Emergency medical services in New Zealand
Both have a history of long service to their communities, St John since 1885 and Free beginning in 1927, traditionally having a volunteer base, however the vast majority of response work is undertaken by paid career Paramedics.
[9] [10] Air ambulance and helicopter rescue services are vital given the low population density of New Zealand and the significant distances between tertiary hospitals.
[13] The rest of North Island is covered by Central Air Ambulance Rescue Limited (CAARL), which is owned by five regional charitable Trusts.
The standard FENZ response to a medical emergency is one fire appliance equipped with an automated external defibrillator and oxygen therapy kit.
The New Zealand Defence Force has personnel and equipment available at short notice to assist in civilian matters including medical emergencies.
[20] The clinical education of Ambulance staff in New Zealand historically draws parallels to the Anglo-American development of the Paramedic profession generally but has undergone radical transformation in the past decade closely mirroring developments pursued by nations such as Australia, South Africa, Canada and the United Kingdom Prior to 1977 the "training" of Ambulance Officers was arranged in an ad-hoc fashion to a varying degree of first aid preparation to enable passage of a national examination administered on behalf of the Department of Health by an Examination Board of the Order of St John; a requirement established by the Ambulance Transport Advisory Board in 1963.
[24] Into the 1970s there was considerable development of local training amongst ambulance services over-and-above the basic DOH/ATAB requirement; this training particularly focussed on defibrillation to treat cardiac arrest and was most notable in Christchurch, Wellington and Auckland; with Auckland introducing the first Mobile Intensive Care (Life Support Unit) on the North Shore in 1970 however other subjects covered included the administration of entonox (nitrous oxide) for pain relief and the taking of a patient's blood pressure.
[21][25] The introduction of out-of-hospital defibrillation by civilian Paramedics to New Zealand (1970) is again among the earliest examples in the world; predated only by the original 1966 Pantridge Experiment in Belfast (Northern Ireland) [26] and its earliest direct replication projects by the Miami Fire Department ("Rescue 1" in March 1967 under Dr. Eugene Nagel) [27] and New York City with the Mobile Coronary Care Unit established by Dr. William Grace of St. Vincents Hospital) also introduced in 1967.
Walton and Offenberger compiled a review of the NAOTS (and Ambulance Officer training generally) for the Department of Health in 1984 which led to the following reforms: The review also consideration the necessity of using qualified Ambulance Officers when undertaking non-emergency transfer duties; this can be seen today as the Patient Transport Service whereby transfers of nonemergency patients between hospitals, clinics and home are provided by staff who have only minimal clinical training (First Responder) as this is the need dictated by their duties.
Following closure of the National Training School and disbanding of the New Zealand Ambulance Board which had previously published the National Authorised Patient Care Procedures each service took on responsibility for its own clinical education and standing orders (patient care procedures) which would further aggravate regional differences and ultimately, help lead a return to nationalised clinical education.
In 1999 a programme of "Intermediate Care Upskilling" was introduced by St John (initially in the Auckland District [3]) to equip selected ICOs with adrenaline, morphine, naloxone and (at the time) metoclopramide.
[35] St John also merged the two Post-Proficiency modules back into one education programme at some point during this time so that an officer became qualified in both portions of Intermediate Aid concurrently.
[3] Wellington Free Ambulance chose to adhere to the original Post-Proficiency module design thus retaining two distinct practice levels (cardiac and IV/cardiac).
[38] Wellington Free introduced an "Intern Paramedic" position in 2004 to accommodate staff who would completing the Degree while also working on the road at the same time.
[45] While the format of the qualification has changed significantly in the move to predominantly online learning that the actual content of has not been reduced; if anything it has increased considering the National Certificate had twenty-eight credits at level 5 [32] whereas the Diploma has one hundred and eleven.
During (and after) the online and class phases of National Diploma the student must complete a Portfolio of Evidence for presentation at the End of Course Interview and Assessment.
The Portfolio requires the student to demonstrate integrated clinical practice as well as self-reflection/professional development through skill logs, mentor reports and exemplars.
[45] The Degree was scheduled for introduction by the beginning of 2012 [47] however it is understood that there have been delays in assembling a realistic framework to transition totally away from an in-service education model.
The degree is a comprehensive education programme over three years consisting of 3,600 hours of learning which enables students to build a solid foundation of knowledge, skill, rationale and clinical judgement to the ILS level as a mixture of classroom, simulation suite and practical (on-road) experience catering for both school leavers who wish to pursue a Paramedic career (in the same way at other health professional degrees) and also for working Ambulance Officers who wish to upgrade their knowledge and obtain a tertiary qualification.
[34] There were previously suggestions by St John that the organisation may follow Western Australia, the Northern Territory and the Ambulance Service of New South Wales by offering employment at a defined exit point of the Degree allowing the student to essentially become a BLS Emergency Medical Technician full-time and complete the rest of the degree over a number of years and qualify as an ILS Paramedic.
The specific scopes of practice are set every two years as part of the Clinical Practice Guidelines developed by the Clinical Working Group (part of Ambulance New Zealand) which consists of the medical directors, medical advisors and paramedic representatives from both St John and Wellington Free Ambulance as well as the New Zealand Defence Force.
Knowledge and skill to provide invasive care that significantly builds upon BLS capacity in terms of clinical judgement and capability including a wide range of pharmacology.
Provides advanced management where knowledge, rationale, judgement, skill and leadership are well developed and utilises the most comprehensive regime of pharmacology, airway support and ECG interpretation.
Current scope of practice: All of the above plus laryngoscopy, endotracheal intubation, capnography, cricothyrotomy, chest decompression, IO access, IO lignocaine, adrenaline, atropine, amiodarone, adenosine, calcium chloride, sodium bicarbonate, midazolam, ketamine, pacing, rocuronium, rapid sequence induction (select personnel only) Additionally, there is a "First Responder" level used for non Ambulance work (such as Events and non emergency transfers (PTS)) as well as community first response in rural areas, as an initial starting point for those on the clinical education pathway (i.e. completing the Diploma or above) or where the standard education pathway has been found unsuitable for a volunteer.
They also process an additional 800,000 calls per year from GPs, hospitals requesting transfers, medical alarm monitoring companies, and from paramedics themselves.
