# Introducing ACP diploma into QL5 training



## adamop

I think the one thing that seperates medics from other professions is that you truly need to commit to it for the life of your career in the army. The training you recieve it seems is not transferable to the civilian side, which has me considering not joining as a medic. I know some people might question if I am already having doubts now then don't bother joining, but how can I possibly pre-determine the next 25 years of my life.

I think they took a big step with introducing the PCP @ JIBC portion into the QL3 training, which will allow QL3 medics to get a license in their province and work on civilian ambulances and such. Besides giving them another career choice if they ever leave the CF, it also may serve as a tool to keep medics seeing patients and such and keep their skills up by allowing them access to more patients.

My question is... does anyone know if the army has considered introducing the ACP course into their QL5 training? It would give all trainees a credential they could actually use in the civilian world and might encourage more recruits to do it. Likewise, it usually takes a second contract before you get offered QL5 anyways, so it wouldn't be like some of the guys joining RegF to get a quick training and then bolting after 3 years. You'd probably need to commit at least 8 years to the army.

Just a thought. Do you think it is a good idea?


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## aesop081

adamop said:
			
		

> I think the one thing that seperates medics from other professions is that you truly need to commit to it for the life of your career in the army. The training you recieve it seems is not transferable to the civilian side



You mean "as compared to other trades in the medical service" *or* "compared to other trades in the CF" ?

If you meant the second one, do i ever have news for you.......


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## adamop

Sorry I made that unclear. Obviously the CF has lots of trades which do not have transferability over to the civilian side. But those are mainly jobs on the CF which have no real world equivelancy (Balistics, Infantry, etc.). Many of the jobs which do have real world equivelances (Miltary Police, Pilot, Engineers, Mechanic, etc.) do offer training in the CF which is transferable over to civilian life. Why is the medic different... I mean one could even become a Physician Assistant, yet they would not (as far as I know) be able to work as one as a civilian.


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## Armymedic

They are looking at it. You are not the first to think of this.

A suggestion was passed up over a yr ago to do something along the lines of what you say. Career course/prehospital care progression would go along like this:
QL3-PCP, QL5- ACP, QL6- Critical Care Paramedicine. Mostly in response to the fact that the QL6 is a 10 day admin course. Some prehospital skills (like ACLS or more adv trauma skills) would be a good addition to the course.

Remember, there is quite a difference between a medic in the Res F and one in the Reg F. Also, with the exception of BC and Que, you can not go to work as a civilian paramedic without some additional (and quite expensive) training and testing.


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## R933ex

WRT the PA's, in the NWT we actually use civy PA's (almost all of them ex CF ) at several mine sites. In addition, both our Mine Safety Regulations and our New (proposed I should say) industrial Safety Regulations also spell out PA's as being one of the corner stones of advanced care in isolated workplaces.


In my current job, I am also aware that both Alberta And Ontario have also come a fair distance in recognizing PA training.


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## Snowy91

"On completion of this stage of training, Medical Technicians receive the professional credential of Primary Care Paramedic Level I." 

Refering to MOC for med tech at:
http://www.recruiting.forces.gc.ca/v3/engraph/jobs/jobs.aspx?id=737&bhcp=1

What is Primary Care Paramedic Level I in translation to civilian jobs? What I mean is, is that enough to be a fully qualified Paramedic? or is it just a portion of the training you need to be a civilian paramedic?


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## X Royal

The point remains that qualifications for ambulance attendents vary from province to province.
I am qualified as a Advanced Medical First Responder & also a First Aid & CPR instructor. But I am not qualified to work on an ambulance in Ontario. In some provinces I am qualified to work in a entry level position but in most I am not. 
Each province sets thier own standards & it would be hard for the CF to comply with all the different standards. Maybe a challenge proceedure based on qualifications earned & years experience would be the best solution? This exists in Ontario for military vehicle mechcanics after 8 years. With proof of time in the trade they can write the provincial exams & if they pass they will recieve thier provincial licence.

Best Wishes: Rick


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## Armymedic

R933ex said:
			
		

> WRT the PA's, in the NWT we actually use civy PA's (almost all of them ex CF ) at several mine sites. In addition, both our Mine Safety Regulations and our New (proposed I should say) industrial Safety Regulations also spell out PA's as being one of the corner stones of advanced care in isolated workplaces.
> 
> 
> In my current job, I am also aware that both Alberta And Ontario have also come a fair distance in recognizing PA training.


There is a long way between recognizing and licencing. You need a licence to practice. There are no provinces who currently licence civilian PA. Every province recognizes military trained PAs as health care professionals, and allows then to be employed as a health care provider.

Same goes for CF trained PCP Med Techs.


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## Armymedic

Snowy91 said:
			
		

> What is Primary Care Paramedic Level I in translation to civilian jobs? What I mean is, is that enough to be a fully qualified Paramedic? or is it just a portion of the training you need to be a civilian paramedic?



PCP Level 1 is a college certificate. Depending on the province (like BC) you may be eligible to be employed by a civilian ambulance company. Other prov like Ont...it gets you bubkas. You still need to complete provincial licencing to be employed outside the military.


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## DartmouthDave

Hello,

I agree with the idea of Med-A training meeting the PCP standard.  

As for the ACP and CCP level I feel that this would be too hard to achieve and maintain in the CF.  You could give this training to a Med-A and I am sure many would excel at it.  However, when would they use it?  How would they maintain it?  

In order to safely and effectively use Advance Life Support skills one needs to use them all the time. Not just when the CF sends you to a civilian hospital or an ambulance services to gain experience and hands-on.  (Perhaps to work with a Res F Med-A in their civilian job  )


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## Armymedic

Sorry to disagree,





			
				DartmouthDave said:
			
		

> In order to safely and effectively use Advance Life Support skills one needs to use them all the time. Not just when the CF sends you to a civilian hospital or an ambulance services to gain experience and hands-on.  (Perhaps to work with a Res F Med-A in their civilian job  )


But that reason is not reason enough to not give the skills.

MedTechs...at least in the Reg F do not use all of their skills all of the time. Giving people the knowledge and skill to use it is the easy part, keeping those skills up is a difficulty we are constantly striving to achieve. But the toolbox is large, and given the variety of employment, any tool may be useful at any time.

The current MSCP does address those issues. That standard is one practice/course every 24 months...for all skills.

BTW...ACP and CCP is not far from the skills and knowledge a clinically competent Med Tech MCpl/Sgt already maintain. (I have done 2 ACLS courses and worked 1 code in 4 yrs)


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## adamop

Interesting replies. In regards to the PCP certificate, I am under the impression that the PCP is a nationally recognized course, and so is ACP and CCP.

In 2001 the NOCP was set to have four levels: EMR, PCP, ACP and CCP.

So anyone completing the PCP course at the JIBC will be eligible to work in ANY province in Canada. The only kicker is, you must pass their provincial licensing requirements. I know some said this, but others said different. It's up to YOU whether you pass it or not. For instance, with the oil rush boom out in Alberta, several colleagues have left BC and gone to Alberta to work as paramedics in oil fields. They have had to get their license in alberta and from what they told me, it wasn't too hard to do. Also. going from BC to Ontario is not too difficult. You would think it would be, since Ontario is a 2 year PCP diploma, and BC is a 4 month PCP certificate, but in BC, the course is VERY dense packed. Like 40 hours a week of classroom time + 30 hours a week studying. And in BC, you have more skills than in Ontario It's basically two semesters jammed into one. And they leave out all the junk you "don't need"). The course is basically the minimum required, which is probably why the army chose the JIBC for their contract and SarTech training - cause it's cheap and effective. Whether it's good or not is up for debate, but it's definitely quicker and cheaper.

The only problem with the ACP course is that meeting the NOCP is a lot more difficult as it requires significant clinical time. I think the NOCP is like 700 hours or something. So the actual ACP course cannot be completed in less than 1 year. I guess my main thought was that perhaps this would lure more people into the army - the prospect of getting free training and learning cool skills that will transfer over to the real world. After all, telling your friends you are a QL5A medic is cool, but they might not know exactly what it is you can do. The other bonus is it will allow people who come in with the credential to get a significant portion of their studies written off. One of the worst injustices in the army right now is having an ACP civvy trained person come in and have to learn all the basic skills over again and start from the bottom. The army job is indeed totally different, but that doesn't mean you need to learn how to intubate all over again and so on. Some skills are universal, army or civvy.

What they have done with QL3 is an awesome start, basically splitting it into 3 different categories:

- The army way (MOC)
- The civvy way (PCP @ JIBC)
- Clinical Phase (Borden)

So why can't they do something similiar with QL5? Then if you come in with an ACP, you can get the ACP part written off, while still doing "the army way" part.

As far as CCP goes, I don't know if that is neccesary at all. CCP's would be bordering on Physician Assistant territory. Why spend all the money and time training someone from an ACP to a CCP when you could just train them from ACP to PA? CCP's skills include things like interpreting xrays and giving more medications, central lines and stuff. Basically a very specialized (very very specialized) field intended only for transportation from hospital to hospital of very ill and sick patients who are on life support or in life threatening situations. An ACP would have a difficult time keeping their skills up in the army, but for a CCP it would be near impossible.


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## Armymedic

adamop said:
			
		

> As far as CCP goes, I don't know if that is neccesary at all. CCP's would be bordering on Physician Assistant territory. Why spend all the money and time training someone from an ACP to a CCP when you could just train them from ACP to PA? CCP's skills include things like interpreting xrays and giving more medications, central lines and stuff. Basically a very specialized (very very specialized) field intended only for transportation from hospital to hospital of very ill and sick patients who are on life support or in life threatening situations. An ACP would have a difficult time keeping their skills up in the army, but for a CCP it would be near impossible.



Maybe, maybe not. You got to remember who the CCP would be for...QL6 Med Techs...Sgts who are 2 yrs away from being loaded onto thier PA course. Also as per skills learned on PCP, not all skills learned on ACP or CCP would be used by CF med techs, but again all are another tool for the tool box when a solution is required.

Besides for the CFs purpose, full qualification is not required so long as equivelency is achieved. With x months of classroom and x months of OJT.

But its still just a proposal, a pipe dream, albiet a good idea to master prehospital skills for Med Techs. Somebody in Ottawa or Borden may take it and run...


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## adamop

St. Micheal's Medical Team said:
			
		

> Maybe, maybe not. You got to remember who the CCP would be for...QL6 Med Techs...Sgts who are 2 yrs away from being loaded onto thier PA course. Also as per skills learned on PCP, not all skills learned on ACP or CCP would be used by CF med techs, but again all are another tool for the tool box when a solution is required.
> 
> Besides for the CFs purpose, full qualification is not required so long as equivelency is achieved. With x months of classroom and x months of OJT.
> 
> But its still just a proposal, a pipe dream, albiet a good idea to master prehospital skills for Med Techs. Somebody in Ottawa or Borden may take it and run...



True enough. But the CCP course is a tricky one anyways. Currently only one school is accredited by the CMA to teach it, Ontario Air Ambulance, and I believe they are taking advantage of that by charging something rediculous, like over $20,000 for it, and 1 year worth of time.

It all depends where you place PA's in the scope of things. Does it go PCP/ACP/CCP/PA .......... or does it go LPN/RN/PA/MD.

The good benefit to what you are suggestion, however, is that it could be a possible career stop for some. For instance, achieve the rank of Sergeant and be trained as a CCP - that is all many may want. Those people would then be ideal to go on extended tours and be very skilled at treating injured soliders in battle should the time ever come again when we have a war of all wars. Many may not want to progress on to WO and become a PA.


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## MedCorps

Just as an aside... 

Ontario Air Ambulance is now called Ornge.  They still have the market on the CCP program as part of the education arm of the organization.   

Did some work with them when they were Ontario Air Ambulance Base Hospital Program.  Good people, and the CCP was / is a good program. 

Cheers... 

MC


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## DartmouthDave

Hello,

Experience, that is what is needed to be good at any job.  CF medics may have the knowledge but in general CF medics lack clinical experience.  A Med-A may have the knowledge of a PCP but not the experience.  A MCPL/SGT may have the knowledge of an ACP but they do not have the experience.  As a general rule.   

Doing some ER or ambulance time every one to two years dose not substitute for working in a medical field on a daily basis. Also, I do not see how a Reg F Med-A or PA can use their skills every day.  How many codes, trauma, or medical patients do they see per month or year?  How many IV do they start per week?  Medications they administer? How many patients have they tubed this month?  

Why teach a skill that can not be maintined?  Or worse case, if called upon may do more harm than good?  For example, airway management.  You teach a Med-A intubation skills.  You learn on 'Fred the Head" and then tube a cadaver or a patient in the OR.  Great.  Then what?  Tube a patient 16 months later? If that?  How can that be safe?


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## adamop

I don't think anyone would disagree. Currently physicians that work for the CF do hospital days once per week to maintain their skills and knowledge. I think the army is more interested in drilling the stuff into your head, and then relying on you to keep up to date with it, practice in your spare time, etc. I doubt many QL5's do intubations at all except in hospitals. I doubt there would be any scenario, in fact, in which a QL5 medic could do an intubation in which a physician or PA wouldn't be there to do it first (in non-war times). So that being said, is there a real need to be an expert at intubation? Yes it would be nice, but is it worth the same type of devotion as is given to a physician (hospital time each week?). It's a skill that QL5 learns. Even if they don't do it for years, they are still able to do it, they won't forget - it will just take some time to remember it. Obviously when intubation is needed, time is of the essence, but if the skill is there, a medic will eventually come around and perform.



			
				DartmouthDave said:
			
		

> Hello,
> 
> Experience, that is what is needed to be good at any job.  CF medics may have the knowledge but in general CF medics lack clinical experience.  A Med-A may have the knowledge of a PCP but not the experience.  A MCPL/SGT may have the knowledge of an ACP but they do not have the experience.  As a general rule.
> 
> Doing some ER or ambulance time every one to two years dose not substitute for working in a medical field on a daily basis. Also, I do not see how a Reg F Med-A or PA can use their skills every day.  How many codes, trauma, or medical patients do they see per month or year?  How many IV do they start per week?  Medications they administer? How many patients have they tubed this month?
> 
> Why teach a skill that can not be maintined?  Or worse case, if called upon may do more harm than good?  For example, airway management.  You teach a Med-A intubation skills.  You learn on 'Fred the Head" and then tube a cadaver or a patient in the OR.  Great.  Then what?  Tube a patient 16 months later? If that?  How can that be safe?


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## old medic

> I doubt there would be any scenario, in fact, in which a QL5 medic could do an intubation in which a physician or PA wouldn't be there to do it first (in non-war times).



I can think of quite a few.


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## adamop

old medic said:
			
		

> I can think of quite a few.



Enough to justify having paramedics do hospital rounds every week like MD's? Because that was the point I was emphasizing. If so, I would love to hear them.


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## old medic

Paramedics don't do hospital rounds every week now.


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## Armymedic

DD,
I agree with you in principle, but disagree in reality. Unlike the civilian fields where a specific set of skills are used and honed over years of experience, a Med Tech's role has too much variety to become expert on all the skills they learn. What is expected is that they are learned in each skill and attempt to maintain and improve those skills. Skills which range the gambit from prehospital point of injury skills right thru the role 1,2 and 3 facilities to palliative care roles.

Also you'd be surprised at the level of clinical skills and experience at the MCpl and Sgt level. Remember, these medics have been working around medicine for 8-10+ yrs in several of those employment positions.

Remember this is just discussing the prehospital role...we still have a whole bunch of other clinical and military training to do as well.

How safe is that? So far so good. Can it be better? Sure. Is there a way to make it better? Not with the op tempo. Though often,it is on those operations (like DART in Pakistan) that medics get to do all those skills and then some. The MCSP goes a long way to attempt to rectify some of the skills fade.

But if lack of skill practice became the limiting factor to prehospital Med Tech training, then the trade would revert back to the skill levels of stretcherbearers.

***************


			
				adamop said:
			
		

> I doubt many QL5's do intubations at all except in hospitals. I doubt there would be any scenario, in fact, in which a QL5 medic could do an intubation in which a physician or PA wouldn't be there to do it first (in non-war times).





			
				old medic said:
			
		

> I can think of quite a few.



I can think of NONE, as intubation is not a skill that QL 5 medics are allowed to independently perform. The PCP training standard is a Combitube (  :-[  ). Currently, you should not see any QL 5s doing intubations anywhere in the military context. 

But this is pulling away the thread...want to talk about why intubation is bad/not a skill needed in the military/tactical context, lets open a new thread.


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## old medic

St. Micheal's Medical Team said:
			
		

> I can think of NONE, as intubation is not a skill that QL 5 medics are allowed to independently perform. The PCP training standard is a Combitube (  :-[  ). Currently, you should not see any QL 5s doing intubations anywhere in the military context.
> 
> But this is pulling away the thread...want to talk about why intubation is bad/not a skill needed in the military/tactical context, lets open a new thread.



I believe we're only discussing this in relation to the "what if" factor mentioned in the thread subject. 
i.e, what if QL5 were ACP. To say that a military ACP couldn't intubate because they don't get into a 
hospital weekly like a doctor, would be incorrect. I can speak for Ontario, and ACP's are lucky to get 
into a hospital a couple times a year.  Even the majority of civilian doctors (GPs) do not get a lot of 
chance for tubes unless they are also doing rotations in a larger ER. 


 <edit: corrected auto wrap format>


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## Armymedic

Then in the what if:

Then there would be very few rare cases (war or not) for an ACP qualified medic to do an intubation...other skills more likely and often. Most QL5 medics are become Advanced BTLS qualifed before going overseas.


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## old medic

Precisely... It's hard for ACP's on the civy side to get all their yearly tubes done 
in some places. The military would be no different than any other place in that 
regard.  If they do not get their required starts, they wind up in an ER/ICU/Surgical
ward looking to get them. That would probably wind up as part of a MCSP .. in theory.


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## medic269

> Obviously when intubation is needed, time is of the essence, but if the skill is there, a medic will eventually come around and perform.



Call me anal but as a medical professional that statement would not comfort me as a family member of a patient.  If the attending medic told me that chances are I'd push them out of the way and work the call myself.  I've thought about the pro's and con's about introducing an ACP certification, and the skill set and knowledge taught would be great for the medics but again maintaining the skills and clinical thinking without the practice is very difficult.  Granted you may not be looking at too many medical calls while in the CF but what happens when someone decides to leave the CF and work the civvy street?  They're just won't be the same context of experience.  Base Hospital certification alone can't make up for not having practiced an arrest or a chest tube in 4 or 5 years while in the CF due to lack of oppurtunity.  

Conclusion of the rant.  If a program like that was introduced I think a maintenance standard would also have to be introduced in which an ex. amount of time is spent dealing with internal medicine and civy street medics per month or two or whatever have you.  It wouldn't make for a perfect solution but I tihnk it'd be alot better than teaching an ALS level medic and having him/her lose the skills within 6 months.


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## Armymedic

medic269 said:
			
		

> Call me anal but as a medical professional that statement would comfort me as a family member of a patient.  If the attending medic told me that chances are I'd push them out of the way and work the call myself.



And you are a medic in the military? Too bad you're not allowed to intubate, it is out our your scope of practice.

BTW-we Med Techs are not medical professionals (we carry no license to practice)


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## medic269

I'm a licensed civilian paramedic...who joined the CF...so as such do refer to myself as a medical professional...being that I do have a license...

Anyone else care to turn a civilized discussion into an "I told ya so" show....


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## Armymedic

Well, good for you. So which is your full time job?


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## Medic19

Hello,
This being my first post, here goes.

the medical technician QL5 course does currently have an ACP portion, called AEC (advanced emergency care) which will give the med tech the same rights as a SAR tech as far as emergency medicine is concerned.  The problem is, that the military has been looking for a ontract for this portion for the last 2 years, SUPPOSEDLY it will be tendered in the new year.


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## medic45

Most ACP courses in Canada vary between 1300-2000 hours.  This would probably entail extending the QL5 course by approximately a year in a best case scenario.  I don't believe the current fiscal and operational reality can support this concept.  The vast majority of the ACP skill set covers cardiology and pulmonary emergencies which are relatively rare in the military context.  A more viable option is probably to have a limited advanced trauma skill set similar to the US Army CMAST (Combat Medic Advanced Skills Training) course.

On the subject of intubation:
There has been considerable controversy around prehospital intubation with the release of the study by Wang et al.  Any implementation of an intubation program for med techs in the CF would have to be accompanied by an aggressive QI program to monitor success/failure and complication rates.


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## Donut

As well, ref Wang _et al_, the magic number was 12, if I recall, per month.  That also, if I recall, was talking about in-hospital intubations.

If you look at the AAA Difficult Airway Algorithm, every pre-hospital airway meets the criteria of a difficult airway.

I don't see the vast majority of CF Med Techs (or even PA, GDMO, etc. ) placing enough tubes to be truly profficient at it over the long term.

I'm sure there's ALS procedures that can be pushed down to our med techs, including needling chests and and crichs ( a la CMAST), but ETT placement is a fine motor skill, which need regular application to be performed safely.

DF


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## medic45

I think the recent trend of incorporating more TCCC philosophy may help to rectify some of this.  The reality is that needle decompression is probably the single most useful prehospital ALS procedure used in trauma managment.


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## Armymedic

medic45 said:
			
		

> The reality is that needle decompression is probably the single most useful prehospital ALS procedure used in trauma managment.



No, the reality is correctly applied bleeding control (read: direct pressure) is the single most useful procedure in military trauma management.


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## medic45

Actually in my post I specified* ALS* procedure.  Bleeding control is not an advanced life support procedure, but I definitely concur with you.


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## kj_gully

Just to muddy this thread a little more... we (SARTechs) have just had intubation removed from our scope of practice, and replaced with LMA (Laryngeal mask airway) w will be using LMA Supreme, which allows passage of an OG tube. Even when we did ET intubation by protocol, we did not have the means to sedate and paralyze patients, so were only permitted by protocol to intubate in three scenarios, as part of the Cardiac arrest protocol, post arrest stabilization protocol, and discontinue resuscitation protocol. I cannot say with certainty that ET tubes were never placed in the post arrest protocol, but I know that the vast majority were placed in the other two, and did not change patient outcomes. :skull: Intubation was a skill that is difficult to maintain ( there are in my experience only a few /day performed in operating rooms) It's a pain to troll the operating theaters looking for "tubes" . As well, most anesthetists, or anesthesiologists,or whatever they want to be called this week, were loathe to let us do any but the most rudimentary insertions, as it was their ass on the line if things went south. Having said all that, I find, as do most SARTechs I've talked to that the actual procedure is pretty easy, and am confident that should I ever need to do it, I will have success. I think the CF is correct in not providing an ACP certification to ql5 medics, based on the amount of time it would take to maintain the skillset, vs the amount of use the skillset provides the CF. It would be a terrific continuing ed opportunity for deserving medics within a unit however.


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## Medic19

As I stated earlier on this topic the QL5 Med Tech course will eventually include all the SAR Tech protocols, and yes the Med Tech will most likely not go with ET intubation and will go with the LMA.  There will be no official ACP course equivalent to the civilian sector, but only the SAR Tech protocols.  Presently the QL5 Med Tech training plan calls the course Advanced Emergent Care, which will allow the deployed Med Tech to provide better care in certain situations.


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## blasty_bough

I"m new at this so please go easy on me. I"ve skimmed over all the posts and I admit I may be repeating some things. 

The CF did consider ACP but, after much review, decided against it. The ACP simply does not meet the needs of the CF. The PCP contract has been let and the site visit will be conducted this week. The AEC course finally got through PWGSC after two very frustrating years. It looks like a pretty awesome product but only time will tell. The Request for Proposal is on the MERX now and the plan is to have at least two courses completed this fiscal year. However, things happen and I tend to brace myself for the worse case scenario.  

In the Fall of this year CFHSHQ plans to conduct a SCOMR to review (once again) Med Tech training, including Physician Assistant.


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