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Kiwiology

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Everything posted by Kiwiology

  1. We just have a standard cop style shirt with your qualification level written on it (e.g. "PARAMEDIC" ), black pants and shoes. We also have a dark green V neck jersey if you want - but that just has "St John" written on it. I know most guys in the UK and Oz wear a green or blue jumpsuit with the Star of Life on the back and "PARAMEDIC" in big letters. Didn't NYC*EMS do something like that ...I seem to remember them using a white shirt and dark green or blue jacket?
  2. Well not to sound like a smart arse, what are we supposed to use? I dug out the GSA KKK Specs and the ACS minimum equipment lists but that differs from our national prescription on equipment and also ourr drug suppliers supply our drugs in NZD based on the prices we have haggled to the death to get (damn cardiac arrests are expensive and we're broke!) ... so am I supposed to convert all those to USD etc? And take my new pimped out Ford E450 Ultramedic, best place to find a price on one of those is online, not sure our local Ford dealer stocks them Now, does it matter what we place INTO the ambulance, clinically wise? i.e. if I want to choose EZ-IO over Cooks or amiodarone over lido does it matter? This is fun, its got me dreaming of a rig our current funding cant possibly provide!
  3. Did I mention our entire budget is around $8 million to run 194 stations and serve around 2.9 million people? $187,000 for an ambulance and all the toys in it ... wowee! I'm in heaven! Can we use the cash to employ an additional three Advanced Paramedics coz I'm sick of single crewing?
  4. Howdy; I am interested in finding out about your scopes of practice by jurisdiction (be it national or at state level). Its unfortunate but New Zealand's EMS system is currently in bad need of an overhaul in terms of qualifications and funding. Our qualifications are standardized by the Government but the SoP is not, and as such, we're looking to develop a national standard with three levels (BLS, ILS & ALS). We currently have five (CFR+D, BLS, 2 x ILS & ALS) any one of which can crew a rig. Ours are below, any international comparison would be appreciated. 1. CFR+D (Pre Hospital Emergency Care or "Please Help, Educaton must Continue") - Advanced first aiid & splinting - AED - O2 & OPA - Entonox/methoxyflurane 2. BLS (Ambulance Officer or "Blast! limited skills, so only able to offer some care") - IM Glucagon - LMA - NPA - Allbuterol (salbutamol) - GTN 3. Paramedic - Manual defib - IV NaCI & D50W - 12 lead EKG 4. ILS Paramedic (or "I am likely to save people") - Morphine - Metaclopramide (maloxon) - Epi - Naloxine (naloxone) 5. Advanced Paramedic (or ALS Paramedic -- "auctually likely to save people") - ETT (incl RSI) - Thoracostomy - Cricothyriodotomy - IO - Pacing - Frusemide (frusomide) - Ketamine - Atropine - Amiodarone - Midazolam Thanks for reading!
  5. Great topic. We Kiwis are in a simmilar situation, most rural services are run by volly medics, if they are at work, well, sorry no cover. Mutual aid, well, sorry, we've only got one or two paid medics in the next town over because they have a low call volume so your mutual aid is probably going to be a single crew transport, if you're lucky, the fire service (also vollys) will get turned out to provide some O2 or first aid. If you need ALS you're probably going to have to wait for a fly car or the whirly bird. We put resources into areas depending on the need - by which I mean, "how much do we REALLY NEED to spend this money?" Our BLS service here is a mix of BLS and CFR+D so if you live in a low workload area, your local ambulance may turn up with one EMT-B and a CFR+D or two CFR+D or worse yet, a single EMT-B or CFR+D because nobody else is able to be rostered on (paid staff to vollys is about 1:3 here) Lets say that your local BLS rig turns up with one EMT-B and a CFR+D to a high speed car crash or some guy crushed by his John Deere (hey, they're out in the boon docks remember?). Or perhaps its some old guy on his farm who codes ... the call goes out for an Advanced Paramedic. Well, Dispatch is either going to send the nearest ILS or ALS ambulance or the chopper (ALS). Long wait, long transport time etc etc etc ... same problem world wide I guess it just does not make financial sense to have Paramedics sitting round in the boon docks playin the banjo and whittlin'. Sad.
  6. Here's the lowdown on how it works here. Remember: In our system you can't sue an EMS provider for anything, you may be able to bring a private claim against the individual Paramedic for neglegance but I have never herad of it happening. I dont totally agree with that system but anyway; 1.6 NON TRANSPORT - is medical treatment required? - Is transport to a medical facility required? - If transport is required, what form of transport is most appropriate? Transport must be recommended if any of the following are present. - Personnel are unable to condifently exclude serious illness or injury or - Interventions (including IV fluid and/oror pharmacologics) have been given, excluding consumer oral anelgesia (eg Tylenol) - There is an exception to (2) in that medical control may state transport is not required When a competent patient declines - Explain the consequences - Involve family, friends and family doctor as appropriate - Provide advice on what to do if they get worse - Read, have them sign and provide thier copy of the AMA statement on the run sheet Basically if you need medical treatment you will be transported. I don't like that, EMS isint a darn taxi service or a replacement for going to your doctor so while transporting you and your stomach flu which you thought was appendicitis somebody else has a heart attack which we can't get to. As far as refusing treatment (i.e. will not treat you) we have nothing in writing but its common sense, if you are agressive or off the planet or nutting out or something like that.
  7. ILS SoP - Manual defib - LMA, NPA, OPA - Morphine, epi, naloxone, metaclopramide (malaxon) - IV NaCI, glucose, D5 and D50W ALS SoP - ETT - Surgical or needle airway (cricothyriod puncture) - Needle thorocostomy - IO - Atropine (brady only) - Frusemide (frusomide) - Amiodarone or lido - Midazolam (benzo) - Ketamine (St John) - TCP & cardioversion - Thrombo (WFA) - CPAP (WFA) Our standing order for codes is 1mg epi q4 and 300mg amiodarone x1 no atropine or bicarb so thats why its not in the ILS skills - I know .... I dont like it either. If you want to come down here, I hate to say it, but, go to WFA. They run only ILS and ALS ambulances - no BLS. Our BLS req here gives basic a new term, its a 5 day course basically equiv to CFR+D (first responder) in the US. As far as vacancies go .... there are always vacancies, we have a national shortage of something like 400 medics. Food for thought anyway.
  8. Not bad, if you're an EMT-P ("Advanced Paramedic" in our lingo) the pay is around $800p/w (US) or $1k NZ but it varies depending where you work. Cost of living is comparable, maybe a little more because of the transport requirements (not unlike Hawaii). Our two big providers are St John and Wellington Free - personally I perfer the latter, they are better funded and run only an ILS/ALS mix. Have a look round and feel free to ask any other Q's.
  9. <SHAMELESS SELF PROMOTION> Come to New Zealand, we need Advanced Paramedics (EMT-Ps) something terrible and its not that far from Oz! Most likely, you'll even get a neat looking fly car (link for pic) and be able to ride the chopper depending on where you are based. </END SHAMELESS SELF PROMOTION>
  10. LOL. Thats my thinking too - I don't want this guy go go into PEA or total resp arrset on us out here in the boon docks. He needs an advanced airway, now, if worse comes to worse then here's my plan of attack. 1. Continue allbuterol and look at breath sounds and a 12 lead 2. Both are good, I would try 0.5mg IM adrenaline q20 max x 2, although he is not having bronchospasam or constriction I want to try it unless there is a contraindication. I am worried about this guy getting tired and stressed out from having resp diff and I don't want him to arrest, so this should help with that. 3. Load this guy into your guvna'd rig and start towards the hospital, the longer we sit here the longer before this guy gets to def care Now, if the breath sounds aren't good it could possibly be a slowly manifesting edema maybe caused by ischemic problem?? Keep the frusemide handy. I am going with it some sort of hypoxia be it ischemic or environmental. I want this guy in the bus and on the way to the hospital, and keep the whirly bird handy, our local Westpac HEMS chopper is bright red and yellow so it wont run into anything out there in the snow. Maybe Santa does HEMS? I'm not too into an advanced airway because thats not going to help up the SO2 if he has a patent airway but if this guy gets really tired and stressed out from having resp diff then I dont want him to arrest on us. I'd looking towards RSI or a surgical cricothyroid puncture to keep him from having to work so hard to breathe - needle is no good, that only lasts about 45 minutes and our guvna'd rig wont go fast enuf to get him to def care in time! Don't think it will come to that, but it might. Did anybody mention getting a sample of that yellow gunk or getting in contact with the ENT doc yet?
  11. Shirt, this is an interesting one. Breath sounds? Good bilateral? Wheezy? Crackly? I am either thinking some sort of airway obstruction (maybe do a laryngascopy) and check for swelling or some sort of hypoxia. As my clinical guidelines say, oxygenation and ventilation are two different things. If the O2 is only 85% then something is preventing oxygenation despite good ventillation. If this kid can breate w/o difficulty it rules out some sort of airway obstruct but I'd still like to take a peek down the throat with a laryngascope just to rule out anything (never say never) stuck down there. Whats his EKG/BP looking like? My concern is that if this kid is stressing out trying to breate and he keeps on doing it, getting tired in the process he might PEA out (had a severe asthmatic do that) so I want to prevent that. I would be looking at the lungs, seeing if they sound clear and good equal breath sounds because I'de be looking at worst, maybe a pulmonary edema which would fix with the hypoxia. Unlikely I know but still. If thats not it then I would be thinking maybe something cardiogenic or edema wise hence the breath sounds. I want to get this guy on a 12 lead and take a good look at the breath sounds, maybe take some bloods for sampling and keep high flow O2 with the allbuterol and try some IM adrenaline if his O2 is still ~85% if the bronchodialators don't work. I would also want to get in a cannula in case he codes out or goes into PEA.
  12. Interesting topic. First off, good on these kids for getting out there and into the EMS system. New Zealand essentially has a similar system (heavily reliant on volly EMTs in many small areas - Darien, CT pop is ~20,000). So I commend them very highly for doing so. Be them EMT-B or EMT-P I am generally not for high school kids staffing emergency ambulances. I say "generally" because somebody who is 16 can be very mature and a practical thinker and make the perfect gurney jockey. Then there are obviously those who are not suited to being the next EMT Pimples. This problem is really not about "can they save me when I code on the floor" because be they 17 or 70 an EMT-B is an EMT-B and an EMT-HP an EMT-P, they carry the same gear and scope of practice (SoP) regardless of age. I am not keen on a teenager turning up in the bus to the next car wreck I happen to be turned out to. Simply because is a teenager really mature and grounded enough to undertake the sights, sounds and responsibilities of an EMS worker? I say no. Then you must consider the other aspect which us Kiwis are having to deal with more and more - say you get some aggressive family member who doesn't want you working on his mother, father, husband, wife etc and starts to nut out. Got to think safety too, I can imagine the situation. Its hard enough for two well trained, physically fit adults to deal with, let alone a couple of teenagers. We have a good tool for that, its called our Maglite with D Cell batteries . I did note that EMT Charlie in the CBS piece seemed to be wearing a stab resistant vest, we need to get those! Problem is a high school student probably lacks not only the general life experience but also the critical thinking skills and driving experience to become an EMT. Here in Kiwi land, you won't get touched to become an EMT until you have at least 3 years behind the wheel on a full license (so around 4 1/2 years in total) and pass a bunch of tests and reference checks showing you can think and act in critical situations. So good on them, if I am in cardiac arrest I'd rather they turn up than waiting for either the fire department or an ALS ambulance from further afield but ..... I'm still not very keen on the idea.
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