Western Australia SJA info wanted

[Timmy]

I think your correct with your lesser people comment there Josh, as someone who has been heavily involved with Johnnies but is now coming to ‘see the light’ and gradually withdrawing involvement out of frustration in the way St John deliver there training and assessment. It all boils down to money and bums on seats, you attend some events to find 90% of the volunteers on duty just have a pulse, a first aid certificate and not much else… Recently I’ve been involved with some really sick patients and it just blew me away at how some volunteers handle the situation, there barley competent.

It all comes down to system error, why do St John have doctors and nurses going out to events with no more equipment than what the average first aid volunteer carries? Why is it when we request advanced care equipment our requests are denied? Do you not trust our country doctors and nurses to perform to the same standard as our metropolitan counterparts who get allocated there own personal ALS drug kits, cardiac monitoring equipment, airway management gear and standing orders? Perhaps rural Australians are not entitled to advanced life support? Why do you hand out Certificate II and Certificate IV level qualifications to people who can’t even take a blood pressure or communicate like normal human beings! It all comes down to money…

St John covers about 95% of the major events in Victoria, I can go on duty in Melbourne and work in a St John field hospital that has 12 brand new ferno stretchers, infusion pumps, syringe drivers, massive plastic containers of drugs, cardiac monitoring, intubation gear, suturing material, POP gear, ISTAT analyser, emergency registrars, critical care nurses and MICA paramedics but were still sending a doctor and a hand full of first aiders to provide care to 400 motocross riders in the country with BLS gear and a few ampoules of methoxyflurance. We have one event here that gets a half hearted health response team that carries half the ALS gear that you would see at a similar event in a metropolitan area, maybe its because we don’t charge 40 grand for our ‘low risk events’.

I’ll highlight a recent incident I was involved in, we attended a state motocross event in a remote area. Our crew consisted of 3 first aiders and 2 RNs. We had a kid come off, unresponsive, decorticate posturing, bleeding obvious he had a massive ICB, couldn’t maintain an airway, the initial response from the ambulance service was to send a community officer backed closely by a single ALS paramedic. Not much any of us could do accept call a chopper, transport him back to the rural health facility which has one ED bed and twiddle our thumbs waiting for the doctor on the helicopter to arrive and RSI the kid. It was over an hour before the kid got advanced care despite coming into contact with 7 healthcare professionals. Now, common scene here (either that or I’m going crazy) shouldn’t the service covering the event identify the risk involved with this event would put a strain on local services if things started going down hill? Geez, maybe we should send someone who can RSI and perform advanced life support next time… Doubtful…

Similar situation recently were I had a patient with severe asthma not responding to Salbutamol MDI, well unfortunately dying patient I can only give you that medication and if it doesn’t work I just pray to god the paramedics are just around the coroner. 30 minutes is a long time to wait when you can’t breath and when you have 2 RNs, one being an emergency nurse specialist you look like a pair of incompetent buffoons. But phone orders for steroids or even putting the patient in our ambulance and meeting the paramedics on the road is not part of the services policy and procedure. After all, what’s wiping off an extra 15 minutes in this situation really going to do to benefit our patient outcome anyway?

Just like Granny Smith and Jolly Volly sitting at the drag car racing… I mean, what more do you need than a few first aiders when your car impacts the wall at 250km/h?? Or when the sprint cars bounce, roll, tumble, twist and burst into flames at high speedway at the local speedway? St John have actually started to pay people to attend events using the volunteers vehicles and gear which makes volunteering not very appealing when you could be getting paid $36 an hour for exactly the same thing!

Unfortunately private companies are not a big deal were I am, you rarely see them. If St John isn’t covering the event or we don’t have enough volunteers 10 bucks says they’ve either pulled a lay member of the public with a first aid certificate and handed them a first aid kit from Safeway or there hoping someone will respond to there request over the PA for ‘any doctors in the house?’. On the rare occasion we’ve worked in co location with private companies but there not all that flash, there’s no way of telling if the ‘paramedic’ is actually someone who is employed by Ambulance Victoria or merely a 21 year old who’s just finished there degree, 90% of the time there just patient transport officers. I’d much rather work with Ambulance Victoria if were doing co location gigs.

I don’t mean to be on a big downer here, it just frustrates me when were not participating in proactive/best patient care!

[Private Paramedic]

I can understand your frustration Timmy, I too spent time in the Rural division and a metro division with St John in Vic, and there was a massive difference in the quality of equipment and vehicles. The rural division had a Mitsi L300 van fitted out as an ambulance, looked like it had been donated from the middle east (drove the same too, I threatened to push it down the hill at Mt Bright...)

3rd world, hand me down equipment, etc. It certainly did seem that St John did not exist outside of metro north.

The metro division had a brand new Mercedes ambulance (this was back in 2001 - 2003), and the latest and greatest in everything. Access to training was a lot easier as the whole region would come together (this was when Mr Eade was running the show, I do not know what it is like now...).

The thing i found most frustrating was the restriction of care. I came to Vic after spending time in NSW and was not allowed to administer methoxyflurane. I would have patients in pain and could only offer paracetamol or wait until RAV arrived. I quickly learnt the placebo power of 'medical oxygen' to cause some settling in pain. Came back to NSW, and felt somewhat normal again (how it all changes though... i feel naked without Fentanyl now lol, and do not use methoxyflurane any more...)

The issues you mention about appropriate levels of medical support at events is certainly something that I face each day. Clients want the best they can get for the cheapest price. I certainly cannot offer intensive care paramedics for the same price as a first responder, I would be out of business rather quickly. But, if the risk profile warrants ICPs to be present, the client will be told this as a recommendation and quoted to accordingly. If someone beats that with lower levels of clinical support, good luck to the client and the provider they choose, I certainly do not lose sleep over it. 99% of the time, the client comes back with the words "we should have listened, these guys were way below what we needed".

One thing is the title 'paramedic' is thrown around by anyone with a business registration and a first aid certificate, making it harder for qualified, authorised and competent paramedics in this industry to get ahead. St John vollies have referred to themselves as paramedics in my area in an attempt to get work from me (in fact, I have vollies apply for work as "ALS Paramedics" b/c they have St John NSW ALS certification - O2, Defib and methoxy...), as well as a large number of providers who are not licenced that call themselves 'ALS Paramedics' and 'Ambulance Paramedics' - with a senior first aid certification, possibly experience on O2, defib and maybe a 4 hour cannulation course along with the free AREMT accreditation as EMT-I that comes with the course.

These are the providers that charge a cheaper rate (got me buggered how you can get 2 'ALS Paramedics', paid, equipment, resources, etc for $100 per day and still show a profit...) and undercut the hell out of what the legit providers are doing. Sorry for the rant there, it has been a long day and I needed to get it out.

Edited March 15, 2011 by Private Paramedic

[BushyFromOz]

Dont mean to seem intrusive PP, but are you working for Ambulance Australia in ACT?

[Private Paramedic]

No, I dont work for ASA in Canberra. I work in a private company in NSW that operates as one of the legit ones.

Edited March 16, 2011 by Private Paramedic

[BushyFromOz]

No, I dont work for ASA in Canberra. I work in a private company in NSW that operates as one of the legit ones.

PMS?

I cant think of what other privateers are up that way.

[Kiwiology]

St John WA probably has a lot of competent ambo's ... they mandated the Degree a few years ago for Paramedic and Post Grad for Intensive Care but ehhhh ... its St John, we can't really expect great things on about 10% of the budget that ASNSW, MAS or QAS have now we can?

StJ here has, like in WA, this great position of what wonderful care they provide (!) and how cheap they do it for.

Hmmm ....

[BushyFromOz]

StJ here has, like in WA, this great position of what wonderful care they provide (!) and how cheap they do it for.

And there in lies the problem "close enough is good enough, why waste money on stuff that wont get used very often?

[Kiwiology]

And there in lies the problem "close enough is good enough, why waste money on stuff that wont get used very often?

Exactly, and they ride along on this "we are StJ we do such wonderful work" coz little old Nanas love them to death, which seeks to only further exacerbate the problem.

I emailed StJ WA two weeks ago asking them for a copy of thier CPGs and scopes of practice as I was an international ambo looking to come over ... and as of yet, no reply.

[Private Paramedic]

Kiwi, you probably will not get them. Many services have their CPGs and protocols held as confidential and do not just release them to anyone without good reason. Sometimes, when I am questioned about care (or meds administration) I will pull out the protocols and encourage the government ambulance service officers to have a look, which leads to the comment 'they are the same as ours.... how did you get hold of them?' It is enough to say that we have a good reason, as it allows for continuity of care for our patients upon transfer.

About the only service that I have seen in Australia that publicly published it's CPGs was Rural Ambulance Victoria. I think Queensland did the same for a while until people started using them in the private industry without permission.

The release probably has nothing to do with that the service has something to hide. There are advanced skills in a CPG that require hours of training and clinical practice, and imagine what would happen of Mr Joe Public with a senior first aid certificate attempted an intubation with a garden hose because he saw the procedure written in a CPG he got off the internet. A lot of review, assessment, reassessment, committee meetings, research, time and money goes into developing CPGs, protocols and the regular review of such.

[Kiwiology]

Oh I wasn't partic interested in reading them it was more an exercise in seeing how they responded, and its clear they havent, so it says more about them than if they did.

Now I recently came across this blog by a Perth ambo (http://perthparamedic.blogspot.com/) who lists such innovations they WA do not have such as 12 lead ECG and has a good go about the vollies ....

I know its only one person's perspective but bloody hell makes our StJ setup look halfway decent

Run an ambulance service on a shoestring budget and look what you get

Edited March 18, 2011 by kiwimedic