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In response to several Community Services inquiries re: the Heartstart AED device, please share the following information with your Branches/CSUs.

After several years of work, SJA approved the Medtronic-Physio Control device only for SJA's Community Services (Brigade) use.

Some divisions have other devices which they purchased or were donated in the past and we cannot do anything about them until they need to be changed.

The rationale for one approved device is synchronicity across SJA's Community Services, the commitment by Medtronic to support SJA with educational and promotional material which has already been agreed upon, and Council (including the Provincial AED Medical Director) happens to feel they have a superior device.

Council agreed that we would not accept other devices even as a donation in that we have made a commitment and have an understanding with Medtronic. If a $ donation is offered, we accept the donation to buy a Medtronic device.

In addition to the above, we (including our AED Medical Director) do not support the Heartstart device since it can only provide low voltage shock dosages and has no option for increasing voltage. The research argument for this low dose-only option is not well supported and some of the most respected cardiologist electro physiologists do not support the low voltage hypothesis and neither does our AED Medical Director.

Hope this clarifies this issue.

Brian Cole
Provincial Manager, Community Services
St. John Ambulance, Council for Ontario
46 Wellesley Street East
Toronto, ON M4Y 1G5
Tel. 1.800.268.7581 ext. 243
Fax. 416.923.4856
Email. bcole@on.sja.ca

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Tyler Mancuso
Member
Username: Tmancuso

Post Number: 15
Registered: 10-2002
Posted on Thursday, December 26, 2002 - 12:02 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Hi Everyone, just wondering how many divisions have an active AED Program. I am trying to initiate the program in SSM, and wanted to find out how many other divisions have the device and are using it on duty!

Thanks!
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Michael Lawrence, RN, BScN
Junior Member
Username: Spud

Post Number: 6
Registered: 10-2002
Posted on Thursday, December 26, 2002 - 08:50 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Mississauga (on the Western border of Toronto) has had defib for 2-3 years now. Our branch helped the city of Mississauga roll out their P.A.D. (public access defibrillation) program for city buildings (pools, city hall, and the like), and offer several AED courses to the public each year.

We have both a Laerdal Forerunner, and the later Heartstream FR2 (essentially the same machine with a new look). We are hoping to acquire a couple more machines over the next year (we've just purchased another ambulance/mobile first aid post and we want to have an AED for each Brigade vehicle we have). Currently, we've got somewhere in the range of 12-15 members AED certified (but I don't know the exact number).

Good luck with your program! My only piece of advice is to ensure that you build in AED training into your normal training even if the people you are training don't qualify for certification but become exposed and don't fear it. As well, make sure to include scenarios that will use the AED in them to help make sure your members are proficient with using the machine (even if BTS scenarios don't incorporate AED... yet!)

-Michael
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Melissa Ying
Member
Username: Mying

Post Number: 13
Registered: 11-2002
Posted on Thursday, December 26, 2002 - 09:52 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Halton Hills (on the northern border of Mississauga ;) ) has had defib since 2000, with the majority of members trained since February 2001. It is considered the first thing adult members do after finishing their BTS-1. They currently have two Lifepak 500s that are out at every duty unless there are more duties than defibs. I've been out of that division for a little while now so I don't know their specifics but probably not much has changed.

To expand on Michael's excellent point about training, every member of the division needs to be familiar with the AED equipment and its maintenance and use, since they are a part of the team and because they will likely be certified eventually. This includes cadets and crusaders and anyone else who goes on duty (in Halton Hills, that includes at least one Therapy Dog member who has her BTS-2). Everyone needs to be thinking about when the AED needs to be ready for action. Having your own AED Trainer is therefore very important since it enables you to bring it out and practise with it regularly.

Maintaining the certification is currently, frankly, a bit of a pain logistically unless you can try to force everyone in the division onto the same certification-CME-practice-CME-certification schedule. Continuing medical education in AED is currently required every three months, with supervised practice every 6 months, and every AED course includes recertification in Level A CPR -- a point which rankles with many members, so they need to be ready to accept that. For the Training Officer, this means planning time to CME and Practice and logging carefully who was there to do it. For one CME, Halton Hills members (cadets too) dissected a couple cow's hearts.
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Melissa Ying
Member
Username: Mying

Post Number: 14
Registered: 11-2002
Posted on Thursday, December 26, 2002 - 09:56 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Oh, I should add that Windsor Division now has a couple AEDs (Lifepak 500s), London Corps has a couple Laerdal Heartstreams (which have seen action), and there should be a couple more programs in Southwestern District divisions within the next year.
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Tyler Mancuso
Intermediate Member
Username: Tmancuso

Post Number: 17
Registered: 10-2002
Posted on Friday, December 27, 2002 - 05:27 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Melissa, I know what your saying about the Training! I am an AED instructor, and all our BTS Level 2s are currently certified and have their standing orders, now all we need is the machine, but retraining is going to be hard, as in the north I was the only instructor to run a course, so they are talking about not doing a re-cert for instructors as there is not a need, and we cannot afford to send me out of the north to recert... so now i am going to run into the situation where the members are certified (until May) but the instructor is expired (as of Jan)....

We are getting a lot of resistance at the board level regarding AED, and how we simply do not need it, so hopefully from this post I can get enough support info from the other divisions that they may consider it, as we respond to a large amount of cardiac calls in a year, usually with at least two to three VSA's. Our boards feeling is that the fire department is only 2 minutes away and they have defib... What they don't consider is when we are working at the race track (where we had a VSA, who was obviously dead for some time, so a defib really would not have helped but if we were called to the scene about 2 hours sooner than we were, it may have) we are thirty minutes away from a defib, so what are the chances of survival at that point??? oh right 2-8% if CPR was started within 12 minutes... The joys of the board being older military men that were in SJA fifty years ago when they dressed in their dress uniforms for duty with the big white belt!

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Melissa Ying
Member
Username: Mying

Post Number: 15
Registered: 11-2002
Posted on Friday, December 27, 2002 - 06:49 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

People off the field get funny ideas some times. I could tell you, but this public forum isn't the place.

Nevertheless, remember your stats and prepare a convincing scenario for your board. The person's chance of survival decreases EVERY SECOND they go before that defib gets there. So even 2 minutes is NOT good enough if you could have it on them in 30 seconds.
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Eddy Wu
New member
Username: Ewu

Post Number: 4
Registered: 12-2002
Posted on Thursday, January 02, 2003 - 09:43 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Does everyone out there know what's going on with the AED program in Toronto District? So far I've seen nothing at all.
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Shannon Cooper
Member
Username: Trainer261

Post Number: 13
Registered: 11-2002
Posted on Thursday, January 02, 2003 - 08:12 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Federal District has has AED now for about 2-3 years. We got in the mix when the city bought them for the whole city and we ended up getting between 6 and 12 for SJA. We have annual recertification with a 6 month refresher. Pre-req's are O2 and BP and obviously BTS1. We haven't acually used them yet (thank goodness) but we almost had to.
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 23
Registered: 10-2002
Posted on Monday, August 18, 2003 - 06:06 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

AFA (EMR) age limit is at the very minimum 16, but 18 is generally "better" as a waiver must be signed for the AED portion, and people under age of majority can't sign legal documents (this goes along with the whole PCR signing problems), though that isn't to say that less than 18 SHOULDN'T sign, but it must be signed by > 18.
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 17
Registered: 07-2003
Posted on Monday, August 18, 2003 - 10:35 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I didn't realise there was a waiver for the AED portion? What is the reasoning for that?

I probably did sign one for my Red Cross EFR a few years ago but just don't remember. I do know that in that course there were some 15 year olds taking it. But they were Lifeguards and it was required where they worked.
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 24
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 05:17 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I haven't signed a waiver personally, but I was told that there is one that exists. The reasoning for it, as far as I know, is that since you work with AEDs (all 3 types), and you are trained in their use, you have to sign that you will not use your knowledge to save people. The AED training is for educational purposes, and although you are expected to know the entire protocol, and have hands-on practice, in real life you may only hook up said AED, and do everything except push the flashing shock button (as far as I understand.. I could be wrong). Doesn't quite make sense, since it's not like you can "wrongly" shock someone. Talk about critical incident stress central when you hold someone's life in your finger.. just one push of a button, and they could very well live.

Sorry bout the ramble...

(BTW, Red Cross EFR may not include AED, since it is an elective in the EFR courses, AFAIK)
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 128
Registered: 11-2002
Posted on Tuesday, August 19, 2003 - 07:24 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

As I walked in the Airports of USA one time, I saw many Yellow AED units stuck on the walls. Available to be used by anyone.

How come Canada has made it into such a big regulated procedure of using these AED?

I think in the future, it will all become deregulated just like the states, so you won't need to take a course to use it.
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 25
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 07:32 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

In Canada's airports there are AEDs stuck on the walls as well (I think it was pearson anyhow). Should someone grab one and use it, and they are not authorized under medical control, there could be lawsuits (including against the airport, as I was told). This is especially true, since if an AED needs to be used the casualty is likely in cardiac arrest, and therefore likely to not wake up again.

AEDs are simple, a trained 10 year old could do it...
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Tyler D.A. Mancuso
New member
Username: Tmancuso

Post Number: 1
Registered: 08-2003
Posted on Tuesday, August 19, 2003 - 07:39 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Just a point of Clarification. The Medical First Responder, Advanced Medical First Responder Level I and II are all a pre-requisite of 16 Years of Age.

As far as the Waiver document, I have been an Instructor for AED for three years now, and an AMFR instructor for a few months, and I have not come across a "waiver" in either of the text materials, nor were we instructed that students had to sign one. This may be a branch specific thing?
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 26
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 07:42 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I personally have not seen such a document either, though from hearsay one may exist...

This also begs the question, why would one teach/study AED if they are not legally allowed to use one.. worse yet.. they are not allowed to hit "shock" should the AED advise of such an action.
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Tyler D.A. Mancuso
New member
Username: Tmancuso

Post Number: 2
Registered: 08-2003
Posted on Tuesday, August 19, 2003 - 07:49 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

When I recently did my re-certification, it was pointed out that "AED" is no longer a deligated medical act in the event of an emergency as outlined by the college of physicians and surgeions of ontario. It is now considered a "first aid" act. The programs are still under medical directive, which is recognized as the comprehensive outline on using the device, however in the event of an "emergency" you could push the shock button.. (Speaking out in public not on duty) that is why the PAD program was introduced
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 27
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 07:51 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

ah, ok. On duties, why do cardiac arrests not fall under the catagory of "emergency" then? (just wondering)

Thanks!
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Don Tai
Advanced Member
Username: Dontai

Post Number: 39
Registered: 12-2002
Posted on Tuesday, August 19, 2003 - 11:05 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The College of Physicians and Surgeons of Ontario continues to see AED use as a delegated medical act, and states the Heart and Stroke Foundation misquoted them.

"It is worrisome that an organization such as the Heart and Stroke Foundation would use a personal communication (in this case, a personal email message) from the College of Physicians and Surgeons of Ontario as a de facto means to declare that the use of an AED by lay people is no longer a controlled act in Ontario. Defibrillation is considered by the Regulated Health Professions Act (1991) of Ontario to be a controlled act requiring direct physician delegation. Policy I-99 of the College of Physicians and Surgeons of Ontario indicates that "at all times, accountability and responsibility for the delegation of a controlled act remains with the delegating physician.""

http://www.cmaj.ca/cgi/content/full/162/13/1805

Regulated Health Professions Act (1991) of Ontario
(2)A "controlled act" is any one of the following done with respect to an individual:
"7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act"
http://192.75.156.68/DBLaws/Statutes/English/91r18_e.htm#P22 8_13636

Yet in the same Regulated Health Professions Act (1991) of Ontario, an exception to the definition of the controlled acts clause states "(a) rendering first aid or temporary assistance in an emergency;"

As the above article states, this is a contradiction of sorts. If you feel use of an AED is part of rendering first aid then there may be an exception to this controlled act. The College of Physicians and Surgeons does not clarify this apparent contradiction. I suppose someone needs to use an AED on a patient, get sued and the results of the court case will make things clearer for us.
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 28
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 11:07 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Thanks for the clarification, however I hope someone will do something about this before someone dies as a result, or be involved in a lawsuit for saving a person's life just because an organization feels they should maintain control over one minute part of their kingdom.
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Tyler D.A. Mancuso
New member
Username: Tmancuso

Post Number: 3
Registered: 08-2003
Posted on Tuesday, August 19, 2003 - 11:19 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Now that is just scary, as it went around to everyone that its no longer a deligated medical act... OUCH!
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Brian Yau
Intermediate Member
Username: Bnb

Post Number: 29
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 11:28 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

So it is still officially a delegated act? Also, how old does one have to be, before they can be delegated a controlled medical act (is this rumour of 15 year olds being given standing orders true?)
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Don Tai
Advanced Member
Username: Dontai

Post Number: 40
Registered: 12-2002
Posted on Tuesday, August 19, 2003 - 11:45 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Until this legal exposure is resolved there will be a reluctance to put AEDs into public places.

We in SJAB are caught in the middle because we may be trained/certified to use an AED or at least have seen a video or actually seen a live AED. It doesn't seem very difficult to use. The thing actually talks to you and tells you what to do.

If a person collapsed in front of me with a heart attack and a public AED was hanging on the wall beside me, on duty or not, I'd have to decide whether this person's life was worth the criminal charge I might face.

SJAB clearly states that use of an AED is a delegated medical act. I'll follow our medical director's advice/command.
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Adam Prieur
Intermediate Member
Username: Beanmedic

Post Number: 24
Registered: 01-2003
Posted on Tuesday, August 19, 2003 - 12:46 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I don't think it would be possible for 15 year olds to receive standing orders since the medical director requires an AED provider to have current CPR and minimum BTS1. who knows
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 129
Registered: 11-2002
Posted on Tuesday, August 19, 2003 - 01:08 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Great literature everyone, thanks!!

Now thats just silly. If its in a public place, unless it has a warning on it, saying "Only EMS personnel may use this", anyone should be able to use it without being charged.

As I recall from an AED course awhile ago, AED will NOT shock if the pulse is non-shockable. Meaning someone can't purposely shock someone in the wrong place or a live person who is NOT in cardiac arrest. Its "idiot" proof right?
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Brian Yau
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Username: Bnb

Post Number: 31
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 01:14 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

You are quite right Johnson, the AEDs are made so they will not shock. I think this is more of a legal debate than really questioning the skills of SJA volunteers, or even the general public in the use of the defib. Hope it gets resolved soon.

Thanks for the responses, at least I know I'm not the only one confused now. ;-)
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 18
Registered: 07-2003
Posted on Tuesday, August 19, 2003 - 01:23 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

It makes sense that the defibs Paramedics and some Fire Departments use would require delegation. Those ones tend not to be "Idiot" proof as many have an over-ride option so the user can decide to shock anyway even if the computer says no.

But the public ones can not be over-riden (to my knowledge) and are therefore "Idiot" proof.

Also, is Oxygen or is it not a delegated act in an Emergency?
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Don Smith
Board Administrator
Username: Admin

Post Number: 263
Registered: 10-2002
Posted on Tuesday, August 19, 2003 - 05:56 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I have performed some pruning of some of these discussions as the discussion on the Identifiers being worn in Ontario as better suited in this previous discussion and the new thread discussion on AED has been moved to into this existing older discussion on AED.
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 19
Registered: 07-2003
Posted on Tuesday, August 19, 2003 - 07:49 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Sorry Don. I frequent discussion boards that make thousands of posts per day (and am an Administrator at a board) so I guess I've gotten used to topics going off-course. Sorry for the inconvenience.

On topic though, I forgot to mention that my Red Cross EFR course did have a defib component in it. I think we used the PhysioControl FR2 (I think that's the model??)
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Dave Wakely
Intermediate Member
Username: Harrypotter

Post Number: 28
Registered: 03-2003
Posted on Tuesday, August 19, 2003 - 10:52 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

AED is more appropriatly called SAED, no AEDs are availible for sale in canada as of the last I heard. SAED requires the operator to press a button to deliver a shock. The fire department uses the same model defib as SJA in mississauga. Primary care paramedics in peel have Zoll defibs that operate in semi auto mode... these are set so you must press the analize button before pressing the shock button. The PCP must also increase the energy if shocks from first responders have been delivered.

As soon as you build something idiot proof they'll go and build a better idiot.

O2 is always a controled medical act(it's a drug) but in emergency situations controled medical act may be performed without delegation.

Hope this helps
Dave
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 32
Registered: 10-2002
Posted on Wednesday, August 20, 2003 - 05:32 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Although O2 is not restricted in the event of an emergency, SJA requires BTS2 certification in order to administer O2, so I have been told. Does holding AEMR-1 or AFA qualify a brigade member to use O2 on duties?
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Eddy Wu
Advanced Member
Username: Ewu

Post Number: 39
Registered: 12-2002
Posted on Wednesday, August 20, 2003 - 05:51 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I was told before that if you were in your uniform but without BTS2, it wouldn't be OK to give O2 even if you've got AFA/EMR-1 but it would be OK if you were not in your uniform as AFA/EMR-1's a public course. Not sure how accurate this statement is but if you've got your AFA/EMR-1, just simply challenge BTS2 then you've got yourself covered, no matter you're in uniform or not.
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 130
Registered: 11-2002
Posted on Wednesday, August 20, 2003 - 05:53 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

"Does holding AEMR-1 or AFA qualify a brigade member to use O2 on duties?"

Great question. I think we need an official rule from our Provincial Training Officer on this.

From awhile ago, the general rule was: to use Brigade equipment (O2, KED, etc.), one must be BTS-2 qualified. If they took AFA at a public course, they still may not "touch" Brigade equipment. Can help the BTS-2 member, but may not use the equipment alone.
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 33
Registered: 10-2002
Posted on Wednesday, August 20, 2003 - 05:58 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Haha, the solution: take off your uniform should the patient require advanced care. (lose the beret, and put on a windbreaker or such quickly...)

Makes no sense..
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Eddy Wu
Advanced Member
Username: Ewu

Post Number: 40
Registered: 12-2002
Posted on Wednesday, August 20, 2003 - 06:05 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Another route is to get yourself O2 certified, then you don't need BTS2 and you can still give O2 to casualties.
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 34
Registered: 10-2002
Posted on Wednesday, August 20, 2003 - 06:06 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Does that occur during BTS exam days? (speaking of which, when is the next one?)
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Eddy Wu
Senior Member
Username: Ewu

Post Number: 41
Registered: 12-2002
Posted on Wednesday, August 20, 2003 - 06:16 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Think we should talk about this elsewhere since this section is for AED but BTS in Toronto District resumes in September as per our new District Training Coordinator.

Also there is a separate course you can take to get yourself certified in O2 administration. I know York region offered this before as well as in other districts but not in Toronto at the moment unfortunately. Hopefully we'll see this type of courses in the future.
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Melissa Ying
Senior Member
Username: Mying

Post Number: 42
Registered: 11-2002
Posted on Wednesday, August 20, 2003 - 07:01 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

You can use whatever first aid training you have while on duty. You have to have at least BTS-1 to be on duty unsupervised and after a year (yada yada) but if you have O2 training or know how to use a KED or take a blood pressure and aren't BTS-2 you can still use it. And please do.

When you have reached the level of BTS-2 please do attempt the exam, because it really does challenge you on your evaluation abilities in a way that the BTS-1 does not, but it is not a requirement to use the skills.

I emphasize first aid training in the first paragraph because when you start crossing into medical acts, like any nurses, paramedics, or *ahem* medical students might be doing, it's a different story. And while the confusion surrounding AED gets sorted out, you need to be careful there too. For now, you must be certified in SJA to use the AED on duty without repercussion.

But yes, if you were trained in advanced first aid measures but not yet certified BTS-2, that does NOT stop you and in fact you are ENCOURAGED to use your advanced skills all the same. It doesn't matter where or how you received that training, but for your sake do make sure you have the training from some reliable source.

The standalone O2 certificate courses as we knew them are gone, though they can be taught by AMFR instructors using modules from their I-guide. However any AMFR instructor can also deliver the training without certification. Also, any reasonably experienced Brigade member, such as a nurse, paramedic, or long-term BTS-2-type, can apply to deliver non-certificate O2 training through discussion with Paul Sims, PTrO. Training without certification should be documented in the member's file, and after receiving the training they can use the equipment.
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 35
Registered: 10-2002
Posted on Wednesday, August 20, 2003 - 07:09 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Melissa, although your post is very encouraging in relation to the ability to practice formally taught skills in the field, I feel it is important to point out that I was told that members are not to administer O2 unless they were BTS-2. Can anyone clarify?

As to BP, I don't think it is on the medical acts radar, and most likely safe, as long as the member has had some practice/instruction in its use and is fairly proficient (i.e. not attempting to take a carotid BP ;-) )
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Melissa Ying
Senior Member
Username: Mying

Post Number: 43
Registered: 11-2002
Posted on Wednesday, August 20, 2003 - 07:37 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Brian,

I am clarifying that you can use O2 as long as you have been trained, and do not need to have passed the BTS-2.

There are, however, two potential wrenches here. First, that it is somewhat within the rights of the District or Divisional Training Officers to mandate that your skills must be overseen before you use them, to make sure they meet standards, and the BTS-2 is a good way to do that. This may be why you were "told" not to administer O2 without BTS-2 and is a reasonable request, but is not the norm.

However, second is that if you have the training, via the AMFR or EFR or whatever, and you do not use it, that could potentially be a liability and more importantly, bad for your patient.

So the bottom line is that you can, and in most cases should, use O2 if you have been trained, even without the BTS-2. If your training was through a non-SJA source you should try to confirm your skills with your DivTO or DisTO to make sure they are compliant -- this is for your sake and your patient's.

I don't want to step on anyone's toes, and do not have the authority to by any means. DivTO and DisTO's do have the right to lay down special "additional" rules for their jurisdictions, and those decisions should be respected. I have seen many members who were trained by other groups to use unusual flow rates or other protocol differences. The best way to catch and correct this is the BTS-2. Still, there is room to discuss this further with your leaders and that is within your rights as well -- and there is no provincial rule stopping you from using advanced skills without BTS-2.

BP is still on the "medical acts" radar in some countries and until recently, some provinces, so there is still a lot of confusion out there about its status.

I don't know if I've been very clear... I have to run off right now (let's go to the Ex!) but hopefully that sort of helps? Don't be stripping off your uniform just to give first aid O2! ;)
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 36
Registered: 10-2002
Posted on Wednesday, August 20, 2003 - 08:17 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The O2 was taught as a part of a St. John AMFR course, so I'm pretty sure it is "correct" with regards to SJA O2 protocol. I was just slightly unsure, since it isn't the PTO or DTO who I was told by, but rather my instructor for the AMFR course that BTS2 was a requirement, so I was wondeirng who I am supposed to listen to and what the "official" word on that is. The only problem is if the supervising BTS1 member isn't O2 certified, and I'm not an IPCP, which would make everything more confusing.

It would be unfortunate if technicalities got in the way of patient care (and probably that will open another can of worms all over again.)

Thanks for all your help!
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 20
Registered: 07-2003
Posted on Wednesday, August 20, 2003 - 03:10 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Ust to further answer the "No O2 unless BTS-2" question, my entire Brigade is made up of BTS-1. We have O2 and have used it many times (I myself was in a situation where I almost had to use the BVM as well). Also, if you were going with the idea that you need BTS-2 to do higher stuff then nobody else would be able to backboard, use KED, use a stretcher etc. All of which my Brigade does.
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Blair Schwartz
Intermediate Member
Username: Medicator007

Post Number: 17
Registered: 04-2003
Posted on Wednesday, August 20, 2003 - 04:19 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Dave,

I was going to bring up the distinction between an SAED and an AED, but it looks like you beat me to it. I'm guessing you've been around prehospital care long enough to remember those early AEDs... sigh... memories!

While AED's are as close to "idiot-proof" as you can come, I do echo Mr Wakely's sentiments about finding better idiots. I am a huge proponent for PAD, have been involved in teaching may golf courses & shopping centers as part of the PAD program that exists in Quebec as a partnership between the Heart and Stroke Foundation and the College of Physicians.

With my colleagues we have trained all our divisional members in the utilization of the SAED (HSFQ Heartsaver "AED"), secured appropriate medical control as required by Quebec law, filed the oodles of paperwork required and actually have an SAED for our use at the Bell Center (our largest contract). Just the Quebec perspective on things.

As for having your hands tied by seemingly draconian legislation. Well, as a trained paramedic and living/working in a province without non-MD ALS I can sympathize with sitting idley by, knowing that if not for arcane laws you might be able to make a difference. It sucks, believe me... but ultimately things do change for the better if enough good people work towards it. Quebec recently started a pilot program to allow non-physicians to provide ALS services in the pre-hospital domain.

Though i'll likely have finished med school and have a medical license by the time i'd make my way through their program :-)

On that note, melissa, what med student medical acts are you referring to? I for one, would never even think of performing a medical act w/o physician supervision as stipulated under the College of Physicians training card I have. hehe :-)

Just my thoughts,
Blair
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 132
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 06:31 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Re: Alex K's post:

Its great that your division has all these equipment. But how did they learn how to use O2, KED, board, BVM, without having been through a BTS-2 course?

If they have all these knowledge, best to take the BAP-2 exam, and get certified. Since in the Training Guidelines, these skills are listed under Level 2.

However, in other cities/towns, such as Chatham, perhaps the distinctions aren't as strict.

Speaking in Toronto, if you're touching an O2 tank, or KED, we better see 2 orange bars on your epaulettes, or you'd be kindly asked to "Step away from the animal" .... :-)
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 37
Registered: 10-2002
Posted on Thursday, August 21, 2003 - 07:12 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Johnson,

I'm not sure of this BTS-2 course you speak of and how that works, but EMR covers O2, BVM, and board; AEMR covers KED. So other than the two orange bars, the person might optionally have an AFA badge?

Not sure.
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Adam Prieur
Intermediate Member
Username: Beanmedic

Post Number: 26
Registered: 01-2003
Posted on Thursday, August 21, 2003 - 07:28 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

how could somebody possibly pass the level 2 BAP if before practicing their level 2 skills (O2, board, etc.) on duty? if a level 1 member is trained and given permission by their training officer, there should be no problem allowing them to practice on duty with the proper supervision.
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Mike Rumble, RPN
Senior Member
Username: Mrumble

Post Number: 87
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 07:36 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Perhaps we're forgetting the idea of "Brigade Specialized Training Modules" here. It is not necessary to complete the entire BTS2 standards to learn each individual skill. This is the category that both AED and Oxygen are supposed to fall under anyway. I myself am one of the rare stand-alone oxygen instructors without being an EMR/AMFR (alphabet soup) instructor. It is true that each district may have different rules regarding who does what and these rules but be obeyed on duty. The same goes for AED. There are restrictions because, at the current time, there have to be. Just a few years ago St. John Ambulance was not able to defibrillate. It may take a few years to iron out the kinks but it's better than CPR for what seems like hours before an ambulance shows up. Perhaps some of you will remember those days. It is good we wish to expand our skills and abilities but I echo the sentiments of Mr. Schwartz in that I have been that person sitting "idly by" with skills I know how to do but am not allowed. Things will change. I am confident we will eventally see (S)AEDs as a first aid measure.
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Melissa Ying
Senior Member
Username: Mying

Post Number: 44
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 08:20 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Blair,

That sentence was less than clear. I meant that some people may have had training that they cannot use outside a certain setting of medical direction or supervision, and that these were a different set of issues from ordinary first aid training and therefore excluded from the discussion. :-)
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 133
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 10:25 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

From what I gather from the short post:
"Ust to further answer the "No O2 unless BTS-2" question, my entire Brigade is made up of BTS-1"

I'm sure they have had training for BSTM or EMR, etc... however, on the post, it didn't say that. So all I see is "My entire Brigade is BTS-1".

And he stated that they are all using and practicing skills of BTS-2 levels.

I'm just thinking in terms of legality. If a casualty sues and investigation finds that BTS-1 only qualified person used an equipment not in the BTS-1 skill list.... then.....

Hence, I also realize different cities can have different issues with this. Speaking in large Toronto terms, I don't think this will be that easy.

I also wonder about the part about "if a level 1 member is trained and given permission by their training officer, there should be no problem allowing them to practice on duty with the proper supervision."

Legal issues? We may be able to trust most officers to judge the skill levels of their members, but technically speaking, only the BAP process designed by our Province can really authorize or give permission legally for a member to treat someone with BTS-2 level equipment I think?
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 38
Registered: 10-2002
Posted on Thursday, August 21, 2003 - 10:31 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

In terms of legality, members probably need a formal examination process that is well documented and accepted by the province to be "legally" certified. As for EMR and AFA, does that hold any water in a brigade duty situation? Just wondering, since most of these posts are revolving around BTS.
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 134
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 10:39 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I think its all a matter of what you represent at the time of treatment. If you are wearing a SJA uniform on duty, then the SJA insurance has to cover you. So you have to behave and be qualified as SJA rules state.

If not, then you have to defend yourself in court as a public trained in first aid, choosing to help the casualty using advanced equipment.

We all know the slight differences of treatment at different certifications of other institutes.

Even a basic task of the Recovery position, lifeguards turn the casualty in a different way than SJA does. Each having our own "advantage" of doing it our way.

To think of a more serious injury, I remember the way to properly position a casualty once on a spine board with head&spinal injury, could be pushing along the side of the body, all at once, or other methods can be push the casualty's body down, then up, and down, kind of like zig-zag with body as one.

So imagine SJA members on duty, using slightly different methods at the same time. Could be arguements, legal issues if something went wrong.

Hence, with all certificates being respected, I would prefer getting all interested members in using > Level 1 to take BTS-2, 3 course.... and get tested by SJA BAP-2, at SJA so we all perform as one and same.

Then again, I'm not the boss! :P
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 39
Registered: 10-2002
Posted on Thursday, August 21, 2003 - 10:44 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I would agree with your concern about slight differences in protocol with other organizations and such, but if the members were trained in SJA for their EMR (possibly by brigade members themselves), then this wouldn't be such a big problem. And as far as I know, Toronto doesn't have a BTS-3.. at least no one attained BTS-3 for the past few years, if you go back and look at the statistics on the adult brigade web site for a few years back. (I heard we don't have any BTS-3 evaluators..)
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 136
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 10:47 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Yup.. agree too
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Eddy Wu
Senior Member
Username: Ewu

Post Number: 42
Registered: 12-2002
Posted on Thursday, August 21, 2003 - 11:21 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I actually wonder if there's any BTS-3 certified member out there now anywhere in Canada as I don't think there's any exam ready for this level nationally (maybe I'm wrong).

So yes Brian you're right. In Toronto District there's no BTS-3 evaluator but I'll be surprised to see if there's any out there in other district. And back to one of your questions above, the 2 orange bars are not the same as the AFA badge. You can wear AFA badge on your uniform if you're AFA certified but you can only wear your 2 orange bars when you've successfully challenged BAP2. I was in this situation before so I finally challenged BAP2 and got my 2 bars. That solved the problem of using advanced equipment when you're on/off duty and with/without your uniform.
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Brian Yau
Advanced Member
Username: Bnb

Post Number: 40
Registered: 10-2002
Posted on Thursday, August 21, 2003 - 11:25 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

BTS-3 guidelines DO exist.. (like the checklist and such) but I haven't come across any exams for BAP-3. I understand that the AFA and BTS2 stripes aren't the same, since they are not interchangeable qualifications, but would AFA allow you to provide AFA service in brigade situations? (I don't think BTS-2 applies outside brigade situations, i.e. no BTS-2 procedures outside SJA?)

I think I'll be quiet and just wait for the next BAP-2 and get it over with.
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Melissa Ying
Senior Member
Username: Mying

Post Number: 45
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 12:21 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The BTS-3 is not being done at all at this time. The national standards and resources that do exist are in need of a massive overhaul, and frankly there are larger, more pressing issues at hand -- like getting all our members to a BTS-1 and improving our BTS-2 numbers. So for all intents and purposes, the BTS-3 doesn't exist. Anywhere. For now.

My personal take is that the AFA badge should not be worn. If I had a say, I would vote in an instant to have it removed entirely from any uniform regulations in existence. Besides being redundant, since anyone who has completed the AFA/EMR/AMFR program should be able to complete the BTS-2 with little extra effort, it furthers making the uniform look like security or scouts. And, it makes the rest of us who don't wear it look like schmoes -- if one guy wears it, then what is everyone else? Emergency First Aid?

Johnson raises a good point about working in a team and everyone doing things differently. Unfortunately, the BTS-2 does not eliminate all of those problems. His excellent point about spineboarding differences illustrates that. The BTS-2 does not care which method of positioning you use -- likewise, for strapping order or whether you cross the straps over the legs or not. It remains a personal preference. To simplify things, divisions or districts may emphasize one over the other, but in a mixed team situation communication is key as it is for everything team-based.

SJA rules do not stop you from KEDding someone if you know how to KED but are only certified BTS-1. Using a KED is not a regulated act. Neither is oxygen, or manual airway suction, or even OPAs... these things all have their risks if used improperly or without appropriate patient assessment, and yes! That's a problem! But so is having a bunch of people who have no training at all, or do and are too afraid to use it, and sometimes the benefits outweigh the risks. But then, I'm not a risk management professional, and while I'm telling you what the rules are right now, they may yet change in either direction. But for now, if it were up to me I'd want to see people get the proper training when they can, and using it when it's needed, and not having to wait to complete the entire BTS-2 skillset before delivering bits of BTS-2 skills.

Nevertheless, excluding any additions at the district or divisional level, the rules are this: You need to be BTS-1/18+ to perform unsupervised patient care in the name of SJA. So long as you are properly trained, you can deliver any first aid skills you have mastered. A really good idea would be to have those verified and documented with SJA -- maybe something should mandate this, but it doesn't yet. An even better idea would be verify, document, and take the BTS-2 when you've met all the requirements.

One thing about the BTS-2.. Passing the Level 2 BAP exam alone is not enough, because it's so hit-and-miss what you will be tested on. You need to have the BTS-2 checksheet signed off by an instructor or the person overseeing your training, and that should be the hardest part of becoming BTS-2 certified. You can work on that check sheet a bit at a time. As soon as it's been documented and filed in your member file that you know how to, say, use manual suction, then I think that's good enough and the rules as I know them say nothing to the otherwise.

In preparation for the BTS-2, you can get the training in the form of the BSTMs or Association courses. You could get it in the form of documented but uncertified divisional training -- a night on "how to use a KED" for example, or the motocross preparation training weekend Mike Rumble organizes for his area, or BTS-2 prep crash courses. You could get it from another organization, though then I caution you on ensuring the organization is reputable. If you learn something in Ski Patrol, then I would see no reason to ignore or suppress those skills. And then make sure that what you think you know matches up with the SJA standards we work by.

One big pickle in all this is the issue of some of our skilled youth members, who may find themselves in the awkward situation of being more highly trained than their adult supervisor. It's a big big pickle, that one, and one that I know is a challenge for a lot of youth members, youth leaders, and provincial youth officers (sorry, Don) -- so far, I don't think there has been a really good happy solution to that problem other than trying to improve the level of training of our adult members, which I think we can all agree is a priority for a lot of reasons.

Okay, this post is way too long. I can't seem to trim it anymore. Sorry.
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Melissa Ying
Senior Member
Username: Mying

Post Number: 46
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 12:26 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Brian,

You can use BTS-2 skills outside of SJA, even if the BTS-2 certificate is the only advanced first aid certificate you have.
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Blair Schwartz
Intermediate Member
Username: Medicator007

Post Number: 19
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 12:41 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Melissa,

Much clearer now! I was a little concerned for a second ;-) hehe.


Mr. Rumble brings up an excellent point with regards to the restrictions. They are to a CERTAIN extent a necessity. The establishment of a College of Physicians & Surgeons, serves as a body wěth the primary aim of ensuring the integrity of the field of medicine. They are given the responsibility for ensuring qualifications of all medical practitioners, maintaining quality control and disciplining its own members for failure to meet standards of care. This professional responsibility is a large burden and one that exists to ultimately protect the patient in the end. The designation of certain procedures as medical acts was based on information and evidence available at the time of designation. Initially defibrillation was solely restricted to physicians.... and not so long ago we medics would get great aerobic workouts doing CPR for prolonged periods of time until we got to the hospital so the pt. could generally be pronounced on arrival.

Then as the technology improved and the studies were done showing that medics and eventually EMT`s and first responders could safely use defibrillators, permission to do so was granted.

Now we are at new crossroads, and I am 100% confident that once the trials and the solid data comes in that this skill can be safely and effectively performed by first aiders and ultimately the general public... the legal roadblocks will begin to come down.

I know its frustrating, and seems to take forever, but at the end of the day this process is designed for the public`s well being!

My advice would be to maintain the high level of training and proficiency in the SAED that SJA has for so long, such that when it does become deregulated as a medical act, SJA can be at the forefront in implementation and training in the this lifesaving device.

Blair
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Gordon Siu
Member
Username: Erdaemon

Post Number: 15
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 12:43 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Going by a few postings here
The so-called waiver in AED course is probably referring to the Statement of Understanding in the heartsaver workbook
It is a condition to receive standing orders in Ontario, as the statement require the candidate to acknowledge that despite receive the defibrillation training, they would not perform such act unless receive medical supervision (if required, since the program is national and a few provinces/territories does not mandate such delegation)
This is more of a legal binding that the candidate would not be covered in SJA liability if s/he does not have a valid standing order in Ontario, and they have acknowledge the responsibility to acquire and maintain such "licensure". As such, it make sense to have a certain minimal age for it.
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Adam Prieur
Intermediate Member
Username: Beanmedic

Post Number: 29
Registered: 01-2003
Posted on Thursday, August 21, 2003 - 12:45 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

i would agree that this makes a lot of sense.
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Adam Prieur
Intermediate Member
Username: Beanmedic

Post Number: 30
Registered: 01-2003
Posted on Thursday, August 21, 2003 - 12:48 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

a little off topic...but does anyone know any good deals on AEDs? our division does not have one, but we have been trying for a while. after an incident on the weekend where it could have been used, we're really getting serious about getting one. any ideas?
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Dave Wakely
Intermediate Member
Username: Harrypotter

Post Number: 30
Registered: 03-2003
Posted on Thursday, August 21, 2003 - 12:48 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Reasonable person guideline: What would a reasonable person who poseses the same training and level of skill as you do in a situation like this?

Legally that is the guide line. By putting yourself in a uniform you are assuming a duty of care. If you know how to use Oxygen and you have some then use it, it'll help your patient. You can not be sued (successfully) for acting in good faith as a reasonable person.

That said BTS is SJA's way of ensuring that they have taken all reasonable efforts to ensure that training standards are met. In this way SJA ensures that it would be hard for the organisation to be sued for negligence.

That said just go get BTS 2. If you passed your EMR you should be able to pass your BTS 2. If you can't your skills are lacking and the AFA badge on your shoulder shouldn't be there.

Dave Wakely
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Paul W. J. Irwin
Intermediate Member
Username: Pirwin

Post Number: 24
Registered: 02-2003
Posted on Thursday, August 21, 2003 - 12:49 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The bottom line of training, and support of the mission of SJA is simple. From a legal standpoint, if you intend to help, weather in uniform or not, you are required to do the best you can with what you have available to you, up to and including all levels of first aid training you are qualified in, and not beyond. IPCP is only an indicator of the some overall first aid qualifications, and may not include specialized training in moduals that go beyond the scope of the currently held IPCP qualification. If you have been trained to use it or do it, then do so if qualified. The insurance will apply to that reasonable use of skills.

S.A.E.D. protocols differ, in that they may only be done under the direction of the delegating medical authority, pursuant to the outlined policy. It remains a delegated medical act at this time. In ontario, if you are P.A.D. certified, you may use a P.A.D. where available while not on duty, or not a Member of SJA. Your P.A.D. qualifications under the P.A.D. medical director of the noted community is what covers you. Contact your local community P.A.D. representative for further information.

© "BE GOOD ALL DAY"
Paul
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Gordon Siu
Intermediate Member
Username: Erdaemon

Post Number: 16
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 12:56 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

It was 2-years ago when the provincial meeting with PTO and ATOs in Ontario were decided to attempt develop our own provincial BTS-3 exams, as National does not develop them.

It was a concern back then as the BTS system isn't aligned with the association SFA/MFR program stream, thus all ATOs were preparing to incorporate the dysfunct MOH MFR program as a BTS-3 delivery vehicle, but that was abandoned as there wasn't a chance to meet with MOH after the WTC incident, as everyone seems to have much more urgent matters to do.

So pretty much BTS-3 currently only exist in 3 forms: the guidelines, BTS-3 certificate and BTS-3 pins.

N.B. with the Community Service Units name changed from Brigade, there might be speculation that the term "BTS" or "brigade training system" might change as well, and that's will be another big can of worms.
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Brian Yau
Senior Member
Username: Bnb

Post Number: 43
Registered: 10-2002
Posted on Thursday, August 21, 2003 - 01:10 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Melissa and eveyone else, thanks for the very detailed responses, it has really cleared up most of the questions on this board! It would seem like it is agreed that the highest level of proficient training in each specific area can and should be used in any patient care setting (exempt SAED).

Is there really a NEED for BTS-3? Sure, it is anothr goal to work towards, and I am sure many would be able to complete it, and/or would study hard to achieve it, but is the problems worth the trouble of having another level when there is much work to be done for BTS-1 and BTS-2 training?
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Johnson Lai
Senior Member
Username: Gundam

Post Number: 138
Registered: 11-2002
Posted on Thursday, August 21, 2003 - 01:11 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Perhaps our wonderful Provincial Training Officer will see all these questions and come up with a Directive for everyone to follow :-)

With a clear Directive, whether members like it or not, we will all be unified.
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Gordon Siu
Intermediate Member
Username: Erdaemon

Post Number: 18
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 02:43 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

As the point brought up by Brian, BAP not only is a learning process, but also served as a formal evaluation tool for quality assurance purposes within SJA.
The BTS system is designed to provide the necessary training for IPCP to perform normal duties, upon completion of the training (checklisted), the candidate will be evaluate at the appropriate BAP levels to determine competency. As such the marking guide in practical scenarios are checked Exceed, Meets or Does not meet standard. This is to determine if the candidate can continue with the level of care defined in the BTS system, after the evaluation.
On the other hand, in a public course, student are certified at the completion of the course based on the criteria that they have completed all the requirements of the course unassisted during the course duration. This is not necessary an indication that the candidate have achieve competency in that skill or not, but they have shown that they can indeed perform that skill independently during the class sessions only. Educators understand that "you can teach all you can, but the students might not learn". The proof of burden later in an inquiry will be on the plaintiff to prove that the provider willfully perform a negligent act and the instructor had omitted or provide wrong instructions.

Going back to the AED discussion, due to slight difference in the IPCP issue, the public AED course prerequisite is CPR-A only, whereas brigade AED course is BTS-1 plus CPR-C. The BTS component ensure that proper documentation training is in place to deal with the post-arrest procedures.

N.B. 1) SJA certification is on specific machine, whereas CRC is on any approved AED, not necessarily on the trained unit only
N.B. 2) Heartstream Forerunner or the newer model called Heartstart FR2, was called Laerdal FR before, had been purchased by Philips Medical. http://www.medical.philips.com/main/products/resuscitation/p roducts
The FR2+ now have the option for 3-lead monitoring and peds electrode to use on child patients.
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 21
Registered: 07-2003
Posted on Thursday, August 21, 2003 - 03:06 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Now we come to... if you have a Paramedic/Nurse/MD/etc that is trained to interpret ECGs is there anything stopping them form hooking up a 3-lead equiped SJA SAED and taking a look? If you look at it from a logic standpoint you probably have more chance of causing harm doing a BP...
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Paul W. J. Irwin
Intermediate Member
Username: Pirwin

Post Number: 26
Registered: 02-2003
Posted on Thursday, August 21, 2003 - 06:44 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Well... there is no 3 lead SJA S.A.E.D. in the field. Monitoring with only two leads is done by a the computerized device. No visual monitor is available. The two leads to the pads remain attached to the patient to allow constant monitoring by the device of the patient. Downloaded information from the device is available post incident for review by Dr. Wasser, in Ontario.

© "BE GOOD ALL DAY"
Paul
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 22
Registered: 07-2003
Posted on Thursday, August 21, 2003 - 07:50 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Paul, from the link Gordon posted there could potentially be such devices in the field in the near future.

I just thought of another one too. Some RTs and even Nurses/Paramedics have their own personal O2 Saturation monitor. Are they allowed to use it on duty?

I guess the overall question is where do we draw the line? Is there a line? Do we eventually have to say "no, no more. We are first aiders not mobile hospitals"
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Gordon Siu
Intermediate Member
Username: Erdaemon

Post Number: 19
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 08:18 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Not all medical staff are ACLS trained and/or certified. Mostly only Advanced Care Paramedics and EMT-P or higher level pre-hospital providers are trained and carry out ACLS procedures. Thus ECG interpretation are traditional reserved for the ACLS trained. Not all "paramedics" and even RNs in some case are delegated to perform such task on a daily basis. Same for some physicians, not all are board certified to perform surgeries.

When you actually say the word "interpret", you might argue that the only way someone can "interpret ECG" is by 12-lead or more (there are 15,18,24-lead placements), 3-lead is only for monitoring (to keep it short, it's all about accuracy). It is not a common practice yet to use 12-lead pre-hospital in Ontario. However, a lot of Multi-Lead medics will tell you "If you on lead-II, you have no clue".

Back to the discussion, if you read the medical directive, SJA AED may only be hooked up to VSA patients, which all its goal is to look for VF and pulseless VT, which are shockable rhythms. The non-display models are aim to take out the ECG reading part and make it "user-friendly". Manual defibrillators will only display the ECG, which then require the operator to recognize the rhythm and determine the mode of treatment which may include pacing or synchronized cardioversion. Defibrillation is actually unsynchronized cardioversion, which send out shock when the button is depressed. The newer more "user-friendly" AED machines have actually change the verbal prompt from the traditional "Shock delivered" to "Treatment delivered".

From all these discussion though, if I may bring up the point, is that in SJA, as a voluntary EMS provider, we have evolved from the traditional "bandaid patrol" first aiders to more trained First Responders with O2 + AED. However, it's not the equipment that distinguish us, it's the professionalism that makes the name shine. Having nice shiny fancy equipment is cool, but able to use them (some antiques as we all know) efficiently and competently is more important and that is what BTS should be all about... Continuous Education. Our communities demand our level of care to improve, but we must also be diligent to improve our training standards to meet those needs. Thus as Tyler mentioned, it's fine and dandy if we got more BTS-2 or MFR or AED trained, but on the other hand, we must increase efforts to provide training opportunities to maintain competency. It's not only what we want to do, but to do what we can do and do it well.
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Gordon Siu
Intermediate Member
Username: Erdaemon

Post Number: 20
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 08:43 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Alex

Pulse oximeter is not an invasive procedure, if that's what you are referring to, thus carried in BLS units. Traditionally you don't find them lying around cause the portable ones cost about $800 each. However, not everyone know what it does and the meaning of its readings. Just like a BP cuff, you can put it in the trauma bag, but it will mean absolutely nothing to an untrained BTS-1 provider. (except it's a very expensive piece of gadget)

With the trend of newer generation of AED, the machines have change not only in price, but also size and function. Defibrillators used to be the size of a fridge, now palm size. Used to be 2" paper output, then to our 4 1/4" 12-lead printout. Download used to be from interior memory, then PC card, now even data can be beamed to laptop or palmpilots via IR ports.
It is crucial that we not only alert to new technology, but be critical to assess its function and durability, not because the manufacturer said so. When the salesperson fail, they lose business or maybe their job; but when we fail in the field, people could get hurt or die. We should focus on our basic training, without which means absolutely nothing. "Treat the patient, not the machine"

The line isn't clear because it keeps updating to reflect current society values. For example, consider a WSIB regulation #1 First Aid Kit, that's was the standard maybe 10 years ago. Would you carry just that on a duty? Even WSIB have change the definition of first aider. It used to be SFA, now it's SFA plus CPR-A, and how long it takes to change the interpretation?
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Gordon Siu
Intermediate Member
Username: Erdaemon

Post Number: 21
Registered: 04-2003
Posted on Thursday, August 21, 2003 - 09:05 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Rick

I feel for you. Equipment do fail and bureaucracy + egos sometimes go beyond and take precedence over patient care.
It is then imperative that you do you best to deal with the situation, cause you are the patient advocate, not the person sitting in an office. I might end up upseting some people in the office, but we all have a job to do in the field.

There were discussion that more CIS training should be out there. Unfortunately, not a whole lot of divisions are interested. With more and more events coverage, as well as more high risk population we gonna cover, we are going to run into dead people sooner or later. Traditionally the public can arrange CISD via hospital emergency department, as they have social worker/chaplain on call. I heard about the military medical protocols on seeking treatment at civilian facility, but i would really have a good talk with your CO. If you experience CIS and deny treatment from civilian facilities based on your status, would you still be in a healthy mental status to properly function as a soldier? They better prepare to provide treatment in military facilities as well.

Bottomline though, AED is good, but it's not 100% save-proof, even if they are present and functioning. The manufacturers and media sometimes made it into our machines that AED is a miracle machine, but it's not. It's the people who uses it and the situation presented, cause not everyone out there is "saveable". You did your best and that's what it counts.

Prayers to you and your colleagues.

N.B. Ontario have a bunch of CIS instructors out there who will be willing to run awareness courses for your division, as it is part of BTS-3 curriculum. Check with your DS and ATO about hosting one in your district or division. Another rare "free" course that council puts out.
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Adam Prieur
Advanced Member
Username: Beanmedic

Post Number: 33
Registered: 01-2003
Posted on Thursday, August 21, 2003 - 10:31 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

although i was not there, there was a st john crew that had one die on them here in hamilton over the weekend. it was a VSA most likely caused by MI, and there were also some equipment problems (not to mention the fact that our division doesnt have an AED yet).

at least we are taking steps in the right direction. a few years ago, when we encountered a VSA, CPR would have to last as long as possible. now we have the AEDs, and we are much better off for having them. unfortunately, there may be problems with equipment or anything else, but remember, we are all new to this. you tried your best. the only thing you can do is make sure that the next person who has to use it is better prepared than you were this time. try not to blame yourself, because you are the only person who TRULY knows what happened out there. i am sure that you did everything you could possibly do to help this person, and i'm sure they would be pleased with your efforts.
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Alex Kroeze
Intermediate Member
Username: Akroeze

Post Number: 23
Registered: 07-2003
Posted on Friday, August 22, 2003 - 01:48 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Gordon,

My apologies on the choice of wording. I did not fully understand the distinction between monitoring and interpretation when it came to ECG. Thank you for clearing that up for me.

Also, I think you answered the question. The directive states you can only hook up a VSA patient. Therefore even if you did have a monitoring capable unit, the trained professional wouldn't be able to use it. However, we could get into the discussion of whether they could step into the role of their profession and then use it... but that is something for another time.

As far as Pulse Ox is concerned, I will very soon be a Nurse. It is part of my program as that is one of the common vital signs I will take. So if I happen to have my own Pulse Oximeter (say I'm a home care nurse and decided I had some extra money) you would have no problem with me putting it on someone in respiratory distress while on duty?

Thanks again for clearing things up for me.
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Michael Simpson
Member
Username: Mdsimpso

Post Number: 13
Registered: 07-2003
Posted on Wednesday, August 27, 2003 - 08:42 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

We need to take a active move towards more CIS training and the policy's and procedures in place to ensure that the training is put to use when it is needed. We have a lot of members in St. John that do not work in medical field outside of St. John Ambulance. They are the ones that need the support from the organization when they are in the treatment of a serious patient (VSA, Anything major to do with a child/Baby.

If the information does not get to the right people quickly after the patient is gone to the hospital then you run the risk of that person having issues that may result in the member not return to duty because of their experience.

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Tim Gallant
Junior Member
Username: Tim

Post Number: 8
Registered: 03-2003
Posted on Friday, September 19, 2003 - 05:51 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Does anybody know the obserde amount for a defib battery,i've heard they are quite high.Our division has a lifepack 12 series.
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Michael Simpson
Member
Username: Mdsimpso

Post Number: 15
Registered: 07-2003
Posted on Thursday, October 09, 2003 - 12:51 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I know the Defib it self is about 5K I think the battery is 1/4 to half of that
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Tyler D.A. Mancuso
Junior Member
Username: Tmancuso

Post Number: 10
Registered: 08-2003
Posted on Thursday, October 09, 2003 - 01:07 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

A battery (Lithium Ion non rechargable) for:

Laerdal FR2+ is $308.80
LP 500 is $282.00
Powerheart is $350.00
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Tim Gallant
Member
Username: Tim

Post Number: 15
Registered: 03-2003
Posted on Thursday, October 09, 2003 - 05:06 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Wow!those are the best prices i've EVER heard of.The last quote i heard for our defib was about 1000$ for one battery.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 43
Registered: 07-2003
Posted on Thursday, October 09, 2003 - 05:20 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

And now you folks understand why we smaller Brigades have a very hard time getting fancy stuff like defibs. We still don't have a full uniform for all of our Cadets yet due to funding...
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Tim Gallant
Intermediate Member
Username: Tim

Post Number: 16
Registered: 03-2003
Posted on Thursday, October 09, 2003 - 06:15 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Alex,
Trust me when i say"I understand".Here in our division,we supply our own uniform,and they would like us to get our own supplies,but for the supplies,one must know the right person to ask.
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Paul W. J. Irwin
Intermediate Member
Username: Pirwin

Post Number: 29
Registered: 02-2003
Posted on Thursday, October 09, 2003 - 06:44 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

When Tim states, "own supplies", that concerns me, deeply!

From a liability standpoint, one who supplies their own supplies accepts some of the civil liability that goes with it! SJA Members should never supply their own supplies. All supplies should be provided or acquired through the organization or its authorized agent. It is simply a technicality that opens the liability door far too wide. You simply never want to go there.

Consult the powers that be immediately at this matter, as it can only mean serious trouble. The chances of it costing the Member anything, if they act in good faith, is next to zero, but it is your life/money that you are messing around with. If you are 18 years of age or over, you could pay for it. If you are under 18 years of age, your family could.

I don't mean to be so scary in my words, but then again, I do. This is not a game.

As to uniforms, that is also a possible problem. A Member can make a contribution to the group that all others can share in, like uniforms. For a Member to buy their own, that can also lead to a legal issue for a non-profit agency like SJA. Regulations for youth Members are specific as well, and should be consulted.

The SJA family has a specific organizational structure, when it comes to financing Community Services. The regulations can be specific. They have been created to protect the organization, and those who are Members of it.

© "BE GOOD ALL DAY"
Paul
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Saskia Wilson
Senior Member
Username: Saskia

Post Number: 92
Registered: 10-2002
Posted on Friday, October 10, 2003 - 03:28 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I dont know how many other division's do this, but here in Fenelon we supply the berrets (how ever you spell that) ties and the flashes. The cadets have to supply their own shirt and pants as we have had a difficult time getting the shirts and pants back when they leave
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Dave Wakely
Advanced Member
Username: Harrypotter

Post Number: 35
Registered: 03-2003
Posted on Friday, October 10, 2003 - 06:42 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Paul,

In order for litigation to be successful you would need to prove negligence. I am interested in hearing how providing your own supplies would increase your liability. If you do not have a first aid kit then you use what is available.

You can argue you establish a duty of care by being at a public duty in uniform. However you would be hard pressed to extend that duty of care to a gauze pad the member supplied. In fact the member, knowing they have no supplies, provided their own; that goes above and beyond the reasonable person standard. Which should absolve them of liability. As far as the purchase of your own uniform leading to legal problems, are you going to sue yourself for a shirt that fades (yes I know there white -- it was sarcasm)

It begs the question of why can’t/won’t the branch/community support them and may even bring into question the divisions fundraising activities (or lack there of) but I take issue with an area officer fear mongering with members who are going above and beyond to meet a standard their division is not prepared to.

The time has come for the organization to stop blindly accepting/creating “legal arguments” that justify policies/statements made on a whim.

Helping people is not a game, but it can be fun. You made a statement that was meant to invoke fear. It invoked distain in me.

Submitted for consideration

Dave Wakely,

My thoughts are my own and do not represent those of 504, SJA, John Paul II, Dr. Phil or the current reigning monarch
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Paul W. J. Irwin
Intermediate Member
Username: Pirwin

Post Number: 30
Registered: 02-2003
Posted on Friday, October 10, 2003 - 08:58 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

The legal issues arise as a result of situations that have occurred, near and far. They may not have often caused legal problems, but had at least the potential to do so.

With the increased American influence on our community, the legal system, and issues, Members simply have to take the best course of action in their decision making, as does the organization. We may not agree with where our legal or organizational systems are going, we simply have to adapt to them and/or offer our input. All Members are entitled to have a voice in the SJA family.

One reason that I would say for ensuring that the organization is providing the supplies, is that if there is a product that causes problems, the organization can be asked why that specific product was chosen. It is hoped that the product chosen by the organization is chosen so as not to cause problems and provide good function for its designed purpose. We as lay people, First Aiders, should leave the acquisition of the supplies to those who know best what to acquire for the use the Members. If the organization makes the wrong product choice, then the legal responsibility lies with the organization. Still, Members are always welcome to have input into the decision making process.

If a Member does chose to offer supplies to use on duty, those supplies should be the same products that would be issued, and should be authorized in writing, at minimum. The Member should also submit a claim for the costs, and are entitled to be reimbursed. It is a matter of quality control. The dollar store first aid product that needs to be replaced sooner than a better quality product has likely not met the best needs of the patient. The organization funding structure is however designed to ensure the Member is supplied with what is required. A first aid kit is a required minimum standard for all Patent Care Services Members. That does not always seem to be the case, but it is what the standards of the organization require. It sounds like Members are having local supply issues that need to be urgently addressed. Some patient care duties are even designed to supply Members with their kit, and don't even allow Member kits on duty.

I am sorry that Dave was offended by some of my words. It was not meant to be an attack on him or any other Member. Maintaining your focus on being there for our community and its people is the most important factor. We just have to ensure we take that full breath and collect our thoughts before taking charge. That includes all of the questions and thought processes that lead up to that time, like knowing what you have in your kit.

As for the majority of this year, I am not having much fun anymore. I have had a few moments, but they have been all too few. I will search out more, and plan to create some/more.

As this thread is entitled "AED Programs", I feel responsible to at least ask some related questions on the topic. What is the SJA position, and your thoughts, on biphasic as opposed to monophasic SAED devices? Are a potential patients needs better served with what is supposed to be a better and more advanced product? SAED's are getting very compact and portable. Are they getting less expensive? Are there quality products available that don't need batteries that are hundred of dollars each? I think some look too much like a toy. Is this a problem?

© "BE GOOD ALL DAY"
Paul

p.s. - Everyone have a great weekend. If you are celebrating Thanksgiving... enjoy! I am thankful to be a Member of the SJA family. p.i.
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Alex Kroeze
Senior Member
Username: Akroeze

Post Number: 44
Registered: 07-2003
Posted on Friday, October 10, 2003 - 09:41 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Could you distinguish the difference between a biphasic and monophasic SAED for those of us who aren't 100% up on the lingo?
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Paul W. J. Irwin
Advanced Member
Username: Pirwin

Post Number: 31
Registered: 02-2003
Posted on Friday, October 10, 2003 - 10:00 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Simply, using a different wave form to do a better job with less power and more effective results.

Try this link. Best to leave the explanation to the experts.
http://www.zoll.com/Biphasic.htm

© "BE GOOD ALL DAY"
Paul
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Dave Wakely
Advanced Member
Username: Harrypotter

Post Number: 38
Registered: 03-2003
Posted on Friday, October 10, 2003 - 11:41 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Put simply monophasic machines send electtricity in one direction at higher energy settings (250J, 300J, 360J) whereas biphasic use lower energy(120J, 150J, 200J). Monophasic is the old standard, biphasic is the new vouge. I have not seen any data on survival to hospital discharge but I know Toronto EMS was involved in a study.

Living better electrically is dependant on time to first shock. As such many studies are retroactive anaylysis of uncontrolled data (as one could argue the study could in some way prolong the time to shock and therfore increase mortality the study design must be scrutinized)

Zolls web site states:
The ZOLL M Series is the only device cleared and labeled as clinically superior to monophasic defibrillators for:
1) cardioversion of ventricular fibrillation in high impedance patients, and 2) Cardioversion of atrial fibrillation.

cardioversion of ventricular fibrillation in high impedance patients -- refers to shocking dead fat people. Case 2 applies to a strictly in hospital procedure(with few acceptions)
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Michael Lawrence, RN
Intermediate Member
Username: Spud

Post Number: 24
Registered: 10-2002
Posted on Friday, October 10, 2003 - 07:44 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I am very pleased to hear that council has finally chosen a unit to put it's name behind!

To answer the question above, the difference between monophasic and biphasic defib is how the energy is delivered to the patient (and the physics of the energy waveform). It is beyond my full understanding and I think most of us... unless you have a degree in electrical engineering or physics!

What does it mean for us, as providers? Hopefully nothing! It is an option that some of the manufacturers try to use as a reason to buy their machine over their competitor. Yes, the Heartstart/FR2 product boasts that it can achieve conversion to Sinus Rhythm from VFib/Vtach with a lower energy setting (ie. 150J per shock non-escalating Biphasic) as compared to...? (I am unsure as to exactly what they compared their findings to... as well, the research that they have claimed is based on implantable defibrillators which do not have the same impedance worries and shock at much, much lower energy settings).

In addition, the literature has not been overwhelmingly persuasive towards biphasic. At this time, according to the American Heart Association and the Journal Circulation, the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (International Consensus on Science) does not reccomend one over the other (mono vs. biphasic) and they don't make any reccomendations regarding escalating vs. non-escalating energy defibrillators.

My two cents,
Michael
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Don Tai
Senior Member
Username: Dontai

Post Number: 43
Registered: 12-2002
Posted on Sunday, October 12, 2003 - 01:35 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

I'm shocked to hear that some SJAB members are forced to provide their own first-aid supplies. It sounds like the SJAB bureaucracy has finally gone from a slow crawl to a complete dead stop. SJAB Brigade members have acknowledged this, have given up on the bureaucracy and, for the greater good for their community and at last resort, are forced to pay for their own supplies.

Buying your own supplies, however, will not solve the problem of fixing the bureaucracy. SJAB is a non-profit charity organization and receives income to support the Brigade. This funding should be properly channeled down to us, patient care providers. This sometimes does not happen on a timely basis. If this does not happen we need to fix the bureaucracy or it'll continue. Without the minimum of first-aid supplies you are not equipped to do a duty and should therefore decline. As a last resort if enough duties are left uncovered someone will then notice and provide enough first-aid supplies.

As well, SJAB should not be a financial burden on brigade volunteers. This is particularly true for cadets and university students. We donate our time and effort in training and duties. If word got out that SJAB volunteers must also provide their own supplies, don't you think this would discourage new and existing members? It's hard enough finding dedicated people to train and go on duty without imposing a financial hardship. Any member of the public should be eligible to become an SJAB volunteer member, rich or poor.

Personal and optional items, such as a steth, bp cuff, and tack pants, should be purchased on your own. The rest should be provided by your brigade.

As for AEDs, yahoo, someone made a decision on which one to get. As Toronto divisions have none, can we get them and start training already?
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Tyler D.A. Mancuso
Member
Username: Tmancuso

Post Number: 11
Registered: 08-2003
Posted on Wednesday, October 15, 2003 - 07:17 pm:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Hey everyone, Just wanted to add a post to this discussion... I started this discussion a little under a year ago, and have some great news. We received a donation of a defib! It should arrive in two weeks!

Thanks for everyone who posted their defib programs here! it really helped!
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Don Tai
Senior Member
Username: Dontai

Post Number: 53
Registered: 12-2002
Posted on Wednesday, November 12, 2003 - 05:03 am:   Edit Post Delete Post Print Post    Move Post (Moderator/Admin Only)

Here's an article from today's National Post, "Public access defibrillators double chance of surviving cardiac arrest"

The first major test of public-access defibrillators found that placing the devices in office buildings and shopping malls and training ordinary people to use them can double the chances of surviving cardiac arrest.

We need training on AEDs.

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