Here's the breakdown of skills performed by each qualification level, as I mentioned previously:
- Primary Care (PC1+2)
- Advisory defib
- oxygen
- entonox
- Ambulance Officer (AO) (as above plus:)
- Nasopharyngeal airways
- Aspirin
- nebulised salbutamol
- GTN
- IM Glucagon
- Paramedic (P) (as above plus:)
- manual defib
- iv cannulation and fluid administration
- iv glucose
- laryngeal mask airways
- Upskilled paramedics (as above plus:)
- morphine
- metoclopramide
- naloxone
- nebulised adrenaline for croup
- IM adrenaline for anaphylaxis or asthma
- IV adrenaline for cardiac arrest
- Advanced Paramedics (AP's) (as above plus:)
- laryngoscopy
- endotracheal intubation
- cricothyroidotomy
- chest decompression
- intraosseus needle access
- adrenaline
- atropine
- frusemide
- amiodarone
- midazolam
- Some AP's are also trained in rapid sequence induction (RSI)
I'll be working with a variety of qualification levels - including trucks with one AO and one PC, one AO and a P, trucks with AP's and the Rapid Response Unit Jeeps (RRU's - 'oscar' or 'tango' units) which are 4x4's staffed with a single AP. They provide two main roles - backing up other crews to provide skills that they cannot (iv pain relief, intubation etc) and rapid response - stabilising the patient with life threatening injuries and illnesses until a truck crew can respond.
All emergency calls ('111 calls' over here instead of 999) for the Northern region of the north island get sent to the control centre at Mt Wellington ambulance station, where call takers try to find out information about location and what type of injury / illness. This is done using a computer system called TriTech which utilises ProQA as an emergency dispatch guidance system. The call takers get presented a sequence of questions to ask, based on the response to the previous questions to ensure they get the appropriate information and can give advice to the caller about any emergency aid that they can give whilst waiting for the ambulance. The call gets logged, and passed to the dispatcher, who allocated the job to an appropriate ambulance, and allocates its priority. This means that any immediately life threatening condition gets the fastest response with lights and sirens. The job information is then sent to the crew over the radio in code format, and to the pagers that they carry - with address details, and any text information about the patient condition.
There seems to be a lot of auditing performed, so everything is coded, distance travelled and times recorded and outcomes investigated. Each patient report form gets audited and suggestions for future practice made if necessary. Each call gets a case code - like a read-code used in medical summarising.
All these new codes provide for a steep learning curve when you are a new person to the system! I'm constantly having to ask or look up all the codes to figure out what people are talking about!
All the different conditions have a code number, such as:
1 - Abdominal Pain/Problems
3 - Animal Bites/Attacks
6 - Breathing Problems
7 - Burns (Scalds)/Explosion
10- Chest pain
17 - Falls
19 - Heart Problems/AICD
21 - Hemorrhage/Lacerations
22 - Inaccessible Incident/Other Entrapments (non-vehicle)
23 - overdose / poisoning
24 - Pregnancy/Childbirth/Miscarriage
25 - Psychiatric/Suicide Attempt/Altered Behavior
28 - Stroke (CVA)
29 - Traffic/Transportation Accidents
32 - Unknown Problems (Man Down) - also comes through as 'Sick Person' - very descriptive!!!
There's also a whole load of 'R-codes' - which are used to request further assistance / notify important information. Some examples would be an R26 - requesting polive presence, R50 - advance life support back-up, R35 - transport not required / refused and an R40 - requesting to be patched through to the ED to notify them of any status 1 or 2 patients to find out if they want them in resus or monitoring (majors).
The patients are allocated a status code on arrival on scene, and again on arrival at the ED. These codes are as follows:
- Status one patients have an immediate threat to life. Examples would include any of the following - obstructed airway or airway needing intervention to prevent obstruction, severe stridor, severe respiratory distress, shock unresponsive to fluid loading, multisystem trauma with very abnormal vital signs, post cardiac arrest with coma, cardiogenic shock, coma with GCS less than or equal to nine.
- Status two patients have a potential threat to life. Examples would include any of the following - moderate stridor, moderate respiratory distress, shock responsive to fluid loading, anyone meeting our pre-hospital definition of major trauma but with normal or near normal vital signs, post cardiac arrest but awake, cardiac chest pain unrelieved by nitrates and oxygen alone, abnormal GCS but greater than nine.
- Status three patients have a condition that is unlikely to be a threat to life. Examples would include any of the following - mild stridor, mild respiratory distress, isolated SVT with no other symptoms, cardiac chest pain relieved by nitrates and oxygen alone, isolated femur fracture.
- Status four patients have a minor condition that is no threat to life.
Well, I think that briefly explains all the things i'm learning about the logistics of the ambulance service. No doubt i'll be needing to update it in the future!
