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Introduction: Paramedic practice is highly variable, occurs in diverse contexts, and involves the assessment and management of a range of presentations of varying acuity across the lifespan. As a result, attempts to define paramedic practice have been challenging and incomplete. This has led to inaccurate or under-representations of practice that can ultimately affect education, assessment, and the delivery of care. In this study, we outline our efforts to better identify, explore, and represent professional practice when developing a national competency framework for paramedics in Canada. Methods: We used a systems-thinking approach to identify the settings, contexts, features, and influences on paramedic practice in Canada. This approach makes use of the role and influence of system features at the microsystem, mesosystem, exosystem, macrosystem, supra-macrosystem, and chronosystem levels in ways that can provide new insights. We used methods such as rich pictures, diagramming, and systems mapping to explore relationships between these contexts and features. Findings: When we examine the system of practice in paramedicine, multiple layers become evident and within them we start to see details of features that ought to be considered in any future competency development work. Our exploration of the system highlights that paramedic practice considers the person receiving care, caregivers, and paramedics. It involves collaboration within co-located and dispersed teams that are composed of other health and social care professionals, public safety personnel, and others. Practice is enacted across varying geographical, cultural, social, and technical contexts and is subject to multiple levels of policy, regulatory, and legislative influence. Conclusion: Using a systems-thinking approach, we developed a detailed systems map of paramedic practice in Canada. This map can be used to inform the initial stages of a more representative, comprehensive, and contemporary national competency framework for paramedics in Canada. [ABSTRACT FROM AUTHOR]

Background: Use of blood conservation techniques in elective surgery reduces the risk of infection and transfusion reactions that result from using allogeneic blood products. We examined the transfusion practice and blood conservation strategies for elective orthopedic procedures in 19 Canadian hospitals. Methods: We reviewed the medical records of patients who underwent total hip or knee joint arthroplasty between June 1998 and January 1999 in a convenience sample of 19 hospitals to determine the pre- and postoperative hemoglobin concentrations, concurrent medical conditions, participation status in an autologous blood donation program, use of other blood conservation techniques, and occurrence of allogeneic and autologous transfusions. Patients were considered eligible for autologous blood donation if the y weighed at least 25 kg, were in good general health without major cardiac conditions and had a hemoglobin concentration of at least 110 g/L. Results: We reviewed 4535 medical records. Of the 4422 patients whose eligibility status was known, 2561 (57.9%) were eligible to participate in an autologous blood donation program. Only 842 (18.6%) of the patients predonated blood. Patients who did not predonate blood were older (mean age 70.1 v. 63.8 years) and were more likely to have concomitant medical conditions (60.3% v. 37.9%) than those who did predonate. Overall, 30.6% (95% confidence interval [CI] 29.1%-32.1%) of the patients who did not predonate blood received allogeneic transfusions. For patients who predonated, the rate of allogeneic transfusion was 14.1% (95% CI 11.8%-16.5%). The frequency with which blood conservation techniques other than autologous blood donation were used was minimal (in 2.4% of all cases). Interpretation: The use of blood conservation techniques among hospitals in Canada remains low. Only a minority of eligible patients participated in an autologous blood donation program. [ABSTRACT FROM AUTHOR]

This paper explores the variation in class consciousness in three Western democracies: Canada, Sweden and the United States. Its main empirical finding is that Swedish levels of working class identification, conflict consciousness and capacity to envisage an alternative form of social organization are considerably higher than their North American counterparts. While this finding is not surprising to comparative political sociologists, it does provide an occasion for an argument that the differences were basically established in the postwar period and are the product of the different outcomes of the social conflict that surrounded the Great Depression. In its reduced form, our argument is that outcomes of social conflict have had an impact on the distribution of social power and the working classes' sense of collective efficacy which, in turn, have profoundly influenced the consolidation and extension of class consciousness. [ABSTRACT FROM AUTHOR]

Descriptive accounts of working class consciousness ultimately obtain warrant from the strength of explanations that underline them. This article examines the explanation which asserts that working class consciousness is fragmented because of internal structure differentiation according to gender, ethnicity, religion, region and skill. The conclusion is that this explanation finds little support from an examination of evidence concerning the political attitudes of the contemporary Canadian working class. Regional differentiation is the only structural basis that affects a modest impact. The implication of this is that students of collective action should move beyond purely internal examinations to consider the impact of class relations and political strengths.

This paper presents a test of S.M. Lipect's thesis that Americans are less respectful or accepting of authority than people from Canada and from the other English-speaking democracies; Australia, and Great Britain. We use data from World Values Survey, 1981-83, to compare adult samples from the four populations, with separate analyses for English Canada and French Canada. Twenty-one dependent variables are employed, measuring beliefs about authority in general, civil dissent and disobedience, authority in the workplace, confidence in social institutions and obedience in children. The English-Canadian-American comparisons consistently disconfirm Lipect's hypothesis, with English Canadians either being less accepting of authority than Americans or showing no significant differences. The results comparing Americans with the other samples are less consistent but also indicate that Americans are not the least accepting of authority. Contrary to Lipect's thesis, Australians are not especially lots in respect for authority, either; nor are the British exceptionally high. Some support is found for Lipect's suggestion that French Canadians are relatively low in acceptance of authority. These results hold both with and without controls for ten social background factors. [ABSTRACT FROM AUTHOR]

This paper brings together two related hut distinct issues in the analysis of culture and values in Canada and the United States. The first of these is Lipset's well-known thesis on the differences in national character and belief systems between Canadians and Americans. The second issue is the purported existence of distinct regional cultures within both countries. Using national sample survey data, we assess both cross-national and regional differences on a range of attitudes and perceptions. The results indicate that the pattern of regional cultures is not significantly affected or defined by the national border separating Canada and the United States. Instead, hierarchical tests of several different models suggest that, with a few exceptions, the map of regional cultures involves three major segments: a relatively left-liberal Quebec, a more conservative southern United States, and a comparatively moderate sector that largely encompasses the remainder of the two countries. The implications for Lipset's thesis on Canadian-American differences, and for the analysis of regional distinctions in both nations, are briefly discussed. [ABSTRACT FROM AUTHOR]

This paper represents the first attempt to assess the relationship between economic dissatisfaction and support for unions, using panel data collected at the national level. A latent variable (LISREL} model is employed to examine the attitudes of a representative sample of Canadian respondents during the period from 1977 to 1981. The findings indicate considerable stability in attitudes about union rights and powers over time. There is some tendency for economic dissatisfaction to produce more negative perceptions of unions among union members. Significantly different patterns are found for union members and 'potential' union members, on the one hand, and individuals who are not potential members, on the other hand. [ABSTRACT FROM AUTHOR]

Introduction: The aging population in Canada is steadily increasing and is placing greater demand on paramedic services, especially through the growing number of non-emergent lift assist (LA) calls. A LA occurs when a person calls paramedic services and requests assistance to get up or mobilize, usually after experiencing a fall. The patient refuses transport to the emergency department for further medical attention. LA calls are time consuming and are non-reimbursable. The increase in number of this call type, specifically amongst older adults, is placing strain on paramedic services., Objectives: The purpose of this study was to describe the characteristics of LA calls in patients aged 65 and older and determine their impact on paramedic services., Methods: A dataset of 1,121 LA calls of patients aged 65 and older was extracted from Middlesex-London Emergency Medical Services (MLEMS) database of electronic patient care reports collected over 1 year in 2015. Statistical and qualitative analyses were performed to describe LAs, perform time analysis, and extract dominant themes from the text in report notes written by paramedics., Results: The LA calls were generated from 611 individuals: 334 women (54.7%) and 275 men (45%), of which 192 (32%) individuals called more than one time. On average, a LA call lasted 43 minutes and ranged from 6 minutes to 2 hours and 23 minutes. In 2015, paramedics spent 801 hours, or the equivalent of 33 days (24 hours/day), solely conducting LAs for older adults. Text analysis determined that the bedroom (24.9%) and bathroom (17.0%) were the most common locations where LAs occurred. Most frequently, LAs were caused by a collapse or drop (28.7%), slide (25.7%), slip (16.7%), or trip (11.7%)., Conclusion: LAs consume the time of paramedics, preventing them from responding to more urgent emergency calls. Alternative solutions are needed to reduce the negative impact of LAs on paramedic services.