# Ont realizes Advanced paramedics save lives



## Armymedic (24 May 2007)

comments to follow:

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070523/paramedics_070523/20070523?hub=TopStories



> CTV.ca News Staff
> 
> Updated: Wed. May. 23 2007 10:55 PM ET
> 
> ...


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## Armymedic (24 May 2007)

I put this article up to highlight a couple fundamental differences between a civilian paramedic, and a military medic. 

At the QL6 level a military med tech should have the same knowledge and skill as the paramedics highlighted in the article. The largest difference you will see is that civilians deal with a large majority of medical conditions (breathing and cardiac problems) with occasional trauma. Where as our military prehospital role is primarily trauma, with the rare breathing and cardiac condition occasionally.  

For anyone joining the military who thinks that being a civie paramedic is what they want to do, then I hope you enjoy your QL3 course, cause that is where the similarities end.


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## herseyjh (24 May 2007)

I was struck by the glowing praise of pre-hospital ALS.  For a while now there has been a few mixed messages regarding the effectiveness of ALS interventions in the field.  I will have to track down the study and take a look.


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## Donut (24 May 2007)

I seem to recall, from the preliminary results presented at the Ontario Paramedic Conference 2005, that ALS had a higher mortality rate when involved in trauma calls.  I should read the article, too.


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## bisonmedic (24 May 2007)

In regards to the ALS Paramedics, it is a fantastic idea to have them, but for the needs of the CF, the PA and senior medics seem to do just fine. It is nice to have all those fancy skills, but in our job it's how fast you plug the hole and how fast you get them to the OR. We as medics have a hard time maintaining our core skills let alone any advanced procedures. :cdnsalute:


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## Armymedic (25 May 2007)

They did have a higher trauma mortality level. Obviously due to the experience level and advanced training. In fact, in a diferent article it stated that after repiratory and cardiac, minor trauma was the next most frequent call.

To those of use who has spent any time on a city amb...well, duh. (Oh, another call to a granny who's fallen and broke her hip. Oh gee, Spring, another kid in a bicycle crash.)


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## bisonmedic (25 May 2007)

Ah yes, the late night calls to the "Lizard Ranch" ( old folks home ). The great majority of calls that are done on civy street are BLS calls. The ALS type of service was drawn up mostly for the rural parts where they did not have the hospitals of the big city. Most time the transport times for the larger centers are short, therefore the advanced procedures done on patients could delay emergency care at the hospital. This is important with cardiac cases that require clot busters ( eg TPA< etc). It is nice to have that large toolbox of tricks, but sometimes BLS with rapid transport trumps stay and play with ALS.


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## Donut (25 May 2007)

St. Micheals Medical Team said:
			
		

> They did have a higher trauma mortality level. Obviously due to the experience level and advanced training. In fact, in a different article it stated that after repiratory and cardiac, minor trauma was the next most frequent call.
> 
> To those of use who has spent any time on a city amb...well, duh. (Oh, another call to a granny who's fallen and broke her hip. Oh gee, Spring, another kid in a bicycle crash.)




That's true in the majority (all?) of Ontario's system, but not at all true in a targetted EMS system, such as in other parts of North America.  In some systems, ALS do ALS calls, and BLS do BLS calls, according to dispatch criteria (MPDS or similar)...some send both, and the call is handled by the appropriate level. This layered response has yet to be studied with the same academic detail as OPALS is attempting to in Ontario.

The article in the NEJM is related only to SOB calls, and doesn't touch on trauma outcomes.

From http://www.ohri.ca/programs/clinical_epidemiology/opals/protocol.asp (the study protocol outline)

For major trauma and respiratory distress,the evidence for ALS programs is even less compelling. Endotracheal intubation may reduce neurologic sequelae for head injured patients or improve outcomes for other conditions but this has never been clearly demonstrated. Furthermore, there is significant risk of morbidity from increased intracranial pressure or aspiration when spontaneously breathing patients are intubated in the field. Similarly, recent studies have suggested that prehospital IV fluid infusion may exacerbate hemorrhage. Many studies have attempted to determine the value of prehospital ALS for trauma patients by comparing two competing strategies, rapid transportation versus field stabilization with ALS interventions. These studies are all limited by many methodological weaknesses. No studies have demonstrated improved respiratory distress patients survival or morbidity with prehospital ALS and there is some evidence that inappropriate prehospital drug therapy may actually increase mortality.


The latest Annual Report from OHRI shows that in 81.25% of trauma calls ALS made no difference, 11.87% had a worse outcome with the implementation of ALS, and 5.43% had better outcomes with ALS involvement. http://www.ohri.ca/programs/clinical_epidemiology/opals/AnnualStatisticalReport20012002.pdf pp 32-37.

72% of the included patients had "Severe" or "Life Threatening" injuries.  Only 4% were "Minor".  This was a retrospective study of the Ontario Trauma Registry based on 13 Trauma Centers in Ontario...not exactly the kid who falls off his bike or granny with the sore hip.

DF


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## bisonmedic (25 May 2007)

I'm all for the ALS crews, could use them where I live. Although they may not make the greatest difference in some of the trauma, they do help with providing faster tmt of many conditions that usually get looked at in the emerg dept. If they can start faster the patient has a better chance of a good outcome. Just remember PARAMEDICS SAVE LIVES, EMT'S SAVE PARAMEDICS. ( Quote from wise old amb partner from Alberta )


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