Introducing ACP diploma into QL5 training

[Armymedic]

DD,
I agree with you in principle, but disagree in reality. Unlike the civilian fields where a specific set of skills are used and honed over years of experience, a Med Tech's role has too much variety to become expert on all the skills they learn. What is expected is that they are learned in each skill and attempt to maintain and improve those skills. Skills which range the gambit from prehospital point of injury skills right thru the role 1,2 and 3 facilities to palliative care roles.

Also you'd be surprised at the level of clinical skills and experience at the MCpl and Sgt level. Remember, these medics have been working around medicine for 8-10+ yrs in several of those employment positions.

Remember this is just discussing the prehospital role...we still have a whole bunch of other clinical and military training to do as well.

How safe is that? So far so good. Can it be better? Sure. Is there a way to make it better? Not with the op tempo. Though often,it is on those operations (like DART in Pakistan) that medics get to do all those skills and then some. The MCSP goes a long way to attempt to rectify some of the skills fade.

But if lack of skill practice became the limiting factor to prehospital Med Tech training, then the trade would revert back to the skill levels of stretcherbearers.

***************

I doubt many QL5's do intubations at all except in hospitals. I doubt there would be any scenario, in fact, in which a QL5 medic could do an intubation in which a physician or PA wouldn't be there to do it first (in non-war times).

I can think of quite a few.

I can think of NONE, as intubation is not a skill that QL 5 medics are allowed to independently perform. The PCP training standard is a Combitube (  :-[  ). Currently, you should not see any QL 5s doing intubations anywhere in the military context.

But this is pulling away the thread...want to talk about why intubation is bad/not a skill needed in the military/tactical context, lets open a new thread.

 

[old medic]

I can think of NONE, as intubation is not a skill that QL 5 medics are allowed to independently perform. The PCP training standard is a Combitube (  :-[  ). Currently, you should not see any QL 5s doing intubations anywhere in the military context.

But this is pulling away the thread...want to talk about why intubation is bad/not a skill needed in the military/tactical context, lets open a new thread.

I believe we're only discussing this in relation to the "what if" factor mentioned in the thread subject.
i.e, what if QL5 were ACP. To say that a military ACP couldn't intubate because they don't get into a
hospital weekly like a doctor, would be incorrect. I can speak for Ontario, and ACP's are lucky to get
into a hospital a couple times a year.  Even the majority of civilian doctors (GPs) do not get a lot of
chance for tubes unless they are also doing rotations in a larger ER.


<edit: corrected auto wrap format>

 

[Armymedic]

Then in the what if:

Then there would be very few rare cases (war or not) for an ACP qualified medic to do an intubation...other skills more likely and often. Most QL5 medics are become Advanced BTLS qualifed before going overseas.

 

[old medic]

Precisely... It's hard for ACP's on the civy side to get all their yearly tubes done
in some places. The military would be no different than any other place in that
regard.  If they do not get their required starts, they wind up in an ER/ICU/Surgical
ward looking to get them. That would probably wind up as part of a MCSP .. in theory.

 

[medic269]

Obviously when intubation is needed, time is of the essence, but if the skill is there, a medic will eventually come around and perform.

Call me anal but as a medical professional that statement would not comfort me as a family member of a patient.  If the attending medic told me that chances are I'd push them out of the way and work the call myself.  I've thought about the pro's and con's about introducing an ACP certification, and the skill set and knowledge taught would be great for the medics but again maintaining the skills and clinical thinking without the practice is very difficult.  Granted you may not be looking at too many medical calls while in the CF but what happens when someone decides to leave the CF and work the civvy street?  They're just won't be the same context of experience.  Base Hospital certification alone can't make up for not having practiced an arrest or a chest tube in 4 or 5 years while in the CF due to lack of oppurtunity. 

Conclusion of the rant.  If a program like that was introduced I think a maintenance standard would also have to be introduced in which an ex. amount of time is spent dealing with internal medicine and civy street medics per month or two or whatever have you.  It wouldn't make for a perfect solution but I tihnk it'd be alot better than teaching an ALS level medic and having him/her lose the skills within 6 months.

 

[Armymedic]

Call me anal but as a medical professional that statement would comfort me as a family member of a patient.  If the attending medic told me that chances are I'd push them out of the way and work the call myself. 

And you are a medic in the military? Too bad you're not allowed to intubate, it is out our your scope of practice.

BTW-we Med Techs are not medical professionals (we carry no license to practice)

 

[medic269]

I'm a licensed civilian paramedic...who joined the CF...so as such do refer to myself as a medical professional...being that I do have a license...

Anyone else care to turn a civilized discussion into an "I told ya so" show....

 

[Armymedic]

Well, good for you. So which is your full time job?

 

[Medic19]

Hello,
This being my first post, here goes.

the medical technician QL5 course does currently have an ACP portion, called AEC (advanced emergency care) which will give the med tech the same rights as a SAR tech as far as emergency medicine is concerned.  The problem is, that the military has been looking for a ontract for this portion for the last 2 years, SUPPOSEDLY it will be tendered in the new year.

 

[medic45]

Most ACP courses in Canada vary between 1300-2000 hours.  This would probably entail extending the QL5 course by approximately a year in a best case scenario.  I don't believe the current fiscal and operational reality can support this concept.  The vast majority of the ACP skill set covers cardiology and pulmonary emergencies which are relatively rare in the military context.  A more viable option is probably to have a limited advanced trauma skill set similar to the US Army CMAST (Combat Medic Advanced Skills Training) course.

On the subject of intubation:
There has been considerable controversy around prehospital intubation with the release of the study by Wang et al.  Any implementation of an intubation program for med techs in the CF would have to be accompanied by an aggressive QI program to monitor success/failure and complication rates. 

 

[Donut]

As well, ref Wang et al, the magic number was 12, if I recall, per month.  That also, if I recall, was talking about in-hospital intubations.

If you look at the AAA Difficult Airway Algorithm, every pre-hospital airway meets the criteria of a difficult airway.

I don't see the vast majority of CF Med Techs (or even PA, GDMO, etc. ) placing enough tubes to be truly profficient at it over the long term.

I'm sure there's ALS procedures that can be pushed down to our med techs, including needling chests and and crichs ( a la CMAST), but ETT placement is a fine motor skill, which need regular application to be performed safely.

DF

 

[medic45]

I think the recent trend of incorporating more TCCC philosophy may help to rectify some of this.  The reality is that needle decompression is probably the single most useful prehospital ALS procedure used in trauma managment.

 

[Armymedic]

The reality is that needle decompression is probably the single most useful prehospital ALS procedure used in trauma managment.

No, the reality is correctly applied bleeding control (read: direct pressure) is the single most useful procedure in military trauma management.

 

[medic45]

Actually in my post I specified ALS procedure.  Bleeding control is not an advanced life support procedure, but I definitely concur with you.

 

[kj_gully]

Just to muddy this thread a little more... we (SARTechs) have just had intubation removed from our scope of practice, and replaced with LMA (Laryngeal mask airway) w will be using LMA Supreme, which allows passage of an OG tube. Even when we did ET intubation by protocol, we did not have the means to sedate and paralyze patients, so were only permitted by protocol to intubate in three scenarios, as part of the Cardiac arrest protocol, post arrest stabilization protocol, and discontinue resuscitation protocol. I cannot say with certainty that ET tubes were never placed in the post arrest protocol, but I know that the vast majority were placed in the other two, and did not change patient outcomes. :skull: Intubation was a skill that is difficult to maintain ( there are in my experience only a few /day performed in operating rooms) It's a pain to troll the operating theaters looking for "tubes" . As well, most anesthetists, or anesthesiologists,or whatever they want to be called this week, were loathe to let us do any but the most rudimentary insertions, as it was their ass on the line if things went south. Having said all that, I find, as do most SARTechs I've talked to that the actual procedure is pretty easy, and am confident that should I ever need to do it, I will have success. I think the CF is correct in not providing an ACP certification to ql5 medics, based on the amount of time it would take to maintain the skillset, vs the amount of use the skillset provides the CF. It would be a terrific continuing ed opportunity for deserving medics within a unit however.

 

[Medic19]

As I stated earlier on this topic the QL5 Med Tech course will eventually include all the SAR Tech protocols, and yes the Med Tech will most likely not go with ET intubation and will go with the LMA.  There will be no official ACP course equivalent to the civilian sector, but only the SAR Tech protocols.  Presently the QL5 Med Tech training plan calls the course Advanced Emergent Care, which will allow the deployed Med Tech to provide better care in certain situations.

 

[blasty_bough]

I"m new at this so please go easy on me. I"ve skimmed over all the posts and I admit I may be repeating some things.

The CF did consider ACP but, after much review, decided against it. The ACP simply does not meet the needs of the CF. The PCP contract has been let and the site visit will be conducted this week. The AEC course finally got through PWGSC after two very frustrating years. It looks like a pretty awesome product but only time will tell. The Request for Proposal is on the MERX now and the plan is to have at least two courses completed this fiscal year. However, things happen and I tend to brace myself for the worse case scenario. 

In the Fall of this year CFHSHQ plans to conduct a SCOMR to review (once again) Med Tech training, including Physician Assistant.