Emergency medical services in New Zealand are operated by three organisations. In each case, the service consists of both volunteers and paid staff, and is subsidised by the government of New Zealand through NASO (National Ambulance Sector Office) a government department combining the Ministry of Health and the Accident Compensation Commission. Additional funding occurs by means of some billing for services to individuals (except Wellington Free), as well as by means of voluntary donations. In recent years, the government has begun to examine more sustainable funding for ambulance services.[1] All three services St John Ambulance in New Zealand, Wellington Free Ambulance and Wairarapa District Health Board - have a history of long service to their communities, with Wellington Free since 1927 and St John since 1885.[2] Since the age of the motor vehicle many Hospital Boards ran their own services. From 1957 - 1990 the Hospital Act stipulated that Hospital Boards had to provide an ambulance service. Many contracted that out to St John or had ad hoc arrangements with them, often for after hours staffing. When the Hospital Act was replaced by Health Boards, many of these Boards saw this as a chance to avoid being responsible and subsequently St John took over from many Boards (e.g. Thames, Bay of Plenty, Wanganui, Palmerston North, Waipawa, Dannevirke, Nelson, West Coast, Ashburton, Southland). Marlborough stayed a Hospital based service until 2007 and Taranaki until 2011 - currently leaving Wairarapa as the only Hospital based service left.
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While the three land ambulance service providers do have paid staff, they also rely very heavily on volunteer members to supplement paid staff. In most cases, paid staff tend to be concentrated in urban areas and in the management of rural areas, with rural response staff being largely volunteer-based. St. John Ambulance reports a total of 2,211 paid staff in New Zealand, supplemented by 7,647 volunteers.[3] By contrast, Wellington Free Ambulance currently staffs 108 paid paramedics and 35 volunteers. Wairarapa DHB employs 21 paid staff and 21 Auxiliary (volunteers).
Land ambulance services are provided primarily by three organisations; Wairarapa District Health Board, Wellington Free Ambulance and St John Ambulance New Zealand. St. John Ambulance provides service to approximately 88 percent (after taking over Taranaki) of the population of New Zealand, through a network of 553 ambulances and 183 ambulance stations.[4] St. John Ambulance reports the completion of approximately 274,108 emergency responses for the year ending July 1, 2008.[5] By contrast, Wellington Free Ambulance provides service to 11 percent of the country, only in the capital region. WFA operates eight ambulance stations, all in the lower half of the North Island of New Zealand, providing service to more than 460,000 residents. They respond to an estimated 40,000 calls per year.[6] Wairarapa DHB cover a mere 1 percent of New Zealand population. District Health Boards [7]
Air ambulance and helicopter rescue services are vital life lines in a country which is largely rural and made up of islands. In both cases, the service is provided by means of a corporate sponsor, government subsidy, public donations, and the cooperation of the two land ambulance services. Westpac is a large banking corporation operating in both Australia and New Zealand. In New Zealand, Westpac undertook sponsorship of local rescue helicopters in cooperation with local Emergency medical services, just as it did in Australia. However, the requirement in New Zealand was different, and a fixed wing air ambulance service was also necessary. In New Zealand, both operations occur under the business name 'LifeFlight'. In the case of rescue helicopter operations, these are based in Wellington, and staffed by paramedics from Wellington Free Ambulance, operating Eurocopter Bk117 helicopters. Air ambulance operations are based in Auckland, and are staffed by either hospital personnel or paramedics from St. John Ambulance, depending on the medical needs (many are premature neonates) of the patient, or in Wellington. These typically use pressurised and fully converted Fairchild Metro aircraft, equipped as flying Intensive Care units.[8] Air ambulance operations are not inexpensive, and it has been estimated that after corporate sponsorship and government subsidy, it is necessary to raise approximately NZ$2,500 (around US$1,400 in 2009) in donations for each mission.[9]
The New Zealand Defence Force has personnel and equipment available at short notice to assist in civilian matters including medical emergencies.[10]
The New Zealand system functions on the Anglo-American model of care,[11] with most care in the pre-hospital setting being conducted by paramedics. Other practitioners, including local physicians and midwives, do appear at calls from time to time, but spend much less time responding to emergency calls than the Franco-German model.[12]
Training occurs across a broad range in New Zealand, and the range of training varies considerably between volunteer and paid staff. As a result, it is permissible to work on an ambulance with only a first aid certificate, or with a university degree in para-medicine. To some extent, availability of training may be affected by the location of volunteers, and also by their time availability, given full-time employment and other life commitments. There are, in fact, eight levels of training available.[13] It is quite common for New Zealand EMS staff to begin their careers as volunteers, and to progress into paid positions.
When entering into the St John Ambulance Service, an induction period is required. The new recruit learns skills of driving, personal safety and manual handling. After which the volunteer will choose one of two pathways, that of the First Responder or of the Ambulance Officer qualification. For the volunteer performing primarily rural and isolated activities (including events), the First Responder role may be more suitable. This requires less training and has no Authority To Practice (ATP) which means they do not need to have their skills re-validated each year or will be required to have registration in the future.
The more advanced role of Ambulance Officer requires a National Diploma in Ambulance Practice (Level 5)and continuing clinical education (CCE) to maintain an authority to practice. Their scope also includes drugs therapies and more advanced interventions. The EMT role is considered to be the equivalent of the international Basic Life Support (BLS) and is the minimum for a paid employment position. The next step up from BLS is the Intermediate Life Support (ILS) role. This qualification has recently been rewritten and is now available. Training is mainly by way of distance education through online learning with three, four day workshops in class and a portfolio of evidence to graduate. ILS officers are usually in paid or casual employment to complete the course. This qualification will be at Degree level in the near future with St John currently in discussion with several universities to provide the necessary support structure for provision.
At present, the Advanced Paramedic (or Advanced Life Support) is qualified by completing a university based degree program. In future this will be in the form of a post graduate qualification. All levels from BLS to ALS are required to supplement their personal training with structured continuing clinical education (CCE) to maintain there ability to practise.
Paramedics in New Zealand are graduates of a recognized three year (minimum) Bachelor of Health Science (Paramedic) degree. This level of qualification was pioneered by Wellington Free Ambulance in cooperation with Victoria University in Melbourne, Australia, but now reaches across New Zealand.[14] The New Zealand College of Paramedic Sciences operates in a joint venture arrangement with Whitereia Community Polytechnic to deliver a three-year Bachelor of Health Sciences (Paramedic) degree.[15] A similar program operates at AUT University, as well.[16] The ambulance services also provide an internship program as a part of the paramedic education process. Following completion of education requirements, candidates must pass a National Certificate in Ambulance (Paramedic) examination, in order to complete their qualifications. Some paramedics may also progress beyond this level to become Intensive Care Paramedics.
Basic life support providers use the same skill set used by BLS providers around the world. With additional training, some BLS providers may operate at an Intermediate Life Support level, including IV starts, and some drugs.[17]
Paramedics will initially complete ALS-A training, which will permit IV starts, administration of cardiac drugs, and the ability to direct cardiac resuscitation. The ALS-B qualification does not have a training program, but is indicative of additional experience. It permits the administration of narcotic analgesia and Naloxone by paramedics.[18]
Paramedics at this level require post-graduate education, and administer an increased range of resuscitation drugs. They also perform a broad range of patient care resuscitation skills including transcutaneous pacing, endotracheal intubation, needle thoracostomy, cricothyroidotomy, continuous positive airway pressure (CPAP), capnography, intraosseous infusions, thrombolysis and 12 lead electrocardiograms.[19]
The EMS system in New Zealand is served by three dispatch centres, located in Auckland, Wellington, and Christchurch. The dispatch centre in Christchurch provides coverage to the entire South Island, and is operated by St. John Ambulance. The dispatch centre in Auckland provides coverage for the north half of North Island, and is also operated by St. John Ambulance. The dispatch centre in Wellington provides coverage for the southern half of the North Island, is jointly operated by Wellington Free Ambulance and St John Ambulance but is staffed by Wellington Free Ambulance personnel. All three dispatch centres collaborate, and are capable of handling overflow of call volume for one another.[20] The call centre technology is fully integrated and seamless, providing a single, 'virtual' national dispatch centre. To illustrate, if an emergency has occurred in Christchurch but those 1-1-1 lines are all busy, the call will be forwarded to the dispatch centres in either Auckland or Wellington. The call will be answered, information gathered, and placed into the computer network. It will then appear as a pending call on the desk of the appropriate dispatcher in Christchurch, all seamlessly.
The national emergency number for ambulances in New Zealand is 1-1-1. The three dispatch centres also include significant advanced technologies, including AMPDS and Siren software for the triaging and assignment of calls. They also include a nationwide network of Automatic Vehicle Location (AVL), showing the location and current status of every ambulance in the country.[21] All dispatchers in New Zealand are certified Emergency Medical Dispatchers (EMDs), and meet the international standard for that qualification. Between them, the ambulance dispatch centres process approximately 300,000 calls per year originating with the 1-1-1 system. They also process an additional 800,000 calls per year from GPs, hospitals requesting transfers, medical alarm monitoring companies, and from paramedics themselves.[22]
http://www.wairarapa.dhb.org.nz/wdhb/HealthServices/Ambulance.aspx
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