Bsc Emergency Medical Science commencing Sept 2015

Tango Alpha 51 wrote: »

Paramedics do 12 leads & can recognise your rhythm, CFR-C's are not allowed use igels. You appear to have a major gripe with paramedics & their training in Ireland ?

Try to keep up, Tango.
http://www.safetyireland.com/cardiac_first_response_advanced.htm
"non inflatable supraglottic airway" = iGel


And being able to read a 12 lead is grand.....but they can't do anything more to the casualty than what a CFR-A can do.

Correct me if I am wrong, mate.....

I can see where BoonDoc is coming from. It's 2014. Not 1984.

We shouldn't be providing double crewed Paramedic vehicles who cannot provide an ALS level of care. Therefore, we should be training to an ALS level, not to an intermediate level of care. I just don't see the logic in training to Paramedic level, it's obsolete and not best practice.

If we look at the UK, with the exception of the SAS, they've stepped away from the training of IHCD Technicians and are focusing on the training of Paramedics. Some are recruiting directly from Uni students and some are going the "apprentice" route and still resulting in a Honors Degree qualification.

19hz wrote: »

BoonDoc I see where your coming from man..and it's hard to say the things your saying cause people tend to see it as unpatriotic to talk badly of anything Irish yano..thank god your not in america or you'd be labeled a terrorist! I agree with a lot of what your saying.
It's pretty black and white.

I wonder how many 1st world countries you could travel to with the Irish Paramedic qualification and gain employment as a paramedic.
Does anyone know the answer to that?

Also on the CFR thing BoonDoc, there is two levels of CRF.. basic and advanced, the basic lads don't use the Igel. Just to clear that up. Still a very valid point about the big overlap of care between a CRF-A and a Paramedic.

Simply put you wouldn't, depending on what state you go to work in, in the US, you'd either be an EMT-B or an EMT-I with the irish Para qual. The AP qual would be obviously the equip to the international paramedic qual with the exception of the different drugs. No disputes this, my point & it's no reflection on Boondoc or anyone else as we're all entitled to an opinion is that we in the service have come along way especially on the last 10years. Yes there's a lot more which could & should be done but I still maintain there is no need to be so negative towards the qualification over here.

Tango Alpha 51 wrote: »

Yes there's a lot more which could & should be done but I still maintain there is no need to be so negative towards the qualification over here.

True but it's annoying we are behind yano.
I think people are being more negative towards the college course than the Irish qual in this thread.

It's a bit weird that a ten week classroom course plus placement and internship will yield the same working title as a 4 year degree course.. at least from what seems to be the case at the moment..like what are they putting into a 4 year degree course to bulk it out?..

stevie06 wrote: »

The NAS will never be in a position To provide full coverage of the country! It's a logistics nightmare!

Wholeheartedly agree.
Ireland has a lot of very rural areas and would be unfeasible to cover these areas that may only have a few 999 calls a year.

I reckon 70% of em will abscond to some far off sunny land if the degree will allow them too..

Would have gotten back sooner but I was working/drinking/caring about other crap other than this thread!

BoonDoc wrote: »

For a femur fracture a nice mix of micro dose ketamine with 2.5mg of midazolam. Sorry, entonox just is not good enough. With the new NR-P coming on board in the US they would even do a femoral block.

No, this is not a nation wide guideline in the US. From talking with friends over there Ketamine isn't administered let alone getting oversight for mixing Midazolam for pain relief.

Femoral block isn't routinely practiced yet either. Yes it may be on the cards but that counts for nothing if you have a fracture today.

BoonDoc wrote: »

My fast heart would get quickly assessed and synced and I would be given a drug to slow it down. Here in Ireland? They would hold my hand on the ride to Tralee or Cork.

Transcutanious pacing isn't regularly practiced either. Adenosine would however be administered, a drug not in use in Ireland or the UK for paramedics/AP's. Here an AP would get oversight for Amiodarone.

BoonDoc wrote: »

In my tiny town outside of Kenmare someone dropped with a heart attack right in the middle of the town. It took 20 minutes to get the PHECC Paramedics there. They could only do what the CFR was already doing (pushing and AED). The GP showed up and he couldn't do ALS either. The guy died from PHECC guidelines.

How did you know it was a heart attack? He died from PHECC guidelines? How? Did the guidelines state to do nothing? No one ever died from lack of intubation, just lack of oxygen. As an ALS provider I can state that ALS doesn't get everyone back. You seem to assume that if there was an AP the patient would have survived.

20 minutes for an ambulance isn't great but this is what happens in rural Ireland. If you want an instant response may I suggest moving closer to a hospital or an ambulance base. If you lived 30mins from a fire station would you complain that it took the fire service 30 minutes to get there??

BoonDoc wrote: »

So basically, a one day trained CFR can roughly do just as much as a four year trained paramedic? They can put in an iGel, attach the AED and push.

CFR-A can insert an I-Gel, this is taught to a healthcare worker and not a layperson.

BoonDoc wrote: »

Let's say I have chest pains. Easy MONA treatment right? Oh, but morphine is an AP skill. So I just have to deal with my chest pain to Cork? For an hour and a half? An the paramedics have no idea what kind of rhythm my heart is in?

As I stated before, Paramedics are well capable of dealing with chest pain. Aspirin and GTN are always a first line treatment, if STEMI then clopidogrel is administered. Entonox can also ease the pain. Their protocols would have called for ALS be it by land or by air and the patient would be taken to the PCI lab.

BoonDoc wrote: »

So again I ask....what is taught on that 3.5 year Paramedic course that will make them better???? UK Paramedics are still going through a 2 year degree and getting far more skills than even APs.

A 4 year paramedic course will teach the same as a 4 year nursing course but with the ability to preform more interventions and administer more medications than a nurse can.

Yes...we are behind.....yes...we are playing catch up, but, we need to identify what we are to catch up to. The USA? The UK? Australia? Canada? All these factors get identified before new CPG's are implemented. Do I think the 4 years is the right way to go...no...but...it may yield paramedics with a better ability and more confidence to go forward to the AP course.

antichrist wrote: »

Adenosine would however be administered, a drug not in use in Ireland or the UK for paramedics/AP's.

I've been on scene when it was used by a para in the UK (Think it was for wolf parkinsons white).. perhaps only certain trusts use it?...
It was a UK Para not ECP or CCP etc..

Adenosine is on the SI 518, Seventh Schedule Part 1 for Advanced Paramedics for use in treating SVT. So I guess there are thoughts or plans for its use in the future, but currently AP's don't carry it.

Actually, this study promotes the use on ACLS drugs

Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study
http://www.bmj.com/content/347/bmj.f6829?pmid=24326886&view=long

BoonDoc wrote: »

Due to that Japanese study on CPR drugs, Adenosine may be removed when the new AHA update gets published in 2015.
Epi will be gone. They are slowly removing all of the toys and just focusing on push and shock.

Still a good idea to intubate in cardiac arrest along with the EZ IO. There is just no way to really secure that airway other than a definitive option. Thus the need for PHECC Paramedics to join the world of intubation and cannulation.

You spent most of the thread talking how we need drugs to look after you when your heart goes into cardiac arrest, but in one statement you contradict all of that!

Focus on push and shock...... Luckily Paramedics are good at that!

Intubation is certainly a definitive airway, but a well placed correctly sized SGA inserted early can provide a effective airway without the interruption to compressions that may accompany intubation! the focus is less on intubation now, and even some trusts in the UK aren't even training their paramedic to intubate. The same trust has shown an almost 50% increase in survival in the last few years...... Now I'm in now was saying they are linked, cause they are not, but it certainly holds fact that it didn't adversely effect the outcome! They focused on early cpr and early defib........ Those are key!

miju wrote: »

Anyway, to answer the OP from what I've heard many times the days of being paid to study as a paramedic by the HSE are over.

That is all...

19hz wrote: »

It's a bit weird that a ten week classroom course plus placement and internship will yield the same working title as a 4 year degree course.. at least from what seems to be the case at the moment..like what are they putting into a 4 year degree course to bulk it out?..

As a current 4th year on the nursing degree in UCD I'd guess there would be a lot of the routine degree padding aimed at the 18 year old school leaver - study skills, researching and writing assignments and doing group presentations/posters. Almost definitely a module on communication skills, and cultural awareness (with assignments to write).

There'll probably also be a hefty dose of sociology thrown in (we've had it in some form or another every semester), and assignments in that to research and write. Probably a module on leadership or management. Maybe a side order of politics in healthcare.

Then there's the electives - one or two modules a semester. Can learn some spanish, something architectural, film studies....whatever you fancy and which can be fitted into your time table.

The padding is what is supposed to differ a degree from a diploma/cert - developing critical thinking, research skills, etc. Using the degree model to train nurses is something I'm in two minds about - as a mature student who had studied previously some of it moved a bit slowly for me BUT I've seen the growth and change in my classmates who came in as school leavers, and how they've benefited.

IMHO, the issue with CAO entry for training to work on ambulances is that it there's no way to assess applicants maturity and personal attributes - I've experienced some distressing things while on placement, and there's a lot of support available for nursing students in training hospitals (ward staff, preceptors, etc) and I don't know if the same could be provided for undergrad Bsc emergence students on placement with ambulance services. Hypothetically a crew could have to help their distraught student as well as patient/family/bystanders at a difficult call out scene.

I don't know the stats for drop out rates from health science degrees - but do remember a fair amount leaving our class after first year, so class numbers for the BSc in emergency medical science would need to allow for that. There's also the economies of scale as UCD would obviously like to have a larger numbers paying registration fees. The lecture theatres in the health sciences building can hold hundreds of students....

palmtrees wrote: »

I am. A phone call to UCD CEMS confirmed that it would be AP standard.

The equivalent AP course in the UK is 3 years, and they get far less holidays than we do in Ireland so it's roughly 3.5 years equivalent for us. Same with nurses, nurses do 3 years in the UK, they do 4 here. Same qualification at the end. Why don't nurses do another year and become a doctor? If they want to be a doctor they will try to become a doctor.

...did you just equate not being able to get a job in the offshore industry with not being able to deal with patients?

The biggest problem with this course is not the standard of training, that will only improve. The biggest problem, in my opinion, is 17/18 year olds being put into an AP course. There should be an interview process for this because I'm sure you will agree that a lot of 17/18 year olds would find it difficult to cope with the stress and horrific scenarios that go with this job.

Guys AP UK and AP IRL Are not the same qualification uk version is more advanced allowing more proceedures and drugs ect, agreed 4 yrs is too long to just come out standard paramedic the uni system will be a shamble as 2019 before first APwill role off production line then HSE will pick top of the class and pay juniir paramedic pay for 18 months with no obligation to keep anyone on so guess what will happen ? Yip revolving door AP system where after 18months experience the new guys will a. Be let go or b. Emmigrate to better pay!! Bad idea all round!