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Stew

Stew

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Hi guys,
My name is Stewart (Stew) from Brisbane in Queensland. I'm an Advanced Care Paramedic with the Queensland Ambulance Service (I believe sits between EMT-I and Paramedic).

I've noticed after only looking around for a short time that there is (at points) fairly significant confusion as to clinical scope of practice for differing levels in Australia so hopefully I'll be able to help out with that, at least from my state.

I not long got back from visiting a friend in Palo Alto and managed to see a lot of the SF Bay area and the drive down to Santa Monica. I have to say I loved the USA more than I though I would so at the minute I'm looking at education opportunities to get me to the EMT-P level on your side of the world.

Thanks guys,

Stew
 
G'day mate bloody Aussies have us Kiwi's outnumbered, man, I gotta be up in here representing 24/7.

Yeah we just confuse the hell outta them American's eh, between Technician, Paramedic, Intensive Care, Advance Care, that thing called a mandatory Bachelors Degree and those cooky meds we carry like GTN and adrenaline .... we're sure upside down eh?

I looked into working in the US, man, thats a whole can of worms right there.
 
The can has been opened but I've been talking with quite a few people who have been amazing help so far. Helps the friend I was visiting is a very EMS pro-active Dr, and one of the guys from my station has just done his NREMT-P certification.

I'll try to do up a little scope of practice for my level, might help a little.
 
It is now, good find Dr Brown. For reference P3s are Advanced Care and P4s are Intensive care. P4s (ICPs) can now administer Ketamine.
 
Stew said:
It is now, good find Dr Brown. For reference P3s are Advanced Care and P4s are Intensive care. P4s (ICPs) can now administer Ketamine.
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Mate I've have a few jobs go swimmingly with ketamine, great stuff.

DrBrown is that crazy old realitive of mine who built a time machine in his garage.

Is the entire state ACP/ICP mix now or do you still have some older levels out in the boondocks?

Unfortunately we are run by the Johnnos here predominantly so .... well, what can I say. Most people are at Paramedic level which is sort of equal to Advanced Care then we have Intensive Care as well which is ALS. The vollies are allowed to run around at Technician level which is basic things like LMA, GTN, nebules etc.
 
Hey Stew,
Welcome to the forums, I travel quite a lot to QLD, so I look forward to talking with you about QAS and their protocols as well as other ambulance services, I'm actually considering QLD as my second state to go to if my first one falls through.
 
A few questions, Stew, if you don't mind.

-Why does your authority to practice matrix list skills like crics and soft collar that no one can do. Might they also include field coronary artery bypass grafts as well?

- What is "Intermittent positive pressure breathing" ...assisted vents?

- You have 12 lead at the P3 level I see, is this universal? How universal is the P3 level (My understanding was that P1 and P2 were student levels). What I'm getting at is - do you have 12 lead on every ambulance?

-Do your P3s get permission to do chest decomps when there isn't IC back up?

-You guys are still using MASTs?
 
Melclin said:
-Why does your authority to practice matrix list skills like crics and soft collar that no one can do. Might they also include field coronary artery bypass grafts as well?
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Outdated perhaps? Are you looking at the skills matrix listed in the 'overseas recruitment' pamphlet? Let me know where you're looking and it might help.

Melclin said:
- What is "Intermittent positive pressure breathing" ...assisted vents?
Click to expand...
IPPB is assisted ventilations, not to be confused with IPPV which are manual ventilations.

Melclin said:
- You have 12 lead at the P3 level I see, is this universal? How universal is the P3 level (My understanding was that P1 and P2 were student levels). What I'm getting at is - do you have 12 lead on every ambulance?
Click to expand...
P3s are Advanced Care Paramedics, our now standard qualification level. All new internal and university graduates are trained to and employed at this level. P1 is our old Paramedic level (what we call 'Charlie') who are basic life support, P2 is advanced skills which is P1 but I believe with IV access (again an old qualification all but phased out).
We do have 12 lead ECGs on all ACP (P3) ambulances.

Melclin said:
-Do your P3s get permission to do chest decomps when there isn't IC back up?
Click to expand...
I have not heard of this occuring although I do work in Metropolitan Brisbane so we generally have access to ICPs at all times or one of two QAS doctors (our medical director and a pre-hospital registrar). I believe it would be on a case by case basis.

Melclin said:
-You guys are still using MASTs?
Click to expand...
No we are not. I haven't seen then used in my time at on road or at uni (since 2006). Again the material you are referring to I dare say is quite dated. Our Medical Director's office is currently reviewing all of our clinical practice guidelines, procedures and have recently completed a review of our drug therapy protocols.
 
Interesting; I'll chip in too mate if that'ls alrite.

- Are ACPs right across QLD or do you have some lesser level out in the sticks? (I fear that bad word 'volunteer' is coming....)
- Do ACPs just acquire a 12 lead or are you interpreting them as well?
- How common is it that you get one of these doctors out on a job, sounds really unusual

Oh, and just my two cents here but it'd be so much simple to just have "Paramedic" and "Intensive Care Paramedic" now that everybpdy is upskilled. It would seem every state uses "Paramedic" and "Intensive Care" nomanclature (even the bloody Johnnos!) except Tas who still has "Ambulance Officer".
 
Hi,

I just signed up to these forums yesterday. Im a first year student (Diploma) working in Brisbane also
 
MrBrown said:
Interesting; I'll chip in too mate if that'ls alrite.

- Are ACPs right across QLD or do you have some lesser level out in the sticks? (I fear that bad word 'volunteer' is coming....)
- Do ACPs just acquire a 12 lead or are you interpreting them as well?
- How common is it that you get one of these doctors out on a job, sounds really unusual

Oh, and just my two cents here but it'd be so much simple to just have "Paramedic" and "Intensive Care Paramedic" now that everybpdy is upskilled. It would seem every state uses "Paramedic" and "Intensive Care" nomanclature (even the bloody Johnnos!) except Tas who still has "Ambulance Officer".
Click to expand...

Hey,

1) As far as I have seen the bulk of Paramedics are ACP's. Qualified Paramedics (which have the silver rank) are stilla round though. Not sure about rural places as ive only worked in Brisbane.

2) I believe ACP's can elect to do a 12 Lead ECG package which includes interpretation. Not all ACP's have done this package.workshop but many just learn it themselves. All off our trucks carry the 12 lead adaptor so even if you have not done the formal training, you cans till do them if you want.

3) Our medical director (Dr Rashford) will often show up on big/critical jobs. Sometimes doctors from the rescue choppers also attend scenes if they are near by. I think we also have a rapid response unit sometimes, which is a doctor + others.

4) I think the final aim is to have just ACP and ICP (plus students), with the other ranks eventually being phased out.
 
A good friend of mine is one of the helicopter emergency service doctors in Townsville, wish the bugger would check his email more often!

You mentioned Diploma and Degree, whats the difference?

Whats the difference between a Paramedic and an ACP?

Are you guys required to ring up the medical director or seek approval for certian procedures or medications?

New Zealand is running a program to upskill all IV/Cardiac level Officers in 12 lead interpretation, adrenaline, morphine, naloxone, zofran IV and one or two other drugs I hope (eg midaz IM/IN). No new IV/Cardiac authorisations are being given unless you've done the drugs module too which I think is fantastic!
 
MrBrown said:
Oh, and just my two cents here but it'd be so much simple to just have "Paramedic" and "Intensive Care Paramedic" now that everybpdy is upskilled. It would seem every state uses "Paramedic" and "Intensive Care" nomanclature (even the bloody Johnnos!) except Tas who still has "Ambulance Officer".
Click to expand...

Even when that happens as here, I think you still need lesser levels in some regard. You know, CERTs and so on for first response. Also we have a few "BLS" guys kicking around that either refused to upskill about 10 years ago when it all happened, or who have had their ALS authorisation taken off them because they're idiots. Scary. ^_^


Stew said:
Outdated perhaps? Are you looking at the skills matrix listed in the 'overseas recruitment' pamphlet? Let me know where you're looking and it might help.


IPPB is assisted ventilations, not to be confused with IPPV which are manual ventilations.


P3s are Advanced Care Paramedics, our now standard qualification level. All new internal and university graduates are trained to and employed at this level. P1 is our old Paramedic level (what we call 'Charlie') who are basic life support, P2 is advanced skills which is P1 but I believe with IV access (again an old qualification all but phased out).
We do have 12 lead ECGs on all ACP (P3) ambulances.


I have not heard of this occuring although I do work in Metropolitan Brisbane so we generally have access to ICPs at all times or one of two QAS doctors (our medical director and a pre-hospital registrar). I believe it would be on a case by case basis.


No we are not. I haven't seen then used in my time at on road or at uni (since 2006). Again the material you are referring to I dare say is quite dated. Our Medical Director's office is currently reviewing all of our clinical practice guidelines, procedures and have recently completed a review of our drug therapy protocols.
Click to expand...

Yeah must be. I was just looking at the link that brown post.

G'day nigs!

I think its a good idea to have doctors invovled in critical frontline care - to actually be doctor/paramedics. I would think they would be better clinical educators that upskilled experienced medics, who are our clinical educators. I would like to align our field with medicine a bit more in general to be honest. (which certainly has nothing to do with my wanting to be a doctor :P ).
 
Further to what puppy has mentioned;
The aim thus far has been to up skill all our old basic care paramedics to advanced care level, however some people don't want to up skill and gradually they are being taken off road into other areas such a patient transport services (IFTs and discharge home basically). These basic care paramedics are still working as first response in some regional areas.

All ACP's graduating are now graduating with 12 lead ECG acquisition and interpretation skills. For those already qualified it's an in service education package which all things going well should become mandatory. Completing skills you're not authorised to practice in is a fine line.

The two primary doctors we have (excluding the flight Dr) are generally available whenever needed. They are automatically attached to certain jobs by our clinical dispatch supervisor (CDS) and can self attached if they've heard a job they want to go look at. I've had experience with both of these Doctors and have to say I'm impressed. They don't barge into a job and take over patient care unless they really really have too, more than willing to do their little skill and stand back. Great learning tool having them available.

Puppy, where in Bris do you work?

Mr Brown, our scope of practice at my level is entirely independent authorisation, with the exception of fluids to a peadiatric patient in some instances. If we want to go outside our scope of practice we have to ring and consult either with one of these doctors or ideally an Emergency Department consultant at the hospital we are transporting too.

We call our internal students (those trained by our service) Diploma students and those trained by the Universities Degree students. After they graduate both are at the same clinical level (ACP) but obviously one has a Bachelors Degree and the other a Diploma (Associates Degree in the USA I believe).

Long post in the post night shift slumber blur!
 
Melclin said:
Even when that happens as here, I think you still need lesser levels in some regard. You know, CERTs and so on for first response. Also we have a few "BLS" guys kicking around that either refused to upskill about 10 years ago when it all happened, or who have had their ALS authorisation taken off them because they're idiots. Scary. ^_^
Click to expand...

True, but you know like how Vic has ALS and MICA Paramedic whereas Qld has Advanced and Intensive Care ... its odd.

I know back in the day you required some point of differentation between the non upskilled and the upskilled guys (we have Paramedic and Upskilled Paramedic) but with the move to phase out the non-upskilled guys it would make sense to have only Paramedic and Intensive Care.

Our guys who do not upskill by 2012 will be dropped back to Technician and because there will be no-non upskilled "Paramedics" the term "Upskill Paramedic" is being removed and it's just "Paramedic".

But whats in a name anyway? :D
 
Stew said:
The two primary doctors we have (excluding the flight Dr) are generally available whenever needed. They are automatically attached to certain jobs by our clinical dispatch supervisor (CDS) and can self attached if they've heard a job they want to go look at
Click to expand...

Do you know what the jobs are that the CDS sends them to?

We have a system called PRIME which sends appropriately skilled primary-care GPs and RNs in the very rural areas to jobs in place of, or as a first responder adjunct to, Intensive Care Paramedics.

Other than that the days of the ambulance doctor or GPs going to ambulance calls is pretty much dead here (as it should be now that we have ICPs).

I have done a bit of lookey-looing and it seems that Dr Rashford is a pretty onto it medical director, good stuff!

http://www.jems.com/news_and_articles/articles/jems/3403/the_aussie_anesthetic.html

http://viewnews.com.au/bm/life-and-...world-to-trial-new-portable-ultra.print.shtml

Stew said:
We call our internal students (those trained by our service) Diploma students and those trained by the Universities Degree students. After they graduate both are at the same clinical level (ACP) but obviously one has a Bachelors Degree and the other a Diploma (Associates Degree in the USA I believe).

Long post in the post night shift slumber blur!
Click to expand...

No worries mate I fell asleep on the way to a job on Saturday night!

Is there a move to transition to only Degree students or not?

We will (eventually) only hire Degree qualified Officers into paid roles, yes, that nasty volunteer word is sitll around unfortunately.
 
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