PHECC grounding Voluntary Ambulances.

Medic475

Anyone know what the jazz is with this? As and from 9 this morning all Voluntary Ambulances have been grounded unless the Ambulance has a Tail lift and has a Paramedic on board!! There's a list of minor injuries to casualties where you can transport with an EMT on board but for anything else you have to ring Ambulance Control and its up to them to decide whether you should transport or wait for a HSE Ambo to come out to you. I'd be interested to know the following...
1. Is there a procedure for Controllers to follow in relation to this?
2. If at an event, the Doctor there says "I'll go with you to the hospital", are we then covered or would we still have to wait for a HSE Ambulance to come out?

ambo112

I cant find anything on the phecc site, where did you get the info?

TylerIE

There is a thread already here which might answer some of your question!

d3exile

silly decision i think, you can half understand where they're coming from but as you say they're grounding ambulances that in fairness are still competent to deal with most situations, if ambulances without tail lifts have been good enough for the last few decades i dont know why suddenly they arent capable of carrying people any more? and as for the skill level, no reason why EMT cant cope with a lot of general cases, paramedic training is costly and time consuming and for the amount of calls where an EMT would suffice it doesnt make sense for vollys to be forced into the extra training...i think it all comes down to having a level head, yeah "best practice" dictates having the required standard but to be fair if there's a man having a collapse in front of a volly ambo with 2 emts and no tail lift they arent gonna call and wait for the hse to send the nearest ambulance which can be 30mins or more away, they're gonna load and go...

Hightower21

What about us who still have to use patient transport wagons which are not even close to being cen complient or without tail lifts etc

BoonDoc

To be fair, there really isn't a lot of things that a paramedic can do above the EMT level.

In comparison to internationally certified paramedics, the Irish paramedics are at the EMT level anyway.

ambo112

BoonDoc wrote: »

To be fair, there really isn't a lot of things that a paramedic can do above the EMT level.

In comparison to internationally certified paramedics, the Irish paramedics are at the EMT level anyway.

I assume you are EMT? I find it hard not to be defensive but will try.

The Paramedic is far superior than the EMT training. 5 weeks vs 2 years.

There are a range of things Paramedic can do more, such as spinal rule out, tourniquet, administer meds such as Midaz, manual defib, I gel, ibuprofen, nalaxone, NPA, peak flow, 12 lead, active cooling, resus decision, Chest auscultation.

While we are a long way off international standard of Paramedic the EMT grade is capped at the current skill level, the paramedic is evolving and up skilling every year and will continue to do so.

It is my understanding that the fourth edition is in draft at the minute.

I dont think this should be an opportunity to argue that the EMT is as good as the Paramedic grade as that is simply wrong, anyone claiming otherwise is grossly miss informed or ignorant of the standards of each grade.

While I appreciate that this practice was ongoing for years and that the vols have come a long way in training and that the EMT is a very high standard.

Remember, we uses to burn witches once, while it may have been done one way in the past, this direction from PHECC will see the vols catch up with best practice of their equivalent organisations in other countries and improve patient care - which is what this is about, it's not about who is better it is about getting more care to the patient, and yes paramedics can provide more care than EMT's, that's not a dig, it is simply fact.

civdef

I don't think the issue really is Paramedic vs EMT, no-one really can argue that the paramedic had more skills and experience (though I should point out that EMT is covered for iGel and active cooling from your list too).

The issue is that EMTs have a capability and authorisation to transport under CPGs, but the NAS are putting out a blanket instruction that if a vol EMT at an event rings control for P/AP as per the CPGs they then have to wait for the NAS to arrive to treat and transport, regardless of the time involved- which is not in accordance with CPGs, nor is it in line with best practice.
P or AP rendezvous would be a much more appropriate policy.

From CPG:

Arrange transport to an appropriate medical facility as necessary and in an
appropriate time frame:
• On-scene times for life-threatening conditions, other than cardiac arrest,
should not exceed 10 minutes.
• Following initial stabilisation other treatments should be commenced/
continued en-route

ambo112

civdef wrote: »

I don't think the issue really is Paramedic vs EMT, no-one really can argue that the paramedic had more skills and experience (though I should point out that EMT is covered for iGel and active cooling from your list too).

The issue is that EMTs have a capability and authorisation to transport under CPGs, but the NAS are putting out a blanket instruction that if a vol EMT at an event rings control for P/AP as per the CPGs they then have to wait for the NAS to arrive to treat and transport, regardless of the time involved- which is not in accordance with CPGs, nor is it in line with best practice.
P or AP rendezvous would be a much more appropriate policy.

From CPG:

Great news about the i-gel and active cooling, didn't realise.

I think the majority of control rooms will allow them to transfer, or meet an AP/P enroute to the hospital. I think they are probably trying to encourage the vols to get a paramedic or AP on their duties.

I like the idea of meeting the vols enroute to a+e it will encourage more inter-agency contact. Again, overall this will improve the care being brought to the patient.

civdef

ambo112 wrote: »

I think the majority of control rooms will allow them to transfer, or meet an AP/P enroute to the hospital.

..............

I like the idea of meeting the vols enroute to a+e it will encourage more inter-agency contact. Again, overall this will improve the care being brought to the patient.

Only problem being that yesterdays letter from the NAS medical director to control centres now prohibits this.

If you're an vol EMT dealing with a serious casualty and you're told the statutory ambulance is 10+ (maybe a lot more) minutes away you're facing a dilemma as of yesterday due to this. Follow CPG or ambulance control?

Medic475

ambo112 wrote: »

I think they are probably trying to encourage the vols to get a paramedic or AP on their duties.

That's going to be hard, I'm sure there's plenty of Paramedics out there who don't have time for Vol's because they're working! When I was working in the UK I said I'd join a Voluntary Service but was just wrecked after work and that was enough for me!

ectoraige

civdef wrote: »

Only problem being that yesterdays letter from the NAS medical director to control centres now prohibits this.

If you're an vol EMT dealing with a serious casualty and you're told the statutory ambulance is 10+ (maybe a lot more) minutes away you're facing a dilemma as of yesterday due to this. Follow CPG or ambulance control?

Surely following CPG has to be the winner here. If the organisations own CPGs which are PHECC approved allow transport without cen A/B ambos and Paramedics then NOT following the CPGs would make the vol liable.

Has this direction come from NAS or from PHECC?
Do the vols have different transport guidelines within the CPGs than the HSE, or have they been ignoring them up to now?

ambo112

ectoraige wrote: »

Surely following CPG has to be the winner here. If the organisations own CPGs which are PHECC approved allow transport without cen A/B ambos and Paramedics then NOT following the CPGs would make the vol liable.

Has this direction come from NAS or from PHECC?
Do the vols have different transport guidelines within the CPGs than the HSE, or have they been ignoring them up to now?

So basically, vols cannot transfer anything outside of this minor list without contacting NAS control - this is from PHECC and you can't go against that as it supersedes anything issued before it.

NAS control have been ordered not to allow vols to transfer by the medical director.

So it's either have a paramedic or not, there won't be an issue about liability etc as this is a direction from PHECC, you are obliged to follow PHECC direction.

P.S. Organisations don't have their own CPG's which are PHECC approved. PHECC dictate and design CPG's to each grade and approve an organisation to use them.

ambo112

http://www.phecit.ie/Documents/Home%20Page/Event%20Ambulance%20Cover%20-%20Clarification%20Statement%2022.06.12.pdf


Panic over, PHECC have not issued any order to ground any vehicles.

It appears that Mr. Cathal O’Donnell issued a document saying that the vols will not be allowed to transfer patient by NAS control rooms. PHECC have not made any change.

You can transfer as always, all this means is that if you contact NAS they won't allow you to transfer the patient. So don't contact them!!!

Is their still any organisations out their who contact NAS control before transferring a patient?

coolmoose

Mis-information as per usual, PHECC have clarified

http://www.phecit.ie/Documents/Home%20Page/Event%20Ambulance%20Cover%20-%20Clarification%20Statement%2022.06.12.pdf

coolmoose

ambo112 wrote: »

You can transfer as always, all this means is that if you contact NAS they won't allow you to transfer the patient. So don't contact them!!!

Not exactly in the patient's interest to not contact NAS Control in the case of trauma by-pass, P/AP backup required, local protocols surrounding pts requiring airway management etc.

Voluntary EMTs have little to no experience with patients and especially seriously injured/ill patients compared to full-time HSE/DFB Ps/APs.

Contacting HSE NAS Control and waiting for HSE/DFB bus may be the most appropriate route of care for certain patients.

Elessar

Well that clarifies it then.

I know that personally, myself and others I work with in the vol I'm in don't call NAS control unless it's stated in the CPGs or we make a clinical decision that we need assistance or we cannot offer what a patient might need etc.

Though I do know a few higher-ups in my voluntary org that would love to see ambulances taken off the road altogether and just have us giving tea and sympathy (and the odd plaster).

As always, follow your CPGs.

ambo112

coolmoose wrote: »

Not exactly in the patient's interest to not contact NAS Control in the case of trauma by-pass, P/AP backup required, local protocols surrounding pts requiring airway management etc.

Voluntary EMTs have little to no experience with patients and especially seriously injured/ill patients compared to full-time HSE/DFB Ps/APs.

Contacting HSE NAS Control and waiting for HSE/DFB bus may be the most appropriate route of care for certain patients.

I had assumed that common sense would be implied. Surely, you don't expect EMT's to transport a patient that doesn't require and intervention from a P/AP?

EMT in itself is a high standard with a large scope of practice, there would be very very few occassions where a P/AP intervention would be required. There is no need to call a P/AP if the injury is covered in the EMT scope of practice.

Example - Serious bleeding, if it can be controlled by direct pressure and vitals are ok, then there is no need to call P/AP. However, if it is not controlled by direct pressure and they need pressure points, tourniquet, fluid etc then they would call P/AP as they cannot do this in their scope of practice.

coolmoose

ambo112 wrote: »

I had assumed that common sense would be implied.

This.

There are voluntary EMTs out there that would not apply common sense.

I have seen vol EMTs perform GCS assessment (not in scope, and carried out incorrectly).

I have seen vol EMT students performing 12 Lead ECGs (not in scope, may result in adverse treatment decision), and when challenged on it, tried to defend by saying it was authorised under supervision - it is not.

I have seen vol ambulances belt it through city with blue lights & siren with a simple fractured ulna on board.

Assuming common sense would be applied is a dangerous assumption. Obviously this is not a blanket statement regarding all EMTs. I am involved in the vols so its not a blanket statement regarding all vol EMTs either. I am also involved in teaching vol EMTs.

However, we are all aware that there are vol EMTs out there who rather than risk not getting to transport the patient, would avoid contacting NAS control.

Also - re scope of practice, I would argue that the scope of practice is too wide for a population of practitioner who will rarely get to perform a lot of the skills/interventions. This is something a lot of friends of mine who are vol EMTs would agree with.

ambo112

coolmoose wrote: »

This.

There are voluntary EMTs out there that would not apply common sense.

I have seen vol EMTs perform GCS assessment (not in scope, and carried out incorrectly).

I have seen vol EMT students performing 12 Lead ECGs (not in scope, may result in adverse treatment decision), and when challenged on it, tried to defend by saying it was authorised under supervision - it is not.

I have seen vol ambulances belt it through city with blue lights & siren with a simple fractured ulna on board.

Assuming common sense would be applied is a dangerous assumption. Obviously this is not a blanket statement regarding all EMTs. I am involved in the vols so its not a blanket statement regarding all vol EMTs either. I am also involved in teaching vol EMTs.

However, we are all aware that there are vol EMTs out there who rather than risk not getting to transport the patient, would avoid contacting NAS control.

I agree, but this can be said about all grades, EMT/P/AP both voluntary and statutory.

It's like anything, we have to allow them to do this and see how it goes, you cannot micro manage this. I am also involved in training EMT/P and below. I feel that the vols should be more invloved with the NAS/DFB and that more inter agency training, third person etc should be done.

Looking to the future of a more local responder approach, the vols will become the key stone to this approach. People like you and I and all others who are statutory and vol trainers are responsible for encouraging best practice, supporting them and guiding them. If they are unsure of what they can and can't do, its down to training.

I note you referred to the incident with the 12 lead and said when "challenged", why not teach, guide or explain - works a lot better

civdef

Not contacting control is a dangerous route to go down I would suggest in all but very minor cases.

Hopefully this sutuation is clarified somewhat, but there are still grey areas to be sorted ASAP.

Coolmoose, in relation to EMT scope, a lot of what you are describing could be ascribed to individual suitability and competence rather than the standard itself. Which items do you feel should be removed from the EMT scope?

ambo112

civdef wrote: »

Hopefully this sutuation is clarified somewhat, but there are still grey areas to be sorted ASAP.

That's a great point, maybe this will highlight the grey areas to PHECC and we might get more definitive answers to this.

coolmoose

ambo112 wrote: »

I agree, but this can be said about all grades, EMT/P/AP both voluntary and statutory.

It's like anything, we have to allow them to do this and see how it goes, you cannot micro manage this. I am also involved in training EMT/P and below. I feel that the vols should be more invloved with the NAS/DFB and that more inter agency training, third person etc should be done.

Looking to the future of a more local responder approach, the vols will become the key stone to this approach. People like you and I and all others who are statutory and vol trainers are responsible for encouraging best practice, supporting them and guiding them. If they are unsure of what they can and can't do, its down to training.

I note you referred to the incident with the 12 lead and said when "challenged", why not teach, guide or explain - works a lot better

Yes challenged, please don't patronise me with regards to teaching/guiding/mentoring etc. I'm fully aware how to deal with scenarios like the one I mentioned, and the student EMT was coached regarding their actions, CPGs, scope of practice etc.

The practitioner is also responsible for understanding their scope of practice, and their own limitations - which is something that cannot be taught. With the reward of PHECC registration comes great responsibility as we all know - and I agree that this is applicable to all practitioners, vol and statutory. However, this discussion is regarding vol EMTs in particular.

ambo112

coolmoose wrote: »

With the reward of PHECC registration comes great responsibility

Thanks for the spiderman quote

I certainly wasn't patronising you, i was bringing some levity to the discussion.

coolmoose wrote: »

understanding their scope of practice, and their own limitations - which is something that cannot be taught

I thing understanding their scope of practice would be one of the main things to be taught!!!

That aside, i wouldn't get so annoyed over the experience you have had with a small few, since you coached them afterwards, i assume you are also responsible for their training?

We need to remember, they don't do this everyday and it is voluntary, but they should still receive a lot of respect for the grade they have been qualified at and have passed all required exams to achieve it, it is not an easy grade to achieve and i feel we would be taking from it. How many years were the public treated by EMT's prior to PHECC which was a much lower standard than the PHECC one, we have come a long way with more to go, remember, it's not done yet.

coolmoose

civdef wrote: »

Coolmoose, in relation to EMT scope, a lot of what you are describing could be ascribed to individual suitability and competence rather than the standard itself. Which items do you feel should be removed from the EMT scope?

I am all for the EMT grade, don't get me wrong. I deliver training at this level for vols. However, I have seen how some of the vol EMT courses are run, and I would disagree with both the course design, and the scope allowed for EMTs in certain situations. It's not so much the individual skills themselves, but the lack of opportunity to implement and practice said skills and interventions.

I'm not having a go at the individual practitioners, but I feel that giving a skill set to someone, who will rarely get to implement it, is unhelpful to both the practitioner individually, and the grade at which they operate. I have witnessed it myself on numerous occasions, from people who I would consider to be competent EMTs - simple lack of experience is quite apparent.

This is all IMO, I'm perfectly open to be proven entirely wrong on this btw.

ambo112

coolmoose wrote: »

I am all for the EMT grade, don't get me wrong. I deliver training at this level for vols. However, I have seen how some of the vol EMT courses are run, and I would disagree with both the course design, and the scope allowed for EMTs in certain situations. It's not so much the individual skills themselves, but the lack of opportunity to implement and practice said skills and interventions.

I'm not having a go at the individual practitioners, but I feel that giving a skill set to someone, who will rarely get to implement it, is unhelpful to both the practitioner individually, and the grade at which they operate. I have witnessed it myself on numerous occasions, from people who I would consider to be competent EMTs - simple lack of experience is quite apparent.

This is all IMO, I'm perfectly open to be proven entirely wrong on this btw.

I have to agree with you there, strongly. I would suggest that there should be more use of third person for the vols, they should feel welcome and free to cover a shift with a paramedic crew who can guide them and allow them to use their skills more frequently.

coolmoose

ambo112 wrote: »

Thanks for the spiderman quote

I certainly wasn't patronising you, i was bringing some levity to the discussion.

I wasn't deliberately aiming for a spiderman quote there...but I guess it works.

ambo112 wrote: »

I thing understanding their scope of practice would be one of the main things to be taught!!!

Not really possible to teach understanding though is it - I've seen EMTs fly through the course, ace the PHECC exams, and then once qualified, come out with some crazy notions of their scope/skillset etc.

ambo112 wrote: »

That aside, i wouldn't get so annoyed over the experience you have had with a small few, since you coached them afterwards, i assume you are also responsible for their training?

Actually no, these individuals would not have been taught by me directly, or indeed be known to me. They would have been interactions I had whilst working, i.e. meeting EMTs at scenes, in the ED etc. I'm not so much annoyed, but I feel that patient care needs to be utmost in everybodys' minds - not their skillset/grade etc. I'd love to say this is true, but alas, it's not. And yes, this isn't just confined to the vols, I agree.

ambo112 wrote: »

We need to remember, they don't do this everyday and it is voluntary, but they should still receive a lot of respect for the grade they have been qualified at and have passed all required exams to achieve it, it is not an easy grade to achieve and i feel we would be taking from it. How many years were the public treated by EMT's prior to PHECC which was a much lower standard than the PHECC one, we have come a long way with more to go, remember, it's not done yet.

I agree. All in favour of it. I just feel that lack of experience in implementing a skillset you're authorised to perform at can be a dangerous thing. And the mechanisms for ensuring competency at skills/interventions are not in place in this country. I travel abroad to keep my skills up in certain areas that I don;t get enough exposure to, how many others do this?

ectoraige

I must say this clarification hasn't clarified much for me.

PHECC wrote:

The imperative is determining acuity of condition and matching this with clinical capability of Ambulance
provision

Are they basically saying that while they believe the best response to serious/life threatening conditions is a CEN B ambo with Ps onboard, that if you don't have those capabilities you still make do with what you do have.

PHECC wrote:

It is not part of PHECC’s criteria, when deciding whether or not to recognise providers which undertake to implement PHECC’s CPG’s, that the provider’s vehicles be CEN compliant.

And here, in theory you don't need an ambulance to gain PHECC approval, a few lads with a hi-ace could do the job, it's just not best practice.

So the issue here is really nothing to do with PHECC, it's the NAS deciding that if they have an ambulance available with Ps which is better than what the vols have, then considering their duty of care to the patient, their best response it to send their own ambulance out.

It seems to me that the vols can still inform NAS, but when the NAS state that they'll send out an ambo the vols can decline it and get underway themselves, with both orgs still following their CPGs.

Obviously this wouldn't a very good example of inter-agency cooperation though, but on paper, is there anything requiring the vols to follow NAS direction?

NeitherJohn

Would the unions have something to say about vol EMTs tagging along as a third for a shift?

I'd imagine there'd be insurance issues as well.

I ask as a volunteer EMT as well by the way.

ambo112

ectoraige wrote: »

Obviously this wouldn't a very good example of inter-agency cooperation though, but on paper, is there anything requiring the vols to follow NAS direction?

I don't think so, and i don't think there should be. PHECC is the independent body for this and I don't think one organisation should be placed above the other.

If they are PHECC recognised then well done they have acheived what all the other organisations have. All these standards can be increased later as they alluded to, they may bring CEN compliance in at a later stage.

coolmoose

NeitherJohn wrote: »

Would the unions have something to say about vol EMTs tagging along as a third for a shift?

I'd imagine there'd be insurance issues as well.

I ask as a volunteer EMT as well by the way.

Unions, and individual crews and practitioners would. This is mainly due to prior experiences I would guess.

I personally would have no issue with a vol EMT tagging along with me for a shift or 2, and I would use the time to refresh their knowledge, and allow them to practice their skillset with supervision and coaching.

On the flip-side, I have had student EMTs out with me before who were no more interested in being there, declined all opportunities to intervene under supervision, and generally just got in the way. Other's have been the most arrogant, know-it-all types, who in their first shift on a frontline ambulance, attempt to teach the crew...amazingly, this happened on more than a number of occasions, and has happened other crews I know of. Maybe I'm just meeting the bad ones?!

ambo112

NeitherJohn wrote: »

Would the unions have something to say about vol EMTs tagging along as a third for a shift?

I'd imagine there'd be insurance issues as well.

I ask as a volunteer EMT as well by the way.

I couldn't see an argument for the unions, i am sure it is a PHECC requirement for practitioners to support other practitioners? If not it should be!!!!

There is also a NAS policy for third person and observational placements for the vols, just doesn't seem to be used yet.

Insurance can be waived or put under the individuals organisation's insurance.

civdef

Maybe I'm just meeting the bad ones?!

Sounds like you're meeting a fair chunk of them anyway. I don't think anyone is arguing that there aren't bad EMTs out there though, there are bound to be wrong 'uns at every level.

ambo112

http://www.hse.ie/eng/services/Find_a_Service/ambulanceservice/rptspoliciesandprocedures/placementsandobservers.pdf

Here's the policy.

ambo112

coolmoose wrote: »

Maybe I'm just meeting the bad ones?!

You are having some bad luck alright hahahahahaha

Surprised you haven't killed one yet

Red Dwarf

coolmoose wrote: »

This.

I have seen vol EMTs perform GCS assessment (not in scope)
I have seen vol EMT students performing 12 Lead ECGs (not in scope)
I have seen vol ambulances belt it through city with blue lights & siren with a simple fractured ulna on board.QUOTE]

This is why there is a register, Code of Conduct & Fitness to Practice procedures. Regarding the fractured ulna incident, contact the volunary org in question and tell them of your concerns.

Most EMTs in Vols realise where they sit on the PHECC educational ladder and are aware of their CPGs and governance. You will always get a few who get "blue light syndrome" & love "flashy badges", but in reality organisations do not want these people as members, because they bring the wrong kind of attention the organisation.

The issue of caring for patients needs to be involve all levels from CFR responder to AP. Remember HIQA 8mins KPI, recognises CFR. If EMTs do come in contact with a patient outside of their scope of practice, the logical & safe treatment as per CPGs is to look for P/AP assistance, if the patient in then in the care of the HSE then NAS transport. If an EMT comes in contact with a patient within their scope of practice, then let them transport.

At the end of the day, it should be about effective, efficient and safe patient care within an integrated system.

civdef

I'm hoping CPC will go some way towards weeding out people who aren't committed to continually improving skills and professionalism. It's going to take a good amount of effort to stay on the register (a lot more then just sending off €30 to PHECC) when it takes effect (July for EMTs apparently?).

coolmoose

I have a student on with me very soon who is interested, willing and capable. So that's what keeps me going.

NeitherJohn

coolmoose wrote: »

Unions, and individual crews and practitioners would. This is mainly due to prior experiences I would guess.

I personally would have no issue with a vol EMT tagging along with me for a shift or 2, and I would use the time to refresh their knowledge, and allow them to practice their skillset with supervision and coaching.

On the flip-side, I have had student EMTs out with me before who were no more interested in being there, declined all opportunities to intervene under supervision, and generally just got in the way. Other's have been the most arrogant, know-it-all types, who in their first shift on a frontline ambulance, attempt to teach the crew...amazingly, this happened on more than a number of occasions, and has happened other crews I know of. Maybe I'm just meeting the bad ones?!

I'd jump at the chance to tag along for a shift or two. There are members of the NAS in my org as well who want to take people out on a shift.

I just don't want to cause friction between them and their co-workers who wouldn't exactly be in favour of the vols. It's a sad state of affairs and it should be addressed.

I'd say you're just unlucky meeting the bad EMT's. The majority of them are sound I'd wager!

coolmoose

Red Dwarf wrote: »

This is why there is a register, Code of Conduct & Fitness to Practice procedures. Regarding the fractured ulna incident, contact the volunary org in question and tell them of your concerns.

All of these incidents were dealt with at the time, I was just using them as examples.

ambo112

ambo112 wrote: »

http://www.hse.ie/eng/services/Find_a_Service/ambulanceservice/rptspoliciesandprocedures/placementsandobservers.pdf

Here's the policy.

Apparently anyone can make the request to do third person?

Elessar

civdef wrote: »

I'm hoping CPC will go some way towards weeding out people who aren't committed to continually improving skills and professionalism. It's going to take a good amount of effort to stay on the register (a lot more then just sending off €30 to PHECC) when it takes effect (July for EMTs apparently?).

Bad for someone like me who is committed and loves being an EMT, but who works shift with very little time off so doesn't get to do it as often as he would like :mad:

coolmoose

NeitherJohn wrote: »

I'd jump at the chance to tag along for a shift or two. There are members of the NAS in my org as well who want to take people out on a shift.

I just don't want to cause friction between them and their co-workers who wouldn't exactly be in favour of the vols. It's a sad state of affairs and it should be addressed.

I agree completely. The vast majority of the lads I work with would have no problem, and those who do, it is due to bad experiences - unfortunately that's a reality, and it can only be addressed by further positive experiences. A rock/hard place scenario.

crackcrack30

I agree, Lack of continious exposure to the full range of real life medical or traumatic conditions and the decision making involved can be hard to achieve for a lot of people.
Under pressure, simple decision making in its self is frought with conquences that may not be immediatly evident to a under exposed or worse still an 'over' confident trainee/practitioner.

We must also remember that transport is still a large 'important' part of what we do and can bring its own proplems with dynamic/ evolving medical/ traumatic conditions, IMO its rarely a non-event taxi ride, its a chance to re-evaluate, reassess, upgrade, reroute to other A&E, retreat, ashice ect..........& on your own usually.
Gaining regular experience and confidence in the varied senarios and envoirnments using the Cpgs that all grades of EMT/P/AP medics are fully trained to do in a classroom/controled enviornment is the bane of the profession and that gos for all grades in my book .

vidar

coolmoose wrote: »

This.

Also - re scope of practice, I would argue that the scope of practice is too wide for a population of practitioner who will rarely get to perform a lot of the skills/interventions. This is something a lot of friends of mine who are vol EMTs would agree with.

I wouldnt say the scope of practice is too wide as it stands, but I do agree that Vol EMTs have little chance to put some skills into real life practice. In the 2 years iv been one, iv done ECG twice and there are still many on the meds iv never given.

While we do monthly continueous training within the org, this can only do so much. I do think the 3rd rider would help this and also bring the vols into a better light for NAS.

I would however like to see guidelines in place and the unions and NAS lads on the ground consulted first. The reserve was forced on us without any of this and that was a big reason it put so many backs up at the start. It was only the efforts of the reserves themselves that soften members view towards the whole idea.

I think myself when the CPC EMT comes into force (should have well by now IMO) there will be a big drop off the register, as alot of people that did it were convinced they would get a job out of it and due to the glut of EMTs they did not and so did not keep up any training.

I got a mail today saying i must have CFR-A and upskilling in pelvic splint done (with a recognized TI) by December to be able to renew registration

ambo112

vidar wrote: »

I wouldnt say the scope of practice is too wide as it stands, but I do agree that Vol EMTs have little chance to put some skills into real life practice. In the 2 years iv been one, iv done ECG twice and there are still many on the meds iv never given.

While we do monthly continueous training within the org, this can only do so much. I do think the 3rd rider would help this and also bring the vols into a better light for NAS.

I would however like to see guidelines in place and the unions and NAS lads on the ground consulted first. The reserve was forced on us without any of this and that was a big reason it put so many backs up at the start. It was only the efforts of the reserves themselves that soften members view towards the whole idea.

I think myself when the CPC EMT comes into force (should have well by now IMO) there will be a big drop off the register, as alot of people that did it were convinced they would get a job out of it and due to the glut of EMTs they did not and so did not keep up any training.

I got a mail today saying i must have CFR-A and upskilling in pelvic splint done (with a recognized TI) by December to be able to renew registration

There are guidelines for third person, I put the policy up a few posts ago, have a browse, see what you think.

BoonDoc

NeitherJohn wrote: »

Would the unions have something to say about vol EMTs tagging along as a third for a shift?

I'd imagine there'd be insurance issues as well.

I ask as a volunteer EMT as well by the way.

I think this is a great answer to the problem of vol EMT/EFRs not getting experience. Riding as a third man would give the crews an additional lift as well as give the EMT/EFR clinical experience.

This will not happen of course but it should.

ambo112

Has anyone viewed the policy i attached? The process is there, has anyone tried to request third person as per the policy?

Topper7

ambo112 wrote: »

Has anyone viewed the policy i attached? The process is there, has anyone tried to request third person as per the policy?

I recently (last 2 month) enquired about EMTs doing placement on HSE ambulances for a few people I know. HSE crew members I asked didnt have a problem as long as it was cleared by others up the line. But it was refused by the higher brass?

ambo112

Topper7 wrote: »

I recently (last 2 month) enquired about EMTs doing placement on HSE ambulances for a few people I know. HSE crew members I asked didnt have a problem as long as it was cleared by others up the line. But it was refused by the higher brass?

That is disappointing :mad: why the policy then i wonder?