Ambulance Scopes Of Practice: Difference between revisions

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The following is a list of current (2007) New Zealand ambulance service provider scopes of practice for paramedical personnel.  A scope of practice is the interventions and pharmacologics that staff can administer when treating patients.
In New Zealand the National Ambulance Sector Clinical Working Group (part of Ambulance New Zealand) formulates the Clinical Practice Guidelines and delegated scopes of practice that Ambulance Officers may use when treating patients.


Each new scope builds on the previous scope(s) and encompasses the skills below it, only new skills are shown below at each level.
The 2016-2018 scopes are as follows:


Clinical capability is classified as basic life support (primary care or national certificate), intermediate life support (diploma) and advanced life support (paramedic diploma or degree).


{| class="wikitable"
! Authority to practice level !! Education Requirement
|-
| Emergency Medical Technician || National Diploma in Ambulance Practice
|-
| Paramedic || Bachelor of Health Science
|-
| Intensive Care Paramedic || Post Graduate Certificate/Post Graduate Diploma
|}


==== Certificate in Primary Care ====
{| class="wikitable"
 
!style="text-align:left" | Skill !!style="width:100px" | EMT !!style="width:100px" | Paramedic !!style="width:100px" | ICP
* '''Education Requirement:''' 5 day course
|-
** Automated defibrillation ''(VT/VF)''
| Adrenaline IM, IN, Nebulised and Topical
** Inhalation analgesia (Entonox(R) and/or methoxyflurane) ''(pain relief)''
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Oxygen / oropharyngeal airways
|-
** Aspirin and paracetamol (St John only) ''(pain relief and asprin for chest pain)''
| Entonox Inhaled
 
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
==== National Certificate in Ambulance ====
|-
 
| Glucagon IM
* '''Education Requirement:''' NZQA level 4 (120 credits - 12mo. full time equiv.)
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Laryngeal mask airway (LMA)
|-
** Nasopharyngeal airway (St John)
| GTN SL
** Aspirin (new core skill for Wellington Free) ''(chest pain/ ACS)''
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Ipratropium (TN: atrovent) (Wellington Free only) ''(asthma and COPD)''
|-
** Sallbutamol ''(asthma and COPD)''
| Ibuprofen PO
** Glyceryl trinitrate spray (GTN/NTG) ''(chest pain/edema/shock of cardiogenic origin)''
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** IM glucagon ''(hypoglucemia)''
|-
 
| Ipratropium Nebulised
 
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
==== National Diploma (IV/Cardiac) ====
|-
 
| Laryngeal Mask Airway
* '''Education Requirement:''' Two additional NZQA units at level 6 (30 credits)
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Nasopharyngeal airway (new core skill for Wellington Free)
|-
** 3 lead ECG monitoring / dysrhythmia recognition
| Loratadine PO
** Manual defibrillation (VF/VT)
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** IV cannulation
|-
** IV fluids (0.9% NaCI and 50% dextrose) ''(fluid replacement / dextrose in hypoglycemia)''
| Methoxyflurane Inhaled
 
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
 
|-
==== Upskilled National Diploma (IV/Cardiac) ====
| Ondansetron PO
 
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
* '''Education Requirement:''' One additional 30 credit NZQA unit at level 6
|-
** Morphine ''(pain relief)''
| Paracetamol PO
** Maloxon (metaclopramide) ''(severe nausea/vomiting)''
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Naloxon (narcan) ''(opiod drug overdoses)''
|-
** 1:10,000 or 1:1,000,000 epinephrine ''(cardiac arrest, asthma, croup, anaphalyxis only)''
| Prednisone PO
 
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
 
|-
==== National Diploma or Bachelors (Paramedic) ====
| PEEP
 
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
* '''Education Requirement:''' 120 credits at NZQA level 6 (2 years) or 360 credits for AUT Bachelors (3 years)
|-
** Laryngoscopy
| Salbutamol Nebulised
** Non sedative endotracheal intubation
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Needle thoracostomy ''(tension pnuemothorax/chest decompression)''
|-
** Needle cricothyrotomy ''(emergency airway)''
| Tramadol PO
** Intraosseus needle access (EzIO(R) (WFA) or Cooks)
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Elastic gum boogie for endotracheal intubation (Wellington Free)
|-
** CPAP (Wellington Free) ''(pulmonary edema/cardiogenic shock)''
| Urinary Catheter Troubleshooting
** Atropine ''(compromising bradycardia)''
|style="text-align:center;" | ✔ ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Amiodarone ''(VF/compromising VT)''
|-
** Lasix(R) (TN: fruisemide/frusomide) ''(cardiogenic edema)''
| Adrenaline IV (cardiac arrest only)  
** Midazolam ''(pain relief)''
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Ketamine (St John) ''(pain relief)''
|-
** Transcutaneous pacing ''(compromising bradycardia)''
| Amiodarone IV (cardiac arrest only)  
** Cardioversion ''(compromising tachycardia)''
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** 12 lead ECG arrythmia recognition
|-
** Thrombolysis (heprain/reteplaste - Wellington Free) ''(STEMI)''
| Amoxicillin/Clavulanic Acid IM or IV
** Predinisilone (Wellington Free) ''(asthma)''
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
** Hydrocortisone (Wellington Free) ''(asthma)''
|-
| Clopidogrel PO
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Enoxaparin SC
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Fentanyl IN and IV
|style="text-align:center;" | ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Gentamicin IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Glucose IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Heparin IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| IV Cannulation
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| !% Lignocaine SC
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Manual Defibrillation
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Metoprolol IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Midazolam IM <br> (seizures or agitated delirium only)
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Midazolam IV (seizures only)  
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Morphine IM and IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Naloxone IM and IV  
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Olanzapine PO
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Ondansetron IM and IV  
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Oxytocin IM
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| 0.9% Sodium Chloride IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Synchronised Cardioversion
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Tenecteplase IV
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Valproate IV  
|style="text-align:center;" |  ||style="text-align:center;" | ✔ ||style="text-align:center;" | ✔
|-
| Adenosine IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Adrenaline (all routes)  
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Amiodarone IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Atropine IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Calcium Chloride IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Chest Decompression (needle)  
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Cricothyroidotomy
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Endotracheal Intubation
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Finger Thoracostomy
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| IO Access
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Ketamine (all routes)  
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| 1% Lignocaine (all routes)  
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Magnesium IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Midazolam IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Pacing
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Rocuronium IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| 8.4% Sodium Bicarbonate IV
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|-
| Suxamethonium (RSI endorsed personnel only)  
|style="text-align:center;" |  ||style="text-align:center;" |  ||style="text-align:center;" | ✔
|}

Revision as of 08:58, 7 January 2019

In New Zealand the National Ambulance Sector Clinical Working Group (part of Ambulance New Zealand) formulates the Clinical Practice Guidelines and delegated scopes of practice that Ambulance Officers may use when treating patients.

The 2016-2018 scopes are as follows:


Authority to practice level Education Requirement
Emergency Medical Technician National Diploma in Ambulance Practice
Paramedic Bachelor of Health Science
Intensive Care Paramedic Post Graduate Certificate/Post Graduate Diploma
Skill EMT Paramedic ICP
Adrenaline IM, IN, Nebulised and Topical ✔ ✔ ✔
Entonox Inhaled ✔ ✔ ✔
Glucagon IM ✔ ✔ ✔
GTN SL ✔ ✔ ✔
Ibuprofen PO ✔ ✔ ✔
Ipratropium Nebulised ✔ ✔ ✔
Laryngeal Mask Airway ✔ ✔ ✔
Loratadine PO ✔ ✔ ✔
Methoxyflurane Inhaled ✔ ✔ ✔
Ondansetron PO ✔ ✔ ✔
Paracetamol PO ✔ ✔ ✔
Prednisone PO ✔ ✔ ✔
PEEP ✔ ✔ ✔
Salbutamol Nebulised ✔ ✔ ✔
Tramadol PO ✔ ✔ ✔
Urinary Catheter Troubleshooting ✔ ✔ ✔
Adrenaline IV (cardiac arrest only) ✔ ✔
Amiodarone IV (cardiac arrest only) ✔ ✔
Amoxicillin/Clavulanic Acid IM or IV ✔ ✔
Clopidogrel PO ✔ ✔
Enoxaparin SC ✔ ✔
Fentanyl IN and IV ✔ ✔
Gentamicin IV ✔ ✔
Glucose IV ✔ ✔
Heparin IV ✔ ✔
IV Cannulation ✔ ✔
!% Lignocaine SC ✔ ✔
Manual Defibrillation ✔ ✔
Metoprolol IV ✔ ✔
Midazolam IM
(seizures or agitated delirium only) 		✔ ✔
Midazolam IV (seizures only) ✔ ✔
Morphine IM and IV ✔ ✔
Naloxone IM and IV ✔ ✔
Olanzapine PO ✔ ✔
Ondansetron IM and IV ✔ ✔
Oxytocin IM ✔ ✔
0.9% Sodium Chloride IV ✔ ✔
Synchronised Cardioversion ✔ ✔
Tenecteplase IV ✔ ✔
Valproate IV ✔ ✔
Adenosine IV ✔
Adrenaline (all routes) ✔
Amiodarone IV ✔
Atropine IV ✔
Calcium Chloride IV ✔
Chest Decompression (needle) ✔
Cricothyroidotomy ✔
Endotracheal Intubation ✔
Finger Thoracostomy ✔
IO Access ✔
Ketamine (all routes) ✔
1% Lignocaine (all routes) ✔
Magnesium IV ✔
Midazolam IV ✔
Pacing ✔
Rocuronium IV ✔
8.4% Sodium Bicarbonate IV ✔
Suxamethonium (RSI endorsed personnel only) ✔
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