Kiwiology

It stands to logic that the faster a trauma patient can be assessed and treated by a Doctor that they stand a higher chance of a normal recovery. That does not mean we should run everybody into hospital on red lights and increase our risk of having an RTA 3000% or stand around the Fire Service like a fly on shit yelling "HURRY UP AND CUT THIS GUY OUT THE CAR!" Can I fix somebody who has been shanked and is bleeding internally from a lacerated liver? No. Does that bag of fluid I am infusing replace the haemoglobin carring properties of blood? No. When we speak of the "golden hour" I feel that we are primarly speaking of hypovolaemic shock patients that will require surgical intervention to fix whatever bit of plumbing has gone kaput. While a severe cardiogenically shocked patient requires more than I can give them in the back of the big white van with tinted windows that plays funny noises we need to seperate who is actually time critical and who is not. Is may not be appropriate to spend thirty minutes trying to intubate a head injured patient on scene when the hospital is twenty minutes away but it may be entirely appropriate to spend thirty minutes on scene ensuring adequate packaging and analgesia for somebody who has broken thier leg. What is being taught here now is consider time to an appropriate hospital vs time to get backup or do what you want to do and at least put the patient in the big white van with tinted windows that plays noises attractive to children and treat enroute. Just make sure I am not the one driving

You want increased education? 1. Remove the IAFC/IAFF who want to suck up all the tax money but have no real interest in Paramedicine 2. Remove volunteers; its nice they want to help but seriously the days of accepting the constraints they place on the system are over 3. Get medicaare to pay something better than what, like 30c on the dollar? ... would be a good start; the DOT/NTHSA are no where as powerful force as the self intereted Fire Unions and volunteers.

Yes good morning, it's Dr Kiwi (DDS) speaking, listen, I work with the helicopter emergency medical services .... we have a patient with a really bad cavity and we're going to be on the pad in about six minutes

More and more procedures and interventions are being moved down to Technician and Paramedic level Officers here with only a small handful being kept exclusively to Intensive Care Paramedics. Adrenaline? 12 lead interpretation? cardioversion? fluids? GTN? naloxone? Our Paramedic level Officers can do all that and more and they have the educaiton to back it up. From a strategic management perspective it makes so much sense!

Lippincott's ECG Interpretation book in thier nursing series (little brown one) is really fab, its just great

Especially if I turn up in it .... For easily accessable multiply injured patients with severe physiologic abnormality (if memory serves) 10-12 minutes is our goal from locating the patient to having them on the way to hospital. I think we should bear in mind that trauma is increasingly a non surgical disease and the most common surgical procedure for trauma patients (I will find a source) is an ex lap. Perhaps I am reading too much into your statement (I think I am). Let's say you go to an RTA where somebody has been hit by a bus. They are unconscious with multiple long bone fractures, a bloody airway and very hypotensive. If you are 10 minutes down the road from the hsopital what do you do? How does thta change if you are an hour away or have a major trauma centre an extra 10 minutes down the road? My thoughts are lots of suction, whip out a fanny gag and throw it down thier gob, blow up the cuff, ventilate, infuse a small amount of fluid (~500cc) and red lights into hospital. Now, if you are an hour down the road it might just be worth spending the extra five minutes to shove a tube down his throat and gain a better airway. Might even be worth ringing up the big flying thing to have them come swann out the sky and take him to the trauma team. My point is really that a sensible and systematically thinking Ambuance Officer will recognise who needs to go with much of the fastness or in the big noisy contraption to a trauma centre and who does not. However there are many who do not and simply run everybody in in the big white van lit up like a christmas tree and do nothing to help advance Ambulance praxis or simply get wiped out by a cement mixer one block from the hospital because the driving Officer did not notice as he was too busy focused on alternating between yelp and wail.

I know in AB and BC a PCP (EMT) can cannulate and infuse; I also know crazy ass Quebec and a few of the Terrorities have no ALS whatsoever and that in Ontario its three years to become an ACP (2 as a PCP and 1 for ACP) whereas say, Alberta its 1 and 2 respectively. Oh and lets not forget BC which is no longer training ACPs thanks to the BCAS Strike. Dare I say Canada needs to standardise?

In Australia the base level Officers (Ambulance Paramedic) and our Paramedic level Ambulance Officers can cannulate and infuse. Silly Canada

Don't matter shit to me coz even if I got that there citizenship I'd still get stopped for talkin funny!

The golden hour is absolute shyte; all trauma patients have a golden time period however this can be minutes to hours or even days .... You shouldn't be staying on scene for two hours playing doctor (unless you happen to BE a HEMS Doctor or something) but nor should everybody with cut ifngers be run into hosopital on red lights at breakneck speed because "everybody with trauma needs a surgeon".

About bloody time we got those firefighters to sit at some crappy gas station for hours on end, lets see them sleep and play scrabopogle in the fire truck Jack Stout eat your eeart out!

Thats what the Clinical Standards Officer said when he was talking to the Medical Advisor in hushed tones when I was asked to wait outside...

What about those of us who are just substandard to begin with despite what is in our bag of tricks?

We have a number we can call to speak to the Dispatcher, buggered if I can remember it; 111 is much easier to memorise

I certianly agree that procedures like IV cannulation, medication administration and cardioversion are more invasive than say taking a blood pressure and therefore require a higher amount of education and skill. That does not mean that they should only be "top tier" procedures, or, by that logic, in tje non EMS setting a Consultant Physician would be the only one allowed to cannulate and the Registrars, House Officers and Nurses get lots of practice at keeping thier blood pressure taking up to snuff or something.

For the last ten years Australia and NZ have had upskilling programs going on which increase the scope of practice and education of base and intermediate level Ambulance Officers. This has bought interventions that were once the domain of ALS into the non ALS arena and allowed us to make greater use of resources and improve clinical outcomes. As time has gone on more and more has been added to the non-ALS scope of practice along with increasing education; nearly every state in Australia and NZ now require a Bachelors Degree as base level entry-to-practice qualification with ALS (Intensive Care) Paramedics requiring Graduate Degrees. Over the next two years ever Paramedic (intermediate) level Ambulance Officer here will be educated in and equipped with 12 lead ECG interpretation, adrenaline, IV analgesia, naloxone, ondansetron and probably midazolam and amiodarone for cardiac arrest too. To say "oh lets simply move towards an all ALS model" is a wee bit of overkill and really does not cure the problem, its just a quick fix - but that is what Western Medicine has become good at; treat the symptom not the problem. It all goes back to the old argument, what the US needs to do follow the rest of the world and increase education and scope of practice for its non ALS providers in particular (but them just as much) and come out of the dark ages.

I blame the whackers, politicians, legislators, volunteers, dumbshits, mill medics, IAFF, mass media (who are as dumb as rocks), IAFC, the general public (who are kept as dumb as rocks thanks to the mass media) and the New World Order.

You need a closing quote tag at the end which is the word quote with the / before it enclosed in the [ and ]

In labling these as BLS or ILS procedures you must remember our education requirements far excceds anything, er, everything avaliable in the US and rival that of many other nations eg Canada, South Africa, the UK. While cardioversion may not be an "intermediate" procedure technically here our intermediate level (Paramedic) can perform syncronised cardioversion. Does that mean they had a couple hundred hours of education and are now able to zap people? No, they had several years of education and experience before they got up to Paramedic level.

Poor old Rob I hope he is OK and being treated well by his live in 20 something veluptious blonde nurse miad he sucked in with his broken down old useless sack of crap in a wheelchair scam \ To answer your question, no. Here "advanced" procedures are those avaliable only to Intensive Care Paramedics, currently they are - Endotracheal intubation - Cricothyrotomy - Ketamine - Atropine - Amiodarone - Midazolam (that may be changing) - Intraosseous - Frusemide (probably being withdrawn next year) - Pacing - Rapid sequence intubation - Thrombolysis Everything else here including things like 12 lead ECG interpretation, adrenaline, naloxone, GTN, cardioversion, laryngeal masks etc is either a Technician (BLS) or Paramedic (ILS) procedure. And yes Bushman is right, we selectively began upskilling people in 2003 ... and it'll have taken almost a decade by the time everybody is upskilled but hey, good things take time right? I might moan a wee bit that they should have just upskilled everybody to begin with but I won't be complaining when we finally see the end of calling up for Intensive Care for a bit of morphine or some adrenaline!

I know mate it's bonkers hence why both here in NZ and AU Paramedics have morphine and Intensive Care has additional options.

According to the new National EMS Scope of Pracitice model the Advanced EMT can use entonox as well

Whats right with America you ask? Well sir, your country still lets me in! ........ for now Now, which State and/or Commonwealth am I banned from again? I forget .....

We have had entonox for well, many decades and methoxyflurane for maybe five years. Our ambulances first got defibs in 1972, nubain/foratol in 1985, morphine in 1990, morph+midaz in 2000 and ketmaine in 2005.

Yes.