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Who has better equipement and training USA or UK


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I did a stand by with Canadian and German paramedics. When they explained their training and

or equipement/drug protolcols- They seem to have been better trained and allowed to do more than

USA medics. Am I suffering from CRI (cranial rectal inversion) or is this true? Be safe.

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Equipment and Education, vary state to state. Of course, some services have higher expectations and goals, therefore set a higher standard. I've always thought the larger services in the UK were a little better off. But I don't know what kind of certification levels, and education requirements the UK has, difficult question to answer.

Edited by 4c6
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Hands-down the UK.

The United States as a system is perhaps one of the most fractured, lowest standard systems in the developed world. There is a lot to be learned from the UK and Australia. I'm sure a quick search will bring up some examples, we've discussed it a few times.

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medic82942003

I believe it is not any one system of education that is the best or that one is from a school with a poor reputation or even a country that determines excellence as that would be gross stereotyping, but by looking across borders and oceans this becomes part of a journey in development.

The self education never stops, its up to the Individual Medic to become the best they can become, I have worked with 3rd world trained RNs .. that put developed nations RN to shame.

Sure hope assiephil doesn't see this post or we will never hear the end of it .... :argue:

cheers

Edited by tniuqs
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I will try to be as objective as I can here.

I am a US para, my Brother is a UK para and we often swap yarns, as well as having both seen each others working roles first hand...

The main difference between systems is that the UK do not have a medical control, or physician-based system. The Paramedic is the one who makes ALL the prehospital decisions for the patient. They are completely accountable for all prehospital treatment for their patients. They have their own license to purchase, and carry their own supplies of controlled drugs, including Morphine, so many have their own "personalized" drug bags.

Many in the UK make a stink about working to guidelines, over our protocols. This does allow for a little more freedom in treatment options (and again, this is at the sole discretion of the para), but I believe the guidelines are similar to our protocols in the way they have been laid out, and indeed, the word "protocol" is mentioned many times in the literature. The one good thing is, one set of guidelines more-or-less covers the entire UK (England, Scotland, Wales and NI) Have a look.

http://www2.warwick.ac.uk/fac/med/research...ite/guidelines/

With that extra accountability, comes the ever watchful eye of the UK para's governing body, the Healthcare Professions Council (HPC). The title "paramedic" is protected by law in the UK, and one cannot practice unless they are registered with the HPC. Another plus, at least fundimentally - one overseeing body, not 20 or 30.

However, there is much malcontent among many of the HPC registrants, mainly due to some of the "fitness to practice" hearings. Many have accused the HPC of formulating petty arguments to discredit the registrant ("Not tying hair back during her working shift" was one notable comment made on one of the hearings, though not entirely the reason for the hearing). The Paramedic remains answerable to the HPC throughout their career, whether at work or not, and striking off the register, means they cannot work in the UK as a paramedic again.

http://www.hpc-uk.org/

Up until recently, all UK paramedic training was done in-house, and after one had been an Ambulance Technician, and had passed their probie period, could apply for pre-selection on a course. Success was based on personal merit, and the courses were generally much shorter than the US ones. These days, a University degree is only way to become a paramedic - there are some trusts lagging implementing this, but they will be phasing out the in-house courses in time. There is no difference in pay for university vs conventional paramedics at this time.

The US seems to have some more advanced clinical interventions than the UK, or at least more "toys" to play with. CPAP has barely taken off in the UK, Pacing and cardioversion are the exception, not the norm, piggyback drips are unheard of, intubation is only ever done on dead patients (no conscious sedation), capnometry is in its infancy, lack of drugs for symptomatic tachycardias (adenosine, cardizem, metoprolol).

However, in rural areas, they do thrombolise MIs - again, this can be completely without reference to a physician (ulp!)

I would say the ideal system would have a combination of both systems (like with healthcare as a whole), and both can learn from each other. UK EMS has the edge things like clinical autonomy and single system regulation; the US has the edge with technology, and in the best of the best systems - clinical practice.

Have to say, I think the training and education is pretty similar.

Edited by scott33
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Success was based on personal merit, and the courses were generally much shorter than the US ones. These days, a University degree is only way to become a paramedic - there are some trusts lagging implementing this, but they will be phasing out the in-house courses in time.

Maybe education is important?

It is hard to believe they have as little as 500 hours or 3 months to train their Paramedics. But, at least they seem to be correcting that.

I would say the ideal system would have a combination of both systems (like with healthcare as a whole), and both can learn from each other. UK EMS has the edge things like clinical autonomy and single system regulation; the US has the edge with technology, and in the best of the best systems - clinical practice.

But unfortunately the U.S. still has many systems that are "BLS" only with the 120 hour EMT-B and often volunteer running on a limited budget.

There are also many EMS systems in the U.S., even in well known systems, that do not do 12-lead EKG, do not do RSI, do not have ETCO2 monitoring, do not have CPAP and must still transport to the nearest facility even if the more appropriate facility is only a couple blocks away. Most of these things are not even mentioned in the U.S. Paramedic programs. So no these are not necessarily part of an ALS truck in the U.S. Even in some of the systems they have been placed in, inadequate training and education have lead to complications and scrutiny. For 12-lead, some must rely on the machine interpretation. For RSI, often the recipe is inadequate for many of the patients which sets the Paramedic up for failure.

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That is kind of what I am saying.

The fragmented nature of US EMS can mean anything from first aid squads to APP / CPP practitioners. From Volly FD who are obligated to do an EMT-B course, to professional flight teams (professional ones I mean) and everything in between.

As for the lack of hours for traditional UK medic courses. I agree it does seem a little short (they would say the same about our driver training, but that's another story) However, the jump from NHS Ambulance Technician - NHS Paramedic is not as great as the jump from EMT-B - Paramedic. The UK paras also don't spend as much time in class on drug math (no piggyback drips) or need to memorize protocols ad nauseum (the latter of which I felt took up too much time on my medic program).

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New Zealand is simmilar to the United Kingdom (after all, for a century or so we were thier bitch and hey lets not forget where all you American's left to get away from, but you just hide it better than we do what with the Revolutionary War and all)

We operate a mixed Anglo-American/Franco-German model whereby practically out in the street we are completely autonomous and have no "medical control" to speak of; we don't have to call the hospital and ask for orders. We are responsible to an in-service medical director for our actions and clinical practice.

Unlike in the UK (or the US to a lesser extent) we are not responsible to any Governmental body for our practice, ambulance officers' here are not registered as a healthcare provider (unlike in the UK) but we are working on it, slowly.

Education here is varied and follows both the "in-service" model and the University (UK/Australia) model. Most states in Australia only employee degree graduates (NSW and Qld. being the exceptions I believe). In-service education is fairly good but is not as thorough or diverse as the University system (mainly because the service must compromise to allow achievable education to be avaliable to the volunteers).

Anybody here who wants to become an Advanced Paramedic (ALS) must compete the University degree (or parts of it, if they are already a Paramedic (ILS) as they recieve cross-credit for the rest).

As for drugs, scopes of practice and protocols these are not standardized between services but near enough. The scopes of practice and titles are different but only slightly; for example one service here (Wellington) allows ALS to thromblyse whereas the others do not (St John is conducting clinical trials at the mo). Our drugs are on one hand good and ther other bad; only one service (Wellington, again) carries adenosine, corticosteriods (hydrocortisone), anti-histamine (promethazine) and CPAP but we (St John) carry ketamine.

Our scopes very different from the USA; our "basics" (ambo officers) can give GTN, glucagon PO/IM, salbuatmol, oxygen, entonox/methoxyflurane as well as insert an NPA, OPA and LMA. Intermediates (paramedics) can manually defibrillate, insert IVs and give NS/10% dextrose and soon (this is currently a level above) give adrenaline, fentanyl, metaclopramide and naloxone.

I am suprised the UK does not allow for cardioversion.

Edited by kiwimedic
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'kiwimedic'

New Zealand is simmilar to the United Kingdom (after all, for a century or so we were thier bitch and hey lets not forget where all you American's left to get away from, but you just hide it better than we do what with the Revolutionary War and all)

Almost the same deal in Cankistan .... well about being the UKs bitch part ... sorry Kiwi that just struck me as funny we respect the commonwealth of nations but they ALL talk funny :shiftyninja: So do you kiwis and Oz too btw EH.

We operate a mixed Anglo-American/Franco-German model whereby practically out in the street we are completely autonomous and have no "medical control" to speak of; we don't have to call the hospital and ask for orders. We are responsible to an in-service medical director for our actions and clinical practice.

Well we in Canada are screwed up and still have to live with the frogs even though we beat their asses, (Quebec without doubt is the weakest link with seriously very few Advanced Care Practitioners) btw I think we are the only country that can tolerate them <_< the french that is. The Canadian system is fragmented in regards to levels of care and standards in training basically because health care delivery is a provincial responsibility many provinces consider Ambulance part of the health care system, some do not, some allow private service EMS operations, some provinces do not, some provinces have integration with Fire Departments some do not, it becomes a municipal funding issue.

If one goes to the Paramedics of Canada website ... the national occupational competency based objectives can be found there and cross referenced for those looking for reciprocity from one province to the next ... shame we can't get collective poop in a group across the nation.

As for Autonomy (just speaking for Alberta) although we have medical directors signing standing orders/protocols/guidelines seldom do we ever "call in" other than to inform that we have a high priority "intubated or unstable patient" We are responsible to a medical director for our actions and clinical practice. RSI is pretty much standard fare for all ALS providers, most areas are working towards Thombolytics but that does require MD approval CPAP is "being considered" but we are way behind in that area (ps as an RTT BI Level support is the far better IMHO) the vast majority of practitioners have a great deal of latitude the newer move in Alberta is to as they do in the UK. In Ontario only CCP can RSI and only when they are on Aircraft ... thats just wrong, I believe that Saskatchewan will become the next leader as Ontario and Alberta and BC are falling behind in development and hopefully the Saskatchewan College of Paramedics will learn from the other "Colleges" failures.

Unlike in the UK (or the US to a lesser extent) we are not responsible to any Governmental body for our practice, ambulance officers' here are not registered as a healthcare provider (unlike in the UK) but we are working on it, slowly.

Just a word of advice Kiwi ... assure that Field Evaluations and Endorsements are a big part of Licensure/ Registration/ Practice Permit and do not allow the government to dictate ... it should be "Paramedic Driven" and an advocacy for the Profession included, as this is where Alberta fell flat on its face and just recently.

We are moving towards even more autonomy with licensure and independent malpractice insurance as prior we were presently covered under the blanket policy of the medical directors insurance we have a well established registry/overseeing body, called the Alberta College of Paramedics, unfortunately not well respected nor supported by the vast majority of providers and really not enough teeth in legislation (presently) to do anything but slap on the wrist, but times they are a changing with a Government incentive to treat or cancel or triage transport to clinics or ERs.

I am suprised the UK does not allow for cardioversion.

I am too and not buying that .. ILCOR pretty much sets the ALS standards for the world and cardoversion and "weld at will" is a standard in London anyway.

Funny thing I spoke with an ER MD friend just lately just returned fro the UK ... He was totally convinced that the UK was Physician driven system ... where as Stephen Hines from London Ambulance service Clinical Dispatch (we spoke indepth @ EMstock on Bledsoes Ranch in Texas) the clinical dispatch center does the majority of "advice" communications Paramedic to Paramedic.

cheers

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