ranks and a "0" trade. It is almost as if CFMG was about to stand up on its own and then some clerk tapped the staff officer on the shoulder and said something along the lines of ....excuse me sir but what about the reserves?

I think that one of the major problems is that we keep on tyring to re-invent the wheel over and over again. We seem griped on having a "Canadian Solution" to every problem. This has caused such fiasco as the LSVW to name just one.

What is wrong with taking the lessons learned the hard way from other armies and embracing it as our own. There is some move to make the TCCC or Combat First Aid course available to the Combat Arms for tours but the Reserves are still stuck with a CIVI course, AMFR2, which does not address the problems of the modern battle field. 

I am afraid that my frustration is beginning to show so I will sum this post up with the belief that the Medical Reserves have allot of committed personnel with a strong desire to learn and do the job the problem is that they are continuously being told that what they are to learn has changed and placed on a lower priority and skill level.

Take a look at the courses I have outlined above. If we can not take the whole course due to some archaic relationship between Saint John Ambulance and DND then we can take some of the valuable points and incorporate them into training such as TCCC.

GF


----------



## Fraser.g

It seems that we are changing from BTLS, the gold standard of pre hospital care in north America, to PHTLS. I have not seen the PHTLS course package or what the differences are as it is not offered in Western Canada as far as I know.
 If any one out there can clarify or explain the change please wade in.
As a BTLS Advanced instructor I would like to know what the changes are and what the BTLS Instructors will have to do to cross over to PHTLS.
It would appear that we are bickering about the basics and not looking forward IMHO.


----------



## old medic

starlight_745 said:
			
		

> I know an awful lot of people that are planning on clearing out because they've reached their limit.  I think the medical reserve dearly needs a clear mission, scope of practice and the equipment to accomplish it.



I don't think any medical types are going to disagree with you. There is still a long way to go.  But it's come a long way already.
It wasn't so long ago the reserve medical units were stuck inside the local Svc Bn's.  The years under the Reserve Brigades were not 
much better. (<- I'm sure that will draw a comment or raise an eyebrow). 

Change is constant, especially in any medical field. Medics have to be willing to change. 

I am curious about your "people that are planning on clearing out" comment. Any specific frustrations?

Cheers.


----------



## vr

I'll wade in with my own frustrations.

The Reserve side of the CFHSG is concentrating on increasing it's numbers of civilian trained personnel, Drs, RNs, EMAs, et al.  They are doing this by no longer recruiting (? for time being) non-civilian qualified personnel.  My unit's stream of new recruits has practically dried up while the 20% attrition continues unabated.

We non civvy qualified 737-M's are very limited in what we are allowed to do.  As far as going overseas in our trade, forget it.  There are still openings as amb drivers but those are few and far between.  The LFWA guidelines for medical coverage basically state that anything not requiring a paramedic can be covered by a SFA qual troop.  So another opportunity to gain employment and support our fellow soldiers is gone.  It is very frustrating to some of us older troops that the only time we can get on taskings is to drive Cpls around.

The reserve-trained Med-A is the backbone of the Reserve units.  These are the people who attend the exercises, parades and do all the sh#tty little jobs that make units go.  It is my personal experience that due to the nature of their employment civvy medical personnel are irregular paraders.  The most dedicated and hard-working members of Reserve units are being marginalized and they know it.

Apparently this whole PHTLS thing came about as a result of Reserve CO's pressing for it at OP-Med.  It was news to my CO.  PHTLS has absolutely no footprint in this province.  None.  It's not taught or practiced anywhere whereas with BTLS we have access to the resources or our paramedic schools.  It is going to be a royal pain (expensive!!!!) to train instructors, train and retrain the troops.

My real question is what is the advantage of PHTLS over BTLS?  Will we have to keep doing SFA/AMFR-2/PHTLS/BTLS over and over again?  We are saving lots of money on FOA out of this though. :dontpanic:


----------



## old medic

I can't accurately answer the PHTLS question, so I'll stay away from that one until someone digs up some answers on it.
Renewal of SFA/ BTLS etc is a constant thing. That will never change. I'd be afraid of anyone who takes it once and doesn't
want to do a renewal or refresher. Mosty civy medical trades have alot longer list of yearly renewals than your average 711/737.

Your comment about first aid vs. Paramedic coverage is interesting. Do you think that was a result of the lack of civy qualified paramedics in the  units? I would think a EMR qualified R711 would be better to have than a first aider. I know I'd want the highest possible level of care. Is that list of first aid coverage only activities just a way to save a few dollars? It's probably also a way to ensure training actually takes place, while there is a shortage of civy qualified pers. 

I'm curious to hear a few more gripes.  Of course, lets start throwing around a few ideas on fixing the problems too.  What training would you change for the reserve Med-A right off the street (not a civy paramedic)? How should the reserve Fd Ambs provide coverage and support to the brigade units?  What skills and equipment changes would everyone like to see?  I'd like to see some new NATO light box ambs myself, I have nothing good to say about the five-quad remounts on the LSVW.

In Arduis Fidelis


----------



## Fraser.g

Gripes first

The above posters are right on several points
1. The onus is on recruiting qualified and practicing medical professionals but they parade infrequently or are on the PRL.
2. The reserve medic is being marginalized out of existence because they are not given the skills, training or scope of practice that makes them any better than a first responder
3. The equipment that we are using is outdated and in some cases illegal to use on Civi Street. A regular medical professional would take one look and RUN!


Suggestions

1. Call a spade a shovel. For the most part the reserve units are Plt and Coy sized units. We should amalgamate in to regional field hospitals and not pretend we are something we are not. Think of the savings in Salaries alone.
2. Local PRL should affiliate with the unit.
3. If a unit is a Coy then kit it out as a Coy, Medical Equipment, Ambs, SMP the works. If it is a Plt then the same applies and the equipment waxes and wanes as numbers change. Talk about incentive! Recruit or we will take away your toys!
4. Where is our Regular force staff? They have been pulled out of the units, not replaced, and funding for the positions held back so that Class B back fills are not possible.
5. Train the members up to at least the Combat First responder as laid out by the 10th Mountain Div Surg office (See Attachment)
6. Reserve spots on the PCP courses held across Canada. They cost approx $2000 per candidate and would give our own medics clout on civi street as well as giving our medics a chance to gain valuable civi side exp. Paying for the course would be less expensive then paying for their salaries for the same time period. 
7. Become self sufficient with instructors BTLS, BTLS Advanced, PHTLS, ACLS, AED, SFA, CPR-C. Not only will this save the units money by not having to go to out side agencies but give the troops a chance to gain skills that they can use on civi street.
8. Set up manned Mir's within the garrisons. Why are we going to civi agencies to have recruiting and promotion medicals done when we have medics, NOs and MOs in the units????
9. Sync up the LFWA and medical coverage papers so that they need at least a QL 3 Medic for all ranges and live training. We are there to support the brigades so make it so that we have to.
10. Give 4 qualified medics a OTC med course so that they can dispence items such as Tylenol and Motrin out of the back of their ambs. You would be surprised what will happen to unit trust in the medical corps when a troop comes to one of our medics felling sick or hurt and laves feeling better.

Please feel free to add or comment. We all have to push togeather if this thing is going to get better instead of worse.


----------



## old medic

Good Post Sir,

I wouldn't play with the Pl, Coy, Fd Amb thing at all. That was tried before (1954 and 1965) with horrible results.  A reserve Field Amb will never parade peace time at full (wartime) strength. In 1939 many of the reserve Fd Ambs had an effective strength of about 20 all ranks,
but the establishments and entitlements enabled them to jump to 150 - 180 men. If the Fd Ambs were only Platoons or Companies,  they wouldn't be as useful.  I would also suppect the meager bugets would take further cuts.

I'm curious about your second point.  My understanding is that local PRL has to affiliate with the closest medical unit. Are there places this hasn't happened?

Equipment side, the more kit the better. you'll have a hard time recruiting or keeping anyone with borrowed (read Svc Bn) or missing gear. CFHS should also have control of their own vehicles as far as I'm concerned.  Also, if you have regional Field Ambs or Field Hospitals, then you wind up with only one set of kit spread out all over the country.  Ambs in one city, Panier sets in another etc. It would also turn a unit level exercise into an area wide event.

Training I agree with as well. I do agree with recognizing the distinction between civy and non-civy qualified members. There should be some upgrading for the members who came up through the QL system. In Ontario, the EMA's were able to take training courses to upgrade their skill set to the PCP level. Although the PCP's with the sheep skin are still considered the senior medic when working with an EMA.  An upgrade course, such as your suggestion on OTC's, and your thought about holding spots in the local colleges for PCP upgrading would be easy to do.

Is your unit not self-sufficient with instructors already? 

The MIR thing I completely agree with, and I've seen such arangements in the past.  My only comment there is funding.  The funding has to be there from the recruiting system to support it, otherwise the unit budgets will take a hit on man days. 

I think the biggest retension problem is keeping medics employed in trade.


----------



## Fraser.g

Old Medic

*From Old Medic I wouldn't play with the Pl, Coy, Fd Amb thing at all. That was tried before (1954 and 1965) with horrible results.  A reserve Field Amb will never parade peace time at full (wartime) strength. In 1939 many of the reserve Fd Ambs had an effective strength of about 20 all ranks,
but the establishments and entitlements enabled them to jump to 150 - 180 men. If the Fd Ambs were only Platoons or Companies,  they wouldn't be as useful.  I would also suppect the meager bugets would take further cuts.[/font]*

I do not propose that we flush up to war strength but instead we hold the position for one higher. This way if you parade a Platoon full strength then you have another Coy as Holding or expanding. Not kitted but there on paper. The difference is that we are now calling a platoon or two a Field Ambulance.
As for them not being as usefull, I disagree, we are only as usefull as our equipment and training. That is to say if we have a platoon worth of medics or even a platoon each in two locations why the heck are they called a Field Ambulance. Also when in the history of war has their been two or three Field Ambulances in a Brigade organization weather Op Com or not. Take the example of 38 Bde, They now have OP COM three Field Ambulances. Each parading at Plt with attached HQ strength. How does this make sense. 
Now on to the budget, Task the medics as you want them to function. Now they are asking us to function as a Fd Amb with only a Coy or Plt strength. We do not have an Amb Plt, We do not have a Maint or HQ Plt, We do not have our own trucks! 

Our mission is to provide 1st and limited 2nd line medical support Give us the kit to do that and not more. That means ALL the kit. MSE, Canvas, Panniers if a reg med plt has it we have it. This way it is not a shock when they finally realize that they have way over extend the Reg Fd Ambs and need augmentation. 

[*color=Red]Old Medic I'm curious about your second point.  My understanding is that local PRL has to affiliate with the closest medical unit. Are there places this hasn't happened?[/color]
They can be but do not have to be. As a matter of fact we have experienced some difficulty in getting the names of local PRLs from CFMG.*

[*color=Red]Old Medic Is your unit not self-sufficient with instructors already?  [/color] * 

We were in a limited capacity we needed to send more pers on instructor courses. Now that they have changed to PHTLS we have to start from scratch again. The other problem is that PHTLS is not recognised in Sask or Manitoba. We will probably have to go to Ontario for the initial bridging and Instructor training. Talk about a waste of money.


----------



## old medic

I'm surprised about the PRL problem.  I remember years ago seeing a print out of everyone on the SRR/SHR in my area.
I would have thought CFMG units would have a listing of CFMG assets in their area.  That certainly needs fixing.

No matter what a unit can effectively muster on parade, your unit establishment should have all the positions for a full Field Ambulance. Some of the positions should be listed as restricted so that you can't fill them during peace time This is probably where your Maint Pl is.  
When I said "not useful" earlier I meant from a wartime planning perspective. If you have a Pl that you bump up to company strength, then your going to need alot more Medical Companies when it comes time to create a full Field Ambulance.

The Reserve Brigades are really bad examples to use here. A brigade is 3 Infantry Regiments, supported by one Field Ambulance. 38 CBG has five Infantry Regiments.  The Reserve Brigades are more about Geoghrapic areas for training and administration than they are combat formations. 
When you consider strategic planning for the 51 reserve Infantry Regiments, you actually need to plan for 17 reserve Field Ambulances. Meaning we're short.  You must also consider that even though 38 CBG has 3 units to support 5 units, Ontario has 3 units to support 23.
In a real wartime situation, CFMG would assign the Field Ambs whereever they are needed. Likely not in support of their local area units.

When you consider the strategic plan for the reserve, then the Fd Ambs make alot of sense. I hope that explains what I was trying to get across.

As for the budget points and instructors, once again we completely agree.

Cheers


----------



## Fraser.g

Wow I was trying to make my previous post more readable with font and color. Now FUBAR is about right. wont try that again.

Now back to the discussion;

I understand what CFMG is trying to do by re-naming all the reserve units. They wish to hold a small reserve name in place so that in case of general call up they have an infrastructure to fill into. The problem is that in the next breath they don't give us enough kit to fill out a platoon, heck I was contacted by an Ontario unit because they did not have enough panniers to kit out a section!

They then say that it is going to be all about civi maintainable skills and for us to recruit medical professionals but we don't have a thing that they may be interested in doing. Does an ACP medic want to go out and work with a bunch of out dated equipment and no courses that they may be able to get that would maintain their skill set.

We have to update, improve our skill set and increase our participation with both our reserve brigades and with our public health care systems in our areas or become extinct!


----------



## old medic

Your Right on the money,

The Reserve Field Ambulances need the vehicles, canvas and kit (read major medical gear upgrading) to function properly.

Any thoughts on changes to the medicial equipment entitlement ?  What kit would you like to see added? What would you toss right out the door?


----------



## Fraser.g

Things to get rid of:

MAST (I know that they are supposed to be out but I still see them once in a while)
Needled IV tubing and locks There are many systems out there that do not require breach with a sharp to add lines or push meds
Wooden Spine boards
Hope II oxygen systems
Self sheathing IV Cannula. I was teaching IV starts the other day and they were so dull it felt like I was canulating with a pencil lead  :'(


Things that are needed

Blood glucose monitoring kits
SAO2 Pulse oxymiter
Lifepack 3/5 lead cardiac monitor and defibrillator
Free flow O2 regulators to replace the Hope 2
Clave System for IV lines and Locks The last thing we need is unsheathed sharps in the back of a moving bus.
Med lock up for the back of the amb.
New jump bags and medic packs. We don't have enough of the old ones and getting replacements are like pulling teeth.



THE ABILITY TO TRAIN ALL THE MEMBERS OF THE UNIT TO AN ACCEPTABLE LEVEL SO THAT THEY CAN USE THE EQUIPMENT!!!!!!!!!!!


These are off the top of my head, I am sure there will be more as I dwell on the matter more.


----------



## Donut

This thread still going?   Holy Cr@p!

Ok, things to add:

BVM's with reservoir bags.   What a concept, I know.   How about disposable, while we're at it?
New jump bags, for sure.
New stretchers (I recently noticed the Brit ones come with 3 patient straps already attached to runners built into the METAL poles)
2-piece plastic spine boards, scoop strechers, SKED strecher/SKED drag
one-handed tourniquets
Entonox, or that Australian inhaled analgesic (name escapes me, big debate after Survivor burn)
Needle-less fluid and drug systems
Monitors (any new flavor will do)

I'm sure I'll have more to add after I catch up with the other threads, too.

DF

Edit:   I agree, we've got a #9, cats hairy bum that piece of kit
Big O2 cylinder in the cars
Suction
LMA


----------



## old medic

I remember going around to borrow proper backboards, scoop stretchers etc
from the local civy ambulance services before going out on no-duff coverage.
That's a pretty sad state of affairs now that I look back at it.

I'd like to see a Ferno #9 or similar stretcher with the ambs. Just stick the cup posts on one of the bench seats.
As I mentioned earlier, the LSVW ambs were a big step backwards with an out of date box.  In the M886 and M1010 you
could put padlocks on cupboards and keep your more important items locked.  And the M1010 would take the installation 
of a G or M oxygen tank as well, not to mention a long list of other, better features.

The last two posts are a good list. I'm sure I'll remember a few items once I sit down and think about it.


----------



## Fraser.g

Still going???

I only started it on the 19th bro. Perhaps you were looking for another thread with the same basic theme but not as much thought or eloquent posting ;D

ya got no beefs from me on your list. 

How about a strap collapsible stretcher so that a medic could roll it away somewhere when dismounted.

By the way welcome home.



GF


----------



## Donut

I guess it just keeps coming back.

Thanks, man.

How about those US Stretcher dollies to move patients on, too
Jungle stretchers, too


----------



## Fraser.g

How about climate control in the back of the amb for summer and while we are at it a better way to communicate other that the ICS which is dubious at best and non-functional at worst. 
The big problem is that there are so few reservists trained up in the new radios. There has only been one comms course run in Sask since the new 522s came into play and it was a joke due to lack of equipment.

Again give us the tools and knowledge and we will do the job.


----------



## old medic

There was a thread on restructuring in general, but this is reserve restructuring.  

What's out there for traction splints, still the older simple Hares?
Or have they replaced them with the multi-adjustable ones ?


----------



## old medic

RN PRN said:
			
		

> How about climate control in the back of the amb for summer and while we are at it a better way to communicate other that the ICS which is dubious at best and non-functional at worst.



Yes... that was another step backwards. I miss the dual front and rear A/C of the 1010.  The LS ambs are sub-standard in venting,  heat and A/C.


----------



## Fraser.g

So we all know that the kit needs an extreme overhaul. This will cost a massive infusion of cash that we do not have right now. 
So the other option is to train to a level of higher medical skill sets that require less kit or more simplistic kit that is already in the system or be relatively cheep to purchase like one handed tourniquets.

An option that I like it that of the Commbat first aider and Trauma Focused individual Training called T-FIT.
Please take a sec to look at the below link and then come back and discuss.
http://www.drum.army.mil/sites/tenants/division/CMDGRP/SURGEON/home.htm

It is all there, equipment lists, instructor programs, PPT presentations, Student checklists the whole shooting match.

Is it training up to the PCP Level...no
Is is more than we have now in the reserves...yes
Dose it make sense IMHO...yes

The progression would be 
QL3 (AMFR2)
BTLS Advanced (PHTLS ?)DF, there was a message while you were away that said that the reserves was moving to the PHTLS.
T-FIT
Combat Lifesavers course
Combat (Ranger) First Responder
PCP (QL5)


GF


----------



## old medic

Just as a side bar, I noticed this statement on your link:

"The ratio of combat medics to war-fighting soldiers is 1:17. "

It would be interesting to see some figures for the CF.


----------



## Donut

It certainly looks better then what we have now.   

I'll add a sidebar, too then     8).   Look at the sig at the bottom of the TTPC letter:   2LT, SP PHYSICIAN ASSISTANT. More applicable to the Reg, but a RESO PA program...


One thing that isn't being addressed here (although tie this to the sidebar.   The conclusion is left as an exercise for the student) is clinically oriented, primary care to our soldiers.   I've certainly seen several thousand more SICK people in my time in the CF then critically injured, whether that's the bleeding awfuls or a case of the sniffles, and we need our people to be able to sort the wheat from the chaff in these cases, too.

T-FIT looks an awful lot like BTLS, in fact slide 27 of TFIT corresponds exactly with the diagram on P175 of BTLS 4th Edition.   It does have a few additional points, though, and presents ALL the information on the ppt, not just the stuff the instructor is supposed to add TO.   Other then that...it's BTLS

For a basic trained part-time medic, it's really about as much as we can hope for (and far less then we'll ever get).   Add the OTC med package and some experience separating wheat from chaff and you'd have a fine company med-a.

WRT the BTLS/PHTLS difference, I really no longer care, so long as we can get SOME kind of training to our troops (btw,   the BTLS website now lists the BTLS Military edition for sale).   Besides, if I don't have to teach the damn course, that's only one uncompensated weekend q 3 years for me, not every year as it is now.


----------



## Fraser.g

OK so add the OTC pack to the 4s, send ALL the BTLS instructors on a week long all expenses trip to Ontario for the PHTLS conversion and we are good to go.

By the way, what is the da3n?

So the three of us are in support, how do we get the rest of CFMG on side so that we can offer some quality training and have a decent end product?

GF


----------



## Donut

I was self-censoring.  Never noticed the 'puter does it for you.


----------



## old medic

RN PRN said:
			
		

> So the three of us are in support, how do we get the rest of CFMG on side so that we can offer some quality training and have a decent end product?
> 
> GF



Probably the only chance is some well written proposals, a trial study, and a strong, documented result.
Any takers?


----------



## Fraser.g

I could do it with assistance. What do you day DF and Old Medic
The logical pilot course should be my unit for several reasons the formost of which would be that you have already won over the Ops/Trg O ;D.

We will have to pitch at both the Reg Area surgeon and Fd Ambs so that once the proposal is done the medics can be employed to the level that they are instructed to.

The proposal I believe should be over and above the normal training so that MCSP is not compromised.

We could easily use next training year as the target for this with final confermation at the next area concentration.


----------



## Armymedic

RN PRN, whats the fascination with PHTLS?

BTLS is and will remain to be the standard of prehospital trauma care in the CF. Dispite what you may infer with the development of TCCC from the US, and what Edm and 1 Fd Amb did with the with thier pilot courses, BTLS will maintain its revelence in the CF medical system.


----------



## Fraser.g

It is not my fascination with PHTLS,

CFMG in its ultimate wisdom has decreed that the reserves will from this day forward teach PHTLS and not BTLS. What I am trying to do is come to terms with how I can incorporate the new system, my skill base and the theory and aplication of a TCCC based package to better the medical skills of the reserve medic.

I am a BTLS Advanced instructor and although I have not seen the format or changes that PHTLS will cause I am hesitant as it is only offered and recognised in Eastern Canada.

What my fascination is with is the concept of TCCC and battlefield treatment of casualties by buddy aid and then the medical branch.

GF


----------



## Armymedic

RN PRN said:
			
		

> It is not my fascination with PHTLS,
> 
> CFMG in its ultimate wisdom has decreed that the reserves will from this day forward teach PHTLS and not BTLS. What I am trying to do is come to terms with how I can incorporate the new system, my skill base and the theory and aplication of a TCCC based package to better the medical skills of the reserve medic.



Say WTF???  

Since when was that, and why would it be sooooo out of step with what we are doing on the reg side?


----------



## Fraser.g

Two weeks ago,

See my PM


----------



## Armymedic

I see...

What a waste.

As if there is not a large enough divide between reg and res force med tech training....


----------



## old medic

For all you medics who may be following this thread..  In addition to discussing the good and bad on the reserve side of CFMG,
We are also discussing ways to upgrade the skill set of a reserve Med-A.  How do we bridge some of the gap between EMR/EFR 
and the PCP level? What training can take place at the local unit level to make non PCP Med-A's more trade employable?

Opinions Welcome !


----------



## Brad Sallows

Out of curiosity, who "owns" PHTLS and where does the money flow?


----------



## Fraser.g

Brad,

Here is a link to their flashy web page. 
http://phtls.org/executive.htm
As to where the money flow goes, I have no idea. It is very hard to ascertain as I have not even received a text book but have been told that it is a way of the future for the reserves. I would put a smiley here but I can not find one with its tongue in its cheek and frustrated at the same time.

GF

Edit: forgot the link


----------



## old medic

I see that 51 Fd Amb just had a course on the weekend, and 52 Fd Amb is having one next month.

Anybody know anyone from those units?


----------



## Fraser.g

old medic said:
			
		

> I see that 51 Fd Amb just had a course on the weekend, and 52 Fd Amb is having one next month.
> 
> Anybody know anyone from those units?



PHTLS or BTLS?

I know that 17 Fd Amb had a course run this past weekend and next weekend 12 Fd Amb is running a BTLS course next weekend. They were both planned before the order came down from Ottawa and could not be turned off with out significant financial penalty due to the use of external instructors.

This also goes back to the earlier question of internal instructor cadre, it seems that many units are dependant on the civilian agencies for instructors. 
Now what happens when we go to a course that is not offered or acknowledged in the Provinces?

GF


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## Donut

Out here it will be another Army course the civi sector has never heard of, much less has a use for kind of like SJA AMFR2.  What a recruiting/retention incentive that will be. 

So instead of hiring working, experienced paramedic instructors we'll run a course taught be people with limited hands-on for people with very limited hands on.

I can hardly wait.    :-X


DF


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## old medic

If you search through the PHTLS web site, you'll find a listing for international courses.., go down to Canada, and you'll find 51 and 52 Fd Amb listed there.


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## Marti

I'm a bit confused by all this talk about PHTLS. First off, my unit  (15 Fd Amb) ran a PHTLS course just under a year ago. 2 mbrs from 12 Fd Amb flew out to take the course with us. Talking to the French teams at the EFMC in Borden this summer, their units had also made the switch. Why were some units already on PHTLS, did this just start getting enforced? Furthermore, I'm wondering what the difference is between the two courses. I haven't taken BTLS, but everyone I've asked who's taken both say there is very little difference between the two.

As far as having to contract outside instructors, I think it's a pretty good way to get some new ideas and techniques into the unit. This may just be because I'm still fairly inexperienced, but I was really impressed with some of the new tricks they had for us.


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## old medic

I See that CCEMS in Edmonton seems really big on PHTLS.   Most of the Canadian Directors seem to work for them.

Here are a few other links on the course:

http://www3.us.elsevierhealth.com/MERLIN/PHTLS/course_information.html
http://www.dmrti.army.mil/PHTLS/phtls.htm
http://www.health.qld.gov.au/skills/phtls.asp
http://msop.ca/index.php?menid=01/07/01&mtyp=1



http://www.emsvillage.com/forums/messageview.cfm?catid=39&threadid=941
EMS Village Forums - BTLS or PHTLS??? Better?


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## old medic

Brad Sallows said:
			
		

> Out of curiosity, who "owns" PHTLS and where does the money flow?




The National Association of Emergency Medical Technicians in the US


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## old medic

PHTLS Textbook - 5th Edition - 0323032710 - Military Version

By National Association of Emergency Medical Technicians

Author(s): NAEMT, Norman McSwain, Jeff Salomone
ISBN: 0323032710
Cover: Softcover
Pages: 464
Illustrations: 250
Edition: 5th
Published: November 2004

New In This Edition

    * Includes new photographs geared specifically to the military.
    * Describes differences in procedures in a non-combat situation and those in a combat situation.
    * The Military Medicine chapter, written by the military, provides special trauma considerations and protocols.
    * Military procedures are also found throughout the text, where applicable. 

Prehospital Trauma Life Support (PHTLS), 5th Edition, Military Version is a unique, continuing education program that directly addresses trauma issues in the prehospital environment. Following the publication cycle of ATLS (Advanced Trauma Life Support) by the Committee on Trauma of the American College of Surgeons, the PHTLS program is designed to enhance and increase knowledge and skill in delivering trauma care. The PHTLS textbook is the required book for the PHTLS course, and is also ideal for use as the trauma component of a paramedic course or as a general reference book on trauma assessment and management. Based on Prehospital Trauma Life Support (PHTLS), 5th Edition, this military version combines both basic and advanced trauma concepts and skills in one definitive resource and features an entirely new chapter on evidence-based guidelines for military medicine, developed by the Committee on Tactical Combat Casualty Care.


http://www.999supplies.com/product_info.php/products_id/3292


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## old medic

I had Chapters mail me one of the Military PHTLS textbooks.  I'm curious to see what all the fuss is about.
They list the military text as an orderable item right from Mosby.
I guess that means I'm posting a book review when it shows up.

In the meantime, This thread is kind of quiet, so I'll ask this:

What do you medical types see as the good things that have come out of the restructure?


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## Fraser.g

Another blow to the Medical Reserve

OK so here is the latest and greatest. My part time recruiter attended a telcon last week where recruiting targets for the next fiscal year came out. From my understanding this is how it reads.

1. The new direction we have received is that there are only 100 positions on BMQs nationally for the medical reserve. 
2. The priority for recruiting is
        a. Medical professionals on Civi street eg Doctors, Nurses, PCP or higher tecs etc.
        b. Applicants who are currently enrolled a post secondary program in a medical field
        c. Applicants who show a genuine intrest in the medical reserve

3. Units who attained their recruiting goals last year will not be permitted to recruit this year at all.
4. All applications have to be vetted by Ottawa before the application process is permitted to procede.

It looks like they want their cake and eat it too. Recruit free professionals that they do not have to pay the education for, do not have to deal with MCSP. The problem is that most professionals do not or are unwilling to invest the time in the Primary Reserve. This is why the life blood of the MO is the late high school and post secondary student. Now we are being discuraged from targeting them.

This kinda makes the whole BTLS / PHTLS argument moot.

It certainly sounds like they want to do away with the medical primary reserve as a whole and simply keep the PRL going IMHO


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## Fraser.g

Does anyone know the exact cost of sending a new medic on their reserve 3s course?

Where I am going with the above question is this:

In Saskatchewan the tuition for the PCP course is $2000.00. I would imagine that the cost is about the same across Canada but I may be wrong.

If the cost of sending a new Pte on his/her 3s is more than it would cost to send a person on their PCP then what is the detriment of sending them on the PCP?

Argument: They will only get the course and then leave.
Response: The average service in the Reserves is 3.5 Years. If we can get a better product (Regular Force 3s equivalent) for less cost then why not. 

Argument: The PCP does not make an army medic.
Response: True but then the individual units would only have to concentrate on the army skills that are different from the civi pre-hospital stuff. This would cut the cost of running a unit conciderably. Maintenance of medical competencies could be done by the ambulance service that higher on the medic after the PCP course is done. We would only have to bring them in for training in the battle task standards and ELOC. This would also ensure a steady flow of qualified members for deployments and tours.

Argument: We can't get spots on the civi courses.
Responce: With recruiting going the way it is, we would only have to reserve three to 5 spots a year. SIAST runs three intakes a year for PCP. To increase the class size by one or two would not be a big deal IMO.

Argument: It would cost too much.
Responce: For several years we were paying up to $8000. per member for post secondary education. Up to $2000.00 a year. And this was on top of army training.It was a great deal but what did the army get in return? More degrees in non-applicable fields for the most part. This would cost the tuition and books plus Class A days for the course. Assuming that the course runs a term (4 Mos) then class "A" for a pte would work out to $6472.00 if we only paid out for the school days (5 Days a week) assuming a base pay of $80.90 a day.
Total cost $8472.00

I believe it costs more to send a troop on his 3s when you factor in Travel, TD, and the rest of the clag expenses that are associated with a summer class B contract.

I believe this would even apease the gods in Ottawa as far as only recruiting skilled members. See criteria #2 in ealier post.

IMHO


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## Brad Sallows

One of the joys of the reserve is that when you make a recruiting policy mistake, it takes a few years to recover.  Good luck.


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## Armymedic

I thing CF H Svc Gp is more concerned about finding professionally qualified reservist of all ranks and professions so they can supplement the Reg force shortages in those same professions for operations. 

I am going to stop reading this thread now....

With all the changes in the Reg Med Service, on other daily issues I deal with...If I concern myself with Res restructuring... ???...I'll pull my hair out.

No wait, I don't have any hair...


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## Fraser.g

If you want to picture my hair line just stop typing for a minute,
rest your elbows on the desk,
form loose fists with your hands,
Support your head by placing both fists close to but just above your temples while hanging your head in frustration
any spot where the heal of your hand touches hair....shave it.

There ya go. It started while I was a MCpl Instructor at WATC and it is now accelerating rapidly away from my eyebrows.

I just cant wait for the next fastball from Ottawa


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## old medic

I'm going to stay away from the PHTLS / BTLS thing until I can sit down and go over the two texts. Now that it appears the Military version of the PHTLS text was overhauled by the TCCC group, maybe there is method to the madness.  Maybe it's one step closer to Combat First Responder / TCCC.  The Jury is out.

On the 100 BMQ spots, what was the number last year? RN PRN, how many new medics did your unit send for BMQ last summer?
how many applicants are being processed by the CFRC right now, and how many do you have to send this year?  Is it more than 7 or 8 ?
When I do the Math, that's the number I'm coming up with per unit.


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## Marti

*If the cost of sending a new Pte on his/her 3s is more than it would cost to send a person on their PCP then what is the detriment of sending them on the PCP?*

For one thing, there is no nation-wide continuity in EMT-B level courses. What would've been nice is that instead of AMFR2, they would have picked another course that meets the minimum standards EMT-B of every province and got recognition for it. As far as getting the qualification itself, my unit used to run a bridging courses, over a weekend or two, to bring QL3s up to Alberta EMR standards, then paid for the certification. Although, this hasn't been done with the new AMFR2 QL3 yet, I think it was pretty good way of getting the civy equivalent. It's fairly low cost, new recruits still get the "course experience" and the military skills of QL3, and the unit can be selective as to who gets this extra boost to their qualifications so funds aren't spent on mbrs who display an obvious lack of interest in the proffession.

*Maintenance of medical competencies could be done by the ambulance service that higher on the medic after the PCP course is done. * 

I'm not sure where you're going with this one, are you expecting all mbrs to work for ambulance services in addition to weekly parades, exercises and civy employment/education? Maybe this argument is better suited to why CFMG should only recruit medical professionals. 

I agree that the current RQL3 MedA is not adequate, but I'd rather see the course's content raised to meet EMT-B standards across Canada. This will maintain a unified standards across the board while still giving reservists a meaningful qualification.


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## Fraser.g

_For one thing, there is no nation-wide continuity in EMT-B level courses. What would've been nice is that instead of AMFR2, they would have picked another course that meets the minimum standards EMT-B of every province and got recognition for it._

The PCP course is designed and authorized through the Paramedic Assn of Canada. Therefore it is as close to a national standard that you can get. This is why the Regular Force has adopted it for their 3s Package. EMT-B is an old term and is seldom used anymore for just the argument that you use. The designation varies from place to place and province to province. Even the term "first Responder" means different things in different areas. In BC it is OFA Level III which is a two week course. In Saskatchewan it is a one week course run through the local ambulance service, In Manitoba it is a two week course again. The list goes one.

_I'm not sure where you're going with this one, are you expecting all mbrs to work for ambulance _ 

If they can, yes. We have given them a skill that is not only deemed valuable by army standards but on Civi street. A skill that they can make a good living out of.  If not then once they have the qualification there should be no problems with them going in under a MOU for work experience the same way as we send regular force medics to work at VGH ER in Vancouver. It is a question of standardization of training both in the Civi and military worlds.

I hope this answers your questons and welcome to the forum. 

IRT the BTLS and PHTLS I want to see the package but I still have issues with it not being recognised in the west. I am sure it is a good package and that personal are competent while preforming their duties however if you hold a qual that no one recognises...what good is it?


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## old medic

The only problem is, EMT-B is a US thing. DND is already a charter member of the PAC (Paramedic Association of Canada) 
www.paramedic.ca

Previous the to the PAC creating the National Occupational Competency Profiles (NOCP's) there were no national standards. 
In fact, the province to province standards were miles apart from each other.  

The NOCP's created a minimum skill set that the provinces could agree on as the different service levels. This is why EMR, EMT, EMP disappeared from Alberta, EMA, EMCA, P1, P2, P3 disappeared from Ontario, etc etc. and Nation wide, you now have EMR, PCP, ACP, CCP standards that everyone has to meet.  The next big hurdle they are correcting is portability between provinces. That's come a long way, but there is still alot of work to do.  Right now the standard of care is there, but you can't move between provinces very easily. Correcting this is one of many goals of the PAC.

So you do have National Standards that CFHS has mandated we now meet.  The National EMR NOCP for the Reserve, and the National PCP NOCP for the Reg Force.  Personally I would like to see everyone meeting the PCP standard.  I would also love to see all medics supporting the provincial paramedic associations and the PAC.  If the PAC can win skill portability from the provinces, then your Reserve or Reg Force EMR or PCP will qualify you civy street in every province.   

On another note,  If all the Reserve Medics worked for the local city Ambulance service we'd have big problems. The moment you needed the reserve unit for even a domestic op,  you'd have the civic and provincial governments up in arms when all their medics leave or put in LOA requests.

There needs to be some ability to maintain our own skills, especially for quality of care control.

Welcome to the thread, It's nice to have a few more medics come to the debates!


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## HCA

old medic said:
			
		

> In the meantime, This thread is kind of quiet, so I'll ask this:
> 
> What do you medical types see as the good things that have come out of the restructure?



More money


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## HCA

Marti said:
			
		

> I'm a bit confused by all this talk about PHTLS. First off, my unit   (15 Fd Amb) ran a PHTLS course just under a year ago. 2 mbrs from 12 Fd Amb flew out to take the course with us. Talking to the French teams at the EFMC in Borden this summer, their units had also made the switch. Why were some units already on PHTLS, did this just start getting enforced? Furthermore, I'm wondering what the difference is between the two courses. I haven't taken BTLS, but everyone I've asked who's taken both say there is very little difference between the two.
> 
> As far as having to contract outside instructors, I think it's a pretty good way to get some new ideas and techniques into the unit. This may just be because I'm still fairly inexperienced, but I was really impressed with some of the new tricks they had for us.



I believe you are mistaken. We have no one qualified PHTLS in the unit at this time.


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## HCA

Brad Sallows said:
			
		

> One of the joys of the reserve is that when you make a recruiting policy mistake, it takes a few years to recover.   Good luck.



It is funny but I actually now look forward to retiring in 2010. I wonder how small the unit will be by then. Then again surely if this new gambit goes badly for us the policies would change.....


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## Marti

*I believe you are mistaken. We have no one qualified PHTLS in the unit at this time.*

Right, they were from 11 Fd Amb. My mistake.


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## vr

The intro of the MCSP has been a positive aspect of restructure.  Its about time we set up some core competencies and ensured all medics no matter where they parade meet them.  This shows a committment to the development of our members and requires them to make a committment to meet the requirements.  The only downside is that MCSP has become the proverbial 800 lb gorilla in our training plain leaving little room for anything else.

Question to DF et al.:  Will mbrs who have taken PCP in non-PHTLS provinces ie BC now have to take and maintain PHTLS to maintain their status as Reservists???  Enquiring minds want to know?


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## Donut

Bart, feel free to jump in here.

Usul:  BTLS isn't required in BCAS.  The only providers here who NEED it, besides us, are the Fed Govt RN's working on reservations and outposts, I believe.  They've made up the bulk of students in most courses out here, the ones I'm familiar with anyway.  That's changing now that the ACP is fee-for-service, and as more BC paramedics look to further their training in places like Alberta, Ontario and the Maritime colleges, where BTLS is a prerequisite.  BC does like it's made-in-BC solutions, and BTLS isn't one of them.

The JI PCP teaches BTLS, they just don't call it that.  The trauma block (about 2 weeks, if I recall correctly) is a very long-running version, with more pathophysiology and A&P, but the skill sets are those of a BTLS basic provider.  They don't use the BTLS mnemonics and jargon, but the end product is virtually indistinguishable.

Slightly off-topic, do you know that a physician working in a BC ER isn't required to have a valid ATLS?  Not only that, but since ATLS only turns out about 120 providers a year province-wide, a very small percentage of EPs in this province are truly current.


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## old medic

It's the same in Ontario.  PCP's are not required to hold BTLS or PHTLS for Ministry of Health licensing.


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## Donut

Now that I've answered the question, I'd like to agree that the MCSP is exactly that,an 800lbs gorilla, the end all and be all of our training plan, dicated from on high.  

It's also far better then the old (lack of) CME model.

There has to be a point at which we recognize that not everything we need our medics to know can be learned in a classroom setting, and adress that with OJT rotations.

However, we also need a point at which we can say that a person has done it enough times in the classroom, and drop to a less frequent, perhaps every two year, refresher cycle for these basic skills.  That would clear the way for more, and different, training.  

Our reserve medics should not top out with the current QL6A skill set, clinically speaking. 

We can't lose sight of these skills, too, as well as realizing that a huge amount of military medicine is not emergency, it's sick parade.

DF


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## starlight_745

Split up the MCSP and do only 2-4 mods one year the rest the next etc and alternate through it.  Do the one day BTLS/PHTLS refresher instead of always retaking the whole course.  Add OTC med package to the reserves and maybe make it part of a QL5 course.


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## old medic

A two or three year cycle on a training plan is not unheard of.   Larger units could probably split into two progressions. One for returning members, one for new medics.


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## Fraser.g

Here is an idea,

If we teach to the highest combined level that incorporates all the skills of the lower levels then we can get rid of allot of repetition.

You do not have to splint 5 lower extremity # to demonstrate that you understand the concept. You do not have to crack several ribs and dislocate several sternums to prove that you can do CPR. One mangled mannequin is enough.

If we were to set up a spread sheet that incorporated all the skills required and not block them into CPR, SFA, AMFR2, BTLS, PHTLS, TCCC yadda yadda. and if the instructor cadre is qualified to instruct all those courses then we could get all the MCSP done in a trauma week or a month of training That month being your usual parade night and one Ex. There Done for another year.

We have one of the shortest QL3 Courses in the reserves right now. WTF??? If the new candidates can demonstrate all the skill that are required at that level in 4 weeks then we are not asking enough of them. Put it back to 6 and get some good training out of them. Even if the last week is a Field Ex it would be better then sending half ass medics back to the units so that we have to pick up the pieces.

IMHO

GF


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## Donut

I think the number of class room days is alright for the QL3, now we need to add an OJT package to it.

The first fracture a reserve medic sees shouldn't be in the field, the first airway they manage shouldn't be on Ex, the first art bleed they need to get a grip on shouldn't be 3 hours away from back up. 

If you look at the difference in the NOCP's for FR vs PCP, FR's must be "familiar with" or "Demonstrate in a simulated setting" many of the skills that a PCP has a field preceptorship in, and must demonstrate competency in the field.

CF medics are frequently, even on dom ex or dom ops, it for medical support. For HOURS.

   I know, working civi side, that if I really can't manage a patient, I can ask for airevac, I can ask for an ALS interecept, or I can pull into a local community health center to find a doc to give me a hand or take over, depending on what's what.   CF medics very rarely have the luxury, and they need to have a better understanding, outside of the classroom, of what works and what doesn't.

DF


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## old medic

It should be a standard OJT that new medics back from summer QL3 are assigned a preceptor or two and brought into the local civy ER for a weekend. Have the preceptor observe them while they practice assessments and as many BLS skills as they can. Start enforcing the skills they learned and make sure they can function hands-on instead of classroom.


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## Fraser.g

old Medic,

This is exactly what I have been trying to do for three years now. Each time I am told that we need a MOU with the district and that there is only one person in Ottawa working on it.  

The first concept I had was to bring them up onto my old Surge ward. 47 beds, vascular and thoracic surgery mostly with some general put in to keep things interesting. 8 Obs beds.
Gee what does the CF have that is around that number...an FSH. 50 beds. It is the closest thing the civi system has but I can't get troops in because there is no  MOU in place.

GF


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## old medic

Instead of one man in Ottawa trying to work on all these letters of understanding, It sounds like they need some generic agreements that the units could individually take to the local facilities. A generic agreement the CO or the local MO could use to work out details with a hospital.
Colleges and Universities enter into these all the time for various types of medical students. 

Probably the only way to fix that, is have the CO's and MO's start up their chain of command.


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## Fraser.g

The problem is JAG will have a kinipshin over liability

G


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## Brad Sallows

Sorry, just can't pass that one by: "conniption".


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## old medic

I can understand a concern over liability, but in a clinical setting like a hospital, the patient belongs to the hospital staff.  It shouldn't be that hard to overcome.


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## Fraser.g

No problem Brad,

As for the liability, yes the patients are under the care of the hospital and the medical staff are covered by that facility. The question is what kind of liability do we Cary when we are treating Civies? The answer is zip unless there is some special scenario set up. I would be interested to know what the arrangement is with the trauma training facility at VGH. Paramedtec, can you ask around?

Anyway that is the biggest hurdle that I have come across.

G


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## Donut

I'll ask the CPO2 who runs the place next time I see him, should be next week sometime.

DF


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## Fraser.g

Medtec,

Any word on this?

I am confident we can find a sec at Cougar Salvo to sit down and have a coup of coffee over this and other issues

GF


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