# Milnet.ca Medic Q&A



## Armymedic

Milnet.ca Medic Q&A

Here is an opportunity to answer your questions at the same time giving medics on the boards something to research in an attempt to answer for you.

It is quite simple, post a question about medical training, drugs, illness or injuries, medical procedures or anything along that lines and we will do our best to provide you with an answer.

To keep this manageable please follow these guidelines:

1) Do not put questions about your or anyone else's recruit medical in this thread. There is already a board for that in the recruiting section.

2) Do not look for a personal diagnosis. A website is not a substitute for professional medical care. 
    We will not diagnosis and recommend treatment for you. But,
         a) we may be able to answer your questions as to what a treatment is for a diagnosis
         b) given a set of signs and symptoms, we may hypothesize as to a diagnosis

3) We know our lane. People who have no medical training beyond "well my doctor told me this about me so it MIGHT work for you or be what's wrong with you" should stay in their lane. This is our thread to answer your questions. 

4) Do not ask questions about conditions that will result in a decision at DMed Pol, i.e. if I have been diagnosed with X will I be kicked out?

We reserve the right not to answer any question.

Fire it up.


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## TN2IC

I was wondering, do I need a prescription for ibuprofen from the pharmacy? Like can I walk in to the pharmacy and request this without any documentation? I don't want to waste the sick parade time. Just need a some more for my ankle.

Thank you for your time,
Regards,
TN2IC


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## navymich

MIR at CFB Esquimalt changed their policy awhile ago.  Lozenges, cough medicine and stuff like that was straight over the counter from the pharmacy with no prescription required.  Sorry, I don't know what else was included in it.  However, I do know that Sick Parade on weekends are usually very quiet, if not completely dead, so you might want to check it out tomorrow.  If not, give the pharmacy a call at least, to inquire before you go in.  Good luck!


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## nurse sarah

Just walk in and ask for it. I'm not sure if it's always 200's or 400's but you'll get some.


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## Armymedic

TN2IC said:
			
		

> I was wondering, do I need a prescription for ibuprofen from the pharmacy? Like can I walk in to the pharmacy and request this without any documentation? I don't want to waste the sick parade time. Just need a some more for my ankle.


Ibuprofen 400 mg and 200 mg are OTC drugs, so any qualified Med Tech can perscribe and dispence them or you can buy then off teh shelf in any drug stor under the brands of Motrin or Advil.

There is always some sort of documentation if any drug, Rx or OTC is given out in a CF medical facility. You may not see it, but there is always a record of the drug being given out.

IF the person does not ask (other then name, rank, SN) you a minimum of 3 important questions;
1. What do you need it for, or what is your symptoms,
2. Do you have any allergies, or
3. have you taken it before, 

then I would think that the person giving you the meds are just too busy or too lazy to care for you properly. If you do not have the time to talk for 5 mins....

Then go to a drug store and spend $5.


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## kj_gully

Good morning. I am wondering if medics carry NPAs (nasal pharyngeal airways) . If you do, what brand, and are you happy with them. We currently carry OPA, combi tubes and ET Tubes, soon to be augmented/replaced by Laryngeal Mask Airways. However, I think NPA would be more benefitial than any of these adjuncts, as we do not have any sedatives or paralytics appropriate for RSI.


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## RCR Grunt

I'm not a medic, but I am TCCC, so that practically makes me a doctor!  Just kidding.

We had NPA's in our TCCC kit, I'm not sure what brand they were but they were pretty alright.  The nice thing about them is you can put them into a conscious patient, which I demonstrated on a young volunteer private, much to the delight of the rest of the platoon!


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## MedTechStudent

Well, I guess this falls under "Training."  And I know this sounds really basic but I could NOT find this anywhere on the Institute site.  After the first 16 week section of MOC training in CFB Borden, how long is the MOC Training at the Justice Institute?

Cheers, Kyle


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## Armymedic

kj_gully said:
			
		

> Good morning. I am wondering if medics carry NPAs (nasal pharyngeal airways) . If you do, what brand, and are you happy with them. We currently carry OPA, combi tubes and ET Tubes, soon to be augmented/replaced by Laryngeal Mask Airways.



Yes they should, and have better be.
Raucsh 28 Fr. They work ok. They have a moveable flange which enables the tube to be adjusted for size...They have not failed me yet.

I have used LMA...they are not as good in the field as people think. They work awesome in the OR where the patient does not move.


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## kj_gully

Are Raush the "soft red rubber" airway?


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## Civvymedic

I believe CF Medics are using Hypertonic saline (Dextran) in Afghanistan. If so how is this going? Do you see benefits that could be useful for civilian pre-hospital care?

What kind of studies are being done if any to compare it's use to Normal Saline or Ringers Lactate? If not is sufficient data being collected to create a retrospective evaluation or Epistry?

Thank you!

In regards to NPA's and/or LMA's. I really think that Intubation is the gold standard but other A/W adjuncts have there place. LMA's were originally designed for the O.R. environment and for use with fasting Pt.s. It used to actually say this on the package. We all know most people we deal with do not have empty stomachs and the LMA is a problem with gastric contents. I really like the King LT A/W!! As easy as a LMA but with 2 bladders, one blocking the Esophagus. Less movement as well.


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## X-mo-1979

I have been talking to a couple guys who had "diluted"urine test for drugs in the regular force.They cannot think what had caused it.Honestly I do not do drugs or be around anyone who does,however what kinds of stuff would fail me on a drug test.

Also I am guilty of a few months ago taking a Tylenol 3 which I have left over from a previous injury.Does the drug testing know the difference between codeine or cocaine or just test for opiates?


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## kj_gully

Civvymedic said:
			
		

> I believe CF Medics are using Hypertonic saline (Dextran) in Afghanistan. If so how is this going? Do you see benefits that could be useful for civilian pre-hospital care?
> 
> What kind of studies are being done if any to compare it's use to Normal Saline or Ringers Lactate? If not is sufficient data being collected to create a retrospective evaluation or Epistry?
> 
> Thank you!
> 
> In regards to NPA's and/or LMA's. I really think that Intubation is the gold standard but other A/W adjuncts have there place. LMA's were originally designed for the O.R. environment and for use with fasting Pt.s. It used to actually say this on the package. We all know most people we deal with do not have empty stomachs and the LMA is a problem with gastric contents. I really like the King LT A/W!! As easy as a LMA but with 2 bladders, one blocking the Esophagus. Less movement as well.



There is a topic going on HSD, I am interested in this product as well. As for LMA, we will be using LMA Supreme, which has a port to provide for passing an OG tube. I have questions about its use pre hospital as well, but regardless, I am more interested in getting an Adjunct we could use (my thinking is NPA) vs one we may use once or twice if ever. Our current use for ET is for Cardiac arrest, and discontinue resusitation (no paralytics required)


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## Civvymedic

Fair enough on HSA. I was lucky enough to sit in on a presentation by 2 members of 2 Field Amb at a conference in September and I think Dextran sounds like the way to go.

NPA's? Use them, like them, although some traumas make there use difficult. Biggest problem is you still need 2 rescuers to Ventilate the Pt. Especially on the move and in cramped spaces this becomes difficult, and you still get Gastric air no matter how good you bag. If you cant Intubate I still prefer an LMA or Combitube with a C-Collar trauma or not to  minimize movement.

We looked closely at LMA's in the service I work for and settled on the King A/W after some research. You can also get a King A/W that allows for the passing of an OG tube.

www.kingsystems.com


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## Armymedic

Civvymedic said:
			
		

> I believe CF Medics are using Hypertonic saline (Dextran) in Afghanistan. If so how is this going? Do you see benefits that could be useful for civilian pre-hospital care?
> 
> What kind of studies are being done if any to compare it's use to Normal Saline or Ringers Lactate? If not is sufficient data being collected to create a retrospective evaluation or Epistry?


I am not sure about studies, but LCdr Philips (sorry for the misspell if I have) spoke at the last OPMED conference about the effectiveness of HSD vs R/L and its effect on blood acidity and volume retention. The baseline is that HSD is much better volume replacement than either isotonic solution, and the most suitable solution to infuse until the trauma patient can get blood products.



> In regards to NPA's and/or LMA's. I really think that Intubation is the gold standard but other A/W adjuncts have there place.



Intubation is still the gold standard, but as it is a skill that is difficult to maintain, not everyone is proficient nor allowed to use it. Hence the purpose of the other adjuncts avail. My opinion of LMA vs King LT is that the King LT is much better for use in the field.


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## Armymedic

kj_gully said:
			
		

> Are Raush the "soft red rubber" airway?



yes, with the moveable flange


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## EMER DOC SPEC

The most recent randomized clinical trial of hypertonic saline versus regular crystaloid as brought into question the whole process of pre resus treatment with fluids. Retrospective studies have demonstrated that patients do worse with resus fluid.  Why?  The interstitial space needs to be resuscitated first.  When using NS it will go to the interstitial space first.  Hypertonic saline will not and will in fact draw fluid into the vasculature.  You would think that this is what you want right?  But we now know that before you give blood products use crytsaloid about 2 l in the trauma patient (weight 75kg) then packed red blood cells.  Don't forget to replace the clotting factors as they are not in PRBC's.
  A typical resus regime for a trauma patient would be 2 liters of NS + 6u PRBC's + 4u FFP (fresh frozen plasma) then 10 units of platelets.  It works well.  Many people stop after the PRBC's and having the patient go into DIC. In the field I would give the 2l NS as only a 3rd will stay intravascular anyway until transport to the field hospital.

  Just my two cents.


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## kj_gully

thanks for the post, touches on another related aspect of prehospital care, permissive hypo tension. There has been lots (as I am sure you are aware doc) new looks at old practices, with permissive hypo tension being one. Saw some interesting stuff written during WW1, confirmed in WW2, then promptly disregarded in Vietnam, stating a systolic pressure of about 80 would be acceptable. I think that some more info will be forthcoming out of the current conflicts. I know my patient care is now less tied to a number, and more related to overall patient presentation.


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## Donut

EMER DOC SPEC said:
			
		

> The most recent randomized clinical trial of hypertonic saline versus regular crystaloid as brought into question the whole process of pre resus treatment with fluids. Retrospective studies have demonstrated that patients do worse with resus fluid.  Why?  The interstitial space needs to be resuscitated first.  When using NS it will go to the interstitial space first.  Hypertonic saline will not and will in fact draw fluid into the vasculature.  You would think that this is what you want right?  But we now know that before you give blood products use crytsaloid about 2 l in the trauma patient (weight 75kg) then packed red blood cells.  Don't forget to replace the clotting factors as they are not in PRBC's.
> A typical resus regime for a trauma patient would be 2 liters of NS + 6u PRBC's + 4u FFP (fresh frozen plasma) then 10 units of platelets.  It works well.  Many people stop after the PRBC's and having the patient go into DIC. In the field I would give the 2l NS as only a 3rd will stay intravascular anyway until transport to the field hospital.
> 
> Just my two cents.



Could you please cite a source for this (esp the need to resus the interstitial)? There's several threads that this might be more appropriate for this discussion (such as http://forums.army.ca/forums/threads/23137.0.html or http://forums.army.ca/forums/threads/59238.0.html) but this is news to me, and I'm always looking for evidence to back what we're doing.

Despite the rocky start, welcome to the boards, EMER DOC.


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## EMER DOC SPEC

Helllo,

  Here are some of the references that you requested.  It is a great topic for discussion with lots of pros and cons.  I have a PP presentation that I could e-mail you with some summaries and great slides of  intracellular, interstitial and intravascular space resus and current thoughts about it.  Really two camps.  Traditional and Interstitial.

Carlson RW. Fluid Resuscitation in Circulatory Shock
Crit. Care Clin. 1993;9:313.

Evidence against
Bickell WH. NEJM 331:17 1994

Bickell summary of results.  Sorry I did not summarize the others but they should be available online.

Survival of Delayed Resuscitation		70%
Survival of Immediate Resuscitation		62%				(p=0.04)
Complication Rate: 					23% vs. 30%		(p=0.08)
(ARDS, Sepsis, ARF, Coagulopathy, infection or pneumonia)




Choi P, Yip G, Quinonez L, Cook D.Critical Care Medicine 27:1 1999

This is a summary from a major trauma centre in Canada that will be ready for publishing soon:

Hemorrhage Model dictates results
Medline Search and review of references
96 potential articles, 93 found
32 contained treated and untreated groups

Uncontrolled Hemorrhage – favors control
Controlled Hemorrhage – favors treatment

Thank you for the welcome.  Let me know what you think.  Its a really great topic.  Noticed I included references for both camps.


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## Donut

Sorry it's taken so long to get back to you on this.

I'd run across some of these trials before during searches, and perhaps I need to take a closer look at them, as I'm not sure I'm convinced about them. Perhaps more tellingly, neither are the designers of the Resuscitation Outcome Consortium trials on HS and HSD.  I'm no statistician, and I didn't even stay at a Holiday Inn last night (just the econolodge in Edmonton for the past 6 months  ;D) but if there was an adequate body of evidence that showed these treatments to be harmful to the trial population there wouldn't be the ongoing trials.

Now, I'm not saying these are the be all and end all of resus fluids, but as I've said before on here and in other venues, we don't know, and until we conduct some really well designed trials with a very large sample population, we won't.  I guess the only thing to say is that the jury is still well and truly out on this, but there's lots of military and civi health care professionals awaiting the verdict with baited breath.


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## kj_gully

hello again. My trade is starting to access some of the new operational medical equipment, but info on what products are currently used in theater is difficult to come by as an airforce operator. Does anyone know how to access ECL for TC3 trauma kits, as well as current medic jumpkit (overseas)? Any self administered analgesia in Canadian Prehspital care? I am trying to push inclusion of NPA, as you may gather from previous posts, as well as chitosan dressings. Please provide insights as to some less glamourous new or recycled med gear coming to the pointy end, so I can try and get some for this little splinter at home.


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## Civvymedic

KJ_gully

As far as pre-hospital care goes I really think the King LT A/W is the way to go as opposed to an LMA and the NPA for sure! It has been a standard of care for a long time on civvy street.

Something I'm most impressed with are the Fentanyl "lollipops" We don't use them currently but since I was introduced to them at a seminar in September by 2 CF Medics I have really thought about using them. 

2 weeks ago we had a guy 390 pounds trapped in a car very nasty but isolated tib fib fracture, lots of pain. Not a lot of damage but this guy normally would have had to have squeezed into his car on the best of days, now with damage to his car he was very stuck. Again he was in a lot of pain! It took us a while to get him out. There was no hope of getting an I.V. I gave him Fentanyl 50ug x 2 I.M. but with his size the uptake wasn't there and I would have loved a Fentanyl "Lollipop" for him. Again same thing last week with a Ski-doo crash victim, would have been nice.

I believe it's 400ug of Fentanyl. Definitely on my wish list right now.

As well I find 2-4 mg of Versed is great for sedation, esp. head injuries Pre-Intubation if your looking at that.


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## HItorMiss

KJ,

I can say for certain that NPA are taught as doctrine to TCCC soldiers. Used as a more patent airway because it is less likely to dislodge when transporting a cas over rough terrain and long distance. I suggest maybe PMing Saint Micheals Medical Team to answer some of your other questions. Ref self administered analgesia I know on my last tour that there was none in the scope of practice for TCCC members but the Medic did have Morphine. Keeping my ear to the ground I think it maybe changing or has changed in terms of scope of practice for the regular TCCC soldier but I am not 100% sure. Maybe someone from the following TF (all after 3-06) can say for sure.


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## Civvymedic

Fentanyl lolli's are definately self administered. Tape it to the pt.s thumb. They suck on it. Before they get too sedated it falls out of there mouth.


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## kj_gully

I am aware of fentynol lollis, but didn't know if Canadian medics were using them. I have also heard of a Ketamine inhalor (think Kazoo). there are tons of great products in the market, I am mostly interested in products already in CFMS, since the time lag in attempting to acquire them for SAR Tech use would be shorter.


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## Civvymedic

Fair enough. I do know that Fentanyl lollis were presented to us during a discussion/presentation by 2 Sgt.s with 2 field Amb. So someone in the CF is using them.


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## Sparkplugs

I have no idea if this is the place to ask, but I'll give it a shot.  I won't get into all the details, but I'll explain a bit, and if anyone can answer a few questions, please PM me.

I'm an AVN.  I'm getting posted to Cold Lake, which requires a semi-isolated screening.  I'm good to go for everything but the medical.  Just today, my doctor put me on a T-CAT, telling me I wasn't going anywhere.

Now, I am not sad about Cold Lake, and I don't want to be on CAT.  I told her this, but she said, "It's for your own good."

Now, I'll explain more in a PM, but I don't want my med info on a public board.  So I guess I'm wondering if it's still possible for Cold Lake to say screw it, we can handle her, send her up, or does the CAT prevent that?  I know Cold Lake is different than other bases for that, but I'm just wondering if anybody has any info that could help me.

Thank you.

EDIT:  I have some T6-CAT codes on my chit, wondering if anyone would be able to tell me what they mean?  This CAT thing is all new to me.  =(  I have GST6 and O3T6


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## Donut

Uhm, G6T6, not GS?

Short answer, you don't get posted on a t-cat.  Feel free to PM me and I'll tell you what I can, it's been a while since I administered such things, but I do have some idea.


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## Bigmac

Sparkplugs said:
			
		

> EDIT:  I have some T6-CAT codes on my chit, wondering if anyone would be able to tell me what they mean?  This CAT thing is all new to me.  =(  I have GST6 and O3T6



I can probably answer most of your questions but please read the link below before you PM me. Specifically read the medical category system in Ch 3.

http://www.forces.gc.ca/health/policies/engraph/cfpg_med_standards_home_e.asp?Lev1=7


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## lone bugler

hi i have a series of questions  ;D, I'm planning on being a reserve med tech at 23 field ambulance in London Ontario, and my element is army. 
first question is do reserve med tech need to do SQ? I looked for threads and it seems reg force med tech don't have to sometimes. 

and if you do need SQ,"QL3" is the first trade course for all medtechs after BMQ and SQ right, or is the first trade course after BMQ/SQ called something else for the reserves?  

next is when do QL3 courses run, how long is it? and do you need it to be a private trained? 

last question is that can you do reserve BMQ (20 days i think) reserve SQ (another 20 days, assuming i need to take SQ) and QL3 in one summer (4 months for me from may to august since im in university) 

thank you so much and if i repeated a question im sorry, it's just that i looked at the topic sticky and couldnt find this info


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## Donut

These have been asked and answered before, but since I'm procrastinating, I'll give you the answers again, even though this thread is for health related questions, not medical tng questions.

Most Res medics are land element, so SQ is a must.

The Res training is now a modular version of the Reg training.  Your first trade course is QL3, which is about a third of the Reg F QL3, and then you do QL4, which is the middle third, and then some get loaded on Primary Care Paramedic, which is the last third of the course.

Res QL3/4 run during the summers in Borden, Ontario.  You won't be a Pte trained until you complete at least the Res QL3.

Some have been able to do all three in one summer, but it's very rare.


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## lone bugler

thank you ;D em just wondering how long is reserve QL3 for med tech ;D last question i promise


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## MedTechStudent

I know its been forever, but can anyone answer my question back on page 1?

Pretty please.


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## Pea

MedTechStudent said:
			
		

> Well, I guess this falls under "Training."  And I know this sounds really basic but I could NOT find this anywhere on the Institute site.  After the first 16 week section of MOC training in CFB Borden, how long is the MOC Training at the Justice Institute?
> 
> Cheers, Kyle





			
				MedTechStudent said:
			
		

> I know its been forever, but can anyone answer my question back on page 1?
> 
> Pretty please.



The next course training at the Justice Institute is going to be 6 months in length. We are starting sometime in May, and will be the first 6 month course. (has just been extended from 3-6 months) See this link, for updated info I have posted on course lengths: Course Updates


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## MedTechStudent

Thank you very much!


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## mustard

I'm pretty clueless when it comes to the medical side of the military. Am i supposed to go to the MIR for typical "family doctor" issues?


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## George Wallace

mustard said:
			
		

> I'm pretty clueless when it comes to the medical side of the military. Am i supposed to go to the MIR for typical "family doctor" issues?



A rather interesting question.  Are you in the CF?


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## mustard

yes, reg force. I don't know, i've only had to go to the MIR a few times but that was for work related injuries.


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## medicineman

mustard said:
			
		

> I'm pretty clueless when it comes to the medical side of the military. Am i supposed to go to the MIR for typical "family doctor" issues?



If you're Reg Force - yes.  Now I have a question - wasn't that explained to you in Basic? 

MM


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## George Wallace

Even more interesting.  In all your Service no one had instructed you on all of the "use of the MIR"?  

Yes, it is where you as a Service Member go for all of "your" family related health problems.  That is where your Medical File resides, and the MO is basically your "Family Doctor" and the Base Hospital and Dental Clinic are basically your "Health Clinic".  It is in fact against Regulations for you to go to/use any outside Medical or Dental facilities, unless sent there by the military or in the case of an emergency when away from your "Home Base" (ie. on Leave outside of your Bde Area.)


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## cdn031

St. Micheals Medical Team said:
			
		

> Raucsh 28 Fr. They work ok. They have a moveable flange which enables the tube to be adjusted for size...They have not failed me yet.


St Mike
The Rausch NPA - a 28fr? - Is this the standard sizing for CF / TCCC kits
6mm? 

Thanks


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## Armymedic

yes.


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## the_girlfirend

Hi There!

I am not sure if it is appropriate in this board or the recruiting board... forgive me please...

I am in the process of joining my local unit (I have not applied yet) and they strongly suggested me to start collecting documents from my surgeon and my family doctor now.
I had a spinal surgery last year and they said I would absolutely have to have some strong documentation from those professionals in order to get in.

But at this point I am only wondering if there exists an official document from the CF (that I could get at the CFRC) to be filled in by them or if they can use their own documents or way of giving that kind of information.

I am only asking this to prevent from disturbing them twice for the same thing and extend the delay...
Please let me know
Thank you very much


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## MedCorps

I would do this... 

Get a copy of: 

1. The Generic Task Statement
2. The Task statement for the trade you are interested in. 

You can find them here: 

http://www.forces.gc.ca/health/policies/med_standards/engraph/annex_d_e.asp

Print them out and bring them to your specialists physicians and/or surgeons. 

Ask each one of them to write a letter on their letterhead that looks something like this: 

I have been <your name> <general surgeon / orthopedic surgeon / etc> for the past X years. 

During this time she has been under my care for <insert diagnosis>.  <Follow with a short paragraph explaining the history of your problem, how it was treated and any residual deficit or abnormality that exists>. She is currently on <name of medication, dose, frequency> for this condition and it is expected that this will continue for the next <insert estimated time of medication cessation>. 

After reviewing the attached Canadian Forces Generic Task Statement and the Task Statement for <insert your MOC> I feel that the medical condition for which I treated her will not pose a problem in her attaining these standards.  Furthermore, I feel that the aforementioned condition will not impose restrictions with respect to the type of climate, or accommodation / living conditions that <your name> might be employed in while serving in the Canadian Forces as a <your MOC here> within Canada or while deployed abroad.  This medical condition will not impose any burden upon the Canadian Forces Medical Service.  <Name> will not require any medical care for this condition from the Canadian Forces Health Service other than the routine medical services afforded to any healthy member of the Canadian Forces such as periodic physical examinations and screenings.

If you have any questions with respect to <your name> condition please do not hesitate to contact me at <phone>. 

<signature> 


----

Repeat the same drill with your family doctor.  Modify as follows: 

I have been <your name> family physician for the past X years. 

During this time she has been under my general care.  <Follow with a short paragraph explaining the history of your general health, the problem that arose, how it was treated and any residual deficit or abnormality that exists>. She is currently on <name of medication, dose, frequency> for this condition and it is expected that this will continue for the next <insert estimated time of medication cessation>. 

After reviewing the attached Canadian Forces Generic Task Statement and the Task Statement for <insert your MOC> I feel that the medical condition for which I treated her will not pose a problem in her attaining these standards.  Furthermore, I feel that the aforementioned condition will not impose restrictions with respect to the type of climate, or accommodation / living conditions that <your name> might be employed in while serving in the Canadian Forces as a <your MOC here> within Canada or while deployed abroad.  This medical condition will not impose any burden upon the Canadian Forces Medical Service.  <Name> will not require any medical care for this condition from the Canadian Forces Health Service other than the routine medical services afforded to any healthy member of the Canadian Forces such as periodic physical examinations and screenings.

If you have any questions with respect to <your name> general health please do not hesitate to contact me at <phone>. 

<signature> 

---

They might ask for additional documentation but I doubt it. 

I realize that the staff work on this is not perfect, but it gives you the gist.  The statements are well chosen albeit not perfectly word smithed.  

Cheers, 

MC


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## kincanucks

Stop!

_they strongly suggested me to start collecting documents from my surgeon and my family doctor now._

_I had a spinal surgery last year and they said I would absolutely have to have some strong documentation from those professionals in order to get in._

The recruiters at the reserve unit are not medical professionals and they are not part of the medical processing.  While the suggestion in the post above is well intentioned it is highly recommended that you go through the medical processing first to be truly knowledgeable of what forms/information is required to be submitted by you to complete your medical.  Good Luck.


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## MedCorps

Thanks for that... 

I still think it would be a valuable exercise.  Indeed I would wait to hand them over to the CFRC medical folks WHEN it comes up during your medical inspection.  There is no need to hand them over to anyone else other than the medical system, as they really do not need (or are entitled to know) the details of your medical condition other than how it reflects your potential employability. 

I suggest the above exercise for four reasons: 

1) When you are in the recruiting system, during the medical if you have indeed had a recent spinal problem they WILL (not might) want supporting documentation.  There is no way that you will slide through the recruiting medical inspection without clarification required for such a condition. 

2) It could take considerable lengths of time to get into see all of your specialists, and they may wish a set of discharge from care tests such as CT scans, X-Rays, blood work, etc that take time to go get and then book another appointment with a specialist to review the results.  Especially with multiple specialist this process could take months which you can help to decrease if the process is in the works. 

3) It is possible one of your specialists will not write the letter.  It is possible he/she will not feel that you are fit per the task statements or other comments in the requested letter.  This will serve one of two purposes.  (1) To let you know that you may never be medically fit for the occupation you desire or (2) to allow you to formulate a plan of care with your clinician in order to meet your medical goals.  Even if they will not write the letter I still would encourage you to attempt the recruiting process.  

4) If the CFRC Medical adviser / D Med Pol wishes additional documentation having such a letter already in your patient file at the doctor's office will facilitate a quicker reply to any inquiry or drafting of additional correspondence / completion of forms.  

This is not an uncommon situation... 

Mr Q. Public has X medical problem.  He goes to CFRC does all the good recruiting stuff without any  problems. He is sailing.  Hits the medical stage of the recruiting process.  Known medical problem is identified. Takes some time for CFRC Med Adviser to send a letter to him asking for documentation from the specialists.  Mr. Q Public has 3 specialists.  Specialist A takes 2 months to get an appointment, specialist B takes 4 months to get an appointment, and Specialist C takes 4 months to get an appointment.  All are booked right away.  Specialist A clears Mr Q. Public with no issue, Specialist B wants X-rays and lab work and Specialist C wans a CT Scan in order to clear Mr. Q. Public and write the letter.  X-Rays and lab work are done within a week, but it takes another months to get back into see specialist B who realizes that he forgot to order X test.  X test is done in a week and it takes another two months to get a follow up appointment with specialist B to get in.  All is good specialist B clears the potential member.  The CT... well it takes 6 weeks to get a non-urgent CT scan, so there goes another month and a half.  Then it takes 2 months to get in after that to see specialist C who finally clears Mr. Q. Public.... you get the point... you can help close the time gap on this if you get a jump on it.   

The other problem is poorly worded letters from MD's... 

Letters like this get handed to the recruiting medical system after Mr Q. Public waits 3 months to get an appointment with his specialist....  

Mr Q. Public has an arteriovenous malformation for the past 4 years but it should not pose a problem for him to be in the part-time army. 

It then takes 3 months to reach the reviewing medical officer and offers him nothing useful when he read it. You would not imagine the crap MD's write, mostly out of lack of knowledge of what is medically required to be in the Canadian Forces.  The recruiting medical officer needs to draft a letter back asking for more specific information such as that mentioned above.  Mr. Q. Public books another appointment with this specialist (2 months) who looks at what the reviewing medical officer wants and goes... whoa... you want me to sign a letter which states what?  I did not realize you had to do all of that stuff... I cannot write that letter... you cannot do X in the army with a spinal vascular malformation in the thoracolumbar region...  here is why... blah blah... 

Something to think about... it is only my take on it. 

Cheers and good luck, 

MC


----------



## Roy Harding

And now, with MedCorp's interesting and informative expansion of his original post, I believe the question has been MORE than answered in full.

For the_girlfriend:  I think you've been given a lot of well-informed suggestions.  Past experience here has shown us that questions regarding specific, personal, medical complications can not be answered well on an internet forum.  This is why we tend to lock these threads fairly quickly.  You need to confer directly with CFRC medical staff by going through the medical processing to get truly accurate answers regarding your specific situation.  Best of luck to you.




Roy Harding
Milnet.ca Staff


----------



## Angry_Johnny

Is 10 months a long time to be still waitting for word back from DMED POL, as to my TCAT becoming a PCAT?

Have I been lost in the admin vortex again? 

Is this going to take years?  

I have spoken to a few people (that have gone from TCAT to PCAT, and are awaiting release or still in and accomidated) that are saying I should more than know by now.

Please, someone tell me, should I be asking to speak with someone higher in the med chain at my base, and stop listening to the "your file is still with DMED POL"...or wait another year?

thanks!!


----------



## old medic

Ask for the file to be physically located. Your TCat is going to expire.


----------



## Angry_Johnny

Thanks,

     After speaking with the CDU receptionist, all she told me she could do was to make an appointment to speak with an MO, to let this person know what the situation is.  This could not be done for another three weeks.  I then asked around the unit, and was told to speak with the case manager at the BASE HOSP.

    I got a person that had only been in the job 5 days, but seemed most helpful, and is going to call me when she has any info for me.  I will most likely be back here asking questions of who to speak with next, if there is no joy getting back a message from the case managers office.  I have never dealt with them, so no idea as to a timeline for hearing back from them, but i will give it til tues next week.

   Thanks for the info, and any pre-emptive info would be appreciated.  

   At this time, I am just looking to find out what is going on with my file as everyone short of my dog (trying to keep some humor in the situation) is telling me something seems wrong with the amount of time I have been waiting to date.

   Johnny


----------



## Activated

Hi, I am new to this forum and I would like to ask some questions about being a Canadian Medic (Reserve)

1. If I join the Canadian Army and train to become a Medic, will I have a better chance (Almost guaranteed) to become a Paramedic in civilian life?

2. Is anyone here on the forum a Paramedic and a Canadian (Reserve) Medic?

3. If I work as a Paramedic, will I still have enough time to be in the armed forces?

4. If I am not 18 yet (Minimum requirement to become a medic) and I finished BMQ, am I able to become a infantry, then become a medic afterward?

5. (This is related to #4) Are medics assigned to infantry squads? Or do medics have their own squad?

*Sorry if my information is wrong or anything, I am new to all the army stuff!*

Thanks in advance!


----------



## cdn031

Activated said:
			
		

> 2. Is anyone here on the forum a Paramedic and a Canadian (Reserve) Medic?
> 
> 3. If I work as a Paramedic, will I still have enough time to be in the armed forces?



Activated -
 2. I think we have a couple of Civi/Reservist medics out there - best to include your location
3. Check into the shift schedules in your geography - for example in Ontario there are services that run 28 day rotating schedules of 12 hour day /night shifts
i.e. of 28 days you work 14 -    Seven shifts are 12 Hr 0700hrs to 1900hrs and the remaining Seven are  1900 to 0700  (or when ever your shift changeover is - sometimes 0600 and 1800hrs
since the schedule is predictable (you always work the same shift every 28days) this is pretty achievable. PLUS shift swaps are pretty common, although not that encouraged.


----------



## PMedMoe

Activated:

1.  Not necessarily (at least not "guaranteed").  Each province has different regulations and requirements.  Some make you take the whole course, others, you are able to just challenge the final test.

2.  Yes, lots.

3.  Depends on your civilian shift schedule.  Lots of people do it, or work with volunteer fire departments, etc.  Just remember the military comes first (e.g. they are not going to give you time off for your civvy job).

4.  You have to 18 to be a Medic?  I didn't know that.   However, you can go infantry, just remember that to do an OT (occupational transfer) you need a minimum amount of time in, a certain training level and it's still not guaranteed.  In other words, don't pick one trade hoping to change to another.  If you really want Medic, wait until you are 18.

5.  No, Medics are _tasked_ to units.


----------



## mariomike

Activated said:
			
		

> 1. If I join the Canadian Army and train to become a Medic, will I have a better chance (Almost guaranteed) to become a Paramedic in civilian life?



I don't know about out of town.This is what you need for Toronto:
http://www.torontoems.ca/main-site/careers/medic-opportunities.html
With us you can advance to CCTU, HUSAR, ESU, ETF, Community Medicine, Marine , HAZMAT ( no thanks ), CBRN, bike, PSU, ERU. Special Ops, NEA, probably others I can't think of. MPU was disbanded. It was the best if you like a lot of OT. I worked it for 20 years.  
Best of all, we are completely in dependant from all other city departments. We used to have our own Commissioner. Our "Golden Years" were from 1975 to 1998.
I joined in 1972. The job isn't for everyone, however. A lot of burnout.

"3. If I work as a Paramedic, will I still have enough time to be in the armed forces?"

In Toronto, we work 20 X 12 hour rotating shifts every six weeks with very little "down time" between calls. Obviously, you work Statutory Holidays. There's LOTS of voluntary and involuntary ( forced ) overtime. 
The one big difference between now, and when I was in the militia is that Corporate policy now permits leave of absence for military training.


----------



## Activated

mariomike said:
			
		

> I don't know about out of town.This is what you need for Toronto:
> http://www.torontoems.ca/main-site/careers/medic-opportunities.html
> With us you can advance to CCTU, HUSAR, ESU, ETF, Community Medicine, Marine , HAZMAT ( no thanks ), CBRN, bike, PSU, ERU. Special Ops, NEA, probably others I can't think of. MPU was disbanded. It was the best if you like a lot of OT. I worked it for 20 years.
> Best of all, we are completely in dependant from all other city departments. We used to have our own Commissioner. Our "Golden Years" were from 1975 to 1998.
> I joined in 1972. The job isn't for everyone, however. A lot of burnout.
> 
> "3. If I work as a Paramedic, will I still have enough time to be in the armed forces?"
> 
> In Toronto, we work 20 X 12 hour rotating shifts every six weeks with very little "down time" between calls. Obviously, you work Statutory Holidays. There's LOTS of voluntary and involuntary ( forced ) overtime.
> The one big difference between now, and when I was in the militia is that Corporate policy now permits leave of absence for military training.



Would you mind giving me a suggestion on what path I should take? As in join the army reserve, then in civilian life, be a paramedic, or anything like that? I am open to any suggestions. I am still having a hard time choosing a future career


----------



## mariomike

Activated said:
			
		

> Would you mind giving me a suggestion on what path I should take? As in join the army reserve, then in civilian life, be a paramedic, or anything like that? I am open to any suggestions. I am still having a hard time choosing a future career



I will turn 55 soon. This summer. That means I can retire. I have the same confusion you do about what to do.


----------



## PMedMoe

I still don't know what I want to be when I grow up.


----------



## Activated

PMedMoe said:
			
		

> I still don't know what I want to be when I grow up.



I know what I want to be! A Paramedic! I just have problems planning out my future education after high school and if I should join the Army Reserve...


----------



## MedCorps

I can provide some guidance: 

If you want to be a Medical Technician then apply to the Regular Force as a Medical Technician.  We are hiring.   

If you want to be a Paramedic go to a college, pass the Paramedic program and then apply for a job with a paramedic service. 

If you want to be both then join the Reserve Force as a Medical Technician while concurrently going to college, passing the Paramedic program and then applying for a job with a paramedic service.  

See: the end of the thread called "semi-skilled applicant needs more info" to examine the role of the Med Tech vs. civilian Paramedic. 

Cheers, 

MC


----------



## mariomike

Activated said:
			
		

> I know what I want to be! A Paramedic! I just have problems planning out my future education after high school and if I should join the Army Reserve...



Here is some info:
http://www.torontoems.ca/main-site/careers/becom-medic.html
Don't get any demerit points on your driver's licence!
You may also want to consider becoming a dispatcher. It's clean, inside work with no heavy lifting. 
http://www.torontoems.ca/main-site/careers/dispatch-opportunities.html


----------



## IIMedicII

Ok, im not 100% sure how the East does things, but here in Alberta you are not just a Paramedic
We have three "levels" of training EMR (Emergency Medical Responder), EMT (Emergency Medical Technician), and EMT-P (Emergency Medical Technologist- Paramedic)
Now Im no expert, but personally, Im on my way to hopefully becoming an EMT-P (start my EMT in Sept) but i would say go and take the basic emergency medical course offered.
Reserve MedTech positions are pretty competative nowadays, so having as much "outside" training you can is definitally a boost.
Also, ALOT of people think they want to be in EMS but find as soon as they get into the workplace it isnt for them, so instead of wasting $40,000 on schooling, and commiting to the Forces, only to find your not that into it.  Why not spend $1000 (tops) and see if its really for you...then once finished, toss in an application if you really do enjoy it, and go from there.

PS. And if you aleast have a clue what your doing, it will make fitting in with the rest of the MedTechs alot easier

just my 2cents


----------



## GDawg

Is information about diagnosing and treating leishmaniasis shared throughout the CF medical system _domestically?_

This disease can go undetected for months after you've been back in Canada.


----------



## Gunner98

Leishmaniasis is discussed in the CF Health Risk Assessment for Afg:

http://www.forces.gc.ca/health-sante/wn-qn/adv-avi/op-athena-eng.asp

It is also widely discussed in World Health Organization site:

www.who.int/topics/leishmaniasis/en/


----------



## GDawg

Frostnipped Elf said:
			
		

> Leishmaniasis is discussed in the CF Health Risk Assessment for Afg:
> 
> http://www.forces.gc.ca/health-sante/wn-qn/adv-avi/op-athena-eng.asp
> 
> It is also widely discussed in World Health Organization site:
> 
> www.who.int/topics/leishmaniasis/en/



I've seen all that. What I am wondering is if our military doctors, especially the ones working domestically are actually trained to recognize this disease? Are they able to perform tests to determine the exact type and would they have drugs on hand, or have expedient access to drugs to treat this disease? Any idea on what the statistics are on how many soldiers have gotten Leishmaniasis on deployments?


----------



## PMedMoe

GDawg said:
			
		

> I've seen all that. What I am wondering is if our military doctors, especially the ones working domestically are actually trained to recognize this disease? Are they able to perform tests to determine the exact type and would they have drugs on hand, or have expedient access to drugs to treat this disease? Any idea on what the statistics are on how many soldiers have gotten Leishmaniasis on deployments?



I'm thinking the docs are not _specifically_ trained to recognize the disease but it is something they should take into consideration if they know of the member's deployment and/or travel history.  
Tests, I have no idea, that would be the lab.  
Access to treatment drugs?  Yes, not sure about how "expedient" it is but they are available.  
Stats, again, no idea but I wonder how many of the soldiers who have leishmaniasis or malaria, actually treated their uniforms with permethrin pouch and used their DEET 24/7?


----------



## dangerboy

When I returned from TF 3-06 I had a growth on my wrist which would not go away, I did not pay to much attention to it until I had a medical where I showed it to the PA. As a couple of members of my Sect had been diagnosed with Leishmaniasis I was booked an appointment, they removed it using something that looked like a "hole punch" and sent the specimen away to be tested. Thankfully the test came back negiative.

This occurred at CFB Shilo, so I think that no mater where you go they can do tests.


----------



## GDawg

I'm asking because I have it, and no one had the slightest clue what it was. I was sent to a dermatologist and its now the problem of the civilian medical authorities.


----------



## Armymedic

As a student PA, I can say we had a few slides on recognizing and treating the parasite during that specific portion of the course.

As for the doctors employed by the CF, any military MOs should be aware of it, civilian MDs might not be. But if you were consulted to a dermatologist (see final line below), then I would say your treatment is well under way. It is not an easy thing to recognize nor treat.

For the unwashed, here is the entry for Leishmaniasis in the Current Consult Medicine 2007 edition avail through StatRef!.



> Leishmaniasis
> 
> KEY FEATURES
> 
> ESSENTIALS OF DIAGNOSIS
> 
> • Four clinical syndromes occur
> - Visceral leishmaniasis (kala azar)
> - Cutaneous leishmaniasis
> - Mucocutaneous leishmaniasis (espundia)
> - Diffuse cutaneous leishmaniasis
> 
> GENERAL CONSIDERATIONS
> 
> • Two species of sand flies transmit infection
> - Phlebotomus (Old World leishmaniasis)
> - Lutzomyia (New World leishmaniasis)
> • Transmission
> - Sand flies feed on wild animal reservoir (eg, rodents, marsupials) and domestic dogs and then bite humans
> - Kala azar is transmitted directly from humans to humans
> • Leishmaniae life cycles have two distinct forms
> - In mammalian hosts, the parasite is in its amastigote form (Leishman-Donovan bodies, 2-5 μm) in mononuclear phagocytes
> - The sand flies ingest the parasitized cells when they feed on an infected host
> - In the sand fly vector, the parasite converts to, multiplies, and is then transmitted during feeding as a flaggellated extracellular promastigote (10-15 μm)
> • There is overlap between the four clinical syndromes, and each syndrome is caused by more than one species
> • Leishmania results in lifelong latent infection
> • Cutaneous and visceral leishmaniasis have occurred in US military after exposure in Afghanistan and Iraq
> • Leishmaniae can become opportunistic pathogens through reactivation or new infection
> • In southern Europe, ~5% of people with AIDS have coinfections
> • Diffuse cutaneous leishmaniasis
> - State of deficient cell-mediated immunity
> - Causative organisms: L mexicana complex (New World) and L aethiopica(Old World)
> 
> DEMOGRAPHICS
> 
> • In tropical and temperate zones, ~12 million persons are infected with leishmaniasis
> • 1.5-2.0 million new cases occur yearly
> • > 1 million are cutaneous and 500,000 visceral disease
> • Approximately 50% are in children
> 
> CLINICAL FINDINGS
> 
> SYMPTOMS AND SIGNS
> 
> • Severity of infection ranges from subclinical (self-curing or easily treated cutaneous lesions) to persistent, disfiguring cutaneous and mucocutaneous lesions to potentially fatal visceral disease
> • See Leishmaniasis, Visceral (Kala Azar)
> • See Leishmaniasis, Cutaneous
> • See Leishmaniasis, Mucocutaneous
> • Diffuse cutaneous leishmaniasis
> - There are widespread, leprosy-like skin lesions
> - Skin lesions are generally progressive and refractory to treatment
> • In patients with AIDS who have coinfection with Leishmania, splenomegaly may not occur in visceral disease
> 
> DIAGNOSIS
> 
> LABORATORY TESTS
> 
> • Definitive diagnosis is established by finding
> - Intracellular nonflagellated amastigote
> ◊ In Giemsa-stained biopsies from skin, mucosa, liver, or lymph nodes
> ◊ From splenic aspirates (most sensitive site, but risky procedure), bone marrow, or lymph nodes
> - Flagellated promastigote in culture of these tissues (requires up to 21 days)
> • Occasionally, the organisms are seen in mononuclear cells of buffy coat Giemsa-stained smears
> • In patients with AIDS, diagnostic criteria may be altered (Leishmania antibodies become undetectable; splenomegaly may not occur in visceral disease)
> • Golden hamster or BALB/c mouse inoculation of the nose, footpad, or tail base may be used (requires 2-12 weeks of observation)
> • Polymerase chain reaction has up to 100% specificity and sensitivity
> • Species identification is by molecular, isoenzyme, and monoclonal antibody methods
> • Serologic tests (ELISA, indirect fluorescent antibody, direct agglutination) and the leishmanin (Montenegro) skin test (not licensed in the United States) may facilitate diagnosis, but none is sensitive or specific enough to be used alone, to speciate, or to distinguish current from past infection
> 
> DIAGNOSTIC PROCEDURES
> 
> • Skin lesion specimens should be obtained through intact skin (cleansed with 70% alcohol) at a raised edge of an ulcer margin
> - Can use local anesthesia
> - To obtain tissue fluid for staining, press blood out of the site with two fingers, incise a 3-mm slit, and then scrape with the blade
> • When doing a biopsy, an impression smear is made, a portion is macerated for culture, and the remainder is reserved for pathologic sections. For needle aspiration, sterile preservative-free saline is inserted with a 23- to 27-gauge needle; the aspirate is then cytospun at 800 × g for 5 min
> 
> TREATMENT
> 
> • See Leishmaniasis, Visceral (Kala Azar)
> • See Leishmaniasis, Cutaneous
> • See Leishmaniasis, Mucocutaneous
> 
> MEDICATIONS
> 
> • The drug of choice is sodium stibogluconate or meglumine antimoniate; resistance and treatment failures are increasing
> • Generic sodium stibogluconate is as effective and safe as Pentostam
> - Start with 200-mg Sb test dose followed by 20 mg Sb/kg/d (IV preferable to IM)
> • Meglumine antimoniate (85 mg Sb/mL) is equal in efficacy and toxicity in equivalent Sb doses (20 mg Sb/kg/d)
> • The drug is given QD
> - 28 days for visceral and mucocutaneous leishmaniasis
> - 20 days for cutaneous leishmaniasis
> - Longer courses are indicated in regions where there is resistance
> - Side effects likely to appear with cumulative doses
> • Common side effects
> - Gastrointestinal symptoms
> - Fatigue, fever
> - Myalgia, arthralgia
> - Phlebitis, rash
> • Rare side effects
> - Hemolytic anemia
> - Hepatitis, pancreatitis
> - Renal and heart damage
> • Therapy is discontinued if the following occur
> - Aminotransferases 3-4 times normal levels
> - Significant arrhythmias
> - Corrected QT intervals > 0.50 s or concave ST segments
> • Relapses should be treated at the same dose for at least twice the previous duration
> • In the United States, only stibogluconate is available (obtain from the Parasitic Drug Service, Centers for Disease Control and Prevention, Atlanta, GA 30333 404-639-3670)
> • Second-line drugs are amphotericin B and pentamidine
> 
> Amphotericin B
> 
> • Visceral leishmaniasis
> - AmBisome 3 mg/kg/d (parenteral) on days 1-5, 14, and 21; may be repeated
> - Dosage for immunoincompetent persons is 4 mg/kg/d on days 1-5, 10, 17, 24, 31, and 38
> - There may be comparable effectiveness with cumulative doses of 3.75 or 7.5 mg/kg, given in five divided doses, over 5 days
> • Conventional amphotericin B deoxycholate 1 mg/kg daily by slow infusion (4-6 hours) for 20 days (used in India)
> 
> Pentamidine isethionate
> 
> • Pentamidine isethionate, 2-4 mg/kg IM (preferable) or IV, QD or QOD (15 doses for visceral and 4 doses for cutaneous leishmaniasis)
> • For some forms of visceral leishmaniasis, repeat treatment may be necessary using up to twice the dose, but resistance may persist
> 
> Paromomycin (aminosidine)
> 
> • Cutaneous leishmaniasis: topical application in various formulations has variable success that differs by region
> • One ointment is paromomycin 15%/methylbenzethonium chloride 12% in soft paraffin, applied BID for 15 days; skin reactions may occur. The ointment cannot be used in regions of mucocutaneous leishmaniasis as it does not prevent metastatic disease
> • For refractory visceral leishmaniasis, parenteral paromomycin is promising, but may cause renal or otic toxicity
> 
> Miltefosine
> 
> • Oral drug; approved in India for treatment of visceral leishmaniasis
> • Daily dose is 2.5 mg/kg in two divided doses for 4 weeks (95% cure rates)
> • Promising efficacy for cutaneous leishmaniasis
> • Side effects: vomiting (40%), diarrhea (20%), occasional transient elevations of aminotransferases and creatinine
> • It cannot be used in pregnancy due to teratogenic potential
> 
> OUTCOME
> 
> FOLLOW-UP
> 
> • Patients should be monitored weekly for the first 3 weeks and twice weekly thereafter by serum chemistries, complete blood cell counts, and electrocardiography
> 
> PREVENTION
> 
> • Sand fly habitats are warm, humid, dark microclimates, including rodent burrows, rock piles, or tree holes; these are often in sylvatic areas near forests or semiarid ecosystems
> • Peridomestic sand flies are found on debris close to buildings
> • Biting is generally at twilight or at night but may occur in shaded areas during the day
> • Partial protection is from permethrin applied to clothing, DEET repellent, avoidance of endemic areas (especially at night), use of mosquito coils, and use of fine-mesh insecticide-impregnated nets for sleeping (may be too warm for tropical use)
> 
> WHEN TO REFER
> 
> • All patients should be referred to a clinician with expertise in this disease


----------



## GDawg

SFB, well done to you! I am glad its covered in CF medical training. 

I've got Miltefosine from Germany, _not_ cheap, the CF would do better to buy it straight from the Red Crescent in theatre  ;D

We'll see how she goes, I still need to get the blood work done for monitoring purposes.

It would be a shame if someone out there slipped through the cracks and had their Leishmania go visceral. My perspective is a bit jaded but the system needs to warn those returning from deployment to be vigilant for these sorts of problems because they can pop up months, even years after you're home.


----------



## Armymedic

GDawg said:
			
		

> My perspective is a bit jaded but the system needs to warn those returning from deployment to be vigilant for these sorts of problems because they can pop up months, even years after you're home.



Sorry I can't resist this slam:

They do warn, but only the ones who actually remain awake for the entire PMed predeployment briefing actually hear it.


----------



## GDawg

I vaguely recall pre-deployment medical briefs, and I do not recall a post deployment medical brief...


----------



## Armymedic

were you sober at all during decompression?


----------



## bang

Four quick questions:

1)  You are a reservist with a Tcat.  Does it expire on its own?

(Unrelated with the first)

2)  In the civilian system, if you are given a diagnoses or have been treated in a mediocre or poor fashion that makes you uncomfortable with the doctor, you can switch to a different doctor.  In the regular force or when you are on class C, are you entitled to a different MO or NCM as designated by a senior MO?

If so...  
Did I miss it on the QR&Os or DAODs

Or is it on the a unsuperseeded CFAO, which would not be online for the short term?

Thanks


----------



## PMedMoe

1)  No.  TCats do not "expire" on their own.  You must see a doctor again and be declared fit, usually by having a full medical.

2)  Yes, you do have the option to see another doctor but be prepared to wait and possibly to explain why you want a different MO.  I'm more curious about the wording of your query.  Was the doctor unprofessional?  If so, there are means to report them.  Or did you get a diagnosis you don't agree with?


----------



## Gunner98

CFHS Patient's Rights and Responsibilities

As a patient, you can expect to:
•	Be treated with respect at all times
•	Have the privacy of your health information respected
•	Be involved in decisions about your care and treatment
•	Include you family members in decisions about your care where appropriate
•	Be fully informed about all aspects of your care
•	See a physician, should you desire
•	Know who is providing you with care
•	Request a second opinion, should you desire
•	Have your religious and cultural beliefs respected
•	Be treated in the official language of your choice
•	Have access to your health records
•	Have a second medical staff member, of your gender, present during an examination or treatment, where appropriate.

As your care providers, we expect you to:
•	Communicate openly and honestly with your health care providers about your health concerns
•	Raise any concerns about care with your health care providers
•	Participate actively in decisions about your care
•	Carry out treatment recommendations
•	Attend all scheduled appointments
•	Treat your health care providers with respect
•	Inform your direct supervisor of your medical employment limitations
•	Utilize CF medical facilities whenever possible
•	Inform CF medical authorities of any medical care received outside CF facilities

CFP 154 Chapter 3 http://www.forces.gc.ca/health-sante/pd/cfp-pfc-154/CH-3-eng.asp

Temporary Grading
9. Occasionally, it becomes necessary to temporarily lower one or more factors of the medical category. The validity of such temporary reductions shall not exceed six (6) months, but a temporary category may be renewed once (i.e., maximum 12 months temporary medical category status). This time frame should allow an accurate estimate/assessment of prognosis for almost any medical condition. As soon as the member's condition is stable or is not expected to significantly improve in the foreseeable future, a permanent category should be assigned, even before the end of the 12-month period of temporary category. A statement regarding prognosis shall be made in Section 3 of the CF 2033 and Section 2 of the CF 2088 at the earliest reasonable time. In the rare case where additional temporary status beyond 12 months may be warranted for extenuating circumstances, the case must be reviewed by D Med Pol Standards.


----------



## bang

Thanks, that was educational.  

Number two does not involve me, so I will keep that one down.  Thanks especially for the sources.

Correction - however I was wondering if there was an online source for the rights and responsibilities that would make it the word of law?  If not, is there something that makes this the word of law at all?

Thanks again


Bang


----------



## mariomike

If you enjoy Paramedic Q and A's, here is something from my old "Dr God" aka Base Hospital. It is civvy, but may be relevant to the CF.
 http://socpc.ca/paramedic_resource_manual.html


----------



## Gunner98

Bang said:
			
		

> Correction - however I was wondering if there was an online source for the rights and responsibilities that would make it the word of law?  If not, is there something that makes this the word of law at all?
> 
> Thanks again
> 
> Bang



This is an excerpt from a CFHS glossy policy handout available at every clinic in the CF.  One online Internet source for this document is at CF Health Services Centre Ottawa: www.forces.gc.ca/health-sante/cfhsco.../con-eng-eng.asp


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## PMedMoe

Try this one:

Patients Right to Privacy Protection and Choice of Physician



> Right to Choice of Physician
> 
> 7. Patients should be advised that they have a choice of physician, *within the available resources at the unit or the base*, and that *choice is to be respected whenever feasible*.



Emphasis mine.  For example, if you were in Alert, where there is no MO, only a PA, you obviously wouldn't have a choice.


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## K.Schults

mariomike said:
			
		

> If you enjoy Paramedic Q and A's, here is something from my old "Dr God" aka Base Hospital. It is civvy, but may be relevant to the CF.
> http://socpc.ca/paramedic_resource_manual.html



Thank you!


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## mariomike

K.Schults said:
			
		

> Thank you!



No, thank you. For providing the best patient care possible. Often under hazardous conditions.


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## ROO

Hi, I see it's been a while since this thread has been active, but I'll pose my question anyway

Currently I'm working for a reserve unit where you may not perform duties with a beard.

Today I got a shaving CHT because of some razor rash that has been spreading quite rapidly on my neck. The doctor asked me what I was looking for, so I asked for a no shave CHT. He gave me 30 days simply noting "no shaving", and sent me on my way.

Now, as you can figure out, I can't perform duties, and upon reflection 30 days is much too long and I've really pissed off the people higher up, and given them ideas to RTU my useless butt. Am I really stuck with this 30 day CHT, or would it be feasible to go back to the doctor once it's healed (say 2 weeks from now) to discontinue my CHT once the shaving rash has settled down? I'm essentially getting punished by my unit for having a skin rash here...

Thanks
- - - Roo


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## medicineman

First off, you're not being punished for having a rash...you'd be RTU'd because you're not employable with the restrictions given, FULL STOP.  Secondly, if things have improved after a week or two, nothing wrong with going back to the MO and having that 30 days reversed - conditions change for the better or worse, so if it's better and you're able to manage shaving, shouldn't be an issue.

Good luck.

MM


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## af_med

Unrelated to illness & medical categories, but I'm sure a medic would know.

I'm a new MOTP student and my ULO has ordered a doctor's kit through the MIR for me but nobody seems to have a clue what's in it (not my ULO and no one at the MIR either, they also lost the shipping papers so they can't even look up the contents. OOPS!).

Anyone have a clue what's in this kit? We're starting some clinical stuff and are already needing some instruments. Just wondering what I can get away with borrowing from classmates until my kit arrives.

Thanks in advance!


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## ModlrMike

af_med said:
			
		

> Unrelated to illness & medical categories, but I'm sure a medic would know.
> 
> What is the standard issue steth in the CF?
> 
> I'm a new MOTP student and my ULO has ordered a doctor's kit through the MIR for me but nobody seems to have a clue what's in it (not my ULO and no one at the MIR either, they also lost the shipping papers so they can't even look up the contents. OOPS!).
> 
> The school recommends a Littman Cardio III, so I was wondering if it is part of the "doctor's kit" or whether I should go ahead and buy my own.
> 
> Thanks in advance!



The Littman is probably your best choice for now. I'm a PA and have been using my Littman for 12 years without a problem. Most of the docs in my ER also use the same model.


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## medicineman

The MOTP kit used to have a Hewlett-Packard version of the Sprague-Rappaport type - a very expensive version of the 20 dollar double barrell things you see on TV.  They may have changed to the Littmans, as the Classic II is the standard issue, and when I was in PA school, we were issued the Cardiology III's.  I bought a Master Cardiology for myself later on.  Ask the local Base Pharmacy to contact CMED (Central Medical Equipment Depot) for the NATO Stock Number and Nomenclature for the kit so it can be procured for you (if they don't already have the parts - we did in Kingston when I was there many moons ago).

MM


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## BadgerTrapper

Hey, People. I've a few questions, I'm midway through my Preceptorship phase at PCP school. I was wondering is there are any bridging programs from a QL5 Med Tech to a Civillian ACP?
 Also, I was wondering if I need to be registered in the province in which I'm posted in order to operate as a CF Med Tech or is this only if I want to work on the Civvy side to keep certain skills sharp i.e. Geriatrics, Pediatrics, Bariatrics etc.

If these questions have already been asked then I apologize. Any help is greatly appreciated, Thanks people and have a great weekend! 
-BadgerTrapper


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## mariomike

BadgerTrapper said:
			
		

> I was wondering is there are any bridging programs from a QL5 Med Tech to a Civillian ACP?



It is possible to "bridge" from QL5 Med Tech to Primary Care Paramedic ( PCP ) in Ontario.

"5.  (1)  The operator of a land ambulance service shall not employ a person to provide patient care, whether on a full-time or part-time basis, or engage a person to provide patient care as a full-time volunteer, unless the person is a paramedic who, holds the qualifications of an advanced emergency medical care assistant" ( AEMCA ):
http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_000257_e.htm#BK3

In 2007, the military approached the Ministry of Health and Long Term Care ( MOHLTC ) to permit QL5 Med Techs to challenge the AEMCA. In the past the Ministry has permitted this, but has required an additional 80 120 hrs ( minimum ) with a PCP preceptor crew. 

"Recognition of QL5A & Challenge of AEMCA exam:
Reference A is a confirmation letter by the Ontario Ministry of Health and Long-Term Care, Emergency Health Services Branch, recognizing the CF QL5 Med Tech as meeting the PCP requirements to challenge the AEMCA exam, all QL5 Med Techs are encouraged to prepare for and write this exam with approval through their Chain of Command.  Upon successful completion of this exam, those Med Techs will have access to On-car opportunities to complete their MCSP in Ontario."

See attached .pdf from MOHLTC to CFMSS Commandant for reference.


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## medicineman

Best of my knowledge there is no ACP bridge.  If you want to keep certain skills sharp, you'd likely need a provincial license to either moonlight or do MCSP/MCRP or whatever it's called this week.

MM


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## mariomike

medicineman said:
			
		

> If you want to keep certain skills sharp, you'd likely need a provincial license to either moonlight



If your local service offers part-time employment.

I worked for a career department. There were no part-timers, volunteers / auxiliary. 

When the car count is below minimum, as it often is, it is covered _only_ by overtime.



			
				medicineman said:
			
		

> or do MCSP/MCRP or whatever it's called this week.



As of late last year, our department offered this program to 57 QL5 Med Techs. 

Some other services ( also as of late last year ) that offer it are: Ottawa, Renfrew County, and possibly Simcoe County. There may be a couple of others as well.

However, from what I have read on here, there may be some problems.



			
				Adam said:
			
		

> 11 years in, and I have only had 2 shifts on Amb through the MCSP program.



There are similar posts.

Regarding mandatory licensing of Med Techs:



			
				BadgerTrapper said:
			
		

> Also, I was wondering if I need to be registered in the province in which I'm posted in order to operate as a CF Med Tech <snip>





			
				Rider Pride said:
			
		

> No, Med Techs are not *required* to have a provincial paramedic license.


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## tiffijp

Good day! I'm wondering if anyone can offer some direction - I was a reg force Med Tech and completed my QL3 in 2002, QL5 in 2005 and PCP in 2006. I'm applying for BSN, obviously through a civilian school now and was wondering if there is any type of access to course outlines and/ or transcripts from CFMSS?? I have no problem getting my transcripts from JIBC for the paramedic portion, but I don't really know where to turn if I were to start looking for the military portion. Can anyone offer any assistance or tell me who I might need to contact?? Thanks and cheersWFECEE


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## medicineman

Write to the School with your past SN, dates attended, where you're applying and they should send the stuff there.  There will be some delay, just be aware.

MM


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## tiffijp

It would be silly not to expect a delay! Thank you greatly, I really didn't know if they would do this but happy to know they do! Definitely appreciated, cheers


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## medicineman

No worries.


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## BadgerTrapper

Hey people, quick question. I'm nearing the end of my NCM-SEP PCP program and was wondering at what point would one earn the Health Services badge? Upon completing BMQ? Or upon completing BMQ, BMQ-L and the scope expansion course in Borden?


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## MedCorps

You will be awarded your Canadian Forces Medical Service cap badge at a ceremony, in front of the hundreds of names of our fallen, at the end of your QL3 Med Tech course.  I think you are calling this the "scope expansion course" but really it is mod I and III of the QL3 Med Tech course, as NCM SEP is PLAR'ed for Mod II (PCP).  Only then are you officially part of the family having completed your initial occupational qualification. 

There is no Health Services badge as it is not a Branch or Service, but rather a Group where people in the Medical Service are employed. You are in (will be in) the Canadian Forces Medical Service.  You work for the the Canadian Forces Health Services Group.   

Good luck with the rest of your training. 

MC


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## BadgerTrapper

Thanks, MedCorps. Awesome answer. I've achieved all my Competencies and such as laid fourth by Medavie HealthEd. Graduation is 8 July, then hopefully a July BMQ otherwise it'll be PAT platoon for me. Back on track, I've a few classmates interested in applying as a Semi-Skilled (New Brunswick PCP). Will they learn any new skills/Med Admin as a QL3 Med Tech? If anyone can help it's greatly appreciated, Thanks everyone! -Badger

(Search Function is down for me? Has been down for the past 3-4 days. I'm thinking it may be server overload?)


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## MedCorps

The new scope of practice is approved for the QL3 Med Tech and posted on the DWAN it has all kinds of good things in it.  The new Med Tech Protocols and Procedures manual I am told is in process of being signed off and will be used by both QL3 and QL5 Med Techs, as opposed to just QL5 Med Techs like it was in the past. I hope that they have fixed some of the little problems with the last edition. 

They / you will get some additional skills. It is a pretty impressive document and we are expecting our Med Techs to do more and more as we try and institutionalize some of the skills we acquired during the most recent conflict. This will also be reflected in the MCRP and Simulation Centre. The Training Plans at the CFHSTC are in the process of being updated (with qualification standards boards now done) and I suspect that in a year or so the full scope will be taught at the CFHSTC.  

If you have specific questions let me know and I will try and help you out / call someone who can.  

MC


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## bloomfieldbo

is there any csor medics here? need some answers for some terms on the med plan sheet, thanks


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## CombatDoc

If there are, they're unlikely to identify themselves as belonging to CANSOF.  However, others may be able to help you with your questions.


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## old medic

Medical plans are pretty common documents, but to follow/carry out the plan, you certainly need to be able to 
read and understand it. 

Feel free to PM and ask about terms your not familiar with.  I'm sure the senior medics or doctors here
will aim you in the right direction. 

A better solution would be asking whoever gave you the plan for clarification.


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