Another U.S. Paramedic with Australia questions

[MrBrown]

Originally Posted by High Speed Chaser

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.

[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.

[mycrofft]

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

[downunderwunda]

Originally Posted by High Speed Chaser

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 ups by them.

[MrBrown]

Originally Posted by downunderwunda

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

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

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

[mycrofft]

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.

[High Speed Chaser]

Originally Posted by downunderwunda

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.

Originally Posted by downunderwunda

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.

Originally Posted by downunderwunda

Maybe I am just jaded, bitter & twisted from seeing too many 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.

[High Speed Chaser]

Originally Posted by MrBrown

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?

[downunderwunda]

Originally Posted by High Speed Chaser

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?

[High Speed Chaser]

Originally Posted by downunderwunda

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.

Originally Posted by downunderwunda

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.

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?

Originally Posted by downunderwunda

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.

Originally Posted by downunderwunda

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.