# Another U.S. Paramedic with Australia questions



## ExpatMedic0

Hey guys,

I read a lot of the other post that the other U.S. paramedic posted. I wanted to start my own instead of thread hijacking. I am a NREMT-P here in the states looking at relocating to Australia. I live in Oregon. I have found out our paramedic training dosent seem to be as long as Australia or the U.K. but our scope of practice is about the same. I found this link very helpfull http://www.paramedic-resource-centre.com/overseas/australia1.htm

Anyway let me get to the point for those of you who live in Australia, I hope you can shed some light on a lot of things for me.

My education includes, EMT-B at community college ( 4 months of community college vocational training about 150 hours) EMT-Intermediate (an extra 4 months of community college vocational training about 120 hours) Paramedic (16 months of community college  510 hours of classroom skills/lab training, 300 hours of clinical rotations and  700 hours of field internship experience Also college courses  Anatomy & Physiology 1 and biology 101 before entering the program.) in addition to this I hold PHTLS, ACLS, PALS, AMLS, and GEMS certifications, all worth 40 hours a piece but really only 2 days of training each.

My scope of practice seems to be almost exactly the same as the ICP medic but the ICP medic has more education than I. I have been talking with theese guys by email and am completing all there papper work http://www.ambulance.nsw.gov.au/docs/recruitment/intl_applicants.pdf

questions.
#1 Do you think I will atleast transfer over as a Paramedic?
#2 Do you think I will have the ability to obtain ICP medic in less than a year or work under the supervision of a trainer as an ICP within 6 months?
#3 any tips or advise or extra information that maybe helpfull?

Regards,
Mike


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## ExpatMedic0

Oh I should Add my current scope of practice can be found here. I am the P line on the far right.

http://www.oregon.gov/DHS/ph/ems/certific/scope.shtml


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## thegreypilgrim

Wow, your post/question is so much clearer and better thought out than mine was! 

I'm very interested in doing this too (I was the one who started the other thread). From what I understand the best thing to do would be to go back to school and get your degree. It would be preferable to find a college/uni that offers a degree in EMS which is what I'm doing. A list of institutions that offer such degrees can be found here.

I also found those links and forms that you've referred to which are quite helpful. So, like I said I think the best thing to do is get your B.S. You work in Oregon too, which has an awesome scope so that should help you out as well.


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## SA_Medic

Knowing a few South African Paramedics and National Diploma Paramedic (4 year Univ Diploma) that's gone across I can tell you this much. 

None of them went there as Paramedics. All of them had to drop down to EMT-I and redo the Aussie version of Paramedic. I have been looking into doing this as well but not sure I want to drop down to ILS again


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## downunderwunda

schulz said:


> Hey guys,
> 
> I read a lot of the other post that the other U.S. paramedic posted. I wanted to start my own instead of thread hijacking. I am a NREMT-P here in the states looking at relocating to Australia. I live in Oregon. I have found out our paramedic training dosent seem to be as long as Australia or the U.K. but our scope of practice is about the same. I found this link very helpfull http://www.paramedic-resource-centre.com/overseas/australia1.htm
> 
> Anyway let me get to the point for those of you who live in Australia, I hope you can shed some light on a lot of things for me.
> 
> My education includes, EMT-B at community college ( 4 months of community college vocational training about 150 hours) EMT-Intermediate (an extra 4 months of community college vocational training about 120 hours) Paramedic (16 months of community college  510 hours of classroom skills/lab training, 300 hours of clinical rotations and  700 hours of field internship experience Also college courses  Anatomy & Physiology 1 and biology 101 before entering the program.) in addition to this I hold PHTLS, ACLS, PALS, AMLS, and GEMS certifications, all worth 40 hours a piece but really only 2 days of training each.
> 
> My scope of practice seems to be almost exactly the same as the ICP medic but the ICP medic has more education than I. I have been talking with theese guys by email and am completing all there papper work http://www.ambulance.nsw.gov.au/docs/recruitment/intl_applicants.pdf
> 
> questions.
> #1 Do you think I will atleast transfer over as a Paramedic?
> #2 Do you think I will have the ability to obtain ICP medic in less than a year or work under the supervision of a trainer as an ICP within 6 months?
> #3 any tips or advise or extra information that maybe helpfull?
> 
> Regards,
> Mike



Mike,

I work for ASNSW. 

The biggest problem is that the education levels are so different. Our system is very close to the UK model & I Know they offer reciprocacy for them. However, as there is such a difference between education facilityies in the US, they are looking at each case on an individual basis, in some cases including texting to see the levels of knowledge, and ridalongs with senior paramedics to see what skills are there. This is no gaurentee you will be able to transfer as an Intensive Care Paramedic (we are all paramedics here). 

If you are not assessed as competent, then you may receive some recognition of prior learning & be able to reduce the course length, but if you have to apply to enter the ICP program, that is your 4th year of service.



> #3 any tips or advise or extra information that maybe helpfull?



Dont be arrogant. Looking at your experience, I cant see where you have actually worked in the field, other than 





> 300 hours of clinical rotations and 700 hours of field internship experience


. This will count against you. I wouldnt be in too big a rush to go ICP here, learn that all aussies will take the piss outta you & you need to get through that first. You will also need to be prepared to 'go bush'. There is no gaurentee that you will be in a desireable location in the first instance.

Any other questions, PM me & I will try to answer them for you


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## triemal04

It may be here (again, I'm very lazy right now), but is there any Australian site that lists the various levels and educational requirements?  Idle curiosity only.


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## downunderwunda

triemal04 said:


> It may be here (again, I'm very lazy right now), but is there any Australian site that lists the various levels and educational requirements?  Idle curiosity only.



This will be the closest you will get. The American model they will not complete as there is too much disparity in qualifications & experience.

http://www.ambulance.qld.gov.au/recruitment/pdf/EOQ_Matrix_March_2004.pdf


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## triemal04

Thanks, that helps.  If you've got the time, what I was wondering about is what each of those degrees requires, and what the scope is for the levels.


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## downunderwunda

triemal04 said:


> Thanks, that helps.  If you've got the time, what I was wondering about is what each of those degrees requires, and what the scope is for the levels.



Hmmm, no i dont have time, that would take hours. I would suggest you look at some of our university sites etc & you will get a fair idea.


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## triemal04

downunderwunda said:


> Hmmm, no i dont have time, that would take hours. I would suggest you look at some of our university sites etc & you will get a fair idea.


Gracias.


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## Melclin

schulz said:


> My education includes, EMT-B at community college ( 4 months of community college vocational training about 150 hours) EMT-Intermediate (an extra 4 months of community college vocational training about 120 hours) Paramedic (16 months of community college  510 hours of classroom skills/lab training, 300 hours of clinical rotations and  700 hours of field internship experience Also college courses  Anatomy & Physiology 1 and biology 101 before entering the program.) in addition to this I hold PHTLS, ACLS, PALS, AMLS, and GEMS certifications, all worth 40 hours a piece but really only 2 days of training each.
> 
> questions.
> #1 Do you think I will atleast transfer over as a Paramedic?
> #2 Do you think I will have the ability to obtain ICP medic in less than a year or work under the supervision of a trainer as an ICP within 6 months?
> #3 any tips or advise or extra information that maybe helpfull?



Sorry I came late to the party.

A few links for the degree courses that I'm am aware of and could discuss should you want too.

http://www.med.monash.edu.au/beh/ (I'm currently completing it)

http://wcf.vu.edu.au/Handbook/index.cfm?Search_Courses=Search_Courses&CourseID=6301 (while this one and the Monash course look similar, they are very different, and I'd be happy to discuss the numerous differences)

http://www.csu.edu.au/courses/undergraduate/paramedic/ (the only non, Victorian paramedic program I know much about. The head of the faculty there is a leading professor of paramedic practice and they have excellent simulation facilities I've heard.)

I'd be happy to ask around at uni about the real deal regarding any of the programs you have in mind. Their website polava is largely BS, as is true of anyone advertising themselves. 

There's a book I'd recommend regarding the history, state and future of paramedic practice in Australia, co-written by just about every paramedical academic in Australia. The name escapes me now, but I certainly recommend asking me to track the name down if you are actually serious about coming out here.   

Q.1) Possibly. I would imagine you would apply for employment like any other grad student, and they would assess you similarly too new grads from the uni courses I imagine. There may be some room to gain employment and then learn from a Clinical Instructor on the road, but as I said in the other thread, the yank approach is very different to the Australian approach. You will need to show proficiency in the Australian approach. You will also have to have a much better understanding of the whys and the hows, than your American programs afford you. We do not have online medical control and we are not terribly far away from being licensed to prescribe under our own authority (separate from employment with an ambulance service). 

Q.2) No. Or at least, you shouldn't. This is not a judgment of your abilities, but you simply do not have the education to be administering treatments on your own authority, by our standards. To be perfectly honest, if they did take you on in any capacity as an ICP, it would be because they are so desperate for ICPs in many parts of Australia.

Q.3) My thoughts: I have met a few very poor AP's (see the other thread for levels of practice) even in my short time on the road, who clearly don't know their arses from their stethoscopes. I don't doubt, after having experienced ALS practice (and clearly seeing that you are on this forum, you have some interest in bettering yourself), you would make an excellent AP (better than a lot), and maybe even a good MICA/ICP medic. However, your individual qualities aside, the American approach/ethos is of great concern to Australian paramedics and you will not be looked upon favourably, because of your country's approach to EMS. You're lack of education could, or rather, should be of concern to the employment panels. It does, however, depend on the current climate of the Ambulance service you are applying for. Services are doing a great many things they should not be doing at the moment, in the name of politics and numbers <_<. In general, get more education... and I don't mean more 'certs'. This whole business of ACLS, PALS, WANK...It doesn't mean anything to us. If you understand your business properly, then you don't need to go taking short courses and memorizing robotic algorithms.

*The take home message*: I'm sure the services will tell you all you need to know if you contact them. If you are interested in Victoria specifically, I'd be happy to chase down some answers at uni.


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## MrBrown

You may wish to look at New Zealand and if so, heres a quick two cents:

1.  You will probably be put on the road for a number of shifts (around 20) and have to fill in case logs and undertake practical/vica-voce assessments to demonstrate competency at our basic life support level (which is quite different from your BLS level) *without* having to rely on online medical control and then employed at BLS level.

2.  From there you will move up to Paramedic (intermediate life support) at a pace determined by your performance and how fast the service wants to move you up.  Anywhere from a year to 18 months at BLS level is not uncommon before you can apply to move up *but* yours could be shorter but I'd be suprised if you do it within less than 12 months.  

3.  Intensive Care Paramedic (advanced life support) *will* require you to go back to school and get the Bachelor of Health Science (Paramedic).  This will take you anywhere from 12-24 months.  

The Auckland metropolitan service is pretty short of ICPs (but there is generally one lurking somewhere when you need them it seems most of the time) so you might be able to use that to your advantage.

Like Australia we are moving towards a very flat system of only a few levels and we are seriously looking at registering those levels as indepndant health practitioners who can prescribe drugs and operate within a scope of practice without needing a standing order.

If you have the capability to find a reputable Bachelors Degree program in EMS then I suggest going for that if you want to come to this part of the world.  All your ACLS & PALS & ITLS stuff doesn't mean anything here so the more proper education you get the better.

Brown away! h34r:


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## downunderwunda

MrBrown said:


> You may wish to look at New Zealand and if so, heres a quick two cents:
> 
> 1.  You will probably be put on the road for a number of shifts (around 20) and have to fill in case logs and undertake practical/vica-voce assessments to demonstrate competency at our basic life support level (which is quite different from your BLS level) *without* having to rely on online medical control and then employed at BLS level.
> 
> 2.  From there you will move up to Paramedic (intermediate life support) at a pace determined by your performance and how fast the service wants to move you up.  Anywhere from a year to 18 months at BLS level is not uncommon before you can apply to move up *but* yours could be shorter but I'd be suprised if you do it within less than 12 months.
> 
> 3.  Intensive Care Paramedic (advanced life support) *will* require you to go back to school and get the Bachelor of Health Science (Paramedic).  This will take you anywhere from 12-24 months.
> 
> The Auckland metropolitan service is pretty short of ICPs (but there is generally one lurking somewhere when you need them it seems most of the time) so you might be able to use that to your advantage.
> 
> Like Australia we are moving towards a very flat system of only a few levels and we are seriously looking at registering those levels as indepndant health practitioners who can prescribe drugs and operate within a scope of practice without needing a standing order.
> 
> If you have the capability to find a reputable Bachelors Degree program in EMS then I suggest going for that if you want to come to this part of the world.  All your ACLS & PALS & ITLS stuff doesn't mean anything here so the more proper education you get the better.
> 
> Brown away! h34r:


but it is New Zealand, thats like stepping back in time to the 1940's


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## High Speed Chaser

Queensland looks like it has the best way to get into for overseas people with experience, plus you might get a chance to work on the Gold Coast. But there are problems with some areas as there is very heavy traffic on the Gold Coast in summer. I have heard of a victim in cardiac arrest who waited for ~ 25 minutes until ambulance got to him. Lifesavers performed CPR and wouldn't shock him due to a pacemaker implanted (obviously they need to be taught new protocols). 
Any way here is link for QAS: http://www.ambulance.qld.gov.au/recruitment/priorqual.asp

Then you have SA Ambulance and WA which I think are ones you can apply to and they will train you. But WA should be the last resort if you decide for Australia!! bad dispatch systems and procedure, they don't even use CAD. They have had ambulances dispatched as priority 3 (flow with traffic) instead of Priority 1 (L&S).

Anyway best of luck


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## downunderwunda

High Speed Chaser said:


> Queensland looks like it has the best way to get into for overseas people with experience, plus you might get a chance to work on the Gold Coast. But there are problems with some areas as there is very heavy traffic on the Gold Coast in summer. I have heard of a victim in cardiac arrest who waited for ~ 25 minutes until ambulance got to him. Lifesavers performed CPR and wouldn't shock him due to a pacemaker implanted (obviously they need to be taught new protocols).
> Any way here is link for QAS: http://www.ambulance.qld.gov.au/recruitment/priorqual.asp
> 
> Then you have SA Ambulance and WA which I think are ones you can apply to and they will train you. But WA should be the last resort if you decide for Australia!! bad dispatch systems and procedure, they don't even use CAD. They have had ambulances dispatched as priority 3 (flow with traffic) instead of Priority 1 (L&S).
> 
> Anyway best of luck



Chaser, 

the other states will train you as well, however, they are looking for more Uni grads but the uni cannot keep up with demand. The other thing to remember is that most in the uni courses are undertaking a double degree & have no intention of working in prehospital care, but will take the credentials as a just in case. For example, rostering changes in NSW forced an increase in numbers. To accomodate this 650 extra staff have been recruited this year. Of those less than 100 came from uni. 

The issues in WA are well documented, & they are both underfunded & under resourced. (But it is a contract to a private company, not a government run service like every other state need I say any more when we have seen the failings of a privatised US system?).

QLD are well resourced & underpaid. They have issues with their Union & Association. Every state has its positives & negatives. The main issue is that there is so much disparity between qualifications & experience it is difficult to equate a level from the US to aussie. The UK system is very similar to most aussie states & that is why their medics are accepted without a problem.


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## Smash

downunderwunda said:


> but it is New Zealand, thats like stepping back in time to the 1940's



What is your reason for saying that?  I'm considering New Zealand as a lifestyle move.


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## Scott33

Smash said:


> What is your reason for saying that?  I'm considering New Zealand as a lifestyle move.



When my sister moved to NZ 5 years ago, she did say it was like being back in the 70's. Things like the pace of life, lack of reliance on technology, lack of population / cars on the roads etc. Some of the more rural areas get by on the most basic of provisions.

Not such a bad thing though, depending on what you want in life.

Edit: Got my dates wrong


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## Smash

Sorry I was referring specifically to EMS. I've ridden out with supervisors in a number of places, including Auckland, and it certainly seems like a progressive service with things like road based RSI and so on. This was some years back though, so maybe they haven't kept pace? 

Downunda, can you enlighten me?


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## downunderwunda

If NZ is so good, why do more New Zealanders live in Australia than NZ?

Enough said


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## Smash

downunderwunda said:


> If NZ is so good, why do more New Zealanders live in Australia than NZ?
> 
> Enough said



I see.  So you don't actually have anything to base your comments on?  Is this just a retarded us vs them thing but on a national scale?

Can anyone with something constructive to say, or may actually have any idea what they are talking about let me know how New Zealand has kept up?  As I say, they certainly seemed more progressive than many US services and more than the few Australian services I have ridden along with, but that was a few years back and things change.


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## Melclin

Smash, see this thread for a comparison of the systems. Don't take wunda too seriously, he hates everyone 

http://www.emtlife.com/showthread.php?t=14919

As far as I can see, most Australian services are more progressive than their NZ counterparts. Certainly further along the track in terms of education. 

I don't know about the other states, but certainly here, the majority are not doing the double degree, and of those that are, most I know want to work in EMS, but wanted the nursing degree as well for s**ts and giggles, or to travel and work. 

We have some things that would be considered progressive and others that our trans-pacific cousins would not be very impressed by.

-We have road based RSI (have for a while) approved for many clinical problems.
-Post ROSC hypothermia.
-Our BLS provider operates at a level somewhere between you ILS and ALS and is now required is to have a university degree or equivalent training.
-Pre-hospital fibrinolysis (ALS). 
-Sepsis protocols and excellent scope for hospital bypass (BLS). 
-Many aspects of our ALS section are well integrated with ICU/cathlab management (the upcoming TBI trial will start with paramedic induced hypothermia that will last for up to five days; ALS can triage directly to cath labs).
-Progressive pain relief options: Methoxyflurane, Morphine, Fentanyl and probably Ketamine soon enough.
-Surgical Cric.
-Chopper medics have ultra sound, arterial lines, iStats (sometimes), blood, a range of pain relief options, a range of other induction and paralytic agents, noradrenaline, mannitol and a few other little tricks. 

*On the other hand:*
-even our ALS guys have much fewer pharmacological options than Americans.
-Any addition to scope or pharmacotherapy is slow going because of the difficult and expense of rolling out a new drug/procedure as well as training 2500 paramedics to a high enough level to confidently use it without medical control.
-Even ALS doesn't have IV nitrates making precise management of ACS, esp RVIs rather difficult.
-No Trans cutaneous pacing.
-Because of the nature of funding, it is very difficult to get equipment/drugs that are very expensive, without overwhelming evidence for their use (although methoxyflurane would seem to be against that grain).
-We lack a lot of drug options, that many progressive US services have, that are no strictly necessary as best practice but would be nice and probably help; or drugs that can wait for the emergency department, but would be nice to have and probably beneficial to give earlier (again this is a funding and training issue I think) eg.. Vasopressin, Adenosine, Magnesium Sulfate, activated charcoal, calcium chloride, Diphenhydramine/phenergan/any antihistamine, dopamine, procainamine, bretylium, Diltiazem, Methylprednisolone, Esmolol, isoproterenol, etc.


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## High Speed Chaser

downunderwunda said:


> Chaser,
> the other states will train you as well, however, they are looking for more Uni grads but the uni cannot keep up with demand.


Victoria only accepts uni grads now and I hear other states are looking to do the same. I believe I read Queensland is the easiest for overseas but I'm not really sure where I read it or if it's true.



downunderwunda said:


> The issues in WA are well documented, & they are both underfunded & under resourced. (But it is a contract to a private company, not a government run service like every other state need I say any more when we have seen the failings of a privatised US system?).



NT is private (again St John and they seem to be better). I'm just suggesting that it's better to go seek out other states before WA as I'm not sure anyone outside Australia has heard of these failings. 

It's a shame paramedics have so many problems with the government though 



Melclin said:


> Methoxyflurane


Give me three years and they will teach me to administer that and GTN, even if I haven't finished my Bachelor of Emergency Health or the double degree (which is my first preference). I can't wait!!!


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## Melclin

High Speed Chaser said:


> Give me three years and they will teach me to administer that and GTN, even if I haven't finished my Bachelor of Emergency Health or the double degree (which is my first preference). I can't wait!!!



Don't forget you have to another person with a meds qualification with you :wacko: St John's are crazy strict with their drugs. Fair enough with GTN, I'm not sure they should even be allowed to give that, but really...penthrane? Aspirin? Fair enough I spose, but I wish they'd recognize some of my education before its official conclusion. Still can't even get 2 bloody days off in a row to do their first aid course


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## downunderwunda

High Speed Chaser said:


> Victoria only accepts uni grads now and I hear other states are looking to do the same. I believe I read Queensland is the easiest for overseas but I'm not really sure where I read it or if it's true.
> 
> Victoria are currently reviewing all practices of recruitment I am led to believe as they are unable to meet demand with uni alone.
> 
> Queensland appears to be the easiest because they have a published matrix available on the internet. Other states ask you supply your qualifications & experience & will evaluate each application on its merits
> 
> NT is private (again St John and they seem to be better). I'm just suggesting that it's better to go seek out other states before WA as I'm not sure anyone outside Australia has heard of these failings.
> 
> Anyone who has missed it, it has been posted before it is Here
> 
> Nt also has many problems, similar to WA with poor staffing numbers
> 
> It's a shame paramedics have so many problems with the government though
> 
> If it wasnt with government it would be with an employer.I know a review of Union motions for the past 5 years have shown that 97% of what is demanded relates to patient care, with 1% relating to money, the balance relates to conditions.
> 
> 
> Give me three years and they will teach me to administer that and GTN, even if I haven't finished my Bachelor of Emergency Health or the double degree (which is my first preference). I can't wait!!!



Melclin 

penthrane is a dangerous drug with high nephrotoxic properties.


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## Melclin

downunderwunda said:


> Melclin
> 
> penthrane is a dangerous drug with high nephrotoxic properties.



Well so are most drugs if you give them to the wrong person or in the wrong dose. St Johns give out panadol without a meds cert. Suppose that person had already taken too much panadol that day. 

Chronic affects on ambos and nephrotoxicity in larger anesthetic doses aside (although I might add that even in very high doses the rates of nephrotoxicity were not what I'd consider to be astounding), with simple, easily applicable controls, penthrane seems perfectly safe. 

More to the point, I don't see how three years as a first aider any better qualifies you to take the meds course than a person who's been in it for a month. As long as they are still taught the importance of safe administration just like we are.  

If you can teach a soldier to stitch a chest tube in under fire you can teach a first aider to give penthrane.


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## downunderwunda

I agree, but I dont think St Johns in states where there is a paid service should have drugs at all.


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## High Speed Chaser

downunderwunda said:


> I agree, but I dont think St Johns in states where there is a paid service should have drugs at all.



Why not? As long as people are trained to use the drugs and follow the protocols, I don't see why those drugs can't be given, especially if it can take paramedics sometime to reach a patient due to the size of some locations as well as navigating ambulances through traffic, specifically at major events.


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## downunderwunda

High Speed Chaser said:


> Why not? As long as people are trained to use the drugs and follow the protocols, I don't see why those drugs can't be given, especially if it can take paramedics sometime to reach a patient due to the size of some locations as well as navigating ambulances through traffic, specifically at major events.



Do you not think that a person sgould understand the full ramifications of the drugs they are using. The reason why we give it, the pathophysiology of the illness, the side effects, the pharmacokinetics, the pharmacodynamocs of the drug?

What is learned by professional Paramedics here is well beyond what is required, however, the understanding of what we do, not just 'if the patient has this, then give that', allows us to proceed with treatments based on a full body of knowledge & understanding of what we are treating. Not just looking for signs & symptoms. It also gives us a full understanding of the adverse effects to enable balanced judgment as to the continuation of treatment. 

My _minimum_ lecture on renal anatomy was in excess of 3 hours, this was then added to with a further 4 hours , just to understand what is happening in the renal system before I was allowed to administer Penthrox unsupervised. Will the St Johns system allow for this level of detail to ensure it is full understanding?


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## Scout

How long are the courses for the st john lads?


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## downunderwunda

Maybe chaser can enlighten us.


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## High Speed Chaser

downunderwunda said:


> Will the St Johns system allow for this level of detail to ensure it is full understanding?


Sorry downunderwunda, haven't done the course so I don't know, by the time I'm eligible to do the medications course, hopefully I will have Completed a Bachelor of Emergency Health (Paramedic) or another paramedic course at a different Uni anyway.

The First Responder course is (as I understand it) run for ~14 weeks, for between 2-4 hours once a week, not including operational time spent at events with experienced personnel. Then after that is completed, every year you have to be re-accredited in everything that was done during the initial course. This is done in weekly or fortnightly meetings and a test (and depending on subject, a practical test) usually has to be passed before you are re-accredited.


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## Melclin

Some of the guys have done the meds course in my division. Of course its not up on paramedic level education. As far as I know, aside from the first responder course, its something like a two night session (about three hours each) with some homework you have to do RE contras, side affects and physiology. In theory I agree with wunda, but in practice, when it comes to penthrane at least, I think that with certain tight controls, and modified contraindications, I can't see that you would get any significant adverse affects. As I understand it, anyone having penthrane will be getting an ambulance anyway. 

If you were to modify the drug info .....say, 

Indications :   severe pain/cardiac pain. (Usually pain score >2)

Contras:    Any antibiotics, any acne treatment, any past penthrane in 24hrs, any kidney problems, pregnant women, age >60, age <15.  (*HSC + our US friends*, the contras are usually: >6mls/24h, tetracycline antibiotics, severe renal insufficiency, with a warning regarding Preeclampsia and altered conscious states).

Dose: single 3 ml dose, after an ambulance has been called.  (Usually 6mls)

Realistically, with the modified Rx criteria, whats the difference, if a paramedic will be O/S in 5-30mins. On a similar note, aspirin is pretty safe and it's the only drug we give for ACS that has a definite proven effect on mortality as far as I'm aware. 

That said, I really don't think anyone who can't assess/manage perfusion and monitor rhythms should be giving GTN in pts who haven't already been prescribed it.


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## High Speed Chaser

Melclin said:


> That said, I really don't think anyone who can't assess/manage perfusion and monitor rhythms should be giving GTN in pts who haven't already been prescribed it.



That being said, I actually believe that GTN can only be administered to some one who has been prescribed it before or by a doctor. I also belive that 2 meds accredited people need to be present to administer either GTN or Penthrane. I will check into it on my next duty, which might be Brittany Spears or Kids Choice Awards. Yeh I know (Spears and some Nickelodeon award show, what I can I say, I love going on lots of duties


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## Melclin

High Speed Chaser said:


> That being said, I actually believe that GTN can only be administered to some one who has been prescribed it before or by a doctor.



Oh, I didn't realise. If that's the case, then that makes much more sense, and I stand corrected.



> I will check into it on my next duty, which might be Brittany Spears or Kids Choice Awards



Doing your first responder already? Nice. The way things are going, I'll be backing _you_ up on the defib team.


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## High Speed Chaser

Melclin said:


> Doing your first responder already? Nice. The way things are going, I'll be backing _you_ up on the defib team.



Have not completed First Responder yet, but by late Nov, it will be done, I'm so excited . I have done certificate in Adv resus including AED .  

Backing me up? We can be partners on a defib team (well after January at least)! unless you get assigned to HCP Paramedic team at an event.


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## Melclin

HA! I am so far away from getting my SJA HCP ticket its not funny....SO much paper work with the Johnos.


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## High Speed Chaser

Melclin said:


> HA! I am so far away from getting my SJA HCP ticket its not funny....SO much paper work with the Johnos.



It's called covering our behinds, lol. Wish it wasn't necessary either.
I figured that would let you tag along with a paramedic (or another HCP) attached to St John as they often let students of HCP tag along with the HCP counterparts. In fact I'm was paired with a nurse one duty.


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## MrBrown

At least most of the states in Australia have forbidden the Johnnos from anything other than event standby.  We still have them here for the majority of emerg work but ..... could be worse.


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## downunderwunda

MrBrown said:


> At least most of the states in Australia have forbidden the Johnnos from anything other than event standby.  We still have them here for the majority of emerg work but ..... could be worse.



What truth is spoken!!!!! I couldnt agree more!!!!!! Well said.


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## High Speed Chaser

downunderwunda said:


> What truth is spoken!!!!! I couldnt agree more!!!!!! Well said.



There is a difference. We are volunteers. Are they not full time paramedics in New Zealand? 

downunderwunda, you seem to be anti St John,  why is that?


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## MrBrown

High Speed Chaser said:


> There is a difference. We are volunteers. Are they not full time paramedics in New Zealand?



St John has at heart a flawed ethos of volunteerisim and a multifaceted approach to activities which detract from the professional development of Paramedicine in New Zealand.

Many people I know would gladly leave St John for an "ambulance only" orginisation, although St John brand ambulance services as it's "core" activity, it is treated like a second class citizen and another "product" to be sold in the interests of making money.

Paid ambulance officers (at all levels) here carry around 80% of the workload but are only 25-30% of frontline staff.  They are expected to work alone if a partner is not avaliable and although this is a complex issue it shows that the Johnnos are still promoting volunteers as a reasonable alterative to a full time, paid partner who will generally be at a higher skill level than a volunteer.

Although many people within St John have a very real zeal for what they do and are very good at it; the support systems and top heavy, fractionised and disconnected management structure means it's like following alice down the rabbit hole.


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## Melclin

I understand the problems you have in NZ. But it is a different world to the farmers markets and panadol stands of St Johns here. By all means St Johns should not have anything to do with with the professional emergency services. 

EG. A Johno volunteer keeps some idiot kid cool and breathing while an ambulance is called because hes taken some ecstasy on top of his zoloft at some back water rave at a suburban community centre.

A Johno volunteer whacks an AED on an old bloke at the Telstra dome when he collapses and shocks him into sinus rhythm, when the ambulance crew that got there 15 mins later would have found him in irretrievable asystole. 

A Johno volunteer makes everyone feel better at the local farmer's market simply by being there. He/she puts an ice pack on a sprained ankle and sees the pt to their mothers car, hands out 6 panadol and does their homework all in a short morning.

These are the roles that St John do well, and should continue to do well. Sure vollies have no place in the professional emergency services but that doesn't mean they don't provide a valuable service to the community none the less.


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## mycrofft

*And how ARE the Noongars doing with Perth?*

B).................
Are there indigenous peoples' ambulance companies?


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## downunderwunda

High Speed Chaser said:


> There is a difference. We are volunteers. Are they not full time paramedics in New Zealand?
> 
> downunderwunda, you seem to be anti St John,  why is that?



St Johns also run a paid service in Australia. They run this for profit. In order to ensure they get the contracts, they rely on collies to prop up thier paid service.

St Johns blur the line & try to pretend they are just a little volly squad who does some sports events. I have worked alongside them at a number of sporting events & I can tell you, they wont treat me. I want to live.

Why am I anti St John? Could it be because they try to believe that they are more than what they really are? Could it be because they accept people into their volly ranks that FAIL entrance into paid ambulance service & promote tha false belief that their membership will help with gaining entry in the future??????????????


Maybe I am just jaded, bitter & twisted from seeing too many :censored::censored::censored::censored: ups by them.


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## MrBrown

downunderwunda said:


> ...Maybe I am just jaded, bitter & twisted



... if so, then I am dark, twisted and scary :lol:

Speaking locally it is not so much the people on the ground who are directly the problem rather it is the higher levels of middle and senior management that cause problems.

St John here runs 13 different activities only *one* of which is providing an emergency ambulance service.  These other activities have no bearing whatsoever on the emergency ambulance service and may coincidently reduce a few requests for service.  Despite this the activities other than ambulance all swallow up money and resources that should be divested of them and streamed into ambulance.

There is a perverse incentive to over-promote it's other activities within the context of providing the emergency ambulance service which creates Crown funder and public confusion.  The public has no idea what is going on and neither do the managers, as far as I know none of the very senior managers have any formal management education and are people who have either been head-hunted from other companies or worked thier way up from the street.

Specifically:

• St John is a hugely diverse organization that does not solely provide an ambulance service
• Ambulance is open to perverse manipulation for use as a marketing tool to sell other products and services (be they charitable or commercial) 
• The organization appears overly focused on selling the “brand” of St John which is largely counterproductive to the development of the ambulance service
• The diverse national portfolio is counterproductive to professional Paramedic development
• There is a loose national structure with regional variance in service delivery
• Many of the clinical and management decisions are overly focused on budgetary constraints
• The national management structure is excessively bureaucratic
• There is a lack of Advanced Paramedics nationwide
• Non-road based managerial and “clinical support” roles deplete available resources (particularly Advanced Paramedics)
• In-house “authority to practice” governance limits higher-level clinical support due to difficulty separating employment function of the higher-level managers.
• Control of who is allowed to practice at what level is dominated by non clinical factors negatively impacting patient care 
• Medical audit processes are variable nationwide
• Funding streams are complicated by the part-charge system, which reduces Government willingness to fully-fund the service, and by St John’s lack of willingness to pursue part-charge debt for fear of public dissent and contractural ramifications.
• Lack of remuneration reflecting the increased responsibility educationally, clinically and risk involved with carrying narcotic drugs discourages some Paramedics from moving to Upskilled Paramedic, which deprives the community of higher-level clinical care.
• Educational packages are compromised to deliver achievable training for volunteers
• Volunteer training is variable nationwide despite a nationally structured pathway


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## mycrofft

*Speakng generically, and putting the Noongars aside for now...*

If the management isn't headhunted or worked their way up from the street, who else can do it? But seriously I am in a similar situation, the top people have no experienc and don't want line people input, so they hire the pine poeple who don't want to do it anymore and will say YES to anythings so long as they keep their extra dollar an hour and can skive off a coupke times a week.


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## High Speed Chaser

downunderwunda said:


> St Johns also run a paid service in Australia. They run this for profit. In order to ensure they get the contracts, they rely on collies to prop up thier paid service.


Ok but in states where they don't run an ambulance service, all money sold from first aid kits goes back into the organisation for equipment and logistical purposes. Believe that I think that there should be a government run service in WA and NT, and in fact in every city.



downunderwunda said:


> St Johns blur the line & try to pretend they are just a little volly squad who does some sports events. I have worked alongside them at a number of sporting events & I can tell you, they wont treat me. I want to live.



Please provide some examples, I'm really curious to know what they did wrong. Also I think you are generalising. Every group has good people and bad people. I'm pretty sure paid services have bad people in their ranks, if not many a few.



downunderwunda said:


> Maybe I am just jaded, bitter & twisted from seeing too many :censored::censored::censored::censored: ups by them.



Once again please provide some examples, I'm really curious to know what they did wrong. 


So you want paid ambulance staff at major and local events? Seems a bit stupid to me, Taking off a few ALS crews from general duties.

I want to be a paramedic and I hope that this will give me some knowledge and experience to better deal with that. After all, would you prefer someone to go to Uni with an already basic knowledge and experience who knows what they are getting into, rather than someone who knows nothing at all.


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## High Speed Chaser

MrBrown said:


> Speaking locally it is not so much the people on the ground who are directly the problem rather it is the higher levels of middle and senior management that cause problems.



That is why I believe that all (at least all major) emergency services should be run by the government. After all we don't need a robocop type police, fire brigade or Ambulance service around.

You are paramedic with them?


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## downunderwunda

High Speed Chaser said:


> Ok but in states where they don't run an ambulance service, all money sold from first aid kits goes back into the organisation for equipment and logistical purposes. Believe that I think that there should be a government run service in WA and NT, and in fact in every city.
> 
> 
> 
> Please provide some examples, I'm really curious to know what they did wrong. Also I think you are generalising. Every group has good people and bad people. I'm pretty sure paid services have bad people in their ranks, if not many a few.
> 
> 
> 
> Once again please provide some examples, I'm really curious to know what they did wrong.
> 
> 
> So you want paid ambulance staff at major and local events? Seems a bit stupid to me, Taking off a few ALS crews from general duties.
> 
> I want to be a paramedic and I hope that this will give me some knowledge and experience to better deal with that. After all, would you prefer someone to go to Uni with an already basic knowledge and experience who knows what they are getting into, rather than someone who knows nothing at all.



I will give a couple of examples & leave it there. Firstly, Hyperventilating patients have too much Oxygen in their system, when they get more, they can appear decorticate. Without taking a history from bystanders or even looking at the patient, they had 15l/min running & wondered why the pt was getting worse. Secondly, I have seen them trying to tell me to set up Salbutamol for a patient with myocardial Ischaemia.

When Ambulance Services do sporting events, they are done as a Special Event, & the client charged according to their requirements. The staff at these events are not taken from duty crews, but extra crews for that time period. The major problem has been that Johnnies have styled their uniform the same as other ambulance uniforms, & do not tell the client that they cannot provide advanced pain managment, or anything more than a band aid or ice pack. Is this really acceptable at say a motorcross event?


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## High Speed Chaser

downunderwunda said:


> I will give a couple of examples & leave it there. Firstly, Hyperventilating patients have too much Oxygen in their system, when they get more, they can appear decorticate.
> Without taking a history from bystanders or even looking at the patient, they had 15l/min running & wondered why the pt was getting worse.


I was taught not to administer oxygen to someone hyperventilating and certainly not to administer oxygen at 15l/min (I assume they where using a Hudson mask) unless using a BVM.



downunderwunda said:


> Secondly, I have seen them trying to tell me to set up Salbutamol for a patient with myocardial Ischaemia.


Where I'm from once a paramedic is on scene they run the show and we assist when they need it. 



downunderwunda said:


> When Ambulance Services do sporting events, they are done as a Special Event, & the client charged according to their requirements. The staff at these events are not taken from duty crews, but extra crews for that time period.


Who are over worked and underpaid?



downunderwunda said:


> The major problem has been that Johnnies have styled their uniform the same as other ambulance uniforms,


I'm curious to know which state you are in.



downunderwunda said:


> do not tell the client that they cannot provide advanced pain managment, or anything more than a band aid or ice pack. Is this really acceptable at say a motorcross event?


We also have paramedics, doctors and nurses that volunteer with us. We can administer Penthrane (if the medical course is done) and then an ambulance is called. We can do more then apply a band aid or ice packs. AEDs, Aspirin, Oxygen, use of equipment such as BVMs, Spinal-boards and C-collars.


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## downunderwunda

Chaser, you asked for examples. I gave them to you. These have happened on more than one occasion.

I know doctors that are involved with St Johns, but their involvment is minimal. Same with Paramedics who really dont like the ridicule from their colleagues. St Johns should not administer any medications. As a professional I have to have malpractice insurance, to cover me in the event I make a mistake, St Johns rely on the good samaratin act & hide behind their volly status, again pleading poor. 

Personally, I do not use hudson masks, dont even carry them on my car, it is an NRB, Neb or BVM. dont half do a job.

Yes, when a paramedic arrives on scene, they _should_ be the ones running the show, but again, this doesnt happen because too many jonnies want to show how important they are.



> Originally Posted by downunderwunda
> When Ambulance Services do sporting events, they are done as a Special Event, & the client charged according to their requirements. The staff at these events are not taken from duty crews, but extra crews for that time period.
> 
> Who are over worked and underpaid?



In some cases yes, but these events are offered & it is up to each individual to accept of decline the work. Remember we are responsible for ourselves to ensure we are ready for our next rostered shift. 

If you want to know where I am, ask in PM. I may just tell you.



> We also have paramedics, doctors and nurses that volunteer with us. We can administer Penthrane (if the medical course is done) and then an ambulance is called. We can do more then apply a band aid or ice packs. AEDs, Aspirin, Oxygen, use of equipment such as BVMs, Spinal-boards and C-collars.



Interestingly tho, you name paramedics first. I have a licence issued to me, through my employer, licencing me to carry S8 dugs, prescribe & administer them. That does not carry to St Johns. 

A Drs licence allows them to prescribe & administer, not necesarrily carry (unless they are on helo's) & the nurses can only administer. My question was, originally, how much is taught in the medical course? I know what I had to learn before I was allowed to administer without supervision & someone elses say so. This included A&P, pathophysiology, pharmacokinetics, pharmacodynamics etc. This is relevant when administering any drug. I am still waiting for an answer.


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## Smash

downunderwunda said:


> I will give a couple of examples & leave it there. Firstly, Hyperventilating patients have too much Oxygen in their system, when they get more, they can appear decorticate.



Are you serious?  

Here we are decrying how stupid and unprofessional some organisations are, before coming out with gems like this.  

The irony is so thick it hurts.

Glass houses, throwing stones, so on and so forth.


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## NWParamedic

*Anyone Heard of International SOS*

Wondering if anyone on this thread has hear of International SOS. It looks like they have paramedic opportunities in Sydney, Palmerston, PNG, and off shore. Would like to know what you all downunder can share about this company providing EMS jobs. Here is the link:

http://www.internationalsos.com/en/careers.htm

Thx


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