Kiwiology

I do not think a nurse learns anything that a Paramedic does not need to know. While some of the things you touch on such as long term care plans may not be of the same relevance to a Paramedic who may only see that petient once as opposed to multiple times in the LTC/community nurse environment it is still relevant. Many patients with end of life care plans for example are seen by Ambulance Officers and these plans are often referred to in the context of giving the most appropriate treatment and care when called to that patient. As for your counting years, our Paramedics spend three years in school full time (with a minimum of 1,200 hours clinical placements) then do another full intern year ontop to become a Paramedic. Remember that this is not advanced life support, to reach that level (Intensive Care Paramedic) you must do at least another two full years on the road, then the Intensive Care course, and then another intern period. While your folks might take four years to reach Paramedic (ALS) level as an example, they are in reality only getting probably just over a year of actual education (and that is likely a generous estimate, most Basic/Intermediate classes I have seen that are full time run for a number of weeks, whereas Paramedic classes tend to be nine to twelve months).

It varies by state; in Texas you can get away with 600 hours (literal clock hours) over twelve weeks whereas Oregon requires a two year Degree and then there is everything inbetween. By contrast Australia and New Zealand require several thousand hours in school plus a graduate internship for Paramedic (which is not advanced life support although pretty close) and several more years plus more schooling and internship for Intensive Care Paramedic, which is advanced life support. The UK requires a Bachelors Degree for Paramedic (advanced life support) from 2012. The nations mentioned also offer Post Graduate, Masters and/or PhD in Paramedicine. I know of at least one ambo ere who has a PhD, so we still do have "Doctor" based ambulances

I dislike having the "driver only" concept as it limits you to having only one Paramedic who can treat the patient.

I think the two shows simply deliver what the public wants (wanted) to see. Personally I don't like both shows just because I don't really want to watch EMS related TV I just don't find it interesting. Emergency! is however, far more medically accurate.

Does NJ require ALS to be hospital based still?

Well said Timmah! Mmmm Tim Tam's

That is most disturbing, especially considering the author is an MD I agree Vent. The moves are being made for Paramedic's to become more emergent community health practitioners than the old day ways of "Paramedic" who only dealt with calls by taking everybody to the hospital. A good deal of our Degree is around non-emergent issues like psychosocial care and what to do for them as well as the emergent stuff. In the future it will only get bigger and better as Ambulance Officers get more referral pathways and options other than taking the patient to ED and as expanded scope roles (ECPs) are introduced more progressively. Should you have to do a nursing degree to become a Paramedic? Whole-heartedly not! You should however get an appropriate amount of education in the things you speak of and not just the "emergency" stuff especially as the ability and need to do things other than take the patient to the hospital grows. ER/ICU or even general medical nurses who have a good deal of experience and who are around patients 24/7 are very highly knowledgable and more than capable. I know one or two nurses who work in general medical and who I would have no problem with in the back of the ambulance if they had the appropriate time to get up to speed with the differences in modality. We need to combine the best things that nursing can offer and what those systems with a very high level of Paramedic education are doing that seem to be working well. The Degree gives our Paramedics a strong base of A&P, pharm and patho and they spend a significant amount of time in the hospital and on the ambulance. A lot of the Degree is around chronic and non-emergent management of patients, not just about IVs and driving fast. I can see what Melclin is saying in that Bachelor of Nursing graduates are not appropriate people to be used as Paramedics and they should not expected to be. The Bachelor of Nursing should not be the required Paramedic qualification but an appropriately educated and experienced ER or ICU nurse would make a great Paramedic if they are able to become familiar with the differences in operating modality. That is why Australia/NZ are developing (I beleive Aus. already has them) a one year post graduate conversion program for RN to Paramedic (not Intensive Care (ALS) but our base level). Should they wish to do ALS (Intensive Care Paramedic) they would have to do additional Post Graduate ALS qualifications. I guess our Paramedics who have four years of education and experience and our Intensive Care Paramedics who have a minimum of six are doing something wrong then?

I sort of agree with what Melclin is saying; however the main reason nurses are used is I believe because civillian Paramedics do not exist in the nations where they are used. Israel for example uses MICN/doctor/ and a civillian paramedic on thier MICUs whereas (and WM can correct me) but in the Dutch system they do not have civillian Paramedics. My opinion is that if we take the best of nursing education and the best of Paramedic education and combine the two then you're on the right track to not requiring a nurse on the ambulance.

You're onto it mate. Our doctors are bloody excellent doctors but put them in the prehospital setting and they are useless! They generally have little interest in what the Ambulance Officers do (although there are exceptions) and to that end they don't really have a lot of contact or understanding of what goes on in the prehospital world. Unless a patient is bought straight into resus they never really interact with AOs while the nurses on the other hand, man they are bloody fantastic. While the military medics have to do 6 weeks of civillian Ambulance placements, a medical student does one weekend in thier second year and never sees inside a truck again. The ambulance service themselves are also to blame in a way; up until recently it was possible to have up to seven different titles on your uniform patches and there has never really been a cohesive effort made to "brand" ambulance crews in a way that is easy to understand.

It all depends on what level of education you are going to give your Technicians and Paramedics. While we are it, just call them Paramedic and Intensive Care Paramedic, it's much simpler do not make the mistake of using the "Technician" verbage as it will do you no favours whatsoever. Civillian Paramedics (if properly educated and trained) are comparable to nurse based ambulances (which are still used in the majority of Europe and some Mid East nationss far as I know). I cannot stress how important proper education is! To give you an idea of how New Zealand works: - Paramedic: Three year Bachelor of Health Science in Paramediicine plus one year graduate internship - Paramedic scope of practice: Manual defibrillation, cardioversion, 12 lead ECG interpretation (mainly around ST changes), laryngeal mask airway, IV fluid, adrenaline, amiodarone for cardiac arrest, ondansetron, naloxone, ceftriaxone, fentanyl, salbutamol, GTN, aspirin, glucagon and glucose, methoxyflurane - Intensive Care Paramedic: Paramedic + two years experience + Post Graduate Certificate + one year internship - Intensive Care Paramedic scope of practice: Paramedic + advanced 12 lead interpretation, thromolysis, intubation, rapid sequence intubation, atropine, midazolam, amiodarone for wide complex arrythmaias, ketamine, hydrocortisone, salbutamol IV, mag sulfate IV, frusemide (probably going to be withdrawn) Links to our Paramedic Degrees: http://www.aut.ac.nz/study-at-aut/study-areas/health-sciences/undergraduate-courses/bachelor-of-health-science-paramedic http://www.whitireia.ac.nz/courses/Pages/BachelorofHealthScience(Paramedic).aspx If you have any questions please, you are more than welcome to ask!

Why in the hell did I marked down for that? It is a fact our service writes off a large portion of part-charge debt and the fact that they charge at all is unusual given our genrally free-to-the-end-user-directly universal healthcare system. A lot of people do not know Ambulance response incurs a part-charge (the amount varies based on where you live) and a portion of that debt (I have heard in excess of a million dollarsa year but I do not know a more exact figure) gets written off due to non payment. I am not a bean counter so am unsure exactly why it is not pursued but I believe it has a number of reasons around cost of collection vs the part charge itself (which is nominal) and some fear of perception of the orginisation being seen negitavely if collection were pursued. Furthermore it is an instrument of the Service's contract with the Ministry of Health that the part-charges currently in place are not raised if the contractually agreed amount of funding is to be provided from Government.

I was gonna say something about that but eh .... you know what the media are like.

You clearly cannot read. I have extensive background in aviation systems and regulatory complaince. Standard air-to-ground/air-to-air is 118-136Mhz while Ambulance here at least is 400MHz or there abouts; you try dialing up the Ambulance frequency in your standard airband transciever or likewise, the CTAF/UNICOM/ATS frequency the HEMS chopper is on into the Motorola in the fire truck and you're shit out of luck. If you're gonna diss me, at least diss me for things I actually say and not what you think I said.

I should clarify, this sort of job here would be undertaken by a physician or some specalist as even our Intensive Care Paramedics are not trained to take care of somebody this crook. The hospital would send somebody because he is on a lot of meds and things Ambulance Officers have no experience in.

If that is indeed what happened, and the Fire Service were there first, then it seems a bit weird the cops didn't let them treat the patient. Although on the OTHER hand, if they were indeed trying to access the patient when the Police had told them they weren't able to (for whatever reason), technically I suppose they could be cited for obstruction. That however, is a bit extreme. There is obviously more to this story than meets the eye.

My thinking is that in the time between the transport crew arriving and treating the patient and them (the transporting crew) asking the Fire Service for help; at that interim in the time-space continuim the Firefighters were not directly assisting the crew so had no point in being there. If they were standing there doing nothing because they were not treating the patient and the Ambulance Officers had not yet asked them for help, I don't see the problem with the Police asking them to leave. The article does not say if the firefighters were in the jail standing next to the victim, if they were in the hall outside, or in the foyer, or where they were and what they were doing or not doing. I can only assume they were in some spot the cops did not want them to be and were asked to leave. The Fire Captain saying "I am not going to leave" is a bit weird; if he is not directly involved in patient care, then he is not needed right at that very moment, he has been asked to leave by a Police Officer, so what on earth would posess him to think that he has a reasonable justification for saying no? If I am not needed someplace because somebody else is doing my job and they have not yet asked for my help, why would I stand there not doing anything? Maybe the cop was being a jerk because he disliked the Fire Service or maybe he felt the Firefighters weren't needed and thier presence was somehow detrimental to the overall situation I can't say. Either way, this is strange. Maybe somebody can explain this to me because I obviously don't understand how this works!

Additional fail, they said heart attack and not cardiac arrest! Additional additional fail, "heart attack" should read "cardiac arrest"

I don't understand how your system works with regard to who is in charge where and whether the cops can stand down the fire department Technicians or not so I won't comment there. It sounds like the transporting ambulance crew showed up (or were already there) and did thier thing but the Firefighters hung around long enough where they were not needed (because the transporting crew was dealing with the patient) to cause a stink with this particular Officer. Again, if the transporting crew were doing thier thing, the Firefighters were (at that time) clearly no use so why hang round where you are not needed????

It seems to be local protocol to send Firefighers as "first response". The Deputy decided that he did not think the firefighters were needed despite this however it seems the Firefighters hung around long enough to create a bad smell despite being asked to leave that the cop said he would arrest them, the Fire Captain in his "last stand" mentality said he did not want to leave a medical scene, where at that time he was not needed. Does it not register with this guy that (at the particular time he was told, future circumstances notwithstanding) if he was not needed why would you hang around somewhere you weren't needed to the point that you were told to leave or be arrested? Why on earth would you stay somewhere you weren't needed? The fact that the Ambulance Officers requested the help of the firefighters after the crux of the issue had gone down is of no bearing whatsoever. So what if they needed help at some point after this had taken place? The mentality of the Firefighters is that they would not leave when at that time, they were not needed! They obviously hung around long enough to create a stink that the cop felt he had to challenge them to leave or be arrested. The point here is the firefighters did not want to leave when they were (at that time) clearly of no use.

Seems reasonable! Sounds like the Fire Service hung around long enough to make a turd of themselves and get told to leave or be canned I appreciate what he is saying, but when he doesn't listen to being asked to leave doesn't that seem to register with this guy? He also says it in the typical pro-fire way that the Fire Service seems to be good at; I don't hear the Ambulance Service out there going on about "thier oath to protect the community". This is all very publicity, bright lights and making things look good for the Fire Service, the IAFF would be proud! I agree! Sticking your beek in where it does not belong!! I don't see how oxygen and taking a blood pressure would help? It doesn't sound like this patient was critically sick Why, because they poked thier nose in where it did not belong and got it bit? Oh FFS what a lot of bullshit. Good to see the local IAFF man had to step in and make the fire service look like the victim. No, but he is legally able to arrest those who do not comply with his requests! Sounds like they should look in thier own backyard before condemming others! It seems to be local protocol to send Firefighers as "first response". The Deputy decided that he did not think the firefighters were needed which may have been for any of the following or other reaosns unbeknown to us (we aren't the cop) 1) the transport ambulance was either there or coming, and the firefighters could not transport, 2) the patient was not critically sick, 3) three firefighters on scene in addition to the two ambulance officers who were already there, or coming, would be execssive, 4) the ambulance officers may have been able to provide a higher level of care than the BLS firefighters, Then it seems the Firefighters hung around long enough to create a bad smell despite being asked to leave that the cop said he would arrest them, the Fire Captain in his "last stand" mentality said he did not want to leave a medical scene, where at that time he was not needed. Does it not register with this guy that (at the particular time he was told, future circumstances notwithstanding) if he was not needed why would you hang around somewhere you weren't needed to the point that you were told to leave or be arrested? Why on earth would you stay somewhere you weren't needed?

Sounds kind of screwey, you leave a scence where you aren't needed and get threatened with jail WTF? I think the cop had it right to tell the Fire Department they were not required as the ambulance crew was already treating the patient A bunch of more emergency personnel standing round doing nothing wouldn't help the situation any.

If you have a sufficent number of Ambulance Officers treating the patient, what use can a bunch of Firefighters standing around doing nothing be??? Firefighters are good for holding bags of fluid, but so are cops and members of the public! Infact, Firefighters are better at at holding bags of fluid than the public, they always want to squeeze the darn bag.

Finally somebody who understands a bunch of Firefighters standing around in thier getup doing nothing are not any use! Sounds like something out of Mother, Jugs and Speed ..... oh no you didn't

Hmm, can we nebulise dish soap then, will that clean that nasty icky puss and crap out of our patients lungs? You touch on a very good point; not everybody needs salbutamol and like oxygen, IV fluid and one or two other things out there in the realm of prehospital medicine it is routinely dished out either a) to people who do not require it or in concentrations above what is required. I've known people to take upwards of 5 minutes to give an asthmatic patient some salbutamol because he had a temperature and the Technician was unsure if he could give nebules to a patient with a chest infection. Not to diss the guy for not knowing but *facepalm, know thy medication! Does anybody NEED "high flow" O2 (in the context of ambulance practice to mean fifteen litres on a non rebreather mask)? Increasing O2 probably won't help for oxygenation and ventilation are not the same thing. You can crank that O2 regulator off the meter and cram a truck load of O2 down thier throat but if it's not able to reach the brain and vital organs it won't do much. If anything it may be harmful; it's been drilled into us here in New Zealand that an asthmatic patient who requires manual ventilation should not be bagged more than six times a minute to avoid dynamic hyperinflation. Apparently there have been a few sparky people out there bagging the snot out of respiratory arrested asthmatics. Now if there's a bigger controvesy out there than prehospital frusemide I'm yet to find it. I don't think it should be part of the standard kit of an Ambulance Officer and recent grumblings here in New Zealand show it's probably being slated for removal. So how do you ensure a high FiO2 above what I can deliver with my ubiquidos black and white cylinder of oxygen?

Those people are called Managers right?