Ambulance New Zealand - All Forum posts

Would you support registration of ambulance officers and medics under the HPCA Act? (post by Viking)

Sat, 19 May 2012 04:58:45 +1200

The profession needs to be mindful that if the registration body regulates not only the hours of continuing education (CE) to be achieved, but also dictate compulsory units of CE (as done in other allied health professions) they run the risk of restricting those who wish to extend themsleves with continuing education as there is always a limit to CE budgets and time for CE leaving those with enthusiasm for CE to be burdened with regulated reocurring cross cutural awareness courses and the like

A glance at how other allied health professionals have fared under the HPCA model will reveal that for many of those working part time, the high annual fees made it questionable as to whether they should continue working part time.

The HPCA model seems to burden allied health professionals high registration fees when compared with other NZ professional bodies, and certainly when compared with their Australian counterpart.

Is this a waste of money? (post by bravobravo)

Sun, 21 Nov 2010 22:18:18 +1300

I would agree with you and that has been my opinon for a long time and I think we are getting closer to some aspects of that; e.g. national training, consistent titles however a national ambulance service would require the central government to actively want it.

Registration Of Volunteers (post by keithr)

Wed, 17 Nov 2010 19:46:19 +1300

You can not differentiate between paid and volunteer status in regards to registration. Think ATP and qualification level. ILS and ALS should be registered. The time and training required to reach these skill levels will lend some accountability to our registration.
No offence, but registering BLS will (for lack of a better term) cheapen the value of registration in the eyes of other Health Practitioners

What levels of ambulance officers and medics should be registered - all those at Basic Life Support, Intermediate Life Support and Advanced Life Support or only some - such as Intermediate Life Support and Advanced Life Support? (post by keithr)

Wed, 17 Nov 2010 19:37:41 +1300

Interesting points re what level to register at. Sure BLS staff are as accountable as the next person in regards to pt care. If registration is at that level Ski Patrollers , Life Gaurds etc will all meet criteria!
Is that a qualification something that stands next to Drs , Nurses, Physios and Midwifes for example? all of which are Degree Qualifications. Tpo Register at a BLS level, I believe will make our registration laughable in comparison to other Health Professionals!
There should be no difference whether you are paid or volunteer but lets be serious and recognise the training and service required to maintain an optimal qualafication of ILS, ALS.
This is by no means belittleing the effort and input of BLS staff but in comparison to every other registered Health Professional our Nat Dip training is a fraction of their requirements

Is this a waste of money? (post by thetruth)

Wed, 17 Nov 2010 11:42:49 +1300

If you go back to the Review Of Ambulance Services most of the submitters, who were not ambulance providers, were in favour of 1 National Ambulance Service with an Act of Parliament like the NZ Fire Service Act. This would provide one national organisation with clear powers, like entry, ability to request persons arrested for obstruction, clear authority to act under Legislation and would devolve out to delegated authority from 1 National Commander, 1 set of ATP, 1 standardised set of National Training programs and national skills maintenance requirements.
Rather than registration are we better looking at this ???

Registration Of Volunteers (post by Henderson159)

Fri, 05 Nov 2010 17:07:48 +1300

AlbyGrogan said...
Have to say I'm leaning to Arban79's perspective that employment status should not affect registration. It should be based the clinical level that a person attains. Essentially, once you start administering (or withholding) medical care you need to be accountable for the decisions you make. Volunteers are just as capable of causing harm to patients as paid staff. They therefore should be registered and judged according to the same standard as paid staff. If they are not capable of performing to the prescribed standard they should lose their registration and, therefore, their authority to practice.

Absolutely correct - all or nothing

What levels of ambulance officers and medics should be registered - all those at Basic Life Support, Intermediate Life Support and Advanced Life Support or only some - such as Intermediate Life Support and Advanced Life Support? (post by Henderson159)

Fri, 05 Nov 2010 17:03:59 +1300

St John has a measurable standard in their Continuing Clinical Education (CCE). Unfortunately some overseas registration boards expect an officer to have completed the equivalent to a refresher course or lectures from standardised external courses such as ABLS, ACLS, PEPP, PALS, PHTLS, ITLS, etc to retain their registration. This can make the movement of registered officer from one country to another meaningless albeit that those belonging to a weak registration board become obvious.
The only benefit I see of registration is the protection of the public from Ambulance Officers who work for organisations or employers that fail to ensure their staff maintain a professional standard and provide a robust CCE.
I believe that if the individuals in this industry decide to become registered then everyone from BLS (EMT) needs to be included. If a BLS officer is not competent in delivering their procedures then patients suffer. There is more risk with unsafe defibrillation and poor cervical collar application then there is in some of our ILS/ALS invasive techniques.

Do you think registration will improve ambulance officer and medic standards and benefit the public? (post by Henderson159)

Fri, 05 Nov 2010 17:02:14 +1300

What steps would improve our level of professionalism? (post by bravobravo)

Fri, 29 Oct 2010 17:37:15 +1300

Mum is correct and I'm not blaming St John for all the problems but there is a lot more they could have done years ago in order to alter the point at which Ambulance began to debate moving toward being a true health profession. We've had a Degree program since the early 2000s but its only now that five to seven years later that it is being finally recognised as part of the education framework (or is that they saw everybody else already had up to a decade ago or is moving toward it and decided to hop on the band wagon so not to look bad?) and an issues paper on Registration was put out in 2003 ... to which they provided no input.

Anyway thats not the issue here, they really just fall into the mix or perhaps I am just biased .... no offense intended.

With the drive towards more clincal education, more clinical support and CCE as well as nationally consistent titles and scopes of practice will go a long way to helping make Ambulance a true profession.

What steps would improve our level of professionalism? (post by medicmum)

Wed, 27 Oct 2010 15:13:27 +1300

arban79 said...
Well that begins to come down to the self image and maturity of the occupation, and an acceptance of individual responsibility ....

That about sums it up, and the comments bravobravo aren't indicative of that (sorry, don't mean to cause offence, but it's not about who we work for, or don't work for). While the govt has got it good with vollies making up a significant part of the workforce, we won't be changing providers anytime soon. However, we can all take a professional approach to our practice, communications, dealings with other health providers, patients, emergency services, and colleagues. Professionalism can be taught to a degree, but a lot of it is an in-built sense of who we are. I read in the JEPHC that professionalism is also about prehospital providers developing their own 'knowledge base' - currently our knowledge and practices are based on research generated by other health professionals and handed down in a paternalistic fashion. This isn't conducive to us growing as a profession; a professional is autonomous in their responsibility for their practice, even though they may belong to a professional body. Are we ready for this yet?? Not yet, but I'd like to see it happen. Some of this is starting to happen with university-based education, but this is still a beginning step.

For things to change, first I must change, is a phrase I've heard somewhere, and it seems apt here. We need to stop thinking like 'taxi drivers' and 'because my procedures tell me to' mentality.

Do you think registration will improve ambulance officer and medic standards and benefit the public? (post by AnthonyIvan)

Mon, 20 Sep 2010 09:32:58 +1200

I have to say I am more in the camp of "No" at this stage, but only because I have yet to see an overwhelming case for it (cost vs benefit).
I am concerned that registration is a blunt instrument to fix something that fundamentally isn't broken, or which could not be tweaked a little with adult common sense. The differences between differing ambulance services are related to how those respective services are setup (ie: large volumes of volly ambulances vs mostly paid etc), culture and politics. The latter two being modifiable without setting up a new layer of administration in what is by international standards a small workforce.

Clinical standards are enforceable, we are simply choosing not to in some areas.
Different services have different procedures, again a choice of the relevant Clinical Management Groups.
Complaint and investigation processes: HDC is already available for consumers and transparency of process is modifiable if there is a requirement.

I quite liked the statement by guest of registration being a solution trying to find a problem. Yes the current system has its flaws - but is registration the right tool to address those deficiencies. I am not convinced.

Anthony

What steps would improve our level of professionalism? (post by arban79)

Mon, 13 Sep 2010 14:12:16 +1200

Well that begins to come down to the self image and maturity of the occupation, and an acceptance of individual responsibility ....and registration ... and the need for a professional society that represents the professional interests of the actual caregivers - the paramedic practitioners. The organisational badging is really secondary to the healthcare role, and on the spot, one primarily wants to know just who is who and what their capabilities are. Notice that the medical profession goes the other way in identification and more is less - until the surgeon wears just the simplest of gown....even on TV.
Like hospitals provide the infrastructure for medical practitioners and nurses, so too the service providers can provide the infrastructure support, communications and other mobile clinic needs and transportation services for patients and paramedics - important and complementary.

What steps would improve our level of professionalism? (post by bravobravo)

Sat, 11 Sep 2010 18:48:45 +1200

It's very simple - get rid of St John but that won't happen so what we need to stop using the term "Ambulance Officer" and just call everybody "Paramedic"

Paramedic or Primary Care Paramedic (BLS)
Advanced or Advanced Care Paramedic (ILS)
Intensive Care Paramedic (ALS)

Oh and get rid of the St John branding all over the uniforms would help too.

What levels of ambulance officers and medics should be registered - all those at Basic Life Support, Intermediate Life Support and Advanced Life Support or only some - such as Intermediate Life Support and Advanced Life Support? (post by bravobravo)

Sat, 11 Sep 2010 18:27:56 +1200

I think there is a focus on going "back to basics" with National Diploma and the CCE modules; one was on basic airway care and Craig Ellis did a great DVD on basic airway management as part of that module. There have been varying programmes and methods of teaching the fundamental skills required in Ambulance praxis (CAPS, Elementary/Proficency Ambulance Aid/PHEC etc) and with the introduction of National Diploma and the BHSc degree I think we will see a consistent way of teaching and evaluating the knowledge and dexterity that is cornerstone to being an ambo.

To state BLS care is most prevalant is incorrect; the majority of care is provided by career staff who are either ILS or ALS. Yes there are some paid BLS members and the rest are volunteers, yes some do work with another BLS level officer but others work with ILS or ALS officers to achieve a double crew.

I argue all levels need to be registered, which do you think is more risky; a BLS Officer deciding to leave somebody at home or an ILS Officer slipping in thier 5,000th drip?

Do the existing funding formula's limit the industry? (post by horizons)

Thu, 09 Sep 2010 10:24:23 +1200

To really cause controversy

Western Aussie have a government scheme where ambulance providers do a job and bill the state funding body , no restrictive contracts that shut out competition ! if we want to up the standard of care registration is part of the picture but we have to get rid of this restrictive funding model , things like PTS can be contracted yes but why not have a model that opens things up to competition .

Competition in a market model often results in productivity and qualitative improvements, in this case the quality would in my opinion be the upskilling of the industry, and in this model of competition people upskill at their own cost as they do in many other countries.

Now with this model and being in private practice myself I undertake things such as incorporating sports medicine and heat/cold packs, strapping etc why? Because I have evolved to suit the needs of the market through competition, due to our experience we often (anecdotally) cut down the referrals to ED or ambulance by 75-90%. This is a funding formula dream and patients get the required care immediately.

Registration as part of a framework allows the foundation for changes to funding and becomes part of how we can be paid for Tx and non transport or transport to non DHB Facilities in case of less significant injury within the scope of care of 24 of hour clinics etc.

Feel free to shoot me down, this could be a great debate though.

What levels of ambulance officers and medics should be registered - all those at Basic Life Support, Intermediate Life Support and Advanced Life Support or only some - such as Intermediate Life Support and Advanced Life Support? (post by horizons)

Thu, 09 Sep 2010 10:16:37 +1200

The debate here is really interesting; ambulance services often provide the initial care & treatment and establish the first level of a continuum of care.

Our patients have various needs and often present with complex medical complaints, as treatment providers the ambulance work force can influence the later effectiveness of hospital/medical care through its effectiveness.

The hireacy of medical care requires nurses to work under the direction of policy and procedure and under varying circumstances a medical director even if working independently. A nurse must be a registered health professional and depending on the role may practice some of the same skill sets i.e. use of medications such as glucagon or cannulation if but there skill sets don’t include focus as much on treatment of trauma or acute medical conditions.

And doctors.....well nothing needs to be said as to why they are registered.

We are usually working alone & unsupervised at the time , yes we work under guidelines and ATP but we have one hell of a responsibility working with patients that can be seriously ill and unstable. We as a workforce cant (in my opinion) bury our heads in the sand if there are only 1000 combined ALS and ILS staff in the country yet there is 3000 BLS staff then the level of care would proportionately be BLS therefore registration of those providing clinical care at ILS/ALS would still result in clinical care being largely unregulated.

A guarantee of at least one ILS or ALS officer on every vehicle is equally impossible thus back to square one.

In my experience the largest area of errors I have witnessed is the basics, airway care, respiratory support and when we should be aggressive with CPR are critical.

Given that these are skills we should all be experts on at our various levels and serious harm results when any of these skills are inadequate, are we maybe too focused on advanced levels of care and in our discussion and not focused on the basics in the same manner?

Anyway just my thoughts.

Do ambulance officers and NZDF medics need to be registered? (post by arban79)

Wed, 08 Sep 2010 03:39:48 +1200

I have always been very careful to distinguish between the generic 'ambulance officer' which is a catch-all term and a paramedic who is a qualified person with a set of skills and competencies that equip them to carry out a range of clinical interventions within an accepted scope of practice. If I have inadvertently mixed the two, then my apologies - it was in error.

There is a gradation of risks and there are different levels of skill or knowledge and competencies- or else let's ignore all the shoulder flashes and assume anyone can act as an ECP - but that's not really sensible is it? Or for that matter, why bother registering doctors and nurses and other health professionals.

And not all persons have the same competencies. Let's look for example at a construction site and you will find that you must be certified or licensed to operate a crane or a forklift but not to use a wheelbarrow. The competencies and risks are quite different. But even so a person may lose control of a full wheelbarrow and careen into the street with disastrous outcomes as they hit a vehicle and there is resulting mayhem and injury. Is that likely? Thankfully it's rare, but it has happened and there is a real and finite risk. But we're unlikely to license or certify wheelbarrow operators because experience and common sense tell us that the risk outcomes are tolerable
while everyone operates within their scope of practice or competencies framework. But don't let the wheelbarrow pusher operate the crane when I'm around.

Or look at vehicle licenses where there might be different classes of license and conditions for a probationary driver, a bus driver, an automatic or manual vehicle and a heavy truck and an articulated vehicle. The transport authorities recognise there are different levels of risk, potential outcomes and competencies involved and thus do not countenance people operating vehicles outside the class of license that they hold. And that view is often reinforced by legal sanctions and liability exposure.

My point is that EMS is really little different and the registered cohort should be those identified as performing interventions, dispensing medications and exercising care within a scope of practice generally identified as carrying risks above a particular threshold level. Are nursing aides registered
or is it only qualified nurses? Teachers aides in some jurisdictions have to be registered for other reasons associated with child safety. So it is all a question of relative risk, perceptions and protection of the public.

Voltrex queries the value of regulation and registration overseas based on the example of the New Zealand Institute of Chartered Accountants (NZICA). I thought that was a private body and not comparable with a statutory regulatory authority carrying the force of law under the HPCAA. So does that not mean that the NZICA would be (say) similar to the internal recognition of an EMS practitioner provided by an employer - since there is no other regulatory mechanism currently in force - in which case he's probably right - that's not much help after all and not independently benchmarked..

But regulation and registration under a formal statutory system that establishes the scope of practice, competencies, independent accreditation of courses etc. is a completely different thing. - see http://www.moh.govt.nz/moh.nsf/indexmh/hpca-responsibleauthorities It provides rigour and credibility and removes the potential moral risks of employer (or professional) expediency.

And the benefits really kick in when you can pull out or obtain independent verification of your professional status and current certification to practice based on registration. That's a real bonus internationally - and in future quite possibly significant for those wanting to work in Australia..

The question of a separate Act is proposed for EMS.. GIven that the HPCAA was the consolidation of multiple legislative provisions into a single legislative framework I see this as highly improbable. http://www.moh.govt.nz/hpca

As for enhancing the practice standards and KPIs of the EMS sector, I refer you to NASO and the proposed development strategy, and suggest that a professional body representing practitioners is also needed as a stand-alone association or affiliated with an established EMS society within the region. It's difficult to lobby or provide industry leadership when there is no professional body. Rightly or wrongly, in such a situation government tends to see the representations as the output of a gaggle of individuals.

What steps would improve our level of professionalism? (post by arban79)

Tue, 07 Sep 2010 20:11:41 +1200

Yes of course ,,,,,,,,,,read this document http://bit.ly/d36Oss
and also this one
http://www.naso.govt.nz/wp-content/uploads/2009/10/final-ambulance-strategy.pdf

.......and then reflect on just where NZ EMS fits into the scheme of health care ... or not perhaps?
(reflective assessment on the level of professionalism and practice can be useful)

An holistic approach needs to be taken, which takes us back to the Parliamentary Report in 2008 and the NASO agenda, Worth reading to know what has been / is being proposed. Policy and positive development is like that - one has to look beyond the immediately obvious.

The registration activity is only part of the solution ...but like a jigsaw, the pieces all need to fit to create enhanced service delivery and professionalism.

Who will make up the governing body? (post by arban79)

Tue, 07 Sep 2010 19:46:25 +1200

This has its funny side ........from the current situation where an officer is wholly beholden to a single employer for virtually all aspects of their livelihood and determination of competency and fitness-to-practice, it is being suggested that a regulatory authority formed under the HPCAA is somehow less independent......eh.....how can this be unless one believes in some conspiracy theory ?

The normal structure of an RA can be seen by reference to here http://bit.ly/9fa1Re

And you may then browse the structure and memberships (say) for medical laboratory science
http://www.mlsboard.org.nz/our-board-members
...........and guess what , you can even see who they are. That's part of transparency.

The big difference might be that the registered groups have embraced professionalism and in the main have vibrant professional societies - which appears to be something lacking in NZ paramedic practice. Australia and most other countries at least have strong professional bodies.......even places like Colombia (who have borrowed freely from other jurisdictions like Canada for competencies etc.) http://www.acotaph.org/ At least they take advantage of world best practice.

Indeed, given their invasive interventions and the associated risks, it is not surprising that the non-registered status of NZ paramedics and the absence of a professional body is regarded by many other professionals in health as an anomaly.

Do ambulance officers and NZDF medics need to be registered? (post by voltrex)

Tue, 07 Sep 2010 10:37:01 +1200

I have to agree with whatthe. Regulation does not translate to having our standards recognised overseas. An example of this is the New Zealand Institute of Chartered Accountants (NZICA).

The Final Qualifying Examination (FQE) was introduced in 1989, the same year as the Public Finance Act, which required Crown government departments and Crown agencies to prepare financial statements in accordance with generally accepted accounting practice and have them audited.

It took an Act of Parliament to force changes on the industry to bring them into line with best practice overseas.

Registration does not make the ambulance industry conform to best practice or improve care for patients. It sounds like it may make it worse. Taking equipment, medications, and treatment away from areas that already have them just because they can't be rolled out to all areas of New Zealand is not best practice.

The ambulance industry does not even have its own legislation. It seems to me that we are putting the cart before the horse. We are an emergency service yet we have no legislation? Nuts.

If your going to have registration then all paramedics need to be registered. Look at the arguments being put forward.

"Should all AO be registered? .......not really , it depends on their role and the title they carry and the public perception of their competency to perform particular interventions and health care tasks
associated with their calling......in other words identify the cohort to be registered"

"Should paramedics be registered ...... definitely, if they are to perform the tasks that are seen to pose a risk to the public (see the regulatory criteria and guidelines http://bit.ly/afcnpE) or to be considered professionals in the true sense of the word"

So arban79 suggests that not all paramedics need to be registered but then goes on to say if they pose a risk that they should. Every paramedic of any qualifcation can pose a risk. Just leaving a patient at home can pose a risk.

You could put an argument forward in that case that ALS paramedics should not be registered and BLS paramedics should because the ALS has more education and can do a more thorough assessment of the patient before treating.

Should we be registered? I think we should be lobbing to get our own act of parliament. That is what will truely set the industry standards. Becoming registered will change nothing for industry it may even cost patients quality of care and treatment.

What steps would improve our level of professionalism? (post by AlbyGrogan)

Tue, 07 Sep 2010 10:20:09 +1200

Maybe there are actions we can take instead of/as well as registration to lift the standards of our profession in New Zealand.

Any ideas?

Another approach: Health Ministry Oversight (post by AlbyGrogan)

Tue, 07 Sep 2010 10:06:01 +1200

whatthe said...
How exactly will registration improve key performance indicators such as response times?

Let's hope a mechanism such as registration will help us focus on KPIs that mean something eg, patient outcomes, rather than how fast we can drive through traffic to get to a patient

Who will make up the governing body? (post by voltrex)

Tue, 07 Sep 2010 08:52:02 +1200

So paramedic's become registered. Who makes up the governing body? I have concerns that our employers will have to much controll over such a governing body and it will not be independent.

Registration Of Volunteers (post by AlbyGrogan)

Fri, 03 Sep 2010 18:41:16 +1200

Have to say I'm leaning to Arban79's perspective that employment status should not affect registration. It should be based the clinical level that a person attains.

Essentially, once you start administering (or withholding) medical care you need to be accountable for the decisions you make. Volunteers are just as capable of causing harm to patients as paid staff. They therefore should be registered and judged according to the same standard as paid staff. If they are not capable of performing to the prescribed standard they should lose their registration and, therefore, their authority to practice.

What levels of ambulance officers and medics should be registered - all those at Basic Life Support, Intermediate Life Support and Advanced Life Support or only some - such as Intermediate Life Support and Advanced Life Support? (post by AlbyGrogan)

Fri, 03 Sep 2010 18:24:02 +1200

St John has stated that they will pay the registration fees of those members who become registered. To do this they will have committed part of their budget, and this usually has to be done in advance.

They therefore have a good idea of how many members will be registered, which means they have a good idea of the levels of practice to be registered.

Unfortunately, if this is the case, this discussion becomes largely theoretical...

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by whatthe)

Tue, 31 Aug 2010 18:11:34 +1200

Where you read into my posts the comments and interpretations you come up with just amaze me. I am not suggesting anything along the lines you seem to believe re pt care.

All this money you talk of, well I just dont understand where you get that impression. My role is more than frontline and as such I have formed my responses and input based on more than some tired old company line.

It is always easy for those that dont have the full picture to make assumptions and think they could do it better. I am not saying I see the full picture in my position but I think I am privy to more of it than you do.

This thread is some way off where it should be and it needs to get back on track, as such I am signing off now and leaving it open for others to have their say.

bravobravo, your not the only one been around for a while and I can remember the what you refer to and some (pitt street back in the day..... the less said the better and I am sure you follow my drift on that one :)

I agree, there is an evolution already in place that has been churning away for a few years now with great results and more to come. I think we are on the same page too, its not a bad idea, just not a priority at present?

Well, nice talking.

Another approach: Health Ministry Oversight (post by whatthe)

Tue, 31 Aug 2010 17:56:41 +1200

horizons said...
how can the industry grow with this sentiment? nationalise under the fire service and bring in new ideas.

Most sound business decisions along the lines of growth are made with many factors and when an industry is ready for it, not just to grow for the sake of growing. There are other issues to resolve before we grow as you put it. You seem to keep overlooking the statements I have made, I am not against this I just think there are more pressing areas for improvement that would benefit from such a financial outlay ahead of registration.

Another approach: Health Ministry Oversight (post by horizons)

Tue, 31 Aug 2010 10:31:07 +1200

how can the industry grow with this sentiment? nationalise under the fire service and bring in new ideas.

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by horizons)

Tue, 31 Aug 2010 10:01:07 +1200

Whatthe said
Who else will act on the outcomes, its like the coroners office outcomes of investigations, they dont correct things, they leave it to the appropriate body to sort it......The HDC is completely open, independant and transparent (apart from names) and it came about as a direct result of the whole Bottrill enquiry - correct me if I am wrong but as a Dr was he not a registered practioner already..... look how much impact that had on public safety.

Its not just the needs of the provider. It is always about balancing. Like anything in life, limitations and restrictions (normaly fiscal) impact on the ability to provide perfect 100% services, this is of course impossible so there needs to be balance doing the best for all otherwise we would all be carrying expensive equipment in ambulances such as CPAP ect, you seem to come accross as though your thoughts are the services are not about doing the best thing for the public? I guess my opinion on this differs to yours. This is not a profit driven industry either, it is as I understand it aimed at providing the best service possible which I believe as a whole NZ does exceptionally well already - and without registration. Could it be better? Of course but only with more financial resources.

Thats my thoughts on it anyway

The HDC lacks the ability to enforce any recommendations in a non registered work force without a responsible authority, as you state the HPCA was designed to protect the public from internal regulation as it often results in protectionist practices.

As the first link in a continuum of care why ambulance personnel shouldn’t be operating within the same framework to offer protections and mechanisms to protect their patients.
If this is duplication then the infrastructure would already be in place and the expenses nowhere near as high as is promoted by those opposed to registration.

Road staff very rarely do anything less than their best for patients are you seriously suggesting anything less? Are you suggesting I am saying otherwise? As an experienced front line officer you would have to been suggesting that I would have witnessed otherwise to support this position.

Continuously coming back to funding is the same old tired company line, there is enough funding out there, and this is becoming increasingly clear. If only we could see 100% support from management for staff and the industry rather than entrenched protectionist practices of the monopoly provider.

I have associates that could run ambulance services within the existing budgets why don’t we let them run things if money is so significant......for the sake of patients and staff. Maybe we could see some externally focused changes

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by bravobravo)

Mon, 30 Aug 2010 23:34:22 +1200

If you ask me, aside from the obvious full crewing and more money, what we need is the following

- A national Council for Paramedicine that represents the interests of Paramedics in various clinical and political forums (sorry Ambulance NZ but good try tho)
- National Clinical Management Group and national Guidelines
- National qualifications, qualification patches and titles and scopes of practice
- National clinical education, ah NAOTS how I miss thee ....

Now, all of those things to my knowledge are being worked on ... the Council maybe not so much but in a year or two everything else will be in place and I will feel like an old dinosour relicing back to the days of "Paramedics" with thier "Advanced Ambulance Aid" certificate from Pitt Street and a big white Star of Life patch on thier uniform carrying round a Lifepal 10.

OK I already do feel like an old dinosour but my point is we are making trememdous change towards a better system of education and clinical standards which is common across all four providers. Now, I would like to see a single, national non St John run third service Ambulance model but alas I don't forsee that happening any time soon.

My point is that most of these issues are being worked on independant of registration and would simply be byproducts of registration.

Should Ambulance Paramedics in New Zealand be registered, yes, is now the right time to do so .... perhaps not. I am not sure, but if it comes to vote, I will support it anyway.

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by whatthe)

Mon, 30 Aug 2010 19:34:09 +1200

horizons said...
The HDC is set up so that complaints relating to competence are refered to a registration body to correct the practice of that individual, the intent isnt to drive poeple from a given profession but to insure competence. how can an internal forum based on the needs of the provider be of benefit to the public?

Who else will act on the outcomes, its like the coroners office outcomes of investigations, they dont correct things, they leave it to the appropriate body to sort it......The HDC is completely open, independant and transparent (apart from names) and it came about as a direct result of the whole Bottrill enquiry - correct me if I am wrong but as a Dr was he not a registered practioner already..... look how much impact that had on public safety.

Its not just the needs of the provider. It is always about balancing. Like anything in life, limitations and restrictions (normaly fiscal) impact on the ability to provide perfect 100% services, this is of course impossible so there needs to be balance doing the best for all otherwise we would all be carrying expensive equipment in ambulances such as CPAP ect, you seem to come accross as though your thoughts are the services are not about doing the best thing for the public? I guess my opinion on this differs to yours. This is not a profit driven industry either, it is as I understand it aimed at providing the best service possible which I believe as a whole NZ does exceptionally well already - and without registration. Could it be better? Of course but only with more financial resources.

Thats my thoughts on it anyway.

Another approach: Health Ministry Oversight (post by whatthe)

Mon, 30 Aug 2010 19:21:01 +1200

is it worth the work now...... umm no

paramedic practitioners have been talked about for years now and not as a result of registration, they may or not progress but not directly linked to registration. personally, I have no interest in being a paramedic practitioner, this is something that can better be handled by community nurses rather than emergency services. You talk about what can be saved working within the primary health sector. I can suggest a saving of millions..... avoid wasting $ on registration......

Another approach: Health Ministry Oversight (post by horizons)

Fri, 27 Aug 2010 21:33:19 +1200

in england the profession has grown in new directions, with registration comes definition of the profession then growth beyond that scope eg paramedic practitioner.

paramedicine could potentially be a part of the healthcare continum that treats those able to managed out of hospital , and serves to minimise those unecessary and costly hospital admissions that may otherwise be managed if addressed early and appropriately.

apparently we only have 1000 combined ALS , ILS staff nationally, imagine if through a greater scope of practice 1 in 10 or 1 in 20 patients we see could be treated onsite or out of hospital ( really i am saying managed within the primary health sector) then how much would or could be saved ?

this may prove to be the first solid step that allows for a frame work to open this possiblility if we all work together to the benefit of healthcare and the public interest.

its worth the work now isnt it ?

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by horizons)

Fri, 27 Aug 2010 21:21:54 +1200

The HDC is set up so that complaints relating to competence are refered to a registration body to correct the practice of that individual, the intent isnt to drive poeple from a given profession but to insure competence.

how can an internal forum based on the needs of the provider be of benefit to the public?

Do you think registration will improve ambulance officer and medic standards and benefit the public? (post by bravobravo)

Fri, 27 Aug 2010 21:00:30 +1200

I support registration but the more I think of it, now is not the right time.

A national Paramedic Council is needed now but I think registration is just a by product.

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by whatthe)

Fri, 27 Aug 2010 19:00:15 +1200

The HDC is external and very transparent. 3/4s of complaints are not relating to clinical competance anyway.

I dont see how the public benefit from registration. A lot of money with little impact on the real issues the industry faces.

Another approach: Health Ministry Oversight (post by whatthe)

Fri, 27 Aug 2010 18:54:58 +1200

Show me a health industry that is reaching its targets? Hospital waiting lists get longer, patients are kicked out of hospital quicker and delays to tertiary treatment is longer....... all this in an industry that is not only registered but has statistics all released for the public. Sharing information doesn't necessarily result in outcomes and data can be scewed to reflect the good or the bad. How exactly will registration improve key performance indicators such as response times? Then there is the issues associated with focusing so much on meeting targets that the impact on other issues that arent so focused and portrayed as a % number on a printout, as stated in another post, ED targets are to get patients assessed in a certain amount of time, as that time nears they start to get precedent over the patient that hasnt been there as long but should be getting treated sooner, just to make a statistic look good.

I will say it again, I am not against registration as such, I just think the significant amount of money required could be better spent elsewhere within the industry that will result in a better service to the public and patients we treat.

Heatlh ministry oversight, no thanks, too much political red tape.

Do you think registration will improve ambulance officer and medic standards and benefit the public? (post by whatthe)

Fri, 27 Aug 2010 18:39:39 +1200

I dont disagree with a lot of the comments in support of registration although in varying degrees but all that aside, the money would simply be better spent elsewhere such as full crewing - the benefit of this to the public would be immense and considerbly more than just transparency...... It is frustrating to know that time critical stat 1 and 2 patients are experiancing scene delays waiting to be transported while the single crewed officer waits for another vehicle from somewhere else (which further drains resoureces) as it is impossible to treat, monitor and drive att he same time- and this is common, to me there is more benefit to be had in other areas that would greatly outweigh percieved benefit in registration.

Back to the original question, no I do not think registration would improve standards.

Do you think registration will improve ambulance officer and medic standards and benefit the public? (post by arban79)

Fri, 27 Aug 2010 04:18:28 +1200

I'll keep it brief .....

Do you think there is transparency with other registered practitioners - ie GP's?

Comment - Yes .......look at the HPCAA and compare the composition of the regulator and reporting of regulatory actions and go outside health to other professions like law to see similar principles being applied .. internationally profession callings are generally subject to external scrutiny>>>>>>>>

Comparing us to the UK is like apples and oranges, both fruit but vastly different in many ways.

Comment - Yes, there are operational differences and they may be better in some areas like registration and Pathways and other roles - but that wasn't the point in the post which was to state the underlying purpose of regulation and the appropriate nature of a regulatory body ..... those principles are strongly supported in most countries....not just the UK. surely you're not suggesting that EMS be unregulated in NZ? Let's be brutally honest ....all interventionist health care will be subject to greater or lesser controls in the public interest .....and that involves a cost ... .and what is being sought is an appropriate open, fair and transparent regulatory framework.>>>>>>>>

Like any decision like this, risk, cost and benefit come into play and the benefit is simply outweighed by the cost and the risk to an already excellent service that may not be perfect but there are none that are. Considering the fiscal constraints, I am amazed and proud to be able to provide the service we do.
Comment - Yes the EMS personnel in most societies worldwide do amazing jobs within the constraints of available resources .. but you haven't outlined these comparative costs and benefits and I have yet to see any definitive statement suggesting there are increased risks to existing services - quite the contrary one might think, from the discussion papers and forum meetings. And you can continue to be exceptionally proud of the level of service you provide as a registered health professional as an individual practitioner or as part of a team working for an outstanding employer.

Another approach: Health Ministry Oversight (post by horizons)

Wed, 25 Aug 2010 10:19:42 +1200

Whatthe has said

Why would some of this information be released and to whom? I actually think there is quite a bit out there, particularly as a result of the select committee outcomes.

OH i dont know......... lets say the public. rather than me justifying my position as you put it last time , tell me was there an effort to inform the public that in the prior to 2007 national data on response times wasnt collated nationally , and that published data indicates ambulance services are generally not meeting their responce time targets.

just minor things im sure

the information is contained with those circles that collate it, and difficult to obtain.

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by horizons)

Wed, 25 Aug 2010 10:04:33 +1200

External transparency would benefit the industry, as opposed to the current policy of in-house complaint management which is fairly unique within healthcare contexts to some ambulance services.

This would be good for public confidence ......maybe not the monopoly provider but then again the public are the ones who are served by registration/regulation.

Is regulation of the profession (including registration of individuals within the profession) needed to increase public safety? (post by whatthe)

Tue, 24 Aug 2010 19:24:09 +1200

arban79 said...
A better question might have been "Is regulation of the profession (including registration of individuals within the profession) needed in the public interest? That is because "the public interest" embraces public safety - and the question of public safety is a fairly vexed question of risk management. Just about every individual desires "the best" health care, but that is not really feasible since there are finite resources, and inequities in access and service levels will inevitable occur. The public interest involves public perceptions and public confidence as well and independent validation of practitioners through registration will nearly certainly enhance the already high trust placed in paramedics. So that's a near certain plus. The measure of public safety will be a combination of the availability and distribution of competent practitioners across all regions which is currently a little difficult to determine from a policy perspective since the paramedic workforce isn't even registered. The comparison with data available for the other registered professions is interesting. So from the point of view of knowing who and what and where the paramedic workforce is available, and having a basic framework from which one can assess needs based on consistent competencies and skill sets of a registered paramedic workforce I have no doubt that better decision-making will take place, funding and workforce training can be improved, and there will be an overall improvement in the general public safety. The public at large should benefit. So the answer from that perspective of public policy outcomes- which drive funding and so many other service delivery matters - registration again should give rise to an improvement on the present situation. Good governance comes from making the right decisions, for the right reasons, at the right time and in the interests of all stakeholders. As to individual patient outcomes and specific cases, registration won't solve every issue and neither will other forms of regulation - once again that's simply a recognition that sentinel events will continue to occur, mistakes continue to be made and unfortunate outcomes take place. But registration won't add to those risks and has the potential to improve overall practice outcomes by creating an objective and transparent landscape in which to examine the issues and on which to build evidence-based improvements.

Registration may or may not add to those risks but will the cost of it actually improve overall practice enought to see good value for money?

An example of best healthcare - hospital waiting times were too long, the push to reduce them so that 80% of patients presenting at an ED are seen within a certain timeframe pushed the emphysis away from treating in order of priority to treating the flu patient that has been waiting too long..... Overworked and understaffed departments focus shifted to a performance figure that doesnt accurately highlight the issues they face, mutton dressed as lamb with a bit of gloss so the politicians have a fact and figure saying things are just peachy :)

Another approach: Health Ministry Oversight (post by whatthe)

Tue, 24 Aug 2010 19:18:17 +1200

horizons said...
This question is part of my other posts where is a frame work to collect data such as my question ? it may exist but isnt readily avaiable to external interests and this is my point. under the current system , although not a perfect model having incresed ministry of health (or NASO) oversight as goverment bodies will increse transparency thus access to information that isnt readily released.

Do you think registration as suggested will reslove this?

The data is there as it is a measure (KPI) for how providers are evaluated, not to mention how funding is applied. Having a national body wont change this, each area needs to be looked at seperately anyway.

Why would some of this information be released and to whom? I actually think there is quite a bit out there, particularly as a result of the select committee outcomes.

Do you think registration will improve ambulance officer and medic standards and benefit the public? (post by whatthe)

Tue, 24 Aug 2010 19:12:31 +1200

Do you think there is transparency with other registered practitioners - ie GP's?

Comparing us to the UK is like apples and oranges, both fruit but vastly different in many ways.

Like any decision like this, risk, cost and benefit come into play and the benefit is simply outweighed by the cost and the risk to an already excellent service that may not be perfect but there are none that are. Considering the fiscal constraints, I am amazed and proud to be able to provide the service we do.

Would you support registration of ambulance officers and medics under the HPCA Act? (post by whatthe)

Tue, 24 Aug 2010 19:03:32 +1200

bravobravo said...

I believe we now have new titles that all services in the sector will use: Emergency Medical Technician (current AO/ BLS paramedics); Paramedic (ILS paramedics); and Intensive Care Paramedic (ALS/ Advanced paramedics). The sector is moving together WITHOUT regulation, so why not let that process continue and save the cash needed for a new agency?

Last I heard it was Ambulance Technician but anyyway I was just making the point that from a systemsview would it not make sense to have one body in charge of clinical governance and oversight rather than duplication of effort at a service level? We USED to have a National Clinical Advisory Group under the Ambulance Education Council and Ambulance Board back in the 1990s but that was disbanded early in the 2000s. What we need in New Zealand is a professional Council representing the future interests of Paramedicine. Yes, we have Ambulance New Zealand but that needs to be taken one step further and built into a strategic management entity that lifts Paramedicine out of the warm, fuzzy aw shucks image that St John would like it to be and towards a 21st century health disclipine. Do we think we'd be in the same position that NZ is if we had a body for Paramedics that was as powerful as tne Nursing or Medical Council? This is not a NZ only problem and nations the world over to a greater or lesser degree grapple with lifting Paramedicine away from its historic perception and reshaping it into a true health profession in the eyes of the public and Government, but also within the sector itself.

EMT is the final outcome for BLS qualified staff.

Didnt realise we weren't in the 21st century with paramedics. I dont see how registration and a governing body will enhance current practice regimes.

If the government took the ambulance service out of St John hands and pumped more money into the sector then I would support it but as it stands, money could be better used. I just dont think the service is broken and an old adage comes to mind, if it aint broke, dont fix it. Is it perfect, no but tweaking what we have is surely easier and more cost effective than shelving it for something unknown.

NZ paramedicine is up there with some of the best in the world as is our current education beyond the new EMS qualification equivilent.

Would you support registration of ambulance officers and medics under the HPCA Act? (post by bravobravo)

Mon, 23 Aug 2010 21:04:26 +1200

Last I heard it was Ambulance Technician but anyyway I was just making the point that from a systemsview would it not make sense to have one body in charge of clinical governance and oversight rather than duplication of effort at a service level?

We USED to have a National Clinical Advisory Group under the Ambulance Education Council and Ambulance Board back in the 1990s but that was disbanded early in the 2000s. What we need in New Zealand is a professional Council representing the future interests of Paramedicine. Yes, we have Ambulance New Zealand but that needs to be taken one step further and built into a strategic management entity that lifts Paramedicine out of the warm, fuzzy aw shucks image that St John would like it to be and towards a 21st century health disclipine.

Do we think we'd be in the same position that NZ is if we had a body for Paramedics that was as powerful as tne Nursing or Medical Council? This is not a NZ only problem and nations the world over to a greater or lesser degree grapple with lifting Paramedicine away from its historic perception and reshaping it into a true health profession in the eyes of the public and Government, but also within the sector itself.

Would you support registration of ambulance officers and medics under the HPCA Act? (post by paramedic)

Mon, 23 Aug 2010 17:09:53 +1200

bravobravo said...
Employer self regulation is clumbersone and duplicative of effort which could be used to much better value if it were applied nationally. At the moment each Service has medical advisors, clinical standards managers, tutors, continuing education policies and materials, ATP guidelines, reval processes etc .... talk about duplication! Wouldn't it make sense to have ONE national clearninghouse for all these things which were applied across all providers?

We need a Council of Paramedicine, but first of all we need to do away with the 70s and stop using the term AO ... it's long outdated, but then again so is ICO right lol

Would you support registration of ambulance officers and medics under the HPCA Act? (post by bravobravo)

Fri, 20 Aug 2010 21:20:32 +1200

Employer self regulation is clumbersone and duplicative of effort which could be used to much better value if it were applied nationally. At the moment each Service has medical advisors, clinical standards managers, tutors, continuing education policies and materials, ATP guidelines, reval processes etc .... talk about duplication! Wouldn't it make sense to have ONE national clearninghouse for all these things which were applied across all providers?

We need a Council of Paramedicine, but first of all we need to do away with the 70s and stop using the term AO ... it's long outdated, but then again so is ICO right lol

Do ambulance officers and NZDF medics need to be registered? (post by bravobravo)

Fri, 20 Aug 2010 21:13:52 +1200

I agree that Ambulance data reporting is pretty crap.

Region based paper based PRF audits get fed up to the CSMs and nationally to the CMG which I guess they have some sort of tend analysis and "oh bugger" register but I have no idea!

The scoping project for electronic PRFs will go miles towards getting better data streams onboard and allowing the services to participate in real, meaningful clinical audit, trending and system planning.

As for when things go wrong I have a perceiption that (as others said here) the cover ups work quite well and it gets swept under the carpet. I know a few Officers who like to put 14s in people but I don't know of any who have killed anybody ...

This issue won't be solved by registration but I see it as being a requirement for data outputs by the Services that the MOH needs to enforce.

Another approach: Health Ministry Oversight (post by horizons)

Fri, 20 Aug 2010 09:10:15 +1200

This question is part of my other posts where is a frame work to collect data such as my question ?

it may exist but isnt readily avaiable to external interests and this is my point. under the current system , although not a perfect model having incresed ministry of health (or NASO) oversight as goverment bodies will increse transparency thus access to information that isnt readily released.