All non-USA EMS systems

[cosgrojo]

Recent discussions about standards of care got me thinking... are their any other countries' EMS systems that are as inexorably linked with another service (i.e. Fire/Police...sometimes)? Or are they stand alone entities, judged and evaluated based on their own performance/need?

I've read many threads about treatment protocols and education, but I can't remember if we ever discussed this aspect. I think that it could serve as a valuable distinction between the level o' standards, and possibly explain some of the fundamental differences between the U.S. and others.

[celticcare]

Recent discussions about standards of care got me thinking... are their any other countries' EMS systems that are as inexorably linked with another service (i.e. Fire/Police...sometimes)? Or are they stand alone entities, judged and evaluated based on their own performance/need?

I've read many threads about treatment protocols and education, but I can't remember if we ever discussed this aspect. I think that it could serve as a valuable distinction between the level o' standards, and possibly explain some of the fundamental differences between the U.S. and others.

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

[Kiwiology]

As Scotty said; New Zealand has two not for profits (hell they run defecits exceeding ten million pa no chance of a profit there!) and two hospital based systems that provide emergency 111 ambulance (EMS).

St John is the main provider operating a loose national structure across five regions with service level agreements between the national office and each region - don't get that? hell me neither. This leads to some variance in how the services are operated across each region although in the last little while there has been a hard push by management to create a single, national way of operating.

Our scopes of practice and clinical procedures are (within St John) nationally consistent and come from a panel of our 5 medical advisors (1 of which is the national medical director) and 5 ALS Paramedics. Before '99/2000 we did have nationally consistent procedures and practice levels for all of New Zealand but the group responsible for this was disbanded. Having said that there is now a new system being built where all providers will have consistent levels and education across the four providers and the defence force. Our scopes of practice across the four providers are almost consistent but there are some minor variances (e.g. thrombolysis and corticoteriods) but again, we are working on a national scope of practice.

The New Zealand Fire Service is a totally seperate entity and does not get involved in medical calls except for rural first responders and on-scene medical care say at an MVA before the ambulance turns up. The highest level of care for the Fire Service is basic first responder and AED; we don't have Firefighter/EMTs or Firefighter/Paramedics - although when I was running with the Fire Service they liked me for my medical skills; does that make me the only Firefighter/EMT in the country? *tongue firmly in cheek

As far as our funding we are funded partly by the Ministry of Health for medical calls and ACC for trauma. ACC is our national accident insurer so does not "bulk fund" like the MoH but rather pays use per-patient; I know the amount ACC pays is set per call and whether the ambulance has one crewmember or two. This creates a bit of an incentive to transport people who don't really need it to earn as much money as possible.

[celticcare]

As Scotty said; New Zealand has two not for profits (hell they run defecits exceeding ten million pa no chance of a profit there!) and two hospital based systems that provide emergency 111 ambulance (EMS).

St John is the main provider operating a loose national structure across five regions with service level agreements between the national office and each region - don't get that? hell me neither. This leads to some variance in how the services are operated across each region although in the last little while there has been a hard push by management to create a single, national way of operating.

Our scopes of practice and clinical procedures are (within St John) nationally consistent and come from a panel of our 5 medical advisors (1 of which is the national medical director) and 5 ALS Paramedics. Before '99/2000 we did have nationally consistent procedures and practice levels for all of New Zealand but the group responsible for this was disbanded. Having said that there is now a new system being built where all providers will have consistent levels and education across the four providers and the defence force. Our scopes of practice across the four providers are almost consistent but there are some minor variances (e.g. thrombolysis and corticoteriods) but again, we are working on a national scope of practice.

The New Zealand Fire Service is a totally seperate entity and does not get involved in medical calls except for rural first responders and on-scene medical care say at an MVA before the ambulance turns up. The highest level of care for the Fire Service is basic first responder and AED; we don't have Firefighter/EMTs or Firefighter/Paramedics - although when I was running with the Fire Service they liked me for my medical skills; does that make me the only Firefighter/EMT in the country? *tongue firmly in cheek

As far as our funding we are funded partly by the Ministry of Health for medical calls and ACC for trauma. ACC is our national accident insurer so does not "bulk fund" like the MoH but rather pays use per-patient; I know the amount ACC pays is set per call and whether the ambulance has one crewmember or two. This creates a bit of an incentive to transport people who don't really need it to earn as much money as possible.

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.

[Kiwiology]

I stand corrected then; at any rate the co-operation of the Fire Service and Ambulance here is generally very good and I do like the Fire Service; if you need a car turned into a convertible or somebody cut out of whatever situation they have entangled themself in the Fireys are bloody fantastic.

However that said both the Fire Service Commission (the link between the Fire Service and Central Govt), the Professional Firefighters Union and the ambulance services are very much opposed to any form of merger between the two services. They are totally seperate and there is no opposition to keeping it that way. Each has expertise in thier own area and joining the two would not be in the best interest.

To answer the second part of the question: Ambulanche here is a totally seperate emergency service (although it is not offically recognised as such by Government; the Fire Service and Police both have Acts of Parliment that define thier role, responsibility and guarentee an adequate level of funding, which Ambulance does not have) and we are judged based on our performance as stipulated in the contracts between the Ministry of Health/ACC and the individual services; which says we must meet certian requirements as best we can (e.g. response times, crewing levels and qualifications).

Unlike some services in the UK we have not gone totally apeshit and put a rapid responder on every street corner (ok that might be a bit over dramatic but you get the point) to meet the all-powerful God Orcon's eight minute response target ... but I do notice those rapid response jeeps are cropping up more and more.

While I vehemently despise some aspects of service delivery here which detract from the professional progression of the Paramedic profession in New Zealand (but that is not a generic model issue it's specific to our service providers) I must hold us in very high regard for what we are doing that the rest of the world can learn from; specifically we are working towards a nationally consistent model for practice levels, education and scope of practice.