Kiwiology

More action from down under; New Zealand's Advanced Paramedics take to the skies with Auckland baswd Westpac Resuce (HEMS). Unlike the rest of the country (which uses a roster of regular road medics) the Auckland service employs its own Advanced Paramedics (EMT-Ps). We're a bit quirky in the way we do things down here; so just a recap. Most of these jobs are way out in the whop whops where the road crews seen here are "Primary Care" officers who are "pre-BLS" studying toward the BLS qualification and are trained to what the US call "first responder" (40 hours) - basically O2/AED. You also see some weird looking vanbulances Yoiu'll also see some "ambulance officers" which are BLS and "paramedics" which are ILS. One job uses what is called PRIME (Primary Resource in Medical Emergencies) which are ALS trained local doctors and RNs used in areas where ALS is more than 30 minutes away if the patient is critical (this program has been met with some mixed results here and outside it, doctors haven't been used on calls since about the early eighties). More as I get them. If you want to see our road ALS in action, watch these videos (links are spread thoroughout the post) Episode One Part One Part Two Part Three

Episode Five Part One Part Two Part Three

I dno if there's a dealie that does it contionously; I made that up so the scenario based off things I read in two journals at 1am would work, shudddddupa your moutha!

You're dispatched to a neighbourhood medical center for an old lady who says somebody stole her breath. Upon arrival you find a police officer standing in the triage bay; he tells you he has not been called to take a theft report and points you to one of the nurses. One of the nurses leads you to one of the rooms where you find a 75 yof cc sob. Over an hour ago the CNA put her on salbutamol and it's been running ever since because they are busy the CNA was needed elsewhere. S - SOB, diaphoretic, skin cool/clammy and feels light headed A - nil M - atrovent, nadolol and januvia P - mild asthma, HTN, NIDDM L - breakfast q 6hr ago E - nothing remarkable Vitals BP 140/90 RR 24 with insp wheeze spO2 95% CR < 2 s. PR 100 GCS 15

LMAO that was good for a laugh

Episode Four Part One Part Two Part Three

Driving is dangerous enough at is it when contending with all the stupid people out there on the road; the cellphones, drunks, bad drivers, old people and foreigners without putting you in a big, shiney vehicle with lights and sirens ... did I mention stupid people? The days of the "ambulance driver" in his big powerful Cadilac going like a bat out of hell are loooooong gone.

This shows the service in metropolitan Auckland; which is not representative of the rest of the country. Also of interest is the fact that metro Auckland staff are 100% paid full time officers. Yes, in a nutshell within the Auckland metro area trucks are staffed with either a basic ("ambulance officer") or intermediate ("Paramedic" or as us old timers call them. "intermediate care officer") or two basics. There would also be one or more trucks (from my experience (which again, is not within the Auckland service) usually one) on a station which is ALS capable ("Advanced Paramedic" or as the old, old timers call then (I aint that old) "advanced care officer"). On that vehicle the ALS officer would generally be paired with either an ICO or a basic AO. All other ALS (Advanced Paramedics) are in the 4x4s as you see here. Outside metropolitan Auckland the service is "composite" meaning paid staff work alongside volunteers to make up crews. Vehicles generally follow the BLS/ILS/ALS forumla. The system of chase-car ALS is replicated in one or two large cities (like Hamilton and Christchurch) while outside those the ALS are on a truck on station. Our station for example has one ALS truck and 2 or 3 ILS trucks (depending on workload; you obviously roster on more people for saturday night than a tuesday morning). The Team Manager is also an ALS officer who has a chase car, this is generally true in most of the smaller cities where the managers are ALS and operate either on a watch or on a watch then on call. Our "Advanced" Paramedics are not any more "Advanced" than what we think of as a "Paramedic" (EMT-P) it's simply a name used for marketing purposes. They are simply run-of-the-mill ALS; basic run down is ... Ambulance Officer (BLS) has O2/AED/nitro/glucose/LMA/methyoxyflurane/n2o Paramedic (ILS) adds IV NS and dextrose/manual defib/IM epi/morphine/naloxone/metaclopramide Advanced Paramedic (ALS) adds amio/ketamine/midaz/lasix/IV epi/12 lead/TCP/SCV/ETT/cric/IO access There are some changes going on here which hopefully will make all paid staff up to the ILS level and exapnd the ALS level to extended care/primary care paramedic practitioner level (ECP - extended care paramedic) but this is several years off from the limited information I have. Hope you find this interesting!!

Driving over the speed limit is illegal and dangerous; remember the kinetics of high speed impact on organs like the liver, spleen and heart? I'm not getting all soap-boxish here but sure, I speed in my persy vehicle (barely possible, cheap POS Nissan that my mate totalled anyway) but we're talking like a mile or two over the speed limit. When it comes to driving the ambulance I don't see the point; is the patients condition really that serious that shaving thirty seconds or a minute off transport or enroute time really going to make a difference? Bledsoe says no. I'm inclined to agree with him. Our most effective tool here is the red and white lights; they do a good job, air horn works marvel (I love the air horn) and the siren prn (read: not all the bloody time!)

Woohooo!!!!! Good going mate, I'm happy for you n' the mrs

Episode Three Part One Part Two Part Three

I can only assume they shocked him, you hear the medic saying "shock it". They did sedate him with rohypnoval (I hear they also have rocronium and sux) but it's not something that's made its way out of the Auckland service from what I understand. There are some noises being made about requiring us to tape down people to the board and/or transport them on a board. Our guidelines state that "Spine boards are recommended as extrication aids only and patients should not be routinely transported on them". Second ep is below (the audio is in sync now) Episode Two (includes another cardiac arrest) Part One Part Two Part Three

Below are some links to our own local TV series called Rapid Response which follows around our ALS Paramedics in Auckland. Because the source video was only viewable here in NZ I had to rip and convert then reupload it; go my mad technical skills. New link are below I have only ripped the first episode that includes acardiac arrest for the time being; the rest will come later today Episode One Part One Part Two Part Three

You're shitting me I thought I fixed that!! I'll try to rip them and upload 'em

Hey all; Below are some links to our own local TV series called Rapid Response which follows around our ALS Paramedics in Auckland. The files are .FLV which is Flash Video but can be played in VLC, Quicktime etc (I think they have native support) or any other player including WMP (but you need FFDShow codec) You will notice we are a bit quirky in the way we operate, so the following local lingo is essential: Primary Care Officer - volunteers who are used to augment paid staff and make a 2 person crew (very suprised if you see any on here) Ambulance Officer - read EMT Basic Paramedic - read EMT Intermediate Advanced Paramedic - read EMT Paramedic Patients are classified as status one to four: Status 1 - unstable, imminent life threat Status 2 - unstable, serious life threat Status 3 - stable with potential to change Status 4 - stable and not likely to change I am sure Scotty and I'd love to hear what you think of how we work Episode One (includes a cardiac arrest) Part One Part Two Part Three Part Four Episode Two (includes a cardiac arrest) Part One Part Two Part Three Episdode Three Part One Part Two Part Three Episode Four Part One Part Two Part Three Episode Five Part One Part Two Part Three Episode Six Part One Part Two Part Three

Affirmative action (yes we have it here in New Zealand too) is simply reverse racisim. Strikes me as a way for white, middle class, able bodied, well educated males who feel bad about themselves for looking down on minorities to try and find a way to rock up to the Pearly Gates and go "yo St Peter, dude, look what we did!". I whole heartedly support equal opportunities for all people be they white, black, brown, orange, poor, rich, middle class, disabled or not, college graduate or high school dropout, gangbanger from the ghetto or rich kid from the suburbs or whatever but this shit is crazy. While not disagreeing that maybe we didn't do so good on that slavery thing (or in the case of the British settlers in New Zealand; getting the Maoris to sign over the country and trying to breed them out of existance) but this was hundred of years ago ... get over it. You can't tell me that any person be they black, white, blue, rich, poor, disabled or not, educated or thick as pigshit who spent high school out back smoking and faunicating behind the sports equipment shed does not have the same opportunies to make something of themselves as any other person. Pull your heads out your arses and realise that by playing the race card you are ignorant; you are expecting us to feel bad for stuff done generations ago and give you something baed upon that. It's not "righting a wrong" or anything; it's pure manipulation that I see at work EVERY DAY; every day I see people who simply use their skin colour to try and manipulate the system into getting what they want. Makes me puke. Tell you what, today, in 2009, you go walk your ass across the Edmund Pettus Bridge and I tell you what, if a bunch of Alabama State Police come beat you up then I'll take it all back. Ben

I am truly shocked and horrified mate. This guy is beyond what I'd class as a whacker and he sounds like he has some mental health problems going on from what you describe. I don't know enough to speculate as to what he might have going on upstairs, and even if he doesn't, his actions are totally unprofessional and apalling to say the least. I am not sure how your structure works over there in relation to ours but given the behaviour you describe I would document the hell out of it and just give him the boot; its not like he can sue you for wrongful dismissal. Surely you must have standards, regulations etc ?????? I feel bad for you mate Ben

When I was with the Johnnos we had a big thick manual of SOPs, regs etc .... mind you we were in the same group as the road vollies but still this guy would be in violation of lots of them over here, sounds like you do things differently .... talk to your operations manager mate

"Hypo" simply means lower than "normal" which is kind of subjective ... the National Heart Lung & Blood institute's website now says hypotension is a BP of < 90/60. As for treatment, well .... is the patient physiologically stable or are they showing signs of hypoperfusion? I've seen a guy with a blood presssure of 80/50 up dancing around (well not quite but you get the idea) whereas when I got sick last I was running a pressure of about 90/70 and I was pretty cold and pale. BP, heart rate etc are helpful in guiding you towards your diagnosis or showing you where to look for further evidence; ok so this guy's pressure is way low, could be cardiac, could be renal, could be that he has a big ass wound and is loosing lots of blood etc

some old dude who was "generally unwell"

This sounds like one of Grandpa Simpson's moments lol

We'd take the patient probably and send the nursing home a large bill for whatever unscheduled patient transfer is .... it's not cheap.

Better late than never

... or when NYC*EMS was run by the Health & Hospitals Corporation and you could find a bus at a station rather than parked on the side of the street at 6am with the crew turning the engine over every hour to get warm. ... and when telemetry was OLD SCHOOL which includes auctually calling for orders (something we never really got into) or when you had to call for valium or dextrose! http://www.youtube.com/watch?v=xV3gpRyKWLc

My MD friend (yes ... I have friends, don't look at me like that! lol) were discussing it, he says it's called tako tsubo cardiomyopathy, also called broken heart syndrome, where excessive stress with very high catecholamine release causes stunning of the heart, seen in a tumor called a phaeochromocytom that release massive amounts of catecholamines (epi/norepi)