Timmy

That’s fine ruff, I wasn’t having a go just offering my opinion due to my circumstances. I too would not stop on a busy metropolitan highway due to safety factors and as I’ve said it’s totally circumstantial as to when I’d stop to help. I’ve recent attended a few accidents with both the EMS and Fire services. The one I attended with EMS was literally 10 meters from my front door, I live on a gravel road and the traffic on this road is maybe 6 cars and tractors in a 24hour period, certainly nothing like a major highway. Two international fruit pickers had come across the highway and onto my gravel road at HIGH Speed (200km plus) and impacted a massive tree causing the driver to be objected from the vehicle and injuring the passenger, on arrival I found the pair sitting in the back seat asleep. When I started making some noise, asking if they could hear me, trying to get the door open they woke up and actually refused treatment! (based on immigrations issues I later found out) but never the less I had the cavalry on there way based on the mechanism of injury (the car was defiantly mutilated). We assume the accident occurred around 2400hrs but the alarm wasn’t raised until 0530hrs when I responded and waited 30mins before any other services arrived. I know our next door nebigour would have driven past this accident at 0200 on her way to work but did not stop stating the car looked as thought it had been ‘tended to’ because the impact was so great the car actually bounced meters off the tree and positioned it self on the road as though it had been pulled off the tree awaiting the tow truck… The second incident I attended was with Fire, a car vs tree at high impact (150km plus). The kid was highly intoxicated and some how managed to find his way through the wreak and into the back seat for a little seaester... We had no details from this accident in regards to what time it occurred but on further discussion with the police a few days later (after they did a door knock for witnesses) it was revealed 4 cars had driven past the accident which occurred at around 0200 yet no one was called until 0430. The reasons for this, some of the vehicles were the victims mates, they were also very intoxicated and drink/drug driving, they thought the accident was so bad that the victim must be dead but didn’t want to get busted for drink/drug driving/possession, so they left in fear of getting a conviction. It wasn’t until the milk tankers from the milk factory which use this road fired up for the morning rounds called it in. Fortunately the boy escaped with only minor injury. In situation one the gas tank on the vehicle had been ruptured and had actually leaked out and was empty when I arrived and in situation two the vehicle was leaking fuel all of which could cause the vehicle to erupt in flames, yet everyone was to scared to get involved and help out or even call for help. So yes, in my situation I would stop because I think waiting 5 hours for assistance is just absurd and from what I’ve seen in my local community, people just may not stop or even call for help…

I’m afraid I’m going to have to call your post a little naive there Ruff. I think your comments in regards to looking “cool” and what not are a broad generalisation but at the same time I must reflect on my previous post and point out that stopping at an accident is very circumstantial and depends on many variables. I’m sure it’s different in metropolitan areas were Rescue and EMS are on scene within minutes but I’m a country boy and fact is, to have an ambulance on scene within minutes is not likely. On some roads here it could take hours before another vehicle travels by and raises the alarm, there’s minimal cell phone reception in some areas, if EMS are already on a call then it could be over an hour before another unit arrives so in my situation if I come across an accident I’m going to stop and help if no ambulance is already on scene. I have experience and training with Motorsport EMS and emergency fire and rescue so I’m not going to stand back and let some bystander extricate an injured party with no due regard to scene safety, spinal immobilisation, airway management or bleeding control while it takes EMS 30mins to arrive on scene. As I’m sure your well aware simple, common sense interventions save lives but when you start involving lay bystanders who have been involved (physically or emotionally) in the accident trying to render aid things can turn pear shaped quiet quickly. So if ambulance is not already on scene and the scene is safe in my situation I’m more than likely going to stop and render assistance. Of course once the appropriate authorises arrive I’m going to step back, give my statement to the police and be on my merry way. I’m not going to brag about the incident or think I’m “cool” because frankly, it’s no one else’s business and if I’ve helped someone that’s all well and good, if I stood there with my hands in my pockets then I haven’t caused any further harm… We do have a law in Australia relating to this very topic. It’s under the traffic operations act. This act states: - If any person is injured in an incident were the driver is directly involved or a motor vehicle which is involved elsewhere it the responsibility of the individual to: (i) remain at or near the scene of the incident and immediately render such assistance as the driver can to the injured person; and (ii) make reasonable endeavours to obtain such medical and other aid as may reasonably be required for the injured person. *Maximum Penalty - Failure To Remain At A Road Accident Maximum penalty- (a) if death or injury is caused to any person-20 penalty units or imprisonment for 1 year; or ( otherwise-10 penalty units or 6 months imprisonment. Under section 92(4) of the Transport Operations (Road Use Management) Act (Qld), if the accident involves an injured person and the driver shows 'callous disregard' the court must impose a period of imprisonment. *Possible Defences - Failure To Remain At A Road Accident Possible defences to this offence include but are not limited to 1. The accused was not involved in the crash. 2. There was in fact no crash. 3. There was in fact no crash involving any injury or death to any person or any damage to any property. 4. The accused did in fact stop and remain at the scene. 5. Duress - example: there was a threat of harm against the accused or another person that the accused reasonably believe would be carried out if he/she did not flee the scene. 6. Necessity - examples: (a) The driver was injured and required medical attention and thereby had to leave the scene; ( Another person was injured and required medical attention and thereby the driver had to leave the scene. 7. Insanity 8. Identification i.e. the accused was not the driver in the crash 9. Mistake of fact - examples: The accused had an honest and reasonable, but mistaken belief that he/she were not involved in a collision that required him/her to stop (i.e. they believed the damage was less than $2500). Lawful Excuse - example: The other person/s involved in the crash fled and the accused thereby had no reason to stop and remain at the scene.

In Australia I’m sure in all states it’s law to stop and render aid, I have heard of people being charged for ‘failing to stop and render aid at the scene of an accident’. To be truthful I’ve never stumbled across an accident without being in a marked vehicle or being called out… I see your point in regards to the dangers posed by rendering assistance on a busy highway but personally I live in a rural area so heavy traffic really isn’t an issue and the limited oncoming traffic would pull over anyway if no emergency cars were on scene. I’m sure there’d also be some implication on my nursing registration if I didn’t stop. I’m sure in nursing legal and ethical class they did say something about establishing a relationship with the patient then you form a duty of care, something like that anyway. So technically if I didn’t identify myself as a Nurse I have no duty of care but living in a smaller community where every man and his dog knows of you it’s quiet hard to keep that fact to your self. I guess I could just drive past but chances are we’d just be paged back there… If the incident occurred out side of my local area, say travelling home from a holiday or likewise it would obviously be circumstantial if I’d render assistance or not. My personal safety comes first so if it’s not safe then obviously I’m not going to put my self in any situation that may compromise my health or wellbeing, if emergency services are already on scene I’m not going to stop either. Now in saying that Australia has a large geographical area so in some places it could be well over an hour before an ambulance arrives, in that situation I would stop and render assistance.

I agree, that demonstration model does not look comfortable! She does appear to have a rather obvious anterior posture which could lead to lumbar spine issues. Never the less, an interesting product.

I think I saw that on TV once...

I agree, EMT level providers should not be making clinical decisions in regards to patient transport. In Australia (my state) our requests for emergency ambulance care are put through a triage type system and put into either one of the four categories. Code One Emergency = life threatening, Code Two = semi emergent, Code Three non life threatening and Code Four = psych patients. We also have a nurse on call system were you can receive information over the phone. Maybe Josh or Phil could enlighten the situation because I don’t work for the ambulance but as far as I know paramedics here can refuse to transport. Were also seeing a growing number of paramedic practitioners who attend non life threatening jobs and can treat a patient accordingly, these guys have higher education in the primary health care area. We also have a paramedic clinician in all the operations centres who can decide what happens with a patient.

Holly cow! That is grossly unacceptable, very unprofessional and a massive infection control risk! The poor patients… Not that I have bared witness to an individual in Australia partake in such an unusual activity but I’d blatantly refuse to work with anyone displaying such odd behaviour… Come on bro, you’re a health care professional… Spitting into a cup or your masticated tobacco coming into contact with a patient’s eye?? And I thought chewing gum in front of a patient’s was unprofessional… FAIL!

Attractive....... Can't say I've ever heard of it lol

Define Dip?

RIP

No Prob, thanks for clearning that up

So… Let me get this right… You have staff who are qualified in advanced first aid doing critical care transports? I pose this moral question, how is this possible?

I also concur with the general consensus of the team. It’s your course, you either make it or break it. If you’re not happy with the university transfer to another… It’s adult education not high school.

Yes, quiet lucky indeed. We've had a few Motocross bikes rumble into the crowd on the odd occasion over the years. Never had anything like that happen at speedway though, on the odd occasion a spectator may get whacked in the head by a flying dirt ball. Rodeos tend to get a tad interesting when the bull takes off into the crowd though…

Sure. With out knowing this person or the situation it’s hard to pass comment. The way I run things with the new members and cadets is tell them to take the lead while I provide supervision and support, tell her to ask questions if she’s stuck but at the same time warn them not to be offended if things start to turn pear shaped and I need to step in and take over. At the end of the call sit down with her, ask her how she went, ask about weak and strong points and ways to improve and then offer your feedback. I’m sure with some constructive feedback and extra training and support things will work out for the best. On the other hand: Does she really want to be in EMS and takes a strong interest or just she just want to help around the station with cleaning trucks and so on? There’s nothing wrong with taking a step back to provide a support role.

I too had a similar problem with one of my volunteer members. There’s not a great deal you can do, as a manager I just documented and wrote incident reports every time something went wrong and reported it to the regional clinician. Because it’s a volunteer service there really wasn’t many options in regards to having him dismissed because of discrimination and so on but I did suspend him from his operational role pending medical investigation, subsequently he is no longer an operational member and can not treat patients but still has full rights to attend meetings and trainings which he takes full advantage of to everyone’s dismay! The first step I recommend: You inform your OIC. and You approach him with your issues to define a cause to these problems - in the company of a mediator and have the conversation documented. It may be something as simple as lack of confidence that can be rectified with more education and training. Pending the outcome of this interview will dictate as to what action is needed next.

There’s no need to apologies, this is a forum of adult education were mature and up standing citizens voice there educated opinions and receive constructive criticism in a professional and well educational environment. Nah, it’s all good. I once was a Student Paramedic back in the day and made the switch to Nursing as we were constantly told that undergraduate high school leavers would never be accepted into the graduate program with AV because we had no ‘life experience’ and we’d be better doing nursing first then coming back to paramedics. I was also a little uneasy about the shear volume of first year students they accepted into the paramedic degree. (Not to mention the better pay, hours and work conditions compared to being a paramedic, have you seen what a RN Div One can earn on agency? It’s not to shabby at all) So I moved back to the country, found my self a hospital that paid for my training, paid me a full time wage, were crazy enough to pass me then gave me a scholarship to bridge into the nursing degree… I know deep down that I immensely want to be a paramedic but for the time being I enjoy nursing, it’s fun, challenging and I’m learning a lot. Anywho, enough about my life story… As I said in my previous posts, there two different courses. After all, what’s the point of having the same course for two different industries? Someone posed a question in a previous post what defining relevant paramedic education. I have no direct answer to that as I’m not a health sciences teacher nor am I a paramedic but like anything you need to assesses what previous qualifications, skills, education and experience these people have, you then need to implement a plan of action to over come these gaps in knowledge by both theoretical and practical education and possibly assess them on what there new scope of practise maybe as a paramedic with the aim of producing safe and competent partitioners. There was mention that Nursing and Paramedics are very different in regards to clinical environment, approach and support mechanisms – this is very true. How do we overcome this? More than likely with clinical supervision and guidance from an experienced practitioner in that particular speciality but at the end it all comes down to time and experience.

Melclin - for sure, there’s heaps of courses RNs can do to increase there scope of practise in the ED. As I said, it completely depends on what standing orders are in place and what the facilities policy is regarding what nurses can do. At a rural hospital I work at the senior nurses have an individualised scope of practise which is signed off by the hospital chief medical officer that if X situation arises then X nurse can perform X task without medical direction. Just look at the RFDS, they sometimes send nurses out on emergency missions without a doctor and can perform to a similar level as MICA in remote situations. I know this is a little off track and maybe a little basic but St John have a standing order for any volunteer RN (including grad nurses) to independently administer and carry methoxyflurane, GTN, paracetamol, salbutamol, ant acids and acetylsalicylic acid (soon to add adrenaline and IM glucose) with out any medical direction what so ever and it's more than likly they can not administer these medications at there workplace without an order, I know these are basic drugs but it's just a little example to support my cause on facility standing orders lol. The base line course that is offered around Victoria for any RN is called Front Line Emergency Care, this course encumbers basic emergency education but only allows slight increase in scope. We have a Remote Area Nursing course which includes X ray interpretation, ECG interpretation, initiation of first line emergency medications, suturing, back slabs etc. There’s also a course accredited by the Royal Australian College of Nursing which encumbers a number of ALS skills such as airway management including LMAs, ETs and Crics, IVC and venous cut downs, head injury assessment, splinting and spinal immobilisation using collars, spine boards, KEDs and traction splinting, chest tubes, burns management and fluid balance, managing shock and so on. There’s heaps of courses based around the concept of ALS/PALS/ILS/ACLS and the list goes on and on. As I said, the standard nurse can not perform any of these but certainly a Grade 5 Nurse who has under gone this further education can with approval from there employing facility. Just so we don’t have our wires crossed here, I do not support any RN to work on ambulance without the relevant paramedic training.

You and your damn Tim Tams Ben, poor kiwis your missing out on the good stuff. I acutally have a Tim Tam Easter Egg sitting in my room, collecting dust lol Anywho, back to the topic.

I sense a little naiveness here. I don’t think a Registered Nurse is any more or less educated than a paramedic, merely you’re provided with industry specific education. The Bachelor of Nursing degree in Victoria is not based around emergency or pre hospital care, while it has some elements of life support and basic emergency care this is not its intended content. The aim of the graduate nurse from this degree is to be a competent practitioner in holistic nursing care, I see the nursing degree as the fundamental or baseline level of nursing with hundreds of educational opportunities and courses in the specific area of nursing I enjoy and dabble in after I graduate. If I want to work in an Emergency Department I can go off and study my Graduate Diploma of Emergency Care or Master of Nursing (Emergency Care), if I want to work in the Cardiac Unit I can go off and do further education in this field, same with community nursing, continence care, intensive care, acute nursing, diabetes and the list is endless. I’m sure you’re fully aware of how a Registered Nurse becomes a paramedic in Victoria. One must hold a Bachelor of Nursing, Graduate Diploma in Emergency or Intensive Care then complete the Graduate Diploma of Paramedicine. That’s 5 years of tertiary education plus experience compared to a undergraduate paramedic who has 3 years education. I’m not sure how much rural exposure you’ve had but we have a doctor shortage out in the sticks, in smaller rural facilities were there are limited/no doctors, nurses are often the only health professionals present during an emergency and depending on what level of training the RN has depends on what can be done for the patient. Depending on the facilities standing orders specific RNs can RSI, thrombosing, perform needle chest decompression, give front line medications and take any measure to sustain life within their scope of practice with out a medical order. We have an excellent relationship with the paramedics which is an essential part of the multi disciplinary team which ultimately contributes to a positive patient outcome. I’m merely a RN Endorsed Division 2 (shock, horror what would I know). I work casually in a small rural setting as well a regional hospital to support my way through my degree and I can tell you it’s no walk in the park. I mostly work weekends and nights were we have limited contact with a doctor. Sure I need to have a doctor’s order (direct or indirect) to give a medication or perform an invasive procedure but I can assure you the young intern/resident who has no interest in general medicine or surgery because they’ve been shoved out in the sticks as part of there rural cohort training and mope around all shift grumbling about not being at the Alfred or RMH, they makes quiet a number of mistakes and I need to know what’s going on in order to prevent being dragged in front of the coroners court. Most of the time they just okaying what I’ve suggested is best for the patient based on my clinical observation through out a shift, 9 times out of 10 they wont even come back to the ward to R/V the patient because there too busy waiting around for the next MET call. In certain ways nurses have a greater scope of practice, even though doctors must prescribe a medication I’m still responsible and accountable for giving it, this means I must be aware of the pharmacokinetics, pharmacodynamics, adverse reactions, interactions, contraindications – equally must a paramedic. The difference being you guys have… 40?? Drugs in your bag of tricks but we have a whole room full of medications. We can catheterise, deal with central/PICC lines etc etc were a paramedic would not know were to start. But on the other hand, as you say paramedics have greater flexibility in prescribing your own medications and doing what you like, per say. In conclusion please don’t short sell nurses because we all have our place and our speciality, I have great respect for ambos, your knowledge and skills and one day I hope to become a paramedic as well. But with a appropriate bridging program and education in the relevant specialist area I see no problem in a RN becoming and ambo or vise versa

To become a Registered Nurse or Paramedic in Australia you need to complete a 3 year degree, the training standards between a paramedic and nursing degree is pretty similar but obviously it’s industry specific. You can’t expect a Registered Nurse to jump into an ambulance and be expected to perform at an advanced level of pre hospital care with out appropriate specialised training in that area, just as you can’t expect a paramedic to perform at an optimal level in say a surgical environment or in the nursing intra hospital environment. I’ll draw you a little flow chart which demonstrates how a Registered Nurse can become a paramedic in Victoria, Australia. Bachelor of Nursing (3 years) ^ Graduate Year (One year of mentoring in a hospital) ^ Registered Nurse, Grade Two (Base Line Nurse) ^ Graduate Diploma in Emergency Care or Intensive Care (One year) ^ Graduate Diploma in Paramedic Care (One year) ^ Graduate Paramedic ^ Advanced Life Support Paramedic Unfortunately there’s no bridging program for a Paramedic to become a Registered Nurse. While it’s all well and good to have RN’s running around on the ambulance your company needs to have a bridging program to ensure a smooth transition.

As of late my volunteer EMS management role has been causing great personal frustration!!! I can't believe the minor, trivial, mind numbing incidents the public complain about!! In the past two weeks I've had to deal with: I had the park ranger at a bike race event follow two of my ambulances with beacons active one hour up a mountain to an incident then abuse my volunteers (Intensive Care Paramedic and Registered Nurses) for not stopping at the check gate to identify themselves and threatened to give them a fine for failing to stop, yet he would let 2000 bike riders go through the same gate with no issue, this part of the mountain was a planned route for the bike race and he was aware of this. I've just had a douche from the public complain about having to speed past 3 of my ambulances on the way home from an event because they were travelling 5km under the posted speed limit. He told me it made him very 'frustrated' to be driving so slowly. I had a lady at a horse racing event abuse me for parking the ambulance under a tree on a stinking hot day and blocking the public view even though this area was marked on the event map as were the ambulance would be located, the event organiser had told me to park there and it was the only position were I could see the whole track. I had a crew driving home from an event in Melbourne (3 hour drive), a man complained that my guys had gone into McDonalds, consumed the food then parked the ambulance in the rest area at the truck stop and proceeded to have a power nap... They've just done a 15 hour shift and I commend them for having common scenes to stop for a break, get something to eat and rest before a 3 hour drive home. What do I say to these people? I'm certainly not going to apologies for my crews actions because they've done nothing wrong. I advice them if they wish to make a complaint it should be submitted in witting and it will be investigated. I have a good team of volunteer health care professionals and first responders who give up there time from there normal well paid jobs to help the community and they feel like wise. I give up a lot of my time to help out here, I'm only 20, I'm a nurse, I work full time, University goes back soon and as much as I enjoy running the EMS service if things like this keep coming up I will reconsider my appointment, I certainly don't volunteer to deal with such minor complaints. People can be so shallow sometimes!

I agree probably a lot of media mumbo jumbo. Not that I have any emergency on road experience but I have done a substantial amount of EMS standby at major rave parties, dance and trance events and outdoor music festivals. We deal with an extreme amount of multi polysubstance abuse and intoxicated individuals in various stages of mental states, euphoria and what ever else comes along. You deal with adolescent crowds ranging from 30,000 to 70,000 in both outdoor and indoor environments and sometimes in high temperatures. At most events it's not uncommon to have 1 in 3 in possession of an illicit substance and 90% of the crowd extremely intoxicated, it's not uncommon to treat over 400 patients in a 8 to 12 hour period with a major of incidents related to drugs or alcohol. The cases of assaults on the EMS volunteers and paid staff is very low for the number of patients presentations and the environment we work in. Sure there may be the odd verbal assault but when it comes to physical assaults these figures would be very low. Even at the outdoor dance festivals the revealers may be dancing in 40c temperatures, the crowd is obviously very irritable but physically violence on staff is low. I worked at a dance party only last Tuesday, we had around 90 EMS staff on over 10 hours and I didn't hear or any assaults on EMS staff.

Happy Birthday