Another U.S. Paramedic with Australia questions

[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.

[High Speed Chaser]

Originally Posted by downunderwunda

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.

Originally Posted by downunderwunda

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 :(

Originally Posted by Melclin

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!!!

[Melclin]

Originally Posted by High Speed Chaser

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 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

[downunderwunda]

Originally Posted by High Speed Chaser

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.

[Melclin]

Originally Posted by downunderwunda

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.

[downunderwunda]

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

[High Speed Chaser]

Originally Posted by downunderwunda

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.

[downunderwunda]

Originally Posted by High Speed Chaser

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?

[Scout]

How long are the courses for the st john lads?

[downunderwunda]

Maybe chaser can enlighten us.