Response - Paramedics Australasia · PA Conference 2013 Should we review Methoxyflurane use?...

PA Conference 2013

Should we review Methoxyflurane use?

Paramedic Pharmacology

UK Paramedic Registration Process

A Journal of Paramedics Australasia (formerly ACAP) Volume 40 No. 4 (Since 1974)

Response

Sum

mer

201

3/14

The Desktop ................................................................................... 2

Board Matters

Proposed South Australian Paramedic Title Protection Legislation ......... 3

PA Annual Report ......................................................................... 5

Points of View

Is lack of Registration affecting your future? ......................................... 15

Student Paramedics Australasia

Letter from the Convenor ..................................................................... 17

What’s happening in land of SPA…? .................................................... 18

Club Red Challenge ............................................................................. 21

Society Spotlight ................................................................................. 22

Special Feature

2013 SPA International Conference ..................................................... 23

2013 PA International Conference ........................................................ 26

Frontline

The time has come to consider an alternative to

Methoxyfurane use by Ambulance Service Paramedics........................ 29

Education & Training

Unifying emergency pharmacology:

Creating medication guidelines for paramedic students ........................ 36

International Perspective

Tanzania .............................................................................................. 40

Paramedicine Quiz ..................................................................... 43

Employer News and Views

Exploring the Frontiers – Paramedicine of the Future ............................ 44

Chapter News .............................................................................. 46

Events Calendar .......................................................................... 48

PA Membership Application ................................................... 49

Contents

For this edition, the winner is Steven Wright for his review of guidelines for using methoxyflurane in the ambulance setting.

Congratulations!

Editor’s Choice $150 prize

ResponseVol 40 No. 4 – Summer 2013/14 1

RESPONSE JOURNALEditor, Response Ms Amy Cotton [email protected]

NATIONAL EXECUTIVE

DIRECTORS

CHAPTERS

PresidentMr Ian Patrick FPA

[email protected] Mob: 0419 338 965

Vice PresidentMr Richard Larsen FPA

[email protected]: 0437 320 635

TreasurerMr Mick Davis FPA

PO Box 1425BRISBANE QLD 4001

[email protected]: 07 3247 8027Fax: 07 3109 5046Mob: 0411 554 955

SecretaryMr Les Hotchin FPA

PO Box 345WBALLARAT VIC 3350

[email protected]: 03 5331 9584Fax: 03 5333 2721Mob: 0417 336 490

Membership RegistrarMr John Hall FPA National Executive

PO Box 554, Gymea NSW [email protected]

Mob: 0499 775 353

Richard Brightwell [email protected]

Peter Hartley [email protected]

Neil Noble [email protected]

Tony Hochberg Community [email protected]

Mick Lazell [email protected]

John Richardson [email protected]

Nicole Nott Community [email protected]

Gary Strong [email protected]

QUEENSLAND

Chairman:Mr Colin Allen MPA

[email protected]

Secretary:Mr Ron Gibson MPA

[email protected] Box 1383 Gladstone QLD 4680

AUSTRALIAN CAPITAL TERRITORYActing Chair/Secretary:Joshua Mundy MPA

[email protected]

TASMANIAChairman:

Mr Stephen Trewin [email protected]

Secretary:Simone Haigh MPA

[email protected] Station Street Sheffield TAS 7306

WESTERN AUSTRALIA Chairman:

Mr Andy Symons [email protected]

Secretary:Mr Wade Bloffwitch

[email protected] 57 Division Street Welshpool WA 6106

NEW SOUTH WALES

Chairman:Mr Joe Acker MPA

[email protected]

Secretary:Mr Lyle Brewster

[email protected]

NORTHERN TERRITORY

Chairman:

TBC

Secretary:

Amanda McNeill [email protected] Box 42750, Casuarina NT 0811

SOUTH AUSTRALIA

Chairman:

Mr Glen Cuttance [email protected]

Secretary:

Ms Kim Nguyen [email protected] PO Box 647, Modbury SA 5092

VICTORIA

Chairman:

Mr Paul Jennings [email protected]

Secretary:

Mr Peter Hartley [email protected]

PO Box 469, Buninyong VIC 3357

NEW ZEALAND

Chairman:

Mrs Sharon Duthie [email protected]

Secretary:

Mrs Sarah Werner [email protected]

12 D’Oyly Drive, Stanmore Bay Auckland 0932 NZ

Views and opinions expressed in this journal are not necessarily those of the Paramedics Australasia, the editor, the publisher or printer. It is not for Paramedics Australasia or the publisher to ensure that advertisements published in the journal comply with all aspects of The Trade Practices Act 1974.

Published by Emergency Media Pty LtdLevel 1, 560 Lonsdale Street, Melbourne Vic 3000Direct all advertising enquiries to 1300 855 444.

Print Post approved: 336663/60646. ISSN 1836-2907.

with President Ian PatrickThe Desktop

Conference

The Paramedics Australasia (PA) International conference in Canberra this year was a great success thanks to the hard work of the conference and scientific committees, the presenters and our sponsors.

What makes our conference memorable is the opportunity it provides for paramedics to present their own research and share their knowledge and information with broad range of their peers.

Congratulations to the winners of the research forum. The best paper (David Komesaroff) award was won by Tony Walker. Tony generously donated his prize to Judy Willie the first indigenous paramedic in Vanuatu.

Other winners were Paul Davis for the best higher degree paper, Lynsey Smit for best undergraduate paper and Paul Davey for the best poster.

Executive Officer

As our organisation continues to grow we have reached an important milestone of development for our future. We are currently engaged in the recruitment of an Executive Officer to help us deliver improved member services and enhanced organisational performance. This move will provide additional professional level resources to assist the dedicated band of volunteers who have tirelessly worked to advance the role of PA and the paramedic profession.

The selection process is well underway with interviews beginning in November and we expect to make an appointment by the end of the year. We hold high hopes about this position. Keen interest has been shown by applicants resulting in a strong group of candidates to choose from.

Annual General Meeting

Thanks to all the members who attended the Annual General Meeting on the 17th October 2013 at Rydges Lakeside Hotel in Canberra. Members are showing a great deal of interest in the progress of their society and it was refreshing to see so many faces present with the best attendance we have had in recent years.

Director Elections

The election of Board Directors saw the re-election of Directors Tony Hochberg, and Richard Larsen and the election of a new Director Neil Noble. Congratulations are extended to them and a thank you to the strong group of unsuccessful nominees for election. I’d also like to pay a tribute to Helen Eyles for her contribution to the Board of PA during her two-year term.

I will be taking leave of absence for 3 months to deal with some health issues, during this time Richard Larsen will be acting president and Richard Brightwell will be acting Vice President.

Response Vol 40 No. 4 – Summer 2013/142

Happy Holidays…Season’s Greetings and Best Wishes for a Happy New Year

to all our members and their families

Board Matters


Proposed South Australian Paramedic Title Protection Legislation

The South Australian Health Minister Jack Snelling has introduced legislation into Parliament to amend the Health Practitioner Regulation National Law (South Australia) 2010. In the words of the Minister the intent is to:

“ ... protect the public by ensuring that any person employed as a paramedic in South Australia holds appropriate qualifications and training.”

The Minister’s media release can be read here: http://bit.ly/165k482

One of the principal features of the Amendment Bill is the use of the title “paramedic”.

Paramedics Australasia is pleased to see the acknowledgement of the professional role of today’s paramedics and the risks involved in health care performed by paramedics. It agrees that the protection of title is a vital step in protecting the public from the possibility of being treated by untrained or under-trained persons.

Paramedics Australasia has long advocated for national registration of Australian and New Zealand paramedics to protect the public. An Australian government inquiry under the auspices of the Australian Health Ministers Advisory Council is currently underway to consider the regulation of paramedics. A similar process of review is underway in New Zealand.

Within Australia, there is overwhelming support from public and private practitioners and other stakeholders including the public, unions and student paramedics for the national registration of paramedics under the Health Practitioner Regulation National Law and the Australian Health Practitioner Regulation Agency (AHPRA) framework.

Paramedics Australasia recognises the SA move as an overall positive transitionary measure and has provided in-principle support for the proposed legislation. At the same time Paramedics Australasia believes that the long term need is for a national scheme to regulate the paramedic workforce – given that paramedics work in many settings across the nation, offshore and in the public, private and defence sectors.

Crucial to this regulation is the definition of role and the criteria used to define a paramedic who currently may be qualified through several educational pathways including Degree programs, VET Diploma courses, other VET Qualifications, In-Service training and various educational programs obtained overseas. As the peak professional body for the profession Paramedics Australasia has developed and promulgated comprehensive guidelines and definitions for paramedics to provide a consistent national structure for paramedic practice.

Paramedics Australasia has already met with members of the Minister’s Office and the Health Department of South Australia to address the issues associated with the practical implementation of the proposed legislation. Among the key issues is the adequate provision within the regulations for those paramedics who may be qualified through various recognised mechanisms at this time but who do not currently hold a Degree in Paramedicine.

Paramedics Australasia believes the Government must consult widely to avoid unintended consequences such as denying the title to existing persons who are practising legitimately as paramedics but who may not have undergone the bachelor degree pathway of qualification.

Paramedics Australasia has received assurances that extensive consultations will be held with stakeholders in determining the definition of a Paramedic and the drafting of the regulations under the legislation to ensure that any changes are implemented with sensitivity and that various measures such as ‘grandparenting ’ will be applied in the transition period of implementing the legislation.

In summary, Paramedics Australia’s view is that jurisdictional regulation is a transitionary measure, and the only effective long term approach is national registration under the established regulatory framework of AHPRA and the National Law provisions as for other registered health professions.

On Wednesday 30 October 2013, the South Australian House of Assembly passed legislation introduced by the Health Minister, the Hon Jack Snelling MP, for the Protection of Title – Paramedics. This followed the tabling of an Amendment Bill to the Health Practitioner Regulation National Law (South Australia) 2010 last week.

Following discussions with Paramedics Australasia and other stakeholders, the Government moved an amendment to revise the definition of a paramedic, but otherwise the Bill was unchanged from that tabled previously. The amended Bill No 197 now reads as follows:

Amendment No 1 [Health—1]—

Clause 4, page 3, lines 1 to 4 [clause 4, inserted section 120A(2)] —

Delete subsection (2) and substitute:

(2) For the purposes of subsection (1)(b), a paramedic is a health professional who provides emergency medical assessment, treatment and care in the pre-hospital, or out-of-hospital, environment.

The Bill was introduced into the Legislative Council on 30 October 2013, and will be debated at the earliest opportunity.

Paramedics Australasia has formally clarified that the intent of the proposed legislative change is to protect the public by ensuring that any person employed as a paramedic in South Australia holds appropriate qualifications and training. There is no intention to prescribe or restrict the scope of practice as part of the current legislation or regulations. SA Health has confirmed that:

“ ... It is expected that employing organisations would have governance structures in place to ensure that a paramedic could only undertake those procedures in which they are qualified and are competent to perform. It is also expected that paramedics themselves would have responsibility in understanding what their scope of practice is based on their education and competency.”

Paramedics Australasia trusts that this advice will provide reassurance to practitioners in both private and public sectors regarding the intent and potential impacts of the amended legislation.

Paramedics Australasia will continue to meet with the South Australian government in identifying and resolving the complex issues involved in these transitionary moves and will report the outcomes of our discussions as further information becomes available.

PRESIDENT’S REPORTI reported last year that we had growth in our membership and strengthening of our financial position and this has continued.

We are now in a position to be able to go ahead and employ and Executive Officer. This has been a key objective to deliver improved member services and continue to provide Paramedics with a strong voice in important Health issues. We aim to make an appointment by the end of November 2013.

Another important objective was achieved when we launched the Paramedics Australasia eLearning activities for paramedics. The site is user friendly and provides an innovative platform from which all members can access the online learning activities, as well as keep track of and register for local Chapter events and activities.

I can again report that we continue to operate at a professional level within the complex field of Health Care, and we have achieved a great deal through the commitment, dedication and expertise of volunteers who perform at a level expected of a professional body. The board has used resources strategically to retain expert staff to support them to deliver the representation and member services that are now expected and warranted.

Among these dedicated staff are: Secretariat and conference convener Les Hotchin, communications Amy Cotton, membership John Hall, registration, strategy and lobbying Ray Bange, finance and book keeping Leesa Thomas. It would not be possible to operate PA at the present level without their valuable work on your behalf, which goes well beyond their paid hours.

PA continues to the monitor the progress of paramedic registration and have responded to opportunities for lobbying and consultations they have presented, however there has been no significant development in recent times. No estimate is offered for any timeline for the paramedic registration impact report and Ministerial determination. In a separate a development, health ministers have adopted a policy on regulation of unregistered health practitioners which has been well reported on our web site.

With new CEOs in place at both St John and Wellington Free Ambulance, a timely supportive visit from Vice President Richard Larsen and myself took place in March. A face to face meeting with Diana Crossan, CEO of WFA, and a telephone meeting with Peter Bradley, CEO of St John, provided valuable opportunities for raising awareness of the role of PA and the nature of PA activities.

Both meetings were positive, opening the way for greater promotion of PANZ in both services. We also met with David Waters, CEO of Ambulance New Zealand, for an update on progress towards registration in NZ. The New Zealand chapter had their first AGM under the leadership of Sharon Duthie, which we attended. The chapter is active and growing which is an important and strategic development for PA.

The PA eLearning platform is a unique solution that provides opportunities for professional development activities at a time place and pace that suits members. The eLearning modules are available only to members of Paramedics Australasia.

We have launched the Australasian Journal of Paramedicine (AJP), formally the Journal of Emergency Primary Health Care (JEPHC), the official open access, peer-reviewed, international journal of Paramedics Australasia.

With a new look and feel, the AJP will feature unique, innovative and hard-hitting research relevant to the paramedicine community in

Australasia and internationally. The journal will advance and promote the science of pre-hospital care research and provide an avenue for publishing a range of studies – including short reports, case studies, literature reviews, research updates and small experiments.

The new AJP Editor is Dr Malcolm Boyle, who will lead the journal with a team of Associate Editors, who come with a wealth of knowledge and experience in the field.

Paramedics Australasia continues our work promoting Australasian paramedics internationally. Working with the British College of Paramedics we developed a formal mechanism for information sharing and collaboration. We have also continued to assist the development of the organisation of International Paramedics.

As background to consideration of regulatory policy, PA has placed a high priority on presenting a factual picture of paramedics in Australasia. It is only with the best possible knowledge of the operating environment that good policy can be made.

Continuing earlier work on the nature of the paramedic workforce in Australia, PA has developed a paper that provides updated information on paramedics following the release of the 2011 census data by occupation on Tuesday 30 October 2012.

PA has analysed the census data set and provided a comprehensive report on the paramedic workforce in Australia.

Over this past year we have strengthened the PA Continuing Professional Development program, this is a voluntary regulation program that will form the basis of our ongoing move towards professional registration.

We have developed a set of paramedicine role descriptors to provide an introduction to the current clinical roles within Paramedicine in Australia and New Zealand. This work covers the broad classifications of professional, technical and communications streams of practice. This has been an important piece of work that for the first time captures the clinical roles of Australasian Paramedics.

We have continued to contribute to Health Care policy. PA vice-president, Richard Larsen has attended meetings of Health Workforce Australia’s Health Professions, Standing Advisory Committee to represent the views of Paramedics.

PA New Zealand prepared a formal submission to the recent review of the Health Practitioners Competence Assurance (HPCA) Act 2003. The review commenced on August 31 2012 with the release of a discussion document published by the Ministry of Health seeking views from stakeholders.

Achievements by PA 2009-2013

Paramedics Australasia has articulated a national strategy for the future directions of paramedic practice at the same time as implementing sweeping organisational change. This has involved leadership through greatly enhanced communication with members of the profession and other key stakeholders within the region. Some of the more significant activities in that process are:

Meetings and liaison activities with key decision makers and related professions• Ministers and Shadow Ministers across Australia and

New Zealand• Key MPs and Senators/political advisors and Committees• Directors General, Directorate staff and CMOs in

Health Departments• Health Complaint and Health Consumer bodies

PA Annual Report 2013


• AGPN – liaison and participation in events• AHCRA – participation as a full member of Alliance, lobbying

activities• NRHA – participate as full member of governing Council• SARRAH – close working relationships e.g. Scholarships, national

lobby• HCRRA, Rural Health West, Health Consumers Council, other

groups• ACEM – Liaison, CPD, joint conferences• ATS – liaison, joint conference• CRANA – working relationship, information sharing• RCNA – working relationship, information sharing• CENA – liaison, joint CPD, workshops, conferences• Heart Foundation – working relationship, information sharing,

workshops• NCAU – ongoing alliance, information sharing, joint registration

workshops• ACHSM - participation in conference activities

Development of reports and submissions

(major items only listed)• NHHRC submission on health reform• Response to NHHRC Interim Report• Complaints procedures• Information sharing and privacy• Clinical training; governance & organisation• Inquiry into St John Ambulance (WA)• ABS ANZCO workforce classifications (ABS)• ASNSW management & operations (NSW Parliamentary

Committee)• Clinical supervision support program (HWA)• Lead clinicians and healthcare integration• Statutory regulation of the health professions (NZ)• Options for regulation of unregistered health practitioners

(AHMAC)• Forgotten Health Profession briefing paper (2 Ed)• Health workforce innovation and reform (HWA)• Health practitioners prescribing pathways (HWA)• Paramedic competencies framework• National survey of paramedic profession• Public risk and paramedic regulation – NRAS registration

submission• Optimising health care regulatory outcomes (2012 Review of

HPCA Act – NZ)• Paramedics in the 2011 Census – review of workforce statistics• ANZSCO Coding Issues – confidential submission to Australian

Bureau of Statistics• Optimising health care regulatory outcomes – NZ HPCAA review

submission• Review of the Tasmanian Ambulance Service Act 1982

– Tasmanian Act submission• Para medicine Role descriptions – national policy document

Registration and regulation of paramedic practice• Implementation of the NRAS Registration Project and monitoring

of AHPRA

Employer and research body / academic liaison• Council of Ambulance Authorities (CAA) – government funded

EMS agencies• Private Paramedic Australia (PPA) - private employer peak body• Ambulance Services (all Australian jurisdictions)• Ambulance New Zealand, WFA, St John Ambulance (NZ)• ADF – Joint Health Command

• Private employers of paramedics and related health professionals• Sponsorship and liaison support for paramedic educators (NAPA)• Engagement with major research and development policymakers• Sponsorship of research projects for national government funding

Membership of key bodies• HWA Standing Advisory Committee for Health Professions• Australian Resuscitation Council• Foundation member – International Paramedic• HWA Interim Council of Future Health Leaders• National Rural Health Students Network• Membership of University, EMS provider and other Advisory

Committees

Engagement with Inquiries and national policy development bodies/groups• Lead clinician consultation workshops• Workforce innovation and reform national framework• AHMC Future development of health workforce• HWA Health professionals in training• HWA Primary care roles• HWA National Training Plan (NTP) for Doctors, Nurses and

Midwives• HWA Rural & remote health workforce innovation• HWA: Extending the role of paramedics• HWA: Health practitioners prescribing pathways• HWA National Ambulance Officer and Paramedic Workforce

Study• NEHTA: Electronic health records• AHMAC options for regulation of unregistered health practitioners

(DoH Vic)• AIHW /ABS discussions on statistical datasets and paramedic

classifications• Clinical Senate involvement in various jurisdictions• ACSQHC discussions on safety and quality in EMS• Strategic review of Australian health and medical research

– McKeon review.• AHMAC: paramedic regulation workshops in all jurisdictions –

NRAS review• Network/Radar – fostering of collaborative practitioner and

research networks

Presentations and collaborative activities• Clinical senate appearances• ACHSM involvement• National Union Congress• University presentations to students and staff

Continuing professional development activities/education and research support• Annual PA Conference / Annual SPA Conference / Several

Chapter Conferences• International Study Tours (USA , Canada, Singapore, other)• Regular Chapter (local) CPD programs / Workshops / Evenings• Online educational modules (eLearning)• Research Workshops• Simulation and clinical support activities and workshops• Provision of links to significant national and international

conferences

Personal benefit services (new services constantly under review)• Paramedic Jobs (local and international reach)• Special Interest Groups (SPA, NAPA and Rural and Remote

Groups)



• Extensive Australian and New Zealand network of University student societies

• Merchandise (9 online outlets offering discounted goods)• Branded products with PA logo identifying profession• Eligibility to carry PA postnominal letters identifying member

status• Research references and links to best practice• QANTAS Club discounted membership• Communication and promotion of professional presence• (internally and externally)• Informative website – news and views with wide coverage of

professional practice• Social media networks and interaction (Twitter, Facebook, Blogs,

other)• Daily health environment scan and media coverage• Australasian Journal of Paramedicine electronic peer-reviewed

journal• Response magazine – quarterly magazine• Rapid Response – regular monthly electronic Newsletter with the

latest news

PA continues to deliver outstanding outcomes from having a national voice for paramedics• National and international recognition of role, name and logo

branding• Substantial growth and recognition across established Chapters

(Aust and NZ)• Expansion of interest areas (SPA, NAPA, R&R, Other SIGS)• Enhanced academic engagement through NAPA support• Strong student societies with a wealth of activities• New recognition and access to Govt. Benefits for paramedics• Expanded paramedic eligibility for government scholarships e.g.

NAHSSS• Paramedic eligibility for Rural Health Continuing Education

Program• Paramedic eligibility for NAHRLS Scholarships• Paramedic eligibility for RHCE2 Program• PA/Joint institutions award of ALTC and other research grants.

I am very proud that we have delivered results well beyond the norm for our infrastructure and resources on our Members behalf. In summary we have had another busy year that has stretched us yet we have been productive. I am grateful to the Board for their continued support. The Chapter chairs and Committee members have continued to increase their focus on member services and provision of an exceptional range and number of CPD sessions.

Thank you for that great work. And to you the members thank you for getting behind us with your increased fees, your trust and professionalism. Without this we would not have progress.

Professor Ian Patrick

ASM FPA

AUSTRALASIAN COLLEGE OF PARAMEDICINE

EduSIG Report to National

The current EduSIG committee consists of Jeff Allan FPA (Convenor), Mike Williams FPA and Chris Huggins MPA.

At our last PA conference in Hobart, we conducted an EduSIG survey asking PA members their areas of interest and whether they would be interested in becoming a member of PA-EduSIG. The results of this survey were very encouraging:

40 returns (approx. 35%), which 24 (60%) indicated that they would be interested in being involved in the EduSIG, of which 22 supplied their email address. Contact was made with all respondants outlining the EduSIG proposed activities.

The main areas of interest were interprofessional education, simulation, e-Learning and work-readiness/job readiness.

SimHealth Oct 2012 – facilitated a ‘breakfast session’ on prehospital care, well attended. As a result we were invited to present another ‘breakfast workshop’ for the SimHealth conference at Brisbane in Sept 2013.

This breakfast workshop theme was on “Does SIM make student paramedics more work ready”, while the in-conference workshops theme was around “Does low fidelity simulation achieving high fidelity results a in a multi-disciplinary multi-casualty simulation reflecting inter agency teamwork”. Both sessions were well attended and we received very positive feedback. We have been invited back next year to facilitate another workshop/breakfast session and a round table discussion on pre-hospital emergency management.

We will be facilitating a ‘breakfast workshop’ at the PA conference in Canberra using EMERGO simulation to achieve high fidelity results in a multi-disciplinary multicasualty simulation reflecting interagency teamwork.

We would like to take this opportunity to thank the conference committee for their support and encouragement over the years. Hopefully we can fly the PA banner for many more years at both national and international educational and medical conferences.

Jeff Allan

E-Learning Report

Since the launch of our new e-Learning system in 2012 PA has continued to add to the number and diversity of topics/services available. This premium member only service has grown to be a very popular CPD offering enabling members to obtain access to both Paramedic specific and more general professional development content.

Two of the major recent developments include:

1 Ability to accept event registrations for Chapter CPD events & generation of CPD attendance certificates for Chapter CPD Events

2 The introduction of the Paramedics Australasia CPD Events Topic which hosts video’s from our chapters of various CPD events

Additional topics are currently being developed by a range of clinical experts for release during the coming year. Members should email [email protected] if they have any queries regarding access or use of this system.



NAPA Report

The Network of Australasian Paramedic Academics is a Paramedics Australasia special interest group comprising individuals with an interest in paramedic education in the tertiary education sector. When the group was established the membership was drawn from discipline leaders from the universities offering pre-employment courses. NAPA now welcomes anyone with an interest in or responsibility for paramedic education. The group aims to meet biannually, and information about each meeting is disseminated via members and the course leaders from each university in Australia and New Zealand offering paramedic education programs. Since the previous (2012) report NAPA has undertaken the following activities:• NAPA provided a response to the International Federation for

Emergency Medicine (IFEM) in relation to the “Draft Model Curriculum for Emergency Medical Technicians” developed by this organisation.

• A web site has been established under the SIG section of Paramedics Australasia: https://www.paramedics.org.au/about-us/special-interest-groups/network-of-australasian-paramedicacademics/about-napa/

• The procedure for formalising membership was agreed at the 3 May 2013 meeting, with the membership form available from the NAPA web site.

• The minutes for the meeting of 31 October 2012 held at the University of Tasmania were not available at the time the 2012 PA report was submitted. These minutes have been uploaded to the NAPA section of the PA web site.

• The first meeting for 2013 was held at the Central Queensland University Gold Coast campus on 3 May 2013. The agenda and minutes for this meeting have been uploaded to the NAPA section of the PA web site.

• Almost 30 people have indicated their intention to attend the next NAPA meeting. This is to be held on Thursday 17 October 2013 at the Australian Catholic University campus in Canberra. The program is attached.

Further information regarding NAPA may be obtained by emailing the NAPA Secretary – Bill Lord at [email protected].

Network of Australasian Paramedic Academics Thursday 17 October 2013

Venue: Room S3, Australian Catholic University, 223 Antill Street, Watson, ACT

Time Session

0900-0930 Matters arising from the previous meeting. Election of Convenor and Secretary.

0930-1000 Exploring options for interprofessional simulation based learning in the undergraduate setting. Gary Strong (Programme Leader, Whitireia New Zealand)

1000-1030 Break

1030-1130 Demystifying the elusive and magical “clinical” experience. We know that the clinical experience is a magical and effective learning environment. But what kinds of experiences are students really having when they leave the classroom? How should one measure these experiences? Patient contacts? Hours? Over the last 16 years a national grass roots effort to collectively track and describe the elusive and magical “Clinical Experience” has been underway. The creation of this web-based FISDAP EMS education community has yielded unprecedented online collaboration, educational research, and academic debate. This session will focus on the lessons learned, the challenges of accurately tracking clinical experiences, and measuring competency. David Page, Paramedic Instructor, Emergency Medical Services Department, Inver Hills Community College, Minnesota.

1130-1230 Paramedics’ transition from the profession of paramedicine to the profession of academia. A major focus of this study will be on identifying the issues that paramedic professionals’ face when attempting to transition their habitus and capital from the profession of paramedicine to the profession of academia.This study aims to:• Identify the demographic characteristics of the

professional paramedic academic;• Determine the factors that influence paramedic

academic identity;• Identify the issues related to the transition of

paramedic professionals into the academy; and• Develop a framework to assist in the transition of

paramedics from clinical practice into the university.

As a result of this research, there will be a better understanding of what are the implications of this paramedic academic identity for teaching and research in the academy. It will aid the academies in selecting more suitable candidates for academic positions and to make their transition from paramedic practice to academic practice more focussed and productive. Graham Munro (La Trobe)

1230-1330 Lunch

1330-1430 Internationalizing the paramedic curriculum. Three groups of Australian paramedic students have had the experience of visiting New York City to learn about the system and ride along on NYC ambulances. This presentation will describe the logistics involved including:• identifying the students;• selecting a host agency; and• funding.In addition we will discuss the program learning objectives and future opportunities and directions. Professor Brian Maguire, School of Medical and Applied Sciences, Central Queensland University paramedic program. Brian has recently returned from the third paramedic student trip to NYC.

AUSTRALIAN PREHOSPITAL EMERGENCY HEALTH RESEARCH FORUM (APEHRF)The Australasian Prehospital Emergency Health Research Forum (APEHRF), as part of the International Prehospital Research Forum is now in its ninth year of collaboration with Paramedics Australasia (PA), with proceedings and guidance for the review and adjudication of abstracts submitted to the PA Annual Conference.

The excellent work of the reviewers is once again acknowledged and commended by the APEHRF Executive, particularly in relation to the time and quality of work that each of the reviewers voluntarily contributes to the process. All reviews were completed and returned to the APEHRF administrator within two weeks of distribution, and results forwarded to the PA Scientific Committee to determine the final selections for oral and poster presentation at the Conference.

The APEHRF continues to promote and ensure rigorous standards in the collection, presentation and publication of prehospital emergency research which is assisted through ongoing collaborations with the US (UCLA Center for Pre-hospital Care) and the UK (999 Research Forum). To this end, our partnerships have provided an excellent opportunity for APEHRF Best Paper Award recipients to attend either UK or US conferences, and for US (UCLA Center for Pre-hospital Care) Research Forum or 999 Research Forum winners to attend PA conferences. This year we look forward to hosting the 999 forum 2013 winner in Canberra and our 2012 APEHRF Best Paper Award recipient, Rachael Wallen, will be presenting in the UK in February 2014.



The APEHRF committee warmly acknowledges the contributions and support of the PA Scientific Committee throughout the past year and would like to thank the PA Board for the opportunity to assist with the PA International Conferences.

AUSTRALIAN RESUSCITATION COUNCILThis is my second annual report as the Paramedics Australasia representative on the Australian Resuscitation Council (ARC). During this time I have had the pleasure of working with a distinguished group of experts who share a common goal: improving outcomes in cases of cardiac arrest. The Council also is active in promoting community-based resuscitation and resuscitation education, and offers advanced training through the delivery of Advanced Cardiac Life Support courses.

The following information provides a summary of the matters discussed at each council meeting over the previous 12 months. I was unfortunately unable to attend the 19/20 July 2013 meeting.

23/24 November 2012 meeting

An update on the work of the International Liaison Committee on Resuscitation (ILCOR) was provided in the lead up to the publication of the next generation of resuscitation guidelines. This process involves meetings of the member organisations (including the Australian Resuscitation Council). ILCOR members will meet in Melbourne on 21-22 April 2013 to continue the process of reviewing international science and knowledge relevant to cardiopulmonary resuscitation. The next update to the ILCOR resuscitation guidelines are due in 2015, and will be published in the form of Consensus on Science and Treatment Recommendations (CoSTR).

The top ten topics prioritised for COSTR 2015 are:• Percutaneous coronary intervention (PCI) following return of

spontaneous circulation (ROSC)• Direct transport to PCI centres• Prehospital fibrinolytics for STEMI• Biomarkers for acute coronary syndrome (ACS)• Maximum time delay for primary PCI• 12 lead ECG• Mechanical CPR Devices in conjunction with PCI• Clopidogrel (and similar drugs) and non-ST elevation ACS• Improving systems of care for ACS• Anticoagulants and STEMI

Worksheets for each topic will be developed that require the use of a systematic review of the evidence relating to each topic. The GRADE evidence evaluation process is used, which is a system for rating the quality of scientific evidence and grading the strength of recommendations appearing in guidelines.1 An ILCOR International Consensus Conference scheduled for February 2015 will result in the finalisation of guidelines that are due to be published late 2015.

At a local level, work to review ARC guidelines is ongoing. The following guidelines are under review:

Guideline 11.6.1 Oxygen Administration in Advanced Life Support. This will address the use of oxygen in cardiac arrest, and following return of spontaneous circulation. Although the use of oxygen for conditions other than cardiac arrest has been modified in some practice settings, there is still insufficient evidence to warrant a policy or guideline for care at the basic life support level. As such, Guideline 10.4: The Use of Oxygen in Emergencies currently advises that oxygen may be beneficial in emergencies including the management of decompression illness. It should be noted that this advice is for individuals providing care in a basic life support role.

It was agreed that a guideline for the management of cardiac arrest associate with trauma should be considered. The aetiology of cardiac arrest is quite different from that associated with sudden cardiac arrest, and as such the management may need to be modified.

New or revised guidelines that have been recently published are:

Guideline 2: Managing an Emergency. This emphasises the importance of ensuring the safety of the rescuer, victim, and bystanders, and provides guidance on when to move the victim.

Guideline 3: Recognition and First Aid Management of the Unconscious Victim. Information previously associated with a guideline for the management of fainting was moved into the unconscious victim guideline.

Guideline 9.2.1: Recognition and First Aid Management of Heart Attack. This guideline now advises the administration of Aspirin (300 mg) if directed. Some ambulance services provide advice to callers about basic care prior to the arrival of an ambulance, and this may include advice regarding the administration of aspirin. However, an anomaly has been identified in cases that occur in the workplace, as Victorian Work Safe Compliance Code: First Aid in the Workplace, states that the dispensing of drugs needs to be managed by a medical practitioner or registered nurse, not a first aid officer. This specifically refers to drugs such as paracetamol or aspirin.

Guideline 9.1.4: Head Injury. This reinforces the need to refer individuals with any head injury (with or without change in level of consciousness) for assessment by a healthcare professional before continuing with sport of any other activity.

8/9 March 2013 meeting

Two guidelines were approved and have now been updated on the ARC web site (http://www.resus.org.au/):

• Guideline 9.1.7 – Emergency Management of a Crushed Victim

• Guideline 10.1 – Basic Life Support (BLS) Training

The BLS training guideline reinforces the need to teach individuals to focus on the performance of adequate CPR rather than the technicalities of achieving set figures or rates. Although the provision of rescue breathing (what used to be called expired air resuscitation) has been deemphasised by some resuscitation councils, the ARC has determined that mouth to mouth rescue breathing must be taught and assessed in any training program. The guideline also recommends that CPR refresher training be undertaken by individuals who are not performing resuscitation on a regular basis. This potentially includes many paramedics, particularly those working in non-clinical settings.

New guidelines currently under review include:• Guideline 10.2 – Advanced Life Support Training• Guideline 11.6.1 – Oxygen Administration in Advance Life Support

There remains scant high-level evidence regarding the role of oxygen in resuscitation, and it is hoped that the results of clinical trials currently in progress may help to inform the use of oxygen in the early stages of resuscitation.

The meeting considered correspondence that questioned the use of uninterrupted ventilation once a laryngeal mask airway (LMA) has been placed in a patient in cardiac arrest. The LMA is not considered a secure airway, and as such the group discussed the current recommendation that chest compressions are not paused to ventilate once a supraglottic airway is in place (Guideline 11.1.1). It was recognised that there is a potential gap in knowledge in this area, with the ARC guideline stating that the “adequacy of ventilation with supraglottic airway devices during uninterrupted chest compressions is unknown.” It is known that simultaneous ventilation and compression has the potential to adversely affect coronary perfusion pressure, and as such the guideline states that ventilations need to be timed with compressions.



Spark of Life conference report

The 9th International Spark of Life conference was held in Melbourne on 19 and 20 April 2013. Local and international speakers described interventions that have the potential to improve outcomes from sudden cardiac arrest. Professor Laurie Morrison examined the significant differences in cardiac arrest survival across different cities in North America, and provided an explanation for these differences.

Laurie outlined an initiative that is currently being introduced in Toronto, Canada that aims to improve access to early CPR and defibrillation in the community. Many community members are trained in CPR, but may be unaware that a cardiac arrest has occurred near their location. The “PulsePoint” initiative aims to alert CPR trained individuals to the occurrence of a cardiac arrest that they may be close to and can assist with as a first responder. Data from the local emergency medical service (EMS) dispatch centre is linked to an “app” that subscribers can download to their mobile phones. When a cardiac arrest emergency call is received by the EMS agency, all nearby PulsePoint users are sent an alert that includes a text message saying “CPR NEEDED”. Their current location and the location of the cardiac arrest are displayed on a map, and nearby public access defibrillators (AEDs) are also shown on the map. The uptake of this program and the influence on cardiac arrest outcomes is currently the subject of research.

An excellent neonatal satellite conference preceded the Spark of Life. Speakers presented new information about the transition from placental oxygenation to air breathing. New medical imaging techniques allow the visualisation of aeration of the lungs following birth, and also provide important information about the efficacy of techniques used to support ventilation in neonates that require breathing support. This was followed by a presentation on the role of sustained inflations at birth based on this new evidence. This research may eventually inform the neonatal resuscitation guidelines.

Associate Professor Bill LordSchool of Health and Sport Sciences University of the Sunshine Coast

FINANCE SUB COMMITTEEA continuing feature of the 2012-2013 financial year for Paramedics Australasia Ltd has been the on-going commitment of funds to the strategic objective of professional recognition for our members and our industry. This on-going commitment was initiated by the Board 6 years ago and supported with enthusiasm by all PA Management Committee and consultative forums since. It is important to note here that this strategic positioning activity is highly valuable and significant progress is being achieved.

It is in this context then, that the past financial year has been a year of high activity, high expenditure and high achievement for Paramedics Australasia. Activities of note included:• Further consolidation of the national financial structure into one

reporting entity and refinement of Chapter financial operations.• The establishment and refinement of the financial operations and

facilities for the New Zealand Chapter.• Improvements in the PA revenue streams and member billing

processes in conjunction with further improvements to the accuracy and currency of the member data-base.

• Full compliance with financial reporting requirements for Registered Companies and with Corporate Governance Standards.

• Full compliance with all GST requirements and timely reporting.• Maintenance of MasterCard payment and reporting system for

office bearers across the Board and the Chapters, including a number of changes to office bearers during the financial year.

• Meeting the simultaneous financial demands of the Registration, On-line Learning and other projects and the on-going evolution of PA Web and Membership Registrar services.

• Supporting the President, Directors and Chapter Officials in representing PA in a range of National Health Practitioner Registration and professional recognition consultative forums to promote the need for registration of paramedic practitioners and promote the aims and objectives of PA in this context. This particular activity is productive and valuable.

• Planning and Presentation of the annual PA clinical conference.• Supporting the planning and production of Chapter clinical

conferences and professional development activities.• Funding the development, research and Scientific Agenda

Frameworks, including the review and re establishment of the eJournal, now renamed the Australasian Journal of Paramedicine.

As your Treasurer I have maintained a constant vigilance on expenditure levels and maintained Director’s awareness of financial trends during this period of high activity. The Board and Management Committee have jointly maintained the momentum and associated progress towards the objectives of Paramedics Australasia Ltd.

I am pleased to report the Key Performance Indicator 1 of the Finance Committee ie “To Monitor the Cash Flows and Financial Performance of PA within Budgetary Parameters” has been achieved.

Key Performance Indicator 2 ie “To Provide Financial Support and Services to PA Objectives and Initiatives” has also been achieved along with the remaining KP1s of the Finance Sub-Committee.

I am pleased to report that specialist Company Auditor, Staines, Reeves and Jones have conducted a most thorough and comprehensive audit on behalf of our members in accordance with the new international accounting standards and also in a timely manner.

It is important for all PA members to note that the end of year financial outcome for the Board has been a very positive outcome in terms of funded achievement.

The Paramedics Australasia Ltd retains the capacity to achieve the evolution towards a fully coordinated, professional and independent Paramedics Australasia Ltd supporting our members.

M. J. Davis AM, ASM, MBA FPA, FCHSM, FAIES

Treasurer

IT SERVICESThe past year has seen the appointment of a specialist systems manager to oversee and provide our IT asset support on an as required basis. This has resulted in timely intervention when faults are notified and advice being readily available to the National office and chapters.

Although many services can be provided by the in-house team (national infrastructure with the purchase and administration of local IT infrastructure), external sourcing of specialised programs has been put in place for eLearning, membership surveys and conference management.

National website management and regular updates is overseen by Amy Cotton and a number of Chapter members also assist at the local level – thanks go to those involved in this vital area.

The existing website is currently undergoing an extensive update and will incorporate a new membership system and a shopping cart to support member service activities.

MEMBERSHIPThis year has seen the introduction of monthly EFT payments of the subscription. This payment option has proved popular and the number of members using this facility is increasing rapidly.



Work is continuing for a payment portal on our new website and this will allow members to pay the subscriptions on line. This should be functional soon. The Board have also approved special subscription rates for Volunteers and Retired members.

Another innovation this year is to allow SPA students who missed joining at the commencement of the academic year, to apply online. This has been working well and has increased the number of SPA students by more than 50 to date.

The Member Management System had a complete audit late 2012 and the numbers dropped following this, as we archived many ex and unfinancial members who had inadvertently been left on the system by some of the larger Chapters. Following the audit, it is my opinion that the actual figures now reflect the true financial membership. On the positive side the Membership Committee reviews 30-35 new applications a month. In some months the number has been closer to sixty.

The membership is increasing by approximately 25 per month and we have an attrition rate of around 2 per month, mostly from retirements or illness. The private sector has contributed to the increase in membership with over 200 of our members working in the private sector, with approximately the same number of ADF personnel.

The overall membership as at 1st September:

Financial Membership ............................................................... 2449

SPA .......................................................................................... 1235

John Hall LMPA

Membership Registrar

PAINAUSTRALIAParamedics Australia is a member organisation of painaustralia. I attended the inaugural National Pain Summit held at Parliament House, Canberra, in March 2010 as a representative of Paramedic Australasia. Since then I have attended painaustralia AGMs where I was able to promote the role of paramedics in the care of individuals experiencing pain. My current interest is the role that paramedics may be able to play in caring for people with chronic pain.

This involvement in multidisciplinary pain management practice and research has enabled research opportunities for a PhD student I am currently supervising that involves a study of paramedic, patient and GP experience in caring for patients experiencing chronic pain. This research has recently been promoted on the painaustralia website:

http://www.painaustralia.org.au/media-news/e-news.html#research

Participate in New Research

Perspectives on Persistent Pain Survey: for GPs and consumers PhD candidate Janelle White, from the University of the Sunshine Coast, is seeking GPs and patients to participate in a survey, for her research into better ways to care for patients with chronic pain in the community. For more information, contact Janelle White [email protected]

Although I was unable to attend the painaustralia AGM in Sydney on 9 April 2013, I am committed to promoting the role of paramedics in the field of pain management at future painaustralia events. The report from the 9 April meeting is available here:

www.painaustra l ia .org.au/about-us/reports-documents.html#AGM2013

Associate Professor Bill Lord

School of Health and Sport Sciences University of the Sunshine Coast

SPA REPORTStudent Paramedics Australasia (SPA) has continued operations throughout the year as a Special Interest Group (SIG) of Paramedics Australasia (PA), the peak professional society for paramedics engaged in the delivery of out of hospital emergency medical services (EMS).

SPA provides a connection with student paramedics and professional organisations to provide a focus for national representation and advocacy across 12 universities and 18 university societies. SPA membership is available to those who fulfill requirements of being enrolled in an approved Australian or New Zealand pre-employment degree (or equivalent) leading to qualification as a paramedic.

The membership price for PA-SPA was a total of $15 for 2013, not including University Society contributions. Membership benefits include subscriptions to paramedic publications; free or subsidized access to PA-SPA affiliated events, and access to Clinical Training evenings; local, state and national representation as a paramedic student; and access to research and conference scholarships, merchandise and prizes.

University Societies

This year has been a productive year for SPA University Societies of Australia and New Zealand, especially in growth and outreach. New societies in Whitireia, Central Queensland University and Port Macquarie Campus of Charles Sturt University have been established, with plans to expand into Auckland University of Technology in the near future. All societies have demonstrated a propensity for activity and promotion of the SPA tenets of networking, professional development and ongoing education through social and professional events. Some examples include CPD Events such as Paramedics and Poisons by Carol Wyllie, by SPU at QUT; ECG Refresher Session with Kerrie Frantz, by PARASOC at Monash University; and Special Op Team and Medstar tour by FUSPA at Flinders University.

Not limited to the academic and educational experience, social events have been planned by societies to promote networking through university societies such as rock-climbing, 10-pin bowling, Oz-tag competitions and the ever popular lawn bowls.

This is made possible by the increased use and exposure to direct communication through social media. This has been established through a central forum for University Society committee members, allowing ease of communication, and horizontal mentoring and support systems for committee members facing similar challenges.

Communications

Through the use of social networking platforms such as Facebook and Twitter, online communication and information dissemination has grown this year. The methods of which we communicate with members, conference guests and other committees has grown with technology and digital infrastructure through the SPA website, automation of social media posts and increased visibility of our networked brand.

The SPA Facebook page has accumulated over 2000 followers from 1300 earlier in the year. Twitter followers have also grown 30% in the past 5 months. Both these channels have proven to be valuable in terms of promotion of events and information. The Twitter hash tag was particularly useful in providing students, speakers and organisations a direct way to interact with promotion of the 2013 SPA conference. The SPA website has also undergone changes in order to maximise impact until rollover to a new WordPress site is implemented. Since the start of the year, easier navigation through Quick Links and other prime homepage positions is current and valuable. The layout of the site also allowed custom access through smart phones, with a mobile layout.



Planning for the new site has been undertaken, and will be an attractive, fresh and useful website to support communication activities, such as e-newsletters, members-only section of the website for careers and forum.

The 2013 SPA International Conference

The 2013 SPA International Conference boasted the largest turnout since the inception of SPA Conferences. Hosted in Melbourne, with 280 delegates, speakers, sponsors and exhibition booth holders, this year definitely demonstrated an enthusiasm for professional practice, further education and networking amongst paramedic students, academic bodies and professional industries.

The annual charity raffle was a great success in aiding the Day of Difference Foundation. The purpose of the Foundation is to permanently reduce the incidence and impact of children’s critical injury in Australia, with $1600 worth of proceeds going towards The Foundation’s Paediatric Critical Injury Research Program which builds evidence to deliver improved outcomes for critically disabled children, their parents and families.

The speakers and presentations provided experiences and insight from paramedics internationally, and a truly unique experience. Delegates were encouraged to view exhibition holder booths and chat to industry representatives, universities, charity organisations and medical equipment specialists. SPA also provided Post-Conference Networking, regardless of geographical boundaries. New friendships were formed and future prospects were discussed, with a total of 150 guests attending this casual get-together. SPA would like to thank the organisations and individuals that have provided generous support and encouragement to the future generations of paramedics.

Melbourne has been an excellent host city in this time, however SPA believes the time has come to share the event nationwide and a change in scenery. With this in mind, the 2014 Student Paramedics Australasia International Conference will be held in Brisbane. SPA looks forward to interacting with a whole new group of paramedic students in the Sunshine State!

Community Engagement

Within the SPA committee, the Community Engagement subcommittee has focused on establishing relationships with external organisations and strengthening the influence we have on local paramedic societies. This year, SPA has achieved an improved relationship with Red Cross’ CLUB RED with the successful running of another yearly blood donation challenge. So far, a total of 319 out of 1000 students have contributed to blood donations, and while this is a target SPA hopes to improve on, SPA hopes to work with further consultation from CLUB RED and local societies to increase parity with membership numbers in 2014. The portfolio has also been in discussions involving a working partnership with a major volunteer organisation with the hope it will promote a culture of volunteering across SPA’s membership network.

Branching further within the country, Rural and Remote Initiatives have been working on promoting the partnership of local rural health clubs and local paramedic societies. This is done through a partnership between SPA and NRHSN, as well as working through local channels, aided by the distribution of a Community Engagement Handbook.

SPA was represented at both NRHSN Face 2 Face meetings and recently the Future Health Leaders Rural Leadership Forum in Orange, NSW. SPA has been able to push the issues of registration, workforce needs and extended scope of practice of paramedic professionals at all these events.

The existing networks between SPA and NRHSN will be crucial to foster a working relationship to represent the interests of student paramedics intending to enter rural communities.

REGISTRATION AND RELATED MATTERSParamedics Australasia (PA) has continued to liaise with policy makers across all jurisdictions as it further develops its professional engagement strategy and transforms itself to remain relevant and deliver greater member value. This saw another demanding year as the issues of registration and continuing professional development have been addressed across the region as part of the commitment to developing and maintaining the standards of education and best practice.

In the second half of 2012 a national consultation exercise was held on paramedic registration under the auspices of the Australian Health Ministers’ Advisory Council (AHMAC). A consultation paper was issued by the AHMAC Health Workforce Principal Committee on Options for regulation of paramedics which set out four options for the future regulation of paramedics and invited submissions from stakeholders.

A number of jurisdictional workshops were held at which PA was a prominent contributor at every session through the participation of both local and national representatives.

Concurrently, PA undertook the most comprehensive study of the Australian paramedic/medic workforce ever attempted, spanning all practice settings in public, private and defence practice, and across both local and international situations. This was done via a national on-line survey of practitioners and students. The PA Survey confirmed the national workforce was far larger and more diverse than was commonly thought and that the profession was strongly in favour of national registration with 86.7% of the respondents nationally wanting registration under the COAG framework or National Law.

The level of response (with well over 4000 full and partial returns), and the strong support for registration shows the profession’s commitment to ensuring the quality of paramedic care and in minimising the risk of harm to the public. The Survey results have been valuable in informing our work and have been incorporated in various PA submissions and policy discussions.

In September 2012 PA lodged a major submission supporting national registration under the title of Public Risk and Paramedic Regulation. This was supplemented by a number of individual and Chapter submissions. Later analysis of submissions showed overwhelming support for the registration of paramedics under the National Scheme administered by the Australian Health Practitioner Regulation Agency (AHPRA). This view aligns with the discussion paper Option 4 – Registration under the National Law. Out of 35 discussion tables formed during the consultation workshops, 34 supported Option 4.

To emphasise the extent and growth of paramedic practice, in November 2012 PA analysed the 2011 Australian Census results and published the outcomes in the paper Paramedics in the 2011 Census. This was sent to the registration project team as a supplement to the original registration submission. The report was also forwarded to Health Workforce Australia (HWA) for consideration by the HWA team currently undertaking a study of the paramedic workforce.

In an almost unprecedented move, the registration consultation period was reopened after initially closing on September 3 and continued until 25 January 2013. The catalyst for this is believed to have been a recommendation from the Office of Best Practice Regulation (OBPR).

To inform members, the various submissions have been highlighted in member mailings, posted on the PA website and promoted via Social Media and the electronic newsletter Rapid Response. Articles have been run in Response magazine and the various submissions and reports have been disseminated to Ministers and their advisory staff with appropriate follow up.

In December 2012, the changes in demographics of the profession were raised with the Australian Bureau of Statistics (ABS) with a view to having paramedics more appropriately classified at skills level 1 under the Australian and New Zealand Standard Classification of Occupations (ANZSCO).



This move forms part of a strategy to identify paramedics as a discrete professional group to be counted correctly within national Census figures in both jurisdictions.

While the ABS recognised the strength of the PA case, they declined to change the classification at this time since the proposed change is outside their present limited terms of reference for review. They have highlighted the matter for a coming major review exercise expected later in 2013/14.

Of particular interest in South Australia is that from 14 March, South Australia has a Code of Conduct for Unregistered Health Practitioners (which currently includes paramedics). The Code comes under the SA Health & Community Services Complaints Act 2004 and sets out a range of minimum standards. This regulatory development has particular significance for the private sector and employers with cross jurisdictional operations (see later). South Australia thus joins New South Wales in having a jurisdictional Code of Conduct for unregistered practitioners.

After a long delay, the AHMAC study on the Regulation of Unregistered Health Practitioners) was finally released in August 2013 (Decision Regulatory Impact Assessment: Final report – Options for regulation of unregistered health practitioners). The Standing Council of Health Ministers agreed in principle to strengthen state and territory health complaints mechanisms via a single national Code of Conduct for unregistered health practitioners to be made by regulation in each state and territory, and statutory powers to enforce the Code by investigating breaches and issuing prohibition orders.

Since it deals with all unregistered practitioners this report has some broad generalisations and doesn’t address the specifics of risks associated with paramedic practice. It is significant however, as paramedics will be captured in one or other jurisdiction or nationally by a Code of Conduct in the absence of registration. PA intends to respond to any consultation about the desirable conduct provisions in the Code and the distinctions that warrant independent registration for paramedics.

Related developments in Tasmania during January February 2013 saw the announcement of a Review of the Tasmanian Ambulance Service Act. PA prepared a response – Review of the Tasmanian Ambulance Service Act 1982 – incorporating our established positions on operational and national registration principles. No further consultation took place until the tabling of an Amendment Bill to the Act in late August 2013.

The implications for individuals and providers under the revised Tasmanian Act are substantial given the powers of the Commissioner under the Act. Among other things, the Act would recognise as a paramedic a prescribed person, or a member of a prescribed class of persons, who meets any requirements, conditions or approvals prescribed in respect of that person or class of persons. It defines a paramedic as a person with qualifications or qualifications and experience approved by the Commissioner and then makes it an offence to claim to be a paramedic or to claim that a business employs paramedics if they are not paramedics. The reservation/protection of title thus seems nearly absolute, but subject to the determination of a jurisdictional Commissioner and not an independent national regulatory body.

Among several other regulatory developments was a call in March 2013 by the WA Coroner for creating a definition of ‘paramedic’ and a form of registration that will ensure that only appropriately qualified people are entitled to use the title of paramedic and to be able to practise in Western Australia as a paramedic. For a number of reasons, PA’s preferred position to meet the identified needs is national registration and not jurisdictional legislation, and this view was relayed to the Minister.

There are a number of practical issues associated with paramedic practice that are significant in an independently registered practice regime. One of these is prescribing rights, and alongside the direct work on practitioner regulation and registration, PA lodged a policy submission on Health Professionals Prescribing Pathways with the HWA.

Articulating clear roles for the profession is highly desirable so as to have a framework around which discussions may be held with government and other stakeholders. PA therefore has continued its work on defining and positioning the profession, with the publication of the Paramedicine Role Descriptions document early in 2013. These descriptors have been widely distributed to paramedics, health professionals, Ministers and other stakeholders within Australia and internationally. The document has been well-received, with positive feedback and comment from members. The NCAU has endorsed the document and the UK College of Paramedics has expressed international support for the embedded principles. PA is disseminating these descriptors as widely as feasible and will review the content for any desirable editorial changes at the end of the year.

Trans-Tasman agreements mean that regulatory matters have cross jurisdictional impacts and the Trustees of Ambulance New Zealand some time ago lodged an Application for Regulation of Paramedics under the Health Practitioners Competence Assurance Act 2003 (HPCAA). With the establishment of the New Zealand Chapter, PA has enhanced its contact with a growing number of New Zealand members and Ambulance New Zealand in relation to regulatory matters.

An earlier PA submission in New Zealand on Statutory Regulation of the Health Professions has been followed up in October 2012 with a further submission to the review of the Health Practitioners Competence Assurance (HPCA) Act 2003. The PA(NZ) submission Optimising health care regulatory outcomes discussed the key issues relevant to paramedics and highlighted the important role that paramedics play in the patient journey.

PA is maintaining a watching brief on current developments but at the time of writing, there are no significant developments on paramedic registration in New Zealand. Any decision is expected to be delayed until the outcomes of the HPCA Review are determined.

In addition to submissions and discussion papers, our advocacy work has continued with private meetings with political leaders and senior policy advisors across all levels of government as well as with other health professions and groups. These include the Australian General Practice Network, the Australian Health Care Reform Alliance, the National Rural Health Alliance, and Services for Australian Rural and Remote Allied Health (SARRAH). PA has also worked closely with the Australian National Council of Ambulance Unions on relevant issues and has collaborated with private sector providers in examinimg proposals to establish a national Private Paramedicine association.

These submissions and consultation sessions, workshops and private meetings have constantly drawn attention to the role of paramedics in healthcare and the importance of practitioner registration in creating a suitable regulatory framework that will serve the public interest.

Among the more significant and wide-ranging liaison activities has been our close association with Health Workforce Australia (HWA). PA members are active on HWA Advisory Committees, Reference Groups and within the Future Health Leaders network. PA also has been engaged with a number of specific projects on Health Workforce Innovation and Reform including Extending the role of Paramedics, with the HWA currently funding a number of pilot studies nationally.

The registration agenda has many elements that are intertwined with the functions of paramedic service delivery. One example is the framing of a national competency framework.

The potential implementation of a registered profession and the mechanics of establishing a suitable regulatory board and supporting infrastructure arrangements will bring further changes to meet the requirements of the National Law. PA has prepared a summary of the likely issues requiring determination by any Paramedic Board in the event that registration is adopted.

The future nature and policing of CPD under AHPRA-like standards is another important matter to ensure compliance with any mandated CPD requirements under registration. Work is continuing on assessing the likely requirements and the current CPD offerings available throughout Australia from various providers. This work will help inform our future Continuing Professional Development activities.



If registration under the National Scheme becomes a reality, then PA hopes to play a suitable role in establishing the necessary infrastructure for a registration Board and contributing towards other functional arrangements such as accreditation. Similar professional input may be feasible if and when paramedic registration becomes part of the New Zealand regulatory scene under the HPCAA.

Despite the exceptional level of support from the public, professional bodies and paramedics themselves, there is no guarantee that a recommendation for registration will be adopted by the Health Ministers in the immediate future. PA therefore continues to work closely with all stakeholders to keep them informed and to respond as needed to any requests for input.

At the time of writing, no firm estimate is offered of a likely timeline for the consideration of any paramedic registration report and subsequent Ministerial determination. Recent contact with the project team indicates that there is unlikely to be any major development until late 2013. In the meantime PA will continue to deal with issues on the assumption that Option 4 Registration will be adopted.

Members may rest assured that PA will continue to provide strong leadership in promoting the development of the profession and in representing the interests of all practitioners and associated personnel across the region. It may take some years to achieve the goal of national registration, but that will come about through the efforts of many, a constant professional focus and solid groundwork.

Please visit the PA website to remain up to date on developments which are reported through the website, via Social Media, and through regular publications such as the Rapid Response electronic newsletter and Response magazine.

Ray Bange

Principal Policy Advisor

RESPONSEThis past year has been a success for Response. We have seen a range of article contributions from members and non-members who have an interest in out-of-hospital medical care. These contributions have covered a range of topics, including clinical items, case reports, discussions of points of view, and legal concepts.

Our regular contributions have grown and developed to provide a broader range of information and ensure coverage of ideas, concepts and knowledge that is relevant to members.

Student Paramedics Australasia has been a big contributor with an array of articles and information from the student community. This has included some great student articles discussing key clinical topics.

We have consistently provided news from employers, the Australian Resuscitation Council and of course, your local Chapters.

The Board has used Response as a means of communication with members to provide updates on activities being undertaken at a corporate level, and also to highlight key initiatives and opportunities that are relevant to the membership.

Our publisher, Emergency Media has continued to provide dedicated support in the development and printing of Response. I would like to personally thank them for their commitment to the quality of the journal and their facilitation in bringing the journal to you.

Thank you also to all of our contributors – without your articles there would be no journal!

I encourage everyone to submit to Response and have the chance of publishing your work – sharing your work is sharing knowledge and professional skills with other like-minded people. And, there is always the chance of being awarded the $150 Editor’s Choice Award!

If you have any suggestions or feedback on Rapid Response please contact us at: [email protected]

Rapid Response

The eNewsletter, Rapid Response has been consistently delivered this year to provide members with the latest updates from the Board, CPD activities and general news relevant to the out-ofhospital community. Using this electronic communication has enabled the Board to promptly deliver the latest news to inboxes, thereby ensuring that members are kept up to date with the latest opportunities and activities.

Once again, we encourage members to provide feedback on these activities to ensure that we are meeting your needs.

RURAL & REMOTEThe interests of paramedics living and working in rural and remote areas of Australia have continued to be supported by the activities of Paramedics Australasia’s Rural and Remote Special Interest Group.

Professor Peter O’Meara continues to do great work and engender robust debate as the website moderator. The R&R SIG provides a ready source of information and advice to all members as well as those with a particular concern for the unique needs of rural and remote communities. This information can be found at http://ruralremote.acap.org.au/

Paramedics Australasia is one of the member bodies of the National Rural Health Alliance. I have the privilege of representing the interest of Paramedics on this council. The National Rural Health Alliance is Australia’s peak non-government organisation for rural and remote health. Its vision is good health and wellbeing in rural and remote Australia and it has set itself the specific goal of equal health by the year 2020.

Fundamental to the Alliance’s work is the belief that, wherever they live, all Australians should have the opportunity for equal health outcomes, and equivalent access to comprehensive, highquality and appropriate health services. In 2012-13 the Alliance comprised 33 Member Bodies, each of which is a national organisation. They include consumer groups (such as the Country Women’s Association of Australia), representation from the Indigenous health sector, health professional organisations (representing paramedics, doctors, nurses, allied health professionals, dentists, pharmacists , health students, health service managers and chiropractors) and service providers (such as the Royal Flying Doctor Service, the Rural Hospitals Forum of Catholic Health Australia, the Rural Health Education Foundation, and Frontier Services of the Uniting Church in Australia). Their website is http://www.ruralhealth.org.au/

The National Rural Health Conference is the largest regular public event on the agenda of those interested in improving health and wellbeing in rural and remote Australia. The biennial Conference is the NRHA’s biggest project, it is a key element of its core business and sets much of the agenda for the Alliance’s work for each two-year period. It has become a key part of the agenda-forming process for the rural and remote health sector as a whole.

The 12th National Rural Health Conference was held in Adelaide in April and it was pleasing to see Paramedics Australasia’s members attending. This resulted with Paramedics having input into of the agenda-forming process for the rural and remote health sector of Australia.

While the SIG is alive and well, it will benefit from a greater level of participation by all practitioners and not just the rural cohort. We thus look forward to a heightened level of engagement by all members in the company year to help fulfil the growing influence of the paramedic profession in helping to shape health policy and practices.

John Richardson MPA




Is lack of Registration affecting your future?Cliff Collett

In early 2013 I was looking to combine my main passion, overseas travel, with some volunteer work. I was unfazed about where the work was or what type of work but felt if I could combine the skills I had learnt as a paramedic, (and possibly enhance those skills whilst away) I would then feel that I had achieved something.

A Google search provided a range of volunteer organisations that travelled to some really cool and somewhat isolated places, delving deeper into the qualification requirements for volunteers I discovered that most, if not all the organisations I was interested in, required medical support. Searching deeper still, these organisations had very specific requirements for the medical support personnel, doctor, registered nurse and/or registered paramedic. A few emails later it was confirmed that irrespective of my paramedic qualifications (Bachelor of Clinical Practice – Paramedic) and work experience (13 years) I would not even be considered as I was not registered in any State or Country. The organisations that offered what I was interested in were based in the United Kingdom (UK) and Canada where paramedics are registered and/or regulated.

It has always been frustrating to be qualified in Australia and not have one’s qualifications recognised outside your own State or Territory, or the fact that in the unregulated out of hospital care arena of Australia, anyone can call themselves a paramedic and potentially put the general public at risk. As other countries recognise the need to regulate and register paramedics to protect the general public from less than qualified practitioners, the lack of regulation and registration in Australia was now impeding my ability to even volunteer with some overseas organisations. Yet Australia has some of the highest education standards for entry level paramedics in the world, that being the bachelor degree. The quality of Australian paramedic education was once again commented on by the overseas guest speakers at the recent Paramedics Australasia conference in Canberra.

Deciding that it was time to stand up and be counted as a professional, the UK offered the opportunity to become registered and become accountable for my actions and clinical standards. The UK have had registration for paramedics since early 2000 and it is currently managed by the Health and Care Professions Council (HCPC). The ability to register in the UK is open to anyone but for those outside the UK or European Union (EU) the process is more complex and takes a little bit longer.

Having experienced how pedantic the British can be (three + years of living in London in the 90’s taught me that they do things by the book), I was well aware that once I started it was going to take the 16 weeks (as indicated on the HCPC website) to complete the registration process. This did not include the time it would take to compile all the information that was required and complete the registration form, 24 pages in all. The process looked quite daunting as I printed off reams of paper about the HCPC registration process, reaccreditation requirements, professional standards etc etc.

The actual application form was electronic, which made it easy to complete especially when one of the requirements was for a complete breakdown of major qualifications that I had obtained while practicing as a paramedic or to become a paramedic, and by complete it means complete. The actual course, each subject within the course and then the learning outcomes of each subject had to be spelled out, this part of the application form at first glance appeared to be the hardest part of the process but in the end turned out to be relatively simple. Contacting both the SA Ambulance Service (SAAS) education

unit (diploma and ICP course) and Charles Sturt University (degree) to complete this information, only required each institution being sent the relevant section for them to populate with the appropriate details. Each institution was aware of the process and requirements and had their part completed and returned within 3-4 weeks of receiving the form. The rest of the form was fairly standard, complete work life history (no time gaps allowed), any secondary courses, any professional bodies that I am involved with, both professional and character references, signed character declaration, signed police check authorisation and the authority to charge my credit card for just getting to this stage.

Approximately two weeks after I had submitted the application I received a letter from HCPC confirming receipt and explaining the process that was to follow: four weeks for my application to be reviewed to ensure that it had been completed correctly and all required certified copies of certificates had been submitted; followed by a further 12 week process where my application would be reviewed by two assessors from the paramedic registration panel followed by a further review of their decision by the education and training committee who makes the final decision as to my suitability to be registered in the UK.

At about the 16 week mark and with the usual British promptness a letter arrived congratulating me on being accepted as a registered paramedic, subject to paying the $240 (£152) registration fee (good timing with the Australian dollar being strong against the British pound), my registration card arrived a couple of weeks after paying the fee.

The HCPC registration is for two years, where as in Australia for example nurses are required to reregister every 12 months. It was interesting to read the registration letter and being informed that I was now “entitled to use a protected title”. In Australia anyone can call themselves a paramedic irrespective of education, training or clinical experience, yet in the UK it is a protected title and only those who meet the standards set by the HCPC and become registered are able to use the protected title “Paramedic”. Heavy fines and penalties apply if you are charged with unlawfully using a protected title.

Where to from here? As part of the process of being a registered professional I now need to take full responsibility for my education, training and clinical competence so in 2 years when my registration renewal is due, I am able to pass scrutiny in the event of an audit by the HCPC.

Points of View


The HCPC audit 2.5% of all registered professions on the anniversary of the professions re-registration, and if selected I will need to complete and submit a CPD profile (along with evidence) to prove that I have maintained and met the reaccreditation standards. HCPC reaccreditation audit standards are divided into a number of assessment criteria and include descriptive terms such as:1

Standard – “…up-to-date and accurate record of their CPD activities”.

Standard not met – “The registrant’s CPD is not relevant to their current or future practice, as described in the ‘summary of practice’.”

Standard partly met – “There is some evidence that the registrant has kept a record of their CPD”.

Standard met – “There is evidence … has maintained a record of their CPD activities, and as part of their supporting evidence they have sent in a brief summary of all the CPD activities…”.

Being audited is a standard process of any registered profession and for Australian allied health professionals such as nurses, it is a possibility that at any time the Australian Health Practitioner Regulation Agency (AHPRA), can ask for proof that they have met the standards to continue to be a registered professional. A Paramedics Australasia professional portfolio now sits on my book shelf and any CPD event, eLearning certificate, in-house training, clinical audits, conferences, webinars etc are now entered into my portfolio for that 2.5% chance of being audited.

Has registration changed my practice? I have always operated under the saying “Do No Harm”, and I always try to do what is best for my

patient, this has not changed. What has changed is the realisation and acceptance that I am now fully accountable and responsible for my actions, my clinical practice, my self education, that I am now open to public scrutiny and unable to hide behind my employer.

Have I used my registration to work as a volunteer? Not yet, but I did spend a week at a remote health care centre located at Big Bay, on Santo in Vanuatu while waiting to become registered. The health centre was run by two nurses from the Solomon Islands (an RN and RN/RM) who were more than happy to have us there, of course discussions were had about the role and skills of an Australian paramedic. It came as no surprise to myself that they were both surprised that paramedics are not registered in Australia considering our education, autonomy and skill sets, many of which can cause harm to a patient. If they can work it out why can’t we? I also learnt more about tropical illnesses in that week than in my 13 years as a paramedic and yes, you can survive without coffee.

About the Author

Cliff Collett FPA (Bachelor of Clinical Practice (Paramedic), Diploma of Applied Science (Ambulance Studies)) is an Intensive Care Paramedic with the SA Ambulance Service and works at Pt Pirie.

Reference

1. At the time of writing this article the South Australian Government was about to introduce legislation into the SA parliament to protect the title “Paramedic”, set required education standards and make it illegal for unqualified persons to call themselves a paramedic.

http://www.hcpc-uk.org

Points of View

Letter from the Convenor…


As the university year comes to an end, paramedic students from around Australia and New Zealand have been frantically studying: memorising GCS tables; running through primary and secondary surveys out loud to no-one; re-writing everyone’s favourite equation: CO2+H2O↔H2CO3↔H++HC03; drinking far too much coffee for one person; and staying up till the early morning most nights. This insanity is all about the determination to get through this year and move onto the next phase of their study. For the lucky ones, this will be the last exams they will ever sit for their degree.

Yesterday as I read through my facebook newsfeed, in procrastination of writing this article (yes, this fine skill I learnt in university has followed me!), I read a stream of updates from university paramedic student friends in their final year, who’d just received their letter of offer for employment by one state Ambulance Service. The sheer excitement and overwhelming relief that all their hard work had paid off was contagious.

I felt myself recalling my own feelings of elation when I first received my offer. The excitement that has a somewhat chemical reaction to jump up and down on the spot and do a happy dance, is a priceless right of passage for those exiting university study and entering the work force.

At a time when the task at hand seems so overwhelming, it’s important to focus on the light at the end of the tunnel. Remembering that you are in fact very capable of passing your exams and that your career as a paramedic is quite literally just around the corner. From those of us who have been in your shoes, we know just how tough it is, though speaking from experience, it is 110% worth the sleep deprivation, exhaustion and overwhelming fear that you won’t pass your biomed subject (because who really cares about mitochondria anyway?!).

As the year closes, new society committees are electing new representatives to follow on from the amazing work already completed this year. We would like to thank all of the committee members for their sheer dedication and commitment to the advancement of the next generation of paramedics.

To those of you brave enough to apply for positions - well done! There are exciting times to come for you! Not to mention fantastic management experience and networking that you’ll gain.

I would like to thank the SPA Executive Committee members for their unnatural dedication and for their amazing ability to band together as a team and create amazing outcomes. We are lucky to have such a fantastic team of inspiring future paramedics and future leaders!

There are changes in the wind for 2014, SPA looks forward to upgrading our infrastructure in the coming weeks, we’ll catch you all next year with a new look membership!

Happy holidays to the returning students for next year and a huge congratulations and good luck to those finishing university and stepping into paramedic uniforms!


“Finally got the letter I’ve waited 3 years for!!! Pretty Damn excited!!” – Justin.

“Can’t wait to start on road with some of the best friends i’ve met at uni! Congrats guys – this is

what we’ve been waiting for!” – Karen.

“It’s been a long time coming! Got my official letter of offer from ambulance!!” – Amie.

“Thanks to everyone for the support over the past three years while I’ve been studying and throughout the application process; you’re all amazing. I could not be

more excited to start my career as a Paramedic!” – Hayden.

with Crystal Cooke


University of Queensland

On the 3rd of September University of Queensland Student Paramedics (UQSP) held their second fundraising event and first professional development for the semester; a screening of Paramedico combined with a presentation from Author Ben Gilmour and a Q&A session.

This event was attended by UQ paramedic students, medical students, staff, local paramedics, health workers and even some visitors from other SPA groups. All agreed the film was fantastic, Ben was a great speaker and provided some fantastic insight to a wide variety of questions. Ben also took the time to talk to students and staff after the event had finished.

Across the two fundraisers UQSP have raised upwards of $450 for their Community Partners program.

UQSP held a members only social event; ‘Lawn Bowls and Happy Hour with UQSP’.

Some strained muscles indicate that perhaps the group should add more exercise based events to the UQSP calendar!

UQSP’s first event for semester two was on the 20th of August.

The evening was an opportunity to introduce the group’s two new Community Partners to the students group, while also raising some much needed funds.

What’s happening in the land of SPA…?


There was a BBQ with representatives from the community groups, followed by a presentation by the groups and a trivia night.

Unfortunately the Med students beat the Paramedic students in the trivia... but we say they cheated (a team of 7 compared with 4 people in all the other teams). In other words we need a rematch soon to even the score and raise some more money!

Victoria UniversityVictoria University Student Paramedics Australasia (VUSPA) just finished a six week Auslan course that was tailored to paramedicine students. Thirty-four people took on the extra challenge, and everyone enjoyed it. Many of the participants plan to come back for level 2!

Queensland University of TechnologySecond semester at QUT has provided students with some unique learning opportunities. Guest speakers from the Poisons Hotline and the Royal Flying Doctors Service have spoken about their daily tasks and how they assist the community and Paramedics.

ResponseVol 40 No. 4 – Spring 2013 19

The semester will be rounded out with a SPU run BBQ and some peer-tutoring sessions to assist with final exams.

Monash University

On September 22nd, a group of paramedic students from Monash were given the opportunity to participate in a joint mass casualty incident exercise with various branches of local Country Fire Authority (CFA) departments at the CFA Bangholme training facility.

Over the course of the day, three successive exercises were

undertaken with the scenario based around a vehicle colliding with

a diesel powered passenger train carriage. While there were different

CFA branches taking part in each drill, the paramedic students were

able to rotate through assorted roles including those of mock patients

in assorted stages of triage.

The paramedic students were overseen by two Ambulance Victoria

Instructor Paramedics who monitored each manoeuvre and provided

valuable advice before and after each event. It was a fantastic day

providing PARASOC with insightful learning experiences. Everyone

who took part in the event realised just how much more there is to

know about dealing with a mass casualty incident and how important

it is to undertake this type of training.

Flinders University

The FUSPA calendar has continued to flourish since our last update,

proudly offering members between 2–3 events per month. In early

August, FUSPA members met with employees of SA Ambulance

Service’s Special Operations Team at Adelaide airport for a tour of

the Special Operations unit and the MedStar Retrieval base. Many

members returned later in the week to further their insight into

South Australia’s retrieval service by attending the August Clinical

Governance Day (MedStar).

Thank you to all the SOT/Medstar employees and flight staff who

volunteered their time to present and induct us to your services on

both these days!




Later in the month, FUSPA members flew across to Victoria for the sixth annual Student Paramedics Australasia conference. South Australian students contributed to a personal best in attendance with more than 40 Flinders students attending the conference (compared with only three in 2012!).

September followed on with another busy month beginning with the annual Clinical Skills Camp which kicked off on the first weekend of semester break. This 3 day event took place at the Woodhouse “Old House” beside the adventure park. The weekend involved team-building exercises, emergency and non-emergency scenarios, case studies, navigation training and several guest speakers. FUSPA would like extend our gratitude to our volunteer facilitators and guest speakers: Hilding Hanna, Nick Williams, Kat Mason, Paul Salamon, Greg Wittles and Simon Coombe. Our thanks also to Flinders University for providing the university’s ambulance fleet and equipment.

September then offered students a look into post-grad employment. An employment information evening featured speakers discussing their employment with, or speaking on behalf of the following services: SA Ambulance Service, Ambulance Victoria, SiteMed and the Australian Defence Force. FUSPA would like to acknowledge our generous speakers Rob Elliot, Glenn Peddey, Kat Mason – and particularly Stacey Kelly who flew in from Victoria for this session.

A second session in the same week offered soon-to-graduate students a training seminar on interview panels in preparation for job application. This session was facilitated by Prof Grantham (professor of paramedics at Flinders University) and Mr Driscoll (operations manager SA Ambulance Service) and incorporated a mock interview between the pair who generously donated their evening!

September finished with a new event. A small group of members trekked across to the Australian Defence Force’s cadet Annual Field Exercise (AFx) at the Murray Bridge base. Here they presented to a group of 30 cadets taking part in the medic-specific section of this course.

Members presented and ran scenarios on a range of BLS topics, creating and presenting their own material.

An invitation was extended for FUSPA attendees to stick around to join the cadets in the later field component of this field exercise over the last 4 days of the session! James and Abbie (pictured below) stepped up to the challenge!

Charles Sturt University, Bathurst

Students from Charles Sturt University Student Paramedics Australasia (CSUSPA) in Bathurst were treated to an international guest presentation by Kris Gagliardi from St John Ambulance New Zealand. This CPD event showcased what it’s like to work as a young Intensive Care Paramedic in an international service.



CLUB RED CHALLENGE

The 2013 Student Paramedics Australasia CLUB RED Challenge has been more successful than ever with a total of 399 blood donations across Australia.

This means that SPA members have saved the lives of 1197 fellow Australians through their blood donations, almost one life saved for every SPA member. In the interest of fairness to all societies big or small, the winners are based on the percentage of donations to student paramedic society memberships. SCUSPA from Sunshine Coast University have claimed first place with PARAQUINAS from ACU Ballarat following close at second, and ACU Canberra coming in at a close third.

All societies should be proud of their contributions and SPA looks forward to running an even more successful and smooth CLUB RED Challenge in 2014. Society’s committees should keep a close eye on social media and email for updated CLUB RED details for 2014 and email the Community Engagement executive with any suggestions for next year’s challenge.

For more information on SPA’s Club Red Blood Challenge visit http://www.studentparamedic.org.au/index.php/community/club-red

SPA RED CROSS – CLUB RED 2013 FINAL

1. Visit www.donateblood.com.au or call 13 14 95

2. Book your appointment and write down your donor number.

3. Write down your donor number.

4. GO ONLINE and associate your blood donations with your local society. http://www.donateblood.com.au/who-can-give/club-red/join-group

5. Go donate blood!

Please use the society club names below to register for your society. PARASOC (Monash University)SPU (Queensland University of Technology) VUSPA (Victoria University)SCUPA (Sunshine Coast University)CSUSPA (Charles Sturt University) – BathurstUQSP (University of Queensland)PARAQUINAS (Australian Catholic University – Ballarat)SOAPS (Edith Cowan University)FUSPA (Flinders University)LASPA (La Trobe University Bendigo)SPSPA (Australian Catholic University - Melbourne) HOBSPA (University of Tasmania Hobart)CQUSPA (Central Queensland University)BRISPA (Australian Catholic University – Brisbane)CANSPA (Australian Catholic University – Canberra)


1. Who are you?

University of Queensland Student Paramedics or UQSP, based out of the School of Medicine at the UQ Ipswich Campus where a new Paramedic Science program was initiated in 2012 with the student society forming late that same year.

2. How many members do you have?

UQSP currently has 70 members; something we are proud of considering we only recently celebrated our first birthday and the current course enrolment is about 120. We are working on getting the remaining 50!

3. Committee Names and Positions

The UQSP committee structure has an Executive Committee, General Committee and Cohort Representative Group. We have had a big first year and plan an even bigger second year. We try to share the workload so we can provide the best for all of our members.

Our new Executive Committee for 2014 is:

• President: Rose Blackman• Vice President: Michael Birtill• Secretary: Chris Godden • Treasurer: Dan Rodriguez • Event Manager: Carolyn Emerson• Project Manager: Blake Singleton

Our Cohort Representatives:

• 2014 Cohort: Michael Birtill, Carolyn Emerson, Jessica Wissa

• 2015 Cohort: Dan Rodriguez, Emily Clancy

There are an additional 10 members involved in the general committee across a variety of roles.

4. Society motto.

One role we didn’t add to the committee structure was ‘motto writer’ and as such we haven’t got around to that… yet. What we can tell you is:

UQSP aims to provide our members with representation and support as well as professional and social opportunities throughout their degree.

Through a combination of professional development programs, community programs and social events the UQSP group provides fellow students with a variety of avenues for involvement that will not only contribute to their time on campus but benefit students in their development as future paramedics.

5. Tell us about projects and events from this year.

This year has included a mix of projects and events including:

Placement Packs –A duffel bag available for purchase that is big enough to carry our safety kit, lunch and some essentials that we have included such as a notebook, water bottle, penlight and shears.

Community Partners Program – UQSP has joined with Ipswich Hospice Care and Headspace Ipswich as community partners, organising fundraising events and providing volunteers.

SOCIETY SPOTLIGHT


UQSP Website – we have been building our website and expect it to be up and running around the end of the year, it will include event calendars, helpful links and a member’s resource section.

Skills Day – involving, races, group scenarios and OSCE practice sessions.

Social Events – including BBQs, a Trivia Night, lawn bowls and still in the planning phases a laser/paintball skirmish end of semester event and a committee leadership camping trip (what could possibly go wrong?)

Our CPD event for the semester was a screening of Paramedico with a presentation and Q&A session with author Ben Gilmour.

6. Why do you think being involved in a student paramedic society is important for the future of the students?

Involvement in UQSP and the wider SPA group provides our members with an opportunity to take control of their education and build professional development practices that will help them throughout their career. UQSP also believe that the personal and professional relationships formed through SPA will provide networks to support our students long after they have graduated.

For any membership or event enquiries please contact:

Email: [email protected] or

Facebook: www.facebook.com/uqparamedic.studentgroup


The 2013 Student Paramedics Australasia International Conference was SPA’s biggest and best yet! With 280 delegates, speakers, sponsors and exhibition booth holders this year was definitely a hub of excitement and a fantastic atmosphere for paramedic students and professionals to ‘talk shop’.

The speakers and presentations were outstanding; capturing experiences and insight from paramedics not only from across Australia and New Zealand but from all over the world. This kind of insight was invaluable and a one of a kind opportunity for all of us.

Speakers

Dr Robert Gooley – Cardiology consultant at MonashHeart Dandenong, VIC.– Presentation: Cardiac Cases: Assessing and treating a cardiac

patient

Brian Butler and Nicola Butler – Lateral Love Australia– Presentation: An aboriginal perspective: Cultural safety in service

delivery

Mathew Caffey – Paramedic Lecturer, Charles Sturt University; Critical Care Paramedic; Licensed Physicians Assistant (USA); pharmacology textbook author. – Presentation: Prescription Medications

Grant Gallagher – Paramedic Lecturer, Flinders University; SAAS Paramedic; Rod Kershaw ASM Scholarship recipient.– Presentation: Mass Casualty Indidents: Lessons from the

Palestinian/Israeli Conflict.

Christopher Foerster – Paramedic Tutor, University of Queensland; Lambton EMS Paramedic; Journal author.– Presentation: Been there, didn’t do that: Things I wish I knew as a

student paramedic.

Team Australia EMS: Current holders of the #1 Paramedic/EMS team in the world. – Presentation: Workshop on International EMS Competitions.

Jeff Kenneally & Dianna Inglis: Ambulance Victoria MICA Team– Presentation: The Paediatric Patient: Big emergencies brought

down to size.

Kris Gagliardi: Intensive Care Paramedic, St John New Zealand; Founding trustee of the NZ Paramedic Education & Research Charitable Trust.– Presentation: Earthquakes in New Zealand: Being a young

Paramedic in a natural disaster.

Delegates had time to wander past all the exhibition holder booths and chat to representatives from ambulance services, universities, charity organisations and medical equipment specialists.

Student Paramedics Australasia would like to acknowledge the following organizations for their generous support and encouragement to the future generations of Paramedics:

2013 SPA International Conference

Special Feature

Our annual charity raffle was a great success, students’ parted ways with their dollars in support of the Day of Difference Foundation. This year we raised over $1600.

The purpose of the Foundation is to permanently reduce the incidence and impact of children’s critical injury in Australia. The money raised will go towards the Foundation’s Paediatric Critical Injury Research Program which builds evidence to deliver improved outcomes for critically injured children, their parents and families. This pioneering program, led by Associate Professor Kate Curtis of the Sydney Nursing School, University of Sydney will take 6 years and $960,000 to complete.

An Australian-first, the program comprehensively explores the challenges faced by these children and their families throughout the trauma journey. It will assess the health-care system’s efficacy in addressing these challenges. SPA is happy to support such a worthwhile organisation that has such close links to the everyday cases that paramedics in Australia experience.

Following on from a very successful day of learning, engaging, and networking, SPA thought it best to continue the fun and host an After Party. This gave all delegates, speakers and guests the chance to chat one on one in real time. Geographical boundaries were broken down, new friendships were formed and future prospects were discussed. With upwards of 150 guests, the event was a definite winner!

The big post conference announcement was made that thanks to your continued support over the last six years the SPA international conference has grown into the biggest annual event for student paramedics in Australia and New Zealand. Melbourne has been an excellent host city over this time. However, SPA believes that the time has come to begin sharing this event, so that other student bases have the opportunity to facilitate and participate in the activities.

With this in mind, the 2014 Student Paramedics Australasia conference will be held in Brisbane. We look forward to interacting with a whole new group of paramedic students in the sunshine state!


Special Feature


Special Feature

Paramedic Research Showcased at PA Conference 2013

The 2013 PA Conference once again showcased some of the latest local and international research being conducting in the field of paramedicine.

Some of the key highlights were the international speakers who gave a different perspective to out-of-hospital care. Associate Professor Henry Wang from the University of Alabama at Birmingham discussed the vital importance of scientific research for guiding and shaping Emergency Medical Services. He said that at times it is easy to brush aside science in the face of the daily demands of prehospital practice, but shared some important lessons that had been learnt from organised EMS research. This is the reason why investment in the research process is essential.

Paul Gowens and Paul Younger presented some of the latest research conducted in North East England – the study which was awarded the prize for ‘Research most likely to change practice’ at the 2013 999 EMS Research Forum in Cardiff, UK. The research project looked at the introduction of a sepsis screening tool and education program for paramedics and followed patients to review whether the patients received the sepsis treatment bundle.

Local research was also presented through oral abstracts and poster presentations – the topics covered a broad range of topics and ideas. These will be published in the Australasian Journal of Paramedicine (www.ajparamedicine.org) in the coming months.

Australasian Prehospital Emergency Health Research Forum

Awards for Best Papers and Best Poster were presented as part of the Australasian Prehospital Emergency Health Research Forum. For this year the winners were:

APEHRF (David Komesaroff) Best Paper

This year’s winner was Tony Walker for his paper titled: The optimal technique for removal of upper airway foreign bodies: a repeated-measures, cross-over trial in a porcine model. Co-authors of this paper were; John Lippman, David Taylor, Ron Slocombe, Christine McDonald and Gary Nolan.

Best Paper in the Category Higher Degree

The winner was Paul Davis for his paper titled: The Accuracy of New Zealand Paramedics’ Clinical Decision-making in the Application of an Autonomous Pre-Hospital Thrombolysis Protocol. Graham Howie co-authored this paper.

Best Undergraduate Student Paramedic Paper

The winner was Lynsey Smit for the paper on Management of ankle injuries in the prehospital environment – A review of the literature. Co-authored by Malcolm Boyle.

Best Poster

The prize for best poster was won by Paul Davey for his poster on the effect of paramedic position on external chest compression quality. Co-authored by Chris Whatman and Bridget Dicker.

Generosity Reigns

The generosity of paramedics was highlighted at the recent PA Conference in Canberra, with two prize recipients gifting their awards.

Tony Walker, the winner of the APEHRF (David Komesaroff) Best Paper Award has gifted his prize to another conference attendee: Judy Willie. Judy is the first indigenous paramedic in Vanuatu and attended the 2013 conference to extend her knowledge in the field.

The prize is a travel award currently worth $4000 and will allow Judy to attend one of the APEHRF reciprocal conferences and present a paper. The reciprocal conferences are held in the UK and the US and the prize

includes conference registration, return travel and accommodation costs.

Gary Strong won the door prize, which was a Panasonic Toughpad. Gary has donated his prize to the New Zealand Chapter of PA, to be used by individuals conducting field research.

PA would like to recognise and congratulate these most gracious gestures from our colleagues.

Conference Sponsors

PA would like to make special mention of our conference sponsors – without whom the conference would not be as successful. We thank them for their continued support and contribution to the profession.

• Laerdal (Platinum Sponsor)

• RAPP Australia

• Active Mobility

• AMSL

• Britax Automotive

• Byron Group

• Edith Cowan University

• Ferno

• Karl Storz Endoscopy

• Mayo Healthcare

• Medical Developments International

• Monash University

• Physio Control

• SP Services

• Stryker

• UCB

• Vidacare

• Zoll


Special Feature


Inspiring, thought-provoking, educational and fun

Views from a South Australian Rural Volunteer Ambulance Officer…Susan Felby

This year’s offering in Canberra centred around the all important field of paramedical research. It did not fail to impress the importance of such, nor the onslaught of forward thinking needed in this exponentially developing dimension of modern health care.

There was a very strong contingency of attendees from South Australia, and such a delight to mingle with paramedics from as far away as Vanuatu and the UK.

For an Ambulance Officer Volunteer, (and therefore having a somewhat limited scope of practice), the conference nonetheless gave tantalising insights into how paramedicine on all levels has the potential to evolve in the future- hopefully of course, in pursuit of excellence in care and improved outcomes for those we are called upon to treat.

There were plenty of delicious notations to take away for future perusal and further research, and most of the presentations were thought inspiring- especially those detailing some of the wonderful ‘gadgets’ that were also proudly put on display by the various companies.

Of particular interest were the Autopulse machine manufactured by Zoll- this unit was referenced in several presentations concerning CPR, and is credited in part for increased ROSC in cardiac patients. It promises to take on a critical role in continued patient treatment during extrication and transport where ‘all hands on deck’ are by necessity forced to be utilised elsewhere.

And unlike some of the other models of automated CPR machines on the market, this unit has not been linked to traumatic secondary chest injury as it squeezes the chest rather than pulverizes! The importance of consistent, effective CPR compressions were highlighted as being a major element in survival of cardiac arrest, and it was further impressive to see that feedback units were being utilised by ambulance services in the USA in order to provide a pictorial demonstration of the paramedic’s CPR technique on actual cardiac arrest patients. The resulting print-outs clearly demonstrate any failings in the quality of CPR delivered and are therefore a valuable learning tool.

Apart from the fabulous stretchers (that SA should’ve recently acquired!), another impressive piece of kit was the lactate test unit- just like a BGL monitor in size, shape and operation, these clever little devices are used to detect sepsis in patients in the pre-hospital setting. Again, this new technology was backed with an excellent presentation on the importance of early detection of sepsis by Paul Younger from the UK, and again promising to greatly improve survival outcomes for critically ill patients. According to one manufacturer, in the very near future, single monitors will test for all 3- sepsis, BGL and ketones, only requiring specific sensor strips, for each. It was very interesting to learn that most BGL monitors on the market give false readings on patients that are anaemic-in these cases, analysing BGLs to be higher than what they actually are. Such distortions have apparently been rectified in these new generation devices.

David Caldicott’s presentation on recreational drugs was informative, and highlighted the ongoing issues with the manufacturers of illicit recreational substances having the upper hand when it comes to staying ahead of authorities. Apparently even animal wormers are useful in the creation of some of these dangerous new potions!

David Page’s offering, “Daily Habits of Clinical Masters” was both inspiring and humbling, whilst the forum ‘To intubate or not intubate’ was not only amusing but also conjured a great deal of food for thought around the practice of intubation in general.

Overall, the 2013 Conference offered speakers, workshops and plenary that were fun, educational, inspiring and thought provoking. One feels that even within the next five or so years, vast improvements in pre-hospital care will arise for patients as a result of the relentless research being carried out into the science around the world today.

I’d like to thank Paramedics Australasia for supporting my participation through its sponsorship program. I gained a great deal of insight and enthusiasm for my ongoing role as a volunteer with SAAS, and look forward to watching the flower of paramedicine unfold into the future.

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The time has come to consider an alternative to Methoxyflurane use by Ambulance Service Paramedics Steven Wright

Abstract

This paper will compare selected Australian ambulance service guidelines against present SA Ambulance Service (SAAS) guidelines with the intent to compare the guidelines for the use of Methoxyflurane and discuss the potential hazards of exposure to the drug. It further seeks to consider a cost effective alternative solution, being IN Fentanyl, which is readily available to all paramedics.

Key Words

Methoxyflurane, Paramedics, Fentanyl

IntroductionMethoxyflurane (Penthrox®) for analgesia (doctor’s bag listing)1 notes ‘Methoxyflurane provides rapid short-term analgesia using a portable inhaler device’. Its primary role is in the acute trauma setting but it might also be used for brief procedures such as wound dressing or for patient transport. It is noted as a non-opioid alternative to Morphine and is easier to use than nitrous oxide.Methoxyflurane has been an integral part of paramedic practice for many years and was seen as an easy to administer and cost effective pain relief device. It was originally used as an anaesthetic agent however further studies noted the toxic effects on patients with the doses used.Several ambulance services presently uses Methoxyflurane as a first choice pain relief drug and it is then supplemented by the use of an opioid where the attending officer is qualified to use opioids. Where they are not qualified to use opioids, they are restricted to the use of only Methoxyflurane. Methoxyflurane is used as an initial dose of 3ml and the patient may receive a subsequent 3ml dose if the patient is being treated by some service paramedics.2,3 Whilst the single dose used per patient does not present as a hazard for the patient, the frequent exposure of the paramedic to Methoxyflurane both during a single shift and also the continued exposure during a shift rotation does18.In stating a single dose of Methoxyflurane does not present as a hazard for the patient, this is assuming the patient is encountering minimal exposure to the drug. Where the patients are encountering the drug on a regular basis and some times multiple times in a day or week, there is a potential for long term adverse reactions to be encountered.

Methoxyflurane Material Data SheetThe following section is a direct quotation of the data sheet provided by the Australian sponsor and distributor4,5

Pharmacology

Methoxyflurane vapour provides analgesia when inhaled at low concentrations. After Methoxyflurane administration, drowsiness may occur. During Methoxyflurane administration, the cardiac rhythm is usually regular. The myocardium is only minimally sensitised to adrenaline by Methoxyflurane. In light planes of anaesthesia some decrease in blood pressure may occur. This may be accompanied by bradycardia. The hypotension noted is accompanied by reduced cardiac contractile force and reduced cardiac output. Biotransformation of Methoxyflurane occurs in man. As much as 50-70% of the absorbed dose is metabolised to free fluoride, oxalic acid, difluoromethoxyacetic acid, and dichloroacetic

acid. Both the free fluoride and the oxalic acid can cause renal damage in large doses; however dose-related nephrotoxicity seen with clinical doses appears related to a combination of free fluoride and dichloroacetic acid.

Methoxyflurane is more susceptible to metabolism than other halogenated methyl ethyl ethers and has greater propensity to diffuse into fatty tissues. Hence Methoxyflurane is released slowly from this reservoir and becomes available for biotransformation for many days. Approximately 20% of Methoxyflurane uptake is recovered in the exhaled air, while urinary excretion of organic fluorine, fluoride and oxalic acid accounts for about 30% of the Methoxyflurane uptake. Studies have shown that higher peak blood fluoride levels are obtained earlier in obese than in non-obese and in the elderly.

Precautions

(ii) Liver disease: it is advisable not to administer methoxyflurane to patients who have shown signs of liver damage, especially after previous methoxyflurane or halothane anaesthesia.

(iii) Diabetic patients: may have an increased likelihood of developing nephropathy if they have impaired renal function or polyuria, are obese, or are not optimally controlled.

(iv) Daily use of methoxyflurane is not recommended because of nephrotoxic potential.

(viii) …

(ix) Health workers who are regularly exposed to patients using PENTHROX® inhalers should be aware of any relevant occupational health and safety guidelines for the use of inhalational agents. The use of methods to reduce occupational exposure to Methoxyflurane, including the attachment of the Penthrox Activated Carbon (AC) Chamber, should be considered. Multiple use creates additional risk. Elevation of liver enzymes, blood urea nitrogen and serum uric acid have been reported in exposed maternity ward staff.

Dosage and administration

For use only as an analgesic agent, see “contraindications”

Dosage: Up to 6 mL (2 x 3mL bottles) of PENTHROX® (Methoxyflurane) per day, vaporised in a PENTHROX® Inhaler. If refilling the Inhaler with a second bottle of PENTHROX® (Methoxyflurane) Inhalation Methoxyflurane, this should occur only once and must be conducted in a well ventilated area to reduce environmental exposure to Methoxyflurane vapour. To maximise safety, the lowest effective dosage of PENTHROX® (Methoxyflurane) to provide analgesia should be used, particularly for children and the elderly. The total weekly dose should not exceed 15 mL. Administration of consecutive days is not recommended.

The cumulative dose received by patients receiving intermittent doses of PENTHROX® (Methoxyflurane) for painful procedures (such as wound dressings) must be carefully monitored to ensure that the recommended dose of Methoxyflurane is not exceeded. Methoxyflurane may cause renal failure if the recommended dose is exceeded. Methoxyflurane-associated renal failure is generally irreversible.4,5

The above precautions quoted are directly from the Australian sponsor and the distributor recommends the use of a Penthrox Activated Carbon (AC) Chamber.

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The chamber fits into the dispensing unit and is used to filter the expired breath of the patient. The perceived advantages offered by this unit require the patient to expire their breath completely back into the unit and not allow any expired air to bypass the unit such as when they open their mouth to breathe out. As has been experienced by many paramedics, the patients that use the device will place their lips around the device to inspire but they will then open their mouth in a totally natural way and expire around the unit. Whilst the chamber is now included in selected packaging and at no additional cost to the purchaser, it potentially serves little, if any value and does not prevent exposure to those in the vicinity of the patient.

Malignant Hyperthermia The notes from the Australian sponsor and distributor4,5 also makes mention of precautions when the patient may be assumed to have Malignant Hyperthermia. Malignant Hyperthermia (MH) is an acute disorder, which develops during or immediately after the application of general anaesthesia involving volatile agents and/or depolarising muscle relaxants. The disorder is thought likely to be a result of a defect in calcium channel regulation in the muscle cell. It occurs when volatile anaesthetic agents and depolarising muscle relaxants interact with the calcium channel resulting in the clinical crisis.Whilst I have been unable to obtain figures for Australia, the United States has a reported frequency of malignant hyperthermia (MH) in the ranges from 1 in 10,000 patients receiving anesthetics to 1 in 50,000; and the reported frequency in children is higher. The true incidence of MH has not been established with precision due to a lack of universal reporting procedures there. The above quoted figures should also be viewed as being on the low side as many MH-susceptible persons have not been exposed to the triggering agents. The reported annual number of suspected MH cases per year in the United States is around 700.6

Hayes, et al, noted in their paper ‘muscular dystrophy: an old anesthesia problem revisited’ that whilst muscular dystrophy is not associated with MH, it is nonetheless wise to refrain from administering inhalational agents to patients with muscular dystrophy so as to avoid AIR and hyperkalemic cardiac arrest.7 Treatment of Malignant Hyperthermia is required immediately and that treatment is by the use of Dantrolene. Indications for treatment of malignant hyperthermia (MH) with Dantrolene include signs of hypermetabolism, a rapid rise in carbon dioxide in the face of an increase in the minute ventilation, tachycardia, muscle and or jaw rigidity (after succinylcholine), and fever (a late sign).8

As no ambulance service carries Dantrolene as part of their usual drug regime, Malignant Hyperthermia is a potential risk for patients when a paramedic is administering Methoxyflurane. This is due to the patient or family member not being aware of their genetic profile and the interaction with the ambulance service could be the first interaction with an inhalational agent. Also we encounter a number of patients suffering from Muscular Dystrophy and as above, this subset of patients may well fall into the same subset of susceptible patients.

Guidelines for Use of Methoxyflurane in Selected Australian Ambulance ServicesMethoxyflurane is used by all government funded ambulance services in Australia2,3,9,10,11,12,13,14,15,16 as a form of pain relief however the guidelines utilised by these services differ in the amount of Methoxyflurane that can be administered to a patient. They also vary in the amount of interaction a paramedic may have with the drug use per shift and also the order or use for the drug. In this section I will identify various guidelines used by Australian services and highlight the differing points when compared to the SAAS guidelines.

SA Ambulance ServiceThe SA Ambulance Service (SAAS) has differing guidelines2,3 for ambulance staff depending on their level of authority to practice. These levels include ambulance officer, paramedic, and intensive care

paramedic (ICP). Some sub streams also exist within the ICP level including extended care paramedics and rescue/retrieval paramedics. Whilst ambulance officers are restricted solely to using Methoxyflurane, both of the Paramedic and Intensive Care Paramedic guidelines note that pain control should not rely solely on inhaled analgesics and supplemental narcotics should be considered.2,3 Both of these guidelines continue to address the sequence of treatment as basic care, assess and record initial and ongoing pain scores and then to commence Methoxyflurane 3ml inhaled. Based on this guideline, all patients encountered by a paramedic or ICP, and requiring pain relief, will be offered Methoxyflurane prior to any other pain relief being considered. Whilst this is a guideline and is open to some interpretation by the attending officer, and they may choose to bypass the Methoxyflurane, from my experience most officers will commence with Methoxyflurane and rarely go to the next stage of narcotic pain relief.Ambulance officers in South Australia are educated to Certificate IV (Healthcare Ambulance), and include volunteers located in country stations and also career ambulance officers located in both the Adelaide Metropolitan area and larger regional centres. These officers provide the emergency ambulance responses to their allocated towns and areas. Whilst workloads do vary within each area of work, they are all limited to only Methoxyflurane as their pain relief of choice.To further expand on this point, volunteer ambulance officers and some career ambulance officers work in the smaller country towns and may have extended transport times and also be the sole responding ambulance to serious and multiple patient incidents. This work profile can translate into prolonged exposure to Methoxyflurane being used by a patient and also a second dose being required whilst being transported in the ambulance.In the Adelaide metropolitan area and larger regional areas, the career ambulance officers are rostered onto the Emergency Support Service ambulances and these are tasked predominately with non-emergency tasking, many of which involve pain and traumatic injuries. These officers may have a workload of up to 12 cases during their shift and many of these may require pain relief. Due to the nature of their workload and possible exposure levels, they could frequently encounter exposure to Methoxyflurane many times in a shift and also in an even greater concentration over their shift rotation of 4 shifts of 12 hours in a four day block. Whilst they have the option of seeking support from a paramedic or ICP crew, these are not always available and the patient would have been commenced on Methoxyflurane prior to the other crew’s arrival.Paramedics and ICPs may encounter a number of patients requiring pain relief both on a specific shift and also in their roster rotation of generally fours days on and four days off and this would therefore allow for a potentially large number of exposures to Methoxyflurane vapours during the shift rotation. As the general practice in SAAS is to swap around as driver and attendant after a case, this may limit the direct contact of a specific officer however it is also statistically likely that a specific officer may encounter a larger proportion of patients requiring pain relief which is similar to the interstate models where one paramedic will drive for the entire shift and the other paramedic attends. The ambulance is also an enclosed relatively small room and the driver will still be exposed to the exhaled drug by the patient and this will therefore still add to their overall exposure on a shift. The paramedic guideline includes the following wording ‘Consider the early activation of clinical support in all cases of significant pain or pain that is likely to be difficult to control’2 3 based on this, there is a high likelihood that an ICP may encounter a number of patients that have commenced using Methoxyflurane prior to their arrival. This would then add to their exposure amounts and would generally still have the patient using the inhaler whilst they commenced narcotic pain relief.

Ambulance Victoria Ambulance Victoria (AV) also has three general levels of paramedics providing their ambulance services; similar to SAAS however there are some sub sections providing specialised services such as the Air Ambulance paramedics and MICA paramedics.

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The AV guideline indicates the maximum dose of Methoxyflurane is 6ml per 24 hour period9. This appears to only relate to the patient and not the exposure of the attending paramedic. The starting dose of Methoxyflurane is 3ml which is the same as SAAS but they are able to repeat if required to the maximum of 6ml. Of note in the AV guideline is the following ‘Action – Consider Methoxyflurane and/or Fentanyl IN if appropriate or while establishing IV access’9. This point therefore allows the attending paramedic to make a judgement as to which drug they choose to use and is a way to limit both the patient’s and their exposure to Methoxyflurane.The Drug section of the clinical practice guideline CPGD0179 notes that oxygen supplementation may be added under the route of administration section and this is different to SAAS where this is no longer an option to add supplemental oxygen. Under the section titled Side Effects9, it is noted that exceeding the max. total dose of 6ml in a 24 hr. period may lead to renal toxicity. Once again the generally implied consideration is to the patient that has been exposed to the Methoxyflurane and not the paramedic that was present during the administration.

NSW Ambulance ServiceNSW Ambulance Service (ASNSW) has three general levels of paramedics providing their ambulance services, similar to SAAS with once again some specialised areas such as the Retrieval Paramedics and rescue (SCAT) paramedics.The New South Wales Ambulance Service protocol F410, notes under the pharmacological options that ‘an opioid is the preferred medication therapy for patients with moderate to severe pain’. Methoxyflurane is reserved for situations where the administration of an opioid is not authorised, contraindicated or in special circumstances…: They continue that Morphine is the first choice and Fentanyl is the second choice if unable to cannulate or contraindications to Morphine. Even in mild pain in adults, Methoxyflurane is listed as the second choice behind paracetamol demonstrating the intention of limited use of this drug. Based on this protocol, exposure to Methoxyflurane by paramedics would be extremely limited if at all during a whole shift rotation.In the pharmacology 220 protocol10, it lists Methoxyflurane may be repeated once if indications persist and a maximum dose of 6ml daily and 15ml weekly may be given. It continues further to indicate that oxygen should not be used in conjunction with the inhaler as is the situation in SAAS.As an attempt to limit the exposure of paramedics to Methoxyflurane, the protocol continues that ‘Methoxyflurane can only be administered twice in any one shift per paramedic’10. Only 3ml of Methoxyflurane can be administered at any one time in the back of the ambulance’. SAAS has no such exposure limit in place at this time however we generally use a 3ml maximum dose unless long transport times are experienced.

Queensland Ambulance Service

The Queensland Ambulance Service (QAS) has various levels of paramedics within their service but they roughly align with SAAS. They have a further stratification of their paramedics into Advanced Care level 1 and 2 officers and they also have Flight ICPs.

QAS use Methoxyflurane as a front line pain relief agent in conjunction with paracetamol, Morphine, Fentanyl and Ketamine11. The choice of drugs used appears to be the attending paramedic’s choice but it is limited by their level of training and authority to practice.

Under their CPG listed as pain management11, it includes the following special notes:• The total weekly dose should not exceed 15ml with administration

on consecutive days not recommended;• To reduce the risk of occupational exposure to Methoxyflurane

officers are to ensure the following:– Only one dose of 3ml should be administered per patient whilst

in the ambulance vehicle.– No single officer should administer more than two doses of

Methoxyflurane in the ambulance vehicle per shift.

– Where possible, ambulance vehicles are to be adequately ventilated.

– Oxygen administration via Penthrox™ inhaler should not be initiated in a confined space.

The pharmacology page under their Drug Therapy protocols12 lists side effects as… Renal/hepatic failure (following repeated high dose exposure). Whilst it does not indicate it, it is open to conjecture that the service has considered this possible side effect occurring with the exposure of their paramedics to routine administration of Methoxyflurane and has issued the above guidelines based on this.

St John Ambulance Australia (Western Australia) Inc

The St. John Ambulance Australia (Western Australia) Inc (SJWA) utilises 4 levels of officer ranging from ambulance transport officer to paramedic, similar to SAAS but they also have industrial paramedics due to the large number of mining and other industrial sites within their state.

SJWA utilises Methoxyflurane, Fentanyl and Ketamine as pain relief drugs13. Within their CPGs under 1.6 Relief of Pain they have the following indication for use of Methoxyflurane; ‘Note: Try giving Methoxyflurane first. If severe unrelieved pain use Fentanyl’.

Further examination of their CPGs13 reveals at 1.5 Use of Oxygen they have the following section: With’ Penthrox: inhaler:• 3L/Min. = at least 35% Oxygen.• 8L/Min. = More than 50% Oxygen.

As it appears the use of oxygen is not recommended by most services in Australia when using Methoxyflurane, I find this guideline for the use of oxygen to be concerning and would greatly enhance the available Methoxyflurane within the proximity of the patient and therefore in the proximity of the treating paramedic. The use of oxygen has also been shown to reduce the time that the Methoxyflurane will last due to the evaporation of the drug within the holder.1

The SJWA also utilises a skills manual to accredit their staff and also to demonstrate the correct use of a particular piece of equipment or technique for a skill. Under Skill 603 Administration of Methoxyflurane via Penthox™ Inhaler it indicates that a second dose of Methoxyflurane may be administered if required.

Within the same skill sheet, it makes mention of an activated carbon filter being available for staff to use and it indicates it ‘reduces the expired concentration of Methoxyflurane to the atmosphere when attached to the Penthox™ inhaler’14. It does not indicate the amount of reduction when used with an already expensive drug administration device and at what benefit based on patient behaviour to breathe out around the device?

Tasmanian Ambulance Service

The Tasmanian Ambulance Service (TAS) utilises a similar make up as SAAS but their paramedics in the country areas quite often work on their own or with a volunteer if available. Other branches are rostered exclusively by volunteer ambulance officers similar to SAAS with back up by paramedics when and if available. I initially had some difficulty accessing the paramedic CPGs but the volunteer CPGs are available on the internet15.

The ambulance officer CPGs that are available indicate that Entonox is still used in conjunction with Methoxyflurane and they are able to give up to 6 mls per patient.

The guideline states:

ISOLATED PATIENT/ DELAYED EVACUATION

Entonox if available

Methoxyflurane (PENTHRANE) Inhaled Analgesic

– self administered by patients of age of understanding of instructions

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Dosage Adult and Child

– 3mls via “Penthrox Analgiser” (with 2-4 litres of oxygen when available) MAX 6mls in 24 hours and 15mls in 7 days.

Special Note: Onset and offset of effect is 3-5 minutes

Methoxyflurane should not be administered in confined spaces unless a Scavenger filter fitted. The scavenger system is located on the patient side of the ambulance and is an electric operated suction outlet. SAAS ambulances also have this facility available. It tends to be noisy when used and if the rear heater or air conditioner is operated, the total noise level makes patient communication almost impossible.Once again oxygen is indicated for use and an upper limit for Methoxyflurane of 15mls in 7 days is advised. This is once again not the present situation in SAAS.The career staff guideline has just been updated and has not been released to staff at the time of writing this paper. I was able to obtain a copy of the proposed CPG and it follows a very close format and instructions along similar lines to the AV guidelines. The indication is to consider IN Fentanyl and/or Methoxyflurane however the use of IV Morphine is the preferred method.16

Experiences Worldwide With MethoxyfluraneMethoxyflurane has been withdrawn from the United Kingdom, the European Union and the United States some years ago due to the occurrence of renal failure in patients. As a result it no longer has a licence for use in the United Kingdom, the European Union or the United States. The use of Methoxyflurane was withdrawn in the USA by the FDA as of the August 16, 200117 due to adverse health outcomes both by patients and medical staff. The FDA determined that Methoxyflurane Inhalation Liquid, 99.9 percent should be withdrawn from sale for reasons of safety. The review undertaken by the FDA shows that Methoxyflurane is associated with serious, irreversible, and even fatal nephrotoxicity and hepatotoxicity in humans. The FDA then undertook a further review of the latest approved labelling for Methoxyflurane and has determined that this labelling is inadequate. The FDA believes that the risks of toxicity outweigh any potential benefits if Methoxyflurane is used according to the latest approved labelling. The FDA continued to explain its reasoning as since the initial approval of Methoxyflurane in 1962, alternative safe and effective anaesthetics have been approved by FDA and entered the market. The FDA determined that new clinical studies are necessary before Methoxyflurane could be considered for reintroduction to the market. There has been a further study by Cohen and colleagues noted in ‘Anesthetic Gases: Guidelines for Workplace Exposures’.18 The retrospective study by Cohen and colleagues reported that female dental chair side assistants who had experienced heavy exposure (defined as more than eight hours per week) to waste anaesthetic gases reported a significant increase in the rate of spontaneous abortions (19.1 per 100 pregnancies) compared with the rate in the non-exposed pregnant control (8.1 per 100). For the wives of dentists who had also experienced heavy exposure, a significant increase in the rate of spontaneous abortions (10.2 per 100) was also reported compared with the rate in the wives of dentists not exposed (6.7 per 100). The non-exposed group was restricted to those who did not report anaesthetic exposure in any of the years before conception and including the year of conception.Based on anticipated exposure rates of paramedics in Australia, this study is cause for a greater rate of consideration than is now given to the use of Methoxyflurane. Most patients in South Australia would utilise the Methoxyflurane from the initial arrival of paramedics to hospital arrival. Based on the CPGs there is no expectation to move to an opioid if the pain is controlled to a satisfactory level. This exposure time may well be close, if not exceed, the noted eight hours per week in the study above.

Safe Use Levels of Methoxyflurane by Patients and Paramedics

Methoxyflurane Product Sponsor and Distributor Information

The product sponsor and distributor (Medical Developments International Pty. Ltd. and Nycomed Pty Ltd) make it clear that a dose of up to 6ml (2 x 3mL bottles) of PENTHROX® (Methoxyflurane) per day, vaporised in a PENTHROX® Inhaler is the upper limit they recommend for a patient to receive4,5. They continue further to indicate a total weekly dose should not exceed 15ml and administration of consecutive days is not recommended. There are no direct recommendations related to the person who is administering the Methoxyflurane and the upper amounts they should be exposed to.It is generally accepted that paramedics could encounter Methoxyflurane use by several patients during both their shift and also their roster rotation. The sponsor and distributor have a section on their material data sheet that covers this intermittent use all be it by a patient. They note that ‘the cumulative dose received by patients receiving intermittent doses of PENTHROX® (Methoxyflurane) for painful procedures (such as wound dressings) must be carefully monitored to ensure that the recommended dose of Methoxyflurane is not exceeded’.4,5

Whilst most services do allow for the refilling of the Methoxyflurane inhaler, SAAS specifically does not allow this, with the exception of ambulance officers and only after a consultation with an ECP, however a direction from the sponsor and distributor is still relevant to SAAS uses. It is noted on the material data sheet that if refilling the Inhaler with a second bottle of PENTHROX® (Methoxyflurane) Inhalation Methoxyflurane, this should occur only once and must be conducted in a well ventilated area to reduce environmental exposure to Methoxyflurane vapour. The issue of a well ventilated area is something that is open to wide interpretation and could be considered not to occur in many of the situations where Methoxyflurane is used. Paramedics are often commencing treatment in a room or other enclosed area and this also would apply to the rear compartment of an ambulance. The rear compartment of an ambulance is indicated as not being suitable by several ambulance services in their guidelines listed above. This then leads to an interpretation that the use of a second vial by ambulance officers in the rear of an ambulance would not be conducive with the manufacturer’s recommendations and could lead to potential adverse effects to the paramedics and the patient. The sponsor and distributor continue to state that to maximise safety, the lowest effective dosage of PENTHROX® (Methoxyflurane) to provide analgesia should be used, particularly for children and the elderly. They also indicate that Methoxyflurane may cause renal failure if the recommended dose is exceeded. Methoxyflurane - associated renal failure is generally irreversible.

Present Guidelines to Limit Exposure of Patients Implemented by Ambulance ServicesThere are clear guidelines indicated for the use of Methoxyflurane issued by the product sponsor and distributor (Medical Developments International Pty. Ltd. and Nycomed Pty Ltd) setting both an upper limit per day and also per week with the added recommendation of use not occurring on consecutive days.4,5 This appears as an attempt to limit exposure of patients to the drug and also move responsibility to the end use provider to monitor the use by patients and be responsible if these guidelines are breached and some harm comes to the patient.Whilst all of the Australian ambulance services examined above make a point of pointing out the recommendations in their guidelines, no point is made for the paramedic, issuing the Methoxyflurane, to ask the patient when they last used it. This also leaves the option for the patient to call multiple times in a short period of time, and appear to be and indicate they are in pain, to obtain exposure to Methoxyflurane. A give away may be the request for ‘the green whistle’ or a comment such as ‘they always give me the green whistle when ever I call’ however this may not act as a warning to the attending paramedic. The patient could then potentially be exposed to an increased amount of Methoxyflurane and thus an increased risk of side effects.

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All ambulance services have a number of patients that call for the same problem on multiple occasions and these are colloquially know as ‘frequent flyers’ within the pre-hospital arena. These particular patients may be at extreme risk of suffering the noted renal and hepatic effects of prolonged use of Methoxyflurane and the question is then who would be held legally accountable for the harm and damages they incur if it became a legal matter seeking compensation for their injuries? I feel this may well fall at the feet of the ambulance services due to the frequent and uncontrolled provision of Methoxyflurane to the patients. This cost could well become a large and unnecessary liability on the ambulance services and is counterproductive on the services and their ability to provide services in the future. Another problem encountered by ambulance paramedics, when dealing with patients using Methoxyflurane, is that the chance of a patient who receives Methoxyflurane being seen by the same crew again in the foreseeable future is limited. If they were to be seen by the same crew they may be noted to have received Methoxyflurane recently or even that day. As paramedics work a rotating roster and cover a large area whilst on shift, it is rare to ever see the patient again within a week or two even if they were to ring for service every day. Unfortunately I can not see a way of preventing repeated use of Methoxyflurane by patients as there is limited available information able to be kept under privacy law. Also there is a large private and event first aid services that now utilise Methoxyflurane as a follow up pain relief agent after Paracetamol due to the strict licensing arrangements for opioid drugs. These services may use Methoxyflurane whilst the patient is with them and the patient may be transported to hospital by other means and not the state funded ambulance service. These patients would thus be unknown to the ambulance service and as such, no records would be maintained on their exposure to Methoxyflurane. If the patient was not to inform the paramedics of this use or the patient was not asked, then once again the opportunity for increased Methoxyflurane use would be possible and highly likely.

Present Guidelines to Limit Exposure of Paramedics Implemented by Ambulance ServicesThere appears to be limited acknowledgement by ambulance services in Australia of the risk that repeated exposure to Methoxyflurane may have on their paramedics and ambulance officers. Many acknowledge an upper limit of 6ml per patient per day and the distributor continues further to indicate an upper limit of 15ml per seven days but only two services have a limit per paramedic.ASNSW limits exposure to Methoxyflurane to an administration twice in any one shift per paramedic10 however they also maintain an upper limit of 6ml per patient. This could potentially allow one paramedic to be exposed to 12ml per shift based on two patients utilising 6ml of Methoxyflurane each. They do limit confined space exposure in the ambulance to 3ml of Methoxyflurane being administered at any one time. QAS11utilise a similar CPG to ASNSW however it indicates that a patient should not exceed a total weekly dose of 15ml with administration on consecutive days not recommended. They have expanded further on their attempts to limit occupational exposure to Methoxyflurane for their paramedics on the same limits as ASNSW but also, where possible, ambulance vehicles are to be adequately ventilated.

AV, SJWA, TAS and SAAS9,13,15,16,2,3 have no such exposure limits in place at this time and a paramedic can be exposed to a large amount of Methoxyflurane in a shift and further during their rotation of work. This leaves these services in a position that may involve liability should a paramedic become sick or injured as a result of exposure to Methoxyflurane.

A Safe Exposure Level to Methoxyflurane for ParamedicsThe sponsor and distributor of Methoxyflurane in Australia make mention of exposure to paramedics in their material data sheet issued in the packet and also in their publications. They note that ‘Health workers who are regularly exposed to patients using PENTHROX® inhalers should be aware of any relevant occupational health and safety guidelines for the use of inhalational agents.

The use of methods to reduce occupational exposure to Methoxyflurane, including the attachment of the Penthrox Activated Carbon (AC) Chamber, should be considered. Multiple use creates additional risk. Elevation of liver enzymes, blood urea nitrogen and serum uric acid have been reported in exposed maternity ward staff’5.They further have a recommended exposure for patients of 6ml of Methoxyflurane per day with a total exposure of 15 ml per week with consecutive daily exposure not recommended. This is not listed as a consideration for paramedics but based on the above note; it could be reasonably assumed that it would also apply to paramedics. There is also a noted reference to the above study by Cohen and colleagues in relation to maternity ward staff. This then adds credence that the same risks would be possible and a risk to paramedics when interacting with Methoxyflurane. Whilst it may appear simple to transpose the patient limits above to the paramedics being exposed to Methoxyflurane, it would severely limit the amount of times a paramedic could use Methoxyflurane. Based on a roster configuration of four shifts on and four shifts off, a paramedic could reasonably be limited to using Methoxyflurane a maximum of four times over the four shifts and not on consecutive days. The end result would be a number of patients that could not receive effective pain relief based on a Methoxyflurane first/only use basis. A study by toxicology consultants commissioned by NSW Ambulance has found that methoxyflurane is unlikely to cause significant adverse health effects in ambulance officers.19 The report did, however, recommended that no more than two patients are to be administered methoxyflurane per shift and that oxygen was not to be administered concurrently. This is in order to keep exposure levels below that recommended by the National Institute for Occupational Safety and Health.20 Many paramedics in Australia are now part of private ambulance and first aid services on their rostered days off and these services presently use Methoxyflurane as their second line pain relief drug. Whilst the findings of this paper will also be relevant to them, it will be even more relevant to the state ambulance services as this would potentially be another exposure within the weekly limit noted by the distributor. This would then further limit the number of times it can be used during the rostered hours of their employee and add considerably to possible adverse reactions being received by paramedics.

Atmospheric Testing in VictoriaThe sponsor and distributor of Methoxyflurane in Australia states in their documentation that ‘approximately 20% of Methoxyflurane uptake is recovered in the exhaled air’. This therefore translates to the paramedics being exposed to that amount when treating the patient and more importantly, when transporting the patient in the enclosed ambulance. Ambulance Victoria has undertaken atmospheric testing of Methoxyflurane in their ambulances at various locations.21 These have included driving around the metropolitan suburbs and also at Essendon Airport. These reports have shown that both the driver and the attendant of the vehicle are exposed to high levels of Methoxyflurane when it is used in the back of an ambulance.Further studies were undertaken when the original results were obtained during the road testing and they then moved to the airport to allow for the use of open spaces and greater wind to be encountered. This test showed some reduction in the total exposure levels but it could be construed as being an unreasonable test method to lower the readings as ambulances do not normally travel in such an open and exposed area as found at an airport during the transport of patients to hospital.The original test in ambulance conditions would hold as the correct way for the test to be undertaken as this is the scenario that is experienced by ambulance officers on a daily basis. The readings obtained during this testing showed a high concentration of Methoxyflurane was encountered by both officers. This must then be expanded on to allow for the amount of time that those officers would be exposed in a shift and then in their entire shift rotation. It cannot be viewed as a total exposure level on its own.

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Occupational, Health Welfare and Safety Considerations

Occupational Health, Welfare and Safety considerations must form the very beginning of any consideration for the use of a drug, treatment regime or procedure involving paramedics. Safework SA, in their publication ‘WORKPLACE HEALTH AND SAFETY HANDBOOK’22 notes the following:

Preferred order of control measures to eliminate or minimise the risk of injury or harm.

1. Elimination — removing the hazard or hazardous work practice from the workplace.

2. Substitution — substituting or replacing a hazard or hazardous work practice with a less hazardous one.

3. Isolation — isolating or separating the hazard or hazardous work practice from people involved in the work or people in the general work area.

4. Engineering controls — if the hazard cannot be eliminated, substituted or isolated, an engineering control is the next preferred measure.

5. Administrative controls — this includes introducing work practices that reduce the risk, such as providing procedures, instruction and training.

6. Personal protective clothing and equipment — these should be considered only when other control measures are not practicable or to increase protection. While essential for some work procedures, these should be last in the list of priorities.

In some instances, a combination of control measures may be appropriate. There appears a very easy way to eliminate the hazard and also substitute it for a less hazardous substance at no further cost expense to ambulance services and I now wish to address that.

Is There a Safe Alternative? The simple answer to the above question is yes and it is already being used by a number of ambulance services in Australia. Intranasal (IN) Fentanyl is listed as available for use by paramedics as a first line pain relief drug either as an alternative to Methoxyflurane or combined with it. The availability of IN Fentanyl therefore would make the removal of Methoxyflurane from paramedic staffed ambulances a real and highly effective means of limiting the danger to paramedic’s health and safety. This could also be extended to all levels of ambulance care and would ensure a safer environment for the staff to undertake their duties. Whilst there would be some increased training required for some ambulance staff, there is a large percentage of paramedics that are already authorised and trained in the use of IN Fentanyl. Based on the large number of trained staff, the changeover could occur immediately an ambulance service chose to cease the use of Methoxyflurane.

IN FentanylFentanyl is an opium-derived pain reliever first synthesised in Belgium in the late 1950s. It is a powerful narcotic that is almost 100 times stronger than Morphine. It was first used in the 1960s as an intravenous anesthetic, but its medical use was strictly regulated as it is one of the most potent drugs ever created.Several ambulance services in Australia use Fentanyl Intranasal 600mcg/2mL 2mL supplied by ORION Laboratories Pty Ltd. This particular preparation requires no mixing by the paramedic and is ready for use. The only preparation required is the drawing up of the desired amount of the drug and the attachment of the atomising device.The cost to SAAS of IN Fentanyl is comparable with the present cost of Methoxyflurane and therefore no cost increases would be expected once a change was made. There may also be a chance of a price reduction based on the increased use of the new drug and its movement from the experimental first use phase of its development into the medically expected and utilised arena. Should use also increase in other ambulance services, then a further reduction could be expected in the cost of IN Fentanyl.

SAAS is also introducing IN Fentanyl to the ESS paramedics via an increase in their clinical knowledge and practical application of the drug so this also lends itself to a wider exposure to all ambulance officers and paramedics in South Australia.

Paramedic Use of IN FentanylAs stated above, all ambulance services in Australia, that I have been able to obtain access to their guidelines, already use IN Fentanyl to some extent. Whilst it is not a first line drug for pain control in several, I believe this is because the other services have only recently changed to including IN Fentanyl in their guidelines. The main area of limited use of IN Fentanyl seems to be the ambulance staff with a limited scope of practice. Whilst this may seem appropriate, I believe the time is right to increase the level of knowledge within this group and therefore increase their skill set to include IN Fentanyl.I do not believe a set of patients should be denied an increased effect and longer lasting drug that is also safer for all involved in its use.In most regions of Australia, it is the country volunteers and paramedics that have the longest transport time and are limited in their choice of drug to assist in limiting pain in their patients. They also tend to have the roughest transport conditions and this does not allow for the prevention of further pain. This is also transposed in the metropolitan area where our ESS paramedics tend to encounter a larger percentage of patients that also require pain relief and they are denied access to IN Fentanyl at this time. The added advantages of ease of use and length of effect would allow greater relief of pain for the patients and this would also continue once they were received at the hospital. As there is usually a delay from arrival until pain relief is started, the use of IN Fentanyl would thus cover this time gap.

Patient Pain ControlOptimal pain management is the right of all patients and the responsibility of all health professionals. Additional to this is the safe provision of the optimal pain management for both the patient and the attending health professional. IN Fentanyl has a slightly longer time to effect than Methoxyflurane however it has a distinct advantage that it’s duration of effect is considerably longer. It also does not require the patient to continue to hold the administration device. I believe for these reasons the use of IN Fentanyl is the optimal pain management drug of choice for ambulance services as a first line drug in place of Methoxyflurane.

RecommendationsAfter due consideration of all of the research undertaken SAAS is placing itself at considerable risk by maintaining the reliance on Methoxyflurane as a first line drug for pain relief. The exposure rates of paramedics could well be considered a breach of the Occupational Health, Safety and Welfare Act and also the government’s policies issued by SA Health and the premier’s zero harm initiative.Also as there is considerable risk of patients being exposed to Methoxyflurane above the recommended doses, it also leaves the service open to legal action should a patient consider they have suffered because of their experiences with Methoxyflurane.For all of the above reasons, SAAS should move from a regime of Methoxyflurane use in pain relief guidelines for all levels of paramedics and ambulance officers and replace it with IN Fentanyl. This will be a contentious move amongst both paramedics and the medical profession but the risks to paramedics and their patients outweigh those concerns and views.

ConclusionMethoxyflurane has been removed from use within the USA and UK for many years based on conclusive evidence that is was both harmful to patients and the people administering it. The review undertaken by the USA FDA showed that Methoxyflurane is associated with serious, irreversible, and even fatal nephrotoxicity and hepatotoxicity in humans. In Australia testing has been undertaken by two states and

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this has resulted in a limiting of exposure for paramedics and also the high levels present within an ambulance when Methoxyflurane is used.At present, SAAS is open to legal action by a patient that has been given Methoxyflurane and suffers an adverse reaction due to the lack of questioning by paramedics about previous use but also because the patient may not disclose previous use. In addition to this, SAAS may be placing their staff in direct danger by the use of Methoxyflurane in an enclosed area and by the frequency of use within the service. Within SAAS, I do not see any area where the safe use of Methoxyflurane would be achievable and we already have a multitude of staff trained to administer the safer option. This could then be extended to cover all paramedics and ambulance officers involved with SAAS and without any increase in cost and minimal training time. In conclusion, optimal pain management is the right of all patients and the responsibility of all health professionals. Additional to this is the safe provision of the optimal pain management for both the patient and the attending health professional. It is therefore paramount that SAAS should consider ceasing the use of Methoxyflurane and implement an occupationally safer alternative, namely IN Fentanyl without delay.

References

1. Methoxyflurane (Penthrox) for analgesia (doctor’s bag listing) Published in NPS RADAR Date published: 10 November 2010 http://www.nps.org.au/publications/health-professional/nps-radar/2010/may-2010/methoxyflurane (accessed 1 June, 2013).

2. SA Ambulance Service. Clinical Practice Guideline. Paramedic Pain control, 15-Mar-2012 https://www.saambulancestaff.com.au/NR/rdonlyres/8E38508B-AD28-4666-B47A-1259BE468A33/20893/CPGCS023PainControlV20120316.pdf (accessed 1 June, 2013).

3. SA Ambulance Service. Clinical Practice Guideline. Intensive Care Paramedic Pain control, 01-Jul-2009 https://www.saambulancestaff.com.au/NR/rdonlyres/8E38508B-AD28-4666-B47A-1259BE468A33/12968/CPGCS055PainControlV10090702.pdf (accessed 1 June, 2013).

4. Medical Developments International Ltd. Penthrox (methoxyflurane) Product information, July 2010. http://www.medicaldev.com/pdf_files/Products_Pain_Relief_Patients/Consumer%20Medicine%20Information%20Sheet.pdf (accessed 1 June, 2013).

5. Medical Developments International Ltd. Penthrox (methoxyflurane) Consumer medicine information, October 2010. http://www.megamedical.com.au/_literature_115957/Penthrox_Medicine_Information (accessed 1 June, 2013).

6. Emedicine - Malignant Hyperthermia http://emedicine.medscape.com/article/1445509-overview#aw2aab6b5 (accessed 1 June, 2013).

7. Hayes J, Veyckemans F, Bissonnette B. Duchenne muscular dystrophy: an old anesthesia problem revisited. Paediatr Anaesth. Feb 2008;18(2):100-6. http://reference.medscape.com/medline/abstract/18184239 (accessed 1 June, 2013).

8. Emedicine - Malignant Hyperthermia (Treatment) http://emedicine.medscape.com/article/1445509-overview#a11 (accessed 1 June, 2013).

9. Ambulance Victoria. Clinical Practice Guidelines. Drug Presentation, 10-Sept-2003. http://www.ambulance.vic.gov.au/Media/docs/x05_CPG%20_PHARMACOLOGY-web-b1ea4130-2728-4556-8c12-f3ba27c3eee7-0.pdf (accessed 1 June, 2013).

10. Ambulance Service of New South Wales. Protocols and Pharmacology, January 2011. http://www.ambo.com.au/download/protocol_2011.pdf (accessed 1 June, 2013).

11. Queensland Ambulance Service. QAS clinical practice manual, 2011 http://www.ambulance.qld.gov.au/medical/pdf/cpm_introduction.pdf (accessed 1 June, 2013).

12. Queensland Ambulance Service. QAS field reference guide, 2011 http://www.ambulance.qld.gov.au/medical/pdf/frg_101212.pdf (accessed 1 June, 2013).

13. Clinical Practice Guidelines for Ambulance Care in Western Australia Version 11 http://www.fair-go.com/docs/Clinical%20Practice%20Guidelines%20V11%2022.07.11.pdf (accessed 1 June, 2013).

14. Skills Manual for Ambulance Care in Western Australia Version 6 h t tp: / /www.fa i r-go.com/docs/Skillls%20Manual%20V6%2020.07.11.pdf (accessed 1 June, 2013).

15. Department of Health and Human Services HEALTH AND HOSPITALS - AMBULANCE TASMANIA Volunteer Ambulance Officer Clinical Protocol Manual Version: 1.0c 21 January 2013 http://www.vgate.net.au/downloads/VAO_Protocols_21-01-13.pdf (accessed 1 June, 2013).

16. Personal communication with Tasmanian Clinical Educator17. Federal Drug Administration reasons for withdrawal http://www.fda.gov/ohrms/dockets/

dockets/04p0379/04p-0379-ans0001-vo l1.pdf?utm_campaign=Google2&utm_source=fdaSearch&utm_medium=website&utm_term=Methoxyflurane&utm_content=2 (accessed 1 June, 2013).

18. Occupational Disease in Dentistry and Chronic Exposure to Trace Anesthetic Gases (Abstract). http://www.ncbi.nlm.nih.gov/pubmed/6930434 (accessed 1 June, 2013).

19. Flynn M. Clinical update – methoxyflurane. Sirens 2001; 6: 420. Flynn M. Clinical update – methoxyflurane. Sirens 2002; 7: 2. 21. Eva and Associates Pty Ltd report for Ambulance Victoria titled ‘AMBULANCE VICTORIA

METHOXYFLURANE STUDY SUMMARY’ dated 21/06/1122. Safework SA Workplace Health and Safety Handbook Updated November 2012 http://www.

safework.sa.gov.au/uploaded_files/hsr_handbook.pdf (accessed 1 June, 2013).

About the Author

Steven Wright, BHthSc (Paramedic), AFPA, is an Area Clinical Team Leader, Intensive Care Paramedic with the SA Ambulance Service and works in Adelaide South Australia. He has been a career paramedic with SA Ambulance Service based in metropolitan, country and air ambulance operations for the last 26 years.

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Unifying emergency pharmacology: Creating medication guidelines for paramedic students Matthew R. Caffey and James W. Crane

Abstract

Despite an increasing focus in healthcare on the use of evidence-based practice, paramedic pharmacology guidelines vary greatly between the different states of Australia and also New Zealand. Imported textbooks, differences in medication availability, and provider/service preferences result in a lack of consistency in the choice of pharmacology options used for the treatment of many common medical emergencies.

As the paramedic profession continues to move towards tertiary education and national registration, the lack of consistency in drug guidelines presents a challenge to educators and paramedic students alike. In an attempt to address this issue, an examination of current ambulance guidelines throughout Australia and New Zealand was conducted and the results compared against existing literature and approved information from therapeutic regulatory agencies. After this review, information relating to ninety-two medications was compiled into a standardised format in an attempt to provide a unified view of the pharmacological profile and recommendations for use within Australasia of each medication.

The end product is a reference that consolidates the differences in pharmacology guidelines that currently exist in Australasian emergency medicine. To our knowledge, this reference represents a first of its kind drug guide for medical education in the Australasia region to aid in the teaching of emergency pharmacology to paramedic (and other healthcare) students.

Key words

Paramedic, Medical education, Pharmacology guidelines, Student references, Emergency medicine

Introduction

There is a shortage of paramedic texts developed specifically for the Australasian region and imported texts often differ from Australasian paramedic practice in important ways, such as language, treatment policies and information related to fundamentals of practice.

This discrepancy between available textbook material and Australasian paramedic practice is a specific problem to educators attempting to teach to current national trends.1,2,3,4 In addition, a lack of conformity between paramedic practice guidelines throughout the states and territories of Australia, and New Zealand, further complicates attempts to unify the paramedic education to Australasian standards. Yet, as the industry continues to move towards graduate entry-level qualifications and national registration, universities must produce students capable of working not only within their local jurisdictions, but the rest of the Australasian region as a whole.5,6,7

The teaching of pharmacology typifies the difficulties faced by paramedic educators attempting to teach to Australasian standards. Pharmacology is a complex practice that is made more difficult to teach by the many variations that exist between state and international guidelines. For example, there are four different pharmaceutical interventions for the treatment of nausea (each proven to have a similar efficacy) that are used within emergency medicine regularly based on provider preference.8

Furthermore, each ambulance service may then only employ one or two of these agents, and then describe items such as mechanism of action or dosages differently.

These differences create difficulties for students who find themselves faced with learning the fundamentals behind the drugs used in their current jurisdiction as well as the details of other medications used throughout the region. In order to simplify the teaching, and learning, of emergency medicine pharmacology, a review of all current ambulance service guidelines in AU and NZ was conducted and the results compared to the current recommendations from therapeutic regulatory agencies.

The results of this review were then used to compile a manual “Paramedic and Emergency Pharmacology Guidelines” suitable for undergraduate and post-graduate paramedic (and other medical) students within the Australasian region.9

Reviewing the Guidelines

The most recent copy of each Australian state ambulance service’s guidelines or protocols was located to examine their pharmacology sections. In addition, guidelines were reviewed from the Australian Resuscitation Council, St. John Ambulance Australia, St. John Ambulance New Zealand and Wellington Free Ambulance of New Zealand.10,11,12,13

A list combining all available drugs from these existing guidelines was created and assessed for use in the emergency medicine setting. This initial assessment first removed redundancies such as multiple preparations of the same drug or similar medications of the same class that are not used throughout the vast majority of Australasian practicea. Next, regional specific items, such as some vaccinations, antivenins and less common antipsychoticsb were removed.

Lastly, in order to make the list more inclusive of emergency medicine and useful for additional students beyond traditional paramedic practice, several reversal agents/antidotes and other emergency medications were added to the listc. A complete index of the medications included (and list of appendices included in the guidebook) can be found in Table 1.

Once a medication list was compiled, a profile template (see Table 2) was developed that recorded the necessary details about each medication. This profile included: a basic description of the drug, indications, mechanism of action, pharmacokinetics, contraindications, adverse effects, precautions and facts, preparation, and dosages with administration routes.

These fundamentals were chosen based on the requirements and recommendations by Therapeutic Goods Administration’s Australian Regulatory Guidelines for Prescription Medicines and the United States Food and Drug Administration’s Labeling for Human Prescription Drug and Biological Products Format.14,15 In addition, a general ‘body or organ system’ indication(s) was included for grouping of medications into similar areas (i.e. cardiac, respiratory, etc.).



Lastly, the state ambulance service region where the medication was in scope of practice for the paramedics was included to enable students to determine the pharmaceutical agents available to them in their current or future work-place learning settings.

Examining the Differences and Reviewing the Literature

The first draft of the standardised profiles from the data pool yielded many differences for mechanisms of action, dosages and pharmacokinetics. Smaller variations were seen between indications, contraindications, adverse effects and precautions that were mostly dissimilar in phrasing and listing, than contextually different. In order to homogenise the profiles and rectify these differences, each medication was then sourced using Australia’s Therapeutic Goods Administration, the United States’ Food and Drug Administration and the United Kingdom’s Monthly Index of Medical Specialties databases.16,17,18

These reports were then compared against the standardised profiles to ensure that each medication included the recommended and approved indications, contraindications, side effects and dosages. Changes were made to adjust the language or phrasing differences between the varying profiles in order to simplify each section’s details and match only the approved or reported indications, contraindications and side effects from these databases. Dosages were then adjusted to ranges for most medications to ensure that the approved dosage(s) in the literature matched the dosage variability between regions.

Additionally, an internet based literature review was carried out through Scopus, PubMed, Google Scholar, Web of Science, Web of Knowledge, EBSCOhost, Primo and peer reviewed journals. During this review, the search term used was each individual medication to be included into the guide. There were no limits placed on year of publication during preliminary searches, however, in general only studies published within the last ten years were evaluated.

For inclusion in this review, studies needed to address either the mechanism of action or the use of each medication in a clinical setting to demonstrate efficacy, dosages or other pertinent information that related to its usage. Studies that were excluded from this review were

Page Medication

1. Acetylcysteine

2. Activated charcoal

3. Adenosine

4. Adrenaline

5. Adrenaline dosages

6. Alteplase

7. Amethocaine

8. Amiodarone

9. Aspirin

10. Atropine sulphate

11. Benztropine

12. Benzyl penicillin

13. Calcium

14. Ceftriaxone

15. Clopidogrel

16. Co-phenylcaine

17. Dexamethasone

18. Dextrose 5%

19. Dextrose 10%

20. Dextrose 50%

21. Diazepam

22. Diltiazem

23. Diphenhydramine

24. Dopamine

25. Enoxaparin

26. Ergometrine

27. Fentanyl

28. Fexofenadine

29. Flumazenil

30. Frusemide

31. Glucagon

32. Glucose gel

33. Glyceryl trinitrate

34. GTN dosages

35. Glycopyrrolate

36. Haloperidol

37. Hartmann’s solution

38. Heparin

39. Hydralazine

40. Hydrocortisone

41. Hydroxocobalamin

42. Hypertonic saline

43. Ibuprofen

44. Insulin (regular)

45. Ipratropium bromide

46. Isoprenaline

47. Ketamine

48. Ketorolac

49. Labetalol

50. Lignocaine 1%

51. Lignocaine 2%

52. Loratadine

53. Lorazepam

54. Magnesium sulphate

Table 1: Table of contents from Paramedic and Emergency Pharmacology Guidelines (Caffey, 2012)

Table 2: Example of pharmacology profile seen in Paramedic and Emergency Pharmacology Guidelines (Caffey, 2012)

Fexofenadine NSW, SA, St. John (AU)Page Medication

55. Mannitol

56. Metaraminol

57. Methoxyflurane

58. Methylprednisolone

59. Metoclopramide

60. Metoprolol

61. Midazolam

62. Morphine

63. Naloxone

64. Nifedipine

65. Nitrous oxide

66. Noradrenaline

67. Ondansetron

68. “-oxime”

69. Oxygen

70. Oxytocin

71. Pancuronium

72. Paracetamol

73. Phenytoin

74. Prasugrel

75. Prednisolone

76. Prochlorperazine

77. Promethazine

78. Propofol

79. Protamine sulphate

80. Rocuronium

81. Salbutamol

82. Sodium bicarbonate

83. Sodium chloride 0.9%

84. Suxamethonium

85. Tenecteplase

86. Tetanus toxoid

87. Thiamine

88. Tirofiban

89. Tramadol

90. Tranexamic acid

91. Vasopressin

92. Vecuronium

93. Verapamil

94. Vitamin K

Appendix A: Common prescriptive medications

Appendix B: Common emergency medication trade names

Appendix C: Index of drugs by their emergency indications

Appendix D: Fibrinolytic checklist

Appendix E: Formulas

Appendix F: Common abbreviations

Appendix G: Common paramedic level medications

Notes Section

Description Second generation antihistamine Allergies

Indications Allergic reactions, mild to moderate

Mechanism of Action

Blocks H1 histamine receptors, preventing the action of histamine, reducing inflammation, oedema and other symptoms of allergic reactions. Does not cross the blood-brain barrier and therefore does not readily produce drowsiness.

PharmacokineticsOnset15-30 minutes

Peak Effects2 hours

Duration12-24 hours

Contraindications Hypersensitivity to fexofenadine

Adverse EffectsDrowsiness, dizziness, headache, fatigue, nausea and dry mouth

Precautions & Facts None for its indication

Preparation 180 mg tablets

DosageAdult: 180 mg PO tablet

Paediatric: Not usually indicated in the emergency setting




ones that did not address the medication’s usage or mechanism in human clinical settings.

From this literature review, additional changes were made to the mechanism of action and precautions/facts categories. Terminology was simplified and made analogous across each category to ensure that the bulk of information was included and accessible to undergraduate-level students.

Forming the Final Product

Several review panels were formed consisting of academics within the School of Biomedical Sciences, Charles Sturt University. These review panels focused on evaluating the final profile for each drug to determine its accuracy and suitability for educational use. These panels allowed the formation of a unified opinion on each drug profile from paramedic academics whose backgrounds included clinical expertise in paramedicine, nursing, emergency medicine, hospital-based practice, critical or intensive care, and aeromedical specialities. In addition to these panels, feedback was obtained from the Department of Pharmacy, Charles Sturt University and practicing paramedics in Australia.

To limit profile size and to ensure guidelines were relevant for both undergraduate and postgraduate education, several additional adjustments were made to the drug profiles. First, only the preparations listed by either the ambulance services or manufacturers’ guidelines were included in the profiles. Second, only the most frequent or most severe side effects were included under adverse effects. Lastly, a number of appendices were added to the guidelines to provide tools for recognition of common prescription and trade drug names, indexing of medications by emergency indication and paramedic level, an analogous fibrinolytic checklist, medical math and formula assistance charts, and a table of common medical abbreviations.

Discussion

Williams, Brown and Onsman (2009) argued that the paramedic profession has not yet set standards for its body of knowledge, but tertiary institutions are still providing paramedic graduates for the nation and the varying ambulance services.5 Producing standardised texts provides students with the core knowledge that could one day be moved into a paramedic professional body of knowledge. This paper describes the production of a universal medication guideline that aims to provide a valuable reference for profession and students in paramedic programs across Australasia.9

With the exception of Manias and Bullock’s Fundamentals of Pharmacology (2011), there are generally no published pharmacology texts specifically tailored for allied health care students in Australasia.19 Other texts give relevant pharmacology details for medical students or health care in general, but not give paramedic programs the emergency focus they desire. International texts such as Bledsoe and Clayden’s Prehospital Emergency Pharmacology (2012) could be used, but its North American focus risks alienating or creating disinterest in paramedic students and/or educators in Australasia.20 The reference guide produced as a result of this project aims to provide educators with a useful adjunct to existing resources.

The reference guide produced could also assist students develop and maintain their proficiency with medications during simulated clinical practice or work place learning. Baker et al (2011) identified that the most commonly prescribed or used drugs are associated with the highest number of errors.

Fact checking with a reference guide provides the opportunity for students to limit their errors.21 Additionally, Baker et al (2011) further noted that the creation of a core list of common medications provided a framework for the development of training programs to improve the use of those medications.21

The amalgamation of the paramedic medications for Australasia, as begun-in the current pharmacology guide, could contribute to the development of a new curriculum for paramedic tertiary educational programs.

As discussed in the Reviewing the Guidelines section, medications were added to the universal guidelines to make the reference guide more applicable to other tertiary education programs. Both paramedics returning for post-graduate degrees and additional health care professional students such as medical students, registrars, nurses, etc. could benefit from a reference guide that includes a majority of common emergency medications. For example, as working paramedics return to tertiary institutions to further their career in such areas as intensive care, remote and rural healthcare, nursing, etc., a greater knowledge of additional emergency medications allows them to be more versatile in the fields beyond the ambulance or typical paramedic practice.

Additionally, the paramedic profession is moving towards possible extended care roles and a reference guide for a larger collection of drugs can prove beneficial in teaching for this expanded scope of practice.23 On the other hand, other healthcare students who may have to know many more drugs during their courses could lack the emergency or in depth focus needed for clinical practice. Manias and Bullock (2002) found practicing clinical nurses believed that nursing students suffered deficits in their pharmacology knowledge and education.22 These deficits could reflect a lack of exposure to emergency medicine, and access to a standardised emergency medicine pharmacology guide could be of assistance to these students.

Paramedic services in Australasia have traditionally used guidelines or protocols to provide field practitioners a standardised approach or ‘framework’ for their clinical decision making.6 Clinical practice guidelines (CPGs) are normally based on systematic reviews of existing clinical evidence and then involve multiple disciplinary groups (such as advisory committees) for the appraisal of the research, drafting of recommendations and consultation for their final development and these processes do not generally differ for ambulance services.24 This regular use of clinical practice guidelines is a significant consideration for paramedic education in Australasia as universities must start working together to produce standardised curriculum guidelines in order to move towards national accreditation and becoming a recognised profession.25

The Council of Ambulance Authorities (2010) has begun towards this direction by creating training and competency standards that can be used by both tertiary institutions and ambulance services.26 This document details two key points required of a paramedic for pharmacology: “practices within an approved scope of practice and demonstrates the knowledge and understanding required for practice as a paramedic [which further includes] ‘understands the clinical sciences underpinning paramedic practice, including... pharmacological’”.26

The ability to function in an ‘approved scope of practice’ for many providers can mainly be interpreted as following the clinical practice guidelines set forth by the varying ambulance services. Furthermore, Paramedics Australasia (2011) released competency standards that mirror this point with a competency specifically for the use of evidence based guidelines during clinical practice (2.b.4).27

Ultimately, if the concept for standardisation can be coupled with existing pharmacology guidelines, tertiary education can then move towards teaching universal clinical guidelines in order to create a professional body of knowledge. These guidelines could then be recognised by a future national governing body in order to ensure graduates meet the competencies of the profession.



Conclusion

Here we report on the development of a reference that amalgamates emergency pharmacology guidelines for Australia and New Zealand.9 In doing so, it unifies the discrepancies throughout the region and provides an appealing tool for paramedic and other health care students. Pharmacology like much of clinical science is based on evidence-based medicine and requires research, review and then evaluation to construct functioning guidelines for practice. As the paramedic profession continues to move forward in regards to nationalisation, standardisation in education, such as this pharmacology reference, provides a valuable step in unifying the professional body of knowledge. Furthermore, teaching paramedic and other health care students in tertiary institutions national pharmacology standards provides them with knowledge that can be beneficial to them throughout their careers.

Key Points• Clinical practice guidelines for paramedic pharmacology vary

across Australasia and regional tertiary institutions are producing graduates who could be employed anywhere in the nation.

• There was no standard or universal pharmacology text for Australasian paramedic students.

• The creation of a universal emergency pharmacology guide creates a first step towards possible standardisation in paramedic tertiary education in Australasia.

• Paramedic and other health care students benefit from having an emergency pharmacology reference that they can study for practice with any ambulance service or medical institution across Australasia.

References

1. Smith, G. (2009). [Review of EMT Prehospital Care, 4th Edition]. Journal of Emergency Primary Care 7(2).

2. Lord, B. (2009). [Review of Pharmacology for the prehospital professional]. Journal of Emergency Primary Care 7(2).

3. Hamilton, L. (2008). [Review of Pediatric Education for Prehospital Professionals’ – 2nd Edition. American Academy of Pediatrics, Ronald A Dieckmann (Ed). Reviewed by Leanne Hamilton.,” Journal of Emergency Primary Health Care 6(1).

4. Peters, M. (2007). [Review of Paramedic Pearls of Wisdom – 2nd Edition]. Journal of Emergency Primary Health Care 5(3).

5. Williams, B., Brown, T. & Onsman, A. (2009). From stretcher-bearer to paramedic: the Australian paramedics move towards professionalization. Journal of Emergency Primary Health Care 7(4).

6. O’Meara, P. & Grbich, C., eds (2009). Paramedics in Australia: Contemporary challenges of practice. Frenchs Forest, NSW: Pearson.

7. Bendall, J. & Eburn, M. (2010). The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics. Journal of Emergency Primary Health Care 8(4).

8. Mee, M., Egerton-Warburton, D. & Meek, R. (2011). Treatment and assessment of emergency department nausea and vomiting in Australasia: A survey of anti-emetic management. Emergency Medicine Australasia 23(2): 162-168.

9. Caffey, M. (2012). Paramedic & Emergency Pharmacology Guidelines. Frenchs Forest, NSW: Pearson Original.

10. Australian Resuscitation Council (ARC) (2013). Australian Resuscitation Council Guidelines.

11. St John Ambulance Australia (2011). Clinical Practice Guidelines for Healthcare Professionals, Australia.

12. St John Ambulance New Zealand (2011). Clinical Practice Guidelines. National Ambulance Sector Clinical Working Group, New Zealand.

13. Wellington Free Ambulance (WFA) (2011). Clinical Practice Guidelines. National Ambulance Sector Clinical Working Group, New Zealand.

14. Therapeutic Goods Administration (TGA) (2012). Australian regulatory guidelines for prescription medicines (ARGPM), Australia.

15. U.S. Department of Health and Human Services (HHS) (2013). Guidance for Industry Labeling for Human Prescription Drug and Biological Products – Implementing the PLR Content and Format Requirements, February 2013, USA.

16. Therapeutic Goods Administration (TGA) (2013). Product Information.

17. U.S. Department of Health and Human Services (HHS) (2013). Drugs@FDA: FDA Approved Drug Products. Center for Drug Evaluation and Research.

18. Monthly Index of Medical Specialities (MIMS) (2013). MIMS database drug search. Haymarket Media Group Ltd.

19. Bullock, S. & Manias. E. (2011). Fundamentals of Pharmacology. Sixth Edition. Frenchs Forest, NSW: Pearson.

20. Bledsoe, B. & Clayden, D. (2012). Prehospital Emergency Pharmacology. Seventh Edition. Upper Saddle River, New Jersey: Pearson.

21. Baker, E., Roberts, A. P., Wilde, K., Walton, H., et al. (2011). Development of a core drug list towards improving prescribing education and reducing errors in the UK. British Journal of Clinical Pharmacology 71(2): 190-198.

22. Manias, E. & Bullock, S. (2002). The educational preparation of undergraduate nursing students in pharmacology: clinical nurses’ perceptions and experiences of graduate nurses’ medication knowledge. International Journal of Nursing Studies 39(8): 773-784.

23. O’Meara, P., Tourle, V., Stirling, C., Walker, J. & Pedler, D. (2012). Extending the paramedic role in rural Australia: a story of flexibility and innovation. Rural and Remote Health 12(1978).

24. Turner, T., Misso, M., Harris, C. & Green, S. (2008) Development of evidence-based clinical practice guidelines (CPGs): comparing approaches. Implementation Science 3(45).

25. Williams, B., Onsman, A. & Brown, T. (2010). Australian paramedic graduate attributes: a pilot study using exploratory factor analysis. Emergency Medicine Journal 27(10): 894-799.

26. Council of Ambulance Authorities (CAA) (2010). Paramedic Professional Competency Standards V.2, Australia.

27. Paramedics Australasia (2010). Australasian Competency Standards for Paramedics, Australia.

a However, a note of these similar medications availability was still placed in the guide as possible alternatives to certain medications. For example, tropisetron and granisetron were included as alternatives with ondansetron.

b These medications were chlorpromazine and olanzapine.

c These medications included acetylcysteine, alteplase, diltiazem, diphenhydramine, flumazenil, glycopyrrolate, hydralazine, hydroxocobalamin, ketorolac, labetalol, lorazepam, mannitol, methylprednisolone, nifedipine, noradrenaline, oxytocin, prednisolone, protamine sulphate, tetanus toxoid, tranexamic acid, vasopressin and vitamin k.

Acknowledgments and Conflict of Interest Statement

Mr. Caffey declares that he receives royalties for the sale of the guidelines (Caffey, 2012) mentioned in this article. No funding was sought or granted for the production of the guidelines mentioned.

About the Authors:

Matthew Caffey, PA-C, MMS, CCEMTP is a Critical Care Paramedic, Physician Assistant and Lecturer with Charles Sturt University in NSW, Australia.

Dr James W. Crane, PhD is a Lecturer in Anatomy and Physiology for Charles Sturt University and Adjunct Research Fellow with the University of Queensland, Queensland Brain Institute.


TanzaniaJerry Barrett


Training ambulance staff

As health care professionals we all take Continuous Professional Development (CPD) for granted, in fact in my experience some staff even find it an onerous task that they do not always appreciate.

Most of us have gained our professional status through tertiary education resulting in a formal qualification (although this is not yet standardised across our profession), however in the past it was common for services to conduct their own non-accredited training.

Our Nursing colleagues have had a formal process for some time now, regulated by their governing body with direct input from their employment centre. Some training is mandatory, taught on a regular basis to meet legislative requirements to prevent injury to staff and ensure skill levels are adequate for the position that the health care professional holds.

This type of training is often initiated during our induction period or regular staff training days and can consist of manual tasking, training, drug calculations, CPG’s or possibly even skill stations.

The second component of my mission to Tanzania was to establish a training and familiarisation program for the medical staff in the local area that may be expected to use the new ambulance vehicles and equipment that had just been provided. As I noted in my last article, a fully equipped ambulance is reduced to an expensive taxi if the staff manning the ambulance do not know how to use the items inside.

Although I had gone to great lengths to base the ambulance equipment list on the KISS principle (Keep It Simple Stupid) I still had to establish what exactly the staff level of training was, not only in Tanzania but also more precisely the specific region that I was travelling to; I felt that this was essential.

Although I was working very closely with the Non-Government Agency (NGO) Global Health Alliance Western Australia (GHAWA) I found it very difficult to actually gauge the level of education in the nursing group I was expected to train. I was to discover later in my trip that the level of formal training seemed to differ from district to district plus the fact there was also a two tier system with Enrolled Nurses and Registered Nurses.

The group of staff that I had to train would consist of Registered Nurses, Enrolled Nurses and even some non medical drivers.

Another problem I was faced with was trying to fit the education sessions into the staff’s working schedule. Hospitals in Tanzania have the same staffing issues as any other health care system in the world; I could come up with the very best training schedule possible but if the staff could not be spared to attend it would all be in vain.

On top of the rostering issue I also had to deal with the fact that I had to train staff from three different locations on the same day!

I was based in the village of Masanganya, this location was approximately 45 km away from the main hospital (located in the town of Kisaware) and connected by a single road, sealed for only the last 10km.

Masanganya was the least resourced location in my group, boasting a dispensary

manned by a Doctor and a dedicated group of 4-5 nurse/midwives; all of which lived nearby in the old leaky medical building. There was no power and potable water had only just been provided via a single bore some weeks prior to my arrival (thanks to GHAWA).

Approximately 12 km up the road was the second satellite medical facility located at the village of Masaki. This boasted a larger clinic with multiple buildings; outpatients department and wards.


They also had a brand new Operating Theatre built by an International Aid organisation, but with one problem (that mimicked my rationale that an ambulance was only an expensive taxi if the equipment did not meet the level of the operator); the Operating Theatre lay unused due to the dual problems of no doctors with surgical experience and the fact the room was supplied with an Operating Table but no means of providing Anaesthesia; no Anaesthetic machine and no Anaesthetist! Never the less Masaki had 240 A/C power and a potable water supply.

The central medical resource was undoubtedly the district hospital located in the town of Kisaware, the hospital there catered for Outpatients, Obs & Gynae, Paediatrics, Surgical, GU and Medical patients. It boasted several ambulances (including motorbike combo’s), however very few of them were operational due to basic lack of service and extreme wear and tear. Kisaware were very reluctant to dispatch their ambulances to the villages of Masaki or Masanganya and hence the reason why GHAWA decided to provide these two busy medical services with a much needed medical response and transport system.

Hearts & Minds

From the start of the project I had wanted to locate myself within the community that I was about to facilitate; from my experience in Special Operations having the ability to cohabitate with the group of people gives you great street credibility. Experience tells us that communities in developing countries do not respond well to foreign aid workers driving in to visit and than driving out again without really getting a chance to absorb the atmosphere, contribute towards their community or to get to know the people.

To that end I requested to stay in the location with the least resources, and to experience their daily life and routine. I was mindful of the fact that these people did not have much in the way of spare accommodation; in fact I’m sure that if I had attempted to ‘google’ ‘bed and breakfast in Masanganya’ I would not get many hits. As there was no spare accommodation at all in the village it was decided that I could stay on the floor of the village dispensary, not the most luxurious location but certainly not lacking in atmosphere.

The Training

For mainly political reasons it was decided that I should hold the training in the administration building located at Kisaware hospital, I would hold two sessions a day for 5 days, There would be a morning session followed by an afternoon session so that staff from the other shift could attend. This soon hit a few logistical problems following the discovery that the nursing staff from Masaki and Masanganya would have to catch a bus from their village to attend the training. Already tight for time, and mindful that this extra hindrance would not place the staff in the most receptive of moods I decided to split the training locations between Kisaware and Masanganya, picking up and dropping off staff on route between the two locations as I travelled.

This worked well and staff were happy, it also gave me back an element of control in the training schedule; anyone with experience working in Africa may understand the element of ‘African Time’.

I decided to assume nothing and start at the basics; introducing the vehicle equipment and demonstrating how to use it. The first day saw us unpacking the vehicle equipment and locating it in the ambulance, this had two major advantages as it gave the local staff some input regarding the set up of the vehicle and it also gave me a chance to demonstrate and explain the equipment that I had chosen for the task. Of note during that first lesson was the lesson on the stethoscope.

All the nursing staff were used to using the stethoscope but had never been taught how to use it properly; they were amazed to discover that the head of the stethoscope twisted and had two different functions. This was a common phenomenon with the basic equipment they had routinely been using in the course of their work, they knew how to use it but had never been instructed properly.

Next on the training agenda was basic first aid skills; the fact that they were all nursing staff was not lost on me but in my experience not all nursing staff are proficient at first aid.



Once again my instincts were correct and staff had no idea how to use a triangular bandage to support an upper limb fracture or to immobilise a fractured leg. The staff found it fascinating how to adapt the various configurations of the bandage to serve a multitude of treatments.

One subject that was pencilled in on my training plan to deliver if I had the opportunity was CPR, the subject is an emotive one as I struggled with the concept of teaching these nurses a skill that may have limited benefit’s in their particular environment. There was no access to AED’s in any location where I was teaching, no CCU, no cardiac stenting, no catheter lab no cardiologists to diagnose arrhythmias so what was the point? The point was that they wanted it! Out of all the subjects on my list it was the subject that all the nurses wanted to learn, they had seen it in the movies and they had seen it on medical programs they watched but they had never been taught how to do it properly! Of particular interest was their desire to learn paediatric life support skills, without exception the group vocalised that they wanted to learn that skill as they all felt absolutely powerless to act in paediatric emergencies.

Language difficulty

Although I have had some experience of teaching first aid in Arabic the thought of delivering 5 days training in Swahili did have me breaking out into a cold sweat. The initial plan was to have a translator supplied for the duration of my stay, however that plan was quickly demolished due to the logistics of accommodation and availability. I was fortunate enough to have a group of very keen nurses, all with varied English skills and all very keen to participate in the training and that was a decisive factor.

In the end I managed to communicate with the group well enough to deliver the training with good effect.

Each subject had an assessment factor built into the training in order to document the competency level of the nurses, this was not to be an attendance only course. Each nurse knew that they had to be competent at the task before being signed off.

I guess the best example of how effective my training technique was about half way through the CPR lesson when the district Matron walked into the class. Matron had limited English skills but never the less requested if she could sit in on the rest of the class as she had a great interest in learning CPR.

At this point I asked the class if they felt competent at passing on the skills that I had taught them to Matron, this would be a sure way to assess their competency in the skill. The nurses delivered a perfect example of CPR instruction to the Matron, all in Swahili; Matron in turn demonstrated a wonderful replication of the CPR skills that she had been taught; in all an excellent example of ‘train the trainer’.

This example was repeated many times during my stay, I am confident that the staff that I trained will champion these issues and pass on the skills that they had been taught.

Benefits

My time with the people of Masanganya, Masaki and Kisaware was far too short however I honestly believe that I gave them the ability to use the equipment that we delivered. All the medical staff I interacted with had the positive desire to learn, and a passion to deliver the best care they could; I learnt as much from them as I hope they learnt from me.

One event that sealed my position in the village was when a young child was rushed to the dispensary in the middle of the night after she fell on some sharp bamboo. The Doctor was away from the village that night and the nursing staff woke me up to assess the wound as it was haemorrhaging quite severely. This wound was deep and needed a certain amount of debriding before it could be sutured; this required the use of my own medical pack and personal supplies, as the first aid supplies in the dispensary were limited to a roll of non sterile gauze and a few safety pins. I

have such a remarkable sense of admiration for the medical staff that have to operate this trauma service using nothing but the bare basics. Following that event the word must have spread as I was contently hailed as Mr Jerry or ‘Mzungu (white man) Paramedic’ wherever I went in the village for my remaining stay.

As a foot note, I returned again this year to conduct some reinforcement training for the staff and I was impressed to see the ambulances looking clean and tidy despite their incredible work load.

On my second day there we were called out to attend a 95 km priority one obstetric emergency, mostly on unsealed roads (but that could be another story).



ACROSS2. The management of an Australian native

snake bite involves the application of a pressure bandage and? [14]

10. Sugar state characterised by altered behaviour, pallor and diaphoresis. [13]

12. Clinical Practice Guideline. [3]14. The first ‘P’ in CPAP. [8] 16. Alternate title for a supraglottic airway.

[3] 19. Classification of Diabetes Mellitus where

disease is due to, at least in part, insulin resistance. [6]

22. Normal adult respiratory tidal volume. [5]

24. Temporary neurological deficit from cerebral ischeamia. [3]

25. Abbreviation for condition experienced by Type I Diabetics with uncontrolled Hyperglyceamia. [3]

26. The first line medication for the management of cardiac arrest. [10]

28. Spinal nerve responsible for the nipple line. [2]

29. This street drug results in pinpoint pupils. [6]

31. The most important part of managing thermal burns (not including the airway). [7]

32. New Zealand emergency phone number. [3]

33. An acute, exaggerated, generalised allergic reaction. [11]

35. Fast, wide & regular life threatening myocardial electrical rhythm. [2]

37. Cardiac output is a function of heart rate and? [12]

38. The mechanical action of moving air into and out of the lungs. [11]

41. The level of clinical practice for Paramedics in New Zealand. [3]

42. Asthma is characterised by increased bronchial mucous production, bronchial oedema and? [12]

43. A patient with acute asthma has difficulty with this part of the breathing cycle? [10]

DOWN1. If my P-R interval is gradually extending

and then I drop a QRS, I would have which type of Second Degree Heart block? [10]

3. Very commonly used crystalloid fluid. [6]4. An airway device that sits between the

nasopharynx and laryngopharynx. [13]5. Cardiac compressions in an Adult should

be done at a rate of ___ per min? [3]6. Failure of the cardiovascular system to

provide adequate perfusion. [5]7. The ‘C’ in ICP. [4]8. The waves seen on a normal ECG. [5]9. The most effective therapy in the

management of a VF arrest. [14]11. Control of this is a primary focus

of paramedic management in musculoskeletal trauma. [4]

13. Excessive carbon dioxide does this to blood vessels. [8]

14. Aspirin works on these. [9]15. When attending an MVC involving a

truck and you see an ‘E’ on the rear of the vehicle, you should? [8]

17. Patients with a Traumatic Brain Injury do poorly if they experience this. [11]

18. Medication administered via IMI to manage low sugar states. [8]

20. Dilation of the pupil. [9]21. Accepted abbreviation for normal sinus

rhythm. [3]23. To make energy, cells need oxygen

and ? [7]27. Cartilagenous airway structure that

prevents aspiration when swallowing. [10]

30. The blood volume of an adult. [7]32. Normal adult anatomical respiratory

dead space volume. [5] 34. Heart attack with ST Segment changes.

[5]36. Significant type of trauma that has at

least 3 mechanisms of injury associated with it. [5]

39. New Australian standard for clinical handover. [5]

40. Australian emergency phone number. [3]

Paramedicine QuizTHE CROSSWORD ANSWERS CAN INCLUDE ALPHABETICAL AND NUMERICAL RESPONSES

Check your answers online in the Response members section of the website!


Employer News and ViewsGreg Mundy, CEO, CAA

Exploring the Frontiers – Paramedicine of the Future

This was the theme of CAA’s Annual Conference in Canberra this year, held just before PA’s conference in the same city. In one of the most moving conference openings I have experienced delegates heard from Michael Bosse, Deputy Superintendent from Boston EMS, about the tragic events at this year’s Boston Marathon.

Not only was this a riveting first-hand account, reinforced by graphic video footage from the scene and personal reflections from those involved, it also raised a difficult but important question for ambulance services’ involvement at such events.

One of the reasons that so many people were able to be saved was that Boston EMS crews were already deployed along the Marathon route as part of the health support for the event. This meant that they were right there when the two bombs were detonated and able immediately to provide assistance to the many injured people.

They did not have to negotiate entry to the scene or wait until the site was secured, they were already there, saving precious time and possibly saving lives in the process. There are difficult but important questions here for a wide range of emergency situations.

More questions about the role of ambulance services in emergency management were raised in a CAA Position Paper launched at the conference. Disaster and Emergency Management – the Ambulance Role

argues that better use should be made of the distinctive ambulance capability in our emergency management operations and that ambulance services need to be resourced for this role. The paper is available on the CAA website caa.net.au.

Most of our conference though focussed on our health system, organisational change and new care technologies. We heard from David Butt Deputy Secretary Department of Health about Future Directions for Australia’s Health System and from John Ballard, Associate Vice Chancellor at the Australian Catholic University (Melbourne) about Effecting Organisational Change in Healthcare before we got to lunch on Day One.

An international panel of ambulance CEOs talked about their visions for the future to conclude the day following a rich array of concurrent papers also focussing on the future.

Opening Day Two Professor Russell Gruen from the National Trauma Research Institute spoke about the forthcoming trial of Tranexamic Acid use by paramedics – Tranexamic Acid at the Roadside New Frontiers for Time Critical Treatments.

He was followed by Darren Cutrupi from the ACT Justice and Community Safety Directorate talking about Communicating the Ambulance Message – including the use of social media – another frontier.

In the afternoon we looked at organisational change in a different environment with Grant Tidswell from the Department of Human Services speaking about their change program and at Exploring New Ways of Working with Peter Bradley the CEO of St John New Zealand who spoke about their plans to transform ambulance services. Rounding out the plenary program Etienne Scheepers from Health Workforce Australia brought delegates up-to-date with the Community Paramedicine pilot projects.

Three representatives from the pilot projects: Louise Smith, Terry Whales and Shaun White also spoke about their experiences and progress in implementation on this frontier of paramedicine.

To close the day, Ross Coburn from St John Northern Territory invited delegates to our 2014 conference to be held in Darwin on 27-28th August – earlier than our usual dates to take advantage of the dry season in the Top End.

Rounding out this year’s conference our awards night at the stunning setting of the Australian War Memorial showcased some of the great achievements in 2012-13 by Australasian ambulance services.

Guests seated under the wings of ‘G for George’ a Lancaster bomber flown by Australian crews in World War II, celebrated the achievements of their colleagues in pushing the boundaries over the past year.

CAA Conference 2013 Greg Mundy


Details of the finalists and the winners may be found on our website www.caa.net.au. This year’s Star Award went to St John Western Australia for their Ambulance Surge Capacity Unit (ASCU) an innovative approach to the problem of ambulance ramping. This project is enjoying success in terms of both better patient and health system outcomes in Perth.

As with some of the other new approaches around Australasia, including secondary

triage and community paramedicine, all of which were highlighted during the conference, the ASCU focuses on better, more appropriate pathways for lower acuity patients who ring for an ambulance.

Exploring the Frontiers covered a lot of ground and succeeded in filling in some more parts of the ambulance service map. Our thanks go to our speakers and our sponsors for helping us to mount our most successful conference yet.

Employer News and Views

Russel GruenDarren CutrupiMichael Bosse


SOUTH AUSTRALIA

Annual Chapter Meeting

The South Australia Chapter of Paramedics Australasia had its ACM

on the 28th August 2013, which resulted in a number of changes to

the SA PA committee following the resignation of several committee

including the Chair and Treasurer.

The new committee extend their thanks to the outgoing committee

members for their past involvement with the SA PA committee.

The new committee has a wider depth of experience from both the

statutory and private ambulance sectors, which will improve the

benefits for all PA members.

SA Government legislation to

protect the title of ‘Paramedic’

There has been considerable behind the scenes discussions

regarding the introduction of new state based legislation to protect

the title of “Paramedic” (a summary can be found in the Board section

of this edition of Response).

This state legislation is the first step towards registration, but the

overall position of national registration is still the desired outcome.

This legislation passed the lower house on the 30th October 2013,

where there was bipartisan support.

SA Chapter sponsorship

SA PA sponsored 3 positions to the recent annual PA conference in

Canberra, and by all accounts those that attended came away from

the conference with new knowledge and new networks.

Those sponsored will be contributing written articles to Response;

the first of these articles accompanies the conference feature in this

edition.

The second major sponsorship opportunity that has presented itself

for SA PA members is the annual Woman and Children’s Hospital

Paediatric Emergency and Trauma Day, where five SA PA members

have been sponsored to attend.

SA contingent Canberra 2013

Chapter News

Journal Club – The AVOID Trial

One of the big events the SA chapter of Paramedics Australasia hosted was on Thursday 19th of September – the AVOID Journal Club which looked at the AVOID trial: A randomised controlled trial of oxygen therapy in acute myocardial infarction – Air Verses Oxygen In myocarDial infarction study (Stub et al 2012).

The moderator for the event was Ziad Nehme, a Paramedic and Research Coordinator at Ambulance Victoria and PhD candidate at Monash University. The study has been designed to test the assumption that routine supplemental oxygen is always beneficial to the patient experiencing acute STEMI. Previous assumptions that it is have been based on animal studies that were conducted prior to reperfusion and modern advanced medical management for AMI becoming routine.

Discussion points that came out of the Journal Club included causes of breathlessness in myocardial infarction; oxygen as a treatment for anxiety and pain; and the potentially opposing effects of oxygen and GTN.

There were also a few questions posed to those attending the Journal Club about use of oxygen, such as: what are you trying to achieve by giving oxygen? If the patient has good oxygen saturations, has a GCS of 15 and are not feeling breathless why are we giving oxygen? Do we think about what we want to achieve when we give oxygen or are we giving it because that is what we have always done?

It is exciting and satisfying that Australian paramedics are leading the way in conducting urgently needed pre-hospital research. The AVOID trial has the full support of all 12 metropolitan PCI capable hospitals in Melbourne and the success of the trial may remove pre-conceived obstacles hindering other states to follow in their footsteps and add to this important work.


NEW ZEALAND

The New Zealand chapter has had a busy and exciting few months. We started on a high when PANZ committee members Haydn Drake and Rachael Wallen represented New Zealand paramedics in receiving the Readers Digest award for New Zealand’s most trusted profession.

CPD Activity

September kicked off with a CPD event in Christchurch where Dr Dave Richards from Christchurch ED spoke on fracture management and also delivered a very interesting lecture on tranexamic acid. His presentation was very enjoyable and well received by all who attended.

NZ Success at PA Conference 2013

A strong contingent of Kiwis made it to the PA conference in Canberra including Glen Mitchell (Wellington Free Ambulance) and Andrew Prescott (St John Whanganui), the winners of the two $2000 conference scholarships offered by PANZ.

Paul Davey from AUT won the poster competition, and Paul Davis from St John Whangarei won the prize for best Postgraduate Research project.

At the dinner on Saturday night Gary Strong won the door prize of a Panasonic tablet which he generously donated to PANZ for the use by any member doing field research.

PA at Traumed

The same weekend, PANZ was represented by John Hammond and Sean Thompson at the St John Traumed Emergency Care conference in Whangarei, a fantastic conference where we hope to fly the flag more in the future.

Committee Changes

October saw us bid a sad farewell to Gary Strong, PANZ founding member and PA board member, as he returns to the UK to join family and take up a teaching position at Plymouth University. We wish Gary all the very best.

PANZ is very pleased to welcome Rachael Wallen to her role as student liaison officer on the PANZ committee. We also continue to have enthusiastic involvement with SPA members at the two tertiary paramedic training providers, AUT and Whitireia, with the Whitireia SPA group planning a camp as part of Orientation Week in February.

For more updates and happenings, follow us on our Facebook page and Twitter.

Chapter News


NOVEMBER

2013 National Indigenous Health ConferenceWhen: 25-27 November 2013Where: Cairns, QLDWeb: http://www.indigenoushealth.net/

The 2013 National Indigenous Health Conference is designed to bring together both government and non-government agencies who are working in the field of Indigenous health with the belief that working together can close the gap between the state of Indigenous Health as compared to the health of mainstream Australians. It is envisage that 200 to 300 delegates will attend.

Register early to get a discount! Please note that registrations are set out in an affordable way which changes on a monthly basis. Hence, the earlier you register, the more savings for your organisation.

DECEMBER

8TH HEALTH SERVICES & POLICY RESEARCH CONFERENCE

Doing better with less: Enhancing health system performance in difficult times

When: 2-4 December 2013Where: Wellington, NZWeb: http://www.plevin.com.au/hsraanz2013/

The purpose of the Health Services Research Association of Australia and New Zealand is to facilitate communication across researchers, and between researchers and policymakers, to promote education and training in health services research, and to ensure sustainable capacity in health services research in Australia and New Zealand.

Our Conferences are the focal point of the Association’s activities, which also includes ongoing workshops, seminars and working behind the scenes to promote health services research to research funding agencies and policymakers.

Join us for three days of thought-provoking discussion, information-sharing, strategising and problem solving as well as some great social events and networking. We are looking forward to creating a stimulating program for you as well as an engaging space for you to network, reconnect with friends and meet new people.

MARCH

Fourth International Conference on Health, Wellness and Society

When: 14-15 March 2014Where: Vancouver, CanadaWeb: http://healthandsociety.com/the-conference

This interdisciplinary conference has a history of bringing together academics, university leaders and administrators, public administrators and research students who share a common concern for the in the fields of human health and wellness, and in particular their social interconnections and implications.

Proposals for paper presentations, poster sessions, workshops, roundtables or colloquia are invited, addressing health, wellness and society through one of the following themes:

• The Physiology, Kinesiology and Psychology of Wellness in its Social Context

• Interdisciplinary Health Sciences

• Public Health Policies and Practices

• Health Promotions and Education.

MAY

The 15th European Congress of Trauma & Emergency Surgery & 2nd World Trauma Congress

When: 24-27 May 2014Where: Frankfurt, GermanyWeb: http://www.ectes2014.org/

JULY

New Zealand Resuscitation Council 2014 Conference

Science to Sensibility

When: 24-26 July 2014Where: Rydges Lakeland Resort, QueenslandWeb: http://nzrc2014.co.nz/

The New Zealand Resuscitation Council fosters and promotes excellence and consistency in the education and practice of resuscitation. Our theme this year offers plenty of scope for discussion about scientific developments in resuscitation, and what this might mean in practice here in Aotearoa.

We have approached speakers of international recognition, and I look forward to announcing our keynote speakers soon. Research and news from the International Liaison Committee on Resuscitation and resuscitation practitioners will feature highly, giving you the chance to hear first-hand both global and local perspectives. We are also inviting all CORE instructors to attend a day of workshops, to learn about the latest in resuscitation as it applies to them.

I’m anticipating a terrific event, including time to regroup with friends and enjoy the scenic wonder and fun that is the Queenstown experience—New Zealand’s winter playground.

Events Calendar

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Paramedics Australasia Membership Application

How do I join? Please complete the following membership application form and return it along with the payroll deduction authority to National Secretary, Reply Paid 345 Ballarat West Vic 3350. Alternatively, go to the College website at www.paramedics.org.au and join online.

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unit/House number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Suburb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Post code . . . . . . . . . . . . . . . . . . . .

PO Box . . . . . . . . . . . . . . . . . Suburb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Post code . . . . . . . . . . . . . . . . . . . .

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Home Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Work Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mobile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payroll number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Qualifications/level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payment Details: Please complete either the Payroll Deduction Authority or the Credit card payment details.

Payroll Deduction Authorisation:

I hereby authorise the (insert ambulance service) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .payroll office

to commence a deduction of $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . per week / fortnight to the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paramedics Australasia.

Amount: $312 for Fellow, Member and Associates; $156 for Volunteer Associate Members; $50 for Retired Members.

Payroll number (if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Or if paying by credit card (annual installment)

Bankcard Mastercard Visa

Credit Card Number Expiry Date . . . . . . . . . . ./ . . . . . . . . . .

Name on Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Response - Paramedics Australasia · PA Conference 2013 Should we review Methoxyflurane use?...

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Transcript of Response - Paramedics Australasia · PA Conference 2013 Should we review Methoxyflurane use?...