Ambulance Scopes Of Practice

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.

Each new scope builds on the previous scope(s) and encompasses the skills below it, only new skills are shown below at each level.

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).

Certificate in Primary Care

• Education Requirement: 5 day course
  • Automated defibrillation (VT/VF)
  • Inhalation analgesia (Entonox(R) and/or methoxyflurane) (pain relief)
  • Oxygen / oropharyngeal airways
  • Aspirin and paracetamol (St John only) (pain relief and asprin for chest pain)

National Certificate in Ambulance

• Education Requirement: NZQA level 4 (120 credits - 12mo. full time equiv.)
  • Laryngeal mask airway (LMA)
  • Nasopharyngeal airway (St John)
  • Aspirin (new core skill for Wellington Free) (chest pain/ ACS)
  • 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)
  • IM glucagon (hypoglucemia)

National Diploma (IV/Cardiac)

• Education Requirement: Two additional NZQA units at level 6 (30 credits)
  • Nasopharyngeal airway (new core skill for Wellington Free)
  • 3 lead ECG monitoring / dysrhythmia recognition
  • Manual defibrillation (VF/VT)
  • IV cannulation
  • IV fluids (0.9% NaCI and 50% dextrose) (fluid replacement / dextrose in hypoglycemia)

Upskilled National Diploma (IV/Cardiac)

• Education Requirement: One additional 30 credit NZQA unit at level 6
  • Morphine (pain relief)
  • Maloxon (metaclopramide) (severe nausea/vomiting)
  • Naloxon (narcan) (opiod drug overdoses)
  • 1:10,000 or 1:1,000,000 epinephrine (cardiac arrest, asthma, croup, anaphalyxis only)

National Diploma or Bachelors (Paramedic)

• Education Requirement: 120 credits at NZQA level 6 (2 years) or 360 credits for AUT Bachelors (3 years)
  • Laryngoscopy
  • Non sedative endotracheal intubation
  • Needle thoracostomy (tension pnuemothorax/chest decompression)
  • Needle cricothyrotomy (emergency airway)
  • Intraosseus needle access (EzIO(R) (WFA) or Cooks)
  • Elastic gum boogie for endotracheal intubation (Wellington Free)
  • CPAP (Wellington Free) (pulmonary edema/cardiogenic shock)
  • Atropine (compromising bradycardia)
  • Amiodarone (VF/compromising VT)
  • Lasix(R) (TN: fruisemide/frusomide) (cardiogenic edema)
  • Midazolam (pain relief)
  • Ketamine (St John) (pain relief)
  • Transcutaneous pacing (compromising bradycardia)
  • Cardioversion (compromising tachycardia)
  • 12 lead ECG arrythmia recognition
  • Thrombolysis (heprain/reteplaste - Wellington Free) (STEMI)
  • Predinisilone (Wellington Free) (asthma)
  • Hydrocortisone (Wellington Free) (asthma)