theotherphil

UK: on top of C1 class I had to do D1 but this is no longer mandatory. We also do a 3 week advanced driving course. Week 1&2 covers the system of car control, reading the road ahead, controlling skids (on a skid pan in an ambulance and car - including FWD, RWD and 4x4), manoeuvring in tight spaces, "making progress", avoiding red mist etc. Week 3 is Emergency Response driving...driving on simulated emergencies under response conditions. It is extremely intensive and taught by Ambulance or Police Highway Patrol instructors. Pass marks are 95% and the failure rate is high. On top of this, my service enforced a further 2 weeks driver training with the Police when gaining a position on a rapid response car. So, on top of my normal licence, I had to have 3 yrs experience before gaining category C1 and D1 on my licence (vehicles over 4.5t and passenger carrying vehicle of up to 16 persons). I then undertook the 3 week driver training with the Ambulance Service plus a further 2 weeks for the response car. On coming to Australia, I had to gain a LR category on my licence (roughly equivalent to my UK C1&D1 categories).

To the manager who thinks UK Ambo's have time to sit around and use facebook etc, then you are wrong! I've worked the UK system for the last 7 years and have been working in Aus for the last year. You just cannot comprehend the sort of workload UK services see on a daily basis. London Ambulance Service covers 620 square miles and a population of over 7 million (over 12,000 people per square mile). There is 70 Ambulance Stations, 400 Ambulances and 100 Rapid Response vehicles. LAS CAD figures are 5-5,500 per 24hr period....yes 5,500 Emergency calls in 24hrs! Turn around times at hospital are monitored and you get a job dropped on you as soon as you clear...it's a full shift of work with NO downtime except for the mandatory 30min break. As far as I am concerned, it is up to the service to ensure that there is adequate resources to meet demand. This is not my job as a Paramedic...managers are meant to ensure this therefore any deaths attributed to poor cover is NOT our fault.

Look, they posted images of themselves goofing off where the rest of the world can see....which the rest of the world obviously did as the Post approached their employers for a story. Most employers have a clause that you can be fired immediately for "Gross Misconduct" and they will define a few instances of what is classified as Gross Misconduct. One of the definitions is bringing the service's name into disrepute. As an EMT/ Paramedic, the public expect a level of responsibility and personal accountability for you actions. By posting pics publicly of you goofing off is never a good idea....especially if your employer is identifiable (as it clearly was in this case). Whilst we all agree that the punishment doesn't fit the crime, you need to remember that your employer will drop you like a hot stone should you bring any bad press to their door - no matter how good you are and how many years service you have. This then acts as a deterrent to their other employees.

Thanks for sharing....something I have never heard of before. I have researched it and it does indeed seem very unusual. Treatment for me would have been the same regardless. If I couldn't justify Midaz for a seizure, I certainly could under my "patient management" guideline.

I've seen a few people mention this and I thought I'd share something from a Consultant Cardiologist when teaching on my ECG course. He told me that having the correct landmarks is more important that the slight change in amplitude caused by reading through breast tissue. "Breast tissue appears to have a practically negligible effect on ECG amplitudes, and in women, the placement of chest electrodes on the breast rather than under the breast is recommended in order to facilitate the precision of electrode placement at the correct horizontal level and at the correct lateral positions." Rautaharju PM, Park L, Rautaharju FS, Crow R. A standardized procedure for locating and documenting ECG chest electrode positions: consideration of the effect of breast tissue on ECG amplitudes in women. J Electrocardiol. 1998 Jan;31(1):17-29.

Earnings: $98,000 (AU) Job Title: Intensive Care Paramedic Experience: Nearly 1 year as AU ICP, 2 years as UK SR Paramedic, 3 years as UK Advanced EMT Type: Government State: NSW Avg OT: 12 hrs/fortnight Average fortnightly take home pay is $2,850 AU. I work 2 days then 2 nights then 5 days off. Shifts are 12hrs. I'll echo what Phil is saying. I am Metro and as can be seen above, I earn $98k AU ($88k US) with minimal OT. You are given some nice incentives to work rural and it'll be easy to crack $115k AU without overtime. OT boosts the pay massively....a weekend OT shift (12hrs) can gross between $1,000 and $1,200 AU (>$1k US)

I've gotta say that I also disagree with your view kiwimedic. You really should get that 12 lead before administering the GTN. A full assessment should be made of your patient before implementing treatment options...you need all the info at hand to make an informed decision. Administering GTN beforehand could drop that BP irreversibly in the case of RVI....and you'd be wishing you had started that IV as well. When I was working in the UK, my area used to have thrombolysis and PCI available to us depending on the patients location (and whether they were in the catchment area for PCI). All of it was done autonomously based on our interpretation of the 12 lead and the patient's presentation. We were able to transmit directly to the respective Coronary Care Units but it wasn't a requirement. We'd just call the unit and tell them we've either thrombolysed and need a bed or that we have a patient suitable for PCI and to get the cath labs ready. No passing through ED needed and we were also beating the ED's call to balloon/ needle times by a significant amount. Here in Australia (NSW), cardiac care is behind the UK by a large amount. Only Intensive Care Paramedic vehicles have 12 leads but the ICP's only get sent to Cat 1A and 1B calls routinely. Chest Pains are usually categorised as a 1C so a BLS crew usually deals with those without the benefit of 12 leads and ICP backup is only sent if requested by the BLS crew. We can bypass ED for STEMI's but only after 12 lead transmit and you guessed it - only ICP's can do that

Paracetamol Methoxyflurane IN Fentanyl (paed and adults but no max dosage for adults) Morphine (paed and adults) 0.5mg/kg max, can be repeated after every 30 mins as required Midazolam can be added to Morphine if required.

If the Paramedic was on an unpaid break (my service in the UK had unpaid breaks), then they were OUT OF SERVICE. To respond in these circumstances would effectively mean that they were off duty (by law) therefore, not insured.

Even the most traumatic injuries rarely need more than 20-30mg's so 300mg is a large amount - especially in a single vial. We have some quite useful pain relief options here and we can titrate up to 0.5mg/kg of Morphine and repeat that every 30 mins if pain persists (we can see long transport times). I've never used more than 30mg's in one go and have never induced respiratory arrest either.

After what happened in the last driving thread, I won't even mention what happens in the UK Speed doesn't kill btw, inappropriate use of speed does. If it did, I'd have killed loads of cute puppies today and maybe a fluffy bunny or two

DRABC is used in the UK as well as Aus. Danger Response Airway Breathing Circulation etc Once cardiac arrest is confirmed with an initial pulse check, I wouldn't check again unless there's a rhythm change (and after finishing the 2 mins CPR). No pulse check straight after a shock due to myocardial stunning, although this is lessened on biphasic defibs. edit: speeling

It's funny, but what we would term as FAKE runs are those undertaken by IMAGINATION or on a TRACK. Bureaucracy doesn't come into it. We don't just place a field medic, however experienced, into a training position. Over here, it is a legal requirement to hold a teaching qualification in adult education before you even go near a student. Then you need specific qualifications in the area you are going to teach. Just because you can drive, and have done so all your life, doesn't make you a driving instructor This system ensures the highest caliber of teacher, and education delivered to the student....not just "this is how we've always done it". Evidence Based Practice is a big thing over here - prove we need to change and we will. With the attitudes you guys (I say that loosely as at least some of you can see there's other ways of doing things outside of the USA that may actually be better - shock horror) have to progression/ education, it's small wonder you are stuck in the dark ages with regards to EMS. You'll never move away from protocols, you'll never gain the same autonomy of practice, you'll always be calling OMC, you'll never hold professional recognition, you'll never have the pay that comes with all this unless you embrace change...but that means doing things differently to how you've always done it What exactly are you afraid of? Maybe it's the failure rate? Our student failure rate is massive before they are even let loose on L&S - we lost 8 out of 20 students on my initial course. These guys were then not progressed to clinical training - RTB, EndEX, game over.....back to their old job. Some people can't acquire the necessary skills so will never drive on L&S. Maybe if this was introduced in the USA, it'd cull too many and you'd be out of a job?

DocHarris, we do 2 weeks worth of regular advanced driving and track work before using what we have learnt on "FAKE emergent" runs. We clock up 9hrs driving/ theory a day, every day for the entire 3 weeks. Then, some services insist on a further 2 weeks driver training (a lot on L&S) if the Paramedic is to be a solo responder on a rapid response car. There's no evidence to suggest that there is any better way of doing things as this has been the LAW of the land since time began. Looking at the accident rates of emergency vehicles in other countries vs the UK, then things become a little clearer. Why would we WANT to change something that WORKS so well? If it's not broke, don't fix it! Have you ever thought that the public actually know what to do now when an emergency vehicle is behind them rather than just panicking? See, we're training the public as well Yes, they are real patients but their airway could/ would have ordinarily been managed by an LMA. By changing to ET tubes just for us to practice our skills is surely unethical? How can you justify that? An old army saying...."it's all about the barrel time", exposure to the real thing, or as close to, is the best form of training. I guess I'm just old school after having a forces background where the 7P's are drummed into us....Prior Planning and Preparation Prevents P*** Poor Performance. I'm a big believer in the most realistic training available, not just imagining scenarios and imaging our reactions and then imagining the instructors reactions I guess I lack imagination. This is all by the by though, it will never change when our accident rates are so low in comparison to the rest of the world. Things will change quick sharp if we start mowing down pedestrians or wiping out other vehicles. As can be seen in the above link posted by Scott, it seems it is the USA that needs to change it's practices. This then might stop you guys wiping out pedestrians and mowing into other vehicles

I'm sure you'd like to know that we practice intubation on real patients over here as well! I had 57 tubes in 2 weeks on real patients from 18months old upwards...all done under the supervision of a consultant anaesthetist before being let loose on my own. The LMA's on the list were dropped for ET tubes to allow me to learn. Real practice, for real situations. It helped immensely and gives the student the confidence required to be real slick when it come to doing it for real. That's in addition to all the hours on a dummy that doesn't vomit/ stink/ move like a real patient. Just face it, we do things differently over here. It's not worth worrying about though.