Kiwiology

RSI here in New Zealand is restricted to select Intensive Care Paramedics and Ambulance (PRIME) Doctors. It's fairly new in that we have had it since 2006 here in Metro Auckland and it is now being expanded nationwide, hence the selectiveness. In time RSI should be expanded to all Intensive Care Paramedics as it matures. We use fentanyl, ketamine, suxamethonium and vecuronium. Our success rate is near 97%

Do ask if you can borrow 118, it'll make a fab ride to the church *Kiwi sits by the mailbox waiting for the Postie .....

Technician level Ambulance Officers have ondansetron wafers, Paramedics and Intensive Care Paramedics have IV ondansetron

You do know the golden hour does not exist? You do know that an improperly fitted hard collar will cause jugular venous compression, increased ICP and decreased CPP? You do know that hyperoxic/hyperoxaemic states cause the small precapillary sphinceters/aterioles to constrict? You do know how difficult OPA and BVM will be for a prolonged period of time?

There are already ECPs within WFA and StJ Central are coming online very soon; Clinical Excellence will see ICP move towards a PGCert and AUT reckons there is a BHSc/BN crosswalk path in development so it all looks very promising You just want to look good on RR dont you mate

What, you think I died or something?

Rob you useless sack of crap its good to see you back man, was worried about you. Stop eating whatever shit you are shoving down your gob and get on the raw macronutrient diet, its good for cancer, lupis, diabetes, gout, heart disease, you name it. Kiwi is still making you proud and dissing the 16 week barely homeostasasing loser cookbook paramediocre's with poor cerebral perfusion down at the Houston Fire Department

Oh I wasn't partic interested in reading them it was more an exercise in seeing how they responded, and its clear they havent, so it says more about them than if they did. Now I recently came across this blog by a Perth ambo (http://perthparamedic.blogspot.com/) who lists such innovations they WA do not have such as 12 lead ECG and has a good go about the vollies .... I know its only one person's perspective but bloody hell makes our StJ setup look halfway decent Run an ambulance service on a shoestring budget and look what you get

Exactly, and they ride along on this "we are StJ we do such wonderful work" coz little old Nanas love them to death, which seeks to only further exacerbate the problem. I emailed StJ WA two weeks ago asking them for a copy of thier CPGs and scopes of practice as I was an international ambo looking to come over ... and as of yet, no reply.

St John WA probably has a lot of competent ambo's ... they mandated the Degree a few years ago for Paramedic and Post Grad for Intensive Care but ehhhh ... its St John, we can't really expect great things on about 10% of the budget that ASNSW, MAS or QAS have now we can? StJ here has, like in WA, this great position of what wonderful care they provide (!) and how cheap they do it for. Hmmm ....

Please do not allow me to make an example of a homeostatic imbalace with poor cognitive perfusion who carries round a cookbook of protocols for retards out of you. Go to the two year program.

Our operational uniform is awful SERT and HEMS wear green jumpsuits with 'AMBULANCE' written on them, I want one of them but the executive management did not think that green was very professional looking

If you want to be seen as a looser homeostatic imbalance with poor cognitive function who follows a cookbook written for retards then go take the 12 week course. Or you could come here where it takes FOUR YEARS to become a Paramedic (ILS) and SIX YEARS to become an Intensive Care Paramedic (ALS)

I saw from another SJA medic that in SA they do not have amiodarone (or any anti arrythmatic) as an example and thier medical director just resigned after an investigation. St John is almost like the AMR of down under, they have thier finger in a number of pies and do not soley exist to progress Paramedicine as a profession or core activiy of thier being unlike the state run ambulance services. The St John budget both in WA and NZ is a fraction of what the state ambulance services in AU recieve and St John promotes itself as offering value for money, ie cheap care without significant investment in technology and infrastructure. QAS has over 200 days of supplies stockpiled for resilliance and large quantities of spare vehicles and equipment, whereas St John has few, as an example. Its not so much that St John are cowbodys its just that they do not exist soley to provide an ambulance service and it sort of gets lost in the mix somewhere. Yes, StJ in NZ is totally seperate but not without its problems.

What they cannot do is lots, what they can do is kill people. Stay the bloody hell away from St John in Australia. Have you looked into South Australia?

CHF is not fluid overload, the fluid is in the wrong place *smashes head on wall CHF is not fluid overload, the fluid is in the wrong place *smashes head on wall

Could be a GI bleed or an atypical MI .... did we ever find out what was wrong with this bloke?

Yes I am but it seems the Fire Service are the worst ... altho EMS in the US seems to suck except for one or two areas seriously, the Fire Service are worse than the borg. Now if I need a car turned into a convertible or somebody extricated from a funny place the Fire Service are great, love them to bits and will go across the street to the station for dinner with them every night but when it comes to EMS they are the borg seriously.

Fire Service based EMS is evil, it is driven by a labour union who is looking to protect workers and jobs but does so at the expense of quality medical care and the development of Paramedic as a health profession in the United States. Are Firefighters prepared to go to school for six years to become a Paramedic like our Intensive Care Paramedics? How many Fire Service based EMS systems are doing tightly controlled, highly successful RSI and thrombolysys? How many Firefighter/Paramedics can professionally describe fluid homeostasis, thromboxonase and glyconogenesis? How many Fire Service based EMS systems encourage or require anything more than a couple months at some patch factory? Once again, Fire Service based EMS is evil.

I will get back to you on that but it makes better sense to us and to the Clinical Management Group. If you are going to put a drip into somebody and infuse why bugger around giving IM adrenaline and IV fluid when a much smaller dose of IV adrenaline will have a faster onset and it gives you ready access to more adrenaline by just opening or closing the clamp on the drip bag. Hook up a three way tap and have one bag of fluid, one of adrenaline and you can either run the adrenaline as an infusion or use it to draw up ten ml boluses out of. I would rather use IV adrenaline over IM, esp if the pt. needs more than one dose Now is any of this scientific? No, let me get back to you on that

One other very important thing ..... Adrenaline drip for asthma, bradycardiac and anaphylaxis. We put 1mg in a 1 litre of bag of NS and run at 2gtt/sec (titrated). It seems the US seems to think only IM adrenaline exists.

In the left hand top lockers we keep linens (pillows, blankets and sheets) They are really handy.

Our Intensive Care Paramedics use ketamine its wonderful stuff and I cannot recommend it highly enough. Below is our drugs list if it helps, I think its very sensible. Aspirin Adrenaline Atropine Amiodarone Entonox Frusemide (probably going to be withdrawn in September) GTN (nitrolingual) Glucagon Glucose 10% Ketamine Methoxyflurane Morphine Midazolam Naloxone Paracetamol Salbutamol Suxamethonium Vecuronium

Nope, I mean a small pouch that is secured to the Officers belt

We carry no preloaded drugs, if you are not competent enough to manually draw up a medicine you are not competent to be allowed to use it. Ketamine, morphine and fentanyl and kept in a hip pouch