The topic of whether or not Paramedics are an Essential Service should not even be a question for debate.

It would seem that nearly Every single person in the “non-ems” public is already under the impression that Paramedics are an Essential Service, just like Fire and Police. Once enlightened that Paramedics do not hold this same designation, these same tax paying members of the public state that this is not right.  So again, how is this debate even open?

Toronto Paramedics are making themselves heard and seen.  There has been tremendous attention drawn to this fight in the media thanks to the hard work of Toronto Paramedics.

The Toronto Star shows some of Toronto Medics most recent efforts.

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Why does it seem as all hell breaks loose on or around the Full Moon?  The term Lunatic is derived from the word Lunar (Moon).

Anyone who does not believe that the full moon effects behaviour really needs to go for a ride along with EMS.

So is there any scientific evidence to support this phenomenon?  Or is it just coincidence?

Across the centuries, many people have uttered the phrase “There must be a full moon out there” in an attempt to explain weird happenings at night.  The Greek philosopher Aristotle suggested that the brain was the “moistest” organ in the body and thereby most susceptible to the pernicious influences of the moon, which triggers the tides. Other theories suggest that hormonal reactions to increased positive ions in the air cause hyperactivity, depression, violent behavior, road rage, higher occurrences of migraines and even asthma.

Belief in the “lunar lunacy effect,” or “The Full Moon Effect” persisted in Europe through the Middle Ages, when humans were even reputed to transform into werewolves during a full moon.

Today many people think the mystical powers of the full moon induce erratic behaviors, psychiatric hospital admissions, suicides, homicides, emergency room calls, traffic accidents, fights at professional hockey games, dog bites and all manner of strange events.   In 2007 several police departments in the U.K. even added officers on full-moon nights in an effort to cope with presumed higher crime rates.

Are These Theories All Wet?
Following Aristotle, some contemporary authors, such as Miami psychiatrist Arnold Lieber, have conjectured that the full moon’s ­supposed effects on behavior arise from its influence on water. The human body, after all, is about 80 percent water, so perhaps the moon works its mischievous magic by somehow disrupting the alignment of water molecules in the nervous system.

There are at least three reasons why this theory does not seem to be accurate.  First, the gravitational effects of the moon are far too minuscule to generate any meaningful effects on brain activity, let alone behavior. As the late astronomer George Abell of the University of California, Los Angeles, noted, a mosquito sitting on our arm exerts a more powerful gravitational pull on us than the moon does.   Second, the moon’s gravitational force affects only open bodies of water, such as oceans and lakes, but not contained sources of water, such as the human brain. T hird, the gravitational effect of the moon is just as potent during new moons—when the moon is invisible to us—as it is during full moons.

Florida International University psychologist James Rotton, Colorado State University astronomer Roger Culver and University of Saskatchewan psychologist Ivan W. Kelly have searched far and wide for any consistent behavioral effects of the full moon.  In all cases, they have come up empty-handed.  By combining the results of multiple studies and treating them as though they were one huge study—a statistical procedure called  meta-analysis—they have found that full moons are entirely unrelated to a host of events, including crimes, suicides, psychiatric problems and crisis center calls.  In their 1985 review of 37 studies entitled “Much Ado about the Full Moon,” which appeared in one of psychology’s premier journals, Psychological Bulletin, Rotton and Kelly humorously bid adieu to the full-moon effect and concluded that further research on it was unnecessary.

Persistent critics have disagreed with this conclusion, pointing to a few positive findings that emerge in scattered studies. Still, even the handful of research claims that seem to support full-moon effects have collapsed on closer investigation.  In one study published in 1982 an author team reported that traffic accidents were more frequent on full-moon nights than on other nights.  Yet a fatal flaw marred these findings: in the period under consideration, full moons were more common on weekends, when more people drive. When the authors reanalyzed their data to eliminate this confounding factor, the lunar effect vanished.

Where Belief Begins
So if The Full Moon Effect is merely an astronomical and psychological urban legend, why is it so widespread?  Media coverage almost surely plays a role.  Scores of Hollywood horror movies portray full-moon nights as peak times of spooky occurrences such as stabbings, shootings and psychotic behaviors.

Perhaps more important, research demonstrates that many people fall prey to a phenomenon that University of Wisconsin–Madison psychologists Loren and Jean Chapman termed “illusory correlation”—the perception of an association that does not in fact exist. For example, many people who have joint pain insist that their pain increases during rainy weather, although research shows this is not accurate.  Much like the watery mirages we observe on freeways during hot summer days, illusory correlations can fool us into perceiving phenomena in their absence.

Illusory correlations result in part from our mind’s propensity to attend to—and recall—most events better than nonevents.  When there is a full moon and something decidedly odd happens, we usually notice it, tell others about it and remember it. We do so because such co-occurrences fit with our preconceptions. Indeed, one study showed that psychiatric nurses who believed in The Full Moon Effect wrote more notes about patients’ peculiar behavior than did nurses who did not believe in this effect.  In contrast, when there is a full moon and nothing odd happens, this nonevent quickly fades from our memory.  As a result of our selective recall, we mistakenly perceive an association between full moons and the bizarre events and call we attend.

Putting aside this modern explanation that dispels The Full Moon Effect we are left wondering how the theory got started in the first place.  One intriguing idea for its origins is put forth from psychiatrist Charles L. Raison.  According to Raison, The Full Moon Effect may possess a small kernel of truth in that it may once have been genuine.  Raison conjectures that before the advent of outdoor lighting, the bright light of the full moon deprived people who were living outside (including many who had severe mental disorders) of sleep.  Because sleep deprivation often triggers erratic behavior in people with certain psychological conditions, such as bipolar disorder (formerly called manic depression), the full moon may have been linked to a heightened rate of bizarre behaviors.  Raison and his colleagues’ referred to this as a “cultural fossil.”

Despite the all the studies and Chapman’s theory on Illusory Correlation Full Moon shifts still seem to bring more chaos adventure than the rest of the month.

We have all seen Cops and Scariest Police Chases and watched the dashboard camera video and shook our head in disbelief at how some belligerent person was yelling at the officer.

I am willing to bet that a good majority of paramedics wished they had dashboard cameras with them to record how out of line and disrespectful some of the people we deal with can be.  Sure as paramedics we develop a thick skin and let those remarks roll off our back, or at least we try really hard to do so, but is it right that we have to take the abuse?

What happens when you feel that you have been verbally abused enough for the night?  You make a comment (politely) in reply asking the person to treat you with respect.  The reaction from the disrespectful party?  Nine times out of ten it will be one of “how dare you tell me what to do”… and the show begins to grow and a complaint is likely to follow.

So, keep your mouth shut and take the abuse or risk a complaint?  Not a fair choice.  Keep in mind that when that complaint comes in, it is missing context.  The whole incident is up for debate and your complainant will unlikely be as verbally abusive as they were during your altercation.  If only there was a way to make this whole ugly scene crystal clear.  This is why dashboard cameras were placed into police cars.

There has been recent “case law” where a person’s comments were recorded by cell phone and considered not to be in violation of the person’s rights.  Keep in mind that there are several issues to be addressed here beyond the legality of simply recording a conversation, there are internal service policies, the MOH, patient confidentiality etc. to be considered.

In Canada, privacy laws require that only 1 party (you) be aware that the conversation is being recorder as long as they are a part of that conversation.

Every smart phone is capable of recording voice memos that can be stored for later reference.

It is important to understand where patient confidentiality lies.  If a bystander is screaming at you in the street is there any patient confidentiality?  If your patient themselves is verbally abusive and you are not discussing their medical problems or course of treatment is there an expectation of privacy?  Consider also what internal policies may be in place for your service.

If you do decide to record an altercation make sure your decision is informed and legal.

We are going to try something new here in that we are going to open this article to comments…..  Please feel free to wade in with your thoughts and or opinions.

Coming Saturday April 12 2012!  Make Sure to keep checking back here or at www.paramediccompetition.ca for more details including time, location and prizes!

Want to represent your service and show off your skills?  For registration details check out National Paramedic Competition’s website here.

The following has been taken from the National Paramedic Competition’s website:

History of the National Paramedic Competition

The National Paramedic Competition began in 2003 with the hosting of the first event by the Durham Paramedic Association in Whitby, Ontario.  Each year since then a committee of volunteers has worked hard to bring a great experience to the competitors.

In the beginning the competition was simply called the Durham Paramedic Skills Competition.  Over the last several years the event has grown tremendously. Interest and participation by both Paramedics and Sponsors has pushed this event to the level of a National Competition and in 2008, the Durham Paramedic Skills Competition officially became the National Paramedic Competition.  Paramedics take pride in competing in the Advanced Care Paramedic Division, the Primary Care Paramedic Division and the Paramedic Student Division, which puts ‘soon to be’ paramedics to the test.

2011 is shaping up to be an exciting year. Come join us at the ninth annual National Paramedic Competition!

Truly a National event…

Although based in Ontario, teams have travelled from across the country to compete in this event.  Provinces represented over the years include Alberta, British Columbia, Ontario, Quebec and Nova Scotia (as observers).  We are very honoured to have hosted teams from the Canadian Forces for the last several years and look forward to their participation each year.

An International event…

In 2009, for the first time, an international team competed.  We were very pleased to welcome paramedics from Holland to our event.  We look forward to hosting more international teams in the future.

I would like to add a follow up to yesterday’s article (thanks again for the link Tim).  UBC is currently doing a study on PTSD.

In order to be eligible to participate, paramedics must:

1. Be currently employed as a paramedic in Canada.

2. Have a cohabitating spouse or romantic partner who is also interested in participating. (Exception: If your work partner and his/her spouse are interested in participating, you may still participate.)

3. Be working a block of 4 shifts with AT LEAST 1 day off before and AT LEAST 2 days off after in the near future. This means any rotation which contains 4-shift blocks will work!

If you are interested in participating or learning more about this study visit www.medicscope.com

We have looked at Post Traumatic Stress before.  It goes without saying that our job is one of great rewards and great stresses.  By our very nature, Paramedics put others first.  It is impossible to do our job without becoming emotionally involved in the call.  What makes us effective as paramedics, that emotionally attachment to the call, also puts us at risk.  It is safe to say that we all have left a little piece of ourselves behind after a terrible call.

It is all too easy to lose sight of the fact that we need to debrief or at the very least talk after calls.  Again, the nature of the paramedic is to think of others first so it is hard for a paramedic to stand up and say “I need help”.

Don’t wait for your partners and colleagues to ask for help.  Go offer.  An offer to simply listen can have huge impact.

It is this constant decompression that allows us to remain effective.  Stress is cumulative and will manifest itself eventually.  The key to a long and healthy career and life is being able to balance the good days with the bad.

A recent segment by CTV is drawing the public’s attention to the stresses faced by paramedics on a daily basis.

It is comforting to know that when that day comes there is someone there for us.  TEMA is a non-profit organization that is dedicated to post traumatic stress in EMS.  I encourage everyone to take a look at the work they are doing.

International studies show that the prevalence of PTSD in EMS is 20% and rising.  While it may not sound like much, 1 in 5 paramedics with PTSD is a statistic that cannot be ignored.  Paramedics are taught from their first day of training that securing the scene is of paramount importance. As the saying goes, you can’t rescue others if you need rescuing yourself. Scene safety usually refers to imminent physical hazards, like downed power lines or a patient with a weapon. But the same premise applies to the everyday physical and emotional well-being of the paramedic themselves.

Research has shown that paramedics are subjected to five unique stressors:

The level of uncertainty is high. When a paramedic goes to work they have no idea what to expect.  It could be a fatal road accident, or a serious industrial injury.  Most other professions have at least some idea of what they will face when they arrive at work.

The sounding of an emergency alarm produces a physical response and the body prepares itself for the event. Physiological responses include heightened blood sugar levels, increased adrenaline and blood pressure and an increased heart rate.  These are likely to remain high for several hours and it’s possible that another emergency may occur before the reaction to the first emergency has subsided.

The level of interpersonal tension is also high.  Paramedics work in a crisis environment and this increases the tension between people to a greater degree than a non-crisis environment.  Effects which would be benign in an everyday situation become of vital importance in the theater of an emergency.

The exposure to human tragedy is frequent.  While most people may never be exposed to a serious emergency situation in their lifetime, emergency personnel can be exposed on a weekly or even daily basis.

The fear factor can be extreme.  Emergency situations are often frightening and emergency personnel are expected to both deal with the fear and also the situation itself.  The increase in legislative action against them if they make what is perceived to be a mistake can also add to the pressure that the paramedic faces.  Adding to this, the amount of strain involved trying to uphold a perceived image.

Once you examine these five stressors it is easy to see why paramedics suffer high levels of burnout.  Most cope with it for a low number of years before seeking a route out, some via promotion away from the front line (if available) or a change in career.

Just recently I had the pleasure to attend the latest graduation of police officers from OPC (Ontario Police College) in Aylmer. For those that are not familiar with OPC -  The Ontario Police College is where all police officers spend 3 months in intensive training to become police officers.  This program is quite intensive and culminates in a very formal almost military’esque’ graduation and March Past.  This graduation is steeped in tradition and exudes pride.  One of the most moving parts to the graduation is are the pipes and drums.

Pipes and drums are rich in tradition and manage to convey an incredible sense of pride.

The concept of “Police” just as “Fire” have been in existence for hundreds of years.  EMS is in its infancy in comparison.  One of the most common comments paramedics have about their own profession is the seeming lack of cohesion and solidarity.  Solidarity comes from pride and a sense of belonging and heritage.  A small group of Ontario paramedics are doing an incredible job of establishing this sense of pride and solidarity into our profession.

The Ontario Paramedic Pipes and Drums was formed to honour paramedics, celebrate successes and milestones and promote our profession. This band is the only such band in Canada, and one of only a handful in the world.

The Ontario Paramedic Pipes and Drums was founded in 2009 by a group of paramedics and pipe band enthusiasts in Durham Region.   The original idea was to have a Durham Paramedic Pipe Band.  It quickly became apparent that there was widerspread interest and the band evolved into the Ontario Paramedic Pipes and Drums.

Make sure to check out their website at www.paramedicpipeband.ca.  You can also follow The Ontario Paramedic Pipe Band on Facebook and Twitter.

FieldGuide 2012

It’s new and it’s fantastic!

We want to thank everyone who downloaded our App from iTunes and purchased a hard copy. Your support and feedback has been amazing.

This new version has been updated to keep inline with the many new changes to the Ontario Base Hospital Group protocols and AHA guidelines.

Using your feed back we wanted to incorporate as many of your great ideas and requests as possible while keeping the FieldGuide easy to read and fast to access.

The new guide is an interactive eBook (ePub format) making it accessible by all smart phone and tablet platforms (iPhone / iPad and Android).

This new format has allowed us to give you a lot more information and keep it in an easily navigated format.

This guide has been optimized for the iPhone.

If you are using an iPhone, iPad or iPod we strongly recommend you use the iBooks app (free from Apple) as it has fantastic features that work great with this guide.

Buy online here with PayPal for only $2.99!

Android users don’t worry, we have got you covered too. This new format makes the FieldGuide available across all platforms using the ePub reader of your choice.

The new FieldGuide is puts your protocols into your hands.

The FieldGuide can be viewed in any eBook or pdf reader of your choosing making it available for iPhone, and Androidplatforms.

An Interactive Table of Contents lets you jump to any section instantly.

The Bookmarks feature allows you to Flag the Pages you reference the most often or those you want to get to the fastest. Page font can be customized in style and size to meet your preference.

Pediatric (PALS) Calculations have already been calculated for ages neonate through 12 years of age.

High Resolution Images that can be enlarged and rotated.

Protocols are simple to read and understand and follow in progressive format. Whether you are on your way to a call or charting afterwards you will be able to find the information you need quickly.

Buy online here with PayPal for only $2.99!

For those that prefer to use Kindle the OntarioMedic FieldGuide 2012 is also available on Amazon.com!  Coming soon to iTunes & iBookstore.

Canadian emergency departments (EDs) annually treat 1.3 million patients who have suffered blunt trauma from falls or motor vehicle collisions and who are at risk for cervical spine (c-spine) injury. Most such cases are alert and stable adults and less than 1% has a c-spine fracture.

The vast majority of these patients are transported to hospital by ambulance and end up in a cervical collar and strapped to a back board.

A group of Ottawa emergency physicians conducted a detailed study of traumatic “neck pain” and their findings were outstanding.  This study resulted in the Canadian C Spine Rules.

This new system is now an international standard as it is incredibly reliable and accurate.  The purpose of the Canadian C Spine Rules is to decide when it is safe to “clear” a patient’s C Spine and when radiography is required.

Prolonged immobilization is often unnecessary and adds considerably to patient discomfort.  Tissue breaks down quickly on the hard boards, even more sore in the elderly.  In attempts to get patient’s off these boards as quickly as possible a group of Ontario hospitals will be training triage nurses to utilize the Canadian C Spine Rules to “clear” your patient’s c spine.

Currently, the following hospitals are participating in the CAHO Canadian C-Spine Rule ARTIC Project: Kingston General Hospital, London Health Sciences Centre, Hôpital Montfort, North York General Hospital, St Michael’s Hospital, Sudbury Regional Hospital, Sunnybrook Health Sciences Centre, Thunder Bay Regional Health Sciences Centre, and University Health Network.