Kiwiology

In Australia every Ambulance Paramedic (non ALS) can give adrenaline and IV analgesia. In New Zealand from 2012 every Paramedic (non ALS) will be able to give adrenaline and morphine, and many already can. In Canada every Primary Care Paramedic can give IM adrenaline. Perhaps we are doing something wrong?

I am biased coming from a system where advanced life support by Intensive Care Paramedics is reserved for really sick or severely traumatically injured people. The notion that you need ALS for a bit of morphine or adrenaline, or a BGL check, or some fluid is a wee bit out dated if you ask me. Personally I would consider time to appropriate hospital vs. calling for Intensive Care especially if moving towards hospital is moving away from backup. The sorts of patients I would personally call for Intensive Care are: - Looks really sick and I don't know what is going on - Cardiac or respiratory arrest or near arrest - Severe respiratory compromise (asthma / croup / epiglottitis) - STEMI on 12 lead ECG - Severe new presentation cardiac chest pain with good story (sweaty, nausea, SOB etc) - Poorly perfused haemodynamically compromised arrythmia - Severely SOB/sick pulmonary edema/CHF - Seizures not responding to midazolam - Pain not significantly relieved by or unlikely to be significantly relieved by IV analgesia - Altered or unconscious with GCS less than 12 - Severely anaphylactic patient who needs steriods Anything else I think can safely be treated and transported by the Ambulance Paramedic.

No ipatropium at the Jacko's mate

For mild asthma we give one round of nebs (salbutamol) however for moderate to severe life threatning asthma its continious nebules. The other servive here uses ipatropium bromide, however the area I am currently in does not.

Or you could ask Turnip bloody hell squint is so old he probably trained the first ambos in AB with material written on stone tablet

Thats awesome mate, good on ya. Too hot in Vegas OMG it overloads the transfer of ACh between the synapse at the neuromuscular junctions and causes a massive spike in sympathetic tone ... which is just not good. Hence why I recommend you go to Reno, and they have an arch .... you can't say no to an arch

We hang one litre of fluid to use as a running flush for drugs but thats about it. For a traumatic hypovolaemic arrest or cardiotoxic levels of tricyclics yeah tnen I might infuse a couple of litres and wrap the BP cuff around the bags .... Pressure infusor ambo style! Gangsta

Luck you aint down a mine shaft about now lol it cool bro

NZ/AU does not have any online physician contact. I know MAS has a "Metro Clinician" who is an Intensive Care Paramedic but I dont know about rural, and I don't know if they can authorise out of scope of practice anyway. Have we started driving toward Intensive Care with much of the fastness yet?

Did you record those while you were having a crank or something mate, that wadering baseline, gah!!!!

Hmmm .... I wouldn't have been real keen for this fellow to get in the ambulance with me, he seems pretty crook. Keep up the nebs and drive towards an Intensive Care Paramedic or hospital with much of the fastness

... and have 'staches

best of luck

I do not have a T (tracks) endorsment on my license, nor can I get one, so I can't drive that

Nah, he is probably too busy with his live in 20 something nurse that he got thru his broken down old sack of crap in a wheelchair scam Good bloke tho

None to my knowledge and I don't think any will be out in a great hurry. Online learning is not for everybody, part of my Bachelors was online via WebCT/Moodle and I loved it but it is not for everyone. Our National Diploma in Ambulance Practice is taught using a mix of online/book work, classroom and in the operational setting.

Sorry to hear that mate, you Canadians are alright even if you talk funny eh

Its not always about survival rates, the impact of morbidity and mortality is a much more important consideration. I know of nowhere in the developed world where the entry to practice standard is as low in EMS as it is in the United States. After 14 years of developing the "EMS Agenda for the Future" it is dissapointing that 200 hours of education and the ability to basically do nothing is acceptable. The National Scope of Practice model says a basic EMT can administer oxygen, oral glucose and aspirin. The National Scope of Practice model says an Advanced EMT can cannulate and administer GTN, salbutamol, entonox, IM adrenaline (anaphylaxis), glucagon, glucose and naloxone. ... and this is somehow not neglegently inadequate and the best you could come up with after fourteen years when Australia, Ireland and New Zealand could achieve more in less than ten? Sorry guys I don't mean to bust your balls and I have some appreciation of various issues such as the size of the country and variation of systems you have to work with but OMFG! And before we get carried away into a skills pissing match, you can teach any idiot to slip in a drip and pop an amp of something but it takes a true clinican to do it properly.

Not sure, I think we just had the conference here. Probably to warm us up to the idea that we'll become the next state of Australia at some point :D

Until the US accepts that a hundred hours of training and how ever many fancy add on skill packages you want to get is grossly inadequate to render any form of patient care we are just going to round and round and round. It is disturbing that almost all other developed nations are light years ahead of the US and that we in New Zealand have achieved more in five years than you have since publishing the EMS Agenda for the Future in 1996.

We spend a whopping three hours (two hours in class and an hour long DVD) on childirth, pregnancy and the newborn. If you're in imminent labour it is desirable that somebody else besides me turns up. Well that could be said for most patients now that I think of it.

We have one here in Auckland and I think one or two other places might be looking at getting them; they are however not cheap. Other than that it usually involves a number of Firefighters and a tarp.

You get that coz suxamethonium is a defasiculating neuromuscular blockes whereas some others are not but I am not sure whcich ones ... from memory its vecuronium and the likes

<TONGUE IN CHEEK> Lets see .... sounds like this guy needs the works • Fentanyl 100mcg • Ketamine 150mg • Suxamethonium 150mg • Vecuronium 10mg Somebody want to get me a 20ml syringe? </TONGUE IN CHEEK>

If they are simply acting as an assistant to you then thats not quite as bad, e.g. giving meds you have drawn up as opposed to drawing up meds themselves. Now it may be a little different where you guys are in the US given the huge difference between BLS and ALS. I think us Kiwis and Australians are a little spoilt in that many times we have another person there who can start a line, give some adrenaline or other meds, or do a rhythm analysis and zap the patient while somebody else secures an airway or takes overall clinical leadership of the situation.