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.
{|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
|}


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"style="text-align:center;"
 
|+style="text-align:left;"|The 2019-2022 scopes are as follows:
 
!style="text-align:left" |Skill !!style="width:100px" |EMT !!style="width:100px" |Paramedic !!style="width:100px" |ICP
==== Certificate in Primary Care ====
|-
 
|style="text-align:left;"|Adrenaline IN, IM, Nebulised and Topical
* '''Education Requirement:''' 5 day course
|✔||✔||✔
** Automated defibrillation ''(VT/VF)''
|-
** Inhalation analgesia (Entonox(R) and/or methoxyflurane) ''(pain relief)''
|style="text-align:left"|Aspirin PO
** Oxygen / oropharyngeal airways
|✔||✔||✔
** Aspirin and paracetamol (St John only) ''(pain relief and asprin for chest pain)''
|-
 
|style="text-align:left"|Glucagon IM
==== National Certificate in Ambulance ====
|✔||✔||✔
 
|-
* '''Education Requirement:''' NZQA level 4 (120 credits - 12mo. full time equiv.)
|style="text-align:left"|GTN SL and Patch
** Laryngeal mask airway (LMA)
|✔||✔||✔
** Nasopharyngeal airway (St John)
|-
** Aspirin (new core skill for Wellington Free) ''(chest pain/ ACS)''
|style="text-align:left"|Ibuprofen PO
** Ipratropium (TN: atrovent) (Wellington Free only) ''(asthma and COPD)''
|✔||✔||✔
** Sallbutamol ''(asthma and COPD)''
|-
** Glyceryl trinitrate spray (GTN/NTG)  ''(chest pain/edema/shock of cardiogenic origin)''
|style="text-align:left"|Ipratropium Nebulised
** IM glucagon ''(hypoglucemia)''
|✔||✔||✔
 
|-
 
|style="text-align:left"|Laryngeal Mask Airway
==== National Diploma (IV/Cardiac) ====
|✔||✔||✔
 
|-
* '''Education Requirement:''' Two additional NZQA units at level 6 (30 credits)
|style="text-align:left"|Laryngoscopy (Airway Obstruction)
** Nasopharyngeal airway (new core skill for Wellington Free)
|✔||✔||✔
** 3 lead ECG monitoring / dysrhythmia recognition
|-
** Manual defibrillation (VF/VT)
|style="text-align:left"|Loratadine PO
** IV cannulation
|✔||✔||✔
** IV fluids (0.9% NaCI and 50% dextrose) ''(fluid replacement / dextrose in hypoglycemia)''
|-
 
|style="text-align:left"|Methoxyflurane Inhaled
 
|✔||✔||✔
==== Upskilled National Diploma (IV/Cardiac) ====
|-
 
|style="text-align:left"|Ondansetron IM
* '''Education Requirement:''' One additional 30 credit NZQA unit at level 6
|✔||✔||✔
** Morphine ''(pain relief)''
|-
** Maloxon (metaclopramide) ''(severe nausea/vomiting)''
|style="text-align:left"|Paracetamol PO
** Naloxon (narcan) ''(opiod drug overdoses)''
|✔||✔||✔
** 1:10,000 or 1:1,000,000 epinephrine ''(cardiac arrest, asthma, croup, anaphalyxis only)''
|-
 
|style="text-align:left"|Prednisolone PO
 
|✔||✔||✔
==== National Diploma or Bachelors (Paramedic) ====
|-
 
|style="text-align:left"|Prednisone PO
* '''Education Requirement:''' 120 credits at NZQA level 6 (2 years) or 360 credits for AUT Bachelors (3 years)
|✔||✔||✔
** Laryngoscopy
|-
** Non sedative endotracheal intubation
|style="text-align:left"|PEEP
** Needle thoracostomy ''(tension pnuemothorax/chest decompression)''
|✔||✔||✔
** Needle cricothyrotomy ''(emergency airway)''
|-
** Intraosseus needle access (EzIO(R) (WFA) or Cooks)
|style="text-align:left"|Salbutamol Nebulised
** Elastic gum boogie for endotracheal intubation (Wellington Free)
|✔||✔||✔
** CPAP (Wellington Free) ''(pulmonary edema/cardiogenic shock)''
|-
** Atropine ''(compromising bradycardia)''
|style="text-align:left"|Tramadol PO
** Amiodarone ''(VF/compromising VT)''
|✔||✔||✔
** Lasix(R) (TN: fruisemide/frusomide) ''(cardiogenic edema)''
|-
** Midazolam ''(pain relief)''
|style="text-align:left"|Adrenaline IV (cardiac arrest only)
** Ketamine (St John) ''(pain relief)''
|||✔||✔
** Transcutaneous pacing ''(compromising bradycardia)''
|-
** Cardioversion ''(compromising tachycardia)''
|style="text-align:left"|Amiodarone IV (cardiac arrest only)
** 12 lead ECG arrythmia recognition
|||✔||✔
** Thrombolysis (heprain/reteplaste - Wellington Free) ''(STEMI)''
|-
** Predinisilone (Wellington Free) ''(asthma)''
|style="text-align:left"|Amoxicillin/Clavulanic Acid IV
** Hydrocortisone (Wellington Free) ''(asthma)''
|||✔||✔
|-
|style="text-align:left"|Ceftriaxone IM and IV
|||✔||✔
|-
|style="text-align:left"|Clopidogrel PO
|||✔||✔
|-
|style="text-align:left"|CPAP
|||✔||✔
|-
|style="text-align:left"|Droperidol IM and IV
|||✔||✔
|-
|style="text-align:left"|Enoxaparin SC
|||✔||✔
|-
|style="text-align:left"|Fentanyl IN, IM and IV
|||✔||✔
|-
|style="text-align:left"|Gentamicin IV
|||✔||✔
|-
|style="text-align:left"|Glucose IV
|||✔||✔
|-
|style="text-align:left"|Heparin IV
|||✔||✔
|-
|style="text-align:left"|IO Access
|||✔||✔
|-
|style="text-align:left"|IV Cannulation
|||✔||✔
|-
|style="text-align:left"|Ketamine IM, PO and IV (analgesia only)
|||✔||✔
|-
|style="text-align:left"|1% Lignocaine SC and IO
|||✔||✔
|-
|style="text-align:left"|Manual Defibrillation
|||✔||✔
|-
|style="text-align:left"|Midazolam IM <br> (seizures and agitated delirium only)
|||✔||✔
|-
|style="text-align:left"|Midazolam IV (seizures only)
|||✔||✔
|-
|style="text-align:left"|Naloxone IM and IV
|||✔||✔
|-
|style="text-align:left"|Olanzapine PO
|||✔||✔
|-
|style="text-align:left"|Ondansetron IV
|||✔||✔
|-
|style="text-align:left"|Oxytocin IM
|||✔||✔
|-
|style="text-align:left"|0.9% Sodium Chloride IV
|||✔||✔
|-
|style="text-align:left"|Synchronised Cardioversion
|||✔||✔
|-
|style="text-align:left"|Tenecteplase IV
|||✔||✔
|-
|style="text-align:left"|Tranexamic Acid IV
|||✔||✔
|-
|style="text-align:left"|Valproate IV
|||✔||✔
|-
|style="text-align:left"|Adenosine IV
|||||✔
|-
|style="text-align:left"|Adrenaline (all routes)
|||||✔
|-
|style="text-align:left"|Amiodarone IV
|||||✔
|-
|style="text-align:left"|Atropine IV
|||||✔
|-
|style="text-align:left"|Calcium Chloride IV
|||||✔
|-
|style="text-align:left"|Chest Decompression (needle)
|||||✔
|-
|style="text-align:left"|Cricothyroidotomy
|||||✔
|-
|style="text-align:left"|Endotracheal Intubation
|||||✔
|-
|style="text-align:left"|Fascia Iliaca Block
|||||✔
|-
|style="text-align:left"|Finger Thoracostomy
|||||✔
|-
|style="text-align:left"|GTN IV Infusion
|||||✔
|-
|style="text-align:left"|Hydrocortisone IV
|||||✔
|-
|style="text-align:left"|Ketamine (analgesia and dissociation)
|||||✔
|-
|style="text-align:left"|Labetalol IV
|||||✔
|-
|style="text-align:left"|Magnesium IV
|||||✔
|-
|style="text-align:left"|Metaraminol IV
|||||✔
|-
|style="text-align:left"|Metoprolol IV
|||||✔
|-
|style="text-align:left"|Midazolam IV
|||||✔
|-
|style="text-align:left"|Pacing
|||||✔
|-
|style="text-align:left"|Promethazine IV
|||||✔
|-
|style="text-align:left"|Rocuronium IV
|||||✔
|-
|style="text-align:left"|0.75% Ropivacaine SC
|||||✔
|-
|style="text-align:left"|8.4% Sodium Bicarbonate IV
|||||✔
|-
|style="text-align:left"|Suxamethonium IV (RSI endorsed personnel only)
|||||✔
|}

Latest revision as of 14:39, 15 January 2022

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.

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
The 2019-2022 scopes are as follows:
Skill EMT Paramedic ICP
Adrenaline IN, IM, Nebulised and Topical ✔ ✔ ✔
Aspirin PO ✔ ✔ ✔
Glucagon IM ✔ ✔ ✔
GTN SL and Patch ✔ ✔ ✔
Ibuprofen PO ✔ ✔ ✔
Ipratropium Nebulised ✔ ✔ ✔
Laryngeal Mask Airway ✔ ✔ ✔
Laryngoscopy (Airway Obstruction) ✔ ✔ ✔
Loratadine PO ✔ ✔ ✔
Methoxyflurane Inhaled ✔ ✔ ✔
Ondansetron IM ✔ ✔ ✔
Paracetamol PO ✔ ✔ ✔
Prednisolone PO ✔ ✔ ✔
Prednisone PO ✔ ✔ ✔
PEEP ✔ ✔ ✔
Salbutamol Nebulised ✔ ✔ ✔
Tramadol PO ✔ ✔ ✔
Adrenaline IV (cardiac arrest only) ✔ ✔
Amiodarone IV (cardiac arrest only) ✔ ✔
Amoxicillin/Clavulanic Acid IV ✔ ✔
Ceftriaxone IM and IV ✔ ✔
Clopidogrel PO ✔ ✔
CPAP ✔ ✔
Droperidol IM and IV ✔ ✔
Enoxaparin SC ✔ ✔
Fentanyl IN, IM and IV ✔ ✔
Gentamicin IV ✔ ✔
Glucose IV ✔ ✔
Heparin IV ✔ ✔
IO Access ✔ ✔
IV Cannulation ✔ ✔
Ketamine IM, PO and IV (analgesia only) ✔ ✔
1% Lignocaine SC and IO ✔ ✔
Manual Defibrillation ✔ ✔
Midazolam IM
(seizures and agitated delirium only) 		✔ ✔
Midazolam IV (seizures only) ✔ ✔
Naloxone IM and IV ✔ ✔
Olanzapine PO ✔ ✔
Ondansetron IV ✔ ✔
Oxytocin IM ✔ ✔
0.9% Sodium Chloride IV ✔ ✔
Synchronised Cardioversion ✔ ✔
Tenecteplase IV ✔ ✔
Tranexamic Acid IV ✔ ✔
Valproate IV ✔ ✔
Adenosine IV ✔
Adrenaline (all routes) ✔
Amiodarone IV ✔
Atropine IV ✔
Calcium Chloride IV ✔
Chest Decompression (needle) ✔
Cricothyroidotomy ✔
Endotracheal Intubation ✔
Fascia Iliaca Block ✔
Finger Thoracostomy ✔
GTN IV Infusion ✔
Hydrocortisone IV ✔
Ketamine (analgesia and dissociation) ✔
Labetalol IV ✔
Magnesium IV ✔
Metaraminol IV ✔
Metoprolol IV ✔
Midazolam IV ✔
Pacing ✔
Promethazine IV ✔
Rocuronium IV ✔
0.75% Ropivacaine SC ✔
8.4% Sodium Bicarbonate IV ✔
Suxamethonium IV (RSI endorsed personnel only) ✔
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