oz_paramedic_chick

First of all sorry i've been off these forums for a couple of months. I am currently a 2nd Year student undertaking the Bachelor of Paramedic Science on QLD's Sunshine Coast. The hope is that in approx. 14 months time I will be qualified and employed by QAS. QAS and ASNSW are the only 2 services left in Australia where you don't have to be degree qualified, however, I know here in QLD you have to be degree qualified to become an ICP. I don't really know of any American paramedics over here, however, I know of a couple of Canadian paramedics who have been forced to start at a lower level and complete some assessments before they were granted advanced care paramedic level. Sorry i'm not sure what level they were back home. Here in QLD some protocols that ICPs have that ACPs don't include:

*IV Salbutamol, amiodarone, tenectaplase, heparin, haloperidol, benztropine, atropine, clopidogrel, frusemide, ketamine, promethazine, sodium bic, hydrocortisone. Drug Therapy Protocols (DTPs): http://www.ambulance.qld.gov.au/Medical/dtp.asp

*chest decompression, IO, cardioversion, transcutaneous pacing, ET intubation, ETCO2 monitoring

That's definitely not all skills they have that ACPs don't but just a few off the top of my head. All the best with ASNSW, hope you get the chance to live your dream.

aussiephil....i agree i think the KED/NIEJ is severly underutilised and i think many times it is a case of the paramedic can't be bothered. However on that note up here in qld it is my belief that both the spinal board and the KED/NIEJ are extrication devices only and patients are not to be transported on them. I think making the decision about whether to immobilise or not and choosing how to extricate is a complex one and admittingly i only have a base knowldege at this stage as I complete my trauma subject next semester back at uni. It's a subject i've asked many paramedics about and have received many varied answers.

FL-medic...I see what you are saying and I agree. I guess sometimes we fail to look at the evidence base for procedures. I guess people just collar if in doubt because then they can say they did something and took precautions for a neck injury (which would include collar). I think a lot of the time people feel it's a security blanket perhaps and makes them feel better for having done something. Despite this a lack of evidence to support spinal immobilisation does make me wonder if perhaps protocols need to be reviewed. In saying this I believe over in the US when you spinal immobilise you collar, strap to a backboard and use foam head blocks. Is that correct? Over here spinal immobilisation involves lying the pt flat, cervical collar, and placing rolled towels next to the pt's head (mainly to remind them not to move their head). We don't carry head blocks and spinal boards are only used for extrication.

I have to agree with firefly and say that it does sound to me like a dystonic reaction. As for the cause i'm not that great on my pharmacology yet and really am not sure what would have caused it. The only dystonic reaction i've been to was from Maxolon (Metoclopramide). :-)

Here in QLD emergency calls and transfers are all covered by the Queensland Ambulance Service (QAS). We have the paramedics which run in ambulances and then what we call patient transport officers that run in transport trucks. Some of these transport trucks are similar to the ambulances except that they have 2 stretchers. Others are mini buses that simply transfer people from their homes to hospital for treatment (eg. dialysis). Now PTO officers are not trained the same as paramedics. They are trained in CPR, advanced first aid and AED use but to the best of my knowledge that is the extent of their skill. They run 8 hr shifts either day or afternoon, monday-saturday.

Now this does not mean that we as paramedics do not do interhospital transfers. If a pt so much as has an IV line in...we generally transfer them as PTOs aren't trained to deal with them. This system seems to work reasonably well however, it can be frustrating when there are no crews in an area and comms send us on a transfer into the city (45min drive), only to have an emergency call come in and have to send a truck from another suburb because we (last truck in the area) have been sent on a transfer.

On the other hand some states in Oz, i'm thinking of victoria, the government deals with emergency calls (as in all states in australia to the best of my knowledge) while patient transport is privatised, however, once again the ambulances still transfer the more serious patients.

Personally I completely disagree diazepam....as others have said stealing is stealing and the fact this guy was stealing from his patient is totally unacceptable. If we want to remain a trusted and respected profession (well at least we are here in Oz) incidents like this need to be sorted. It's completely unacceptable conduct IMHO. We meet people at their most vulnerable and to break this trust is disguting. Kudos to the government for conducting 'stings' like this.

Here in QLD we have exclusion criteria. If a pt has no:

1) ALOC

2) Neck Pain

3) Distracting Injury

4) Intoxication (alcohol or drugs)

5) No neurological dysfunction

Then we don't have to collar. In saying that we still take MOI into account and if in doubt we collar....a $30 collar is better than a lifetime in a wheelchair

Welcome from Australia :-)

Ok i've briefly read through all these posts and here's my view. I'm 19, young for the EMS service. However, I am part of a kind of "revolution" in EMS in Australia. As we move towards tertiary education paramedics in general are becoming younger due to the fact they do not require life experience to be accepted. However, tertiary paramedic degrees do have reasonably high attrition rates (we started with approx. 50 and now down to 38 or so 18 months on). Also, I have already been exposed to a few situations where i've seen life experience come into play. One stick out case was a pscyh pt. The young naive person I am tried the softly softly approach...my mentor when for the "stop the bullshit and get in the truck" line. One qualified paramedic said to me "how do you think a mother's going to feel when it's a 20yo telling her they're sorry her kid died from SIDS?". Yes I know I will face opposition and there are certainly some barriers I will face by being a young paramedic. However, as a pt I would prefer a young paramedic who had empathy and knowledge than a 20 yr veteran who had had enough of the service and was simply hanging in to retirement, whinges everytime the pager goes off and fails to have empathy. I believe being younger does make it harder, however, I believe if you know it's what you really want to do then don't let people stop you. I know being a paramedic is what I really want to do and to those who say don't do it young because you lose the best years of your life I disagree. Do it young if you have the passion, you can still socialise with friends and have a life...just make sure you work to live not live to work. While I agree it's great to have enthusiasm and passion it's important not to become obsessed with it because then if you ever lost it it would be like losing your life. Create a balance between work and play. I think when it comes to young paramedics maturity plays a big role. There are people in my course who I am embarrased to be associated with because they're more interested in getting drunk at uni then turning up to lectures but in the end it's them who suffer...it is them who have lower skills. If you think it's the career for you go for it but remember there is still a world out there.

Hey here in QLD we ring the hospital via phone as opposed to radio (well in metro areas anyway).

Here's an example of what we may give:

363: Caboolture ED this is Fred from QAS Bravo 363 bringing in a pt

ED: Go ahead 363

363: have a 40YOM GCS 15 who has thrown fuel on a fire. Partial thickness burns to approx. 18% on his upper R thigh, stomach, groin and genital area. No known allergies, nil meds, nil medical hx. HR: 120, BP 130/85,IV access gained 10mg Morphine IV given so far and 3ml methoxyflurane. Pt covered with burn aid and cling wrap. Our protocol limits us to a total of 20mg morphine. ETA 20 minutes. Are you willing to give permission for additional pain relief if required?

On this job the Dr gave us permission to give up to a total of 30mg of morphine (so 10mg above our protocol) if required (which it wasn't).

***Names changed***

Great work kiwimedic...lovin the videos....can't wait for the next episode. The uploads are very much appreciated...but could you tell your colleagues to stop taking the piss out of the aussies eh

EMS is just a steeping stone job and will never ever truly be a career, that is just that.

In a perfect world, EMS would be pure EMS, and fire would put out fires. It doesn't work that way anymore.

Guys hate to burst your bubble but it is possible to make a career out of EMS and it is more than possible for fire to just put out fires and EMS to be pure EMS. Here in Aus that's how it runs. We have no paramedics on our fire trucks (unless they have become firefighters after being paramedics but even then they work only as a firefighter) and there are plenty of people making a career out of being a paramedic and on decent salaries in most states. The only time firies work with us is at incidents like MVAs and chemical hazards, or if we call them for back up to help us with lifting someone. I think it is wrong to have such a tunnel visioned view that EMS can't be purely EMS and can't be the sole career of someone. I'm pretty sure Aus isn't the only country in the world where paramedics is a career (UK, NZ, etc). I think for someone to be trained as a firefighter and paramedic is a big ask and I would question that they must lack skills in some areas (whether it be EMS or fire) due to the changing protocols and techniques of both jobs where study is endless (please note I am not saying fire/ems paramedics aren't as good and this isn't a "go" at anyone I just wonder how you could possible keep up with all the latest drugs, skills, techniques, etc in both professions).

To me it is slightly bizarre that you guys have "firemedics" and I still struggle to understand how that can work as efficiently as having pure paramedics but in saying that I haven't seen it in person.

From the little I know I think EMS in the US needs a new direction, a higher education system. This job isn't a game you have someone's lives in your hands and I would like to think that the paramedic who picks me up has undergone at least 3 years training and possible a university degree. I don't know how your training works over there but over here to become a paramedic it's generally 3 years on road and classroom training if you apply through your state ambulance service, or as I am doing, 3 years at university with on road prac included in that. Would love to know how long your paramedics spend training in total(this is a genuine question guys)? Now i'm not saying we should become "textbook" paramedics but i'm certainly starting to see the advantages of having some advanced science courses behind me.

I'd also have a quick look in the mouth. Is there any blood present or bite marks on the tongue that might help strengthen suggestions of a seizure?

Hi fellow neighbour . To be honeest I would much rather have done the internal that QAS offers where you spend approx. 3 years on-road doing your training at the same time. However, I didn't have enough life experience to be competitive in selection. The uni program's ok but i'm a hands on learner and count down the days 'til my next observer shift and the weeks 'til my next prac kind of sad really but I love the thrill of been on road and never knowing where your day will take you.

My bad guys we actually use panasonic toughbooks (not toshiba as I previously mentioned). Plus I had a look and we use Mentor Engineering inc. MDT/MDC. The one on this page: http://www.mentoreng.com/products/mdc/mdc.html

Here in QLD we have Toshiba toughbooks which we do all our patient "paperwork" on.

Pros: If a paramedic has messy handwriting there's no problems, if you can't think if you've missed anything you can just scroll through (for example) symptoms associated with respiratory, you don't have mountains of paperwork

Cons: they can be a little temperemental from time to time and as someone else said make you want to throw the thing, one paramedic pointed out on my shift last night that if she ever had to go to court over a case from the toughbook she doesn't think she'd remember it as well as when they use to write the cases out.

Also, in all metropolitan regions and some regional centres (to the best of my knowledge), every truck has an MDT. So in the Brisbane region our pager goes off, we go out to the truck our MDT will be beeping and we hit on case. The MDT brings up the pt's location, age, sex, what's wrong and in some cases significant medical history (such as CABG). These MDT's continue to update with new signs/symptoms on the way to jobs. Not sure which model we use sorry guy's.

Pros: You have a better idea of what you are being dispatched to

Cons: it get's a bit frustrating when it updates with stupid comments such as "Patient is now crying" (only ever had it once but was like WTF?)

Hey with our pt her speech wasn't slurred or bizarre, it was simply hard for her to talk because of the trismus in her mouth. Sorry if I confused anyone!

Haha thanks rat115 glad you're enjoying my posts

I'd really like to know if she was on any psyc meds. Sometime certian psyc meds taken together for the first time can cause a reaction called " a distonic episode". The pt is usually excited, yelling and drooling when this happens for the first time and there mouths seem to be always open ( cause of drooling).

I beg to differ this NYCEMS. I have personally seen a dystonic reaction first hand and the patient is far from excited let me assure you. A quick google will even disagree with your symptoms there. A dystonic reaction may cause the mouth to hang open or may cause trismus (difficulty opening mouth) as our patient had. The trismus in her jaw actually forced her jaw of centre to the extent it almost looked like her mandible was dislocated. This also caused her difficulty speaking. Our patient was also having muscle spasms in her arms and legs and lordosis (swayback), along with torticollis (head to one side). For further reading I suggest the emedicine link off google. So unless I have gravely understood you I believe you are misunderstanding what a dystonic reaction is. If anyone else knows any different please say because I have never heard of a dystonic reaction as NYCEMS described it and would be interested to hear other people's views.

WOW! I'd hate to have to work out of that Porsche. I can assure you our landcruisers are definitely a bit roomier than that. Unfortunately I can't find an accurate picture on the net of the interior.

The landcruiser would definitely be narrower than something like a ford explorer and I guess in general yes it would be a bit smaller

Yer the landcruisers are quite cramped...i've never worked in one thank god!!! But there's not too many of them around either. They are generally only stationed near beaches where the paramedics may be required to drive onto the beach and I think also in some outback/rural towns.

Here in QLD, Aus, we currently run 4 types of ambulances. The oldest ones are the F250/350 with box which have only a small window between the cab and rear. Some have two stretchers while others have just the single stretcher and the stretchers are from Ferno. These are no longer been brought by QAS apparently something to do with them not meeting Australian emission standards. Here's a picture:

The QAS then moved on to the older Mercedes Sprinters. All that I have seen have only the 1 (Ferno) stretcher. Currently there are still quite a few of the older versions running around such as this one:

We also run landcruisers such as this one below just with different markings (this is a victorian one). Single stretcher:

Our latest addition to the fleet are the new Mercedes Sprinters which have one stretcher (Stryker):

The interior shot above is from a victorian ambulance but is very similar to our layout. We carry one stryker stretcher with a frontward facing patient care seat and a rearward facing seat behind the patients head. Next to the rearward facing seat is an airway kit mounted on the wall with LMAs, OPs, etc in it. When you open the left hand (passenger) sliding door there is a shelving system where our response kit, LP12, o2 kit, airway kit, vac splints and stryker stair chair is kept. There is also access to the rear of the ambulance through this door. Opening the right hand (drivers side) sliding door you will find 2xD size o2 cylinders which is what we run off while in the ambulance and 2xC size o2 cylinders for when our response o2 kit runs out. In the rear in front of the frontward facing seat are a set of draws which contain all our cannulation equipment. On top of these draws are a bracket for our LP12 to sit in when we need the patient hooked up to it. Also on the left of this seat is a fridge where fluids and water are kept. Along both sides of the ambulance up top near the roof are clear storage compartments where o2 masks, bandages, burn stuff, maternity kits, etc are kept. All drugs are carried in our response kit and one paramedic within the crew carries the morphine either in their pocket or in a pouch on their belt. Other equipment we carry on our trucks include things like donway's, cardboard splints, NIEJ/KED, spine board, scoop stretcher, spare collars, SAM splints, basic first aid stuff.

Officers in Charge of each station have a station wagon or sedan while on duty and Intensive Care Paramedics often also work as a single officer out of a station wagon however, there are some 2 man ICP ambulances around.

I haven't personally driven one of the new mercedes yet but they are comfortable to work out of. I have however, driven an F series and an older sprinter. In this comparison I think the older sprinter is easier to drive and more responsive however, I like the fact the F series has more guts to it but it is definitely hard to manouvere. In regards to interior, the new mercedes are awesome as the front and rear are fully open thus allowing a qualified paramedic to mentor their student (if the student's treating and qualified driving). This was probably the biggest downfall of the F series, you simply cannot hear nor see from the back into the cab and vice versa. However, I personally feel the F series were a bit roomier in the back but I still feel the new mercedes are big enough. Overall I don't mind working out of either but would probably have to say i'm starting to like the new mercedes better. My station doesn't have any older version mercedes but the couple of times i've been in them i'm wasn't the biggest fan and I also think they're quite ugly.

So after a mile long post there you have it

4cmk6 we have similar in QLD. They are generally F250/F350 cabs with the big boxy back. Here's a pic of one:

However, we are now switching over to Mercedes Sprinters where it's the two rear doors. Here's a couple pics of our new ambulances.

This pic is of a victorian ambulance but gives you an idea of the interior:

We have a forward facing patient care seat and a rearward facing seat at the head of the patient. On the wall next to this rearward seat is a wall mounted airway kit containing LMAs, OPs, etc for quick access. In front of the forward facing seat are draws containing cannulation equipment. On top of these draws are a bracket for our LP12. The left side (passenger side in OZ) has a sliding door which opens up to where our kit, o2 kit, vac splints, stair chair and defib are usually kept. There is also access into the rear of the ambulance from hear. The right hand side (drivers side) also has a sliding door where we store 2xD size o2 cylinders(for use whilst in transit) and 2xspare C size o2 cylinders. These new ambulances contain stryker stretchers and stair chairs where as our old ambulances contain Ferno's. There are storage compartments up the top on both sides of the ambulance where we keep o2 masks, bandages, maternity kits, burn stuff, etc...Pretty much everything we carry in our normal kit.

"We are required to respond to any call with lights and sirens ..."

Wow scoobymedic I have never heard of that. Here in QLD we have 3 response codes: 1(time critical), 2(acute non time critical), 3 (non urgent). In my experience I have ever only done one code 3 and it was transferring a discharged pt from hospital to his home. Code 1 is a lights and sirens response where at the least the lights are to be activated (many just use sirens in traffic). Code 1 accounts for things such as chest pain, syncope, RTC/MVA, difficulty breathing, major haemorrhage, ALOC, seizures, etc. Code 2 accounts for things such as post syncope, abdo pain, minor haemorrhage, fractures, inter hospital transfers, etc.

In regards to transferring to hospital we have the choice whether to go code 1 or 2 and it is quite rare for us to go code 1. In regards to interhospital transfers we get dispatched either code 1 or 2 and that is what we transfer as. On rare occasions we go code 1 and if we are code 1 we generally have a Dr and RN on board.

It's quite interesting to see how the different EMS systems around the world work.