Kiwiology

There has always in some form or another been a skills re-cert program here but it's been quite hit-and-miss and rather patchy depending on various factors. In recent times however the process has been cleaned up and tightened down a bit, which is quite pleasing to see. Beginning late last year a new program was introduced to require 40 hours of continuing clinical education and a re-cert every two years. This is basically one or two shifts where somebody (most likely a Clinical Standards Officer) will come and ride with you and verify you know your stuff. Clinical re-val is quite seperate to "employee development" or whatever flash sounding name has been given to it now. There is a process that every six months you are supposed to meet with your Manager and work out goals and areas for improvement etc however how well this is implemented remains to be seen. I don't think a lot of people really care about it to be honest. With looming registration under the Health Practitioners Competency Assurance Act the onus will shift from the employer to a Council under the Act and basically mandate that the mirrored employer guidelines are setting up now. This means you will have to go to the "Paramedics Council" and prove you have met your CCE and re-val requirements to get a new license for the year. This is currently present in the UK with the HPC for Paramedics (ALS) level practictioners.

I believe in the US a lot of it has to do with taxation at the local level and the almost totally privatised healthcare system. Los Angeles City FD used to have single-role civillian Paramedics employed by the Fire Department but in the late 90s that got too expensive, so it was cheaper to just train some firey's to do it instead.

I don't think many of our senior managers have any formal management education maybe one or two has a class here and there Sounds like with my Bachelors Degree in operational and strategic management I could go far

I think what he means is more NFPA style mandated standards. Of course for that to happen you would need NEMSA! The New Zealand Fire Service has many, many quite specific standards for things like workplace safety, bunker gear, tools, quality management etc while the Ambulance Services standards' are quite broad and generic and of less quality generally than the Fire Service. Last I heard Ambulance Victoria (Australia) has stockpiles of 270 days worth of supplies, PPE and N95s. Most of our PPE is low-level and the full chem/bio suits are only avaliable to the Northern Region SERT team. Contrast this to the Fire Service who has large stockpiles of CBRN gear, very specific standards around it's use and quality and specific standards on general protective equipment eg bunker gear. Me either, but it would be easier to pick up chicks if I had some boots, bunker pants and a blue Fire Service t-shirt to go grocery shopping in

The uniform here is largely white pilot style shirt and black pants. What I like about the uniform - Works reasonably well - Most parts look acceptable - Easy to wash and iron - I have a thing for the fluro glow worm jacket - The service has a zip up polar fleece which I hadn't seen before, looks good What I don't like about the uniform - Value is arguable for the price paid (I think a complete set is about $2,000 NZ) - The white pilot style shirt is not a good choice when you're bending, CPR, squatting, carrying heavy gear, twisting etc - White gets dirty too easy - Black pants only have the two hip pockets - Epaluettes are redundant and pointless - Rank is redundant and pointless, causes more problems than it is worth - There is a preoccuptation with putting the a particular service providers name everywhere possible - Some qualification patches look quite cheap and nasty - Too many qualification patches (this should change at some point) - SERT and HEMS get a green onsie jumpsuit whereas road staff are not allowed to wear them - Fluro vest is quite bulky Management of one service rejected the idea of moving to a onsie UK style jumpsuit (odd considering HEMS/SERT use it) and I believe they are looking at a redesigned rain jacket as well as introducing a new zip up style vest and t-shirt rather than a business style pilot shirt. One small service here uses a blue polo shirt which looks really nice.

If they can't be seen it seems a bit silly. Figure I'd best stop wearing my 18k gold rolex, hate to have to disinfect that

The IAFF strikes again, to thier credit they are very slick at whipping up a bit of fear and getting the politicans under thier thumb. Go back to playing boggle eh

Good points raised by all. Like Medic One we use ProQA/AMPDS so get an A-E detriment; it doesn't really mean much because unlike in the US we do not have true multi-agency or multi vehicle capability. The exceptions are for a D or an E in an area where a first response group exists (usually the Fire Service) they will go or if it's in metropolitan Auckland/Christchurch you may get an Intensive Care (ALS) rapid responder. Under our contract with the Ministry of Health a C, D or E is made priority one so we have to be there within .... I think 8 minutes in an "urban" area and 16 minutes in a "rural" area. It DOES NOT mean we have to use lights or sirens and in some cases no visible warning is given; whats the point if its one in the morning and the call it two blocks down the road? As far as speed I think it's largely unncessary and borne out of false pretence of the "golden hour" or other such crap; Bryan Bledsoe has a good PowerPoint on his website about both. The minutes you save is not worth the risk. Going back to hospital p1 is something I have seen twice in four years; one for a STEMI and once for seizure.

You know Phil I agree. We have about 100,000 people where I am and last year the Fire Service got 47 jobs which they somehow used as justification for four fire trucks (two pumps and one each ladder (skylift) and rescue). Compare that to ambo which got about 2,000+ jobs and has two-three vehicles crewed with two Officers (three during the day and two at night) mind you one of those Officers is likely to be a volunteer at night or they put two paid Officers in a vehicle and take one off the road. On a positive note, we have gone from one Intensive Care Paramedic on days to two. I am vehmontly against Fire based EMS although Seattle has done a fantastic job of it. The Fire Service here does not want medical calls and they have done a fair amount of bitching saying hey look we don't mind helping you guys but this is getting a bit silly when 1/2 of a volunteer brigades calls are assisting the ambos, most often because they are either out of town or only have one officer. If the ambo's were as slick at marketing/PR and had the industrial clout of the fire service (be it the NZPFU or the IAFF/IAFC) look at how much better shape it would be in. ... hmm, I almost draw comparisions between the IAFF and the Johnnos; bloody Johnnos, they are slick at marketing and blowing a lot of hot air up the Government's arse but it's not in the best interest of the patients that is for damn sure. Interestingly last I heard the Fire Service is having problems finding volunteers here and especially Engineer/Operators (drivers) because *gasp apparently a three day course to get your Class 2 license (MR in Australia or CDL in the US) plus a four day (two weekend) Fire Service driving class is too much! You want to know the scary part; in the US many states let any tosser with a regular car license drive a bloody fire truck!

I think that's very true and there are better treatments out there than frusemide, eg CPAP

That is basically what I was thinking more-or-less but didn't quite wrap my head around it sufficently to type it out

Those old LAS Bedford's look like something you might see milk delivered in rather than used for an ambo, they dont even have IV hooks on the roof you can see one of the HEMS doctors holding a bag of fluid up! I love that line of "oh love we're helping you, honest!" I'll have to remember that one, might come in handy! Some more The London One Under Watch video

Truer words were never spoken Sort-of along the same lines, in addition to your LR license what do you require in the way of driver training?

I am not sure if this is a case of letting Fireys drive because they have SINGLE OFFICER responses and nobody is there to drive or if its a situation where BOTH officers are required for patient care. The latter seems slightly more permissable rather than taking a second ambulance crew out of service to get a wheel man. Note I said slightly as I am not too hot in the idea. Something simmilar was looked at here; most of the volunteer firefighters were personally happy to help out but more collectively they (the vollies) and the Fire Service (both the Commission and the Union) didn't agree as it was percieved as a form of cheap labour and prevented the real issue of not enough ambo's from being fixed. Have you seen most of the US system lately?

Agreed Look forward to reading it

I don't know what to say here; I want to be a puppet for "CMG-say-so" sydrome and agree with what our clinical group says; that GTN has no role in an MI. That said I also am capable for thinking independantly and questioning that theory. This study does not support GTN as reducing infarct size http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WK6-4MHPC3V-3&_user=10&_coverDate=02%2F28%2F2007&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1194483771&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5f5c05aee69bef7e020ac3c056413abf This one shows increased mortality and echos the careful need for monitoring and titration http://circ.ahajournals.org/cgi/content/abstract/54/4/624 This study DOES support intravenous GTN http://www.springerlink.com/content/q4p5v41652241175/ This study sort-of supports the use of intravenous GTN and not SL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC483883/?page=4 I've had this discussion before and the apparent outcome seems to be that SL GTN is not appropriate and may be harmful whereas intravenous GTN may be of benefit. IV GTN can also be carefully titrated and monitored invasively which SL GTN in the back of an ambulance cannot. Also our Technician (BLS) level has had GTN for years and they don't have 12 leads (if working with another Technician)

The only research I could find said either M&M was increased (first link) or that a bunch of studies happen to include GTN as part of thier treatment but was not specifically related to GTN. It also does not say if it was talking about carefully titrated intravenous nitrates or sublingul application. I certianly agree that in theory yes reduction in preload and increasing coronary artery dialation sound quite useful it has not proven to be effective at reducing M&M in the context of prehospital application of sublingual nitrates. Perhaps I am guilty of "says-so" syndrome in that the consensus of our clinical group is that GTN doesn't really have a role in MI and I sort-of agree but can't really find any good evidence to support this claim.

The study seems to indicate worse outcomes and the second looks useful but has no abstract http://www.ncbi.nlm.nih.gov/pubmed/18288597?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=59 http://www.ncbi.nlm.nih.gov/pubmed/18347964?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=57 http://www.ncbi.nlm.nih.gov/pubmed/19681463?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=11 http://www.ncbi.nlm.nih.gov/pubmed/19445779?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=19 http://www.ncbi.nlm.nih.gov/pubmed/19681461?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=12 http://www.ncbi.nlm.nih.gov/pubmed/19445778?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=20 Now I could be wrong but I don't really think GTN has a role in myocardial infarction in the context of sublingual application in ambulance practice.

Yeah I think I've heard the cops mention it once or twice; I will try to find out what it is. Me: Edmonton morning, Citation niner november bravo, five one zero CZWG: Citation niner november bravo Edmonton Centre standby, Air Canada calling? ACA: Yes, Air Canada eight-five-four, do you know the hockey score? Me: Hey I want to see one of those televised Canadian fights where a hockey game breaks out! CZWG: Niner-november-bravo, Winnipeg Centre good day, I am forseeing extensive delays next sector, say again? Dramitisation: May not have happened

Ouch looks like they didnt hit the jackpot huh, should have gone to the blackjack or perhaps the Circus slots in Reno

I second that; there are some really amazing people out there who all too often society in general but brushes over and doesn't take the time to recognise them. You know I used to hate elder-care facilities, rest homes etc I was niave and looked upon them as boring or somehow sub-par to you know, doing IVs and dealing with people who are really crook. Now, I've done a 180° and asbolutely love going to them and have started to visit my Nana each weekend in her home; the people are just fantastic and you can often get roped into talking with 'em about all sorts of really cool stuff. Same goes for all patients not just old folk; kids have a wonderful way of talking and looking at the world and you can get some really interesting stuff out of them too. You have some sort of skermish, send in a 12 year old to sort it out and he'll have everybody happy-as-larry playing four square in no time! One of the biggest things that we forget is that patients are people too, Lord knows I have done it!

LOL! Had an old guy once who started getting froggy with his walker at the crew If the Police OC spray somebody here ambo is generally not called as the cops can deal with them, they just break out a bottle of water or I believe they have some anti-OC rinse. Same goes for people being tazed although I think they are checked out by the Police doctor. Guidance for people tazered here basically says give them a check over, take out the prongs and they can be left with the Police as a non transport. YEG is the passenger code (IATA), CYWG is the ICAO code for more technical stuff that pilots and other people like that deal with.

A properly educated ambo with the ability to make good diagnoses and treat or refer to appropriate treatment is what is needed rather than going "I don't know, or, I can't do anything" and taking patients to the hospital.

No changes on 12 lead, not hypoxic, no haemodynamic compromise, no hyperkalemia so I am not concerned Could it be that we have ants in our pants over *gush, something almost totally benign in the absense of any worrying S&S or pathology?

I at least give the OP a +1 for knowing what CYWG means eh Now, go direct to yankee xray hotel, do not pass GO, do not collect $200 and contact Winnipeg Centre, one three two point niner two so long /crams alternate personality back in, thats better