Some years ago, when I was studying at CEGEP, I got a job working in a chronic care hospital for veterans. While I was working there I met a number of colourful characters - among both the patients and the staff! I also come into contact with a whole range of health care workers, from professionals with several university qualifications to folks who had been trained completely on the job.

One summer I was asked to help supervise the orientation of a new co-worker. I was supposed to make sure that he had a proper attitude and approach towards the patients, and that he used the approved techniques and safety measures when it came to things like patient transfers, hand washing, and so on.

None of that sounds so very unusual, does it? What if I said this gentleman was an experienced First Responder whose regular job was working on Urgences Santé ambulances? Sounds a little strange now, doesn’t it?

My co-worker was taking a bit of a sabbatical from his usual job, which was working in an ambulance and - well, I’m not really sure what else. I know he did CPR as part of his job, and I know he was trained to intubate people and install an IV. He probably had a lot more skills than that, though whether he was allowed to use them on the job I couldn’t tell you.

Let me take a stab at explaining the situation (no pun intended!) The Paramedic Association of Canada recognizes four levels of emergency care providers, only three of which are technically paramedics.

Apparently, the folks who work in the majority of ambulances across Canada are Emergency Medical Responders (EMR - in Quebec we call them technicians, and the abbreviation becomes EMT). They aren’t really paramedics. They can perform advanced first aid and CPR, they can administer oxygen, and they can now use semi-automated defibrillators in some provinces. That’s about where their job description ends.

No IV’s. They aren’t allowed to intubate anyone. They can’t give you any medication (although if you have your own they can get it for you so you can take it - if you’re conscious.) Forget what you saw on those 1970’s shows when you were a kid. These guys aren’t allowed to do half of that stuff.

These are the guys working on our ambulances in Quebec. The only ones, aside from a small handful of Advanced Care Paramedics who were involved in a Montreal pilot project, and stayed on afterwards.

According to Wikipedia, paramedic training in Canada is regulated provincially. It varies from three months in British Columbia to three years in Quebec. Yet it is in Quebec that most pre-hospital care is either withheld, or at some times, is provided by a physician who works for Urgences Santé and is called to the scene once the technicians have assessed the situation. We don’t have enough doctors for everyone to have a GP, or to keep all our hospital emergency rooms open reliably. So you know how well that particular strategy is going to work, right?

Some of our Urgence Santé technicians are trained Primary Care Paramedics or Advanced Care Paramedics (that’s the third of four levels recognized in Canada, the ladies and gents who can do all the stuff you saw on TV as a kid.) But the law doesn’t recognize their certification, so they might as well not have it.

If I understand the situation correctly, just recently our EMT’s are finally allowed to use five basic medications for symptomatic relief. And yes, I believe here in Quebec they can use the defibrillators. We’re now calling our ambulance technicians “paramedics” too, but some of them are saying that change is just so much spin.

We’ve got trained ACP’s who have to sit on their hands because the law doesn’t permit them to use their skills. Why? Much like the situation in which Quebec is the only jurisdiction in Canada or the United States where a doctor must diagnose autism (see my post on that here), people who are trained to do a necessary job are being stopped from doing that job. And it’s the public who suffer for it.

So, while there are Advanced Life Support paramedics based on ambulances, firetrucks, and helicopters everywhere else in the G8, here in Quebec, physicians have decided ALS paramedics are just not necessary for the chain of survival.

~ Hal Newman, Quebec Paramedic

A new Pre-hospital Emergency Care program is about to begin next fall at John Abbott College. The three year program brings the standard training up from 900 hours to 2000, and leads to a DEC (college diploma.) According to a Gazette report by freelance writer Patricia Enborg this marks the beginning of a transition, over the next ten years, to the instituting of three tiers of paramedics in Quebec. The John Abbott program will be the new standard for those wanting to work in pre-hospital care.

It isn’t clear whether the John Abbott graduates will be recognized as Primary Care Paramedics or Advanced Care Paramedics - though one would hope with a commitment of 2000 hours and three years, it would be the latter. ACP courses I investigated in other Canadian provinces (Ontario, Saskatchewan & BC) were at most two years long….

Actually, it was a voyage into the wonderful world of acids, bases and indicators - purple cabbage, in our case.

We bought a small purple cabbage when we did our grocery shopping, cut it into small pieces, and boiled it up the other day. It takes about 30 minutes to get a good, deep purple colour to the water. Don’t throw your cabbage out! A science web site I consulted suggested flavouring it with a little vinegar and serving it on hot dogs. We forgot to get hot dogs at the grocery store, so we cooked up sausages and served them like hot dogs, with mustard and purple “slaw” on them!

I mixed up a few solutions for the girls to test with their cabbage water indicator: baking soda in water, diluted vinegar, dish soap in water, baby shampoo in water, and just water itself. I used bottled water that we had kept in the pantry a bit too long. Although it was past the expiry date on the label, we weren’t going to consume our solutions. And bottled water is less likely to have sediments that might affect the results of the experiment. (You can filter tap water too, but this made good use of something I’d otherwise have had to throw out…)

For each solution I used the same amount of solvent (1 cup or 250 mL of water) and the same amount of solute (1 tbsp or 30 mL.) We measured 1/4 cup (60 mL) of indicator into each solution, and were careful to stir each one with its own spoon so we didn’t contaminate the solutions. The girls were sent out of the room while I mixed the solutions, so they wouldn’t know which was which. This was a blind experiment, though not double-blind because I knew what each one was. (The girls did know what ingredients I had used, though. This is bending the rules just a tad.)

Our solutions turned a variety of colours when the cabbage juice was added, from pinkish purple to a rather dark blue. The girls learned that in the presence of an acid the anthocyanins in red cabbage will turn red or pink; in the presence of a base they turn blue or green. This is, of course a simple way of measuring pH.

We arranged our five solutions in a kind of rainbow. Our shampoo and soap solutions came out in the purple range, close to the water. Although they should be basic solutions, they looked closer to acids. I think we would have had better results if I had used a stronger solution. Vinegar was a pale pink, and the baking soda was a really dark blue.

We discussed a little consumer chemistry, looking at our samples of baby shampoo and dish soap. Of our five samples, the one closest in pH to water was the baby shampoo. Some commercials for soaps and shampoos like to talk about the product being pH neutral, or pH balanced. We were able to see that baby shampoo was, indeed, very close to the pH of water. In future maybe we’ll round up some sample bottles of different brands of shampoo and see just how neutral they are!

At the end of our experiment we cut up some coffee filters and dipped them in our left-over cabbage juice, to make some indicator papers. (It would be quicker and easier to dip whole filters and cut them up after drying, but our juice had been stored overnight in the fridge in Mason jars.)

And because the children are always wanting to see it, we made the “volcano” reaction. No papier maché, though I have promised we will do it in future, but I mixed vinegar and baking soda together so they could watch it bubble. I talked about reacting an acid with a base in order to neutralize them both. This type of reaction always creates a salt of some kind, and water. If you did chemistry in high school you will remember acid-base titration. If done right it’s a good lab to get kids interested in chemistry. It’s not too complicated, and if you use a standard lab set-up with burettes, beakers and pipettes kids feel like “real” scientists. The colour change on indicator papers is very dramatic too, especially when all the solutions you start and end with are clear.

Why have I filed this particular post under “safety”? Because Mama was silly when she made her demonstration volcano, and poured entirely too much baking soda into the container. I ended up using the last of my vinegar and causing an overflow when I added the vinegar too quickly. Lesson #1 for the girls: even Mama can make a silly mistake. Lesson #2: it was a good thing the acid and base we were using were both weak & harmless, because Mama ended up wearing rather damp pants when the volcano spilled from the container to the table and over the table into Mama’s lap! (Lesson for Daddy: if had been strong chemicals in a lab, Mama would have stripped the pants off & been in the emergency shower very quickly!)

This work was created by Ruby of Freehold 2, and is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 Canada License.

Excerpts copyright quoted authors. Please visit their sites to read more, and respect the terms of their copyrights. Burette clip public domain, courtesy of Wikimedia Commons. Thanks!

Many thanks to Sonya, who posted this video to her blog at Montreal Homelearners. Mr Tulley’s comment about kids healing fast made me think of my girlfriend teasing the sensei a few months back when he got scratched during a demonstration at the dojo. She said, “C’est loin du coeur.” (Literally, it’s far from the heart - meaning, no great danger that he would bleed out.)

The TED Talks seem to be a very worthwhile series. If you get the opportunity to listen to others, do take advantage!

This work was created by Ruby of Freehold 2, and is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 Canada License.

Excerpts copyright quoted authors. Please visit their sites to read more, and respect the terms of their copyrights. Thanks to Sonya of Montreal Homelearners for bringing this to my attention!