Merck
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In BC it's long been a tiered system, and one that we would never trade. Having ALS everywhere is useless, IMO. Our PCPs have a scope including epi (drawn), ventolin, IVs, D10W, N/S, ASA, Ntg (if Rx), nitrous, and glucagon. It works fine and many towns don't have ACP (medic) - only urban centers so it certainly fills a void. Are there problems? Probably. But there's problems with stupid nurses and doctors too. I think overall it works out best for patients.