scope of practice project

[MrBrown]

Hey all

I have the opportunity to put in my two cents into a project here looking at a nationwide scope of practice for Ambulance Officers.

Now, I'm going to give more than two cents and make a rather volomous submission based on the best evidence I can find. This has the real chance to do a lot of good for ambulance practice here in New Zealand.

Please restrict suggestions to those you can back up with evidence; I'll be going up against a bunch of medical directors who have more letters after thier name than you need to spell mine ... some have rather dry pockets.

Below is sort of my "utopian" proposal.

Ambulance Technician
Oxygen
OPA
NPA
Supraglottic Airway
AED
Acquire 12 lead ECG (new skill at this level)
Aspirin
Clopidogrel PO (not currently nationwide)
Glucagon IM
Glucose PO
GTN SL
Epi Pen (new skill at this level)
Methoxyflurane
Ondansetron PO
Paracetamol PO
Salbutamol neb

Paramedic
Macgill forceps (new skill at this level)
Manual defibrillation
Interpret 12 lead ECG (not currently nationwide)
Synchronized cardioversion (not currently nationwide)
IV cannulation
IV fluid
Adrenaline IM, neb (anaphylaxis, asthma) IV (cardiac arrest)
Ceftriaxone IM (not currently nationwide)
Dextrose 10% IV
Fentanyl IM, IN, IV (to replace morphine)
Hydrocortisone IV (asthma, anaphylaxis) (new drug at this level)
Naloxone IM, IV, IN
Midazolam IM, IN (seizures) (new drug at this level)

Intensive Care Paramedic
Intubation
Cricothyrotomy
Chest decompression
Transcutaneous pacing
IO access
CPAP (not currently nationwide)
Amiodarone IV
Atropine IV
Dopamine (maybe)
Frusemide (maybe)
Heparin IV (not currently nationwide)
Ketamine IM, IV, PO (not currently nationwide)
Magnesium sulfate IV (not currently nationwide)
Oxycotin (maybe) (new drug)
Streptase IV (not currently nationwide)
Suxamethonium IV (not currently nationwide)
Vecuronium IV (not currently nationwide)

 

[Outbac1]

Interesting! Your proposols are somewhat close to what we have here. Mostly a few drug differences at the different levels. I suggest you poke around our provincial EHS site. There are lists of meds, protocols, policies and the evidence behind them all posted online. For reference our levels are
Primary Care Paramedic (PCP)
Intermediate Care Paramedic (ICP)*
Advanced Care Paramedic (ACP)
Critical Care Paramedic (CCP)
* The ICP level is a dead level here. There have been no new ICPs since
2002. It was a temporary level to get some ALS skills spread around the province. In the past several years many of the ICPs and PCPs have upgraded to ACP. I believe there are now less than 100 ICPs still working. However their scope of practice is quite reasonable and covers about 90 - 95% of all calls. They just didn't have the education of a PCP or ACP behind them at the time of creation of the level. I think with an enhanced PCP education the ICP scope would make a good base line for paramedic services.
Here is the link to our provincial EHS site. and the Paramedic Association of Canada which lists our national standard for our various levels. Each province can add to this as they wish. eg: eye drops to PCP for Nova Scotia.

http://www.gov.ns.ca/health/ehs/documents.asp

http://emergency.medicine.dal.ca/ehsprotocols/protocols/toc.cfm

http://www.paramedic.ca/Content.aspx?ContentID=4&ContentTypeID=2

 

[bstone]

I'd only suggest adding IV with Saline or D5W to the Ambulance Tech position. However, I'd also suggest changing that title to something more medical related.

 

[MrBrown]

I'd only suggest adding IV with Saline or D5W to the Ambulance Tech position. However, I'd also suggest changing that title to something more medical related.

Unfortunately, neither of which will happen.