This.

From today's news, right on topic: https://www.cbc.ca/news/canada/toronto/ontario-health-care-workers-warn-of-brutal-nurse-shortage-as-hospitals-brace-for-4th-wave-1.6150255

15 years and no sag. We are not gentle with them either

Great minds.......

Ha. We use. A plastic juice pitcher. Has a handle and the narrow tall shape prevents splash. We don’t drink juice..... hopefully my kids won’t be traumatized by juice pitchers later in life

These church burnings don't represent anti-catholic sentiment by the general population though. They were a reaction to a particular situation (discovery of hundreds of mass graves) by a very small minority to a historical atrocity. . Really recent history - the last residential school didn't close until 1998. FN leaders have strongly condemned the burnings, calling them criminal. The churches that were burned were on FN land. Obviously burning churches is abhorrent, and is not an appropriate way to protest. It's pretty unlikely you are moving to a FN reserve (unless you are a FN person with ties to Canadian bands).

bowl. We have a designated "barf bucket".

I think the regular-testing-in-lieu-of-vax option is going to be phased out by most institutions and employers. Weekly testing pretty much tells you too little, too late - that there has already been workplace exposure by the time the employee has their positive weekly test. Prevention (vaccine) vs mitigation (testing). A large local hospital is in the process of phasing out regular testing as an option now. I think that other hospitals and other instructions that serve vulnerable populations in the province will follow suit, then schools, then other workplaces

Yes. Religion is a private matter. It's just not discussed much.

Catholic Churches are EVERYWHERE. I think every community has one. Every town in Ontario has at least 4 churches: Catholic, Presbyterian, Anglican, and United. Some aren the 4 corners of the same same intersection of the Main Street. They are the four main historical religions/denominations of the country.

Canadian. Never lived in the States, but know plenty of people who have. Taxes will be a lot more than you are used to. Healthcare: Healthcare is a provincial responsibility, and publicly funded healthcare varies a little province to province. I know my own province best, what follows is what's true here: Provincial plans (publicly funded, universal health care) generally pay for hospital and doctor fees. So doctor's visits and hospitalizations are $0 out of pocket. The usual waiting time to be covered by provincial plans is 3 months of residency. There is no parallel private system. EVERYONE uses the public system, whether they like it or not. It is illegal for MD's or hospitals to bill privately for services that are covered under the provincial plan. So you won't have the same kind of choices in healthcare delivery as you do in the US. We DO NOT have universal pharmacare. In most provinces, medications are paid for privately (either out of pocket, or by a private insurance plan). My province's publicly funded pharmacare plan pays for prescriptions medications for those over 65, those on social assistance (unemployment, disability), and children under 25 who do not have a private plan. Everyone else pays for their own privately. Drug costs are cheaper here than in the US, though. There is a movement toward universal pharmacare, but it's not coming very soon, I don't think. Dental is private also. Catholicism: I have never in my life observed an anti-catholic bias in Canada (but I'm not one, so what do I know?). The current prime minister is Roman Catholic. Religion is definitely more of a private issue here, and religious community seems to play less of a role in daily life that it does in the US. The recent church burnings on Indigenous land are a very new thing. Past mistreatment of Indigenous people by the Catholic Church in the residential school system is a red hot issue right now. Many Canadians are learning the truth about the abuses for the first time (with the much publicized discovery of hundreds of unmarked graves at residential school sites), and many Indigenous people are ANGRY. I mean, I think that you'd have to have lived under a rock not to have known about these abuses - there was a commission that got a lot of press 2007-2015 - but, apparently lots of Canadians indeed live under rocks..... Politics: Generally more liberal leaning, though this varies by region. Both your current president and Vice President align politically and policy-wise with our Conservative party, and are way to the right of our liberal parties. Don't misunderstand me, there are definitely plenty of conservatives here, and pockets of very conservative conservatives, but on the whole the culture is much more liberal, I think. Multiculturalism is an official policy. Most cities are extremely diverse. Rural areas markedly less so. Many fewer guns, and many, many more restrictions on their use. ( The images from the Michigan protest last year with the militia guys and their rifles in the legislature just about made my brain explode. That idea of guns at protests is mind-boggling. That would NEVER fly here.) Let me know if you have other specific questions about life here. I don't know much about immigration policy though. ETA: forgot one. Our money comes in pretty colours: blue, purple, green, red, brown.... Coins come in both both silver and gold tones

We're pretty good at managing people. Nobody (patients or their families) in the emergency dept is having their best day.... Managing demanding and anxious people is bread and butter for us. Truly disruptive visitors get kicked out. ETA: we aren't asking families to provide medical care. But the sort of care that they might otherwise be doing at home anyway (fetching drinks/blankets/sandwiches, helping with feeding etc) is not a problem and can be very helpful. For patients with dementia, having a familiar face at the bedside is often very calming and prevents much agitation and behaviours that otherwise would take up much nursing time.

I would so love to have families back in emergency departments again. Not so much for providing care, but more for getting the history and advocating for the patient. It's really, really valuable to have family at the bedside when assessing frail elderly, dementia, chronic illness, and really anything that makes it difficult for the patient to be clear and objective about their history. Having to track down the right family member by phone is seriously time-consuming and not nearly as valuable as having someone who knows the patient at the bedside. I am very, very assertive about declaring a family member an essential visitor to make it happen (I'm quite sure that I annoy admin on this issue) - the quality of care is soooo much better when family can see what's going on, fill in gaps in history and advocate in real time, in person.

CDC guideline on vaccine administration: Aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary because no large blood vessels are present at the recommended injection sites, and a process that includes aspiration might be more painful for infants (22). Note that this quote is pulled from a section about IM vaccine administration for all ages, not just infants.

Not anymore. Aspiration during IM vaccination (unless in the dorsogluteal muscle to be sure you aren't in a particular nearby artery) is not standard of care. Evidence suggests it's not necessary. There are loads of literature reviews on the topic Abstract of one, full text of another, excerpt: "Findings of guidelines and recommendations Vaccination: According to the Red Book 57 published by the American Academy of Pediatrics (AAP), there is no need of aspiration before injection of vaccines or toxoids. Similarly, the US CDC guidelines for administration of vaccines 65 have clear instructions not to aspirate before injection (for both IM and SC routes), as no large vessels exist in the recommended injection site. No recommendations were found in the Pink Book 81 from the CDC in this regard". There aren't any large veins or arteries in deltoid injection site. If you were to somehow hit one, you will get blood flash into your syringe, no need to aspirate Aspiration makes injections more painful, and the two-handed technique makes tissue trauma more likely Some safety syringes make aspiration impossible Evidence suggests that aspiration during vaccination doesn't help, and might harm.

It really is. The logistics of management was also quite fascinating and difficult. There were loads of kids (like a busload) all presenting to the ED at the same time with a ?poisoning/toxic exposure to a neurotoxin. We had to get them all through the decontamination shower, use CBRN (chemical, biological, nuclear,radiation) event protocols etc because there was no way to know it wasn't a true toxic exposure until afterwards. The ED pretty much ground to a halt for all other patients. On the plus side, it was really good training to prepare for CBRN events.

Tangentially, we've had two outbreaks of mass psychogenic illness (also in the class of physical disorder caused by stress, and in this case, also social contagion) flood our ED in the past 20 years. Both in high schools were someone thought they detected a toxin (smelled something) then had sudden onset neurological symptoms. Symptoms spread acutely amongst the student population; the same symptoms plus fainting. The presentations were dramatic, and the symptoms were absolutely real to those suffering them. Exhaustive environmental testing turned up nothing, and the pattern of who got sick and who didn't didn't make any physiological or epidemiological sense (but did fit the expected pattern of a MPI). It all disappeared by itself (symptoms and smell) by the next day. It's a really fascinating phenomenon

I do think it's worth differentiating, because it's a different mechanism. Meaning that prevention would need a different approach. Decreasing the psychological/emotional stress of the vaccine needs a psychosocial approach (both at the individual and societal level), rather than a traditional medical approach. It would be very interesting to me to see FND rates across countries. I suspect rates will be higher in the US, where vaccines are such a hot, polarized, politics, tense issue. FND's are enigmatic, that's for sure.

Bike storage was my thought as well.

I'm just back home from work. Reading the responses in this thread has been quite therapeutic Thanks all.

As individuals? All the things that many of us are already doing: get vaccinated, wear masks, have patience with healthcare workers, use emergency departments for emergencies, not convenience (that last is more of a Canadian issue, I suspect). I think this is going to need a bigger, collective solution. Primary care and other social services need to find a way to see their patients and clients in person and provide pre-pandemic levels of service. Hospitals and governments need to find a way to fix working conditions and staffing. I'm afraid it will take a lot of effort and money.

Continuing on, My coworkers and I have had lots and lots of thank you's for the care we've provided during the pandemic. No doubt that they are sincere. And I appreciate the sentiment greatly. But... I don't really want to be thanked for providing crummy care in a hallway after a 6 hour wait in a packed waiting room, in an overcrowded, understaffed ED with hassled burnt out staff. What I want is to be supported to proved excellent care. And I just don't see how that's going to happen soon

Part rant and part vent, I think. NYT: Nursing is in Crisis:  Staff Shortages Put Patients at Risk CBC: Nurses are leaving their jobs "Roughly two-thirds of emergency room nurses at a hospital in Kamloops have recently left their jobs" Quebec ER's on the Verge of Breakdown "A growing number of emergency rooms in Quebec are struggling to care for patients as hospitals deal with severe staffing shortages caused by nurses fed up with pandemic working conditions." CTV: Ontario nursing sector slammed with shortage as many rethink their careers. This is all over, both US and Canada. My own ED has lost about 1/4 of its nursing staff, almost all pandemic related. The staff who remain are just.so.done. Exhausted and morally injured. Working short-staffed in an overcrowded department is misery. It's becoming impossible to put on a "game face" while at work. I fear that we're into an autocatalytic, vicious cycle. It's very hard to persuade new hires to work in these conditions. There has been a tremendous loss of experienced staff, which really will affect patient safety. Seasoned ED staff are invaluable. It's going to affect every single person needing hospital care for any cause. For years. There have been news pieces all through the pandemic devoted to the HCW experience. So, not a new issue. Yet I haven't seen much about actually doing something about it. (OK, not nothing: We did have modest "pandemic pay" for certain frontline workers, but that ended over a year ago. We also have "resiliency training" and various MH support services available, but none of that fixes the actual problem of poor working conditions and being understaffed) I can tell you what's not going to help: Alberta Health Services invokes emergency work rules for nurses as COVID hospitalizations rise " Alberta's nurses may soon be forced to work mandatory overtime and cancel holidays in response to a chronic staffing problem worsened by surging COVID-19 hospitalizations."

Yes. For most vaccines, paediatric (even babies) and adult doses are the same. For some (shingles, hep), the adult dose is higher (to accommodate for poorer immune response in adults), And for others, the adult dose is actually lower (Pertussis, dipheria boosters - to minimize immune-mediated side-effects more common adults, who already have some immunity). Really, an 11 year old's immune system isn't meaningfully less mature than a 12 year olds. The age cut-off is somewhat arbitrary. There is no such thing as 10 mic dosing here. I don' think that dose has been approved for anyone, anywhere yet?

Full 30 mic dose. We are treating those who turn 12 by Dec 31 as 12-year-olds. It makes sense in our province, as the school age cut-off is Dec 31. So this way all children entering grade 7 (by age) will be eligible for their first dose before school starts after Labour Day. Rather than just 2/3 of the class.