Emergency medical services in New Zealand
Encyclopedia
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. 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.
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.
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.
Wairarapa DHB cover a mere 1 percent of New Zealand population.
District Health Boards
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. 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.
has personnel and equipment available at short notice to assist in civilian matters including medical emergencies.
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.
in Melbourne
, Australia, but now reaches across New Zealand. 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. A similar program operates at AUT University, as well. 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.
analgesia and Naloxone
by paramedics.
, endotracheal intubation, needle thoracostomy, cricothyroidotomy, continuous positive airway pressure
(CPAP), capnography
, intraosseous infusions, thrombolysis
and 12 lead electrocardiograms.
. 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. 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. 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.
http://www.wairarapa.dhb.org.nz/wdhb/HealthServices/Ambulance.aspx
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
in New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
are operated by three organisations. In each case, the service consists of both volunteers
Volunteering
Volunteering is generally considered an altruistic activity, intended to promote good or improve human quality of life, but people also volunteer for their own skill development, to meet others, to make contacts for possible employment, to have fun, and a variety of other reasons that could be...
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. All three services St John Ambulance in New Zealand, Wellington Free Ambulance
Wellington Free Ambulance
The Wellington Free Ambulance provides free to the patient ambulance services in the Wellington Region of New Zealand.-History:The ambulance service was created on 9 November 1927 by the mayor of Wellington, Sir Charles Norwood, and initially operated out of the Old Navals boatshed...
and Wairarapa District Health Board - have a history of long service to their communities, with Wellington Free since 1927 and St John since 1885.
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.
Organization
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. 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
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. St. John Ambulance reports the completion of approximately 274,108 emergency responses for the year ending July 1, 2008.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.
Wairarapa DHB cover a mere 1 percent of New Zealand population.
District Health Boards
District Health Board (New Zealand)
District Health Boards in New Zealand are organisations established by the New Zealand Public Health and Disability Act 2000, responsible for ensuring the provision of health and disability services to populations within a defined geographical area. They have existed since 1 January 2001 when the ...
Air ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
and helicopter rescue
Rescue
Rescue refers to responsive operations that usually involve the saving of life, or prevention of injury during an incident or dangerous situation....
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
Westpac
Westpac , is a multinational financial services, one of the Australian "big four" banks and the second-largest bank in New Zealand....
is a large banking corporation operating in both Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
and New Zealand. In New Zealand, Westpac undertook sponsorship of local rescue helicopters in cooperation with local Emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
, 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
Auckland
The Auckland metropolitan area , in the North Island of New Zealand, is the largest and most populous urban area in the country with residents, percent of the country's population. Auckland also has the largest Polynesian population of any city in the world...
, 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. 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.
Military
The New Zealand Defence ForceNew Zealand Defence Force
The New Zealand Defence Force consists of three services: the Royal New Zealand Navy; the New Zealand Army; and the Royal New Zealand Air Force. The Commander-in-Chief of the NZDF is His Excellency Rt. Hon...
has personnel and equipment available at short notice to assist in civilian matters including medical emergencies.
Models of care
The New Zealand system functions on the Anglo-American model of care, 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.Training
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. It is quite common for New Zealand EMS staff to begin their careers as volunteers, and to progress into paid positions.Basic and Intermediate
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.
Paramedic
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 UniversityVictoria University, Australia
Victoria University is a multi-sector tertiary institution based in Melbourne, Australia with 10 campuses.VU offers qualifications in higher education, vocational education , and short courses...
in Melbourne
Melbourne
Melbourne is the capital and most populous city in the state of Victoria, and the second most populous city in Australia. The Melbourne City Centre is the hub of the greater metropolitan area and the Census statistical division—of which "Melbourne" is the common name. As of June 2009, the greater...
, Australia, but now reaches across New Zealand. 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. A similar program operates at AUT University, as well. 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 and Intermediate
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.Paramedic
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 narcoticNarcotic
The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...
analgesia and Naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...
by paramedics.
Intensive Care Paramedics
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 pacingTranscutaneous pacing
Transcutaneous pacing is a temporary means of pacing a patient's heart during a medical emergency. It is accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract....
, endotracheal intubation, needle thoracostomy, cricothyroidotomy, continuous positive airway pressure
Continuous positive airway pressure
Positive airway pressure is a mode of respiratory ventilation used primarily in the treatment of sleep apnea, for which it was first developed. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, and in newborn infants...
(CPAP), capnography
Capnography
Capnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases. Its main development has been as a monitoring tool for use during anaesthesia and intensive care. It is usually presented as a graph of expiratory plotted against time, or, less...
, intraosseous infusions, thrombolysis
Thrombolysis
Thrombolysis is the breakdown of blood clots by pharmacological means. It is colloquially referred to as clot busting for this reason...
and 12 lead electrocardiograms.
Communications
The EMS system in New Zealand is served by three dispatch centres, located in Auckland, Wellington, and ChristchurchChristchurch
Christchurch is the largest city in the South Island of New Zealand, and the country's second-largest urban area after Auckland. It lies one third of the way down the South Island's east coast, just north of Banks Peninsula which itself, since 2006, lies within the formal limits of...
. The dispatch centre in Christchurch provides coverage to the entire South Island
South Island
The South Island is the larger of the two major islands of New Zealand, the other being the more populous North Island. It is bordered to the north by Cook Strait, to the west by the Tasman Sea, to the south and east by the Pacific Ocean...
, and is operated by St. John Ambulance. The dispatch centre in Auckland provides coverage for the north half of North Island
North Island
The North Island is one of the two main islands of New Zealand, separated from the much less populous South Island by Cook Strait. The island is in area, making it the world's 14th-largest 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. 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
Emergency telephone number
Many countries' public telephone networks have a single emergency telephone number, sometimes known as the universal emergency telephone number or occasionally the emergency services number, that allows a caller to contact local emergency services for assistance. The emergency telephone number may...
for ambulances in New Zealand is 1-1-1
1-1-1
111 is the emergency telephone number in New Zealand. It was first implemented in Masterton and Carterton on 29 September 1958, and was progressively rolled out nationwide with the last exchanges converting in 1988...
.
The three dispatch centres also include significant advanced technologies, including AMPDS and Siren
Siren
In Greek mythology, the Sirens were three dangerous mermaid like creatures, portrayed as seductresses who lured nearby sailors with their enchanting music and voices to shipwreck on the rocky coast of their island. Roman poets placed them on an island called Sirenum scopuli...
software for the triaging and assignment of calls. They also include a nationwide network of Automatic Vehicle Location
Automatic vehicle location
Automatic vehicle location is a means for automatically determining the geographic location of a vehicle and transmitting the information to a requester....
(AVL), showing the location and current status of every ambulance in the country. 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.
See also
- Wellington Free AmbulanceWellington Free AmbulanceThe Wellington Free Ambulance provides free to the patient ambulance services in the Wellington Region of New Zealand.-History:The ambulance service was created on 9 November 1927 by the mayor of Wellington, Sir Charles Norwood, and initially operated out of the Old Navals boatshed...
- St. John Ambulance in New ZealandSt. John Ambulance in New ZealandSt John New Zealand is a charitable organisation providing healthcare services to the New Zealand public. Services include emergency and non-emergency ambulance treatment and transport, first aid training, and first aid supplies...
- Life FlightLife FlightMemorial Hermann Life Flight is an air medical transport service based in Houston, Texas. Life Flight flies into 12th floor of the John S. Dunn Heli-Stop atop Memorial Hermann Hospital in the Texas Medical Center. It was founded in 1976.-History:...
http://www.wairarapa.dhb.org.nz/wdhb/HealthServices/Ambulance.aspx