Kiwiology

They are objective comments when you consider what is taught to an American EMT, what they are capable of doing and how little progress has been made on such issues in nearly twenty years when contrasting it against fair and reasonable alternates from other nations in the developed world. There is no other nation on earth I know of that allows a person of equivalent clinical training and capability onto an emergency ambulance to render patient care. The closest thing is probably the Emergency Care Assistant in the UK but they are strictly forbidden from providing clinical treatment to the patient and are the "Assistant" to the registered practitioner, the Paramedic. In 1994 our base level (Proficiency Ambulance Aid) had a greater scope of clinical capability than a 2012 US EMT

It is entirely reasonable and appropriate that private citizens should be allowed to use reasonable force (including deadly force) to protect themselves or another person from imminent threat of serious danger If I see some dude beating up Nana on the street, I should be able to take whatever measures are appropriate to help Nana, including putting a bullet between the attackers eyes if required.

No surprises here Oh and if it makes you feel any better our Technician qualification (Diploma in Ambulance Practice) requires only sixteen days in the classroom (around 120 hours) .... but that is just to learn practical skills, not including the several hundred hours of online theory and operational clinical mentoring to complete the Portfolio of Evidence and reflective practice Well, at least I tried to make y'all feel better

Talk to your Clinical Standards Officer or local equivalent or medical director about seeing if they can help; do you haz Sim Man or something you can practice on? Are you using a bougie? It might not be much consolation dude but without regular practice its one of those things anybody gets crap at, the ASA says ~200 tubes a year to be "minimally proficient" Hope you feel better mate

Tell the Fire Chief that I will drive, I can turn the steering wheel, work the air horn and make the red lights flash, I might even be able to hook up hoses, work the hydrant and such, at a stretch even pump water ... just don't be asking any funny questions about a truck drivers license or nothing

Nah he didn't really drink, the other guys would have, they were raging pissheads You haz nice fire trucks even in remote Kanadaharada eh? These are our latest ones

LOL, my dad, uncle, cousin, other cousin, grandfather, great grandfather and some other dude on my dad's side were all in the Fire Service My dad was the Engineer/Operator of his local VFD because (seriously) he was the only one sober enough to drive the fire truck (it was a very small little town back in the day and the FD was basically an excuse to get horrendously pissed on a Monday night) and as he'd gotten snapped by the local Constabulary for growing some weed in his shed and wasn't allowed to do the Firefighter course, but they'd let him drive the truck

If we put down our dog because it is in pain or is otherwise suffering from some terminal illness or greatly reduced HRQOL and our goal is a quick, dignified death and end to suffering/pain etc should we not allow the same in humans? I've strung myself up twice to go for the big swing, didn't exactly work real well but y'know, as long as the person agrees to it shouldn't they have the choice?

Don't take the patient to the equipment, take the equipment to the patient esp if it is a cardiac arrest. Moving the patient is really good for that high quality uninterrupted CPR! We have everything in a big green backpack and I mean everything: airway, drugs, first aid bits and pieces, bag masks, LMA, everything and it is not unreasonably heavy that you cant bring it in. It leaves your hands free to take other stuff e.g. the cardiac monitor/defib Here is the backpack

Trev, mate, those fire truck drivers are called Engineers or Engineer/Operators We dont want to get the fire unions any more against ambulance now do we?

We do this now for animals so why not for people? Makes sense

What JP speaks of is sort of what things have been done in New Zealand; for example we have Patient Transport Officers who undertake patient transfers to/from hospital and clinics so what US call "IFT". They do not respond to pre-hospital emergencies and have no independent clinical skills beyond first aid and AED so are prevented from using the generic Ambulance Officer title or a specific practice level title.

The First Responder class is for volunteers community response groups who operate in rural and remote areas to provide immediate care prior to the arrival of the ambulance. The people who work at events are also taught this class. It covers first aid, AED, basic oxygen administration and how to give oral glucose and provide aspirin for self administration in the event of suspected myocardiacal ischaemia. Note "self administration" i.e. they must give the patient aspirin for themselves to take on their own volition, a First Responder is not legally allowed to determine that administration of medication is required but they can supply it for the patient to take, the difference is subtle but important. A First Responder is not authorised to use any clinical equipment e.g. SPO2, ECG, BP nor to transport a patient or crew an ambulance.

You raise a good point, which is why "BLS" by American standards is well, only found in the US and elsewhere a person of such capability of an American EMT either does not exist or is limited to a "First Responder" type deal e.g. Firefighters We have "First Responders" who can give oxygen, glucose for hypoglycaemia (they can also check a blood sugar) and aspirin for suspected myocardial ischaemia, exactly all the same an EMT under the new EMS Agenda for the Future can do. They have 16 hours of training and are not allowed to crew an ambulance nor transport a patient.

There are those communities where it will never be financially viable to employ full time paid Paramedics (or whatever single super level person is invented) because their workload will be extremely low. You need some sort of reasonable alternate to spending years at University for these people. I think New Zealand has it about right in that we put volunteers through a one year course along the lines of the old vocational model which is now obsolete for the higher levels, blocks of time in the classroom and blocks of time on the road until they get all the Diploma requirements finished. There is a sensible scope of practice associated with this level i.e. LMA, tourniquet, aspirin, GTN, salbutamol, glucagon, oral ondansetron and loratadine, paracetamol, entonox etc Something like this should be preserved for the volunteers as a reasonable alternate

I did have a huge reply but the basic 20 is that no it wouldnt work as you simply rob people of the already slim opportunities to use such high risk interventions as chest decompression, RSI, cricothyrotomy etc

Well said sir, remember also that what a Paramedic learns regarding basic biomedical science is pretty bare bones to non existent compared to nursing or any other allied health profession. its not just hope long you learn for but what you learn as well

Don't fuck up and get fired, remember, if you get fuck up and get fired we are going to banish you up north with them damn Yoopers Now, hold on to my coffee and turn that little knob down there to "RUN" for me ... time to test the air horn, HONK, HONK! Radio, Lima 499 responding ...

I now I am being a bit hypocritical on this one but does it not stand to at least the test of empiricalness that advanced education means a greater scope of professional autonomy so the patient is able to receive treatment sooner than if we have to piss around ringing up on the ambo phone and arguing with the Medical Control Physician to authorise it? For example Paramedics here have unlimited opiate (morphine or fentanyl, their choice) plus ketamine all which can be administered IV, IM, IN (fentanyl) or orally (ketamine) and can dish out enough as they need for the patient to not be in pain. No ambophone and warangling with a Doctor they might not even know required. Of course "protocols" vary greatly within the US I accept that but most places are reasonably restrictive i.e. a max of 10mg morphine before needing to call for orders for more is pretty common. I've seen people put 40mg into an old bloke one night and we put 20mg into Nana without batting an eye lid. Then there's those Los Angeles Fire Department Paramedics (with their weeks of training at PMTI) who gave some lady frusemide for back pain, and this is documented somewhere in the medical literature cos clearly back pain is a symptom of cardiogenic pulmonary edema

Nice trucks man, you guys have such nice Ambulances that are so roomy After 20-30 years of not having a standardised nationwide fleet design there have been lurches towards a single national fleet (finally) after much wrangling between various versions of the Sprinter, the decision has been made to settle for this ... this, it looks like somebody had their untoward way with a UK sprinter or Frankenbenz did something unspeakable to an American walk through box. This vehicle is a new delivery and has not been fully kitted out the same way as the the Vanbusprinterlance shown below because it is assigned to the Patient Transport Service (PTS) so does not have all the same equipment i.e. only an AED and a first response pack The Australian style standard vanbusprinterlance was trialled for a brief period but not introduced into mainstream, a few are still around in the national fleet but will be replaced by the Eurosexcrimesprinterlance Personally I would prefer the van provided it has one or two slight modifications so that the back doors fold around the sides like they do in Australia and on the current Sprinter and that a proper bench seat is put in, the two chairs are not enough to put all your gear on if you are working with somebody who needs active treatment and it would mean the provision of seatbelts for the Ambulance Officer in the rear.

The only places I know who pay anywhere close to that are the Fire Departments or maybe one or two of the extremely well run systems but by and far most American Paramedics I have met make somewhere on the poor side of $15 an hour, some I know qualify for food stamps because their pay is so low, most work two or three jobs or pick up extra shifts to make ends meet. I'm not talking like we do an extra day during a down cycle to pay off the house quicker or because we had an attack of the drunken internet shopping I'm talking about the ability to pay the rent sometimes depends on working another job. We must not only look at what you get in your hand to take home but that most employers (as is the increasing case not just in EMS) have severely curtailed or simply no longer provide pension, health and/or life insurance or other benefits which are standard in the UK, AU and NZ. It makes me so sad because the US is such a great place with such nice people; from the Fire union controlled Republic of Kandahalifornia to the Great Nation of Indiana which must never be spoken about negatively and lets not forget New Arizomexas Kiwi sad now ... and also haz hankering for artery clogging fast food, for this is America! to the drive thru!

Hence my argument it's time to go like the rest of the world and change titles to something a little more user friendly, here is what is used elsewhere on earth Australia Paramedic Intensive Care Paramedic New Zealand Emergency Medical Technician Paramedic Intensive Care Paramedic Canada Primary Care Paramedic Advanced Care Paramedic UK Emergency Care Assistant Paramedic South Africa Emergency Care Technician Emergency Care Practitioner Take your pick of any of the above

You're asking for the impossible, what does not exist, I have long wanted to make my Masters degree thesis some sort of trial where we pit ambo's from various nations against each other in some sort of test but there are just too many variables I think we have to look at this empirically The US is paid the lowest of any of the big six nations we have data on, it has the least professional autonomy and career progression, people jump ship because they are burnt out or want to "upgrade" to being a nurse, the fire department actively seeks to cannibalise EMS to pad its numbers and little is done to stop it and the EMS Agenda for the Future has been in existence longer than their rough equivalents in New Zealand, Australia, Canada (Ontario) and Ireland yet the gains made by it seem paltry and small in comparison. I draw a causal relationship between these issues and a lack of professional education, if not a direct relationship than at least an indirect one. Nursing has long required a two year degree in US and I don't see the nurses bitching about how the guy working as a dishwasher at a restaurant makes more than they do or that Occupational Therapy is succeeding at cannibalising them to make OT look good

An excellent point sir I forgot that in the US the Paramedic programs outside of the colleges (which are by far the majority) are taught by "Instructors" who generally have no other qualification than a Paramedic patch and X years of experience. One of the benefits of the university programs required outside the US is that the physiology is taught by physiologists, the psychology by psychologists etc not somebody reading off a PowerPoint slide

You always had to pass the National Registry test, Indiana only did not need it for the EMT level. I think what you are referring to is program accreditation through CAAHEP/COAESMP which is an NREMT requirement that from 2013 all programs must be "accredited" but I do not hold a lot of faith in the fact that "accreditation" means anything; a back room firehouse good ole boy paramedik course can still be "accredited". It's better than nothing but I think little above the fox investigating the hen house, esp with two seats on the board going to the Fire Service unions.