• Review: Paramedicine 2014 (Ontario Paramedic Association)

    by Alan Batt. Last modified: 24/10/14



    Paramedicine 2014 – Conference of the Ontario Paramedic Association


    London Convention Centre, London, Ontario, Canada




    $300 (included breakfast, lunch & coffee breaks)


    This was my first time attending the Ontario Paramedic Association (@OntParamedic) annual Paramedicine conference, and I’m glad I was back in Canada for it!

    The Friday of the conference (which I was unable to attend) comprised of Pre-Conference workshops on 12-Lead ECG Interpretation, and a visit to the Ornge Base in London.

    Saturday morning after registration and breakfast, Rob Theriault (@paramedic_tutor), Professor of Paramedicine in Georgian College, Barrie, and President of the Ontario Paramedic Association opened the conference, welcoming everyone in attendance, before handing over to Dugg Steary (@dsteary), Program Coordinator of Paramedic Programs in Fanshawe College, London, and Critical Care Flight Paramedic with Ornge.

    Dugg welcomed everyone to the event, and then introduced the Opening Keynote Speaker, Susan Schiller (@medic181), Deputy Superintendent of Boston EMS, who spoke on the lessons learned from the Boston Marathon bombings. We listened to actual EMS radio recordings from the day, and watched EMS video from the immediate scene, which was harrowing at times. Whilst bullet points will do her talk no justice, some of the key points made by Susan during this session were:

    • EMS provision within the city must continue during these type of critical incidents
    • Practice does not make perfect – practice makes better. Perfect is unobtainable, but you can work towards it! Keep doing MCI drills!
    • Boston EMS set up their incident command structure whenever they get a chance in order to practice, allowing everyone to get familiar with the system. At minimum, three times per year during:
      • 4th July Celebrations
      • Boston Marathon
      • New Years Eve
    • Interagency cooperation and coordination is essential when dealing with an incident such as the Marathon bombings. Over 60 additional ambulances were sent by private ambulance providers in the after math of the bombings to assist Boston EMS.
    • Triage needs to be
      1. Simple
      2. Easy to implement
      3. FAST! (<30 seconds per patient)
    • Single biggest help at bombings were tourniquets! If in doubt, put it on! If you run out, or there are none – makeshift! Wider = more comfortable.
    • Boston EMS Tactical Paramedics now carry  life threatening haemorrhage control kits; can now manage up to 20 patients per kit
    • Planning pays off. Boston EMS have been planning for these type of incidents for over 10 years
    • Training matters – especially triage training!
    • Bystanders will want to help – let them!
    • Conserve resources, there is always something next. This includes off-duty resources who were trying to respond: not all are needed immediately, on-scene rescuers will need to be replaced
    • CISD is key! Importance cannot be under-stated!

    After this fantastic talk, I went to Dugg’s talk on “Paramedic Students – are we expecting too much, or not enough?” This was an interactive, group-discussion based session, and over the course of an hour, we spoke about entry-to practice requirements, core requirements, increases in core education in Ontario and more. Some of the more interesting points I took away from this session were:

    • Use of vehicle-integrated simulation, and assessment of communication skills in OSCE based settings
    • Emphasis of paramedic training in Ontario is shifting to evidence over directives, and critical thinking not critical errors
    • Community Paramedic thinking needs to filter down to PCP level – acute v chronic, importance of communications, referral options etc.
    • A move to a 4 year degree in Ontario, and in Canada in general needs to be seriously considered in the context of international developments
    • A degree is not necessarily required for clinical practice, but to expand professional possibilities – education, research, administration etc.

    Next up was Dr. Walter Tavares (@WalterTava), Coordinator of Paramedic Programs for Centennial College, and a post-doctoral researcher in the area of paramedic education. Walter’s session was “Is there a ceiling on clinical expertise?” I’m sure we’ve all met someone who was clinically not-up-to-scratch in our time on the road, and at times, we’ve all been that person too in some area of our clinical knowledge. This was a very interesting session which looked at clinical reasoning skills among novice and expert practitioners. Novices & experts use same analytic & non-analytic reasoning skills, but experts come up with better hypotheses. Competence also declines with time, unless we stay current – this is where our focus should be:

    • Confidence is not equal to competence. Experience is not expertise
    • Shift emphasis from can you do it? to can you still do it?From what do you know? to is what you know evolving?
    • Experience is not enough, we need quantity, quality of difficult cases, and we need to avoid routine. We need to deal with difficult cases to develop clinical reasoning.

    Scope has increased since the 1970s but has our process for clinical reasoning changed? Walter says no, and that the system and culture of prehospital care don’t allow for it at present. Autopilot, just cruising along doing what we always do, is tempting. Mistakes are seen as negative experiences instead of learning opportunities. Another area of focus needs to be CMEs. Paramedics are dependent on self-assessment of strengths/weaknesses and needs for CME – science says self-assessment is unreliable because we have natural defence to it. CMEs are proven to be ineffective at changing practice. CMEs need guided, data-driven, self-directed learning.

    During the lunch break I had the chance to talk to Brandon Doneff, a Critical Care Flight Paramedic with Ornge, and author of Medics Little Helper, a handbook for all paramedics. You can check it out at www.medicslittlehelper.com.

    Back from break to listen to Ian Drennan (@IanR_Drennan), an ACP and resuscitation scientist with the University of Toronto. He spoke about the future of resuscitation. Innovations included the use of responder activation apps, mechanical CPR, ECMO, NIRS and more. Ontario will be trialing NIRS (Near-Infrared Spectroscopy), which measures cerebral microvascular oxygenation via transcutaneous sensors. He also spoke about the importance of correctly interpreting the TTM trial (which is regularly misinterpreted by providers), the role of cooling and briefly, the role of epinephrine in resuscitation.

    The next session was presented by Mary Osinga (@MaryOsinga), Coordinator of Paramedic Programmes in Fleming College, and was on the upcoming FRONTIER trial in Canada. FRONTIER is examining the use of NA-1 in stroke treatment. NA-1 is the first of a new class of neuroprotectants – PSD95 inhibitors. NA-1 blocks protein PSD-95 signals in brain that cause cells to die. It has been shown to reduce the volume and number of infarcts. NA-1 buys time for the brain basically! Toronto Paramedic Services, Peel Regional Paramedic Services & BCAS, in Vancouver will begin enrolling patients in January 2015, and preliminary results are expected in 6-8 months. For the first time ever, we may be able to treat stroke patients in the prehospital setting (for more see http://www.emergencymedicine.utoronto.ca/research/ptmr/CS/Frontier.htm).

    My final session, and by far the highlight of my day, was “Community Paramedicine: The Road to Success” presented by Michael Nolan (@ChiefMNolan), Chief of Paramedic Services of Renfrew County. One of the striking things that Chief Nolan said was “we’re always defining ourselves by comparison to others – police, fire, nursing. It’s time to be ourselves”. This is really reflective of the Paramedic profession “growing-up”. Micke went on to say that poverty is increasing, especially among elderly – and this is where our focus should shift, to the needs of the population. Older adults need reassurance that growing old does not need to mean reduced quality of life. He argued that community paramedicine should be part of every paramedics role – we should look after those we deal with the most.

    Go talk to them today, or go lift them tomorrow – Community Paramedicine in a nutshell! Mike Nolan

    He went on to say that Paramedics need to stop hiding out in ambulance stations, only dealing with worst case trauma or medical calls. Yes there’s a role for that, but what he says to his crew is here’s the keys, go be nice to people…it beats being chained all day to a dynamic standby point at the corner of the street! Renfrew paramedics provide 16 wellness clinics per month, mostly older adults present. The just show up, no appointment necessary, get their vitals and medications checked, and go home happy – these clinics have reduced 911 use in these people (many who were repeat presenters) by over 50%! He also provided detail on the PERIL Assessment tool which will be rolled out to every Paramedic in Ontario, allowing every paramedic to be a community paramedic. He finished by saying that Paramedics need to need to increase our value to those we meet most. We need to change from having knowledge to perform skills to having knowledge as a skill! For more information on Community Paramedicine in Ontario, visit http://www.communityparamedic.ca/pages/home/resources.php

    Sunday morning saw the conference continue with a plenary sessions on the future of Paramedicine in Ontario, which I was unable to attend, but from what I saw on Twitter, many of the same themes arose, namely

    • Degree level education
    • Self regulation for Paramedics
    • Community Paramedicine and the changing role of paramedics

    Dugg Steary was the main organiser of this years conference, and he, along with Nalina Williams (MD of www.platinumhospitality.com, conference organisers), the OPA Board and the Student Paramedics from Fanshawe College deserve a huge applause for organising a terrific conference.

    Geoff McBride (@gmacmedic), President of the Toronto Paramedic Association (@TPAnews), was voted in as the new President of the Ontario Paramedic Association, and we’d like to wish him the very best of luck with his term, which hopefully will coincide with some exciting developments for Ontario Paramedics.

    Overall Review

    The conference was engaging and had a varied programme that appealed to all in attendance, from students, to medics, educators and researchers. It also allowed ample time for mingling and networking, and it was great to meet Rob, Walter, Justin, Jason, Brandon and more in person.

    Would you attend again?

    Yes without a doubt! Paramedicine 2015 is scheduled to take place in Niagara, Ontario, and I’ll hopefully be there…and maybe you will be too!

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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