EMS Providers from AUS/NZ/Canada

ah2388

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I am writing a paper on the difference between EMS education systems in the US vs. the countries listed in the title. I am seeking insight from the people who practice in these countries. I've pm'd Brown...but anyone else interested in helping me out please respond here or pm me.

Thanks,
Adam
 

MrBrown

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Adam

I will reply here for the benefit of others who might want to read it too.

Education of Ambulance Officers in New Zealand is radically different than in the US. We focus on outcomes and programs of education to achieve them are measured in years, not hours.

Like Australia, our education model has undergone fundamental and widespread transformation in the last decade progressing from a trade/vocational style in-employment, closed off segregate to a thorough and robust University model aligned with other health professions.

Historically Ambulance education was open only to Officers who were employed by the Ambulance Service. There was no provision for those not employed to gain any Ambulance qualification as it was an exclusive in-house, on the job training package. From 1975-1995 a body called NAOTS (National Ambulance Officer Training School) provided consistent national education in packages known as Proficency (basic), Post Proficency (intermediate) and Advanced Ambulance Aid (Paramedic). When you commenced emplyment you became a "Proficent" Officer in six weeks full time and then worked your way up in various stages to the year long Advanced Ambulance Aid (Paramedic) course which often took five to ten years to gain a spot on. In 1995 the courses changed again. Proficency Ambulance Aid became known as the National Certificate in Ambulance Patient Care & Transport and increased from six weeks to six months in length as it doubled in the amount of education required. Post-Proficency and Paramedic became the National Diploma in Ambulance (Paramedic) and was now a two year program.

As you can see we have always had a robust and thorough education system however a less than optimal proliferation of education over the past ten years has caused us to move to a new system after a massive five year long review process nationwide.

It is important to note that around 60% of our Ambulance crews are volunteer Officers but despite this only perform about 20% of the national workload. By far the majority of care is that provided by career Officers.

New Zealand now has three practice levels which loosely align to the international nomanclature of basic, intermediary and advance life support although there is some crossover by American standards.

Below I will explain our levels and the education required in order to seek Authority to Practice at that level.

Ambulance Technician
This is our Basic Life Support level and requires you complete the National Diploma in Ambulance Practice.

It is largely a volunteer-only level (as this is really what is is designed for) although there are also some paid staff at this level. Paid Technicians are largely pre-intern Degree graduates awaiting movement up to Paramedic, Volunteer Officers who have been recruited and are awaiting a spot on the Degree, overseas converts, a few ex Ambulance Officers who have slipped into Patient Transfer Service until retirement and those Officers who chose not to upskill (more on that later).

The National Diploma is our new Technician level qualification and requires students to complete sixteen weeks of self-paced online and DVD learning (around 75 hours), fourteen days (110 hours) in-class and accrew a Portfolio of Evidence (around eight-ten weeks of clinical exposure).

Generally it covers an introduction to both anatomy and physiology and pharmacology, core skills (vital signs and patient packaging), both a trauma and medical module and a research report (critique and explain a journal article relating to EMS) as well as the Portfolio of Evidence requirement.

During the online and classroom portions of the Diploma the student is under Clinical Mentoring and assigned as a third crewmember on an Ambulance. They are expected to accrew a skills log (see scope of practice), case reports, Clinical Mentor reports and complete a number of exercises in which they have to answer scenarios about law, ethics, patient care and critical thinking required to be a functioning Ambulance Officer.

The specific learning outcomes are included in the links below but there is a strong focus on the "practical" side of Ambulance in this qualification. Although I may disagree with it in principle, if you ask a Diploma only Technician about renin and angiotensinogen they are going to have no idea what you are on about, they are not slipping in drips and infusing fluid so don't learn about fluid homeostasis. They can however tell you in quite some detail about cardiac chest pain and gaining an adequate airway for thier patient.

You can refer to the full list of Standardshttp://www.nzqa.govt.nz/nqfdocs/quals/pdf/1408.pdf for the Diploma and searchhttp://www.nzqa.govt.nz/qualifications-standards/standards/ the NZQA website by Standard number to get the specific learning objectives.

Ambulance Technician Scope of Practice
- OPA and NPA
- Laryngeal Mask Airway
- Automated defibrillation
- 3 lead ECG monitoring, and interpretation of NSR, VT, VF, PEA and asystole
- Oyxgen
- Asprin
- GTN spray (nitro)
- Salbutamol nebules
- Oral glucose
- IM Glucagon
- Paracetamol
- Methoxyflurane
- Entonox
- Ondansetron PO

Paramedic
This level is our Intermediate Life Support provider and requires the completion of the Bachelor of Health Science Degree in Paramedicine.

The Degree can either be completed in three years full-time including 2,400 hours of theory and high fidelity simulation along with 1,200 hours of clinical mentoring or two years part-time with 1,000 hours of clinical mentoring for those who already have Authority to Practice as an Ambulance Technician. Part-time pathway students must undertake a 6 week bridge to University level bioscience and pharmacology and attend between six to nine block courses per year with the remainder of the academic requirements being completed online and by distance education.

Completing the Degree requires passing 24 modules (we call them "papers" whereas you would call them "classes") and is a fully specalised Degree without any general education requirements - as most New Zealand degrees are.

The Degree is avaliable to students who are not employed as Ambulance Officers (career changers, school leavers etc) and educationally is more comprehensive than the Diploma as it is not aimed at volunteer level Officers but those who can commit to full time rigours of University level academic study.

A strong focus on this program is on making the Paramedic into broadly but soundly educated practitioner of prehospital medicine; there is a strong focus upon non Ambulance specific areas of education such as health ethics and law, health systems delivery, scientific research, disaster planning and a third year paper where the students must present a special topic (research report).

A large component of the Degree is the high fidelity simulation lab and clinical mentoring in the field where the student Paramedic learns the psychomotor skills required of him or her.

Degree graduates who are employed as Paramedics undertake a period of on-road consolidation and rigorous assessment before being Authorised to Practice as a Paramedic.

The components of the Degree are as follows

YEAR ONE
555101 Psychology and Lifespan Development
555201 Human Anatomy and Physiology I
555301 Knowledge, Enquiry and Communication
555401 Health and Environment
556107 Introduction to Paramedic Practice
556202 Human Anatomy and Physiology II
576211 Risk Management

YEAR TWO
556301 Intermediate Research
527188 Pharmacology for Professional Practice
557224 Professional Practice and Ethics
576101 Intravenous Therapy
576103 Paramedic Science
576109 Clinical Practice I
576110 Clinical Practice II
577101 Cardiology

YEAR THREE
557221 Health Law & Policy
577212 Disaster Theory
577109 Clinical Reasoning
577110 Advanced Life Support
577111 Paramedic Theory and Management
577112 Integrated Clinical Practice
577213 Emergency Planning

Source

Paramedic Scope of Practice
Ambulance Technician plus
- IV cannulation
- IV fluid administration
- Manual defibrillation
- Synchronised cardioversion
- 12 lead ECG interpretation
- Glucose 10% IV
- Adrenaline IM, IV, neb
- Naloxone IN, IM, IV
- Ondansetron IV
- Morphine IV, IM

Intensive Care Paramedic
This is our Advanced Life Support Level.

Currently ALS ICPs must have the Bachelor of Health Science (Paramedic) Degree and undertake a one year period of on-road Clinical Mentoring once they have been a Paramedic for at least six months in order to be eligible for assessment for ICP Authority to Practice.

A new Post-Graduate Certificate is currently being designed for introduction in 2012 to give Intensive Care Paramedics a distinct Post-Graduate qualification ontop of the Bachelors Degree.

Intensive Care Paramedic Scope of Practice
Paramedic plus
- Endotracheal intubation
- Cricothyrotomy
- Intraosseous
- Atropine IV
- Amiodarone IV
- Frusemide IV
- Ketamine IV, IM, PO
- Midazolam IV, IM, IN
- Fentanyl IV
- Suxamethonium IV
- Vecuronium IV

Rapid Sequence Intubation is currently being rolled out nationwide after a successful two year pilot program in which we achieved a 97% success rate.

Thrombolysis (Heparin IV and Streptase IV) is also currently being rolled out nationwide after a successful pilot program.

Each year all Officers are required to undertake forty hours of continuing education.

I do hope this helps, if you have any questions just ask.
 
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Melclin

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I'd be perfectly happy to help you as best I can. What are you after? I'm still just a student but ask away and I'll see what I can do.

Our system is different to the US in many of the same ways as Brown mentions.

We have an extremely different approach: in education, in drugs, clinical assessment, roles and responsibilities, scope of practice, funding etc.

What do you want to know exactly? In what sense are you comparing?
 

firetender

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Adam

I will reply here for the benefit of others who might want to read it too...
I do hope this helps, if you have any questions just ask.

That was awesome, MrBrown, Thank You!
 

TransportJockey

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Hey Brown, by overseas converts what exactly are you talking about? :)
 

MrBrown

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Hey Brown, by overseas converts what exactly are you talking about? :)

Exactly that; people who are converting thier overseas qualification to New Zealand.

If you jump in quick enough you might get onto the old vocational track before that dies completely otherwise you would have go to through and do the Degree, mind you that would be part of work so you would get paid but still it would be probably at least two and more like three years part time.
 

TransportJockey

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Exactly that; people who are converting thier overseas qualification to New Zealand.

If you jump in quick enough you might get onto the old vocational track before that dies completely otherwise you would have go to through and do the Degree, mind you that would be part of work so you would get paid but still it would be probably at least two and more like three years part time.

If I could come up with the money and a certain someone could come along I'd jump at that in a heartbeat
 
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