ECP dispatch

[Caddy]

G'day all,

I'm an ECP working in NSW. I'm doing some research into how ECPs are dispatched in a number of other juristictions. We are considering a trial of unmarked cars ie. ECPs will only be able to respond to sub-acute cases per MPDS determinates.

Q1. Do you guys run unmarked cars? If so, how's it going?
Q2. How are your jobs allocated?

Cheers,

Dave

[jajafa]

Caddy

Ecps in SA use 2 marked Vito's and 1 territory(soon to be replaced with another Vito)
They are dispatched from the EOC Clinician (ECP in Coms) and crew referals
They also first respond and provide ICP back up as required, hence the marked cars.
But the priority is still sub acute cases and safe hosp avoidance strategies.
There are some similarities with the NSW model but given that we both followed the same systems from overseas that is hardly surprising.
If you need to know more contact SAAS(normal buisness number)and ask for our contact info.

[bittenyakka]

ECP=?

[boredmatrix]

Expensive Care Paramedic   


Extended Care Paramedic.  designed to undertake some of the procedures which ties up A&E Time such as dislodged Urinary Catheters or Peg Tubes.  Also make assessments on some types of injuries and treat at home (eg: Suturing, backslabs etc) and use alternate care pathways instead of sending the pt to hospital. 

it's estimated that for every patient that doesn't go to hospital - you can save the system more than $2000.

the AMA in SA got a bit upset when it first started happening, but realistically lost out on the argument when presented with Statistics that showed that Locums and GP's are seriously under-resourced, as are A&E departments struggling to meet any targets.

[disOrderly]

I only know of one unmarked SAAS car, and that isn't used by ECPs.

I've noticed the ECPs getting out and about, I think its a great idea. The demand on GPs is increasing and locums are expensive and also hard to come across.

[crashndash]

Paramedics wanting to be Nurses?

Seriously, the stuff they do could be done by a Nurse who costs half the price (to pay and train)....not a criticism of the people, just a bit of a dabble in areas other than ours perhaps. But since we are all of the one family now, I guess Grandpa Health loves us for it...

[boredmatrix]

fair call - they use both nurses and paramedics in a similar system in ....wait for it....    the UK!

wow...what a wonderful new concept...directly from Kent!

[jajafa]

paramedics wanting to nurses, makes a change from the nurses wanting to be paramedics argument,
As for cost, the equivalent is a nurse practitioner.
In this case there is no turf war between us.
While there is a lot of overlap in the skills and knowledge required there is also a few notable differences in how we all operate this is still a very ambulance focused program.
But folks we are seeing the great blurring of the lines between the professions.  

[Caddy]

Thanks everyone for the replies...and I appreciate being in the company of other EMS professionals. Even with just a few replies, the vibe is similar to other on-line forums and on the road. Here's my opinion...in NSW the additional skills and drugs are all smoke and mirrors. Anyone can suture or give nerve blocks. ECPs are there to make clinical risk decisions. That's why it takes 50 weeks to qualify as an ECP. And that's why we target sub-acute cases. I'm also an ICP and find the big trauma jobs easier to do because generally they're pretty straight forward. But an adult presenting with mild vertigo? What are the differentials there? What specifically do I look for? What neuro tests should I do? Antiemetic and discharge for GP follow-up? As an ICP, the system is not set up to discharge the patient from care (although the patient may refuse/decline transport). And so generally the option is tranport and the clinical risk is managed by presentation to the ED.

Don't get me wrong. I'm not slagging ICP's. Just highlighting that there are different degrees of clinical risk that an ICP and ECP manage. Besides, I think an ECP has little advantage over an ICP for what the ICP specialises in anyway - acute care.

So what does it all mean? To be honest, I dunno. I joined the job to be an ICP. If we did all ECP work, well then yes, maybe they should hire community nurses to do the job. I'm not a nurse and don't want to be a nurse and I'm not going to give up my ICP status to be an ECP. But if they keep a blended role where I have additional options to manage a patient and where we can successfully demonstrate a model whereby paramedics can operate as truely autonomous clinicians, then I think everyone wins.

Cheers.

[disOrderly]

Caddy, I have a feeling that is the goal. I have seen ECP's used as first responders to MVAs and Cat As.

[boredmatrix]

you're right caddy - why should an ICP lose their skills?

knowing ambos - they will always have that 'Emerg' skillset at the core fo what they do.

if we want nurses to do this sort of thing - then why don't groups like RDNS or other home nursing agencies have nurse practitioners?

the short answer = $$$$$.

SAAS can justify the expense of such a programme, plus it has all the infrastructure in place to be able to respond reactively.  Can you imagine a community nursing department attempting to take the calls, co-ordinate and dispatch everything?   

The cynic in me thinks that half the time they'd just end up calling an ambulance anyway - but only because they didn't have a doctor there to double check their diagnosis and prescribe a treatment!!   

[disOrderly]

Can you imagine a community nursing department attempting to take the calls, co-ordinate and dispatch everything?   

The cynic in me thinks that half the time they'd just end up calling an ambulance anyway - but only because they didn't have a doctor there to double check their diagnosis and prescribe a treatment!!   

Now, I am studying nursing and even I think this is true!

That is another point I had, but I didn't want to say it because I was not sure if this was the case with NPs or not, but Paramedics across all levels can use (certain) drugs without Dr authority, and ECP is an extension on that. Paramedics are used to using drugs as they see fit, while nurses are used giving drugs that a delta romeo has put in the order. As far as I am aware, RNs can't even give paracetamol unless a doc has written it up.

[jajafa]

Too true
the exception NPs, who are at least able to operate reasonably autonomously.

[crashndash]

without getting into the whole slanging match....and I'm certainly not defending nurses...heaven forbid, but...

In terms of medications, paramedics, AOs, ICP and yes, even ECPs are in exactly the same boat as Nurses regards medications. They (the green types) are operating under a Medication Standing Order, underwritten by a Medical Officer (the big H in the case of SAAS). They do not have autonomous prescribing authority, they respond within a set of parameters (call them, oh I dont know - Clinical Guidelines or Protocols, depending on your flavour). Nurses; Enrolled, Registered and even the super Practitioner types, do exactly the same - it's just a more visible presence of the MO. Visit the RAH in emerg and see what the senior nurses there are giving....without referring directly to a MO, just like we do.

For my part....I just see it as a waste for an ambulance service to train and equip an ICP and then lose them again to learn nursie stuff, and have them cost the system double the price of a RN when they are working. Sure they are sometimes available to respond to Cat A's or sometimes Bs....but if they are being utilised efficiently, they will be up to their armpits in Grandpas catheter and drainage bag. Why would you pass that up for a run of the mill SOB?

If SAAS want to organise the system, great...dont care, but seriously, why dont we control the world and include dispatch and coordination for RDNS, and the whole ancillary home help network in the equation? The one stop home help shop....include key cutting and haberdashery and we will corner the market 

 At some stage....maybe we should concentrate on being the best Ambulance Service....goodness knows theres a few places to work on there first.

If you want to get seriously serious, and make real inputs into out of hospital outcomes, ....train them as Physician's Assistants but leave the nurse stuff to the nurses

[amboman69]

Crash wasn't too far from the mark with his toungue in cheek comment about SAAS despatching RDNS and other services, - ever wonder what mental health and AIMs are doing in the EOC???

Now that SAAS is part of the happy family at SA Health, and are competing for a slice of the funding, we have to start cutting out our own little niche and prove what a "worthy and useful" child we are. Just running an effective ambulance service will no longer be sufficient - we have to find new things to attract attention and the bucks, and our despatch/communications "expertise" is something we can sell.

Speaking of bucks, ever wonder why there was an article in SAAS Scene encouraging (?? ordering) ambos to mark casecards as "Treat Not Transport" rather than "Ambulance Not Required".  Apparently, rolling up to a job, looking at the patient and listening to him/her telling you that they will make their own way to hospital constitutes "treatment".

Could it have anything to do with inflating the "TNT" stats supplied to Health, proving that SAAS is doing its bit to stop the flood of cases arriving at the ED departments?  After all, that was one of the prime reasons for setting up the ECP scheme wasn't it?.

Nah - that is way to cynical.

[crashndash]

lolol amboman....you are gonna go straight to hell with that sort of thinking 

your sentence is to work at Eastwood for 26 weeks and undergo psychological readjustment therapy; clearly you are a square peg looking for a round hole..lol

[disOrderly]

One of my lecturers was saying that SAAS were using nurses in a new program to treat out of hospital. I thought she might have been thinking of ECP's but I wasn't 100% certain.

Having said that, she was also trying to tell me that being a Paramedic is a waste of time and that I should be a nurse because they get paid more and if I did a couple of years in ICU after I finish uni I can jump into Retrievals....

[boredmatrix]

your lecturer is a nurse...of course he will say that!

yes - nurses do get paid more than paramedics...in some contexts

the rate for a paramedic at the top level of their incrememnts (which only takes 5 years to get as oppoosed to 9 years of nursing) is around the $65k mark - but then you can add anywhere between 35 and 50% loading on top of that depending on your shift patterns. 

you do the math!

the only advantage to nursing is that there are a lot more career options. 

yes - you can specialise - but bearing in mind that for something like retrievals..you've gotta be pretty filtered good to get a look in (small pond...big fish syndrome)

[disOrderly]

Yeah I know, but they should also be encouraging other professions and not making nurses look like they are the most important profession and that Doctors, Paramedics and allied health are inferior.

Are those pay rates for all classes of Paramedic? Surely an ICP makes more than a P? Or a sottie makes more than an ICP?

Do you get much say in your shifts? I thought everyone did 2 days/2nights/4off?

[whitecloud]

Yeah I know, but they should also be encouraging other professions and not making nurses look like they are the most important profession and that Doctors, Paramedics and allied health are inferior.

Are those pay rates for all classes of Paramedic? Surely an ICP makes more than a P? Or a sottie makes more than an ICP?

Do you get much say in your shifts? I thought everyone did 2 days/2nights/4off?

Not necessarily, there's the normal 4 on 4 off Day night, similar day / afternoon rotations, those which involve leadership and pretty much 9 - 5 and good ol' regional country, where you have 4 days and 4 on call, then 4 days off.

[boredmatrix]

yes I was only referring to an ALS level Para.  SPRINT paras get a higher base, and ICP's get higher than that (not much....but still more!) while SOT obviously get more again.

as white cloud has eluded - shift patterns will vary between days and nights or afternoons, on call in some country areas, or the 4x4 roster (96 hours straight) in some other country areas.  Spares (who work at all stations within a region) get a higher loading as well for the privelige of being the biartch- but still work their set shift pattern.

[disOrderly]

So what would a Paramedic Intern be looking at?

And what roles are you guys in? ICP?

It's good to find all this info out, thanks for the help. I just got to hope I get into the degree!

[misterteddy]

So what would a Paramedic Intern be looking at?

a whole lifetime of pain, torment and ridicule 

[boredmatrix]

 

No...that's just the first 18 months......and then you're on your own!

[misterteddy]

oh it will feeeel like a lifetime...lolol