zippyRN

well anyone is without the skills, knowledge and experience to do a job in particualr kind of setting - a lot ofthe health professionals in SJA have come up through the youth side, been a first aider or even ambulance crew before becoming a Health Professional ... Bread and butter for St john and the British red cross, our involvement in 999 work is pretty much an extra ( peak periods etc ) and some NHS serivces don't do eventsat all leavign it for privates or the voluntary sector others do do events as an addon - some run it as a side line business

Event EMS - mainly doing event work ... like V festival, London Marathon , Concerts etc. Ambulance attendant - 'EMT' has no real meaning in the UK and the 'ambulance technciian' title is meant to be for those who have done the IHCD course, the supervised probation and passed the final assessments and got their 'millar badge' - this was unti lvery recently a 'closed shop' for NHS Ambulance service employees and while it's a good respected and respectable qualification, it's irrelevant for somethign who has a registerable Health Professional qualification as for being an RN - SJA rules in the UK require Registered Health Professionals as supervisors on larger duties ( tied in with event licensing ) and to have oversight roles within training , the event licensing guide requires certain levels of EMS provision including RNs and Doctors for events, as well as various National governing bodies for sporting events requiring Doctor,s Nurses and Paramedics for competitors / participants. For instance a recent large concert in Leeds, W Yorkshire had a gate of somethign like 70, 000 people and we had 4 ambulances ( 2 NHS, 2 SJA ) 4 treatment bases, 5 Doctors ( at least 2 COnsultant / DipIMC / MIMMS provider at any time), 8 Nurses, 8 Paramedics, 8 techs / ambulance attendants 50 or so 'first aid' and support personnel (ranging from 'bog standard first aiders, to ambulance attendant grades including a slack handful of senior medical and Nursing students as well as some comms technical types, dispatchers and logsitics people)

or actually ensuring that providers arem ore than cook book following performing chimps?

one ofthe main problems that US trained providers face with converting to UK qualifications are two fold 1. the requirement for the probationary year at the techncian level for the iHCD award used by NHS services 2. the closureof the 'grandfathering ' route to Paramedic registration with the Health Professionals Council which means in the near future it will be impossible to register as a Paramedic woithout a Suitable Higher Education qualification and at present the main route to registration outside higher education requires the IHCD route to be followed

doctors in prehospital care safe and effective critical care medicine and surgery when you need it on the streets it;s there - look at the UK model of provision particularly LondonHEMS (ground units as well as air) , WMCARE , ATACC , SJMRWY plus the air ambis that fly with flight physicians ... EMT-Bs = really first aiders with extended skills - same quantity of training in the Uk would have you viewed as a first aider with extended skills and perhpas you'd be allowed to use a first response vehicle on a large event where there was lots on site Ambulanc,e Paramedic, Nursing and Doc backup ... Higher education for parmedics -absolutely!

in which case you won't treat and release but what about the known type 1 diabetic who hypos and comes round with some glucose gel or a shot of glucagon, has someone with them, means to get some complex carbs on board and a ride home ... the 'whipcash' neck pains at low speed RTCs... the ottawa negative ankle injury ... or even an ottawa positive ankle injury where there is someone to run them up to the minor injuries unit for the X ray ... the none life or limb threatening wound that needs formal closure in the next few hours but there is no reason why thwy can't go to a minor injuries unit under their own steam the 'difficulty breathing' cat A who is nothign more than a case of man flu ... all stuff that could be treated and released at scene by a decently educated tech never mind a Higher Education prepared paramedic or like Emergency Care Practitioners and Nurse Practitioners in UK Minor Injuries Units and Emergency Depts. act as a autonomous health professional act within theoir own professional scope of practice and discharge / refer / admit as approrpaite or just sticking to using expensive tests where they will affect the treatment of the patient - hence hte reason for the various imaging rules because of the huge burden of unneccessary 'medicolegal' Imaging with the assocated X ray exposure this brings happening o nthe left of the pond ... ditto for haematoloy and clinical biochemistry

true but you have to be a keen johnny to realise, a few other counties have picked up on thestructure ideas and nomenclature as well it appears

sadly you will find that the n either the NHS or the VAS accept US american qualifications EMT_B in terms of contact hours is less than many UK event first aiders / first responders have and the ambulance qualfications run by the VASes have far more contact hours in the training and the standards expected are pretty high US trained paramedics will struggle to get reciprocity , especially now the grandfathering route is closed and the current moveds are for new entrants to be Foundation degree / dipHE prepared ( 2/3rds of a honours degree) - iti s also worth while noting that UK paramedics are full health professionals and work under their own licence to practice ( hence how their own legal pwoers to supply and adminster the prescription only medications contaiend i nthe statutory exemption)

zippy checking in UK based , Emergency Dept RN and SJA bod , Staff Officer ( except it's not called that where iam but telling you my job title would give it away), crew, assessor, general dogsbody

ultimately you will end up with tailifits or ramps and hydraulic or electric raise wheel-in cots http://www.emtcity.com/phpBB2/album_pic.php?pic_id=719

asrnj77 the issues surrounding health professional education revolve around the applicability or not of the liberal arts model to all higher education courses. theUk doesn't have a liberal arts model hence the reason bachelor with honours degrees in the Uk are 3 years for none health professionals and 3 to 4 years where the several thousand hours of supervised practice are incorporated for student Health professionas

that's not the experience 'in Europe' - while it may be the experience of the franco-german system it;s not the experience of the Biritish system with Health Professional Paramedics as the main advanced provider or the Dutch /Scandinavian System with Nurse practitioners as the main advanced provider ...

might be the case i nthe US but in a 3 year Diploma of higher education or 3 - 4 year Bachelor with honours health professional programme in the UK it's all relevant from the start and includes significant clinical exposure ( minimum 2300 hours for Nurses) 4 different models of EMS in Europe 1. British - Has multiple grades of ambulance provider Ambulance care assistant - only does the pre planned patient transport work - might first respond - limited training intermediate tier - does urgent admissions, stable transfers and post triage emergencies - relatively limited training but the training they do get is to professional ambulance standards technician - does full range of emergney ambulance work, limited invasive techniques ( BGM, IM/ SC drugs ) Paramedic - full health professional status, - imminently Highr education qualified for entry to practice Emergency care practitioner - post basic ( degree or post grad) educated paramedic or Emergency care RN - has practitioner skills and wider ranging drug therapy and referal options - relatively limited additional critical care skills if any some field involvement of physicians - but primarily critical care medicine and anaesthesia , prolonged scene times due to entrapment and mass casualty incidents 2. the Dutch / Scandinavian system - where advanced providers are all post grad RNs 3. Franco-German systems with physician led provision 4. mediterrean systems which are back in the dark ages - blokes in vans with first aid boxes

are we talking statutory (bank) holiday / or annual leave working i nthe ED our bank holidays are effectively rolled up into our annual leave ( 27 (short 7.5 hr) leave days + 8 * 7.5 bank holidays) - or you could take it on the day and work one less shift that week. if you work on the day itself it;s thesame as a sunday for pay purposes Base +60% . holiday is usually taken in hours depending on current shift patterns etc.

ambulance , 'motor' or callsign or bits of registration ( one vehicle in the fleet was always called GUA after the last three letters of it's registration rather than it's callsign of 151)

from a Uk point of view - plenty of vehicles avaialbe as emergency services vehicles via their respective manufacturers SVO depts common response vehicles include Vauxhall Astras, Zafiras and Vectras Honda Accord or CRV Volvo V50 or V70 and interestingly enough some small van based vehicles such as the transit Connect

see my previous post or excuse plug come and have a look at www.ambulance999.co.uk - the forums on there are very good in terms of a Uk focused EMS forum and it has a good mix of people from all sectors and services otherwise look up Paramedic scence courses on ucas.ac.uk

i'm with dust here- unless the wait for the ALS unit is 'worth it' ( very prolonged transport time with a short resonse time for ALS) asa riht pondian i find it odd that people consider a basic / para or even an Int/ Para crew 'limited' in terms of ALS - given the UK default crew on NHS vehicles is tech/ para

same sort of picture with St. John Ambulance in UK. SJA Cadets are age 10 -18 and certainly from 13 -14 upwards we get them involved in treating suitable patients , under supervision on non ambulance duties or in treatment centres. From age 15 subject to risk assessment they can observe on Ambulance work ( mainly low risk event work, definitely not motorsport , not support shifts) and from 16 can get independent status as a first aider ... as it stands they can't get ambulance crew accreditation until they are at least 18 and due to the driving rules unless they are NHS trained emergency drivers ( so University paramedic students who have completed the tech phase of the course) can't drive until they are 21 so outside of a few circumstances you can't have 2 under 21s on a vehicle - and if you did one or both would be NHS trained tech uni paramedic students...

eye on the bottom line? 'item of service' or 'payment by results' banging plenty of patients who need little more than advice through the minors side is good for income however proper sinusitis is a painful and distressing complaint which can make you really ill ! (

unless you have advanced practice staff like Uk emergency Care Practitoners who can diagnose and treat a range of minor injuries and illnesses as well as do ALS ambulance stuff...

licenced = proper professional registration and recognition and a qualification that stands on it's own rather than a dependent on being employed by someone certification

http://www.asancep.org.uk/JRCALC/ might work better to get to the JRCALC clinicla guidelines

these you achieve by good QA programmes, adequate training and Education, and involvement in service provision, not by making the guys and girls out on the road ask for permission to do things you have provided them with the education to do ... If medical direction are there to answer questions outside the protocol / guidelines, if medical control physicians are prepared to come out to scene where there is a clear need - that's great - that's what our medical directors in the NHS and Voluntary sector do making people ask for permission to do their jobs is nothing other than a power play ... needless to say in most places outside the USA registered / licenced providers don't have to ask for permission to carry out interventions within their approved skill set... protocol books are bad full stop, clinical guidelines are very good , the UK works to clinical guidelines ( www.jrcalc.org.uk) but has the advantage that paramedics work to their own registration, however the organisation is still vicariously liable to a degree and is liable for all the actions of technicians, middle tier , PTS and first responders only where there is a power battle between the road staff and the medical directors - especially where medical direction is provided by physicians with no appreciable field experience...