Kiwiology

Doesn't seem overly necessary to be honest. Here in Kiwi the Fire Service helmets are yellow and Ambulance are white. If you want to identify a person as an Ambo a reflective jacket is much easier. That's what we use. I do like my glow worm jacket.

Ah the eighties back in the day when drug dealers drove round in LTDs with .41 Magnums and the cops were bad and would shake you down in thier leather jackets with wooden nightsticks .... back when the Paramedics carried Lifepak 10s and used lidocaine. Oh how times have changed and Dallas got rough and you can't drive through Oak Cliff without getting shot at.

Ah, you too should go away. Here's why .... No, they are not. I have not been to a "boring" or "bullshit" call in my life! Anybody who says that shows a lack of understanding and empathy with your patients and a wider perspective of people's needs in general. It's also likley to rub off on how you come across and talk to your patients. I've been to jobs where you can tell who I am with just doesn't care, doesn't want to be there, honestly just doesn't give a fuck. It is sooo obvious by the way the Officer speaks, how they act, what they say and the bitching they do about the job afterwards. Sure I've been to jobs where as the person is speaking all I can think is wanting to shout "stop saying things!" at the top of my lungs and crawl back to bed but I won't let it show. Doesn't matter how tired you are, how much food you haven't eaten, how much your body aches, how many jobs you've done that you consider to be stupid and a waste of time; your callers have called YOU because they have very real needs be they medical or otherwise and YOU have a duty to try to help that person with thier problem. I went to a job the other night which you might consider "stupid". It was a girl about ten who had a high temp and was a bit chesty because she had tonsillitis. It was a simple job, give her a bit of pamol and see you later sort of thing; no drugs, no lights and sirens, no cardiac arrests. Didn't require an Intensive Care Paramedic and flashy stuff you see on Trauma. The crux of this job was that the mother had called us because she couldn't get down to the after hours pharmacy and her kid was sick, as a parent she was worried about her child because she was sick. To me that job is not stupid, it's not worthless, it's not bullshit, it's not anything like that and if you see simple, unexciting jobs (perhaps like this one) as being boring or bullshit then go away and come back when you have gown up. Little simple jobs (perhaps like this one) are about meething people's needs and showing them you care and will help in whatever capacity you can because this person is in some situation they cannot deal with (which might just COINCIDENTLY be slightly medical in nature) so the LAST THING they need is YOU coming in with the attitue of "this job sucks, I can't be bothered dealing with it and want to go back to the station and watch telly!".

Own discretion. If they can walk they do so however if not we either scoop them and transfer to stretcher, use the stair chair or bring in the stretcher and lower it down and help them on.

The Police have outer vests here which are stab and bulletproof. There has been some talk of the need of for Ambulance Officers' to get them. Problem is they are not cheap at about $700 each x ~3,000 Officers ... works out at over $2 million. Also you ever tried to carry the Lifepak, resus pack and oxygen or stair chair with a stab vest on? ...

You need to look at the context of the PVCs. If they in somebody who is nauseated, grey and sweaty, doubled over and saying "why is Kiwi's pet elephant, Stanley, sitting on my chest?" then it's probably not a good thing. On the other hand somebody who has a stubbed toe and a few PVCs because of the pain is increasing sympathetic stimulation eh, no biggie. Amiodarone might be warranted in the cardiac patient who is having runs of PVCs with ST changes on a 12 lead and screaming chest pain becuse the underlying cause for the PVCs is likely to be ischemia and this guy is at risk of going into VT or VF and dying whereas the patient with a stubbed toe isin't.

Adrenaline is a Paramedic or Intensive Care Paramedic skill here; our Ambulance Technicians do not carry it in either ampoule form or autoinjector. By contrast in Canada it is a PCP skill (analouge to Technician) and in Australia (specifically NSW, Vic and Qld) it is a Paramedic (base level) skill becuse they do not have Technicians. Some of our ambulances have a Paramedic, some have an Intensive Care Paramedic and some just have two Technicians (although they are getting less) so its a bit hit and miss.

My understanding is that training for the EMT in Alberta can be less than PCP in BC. You should consult the PAC AIT tool to see what you'd need ... but I have already done that for you. 1. Professional Responsibilities 1.2 Participate in continuing education 1.2.B Self-evaluate and set goals for improvement, as related to professional practice 1.2.C Interpret evidence in medical literature and asses relevance to practice 4. Assessment And Diagnostics 4.1 Conduct triage 4.1.B Assume different roles in a mass casualty incident 4.3 Conduct complete physical assessment demonstrating appropriate use of inspection, palpation, percuss 4.3.M Conduct assessment of the eyes, ears, nose and throat and interpret findings 4.4 Assess vital signs 4.4.C Conduct non-invasive temperature monitoring 5. Therapeutics 5.5 Implement measures to maintain hemodynamic stabili 5.5.O Provide routine care for patient with urinary catheter 5.8 Administer medications 5.8.C Administer medication via subcutaneous route 5.8.H Administer medication via sublingual route 5.8.J Administer medication via oral route 6. Integration 6.1 Utilize differential diagnosis skills, decision-making skills and psychomotor skills in providing ca 6.1.F Provide care to patient experiencing illness or injury primarily involving integumentary system 6.1.J Provide care to patient experiencing illness or injury primarily involving the eyes, ears, nose or throat 7. Transportation 7.2 Drive ambulance or similar type vehicle 7.2.A Utilize defensive driving techniques 7.2.B Utlizie safe emergency driving techniques 7.2.C Drive in a manner that ensures patient comfort and safe environment for all passengers 7.3 Transfer patient to air ambulance 7.3.B Safely approach stationary rotary-wing aircraft 7.3.C Safely approach stationary fixed-wing aircraft 7.4 Transport patient in air ambulance http://www.paramedic.ca/AITTool.aspx

In Kiwi if you are double (full) crewed one Officer can drive and the other can read the MDT. If you're solo (half) crew obviously you can't. Makes me wonder why they tried to fit MDTs into our single responder vehicles and motorbikes, there's a good idea, not. The Police have a really cool MDT system here that will read the information out rather than having to have you look at the screen to avoid this problem.

Anatomy + Physiology I & II with lab Chemistry Pharmacology Scientific research methods English / interpersonal communications

Ozygenation and ventilation are very different things. Just because you bag the snot out of people does not mean it is going to increase the amount of blood that reaches the organs and brain. ETCo2 and SPO2 are helpful but not all encompasing. My concern is if we give them to people with what amounts to almost zero education in pulmonary physiology how many will pull the ambo trick of "more is better" and try to get everybody up to 99% SPO2/30-40 ETCO2 and possibly do more damage than good? How many people here would ventilate an asthma patient who has stopped breathing ... 10, 12, 15 times a minute and then wonder why he had a PEA arrest?

I went to ten jobs last night; none of them required an Intensive Care Paramedic and we did 12 leads, fluids, drugs, IV analgesia all quite comfortably without ALS, why? because our Paramedics have the skills and knowledge to do what needs to be done and keep the ICPs free for when they truly are needed. Now, we did get one along for a look with regard to ketamine but that was more a nice to have, not a have to have. So? How does this change be it a volunteer First Responder in his jammines or a crew of two Intensive Care Paramedics? Irrelevant and not worth mentioning. Well then your way of working sucks and needs to come into something more modern than say, the eighties. There is no evidence that transporting primary arrests (or really, any arrest) to the hospital makes any difference and travelling back to hospital priority one creates an exponential amount of risk which is not outweighed by benefit. If your Officers are forgetting to do CPR on cardiac arrests, that is not a fact I would state pubically. Good CPR and defibrillation are far more important than IV drugs.

That arranged can be. Next time we catch up or just send me a PM.

You people have no sense of humour!

I would not say I am into making Ambos sound "flasher" or "more important" just IMHO, more accurate. With many systems developing alternate pathways and treat-and-leave (which we've been doing for years anyway) the hospital may never treat the patient for the problem they present with today. Maybe its just me but I don't like "prehospital" - yes, in some situations its relevant and in others it is not.

I wonder how they did not transport, unlike elsewhere I know the US ambos need a refusal to not transport.

So what if they transported her to the hospital and she died. This is probably another false positive of "the ambulance came and at some point following this the patient died so by automatic link, the Ambulance Officers are responsible". Having said that, in DC ..... I dno, I hear they're a bit shaky.

What you are talking about here really are two different things and they are both ones I have been saying we need for some time. Personally I distain the term "prehospital" because it gives the illusion that Ambulance Officers are always tied into transporting. I think "life support" (BLS/ILS/ALS etc) is an outdated term that needs to be scrapped because it ignores 90% of patients, well, 90% of the patients I go to anyway. The new term being used here as the Ambulance sector in NZ moves forward is "emergency community health" which I think is a much better term. Ambulance Officers do not always have to transport a patient and have a much broader range of options and referral pathways, like the CARE program in NSW and ECPs in the UK. Now as far as upskilling goes I think this is another thing we have flogged over and over. You and I are used to very high levels of skill at the base levels, our Technicians are getting scope-of-practice creep and our Paramedics are in line for the biggest changes in how treatment and the dispatch grid works in probably at least 30 years In NZ the majority of the workload is carried out by "Paramedic" (IV/Cardiac) level Officers with some upskilled in IV drugs (adrenaline, morphine, naloxone, ondansteron) but with our new clinical structure we are upskilling all "Paramedic" level Officers in those IV medications plus (I suspect, touch wood) amiodarone and midazolam. As I have said above, and you say too, with the right skills (and education) there is really very little need for an ICP.

Exactly, I am sure if we went through the cities budget we could find money. Of course we need to also look at the important issues of recruiting, retaining and developing EMS providers out in Bumblweed, NM so this his skills dont rust out and he gets bored and skips town.

I think it comes down to budget really and how bad the people want ALS care. Let's say for what it's worth we pay a Paramedic $20 an hour, he works 4x 12 hour shifts and then had four days off with five weeks of paid vacation a year. 365 days in a year minus the 35 days he will get in vacation time. That leaves 330 days, which if we divide by 8 means 41 blocks of eight days. Half of that time he will be at work, and half the time he will not. Four work days a cycle multiplied by 41 is 164 days (or 1,968 hours) that our Paramedic will be at work. The three days left over we will give to paid CCE time. At $20 an hour that's $39,360 per year plus say 10% retirement (401k) means it is costing the city, in this example, $43,593 a year to employ one Paramedic. Now we need more than one Paramedic.

Welcome from a Kiwi who once looked into working in Texas and has been to Dallas a couple times. Now, I hear this guy lurks around Texas somwhere, best be watchin' out for him

This may not be the place for you if you are are somehow connected with the IAFF or IAFC, a member of the Advocates For Fire Based EMS Coalition or a graduate of a 10 week medic patch factory.

Ambulance Officers are medical professionals, not a back door to the Fire Service. Go away.

I agree Phil. We've just had a huge, several year review of our total system and have decided it's time to move to a system that has less levels (from 6 to 3) and more education (Diploma/Bachelors/Post Grad vs. vocational training). The new EMS Agenda for the Future goes a little in the direction you're speaking of although it lacks any substantive, meaningful change in my opinion. The model (which is voluntary by the way) will increase education somewhat and skills a little although in some ways it is a backwards step or no step at all. Speaking from an international perspective the "less levels with higher education and scope of practice" is certianly the trend; Canada and Australia have already done it (can't speak for the NT/WA systems at all there), New Zealand is moving towards such a system over the next little while and well I'm not sure what to make of what the UK has done with the "Emergency Care Assistant" thing. From a business perspective there is a concept (I forget the name of it) which basically amounts to having quality people who can do what they need to do to fix a problem at the recieving end rather than passing it on. From your own experience how many times have you heard "I have to talk to my Supervisor" or "Hey man I don't know, I will have to check" or "I dunno I just work here". The same goes for EMS, if you have people who are well educated and can do what needs to be done without having to call backup then the system is more efficent, it costs less and patients benefit because they get the required treatment sooner. About five years ago it was worked out that most requests for backup fell into one of several categories; adrenaline, morphine, GTN or glucose/glucagon. The intermediate level was given adrenaline and morphine (Upskill Paramedic) and the BLS level (Technician) was given GTN and IM Glucagon and wow ... the requests for backup fell quite a bit.

Say no more, the IAFF should be having an accident on themselves turning on the lobby machine to get support for Fire based ALS!