celticcare

Rightyo, BEN, there is a public education plan over the next few years as Technician is introduced to explain the new levels and its talked about during first aid courses. There will be ONE paramedic level and an intensive care paramedic level. The majority of public are aware that someone who works in the ambulance are often called paramedics and don't know the skills. When I was with WFA, there wasn't issue from the public as they saw they were getting an ambulance and people aren't stupid, majoriy of people know that there are different levels for everything. Please get your facts right before making comment about New Zealand EMS unless you work in the service. Scotty

12 lead acquisition is currently a Intermediate Care skill and interpretation is ALS here. I agree with Doc on the elements of GTN and inferior infarcts. Do I really want to bum my patients pressure out and cause more issues because I didn't do a 12 lead and interpret it? Anyone can pick up the basics of ECG and look and see a big wave that shouldn't be there, but the basis of interpretation does have to include knowledge specific to cardiac anatomy. Ben, please bear in mind that the process of BLS is not PHEC any more, it is acquisition of the National Diploma of Ambulance to practice at technician level. All new entry staff will be doing this process, which DOES include anatomy and physiology modules. And they are on a par to what I learnt during my Bachelors of Nursing. Please refrain from comments such as you wouldn't trust BLS with meds or a BVM, as that is an insult to those who have actually achieved the qualification or the skill level. And now back to topic.... More and more paramedic students *including degree and roadstaff upskilling* are required to spend time in Cath lab, CCU, ED and those areas to recognise STEMI's, interventions and bypass therapy options. The education is getting there and will increase, perhaps we are on a lucky level because we are a smaller population we can implement these strategies alot easier. Scotty RN /ACLS L6/ EMT / EMD

Hi, New Zealand RN here, also EMT and EMD. *I am using the terms EMT purely for the fact of that its an American forum*. I like the original poster, have desire for Paramedic *our Intensive care scope* career and future. However, I am going to say get RN first, with the base of being an RN and working in the field as a nurse, it will set you up alot clearer for being a medic. I disagree with the comments that Nurses have limited scope, remember we do have clinical nurse specialists and nurse practioners, who like EMS staff, were once Basics, then intermediates and then medics. We are bringing in cross converstion and post grad registration/qaulifications for RN's to become medics. Honestly become an RN first, get your degree and a new grad year under your belt then look at becoming a paramedic. You will have an established course that frankly here in NZ we don't have for medics. And will always have a qualification you can travel on, Paramedics at this stage you are limited, RN you can have the world as your oyster. ED nursing isn't easy to get into though and you will have to work your way into it, which is better trust me. Send me an E-mail if you want any more information, I started my training at the same institutes as you Scotty RN/ACLS (L6)/EMD/EMT

All the best advise has been laid, also having your monitor in a position that means your leads wont be drooping all over the place and causing gross artifact. Also knowing your monitor, how its calibrated in regards to the limb leads being on the torso or on the actual extremities. Not settling for second best and looking for quick fixes will lead to disaster in the long run. Misplaced leads could lead to misplaced treatment. Take the time, take the care, maintain dignity, but at the end of the day, in regards to female patient, a moment that they may be disrobed to provide an adequate diagnosis, could mean the difference between life and death and life over property. Scotty

Thank you, exactly right. If you know you can do a bit of stabilising in an emergent sense in the lounge and then get them out to the truck then go for it. Rather know that if I had an SVT that I got them out of the cramp spot, into the lounge, do some stabilising, stretch them out, put them on stair chair properly and then get them to the truck. Its case by case but would rather know I had a bit of an Idea what I am dealing with and could have complications wise before going to the unit. And in reality, someone reading that might think "oh hell thats taking ten minutes" when in reality, the process would be a minute, takes longer to explain something than do it. And Ben, implying my new job,

I am curious also, notice no further word from the infamous O/P? I am with Mobey on the replies too

Whilst not the same, we had our limb leads set up in a diagnostic mode in CCU in the days after infarct to continually give the six lead views without the patient being permanantly attached to precordial leads. I am going to check this out with the LP 12 at work, I like the idea that if you have suspicion, you can get a look in, and remember you only need 2,3 and AVR to diagonose inferior MI. I am just worried if anything might void the warrenties on products pressing the button when its not supposed to be used that way, we know how some medical companies get with products. Good thread idea though, just curious are some people reading this as that you are attaching 6 leads *wires and electrodes* to the chest or gaining 6 views of the heart? Scotty

Not very much information about the product on the site, bar the PDF file and couple of videos. Seems if this is the revolutionary method of airway care, there would be more out there about it. Oh well, something else that will be purchased as a fad perhaps. Put it in the trunk with the LUCAS?

Stick to the AUT program, don't go to the other. The process and transition to the ALS/ILS and BLS process is going ahead strongly from initial information recieved. The BLS skill set, despite prior comment, is actually more than the "average" basic level that has perhaps been portrayed by other posters. BLS skill level is essential and with the higher level of skills coming out, BLS skills are not what is perhaps percieved as being a basic grunt. And for someone who actually has done the RN degree here in New Zealand, yes some idiots apply, they soon leave in the first couple of months, and a nurse is more than a nurse, there are critical care nursing avenues, medical, surgical, primary care, nurse practitioners, nurse lecturers. A nurse is more than a nurse as a nurse has a chance to cross across to different facets of care and focus areas. A PHEC provider has a scope that is prehospital in a general scope. Please also remember, we don't have the money like alot of other countries, so we have to have the BLS/ILS and ALS skill level to provide care in general. And there is encouragement for all to be higher than BLS, but please don't paint BLS as being a bunch of Morons with a bandage and some panadol. Scotty EMD/EMT/RN

Could look at how dosages have changed and the pharmacokinetics of each and how both are used to get the heart in a regular form of rhythm *yes basic slang there, its early morning on my fourth night so shuddup lol* and maintain it. Or the use of Atropine in arrythmias as opposed to Cardiac Arrest and the medics use of each. Who knows its wide and complex.... just like a tachy cardia *ka boom boom dush* Sing out if you want articles and resources, CCU RN here. Scotty

Ask for free samples and dont accept anything less than 5k street value Sing out if you want any help, there are some good pharmacology for paramedic books out there and even general nursing pharmacology books will be a help. Think of what your patients have been on in the past, common trends like beta blockers, Ace inhibitors, diuretics, anti psychotics, ntirates, opiates and also street drugs of abuse etc. You will do well Scottster

How did the article/report turn out? Hope it went well and Cardiology is a good area to explore in regards to alot of meds, treatments etc. Hope it went well mate Scotty - RN/EMD

My reputation for rehashing old topics should preceed me and here I am proving it lol. First aid courses I have been involved in teaching are often industry specific (line haul drivers, volunteer firefighteres, ERT memebers, forestry workers, children groups etc) and so each course is tailored to suit the individual needs. If I am dealing with responder teams like ERT that need a two day basic course with CPR, WPFA, AED and some extra skills like C-Collars and O2, I do find introductions are important as I don't work with the people, helps me identify the leaders and the shy ones that I will need to assist through the course and in some courses, you may have members from three or four different ERT teams, so its a chance to mingle with the team memebers themselves. Humour is a brilliant instructional tool, if you can laugh at yourself and with the students, personally, I've found the courses to run alot smoother. I use visual aids such as Powerpoint, video and big clear charts. The books and charts are scattered around the desks for group work of taking a medical condition each and presenting the basic - what it is, how it presents and what treatment is used and whether its time critical or not. I am not a fan of written exams, I am a person who would rather see someone succeed with the practical and verbally give the answers in a relaxed essence. Every instructors style is different and also every countries style is different, New Zealand is a very much, sweet as mate attitude whilst maintaining professionalism. Scotty

MRX is the philips heartstart manual defibrillator which when combined with the QCPR sensor, gives feedback on compression effectiveness. This pad sits in the middle of the chest where you perform compressions and gives feedback in real time to the Monitor to advise CPR changes *push harder, faster, slower...... wait sounds like a night out with the wife.... anyway back to the topic* Only downside to QCPR, not compatable with the MRX units with Paddles as it requires the pads to collaborate the resus information as the pads sense the recoil etc. More information can be found on the philips health care site. Scotty

AHEM BEN!!! We do have medical co-responder units here in Northern region in which firefighters are turned out to medical calls and its NOT just in the rural areas! Wellington Firefighters are turned out to medical calls also. Alot of fire brigades around NZ do have staff on the appliance that are also either volunteer or full time ambulance staff and individual agreements with the brigade officials will give them leeway in response to their skills if agreed between the ambulance service there and the fire officals. *gives an angry glare* My apologies to the OP but had to nib that in the butt.

In the prehospital field, I've seen and personally felt for a femoral pulse during compressions and also looked on the monitor in lead 2 primarily and looked for continious wide complexes in sync with the compressions. Complying with the standards of hard and fast and allowing adequate recoil of the chest between compressions was the standards taught and the evidence presented in the AHA guidelines as well as the training given. We dont have the Autopulse devices etc HOWEVER..... most of the ambulances in NZ are now going MRX with QCPR so be interesting to see what that does to perhaps the CPR we have done for ages thinking was adequate. ETCO2 is also used if the patient is LMA'd or intubated. In Hospital as a CCU RN, the monitors, femoral pulse, ETCO2 and maybe them fighting us off of them is signs we are getting good compressions/resus in. I do think though that CCU is one of the harder areas to assess as we get a defib in within about 10 seconds roughly or at least a Pthump and all of the staff are trained in manual defib with paddles to get the shock in faster. It is interesting though reading the femoral pulse debate. Through any of my training it was standardly taught to feel the groin..... wait that sounds wrong....

Here in NZ the Paramedics run the PRIME courses (PHTLS, ACLS, PALS and Scene management) for doctors and RN's.... I rest my case I think someone was just trying to go har har har, I am in charge now. Welcome back btw SA

Hi there, I am sure this has been written before on another thread, but here in New Zealand, the EMS agencies are independent agencies. Four main services exist with St John being the main provider covering approx 80% of the country. There are five regions spread out each with its own medical director however a national standard of protocols exist for the minimums and some areas have more procedures they perform due to locality or distance from hospital. There is co-operation between NZ fire and Rescue and ambulance but no merger exists. Funding comes from ACC *accident compensation corporation* in relation to trauma calls, and the Ministry of Health provides funding for patient transfer services through the hospital boards, and some funding to fund emergency medical calls, however the rest of the funding comes from bills for medical calls, public donations, bequeths and general do gooders. Two hospital run services are run in the lower parts of the north island and are Hospital board funded and also with ACC for trauma. Wellington Free ambulance is what the name suggests, free ambulance care to the people in the wellington area at the bottom of the north island. however they run in a deficit and rely on public donations as well. Funding comes from ACC and Ministry of Health Contracts. I do hope one day the services will merge as it will mean that more funding can come available and a more unification of the services can occur. This is my own personal opinion, any one replying dont rip a new backside for it because I will show you respect for yours also. Scotty

*Gives Arron the whole bottle and one bottle of water* now you and your best buddy dust can decide how to take these, either orally in one go or a suppository. Or better yet, take the lot as a suppository up dust's ass and that way you get it orally as your often so far up it its not even funny. Dust, I don't know why I even bother now. You're a burnt out washed out has been wanna cry for me medic, all you thrive on, is a reputation for bringing people, beliefs and thoughts down when they dont match your own. But ya know what, its all good, because when your sitting alone thinking oh woe is me, I'm gonna be out on the streets doing the real job and doing it in the advanced world, with my cookbook knowledge because I chose to learn it. Yes completely off topic, but throughout this thread and others, you just dig yourself into the hole that is arriving faster and faster and you just prove that you are an asshole and have your little minnions of assholes who follow suit so well also. I'll just stick up for Happiness and Annie on the way you've acted, and spell check might have been applicable in your original title of this thread,

Looks like Afib with slight st depression starting, could be secondary to the opiate use, with occasional runs of Sinus in also.

*Licks LIps and smiles* Oh sorry were you talking to me?

Granted but it is working with me as my personal sex kitten. I wish more women would job share with Jeep