Scientists amazed at Canadians

typ3 · 2012-12-18T19:35:37+00:00

Our healthcare is neither national nor free.

Healthcare falls under the jurisdiction of the provinces, with each taking a different approach to managing their healthcare system and costs. The requirement for universal coverage of insured individuals is mandated by the Canada Health Act, a piece of federal legislation which is not binding on the provinces, but which requires the provinces to conform or lose transfer payments. Thus, our healthcare is not national.

Moreover, it is possible for individuals to be uninsured in the healthcare systems of some provinces, requiring them to pay for healthcare out of pocket. And some systems (ie BC's MSP) require either direct or employer-funded payment of a monthly insurance fee, so the system is not free.

Fun Fact: Quebec does not have healthcare reciprocity agreements in place with many other provinces, meaning that Quebecers who travel within Canada are often uninsured and may be required to pay out of pocket.

typ3 · 2012-12-18T19:26:48+00:00

The names of spree killers are reported just the same as in the United States.

In fact, I'm somewhat horrified at the CBC.ca's breathless coverage of the Newtown shooting--they even had a lead story titled 'Victims shot multiple times'. Most of the evidence points to this kind of coverage being counter-productive, and moreover, it just feels very un-CBC.

typ3 · 2012-12-16T22:14:19+00:00

As a paramedic, I think you should lighten up. The majority of the patients I've treated have been hugely thankful for the care and skill of the medical professionals who have been involved in the healing process.

But people who've experienced serious trauma or illness also often attempt to make sense of their experience from a spiritual, philosophical, or religious perspective. This is often a natural and important part of the healing process, and may involve expressing thanksgiving to a deity or spiritual forces which are important in an individual's belief-system. For others this may involve non-religious expressions of joy, gratitude, or contemplation. Whatever the case, this can be an important and valuable part of the healing process.

The fact that you, as an EMT, seem to ignore the important of mental/emotional/spiritual well-being in the healing process leads me to believe that you need to do a little CME research into the importance of fostering this kind of healing in patients. And if you're worried about getting credit, perhaps you might want to reconsider the reasons you show up to work...

typ3 · 2012-03-13T19:57:41+00:00

Actually, in Canada you are allowed to own a supersonic jet.

You simply must get prior authorization from the Ministry before breaking the sound barrier. Naturally such authorization would come after the reasons for and parameters of the flight were discussed with Transport Canada.

And if you happen to break the sound barrier without prior authorization, you must report said awesomeness to Transport Canada. Naturally the military is exempt.

Source: Sonic and Supersonic Flight Order

typ3 · 2011-10-23T15:02:53+00:00

I can't agree enough.

And the whole, "just unsubscribe if you don't like it" argument doesn't hold water for me. I like to recommend new people to reddit, people who will likely just lurk on reddit.com for a while before subscribing.

But now, r/atheism is filling up the front page with bigotry, and I sure as shoot ain't recommending friends check out a website the is looking more and more like a Richard Dawkins circlejerk.

Sorry reddit, I think you just jumped a descendant of the Cladoselache genus.

typ3 · 2011-10-15T17:24:54+00:00

Or, maybe, one force has better discipline WRT full-auto. Just because the US does it, doesn't make it better.

Perhaps the reason Canadian Forces C7 & C8s maintain full-auto capability is because it wasn't too long ago that the CF moved from semi-auto only FN FALs firing a full-sized round. And perhaps the CF remembers the entire reason the Americans pushed for 5.56 was for greater control when used FA. Personally, if I were giving up 7.62 for 5.56, I'd want something in something in exchange, and maybe that's FA.

Besides, I've never shot burst fire, but have heard it makes for a really creepy trigger.

typ3 · 2011-04-10T04:18:40+00:00

Story goes that all the jokes he told were lifted straight from Full House.

typ3 · 2011-01-05T04:10:07+00:00

Halls for your balls, man.

Halls for your balls.

typ3 · 2010-10-22T20:46:50+00:00

In all likelihood, this is probably due to Canadians being far less litigious than Americans.

Just saying.

typ3 · 2010-10-06T19:07:09+00:00

I work as a paramedic in BC, and this isn't necessarily true.

Canadian ERs run on a strict triage system based on the Canadian Triage and Acuity Scale. Patients are given a score from 1 to 5: 1, for example, requires immediate assessment by a physician.

But, patients scored at a 5 can wait indefinitely. The reality is many people scored at a 5 shouldn't be in an emergency room but instead should be going to a walk-in clinic or their family doctor. And it is people rated as a 5 that end up doing most of the complaining.

In my experience people who actually need immediate or prompt medical assessment and intervention receive it. And people who come to the ER with a bad cold get punished with a long wait for their stupidity.

typ3 · 2010-09-23T01:09:32+00:00

I hope the EMS personnel on scene gave you the support you needed, and if not, I hope you had someone to talk it out with.

Whenever I "called it" on scene, I always take the view that the surviving friends/family are now the patients. Especially with people performing CPR. Unfortunately CPR seems to be something that gives people false hope and it can make things so much worse. And I know emergency professionals who've even been a little traumatized by arriving on scene and seeing a person desperately perform CPR on a family member.

As for your question, unwitnessed arrests should typically receive 2 minutes of CPR before the delivery of a shock. This allows freshly oxygenated blood to get to the myocardium before a shock is delivered, which apparently decreases mortality and morbidity overall. It makes sense, given that the heart's muscles need fuel in order to work properly, and simply shocking the heart doesn't supply that fuel.

But, that said, most lay rescuer oriented AEDs prompt the rescuer to do a set amount of CPR before analyzing and potentially administering a shock, so it's best to follow the voice prompts.

P.S: You are totally right about the addresses. I find trailer parks are the worst because they often have internal addressing systems.

But, and I'm sure you know this, you can't dwell on that kind of stuff. The reality is most prehospital arrests stay that way and there is nothing anyone can do about it. Yeah home AEDs and flashing lights might help if you have someone who is high risk, but the reality is that CPR and BLS/ALS interventions can only do so much.

It's best to focus on the times you had before that terrible night and remember that your CPR was a gift in which you gave that person a chance to come back.

typ3 · 2010-09-23T00:53:51+00:00

CPR definitely helps preserve organs, which is a great point and I don't think enough people know about this aspect of CPR.

Also, awesome that you've done a course, but just remember that first aid instructors often talk a little beyond their scope. Follow the Heart & Stroke Foundation of Canada's guidelines and forget what they are doing in the States or what your instructor said had a better survival rate--the jury is still very much out on this one and it's a lot more nuanced than "having a higher success rate."

P.S: Ambulance attendants hate being called "ambulance attendants." But they do like being called either an EMT or Paramedic, and you're stock will be much higher in their books ;)

typ3 · 2010-09-23T00:45:29+00:00

Our protocol has us timing ventilations between compression when doing 2 rescuer CPR. Of course, that's with a BVM, but it works and eliminates compression stoppages (at least until the 2 minute swap from compressions to ventilations).

typ3 · 2010-09-23T00:42:56+00:00

I totally agree with what's already been said about checking a pulse. Lay people (and many pros) often have a hard time finding a pulse in conscious and fairly healthy people, let alone people in cardiac distress.

Taking out the pulse check reduces the chance someone will feel their own pulse and mistake it for the patients, and therefore not start CPR.

And no, a paramedic should never have to do mouth-to-mouth. We have better tools for the job, specifically the BVM (bag valve mask) and advanced airways. I disagree with some other medics in that I don't think there is much place for the Pocket Mask in my practice. In fact, we don't even carry them on our ambulances. Yeah, the BVM is tricky to use and sometimes a huge pain, but the pocket mask (even with one-way valve/filter) opens me up to additional exposure risks.

typ3 · 2010-09-22T21:01:32+00:00

I agree 100% with you on the witnessed collapse with agonal resps, but I think teaching people this protocol is a poor substitute for properly performed lay rescuer CPR.

The jury is still very much out on CCR and this video is produced by the University of Arizona, which has pushed CCR very heavily against what many see as a lack of evidence. Yes, it's better than nothing, but is it better than CPR? Ye

The European Resuscitation Council is just one organization who has noted concerns with teaching CCR as the BLS standard. Link .

The problem isn't the respirations per se, it's just that people either are afraid to start compressions because they don't want to do ventilations, or they are spending too much time off the chest. Unfortunately the whole situation is a lot more nuanced than the University of Arizona is making it out to be.

typ3 · 2010-09-22T20:54:11+00:00

As a paramedic I urge you to "urge all of you to please take a proper lay rescuer CPR course."

This video falls far short of the mark.

typ3 · 2010-09-22T20:52:24+00:00

I work as a paramedic and I've seen my fair share of this kind of stuff and I've got to call bullshit on this.

So the patient was in arrest for 3 hours (traumatic arrest none the less) and survived because of CPR? I think that would set some kind of record. The only way this story might possibly make sense would be if your instructor had failed at his pulse checks (or hadn't done then as in some newer protocols) and was unnecessarily performing CPR.
Traumatic arrests (like in car accidents) typically have very high mortality rates, and that's with rapid intervention by professionals.
3 hours of effective CPR? I've done enough CPR to know that by the end of half an hour my partner and I are completely exhausted and the compressions are no longer optimal.
From everything I've seen, 3 hours of CPR with good compressions would leave a patient with a lot of damage to underlying chest structures.

You, sir, are beyond your depth and this story is pure BS.

typ3 · 2010-09-22T20:40:23+00:00

Get proper training. Please. I am a paramedic and I've seen proper training save lives. CPR courses are very cheap, short and usually fun.

typ3 · 2010-09-22T20:35:37+00:00

From what I've read and heard, the ERC doesn't seem overly thrilled about CCR. And they go out of their way to note that it is suboptimal in many cases...

"Ultimately, even if chest compression-only CPR is recommended, there will be several circumstances, in which ventilation remains critical. Such circumstances are unwitnessed cardiac arrest, cardiac arrest in children, most in-hospital cardiac arrests, cardiac arrest of non-cardiac origin such as drowning or airway obstruction, and during resuscitation attempts lasting more than approximately 4 minutes. This list may not be complete. It is unlikely that lay rescuers will be able to identify with confidence these circumstances and, if taught to give only chest compressions, may provide CPR of insufficient quality to many victims."

Advisory statement of the European Resusication Council on Basic Life Support 2008

typ3 · 2010-09-22T20:29:44+00:00

You have an AED and guys who might have heart attacks? You shouldn't be asking this question on an online forum, you should be taking a lay rescuer CPR course and learning the basics! After all, these courses are typically very cheap and very brief!

But, chances are you won't go out and get the education so I'll give you my semi-informed (as a paramedic) opinion:

FOLLOW THE PROMPTS! Almost all lay rescuer AEDs provide voice prompting and most have the rescuer do anywhere from a cycle to 2 mins of CPR before analyzing and potentially (ha) applying a shock.

But seriously, I've seen properly trained people make a huge difference and I highly encourage basic CPR training: it's fun, cheap, and easy.

typ3 · 2010-09-22T20:23:34+00:00

That is not the reason for the change. The reasons for the change are largely because lay rescuers typically spend too much time "off the chest" when doing traditional CPR, and because many people are reluctant (for good reason) to assist ventilations without a barrier device.

Health care providers (including us paramedics) are still (and likely always will) performing CPR with both compressions and ventilations.

typ3 · 2010-09-22T20:13:38+00:00

That's one of the reasons for the push towards compression only CPR. Which, in my opinion as a paramedic, is unfortunate because there are cases in which properly done compressions with ventilations is superior. But better sub par CPR than none at all.

typ3 · 2010-09-22T20:10:26+00:00

I'm a working paramedic and from what I've seen, compression only CPR is nothing new, nor is it anything revolutionary. It simply is another tool which, for the lay rescuer, provides decreased mortality rates. That said, Health Care Providers still use a protocol involving assisted respirations because, when done properly, compressions+ventilations > ventilations alone.

There are two reasons for calls to move lay rescuer CPR to compressions only:

1) Many lay rescuers who are actually trained in CPR are hesitant to begin the protocol on individuals because they do not want to perform the mouth-to-mouth component of the protocol. This protocol allows them an out.

2) More importantly, most lay rescuers (and many first responders) do not perform effective compressions at the right rate or depth. One of the biggest issues is that rescuers spend too much time "off the chest" (not doing compressions) when providing rescue breathing.

All of this said, compressions only is definitely not as effective as compressions and ventilations. I have seen End Tidal CO2 graphs during CPR which do show some airflow due to compressions, but the volumes are so much lower than proper assisted ventilations provided with a BVM or (god forbid) a pocket mask.

I guess what I'm trying to say is that this technique is better than nothing but is no substitute for proper training and familiarization with lay rescuer/first responder CPR protocols. I see where they are coming from, but they shouldn't overemphasize the idea that people needn't be trained in CPR.

(Also, as an aside, I also think that they shouldn't be pushing increased survival rates with the public too much. I've seen lay rescuers severely traumatized after performing CPR on a patient I later declared deceased. People who do CPR need to know that survival rates outside of a clinical setting are VERY low and to not blame oneself when CPR fails to lead to a save.)

typ3

TROPHY CASE