What A Planet Rebooted - Stories from the World of EMS

[Chef Boi RD]

Who says I’m a lefty? Doc is leading you astray my friend. I guess because I ain’t sucking MAGA’s cock like Dawk I’m a lefty? What I can’t stand is this need for some (Doc) who feel we all have to fall into a category on American politics, I could give two fucks but Dawk will tell you different. I’m just more taken aback by how triggered Doc and Topper are over it. They put a lot of effort into it. It’s the hill they are dying on. A shame. The CC has devolved because of it. I’m hoping they move on one day, but that hope is waning.

[Cousin Strawberry]

Ok fair enough. Trump is a cartoon-like caricature brought to life in some alternate reality tv 4th dimension twilight zone acid trip anyway so I can sympathize.

[Topper]

Michelle Obama left a bad taste in someone's mouth

[BCExpat]

Who says I’m a lefty? Doc is leading you astray my friend. I guess because I ain’t sucking MAGA’s cock like Dawk I’m a lefty? What I can’t stand is this need for some (Doc) who feel we all have to fall into a category on American politics, I could give two fucks but Dawk will tell you different. I’m just more taken aback by how triggered Doc and Topper are over it. They put a lot of effort into it. It’s the hill they are dying on. A shame. The CC has devolved because of it. I’m hoping they move on one day, but that hope is waning.

I think you are the one that is the most triggered over it.

[Chef Boi RD]

Who says I’m a lefty? Doc is leading you astray my friend. I guess because I ain’t sucking MAGA’s cock like Dawk I’m a lefty? What I can’t stand is this need for some (Doc) who feel we all have to fall into a category on American politics, I could give two fucks but Dawk will tell you different. I’m just more taken aback by how triggered Doc and Topper are over it. They put a lot of effort into it. It’s the hill they are dying on. A shame. The CC has devolved because of it. I’m hoping they move on one day, but that hope is waning.

I think you are the one that is the most triggered over it.

I thought I was being ignored? Fear of missing out, Theo?

[BCExpat]

Who says I’m a lefty? Doc is leading you astray my friend. I guess because I ain’t sucking MAGA’s cock like Dawk I’m a lefty? What I can’t stand is this need for some (Doc) who feel we all have to fall into a category on American politics, I could give two fucks but Dawk will tell you different. I’m just more taken aback by how triggered Doc and Topper are over it. They put a lot of effort into it. It’s the hill they are dying on. A shame. The CC has devolved because of it. I’m hoping they move on one day, but that hope is waning.

I think you are the one that is the most triggered over it.

I thought I was being ignored? Fear of missing out, Theo?

Not at all - "Left Boi RD"

[Strangelove]

Who says I’m a lefty? Doc is leading you astray my friend. I guess because I ain’t sucking MAGA’s cock like Dawk I’m a lefty? What I can’t stand is this need for some (Doc) who feel we all have to fall into a category on American politics, I could give two fucks but Dawk will tell you different. I’m just more taken aback by how triggered Doc and Topper are over it. They put a lot of effort into it. It’s the hill they are dying on. A shame. The CC has devolved because of it. I’m hoping they move on one day, but that hope is waning.

I think you are the one that is the most triggered over it.

Yup.

*pees on Chef's frontal cortex*

[5thhorseman]

"Left Boi RD"

[Meds]

Come to Vancouver, my Mom broke her hip this summer, took the ambulance an hour to get to her, she lives in Lynn Valley, a 5 minute drive from Lions Gate Hospital. Emergency was a gong show, mayhem, packed, not enough beds, not enough staff, Fentanyl heads everywhere needing some sort of shit, one Fent head in front of us a scag in her short shorts who looked like she sells herself for her dope was bleeding down her leg from her crotch for reasons I don’t want to know was in front of us. If you think the interior hospitals are a ghost town you should come down for a visit to the hospitals of Vancouver. It’s a shit show circus. The infrastructure can’t handle the population growth and drug crisis in Vancouver. Chef is outta here soon, saw a show this week at Rogers arena took the bus to it through the DTES, bus stops for a crackhead at one stop, had to wait for him to finish taking a hit off his crack pipe, not a word of a lie, he got off three stops later, 3 blocks. It was like a safari cruise through fentanyl Mardi Gras for miles on end, it’s growing like wild fire. Unbelievable if you haven’t been through the DTES lately.

This is par for the course everywhere.

The drain on our emergency health services system, both prehospital and emerg room, by drug users is insane. I don’t doubt that wait time for a minute Chef. It sucks, but that’s what happens when citizenship lets politicians make decisions without consequences at the polls.

[Topper]

Several years ago I had a great discussion with a surgeon at BC Children's Hospital about rural healthcare. He asked me what it was like going to see a doctor. I told him, if we call our physician's office, we'll get an appointment date two to three weeks down the road, therefore we go straight to the hospital emergency, wait a few hours and most likely see our family physician or one of his residence's.

The surgeon grabbed a piece of paper a drew a hub and spoke diagram. His idea is that the hospital is the hub, the local Family Doctors have their offices as spokes at the hospital. You go to your Doctor's office at the hospital and then, if necessary, you go through to the hospital for further treatment. The rural hospitals are staffed by the same local doctors and their residencies so it makes sense to have it centralized instead of having your doctors office a twenty minute drive and three week timeline away from treatment at the hospital.

[Blob Mckenzie]

All the hypochondriacs tying up the system are a huge drain as well. Start hitting these drama queens with a user fee, then maybe the "visits" slow down a bit. There's a substantial segment of society that is bored out of their fucking skulls and don't have any friends and feels that they need to be entertained. It isn't just the addicts. There aren't enough fucking beds either. I've spent way too much time at hospitals the last few years. Half the staff is playing on their phones because they can't get the sick person in a bed that doesn't exist. The ER's are overloaded with addicts puking and pissing on the floor. I watched a drunk slug a cop and the cops partner just filled him in.

They shut down Giggle Mountain Hideaway and there is no replacement

[Chef Boi RD]

Come to Vancouver, my Mom broke her hip this summer, took the ambulance an hour to get to her, she lives in Lynn Valley, a 5 minute drive from Lions Gate Hospital. Emergency was a gong show, mayhem, packed, not enough beds, not enough staff, Fentanyl heads everywhere needing some sort of shit, one Fent head in front of us a scag in her short shorts who looked like she sells herself for her dope was bleeding down her leg from her crotch for reasons I don’t want to know was in front of us. If you think the interior hospitals are a ghost town you should come down for a visit to the hospitals of Vancouver. It’s a shit show circus. The infrastructure can’t handle the population growth and drug crisis in Vancouver. Chef is outta here soon, saw a show this week at Rogers arena took the bus to it through the DTES, bus stops for a crackhead at one stop, had to wait for him to finish taking a hit off his crack pipe, not a word of a lie, he got off three stops later, 3 blocks. It was like a safari cruise through fentanyl Mardi Gras for miles on end, it’s growing like wild fire. Unbelievable if you haven’t been through the DTES lately.

This is par for the course everywhere.

The drain on our emergency health services system, both prehospital and emerg room, by drug users is insane. I don’t doubt that wait time for a minute Chef. It sucks, but that’s what happens when citizenship lets politicians make decisions without consequences at the polls.

It was an hour Mëds, unfortunately we couldn’t move her, as you know with broken hips, other wise would’ve driven her the 10 blocks to Lions Gate. The Firemen stayed the hour while waiting.

[Meds]

Come to Vancouver, my Mom broke her hip this summer, took the ambulance an hour to get to her, she lives in Lynn Valley, a 5 minute drive from Lions Gate Hospital. Emergency was a gong show, mayhem, packed, not enough beds, not enough staff, Fentanyl heads everywhere needing some sort of shit, one Fent head in front of us a scag in her short shorts who looked like she sells herself for her dope was bleeding down her leg from her crotch for reasons I don’t want to know was in front of us. If you think the interior hospitals are a ghost town you should come down for a visit to the hospitals of Vancouver. It’s a shit show circus. The infrastructure can’t handle the population growth and drug crisis in Vancouver. Chef is outta here soon, saw a show this week at Rogers arena took the bus to it through the DTES, bus stops for a crackhead at one stop, had to wait for him to finish taking a hit off his crack pipe, not a word of a lie, he got off three stops later, 3 blocks. It was like a safari cruise through fentanyl Mardi Gras for miles on end, it’s growing like wild fire. Unbelievable if you haven’t been through the DTES lately.

This is par for the course everywhere.

The drain on our emergency health services system, both prehospital and emerg room, by drug users is insane. I don’t doubt that wait time for a minute Chef. It sucks, but that’s what happens when citizenship lets politicians make decisions without consequences at the polls.

It was an hour Mëds, unfortunately we couldn’t move her, as you know with broken hips, other wise would’ve driven her the 10 blocks to Lions Gate. The Firemen stayed the hour while waiting.

And that wait time is only going to get worse.

To preface this…..

We colour-code the acuity of our calls.
Purple: cardiac/respiratory arrest
Red: Immediately life threatening (but not dead yet).
Orange - Urgent but not immediately life threatening based upon described event and associated symptoms.
Yellow - Non-urgent, not serious/life threatening.
Green - Non-urgent, likely suitable for treatable at scene and no transport.
Blue - Non-urgent, further triage available if necessary to determine if ambulance even required.

Chef, your mom would have been triaged as a yellow.

The new model that dispatch centers have been working under, for roughly the past 2 months, states that they cannot dispatch an ambulance to a call that is triaged as “routine unless they have a second ambulance that would still be available for an emergency call. According to the above triage system emergency calls are purple, red, and (on a case-by-case basis) orange.

The great flaw in this model is that communities of 15,000 or fewer people will most likely have a maximum of 2 staffed ambulances on a 24 hour pattern. Some will have a single 24 hour pattern and an additional 11 hour daytime car with a callout car at night. Despite staffing levels improving over the last 20 months we still have significant shortfall, and we don’t have a casual employee program that is reasonable enough to maintain retention levels that provide reliable numbers for sick coverage.

Add to this conundrum that BCEHS is the sole provider of inter-facility transport outside of the lower mainland.

If the dilemma is not already obvious I’ll spell it out…..

If, for example, Grand Forks has a double alpha model (2x24hr cars) and they send Alpha1 to repatriate someone back to/from Castelgar, there is now zero capacity to dispatch an ambulance to any call that isn’t at least in the (arbitrary) orange category for the next 3 hours.

If there is a sick call that down-staffs an ambulance , or any community with only a single fully staffed unit, the same problem remains.

The station I’m at has 2x24 hour units (although one of them is still considered a temporary resource) and a staggered pattern with overlapping coverage (0800-1900 and 1300-0000). We also have an on-call unit from 1900-0800…..it is very inconsistently staffed. The other night we had a single casual employee who had signed up for that on-call shift. He was called in and told that Hazelton’s on call ambulance was unstaffed so he was to drive an ambulance to Hazelton (130km) where he would be met by a casual lone member from Smithers (80km past Hazelton) and the two of them would partner up to cover Hazelton while the Hazelton fulltime 24 hour car did a routine call in Hazelton, and then once that was completed the Terrace member and the Smithers member would be released home. They can’t technically keep them in Hazelton without managerial approval because on-call units are only supposed to be activated when there is an event holding that requires their use.

They were literally using 3 ambulances, at massive cost and risk (winter roads at night) to accomplish a single patient event when the changes are very high that the event could have been handled and completed without any emergency events in Hazelton being placed on hold.

So while the policy makes sense to ensure we are able to meet our emergency readiness mandate, it highlights the enormous logistical problems faced by a provincial service.

On the plus side, I’m seeing way less of the Zombie Apocalypse in my town these days…..can’t speak for the DTES crews though.

[2Fingers]

Four ambulances with primary care paramedics, one ambulance with advanced care paramedics, two advanced care paramedic responder units and one paramedic supervisor responded to the scene.

Mëds, what is the difference between primary care and advance care. I assume advance is higher trained and can do more?

[Meds]

Four ambulances with primary care paramedics, one ambulance with advanced care paramedics, two advanced care paramedic responder units and one paramedic supervisor responded to the scene.

Mëds, what is the difference between primary care and advance care. I assume advance is higher trained and can do more?

Primary Care is BLS (Basic Life Support), lower scope of practice.

Advanced Care is ALS (Advanced Life Support), higher scope of practice.

Here’s a list of some of the things an Advanced Care can provide that a Primary Care cannot…

-ECG interpretation
-Manual defibrillation
-Synchronized electrical cardio version
-Chemical cardioversion
-ACLS medications (used during cardiac arrest)
-Transdermal cardiac pacing
-Endotracheal Intubation
-Cricothyrotomy
-Chest decompression
-Procedural sedation
-Chemical restraint (sedation in violent psych)
-Opioid analgesia
-Cardiac monitoring
-A much broader scope of independent medications
-Full scope of medication administration under a physician’
orders

If you live in BC and do not reside in Nanaimo, Victoria, Lowermainland as far as Chilliwack, Kelowna, Kamloops, or Prince George, you do not have regular Advanced Care services.

If you live in Penticton, Vernon, Williams Lake, Cranbrook, or Campbell River, you will sometimes have an Advanced Care single responder unit (ACP in a Ford Explorer) who comes and works with the PCP crew. Terrace and Fort St John both have postings for that as well but they are unfilled. BC has some very good ACP level practitioners, but the culture is garbage. Massive arrogance. They don’t want to be bothered dealing with calls that are “beneath them”…..send the Primary Care crew.

I hold an Advanced Care license, I am limited to Primary Care practice by BC Emergency Health Services unless I am willing to travel back and forth or relocate for 6-12 months to go through the BCEHS mentorship pathway. No other province operates this way. They put ACP level wherever they can and those guys go to whatever call comes in. In fact, you could work as an Advanced Care for 20 years in Toronto, then move to BC and be restricted to Orimary Care until you do their mentorship which is essentially a repeat of practicum which we all have to do in order to graduate and apply for licensing. It started as a seniority driven hegemony and is only now starting to change. But the general consensus up until a few years ago was that BC Ambulance had a special place called ACP Island…..everyone who was trying to swim there had to dodge the rocks that the ACP’s were throwing, and when someone finally made it to shore the first thing they were taught was how to throw the rocks at the wannabe’s who were still swimming.

Some people ask me why I don’t go through the process seeing as there is a posting in Terrace for a single response unit. Well myself and a friend of mine both applied but weren’t even considered because we did not have “3 years plus 1 day experience working as ACP’s for BCEHS. They finally changed that wording last summer, but I did the 50/50 home/away thing for too long. I’m done with that. And the fact is, I don’t want to work as a single responder. It is a viable model in metro areas where you have 50 Primary Care ambulances running around so there is almost always a crew to work with. But in smaller centers some of these guys have shown up at scenes and sat there unable to help because they don’t have a second set of hands and have no capability of transporting a patient by themselves…..thanks but no thanks. Over the past 10 years there has been a steadily growing number of people like me, ACPs who don’t want to relocate to these higher cost centres, don’t want to be run ragged and burnt out at rapid speed…..so we just shove the frustration way down and work at a lower level.

The tax payers of BC doesn’t realize how badly their provincial service is under-serving them compared to the rest of Canada.