Vollie Non Emerg Ambos Vs Paid State Staff

[Penthrox]

Hi,

I am a volunteer Paramedic here in Australia and volunteer for a group here. My paramedic level is recognised by AREMT and is an Advanced Diploma, the state run ambulance service which responds to 000 (aussie equiv to 911) run Ambulance Officers (equiv to EMT - all the way upto Extended Care Paramedics. I was working a motocross on the weekend where a rider came off his bike at 70mph subsequently fracturing his wrist in the process. I was not first crew to him, the first crew consisted of an EMT - B and an EMT - I. The patient's helmet was cracked in several places, on lookers state he was 'asleep and awake' during the time it took for response to him. The patient did complain of loss of feeling in the lower limbs and pins and needles also. Naturally the crew assumed it was spinal and stabilsed the head and neck with a c collar. The patient was haemodynamically stable at the time of primary, for pain the patient was given methoxyflurane (self administered analgesic) which had minimal effect. We do not carry any other medications for pain relief. We called the state ambulance service for transport and a higher level of pain relief. All this was relayed to the comms room of the state ambulance service and they dispatched a crew. During the time it took for them to arrive he because shocky, flucuating bp and nauseous. I made the call to cannulate the patient and administer fluids and an antiemetic medication. To administer the antiemetic medication I need permission from the state run ambulance service according to our drug protocols, so I contacted the clinician of the state service and was given permission.

I administered the medication and started fluids, he once again stabilised although his pain was still a 10/10. The state service arrived and insider were to ambulance officers (emt - who could not administer opiate medications. I also had the patient cannulated and they are not allowed to transport cannulated patients. After explaining to the crew what was wrong with the patient I was talked down to by one of them and he made the statement 'what would you know you are just a wannabe' to which I replied 'I am actually a paramedic and a anaesthetic nursing specialist mate so alot more than you!' which didnt go down all that well. The first thing the state crew did was pat slide the patient to their strectcher although he was on scoop stretcher. They insisted on sliding him across, so we let them. The kicker is the very next thing the ambulance officer does is RAISE THE HEAD END OF THE STRETCHER after he has been told of suspected cervicle injuries. Immediately I lowered it and phoned the clinician at their comms centre. During the time I was on the phone the ambulance officer had stopped the IV which is not qualified to do and removed the cannula, loaded the patient into their ambulance and drove off code 1 (lights and sirens). Gobsmacked I lodged and official complaint and that is the last I have heard.

It just goes to show although there are private cowboys out there, there are also state run cowboys who think they know it all. I felt so bad for the patient and I hope he is ok.

My rant for the day.

Thanks for reading.

[uglyEMT]

WOW

That sounds like a bunch of wackers if you ask me.

I know you are in Oz and things are alot different as far as EMS goes but I always thought you had to hand patients over to a higher level of care. So if I am reading this right you are Paramedic level of care (thus the IV start and pain meds) and the Transport ambo is basics with an intermediate. So wouldn't a CCP transport have been needed?

Beyond that....

These guys need to be wrote up BIG TIME!!. I am talking Medical Director notified, Service Owner advised, their Shift Supervisor advised, their Crew Cheif and Captain / Line Officers advised. I mean in writing advised as well as possible face to face. Something is terribly wrong with that picture. Person in full C-spine and they lift the head? They move outside their scope of practice and stop an IV? They remove the cannula just so they could transport? These bunch of wackers, yahoos, waNkers, whatever you want to call them do not deserve to have a liscense let alone be around anybody with more then a bandaid.

If I am off my mark and appologize being I am from the States and things are a little (alot) different here.

[Penthrox]

WOW

That sounds like a bunch of wackers if you ask me.

I know you are in Oz and things are alot different as far as EMS goes but I always thought you had to hand patients over to a higher level of care. So if I am reading this right you are Paramedic level of care (thus the IV start and pain meds) and the Transport ambo is basics with an intermediate. So wouldn't a CCP transport have been needed?

Beyond that....

These guys need to be wrote up BIG TIME!!. I am talking Medical Director notified, Service Owner advised, their Shift Supervisor advised, their Crew Cheif and Captain / Line Officers advised. I mean in writing advised as well as possible face to face. Something is terribly wrong with that picture. Person in full C-spine and they lift the head? They move outside their scope of practice and stop an IV? They remove the cannula just so they could transport? These bunch of wackers, yahoos, waNkers, whatever you want to call them do not deserve to have a liscense let alone be around anybody with more then a bandaid.

If I am off my mark and appologize being I am from the States and things are a little (alot) different here.

The way it works here in my state anyway is you hand off to the state crew for unstable transports. Being that it was a private event we are not authorised to transport unless directed by the clinician of the state service over the phone (normally an extended care paramedic or doctor). That will only occur under 3 conditions, we will be quicker than them arriving and a paramedic is on crew, it is a triage situation or we are directed by the clinician due to overloading on their crews (they must be stable). It was not a metro event it was out in the country and most of the stations for the country have volunteer crews who are all at a emt b equiv. At some including the one they vollie crew came from had a paid Intensive Care Paramedic on crew in a sprint car (Ford Territory used to arrive quicker). He didn't attend as he was at another job. The sad fact is the constant shame I feel when dealing with them because I am a 'wannabe' or an 'ambulance chaser'. I can't be a paramedic here with the state service because I do not meet my BMI and am considered unsafe, although I can do all the manual handling required for the job.

The case in question was set out like this, for my organisation we have 2 ambulances and 1 4x4 support vehicle. At this particular duty we had 2 paramedics (to international standards), 1 EMT - I, 1 EMT - B and one trainee first responder. At the time I had a patient at our outpost who I suspected had torn his MCL but refused transport to hospital, it was at that time the rider went down. The other 4 (including the other Paramedic) set out to retrieve the patient, he was brought back to the post where I was. I only cannulated because he became unstable, everything else was done. They arrived to us and transported from there, where the above story takes over. We have to handover to a state run service if they arrive irregardless of their qualifications. The fact we are not normally shown any respect is par for the course around here and in the country 99/100 I will have a greater level of training than them. It was reported to the clinician on duty at the time (whom I work with at my hosptial job) and also to the health commission of Australia.

It really makes me question if its ego or the patient they care about. I offered to travel with them as they had Morphine and Fentanyl on board and with permission from a clinician I can administer these medications but that was refused. So for ego the patient suffered the 40 minutes over dirt and broken roads to hospital to get further pain relief when i could have given it to him then and there. It is just the sad fact of life I guess, this is not to say the state service is all bad. The majority show us respect (especially to myself and the other para's) but it just upsets me when pride and ego take over from patient care.

The patient was in full C-Spine and yes they did lift the head end of the stretcher, stop fluids and remove an IV Cannula because they can not transport with cannula in situ (unless I accompany them but oh how embarassing!).

[Kiwiology]

So exactly where did you get this "Advanced Diploma"?

Sounds to me like you are some volly dreamer

[Penthrox]

So exactly where did you get this "Advanced Diploma"?

Sounds to me like you are some volly dreamer

Thank you for proving my point....

The company I work for is where, which is then regulated and checked by AREMT.

I have not mentioned the fact that I am currently studying the Bachelor of Health Sciences Paramedic at Flinders Uni and wouldnt you know I recieved RPL.

I am not here to have an argument with you Kiwimedic as I am assuming you work for St John Ambulance? Just the pinnicle of how an ambulance service is run.

Unless you have some constructive remarks instead of slander please stay out of my thread.

Oh I also have a Bachelor of Nursing from UniSA want to rip that to shreads aswell? I work in a trauma hospital here as a Nursing Specialist but hey im just a vollie dreamer.

Edited May 19, 2011 by Penthrox

[mobey]

Thank you for proving my point....

The company I work for is where, which is then regulated and checked by AREMT.

I have not mentioned the fact that I am currently studying the Bachelor of Health Sciences Paramedic at Flinders Uni and wouldnt you know I recieved RPL.

I am not here to have an argument with you Kiwimedic as I am assuming you work for St John Ambulance? Just the pinnicle of how an ambulance service is run.

Unless you have some constructive remarks instead of slander please stay out of my thread.

Oh I also have a Bachelor of Nursing from UniSA want to rip that to shreads aswell? I work in a trauma hospital here as a Nursing Specialist but hey im just a vollie dreamer.

Don't feel the need to spew credentials here, where you attended college/university/highschool, whatever means nothing to us.

Your posts will prove if you are a competent, mature, and professional provider. Getting in a pissing contest over which school is better only makes both parties look foolish because you cannot prove the quality of the graduate simply by the school attended.

[uglyEMT]

Woooohhhhh Down Boy.

I assume it was stated that way only because you are a new member with little posting history and sometimes we get folks non qualified acting as if they are and it winds up being a shyt storm.

Back to posting..............

Thank you for the clarification as far as the transports go. I didnt realize you have to hand off because they are state. That does suck.

As far as the whole your volley I am paid I will not get into that can of worms (BTW I am volley myself). At big events I do see my fair share of egos. I occasionally have bad experiences, nothing to the extent of your scene, but have had times when I have had to demand, politely, certain things get done (thanks to all here for making me understand what different levels provide and some basic info on things).

I have found sometimes YOU have to be the patient advocate and stay with them. If it means holding onto them and contacting med control while having a hand on the stretcher then so be it.

Hopefully everything worked out OK and the patient is fine. Unfortunatly pride/money/ego comes before patients sometimes.

Keep us updated.

[zippyRN]

Thank you for proving my point....

The company I work for is where, which is then regulated and checked by AREMT.

I have not mentioned the fact that I am currently studying the Bachelor of Health Sciences Paramedic at Flinders Uni and wouldnt you know I recieved RPL.

are you recognised as a Paramedic under the relevant legislation ? does AREMT 'registration' actually provide a licence to practice ...

alternatively does your Nursing registration allow you to independently administer the medication you administered ? whether that's via a Independent prescriber status or by virtue of patient group directives authorised by the State Service or by your employer and acknoweldged by the state service.

if you were to pm me your name , dob and location or registration PIN would I be able to verify your registration(s) ?

I am not here to have an argument with you Kiwimedic as I am assuming you work for St John Ambulance? Just the pinnicle of how an ambulance service is run.

if you want to play silly buggers over organisations - go boil your head mate, it killed ambulance999.co.uk and I don't want to see EMTcity dragged down the same route

Unless you have some constructive remarks instead of slander please stay out of my thread.

there has been questions previously raised over the legitmacy of AREMT , especially when they started suggesting to people outside Aus that 'their' qualifications could be used to gain certifcation / registration with other Countries Professional regulators

Oh I also have a Bachelor of Nursing from UniSA want to rip that to shreads aswell? I work in a trauma hospital here as a Nursing Specialist but hey im just a vollie dreamer.

you want to play Nursing pissing contests, EMT city is not the place to do it there are plenty of US RN+Paramedics / PHRNs / Flight Nurses and a generous sprinkling of other RNs from various countires who work in pre-hospital care including iirc at least one 'Dutch Paramedic' aka a Nurse Practitioner in pre-hospital care due to the way their system works , myself i'm an RN I don't claim to be Paramedic or imply that i can do Paramedic only procedures...

[Bernhard]

Sounds really bad. But, happens sometimes, yes. Just be sure to be not that a**hole next time yourself (with lack of sleep/food/toilet/luck some people simply tend to get nasty out of nothing - not to say, this should be an excuse for bad patient care).

These guys need to be wrote up BIG TIME!!.

Yes. Should be reported, doesn't help to ignore on the long term. A good EMS agency should have a quality management system which has an answer to such incidents sufficiently solving issues instead of just punish someone (hopefully...yes, I'm dreaming sometimes of such things). Beside that individual fail, I see at least three other trouble causes here:

1. Why did they send an ambulance with no appropriate staff/equipment to such a scene? Not sufficient information given in the call to dispatch (improve next time!), really wrong dispatch (another point to report) or simply no other unit available (sh*t happens)?
2. If there really is a protocol, that doesn't allow ambulance transportation with i.v. access (depending on EMT level or not), then THIS is a major systematic error. If this is really the case (I almost can't believe it!), then try to change this, maybe make it public!
3. The original poster (Penthrox) seems to get easy pissed off, from what I see in the other posts above. Maybe there were some other more personal issues additionally leading to the unhappy event. Again, no excuse for bad patient care, but we have only one side of the story. Well, if the venting helps...

But please, just don't get on the "volly vs. paid" track here.That's not the issue in this case.

[zippyRN]

Sounds really bad. But, happens sometimes, yes. Just be sure to be not that a**hole next time yourself (with lack of sleep/food/toilet/luck some people simply tend to get nasty out of nothing - not to say, this should be an excuse for bad patient care).

Yes. Should be reported, doesn't help to ignore on the long term. A good EMS agency should have a quality management system which has an answer to such incidents sufficiently solving issues instead of just punish someone (hopefully...yes, I'm dreaming sometimes of such things).

the problem is in some places, the statutory service simply see themselves as 'above' other providers

Beside that individual fail, I see at least three other trouble causes here:

1. Why did they send an ambulance with no appropriate staff/equipment to such a scene? Not sufficient information given in the call to dispatch (improve next time!),
   

doesn't matter - see above

really wrong dispatch (another point to report) or simply no other unit available (sh*t happens)?

not all services dispatch on the basis of declared levels of skill of the crew , if response time is the primary metric and there is not penalty for not sending an ALS unit - they'll send anything - hence the phenomena in some places of 8 hour courses for 'community first responders' because the response target can be met by a monkey with an aed strapped to it

If there really is a protocol, that doesn't allow ambulance transportation with i.v. access (depending on EMT level or not), then THIS is a major systematic error. If this is really the case (I almost can't believe it!),

i doubt there is , what there is in many services in the Uk at least ( and i suspect elsewhere) a protocol that says if you aren't trained to manage it you can't transport a patient with it - hence the reason hospital staff are needed on transfers etc ...

then try to change this, maybe make it public!

see above

The original poster (Penthrox) seems to get easy pissed off, from what I see in the other posts above. Maybe there were some other more personal issues additionally leading to the unhappy event. Again, no excuse for bad patient care, but we have only one side of the story. Well, if the venting helps...

But please, just don't get on the "volly vs. paid" track here.That's not the issue in this case.

i'd agree with that Bernhard

Edited May 19, 2011 by zippyRN