firstly, lets put a few things straight. I didn't say that a Nurse doing an ALS course knew more than a Paramedic - please check my wording. I said they were allowed to do more with their knowledge having done the course. Secondly, Nurses operate in exactly the same way we do as Paramedics, they operate on case by case written orders, or standing orders (that don't need referring to the MO); we operate on the same things except we call them Guidelines. They are the same. DR1's signature is on them, we as Paramedics (or ICPs/ECPs or AOs) are using his authority in a standing order - please don't think you have autonomy, you don't.
Next, the ACCCN course is but one version of ALS. You are mostly correct in what it covers. Importantly it provides training in the most common Cardiac Arrest Drugs, Adrenaline, Amiodarone and Atropine. The last 2 are not able to be given by SAAS Paramedics, only ICPs/ECPs. Fancy having a system where your highly trained, university degree qualified Paramedic, can't even follow the Aust Resus Council ALS Cardiac Arrest Guideline. Scandalous really, it goes beyond just dumb. SAAS (and SA Health) are quite happy to allow Paramedics (and even Volunteer AOs)to call an arrest after 10 mins of asystole (flat line on the ECG for the hose draggers following along), but won't even allow a Paramedic to administer the drug of choice for the condition (atropine)....I mean the person is dead, they aren't going to die more! The cynical among us would say that's easier than having to put them in an ICU bed and worry about the $$cost of their recovery, but far be it for me to be cynical about SA Healths motives. Is it perfect, no, is it 100% clinical efficous - no, nothing is. Is trying it better than watching someone die for the sake of it - ask the relatives. Hopefully Slater and Gordon the lawyer firm read the forum and can apply one of the few benefits of lawyers; change based on punitive damages.
Other ALS courses, such as the UKRC/ARC ALS, ACLS and ATLS courses provide training and assessment in ETI, ETI failure drills and procedures (including needle cric),IO access, pacing and cardioversion, a more comprehensive drug regime,chest decompression and chest drainage tubes among others. Hospital, practice and remote area nurses are approved to use these skills with the authorisation of their Clinical Director (just the same way Paramedics are given an authority to practice)having completed these courses.
ECGs??....sorry, but your bog standard P3 paramedic cant utilise a 12 lead ECG, only a 3 lead, same as your volunteer Cert 2 (albeit better - it's not about the skill remember, just being able to use it). I've had 2 Paramedics not know where to put the V1-6 chest leads. Yes, this basic skill is being rolled out in the current PDWs....hello welcome to 1980, let alone 2010. How the hell do you activate a STEMI notification with a 3 lead as your diagnostic tool.....oh that's right, a Paramedic can't, only an ALS nurse in a rural hospital, an ICP/ECP or an MO can.
Fluid resuscitation is interesting. Can a SAAS P3 cannulate a patient with a 3 day history of fever and no food/water intake for that duration,displaying obvious signs of dehydration and who has a weak thready radial pulse?.....don't think so. They need to consult. When you deliver them to the RAH, u bet they will get IV fluid from the receiving nurse under a standing order.
I'm not having a dip at Paramedics here,far from it just SAAS and its anachronistic muzzling of it's highly qualified staff. Layers of bureaucracy and a metro-centric mentality (where no case is more than 15 mins from hospital)have meant a dilution of the skills Paramedics have been able to utilise throughout the rest of the world, let alone the rest of Australia. They have the training now (a degree is the standard remember - although large numbers of current SAAS Paramedics don't even have a Diploma), they have the $$ and are close to if not THE highest paid Paramedics in Australia and in fact most of the world, time we got a better bang for our buck as recipients of their knowledge
/rant
