Medical Services restructuring...

[Fraser.g]

Another blow to the Medical Reserve

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

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

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

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

This kinda makes the whole BTLS / PHTLS argument moot.

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

 

[Fraser.g]

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

Where I am going with the above question is this:

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

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

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

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

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

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

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

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

IMHO

 

[Brad Sallows]

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

 

[Armymedic]

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

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

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

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

 

[Fraser.g]

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

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

I just cant wait for the next fastball from Ottawa

 

[old medic]

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

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

 

[Marti]

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

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

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

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

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

 

[Fraser.g]

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

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

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

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

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

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

 

[old medic]

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

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

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

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

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

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

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

 

[HCA]

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

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

More money

 

[HCA]

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

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

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

 

[HCA]

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

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

 

[Marti]

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

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

 

[vr]

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

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

 

[Donut]

Bart, feel free to jump in here.

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

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

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

 

[old medic]

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

 

[Donut]

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

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

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

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

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

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

DF

 

[starlight_745]

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

 

[old medic]

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

 

[Fraser.g]

Here is an idea,

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

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

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

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

IMHO

GF