MCSP

[Fraser.g]

This was my question. The skill sets are similar but the protocol sequence is slightly different.

GF

 

[HCA]

As far as I understand we are to continue to ensure everyone remains BTLS certified as well.

 

[Armymedic]

Excellent, then teach it all....can't complain about being bored then.

Because one trauma assessment technique (i call them drills, because thats really what they are) may not reflect a pers preference, then giving pers options of several diffrent techniques may produce better individual results. The end result being the same regardless...rapid evacuation to further care.

Has any thought been put to doing BTLS Access, or practicing difficult enviromental senarios for both trauma and medical prehospital training.

 

[Brad Sallows]

>Monitor/Discontinue Intravenous Therapy

Interesting distinction.  Can "Decide to Start IV Therapy" and "Start an IV" not be separated?

 

[Donut]

WRT the IV start v decision to start, that's pretty much what is already done out here with the military BTLS we teach, out here in BC anyway--Students have to know the indications for an IV in trauma, but we're not expecting our reserve-only qualified mbrs to demonstrate IV starts anymore.   That's in keeping with the EMR/AFMR standard of care we're training to.   And there's, I think, one of the sources of confusion between the EMR/AFMR and BTLS standards of care--BTLS will expect you to start a line, BTLS will expect you to know how to percuss a chest, expect you to know fluid resuscitation calculations, etc.   Very few, if any, NOCP EMR programs will expect that out of their students.

DF

 

[MedCorps]

Danger...

One of the 10 skills I want from any medic is the ability to start an IV.  This is a skill that should not be lost by the Res F!  We are now crossing the line of no return if you drop skills like this....

Cheers,

MC

 

[Armymedic]

Hear, Hear, MC...

Any basic skill taught during BTLS that med techs are allowed to do by delegated acts should be maintained....

 

[vr]

It doesn't look like the Pres is teaching it's Medics IV's anymore.  We went throught the QL3/4/6A syllabi and couldn't find any mention of starting IV's.  It appears that giving injections has disappeared as well.  If anyone has more up to date info please correct me gently.

The IV portion of BTLS was always meant to be only a refresher for those who had previously been taught.  We didn't even do this on our last 2 BTLS courses due to the logistic and time constraints involved.  A 2 day BTLS course isn't supposed to really teach any particular skills but provides a framework and protocols to use those skills in.

Putting on my conspiracy hat I think this represents further emasculation of the non-civvie qualified Reserve Med A trade.  It also allows NO's to adopt IV starting as reason to justify their existance in field medical units.

Conspiracy hat off, beret back on, and back at 'er..... :dontpanic:

 

[Fraser.g]

I hate to break your conspiracy theory but if you think that I went and got a BScN so that I could start the occasional IV in a Field Hospital then you are sadly mistaken. I will probably me more busy with the arterial lines, complex IV treatments, Drains, Gastric decompression, potassium balance, and other skills to worry about a bolus of a crystaloid or getting peripheral access.

Yes I believe that there is a slow deletion of skill sets from the reserve Med A and it has to STOP! I have even herd scuttlebutt that the regular force wants reservist medics only to be rudimentary ambulance drivers so that they can act as human IV poles and litter bearers. I have not seen anything to justify this rumor.

Yes the BTLS IV portion is designed as a refresher and the actual IV portion is still in MCSP as a unit responsibility.

This year I intend to teach IV initiation, solutions as well as maintenance to my medics unless told otherwise by my chain of command. We have been issued these wonderful training aids and IV arms to practice this skill set so that is what I will do. I do not intend to go around and hold my medics arm every time an IV blows or has to be started. Now if a medic is having problems with a hard start then I will be glad to use my skills to help him or her out.

 

[Donut]

I thought I'd give this thread a kick, and start a new line of discussion in reply to Armymedic.

When I was in Edmonton, 15 (then Med Coy) Fd Amb loaded all sorts of pers onto the variety of BTLS courses that GMCC used to run.  I recall doing a unit-run BTLS in September, a BTLS Access in Oct, and a BTLS Pediatric in December.  I don't recall the unit paying the costs of the second two, but I did get Cl A days for those.  Our Doc loved it, she stripped apart an Econovan in about 15 minutes and then went looking for any un-punched windows in the training area!

I've also given some thought about the potential for a need to arise for extrication or disentaglement in the field;  At WATC, Pet or Gagetown there's a fire department with the Hurst tools, lifting bags etc fairly close, but what has been done on deployments?  It's not like we didn't have MVC's in Bosnia, Croatia, etc.

Has it just never come up, or has it always been a case of improvise, adapt, and overcome, with lucky outcomes?

I've always thought that a small "battle box" kit (probably small enough to fit in the crowsnest of the LS amb) could hold all the stores needed for a BTLS extrication of anything in the CF that isn't armoured.  Our Engr friends also have a pretty nifty hydraulic trailor with lifting bags, impact wrenches,  etc for building Accro bridges.  I bet with the right tools you could access anything in our inventory without much difficulty. 

Slap a Stokes basket onto the roof, throw some static line and a haulage rig into the side bin (ok, not that easy, but you see where it's going) .  Maybe remove one stretcher bench in the back, add more storage and crew it with three and you'd actually have a light rescue unit capable of dealing with most forseeable events.  Oh, yeah, you'd need to train the freakin' crew, too.  How many Mtn Ops medics are there? 

So, despite the fact that we can't equip or properly crew many of our existing ambs, what's the thinking on this?

DF

 

[RatCatcher]

WRT the kit additions "wanted" for the LSVW to do extrication...why don't we look at the fact that we need a new vehicle which is capable of being an "effective" ambulance.  As a Med Tech I remember trans a pt with a back injury in Wainwright and unfortunately it is not an effective Veh in offroad situation. 

As for skills... one of my pet peeves with the new training of Med Techs (ie BCJI) (and one of the reasons for my remuster to PMed) is the fact that we, as military medical pers, are NOT civillian paramedics.  The fact that new Med Techs arrive at Fd Amb and "want" all the new fangled equipment does not constitute the fact that no matter how much high tech equipment you have or don't have you must be able to addapt to the situation at hand.  The Med Tech must be able to work withought the aid of high tech since Murphys Law does play a role IE the eqpt might not last a combat/field environment meaning the military would have to pay to have the eqpt repaired contantly which in turn means that it is not in the hands of the medic anyway. 

With that said ...I am not entirely against the civillian involvement in the training... it has it's place.  BUT the staff needs to remind the candidates that they may not have the eqpt all the time and will have to adapt.  My training in the 90s always emphasized the "what are you going to do... cause you don't have X piece of eqpt." 

The training is always evolving... thats another problem...for another day though....

 

[Armymedic]

no matter how much high tech equipment you have or don't have you must be able to addapt to the situation at hand.   The Med Tech must be able to work withought the aid of high tech since Murphys Law does play a role IE the eqpt might not last a combat/field environment meaning the military would have to pay to have the eqpt repaired contantly which in turn means that it is not in the hands of the medic anyway.  

With that said ...I am not entirely against the civillian involvement in the training... it has it's place.   BUT the staff needs to remind the candidates that they may not have the eqpt all the time and will have to adapt.   My training in the 90s always emphasized the "what are you going to do... cause you don't have X piece of eqpt."

Words from another who obviously has BTDT as well...
What you say is too true and is my greatest asset in knocking the chip off some baby medics shoulder who is fresh out of ql 3 PCP and think they are more "qualified" then I am.

I've also given some thought about the potential for a need to arise for extrication or disentanglement in the field; At WATC, Pet or Gagetown there's a fire department with the Hurst tools, lifting bags etc fairly close, but what has been done on deployments? It's not like we didn't have MVC's in Bosnia, Croatia, etc.

Has it just never come up, or has it always been a case of improvise, adapt, and overcome, with lucky outcomes?

I've always thought that a small "battle box" kit (probably small enough to fit in the crowsnest of the LS amb) could hold all the stores needed for a BTLS extrication of anything in the CF that isn't armoured. Our Engr friends also have a pretty nifty hydraulic trailer with lifting bags, impact wrenches, etc for building Accro bridges. I bet with the right tools you could access anything in our inventory without much difficulty.

Slap a Stokes basket onto the roof, throw some static line and a haulage rig into the side bin (ok, not that easy, but you see where it's going) . Maybe remove one stretcher bench in the back, add more storage and crew it with three and you'd actually have a light rescue unit capable of dealing with most forseeable events. Oh, yeah, you'd need to train the freakin' crew, too. How many Mtn Ops medics are there?

para 1:Yes there are Fire fighter both in Canada and overseas...but who's to say how long they are going to be in getting there, or if they are able to get there at all...In Bosnia the IRT helo had limited space. If the Fire/Extraction crew had to come out, they would, at the expense of other assets that could come out (ie EOD, aneathisist, etc) because of the amount of equip they had to bring. Having the skills/knowledge about what is needed to help extract whoever, whenever allows me to make that on scene decisions about what said assets I need the most. Further, we are the only true army emergency services, no one else has a need for that type of skill set or requirement for that knowledge.

para 3: battle box: really all we need other then good gloves and eye protection is the Force Axe, which is standard issue to any Bison Amb, pioneers and veh tools, and a sturdy hacksaw with a few multiuse blades. Hacksaws are fairly easy to acquire thru your CQ.

para 3: engineers: such said equipment is held in the rear with 25 Sqn (support Sqn, 15, 25, 55 etc depending what brigade) it also is great IF you can get it but then again is the time/avail factor which really makes it an unrealistic option to count on.

para 4: Stokes: not enough to fit every amb, but they are avail on call. On roto 13 we had it readily avail and it was on my discretion as Med comd to bring it based on the info from scene. If we were supporting another camp, then it was always brought. As for Mtn Ops, we try to get as many qual as we can. On this falls 3 RCR BMO serials we are qual 4 more (In my UMS, that will give me 7 of 10 MA's BMO qualified). But BMO isn't a req, as the pertinent skills can be specifically taught to medics. (Armymedic don't got BMO, but can still tie a knot or two)

In all and all, I totally agree with your points, and hence the reason things like these ideas and skills can supplement those boring death by PP lectures.

For those reserve fd ambs, you can do this in a class room...try evacing a cas on a backboard using BTLS protocols, from one side of class to the door without anyone getting any part of their body, or equipment above the level of the top of the desk, and without moving anything in contact with the floor....Do it FFO for a bigger challenge.

Not easy...give it a try.

 

[starlight_745]

I think the move to incorporate civilian qualifications into our training is generally the right thing however it needs to be done prudently.  we must maintain the field medical skill set as well as the do more with less mentality.  Having a defined qualification is good as I think it (may) hopefully give CF health professionals better access into the civilian system for MOCOMP.  I.E.  we can say hey we have x number of PCP qualified med techs can we hook up with some hospital rotations and ambulance time etc.  The thing that I find very disturbing in the reserves is how we are essentially moving to a 2 tiered system.  If you have civvy quals then fine but if you don't you're out of luck.  Now myself, I have PCP quals so it doesn't affect me but I have troops who essentially have very little chance to do anything.  After QL3/4 their only option is doing very limited med support or working in a cadet camp MIR.  There is practically no further medical training beyond annual MCSP?CPR/BTLS etc.  There is no QL5 for reserves, they cannot deploy with the regs so a good learning opportunity is lost there, and 6A's has very little new medical training.  It's no wonder you see all kinds of reserve senior Cpls and Mcpls clearing out or remustering.  There is no way for the system to be sustainable with these kind of losses.  We focus on recruiting but then we're ending up with sections full of green as grass QL3's and virtually nobody to mentor them.

 

[RatCatcher]

Although I am out of the Med Tech trade I have the chance to view the issue from outside/ex-medic eyes.... and ex-militia also.  The problems with the CFHSvsGp right now is both in the regs and the res. The simple fact is that they have to concentrate on one side first then fix the other.  Right now the Gp Chief and the Br Chief are hard at work trying to sort out the Reg F 737 MOC. Once they come to a final stream of training for the Regs I'm sure the Res system is going to start to come into line.  The simple fact is you can't run a 7-8 month reserve course cause all of the new reservists won't be able to attend...therefore they are not equal to the Reg F unless they come in with civvy quals. It is the same in a way with the Regs, if you come in with PCP, they take that into consideration.

As for the branch in general... I had a briefing from the DGHS and the Br Chief today and they are happy (at least with the Regs) with the way things are proceeding.  All I know is I happy to have changed to another 700 series MOC

BTW ArmyMedic...god is my butt sore from sitting in front of my computer all day!!! LOL