 | This article needs to be updated.(December 2018) |
Emergency medical services in Australia are provided by state ambulance services, which are a division of each state or territorial government, and by St John Ambulance in both Western Australia and the Northern Territory.
Ambulance service within Australia can be divided into two basic groups: the statutory services and volunteer groups. In all Australian states, with the exception of Western Australia, and in the Northern Territory, statutory ambulance services are provided by the state/territorial government, as a single-entity, third-service model, government department. In Western Australia, and in the Northern Territory, all statutory ambulance service is provided by St John Ambulance Australia, under contract to the state/territorial government. In all other states and territories, the activities of St John Ambulance are all limited to first aid training and special events support, with the occasional disaster response. In all states with the exception of Queensland and Tasmania, users who are not on welfare benefits are billed directly for their usage of an ambulance. In addition, while not strictly ambulance services, some jurisdictions also have private companies offering medical transportation services on a fee-for-service basis. Ambulance services in Australia operate on the Anglo-American (as opposed to the Franco-German) EMS service delivery model. [1]
Air ambulance service is accomplished in Australia by means of a variety of arrangements and providers. In New South Wales rescue helicopters are split into two districts with Westpac Rescue Helicopter Service and Toll Air Ambulance servicing the entire state. The Sydney-based Westpac Rescue Helicopter is solely used for search and rescue taskings. Some states, such as Queensland share air ambulance resources with other public agencies; in the case of Queensland, air ambulance services are primarily provided by Emergency Management Queensland (EMQ Helicopter Rescue) and a mixture of other providers such as LifeFlight Australia, RACQ CQ Rescue, RACQ Capricorn Helicopter Rescue, RACQ NQ Rescue and AGL Action Rescue Helicopter may fill service gaps. In other states, such as South Australia a mix of service providers, including other emergency services such as the police, continue to operate but medical crews are provided by MedStar, a government entity which provide doctors, nurses and flight paramedics to MAC Rescue (Helicopter) and RFDS (Fixed Wing). While helicopters provide good service in coastal areas with high population density, in the more sparsely settled interior, distances can be vast, and fixed-wing aircraft are the preferred mode of transport. In these cases, the statutory ambulance services often operate the aircraft, in cooperation with Australia's Royal Flying Doctor Service.
There are a number of different first responders in Australia that supplement ambulance services. First responders provide a rapid response to the scene but do not transport patients.
In Melbourne the Metropolitan Fire Brigade, Melbourne (MFB) provides a fully professional Emergency Medical Response (EMR) capability for the metropolitan fire district. Commencing in 1998 the MFB's EMR program is run in partnership with Ambulance Victoria (AV) to ensure rapid trained response to Computer-aided Dispatch (CAD) "priority 0" (suspected cardiac or respiratory arrest) medical emergencies across Melbourne.
To qualify as a Firefighter Emergency Medical Responder, MFB professional firefighters undertake a 12-month training program provided by Monash University following a training curriculum developed specifically for professional firefighters by the MFB and Monash University Faculty of Community Emergency Health & Paramedic Practice. MFB Firefighters are trained to provide basic life support care including oxygen resuscitation and airway management, CPR, defibrillation, spinal and trauma care. When required, firefighters may also provide assistance to ambulance paramedics.
Under the EMR program, MFB firefighters are simultaneously dispatched with AV paramedics to all priority 0 medical emergencies within the metropolitan fire district. In 60% of these EMR events, MFB firefighters arrive first on scene and commence initial patient assessment and provide care as required. On arrival, AV paramedics take over responsibility for patient care with MFB firefighters then providing assistance as required. As a result of EMR response, two minutes have been cut from the response time to cardiac arrest cases in the metropolitan fire district covered by the MFB. This program and the expansion of emergency and MICA ambulance services in Melbourne in recent years is providing the Melbourne community with a higher cardiac arrest survival rate than other Australian capital cities. Due to the reported success of this program it has been expanded to include some full-time stations run by Victoria's Country Fire Authority. The NSW Government has recently proposed a similar program utilising Fire and Rescue NSW but has faced strong opposition from the Fire Brigade Employees Union.
Ambulance services in Australia use, for the most part, well educated professional staff, supplemented in low volume rural areas by volunteers. The level of training for volunteers is considered to be a high level of skill at advanced first aid. Paid staff fall into two categories: Transport Officers and Paramedics. Transport Officers complete certificate level training, and are normally only used for the non-emergency interfacility transportation of patients. Anyone employed on an emergency ambulance must be trained as a paramedic. There are several levels of paramedics in Australia. [4] The term "paramedic" is now legally protected in Australia, with paramedics requiring registration with the Australian Health Practitioner Regulation Agency (AHPRA) since 1 December 2018. [5]
The preferred level of entry into practice for new paramedics is a multi-year, bachelor's degree program in either Emergency Health, Paramedicine or Clinical Practice (Paramedic), including classroom lectures, clinical practice, and internship components. [6] [7] The intent is to make this qualification the only path of entry into the field but so far only the states of Victoria and Tasmania have phased out all other methods of entry. Ambulance services in South Australia and Queensland now draw the majority of their paramedics from degree programs and continue to use the older-style, internal diploma programs only to fill service gaps and shortages in forecasted requirements.[ citation needed ] These older programs continue to be necessary to ensure ambulance services are able to directly train additional staff to fill shortages and as the numbers of degree graduate paramedics being produced by the university system are insufficient to meet ambulance services' requirements for new employees. [8] NSW Ambulance is transitioning to tertiary entrance but this process will be phased in over several years and may be achieved by 2020.
Training as a Mobile Intensive Care Ambulance Paramedic in Victoria, and equivalent Intensive Care Paramedic programs in other states involves the completion of a post-graduate certificate program. The program, which typically takes an additional year to complete, involves theory, clinical and supervised practice components. Graduates possess an expanded skill set which may include intubation, Rapid Sequence Intubation (RSI), additional drugs, and in some cases, certification of death. [9] Those certified as MICA-Paramedics in Victoria function on protocols, working independently and with minimal medical supervision.
Ambulance services in Australia provide emergency medical services by means of a number of service delivery methods. These include both conventional ambulances and aircraft, but also include a variety of rapid response vehicles with single paramedics, including both all-wheel drive type vehicles (SUVs) and motorcycles. Supervisory vehicles are also equipped with medical equipment, and capable of providing first response service, when required. Some services, most notably New South Wales, provided the statutory rescue service in addition to their role in pre-hospital care, this has recently changed however, ASNSW Rescue Units are currently in the process of being disbanded with their rescue duties and resources being reassigned to the NSW Fire Brigade. There is no national standard for the design of conventional ambulances in Australia. All ambulance services have their vehicles built to their own internal specifications. That being said, Australia's ambulances are roughly similar from one state to another with the majority of general paramedic/intensive care ambulances in Australia being based on the Mercedes Sprinter which are upgraded every three years. They all generally comply with the European Standard CEN 1789 as published by the European Committee for Standards, [10] apart from the visual identity provisions. This compliance is, however, incidental.
Ambulances and paramedics in Australia are centrally dispatched. Australia's national emergency number is 000. This number rings at the Telstra Global Operations Centre, where an operator determines the caller's needs and then directs the caller to the appropriate emergency service (police, fire, ambulance). Callers then speak to an operator at a dispatch centre, managed by the relevant state ambulance service (E.g. AFCOM in Brisbane, QLD) or may even speak to an individual officer in the case of rural/remote stations. Dispatch technologies, including automated vehicle locating (AVL) and decision-support software are either identical (as with AMPDS and Computer-aided Dispatch) or comparable with those found in North America and Europe. [11]
Australian ambulance services generally publicise a response time standard of 'around 10 minutes' on high priority emergency calls. [12] [13] Ongoing monitoring suggests that compliance is improving, many "Code one" (i.e. Lights and Siren) calls are reached well within 10 minutes. [14]
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
An emergency medical technician is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and some part-time departments require their firefighters to at least be EMT certified.
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. Certified individuals should have received much more instruction than someone who is trained in basic first aid and cardiopulmonary resuscitation (CPR) but they are not necessarily a substitute for more advanced emergency medical care rendered by emergency medical technicians and paramedics. First responders typically provide advanced first aid level care, CPR, and automated external defibrillator (AED) usage. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene and medically trained telecommunication operators who provide pre-arrival medical instructions as trained Emergency Medical Dispatchers (EMD). Many police officers and firefighters are required to receive training as certified first responders. Advanced medical care is typically provided by EMS, although some police officers and firefighters also train to become emergency medical technicians or paramedics.
Hatzalah is the title used by many Jewish volunteer emergency medical service (EMS) organizations serving mostly areas with Jewish communities around the world, giving medical service to patients regardless of their religion. Most local branches operate independently of each other, but use the common name. The Hebrew spelling of the name is always the same, but there are many variations in transliteration, such as Hatzolah, Hatzoloh, and Hatzola. It is also often called Chevra Hatzalah, which loosely translates as "Company of Rescuers", "Group of Rescuers", or "Rescue Squad". It is the largest volunteer medical group in the United States.
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
In the United States, the paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for patients who access Emergency Medical Services (EMS). This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response under physician medical direction. Paramedics often serve in a prehospital role, responding to Public safety answering point (9-1-1) calls in an ambulance. The paramedic serves as the initial entry point into the health care system. A standard requirement for state licensure involves successful completion of a nationally accredited Paramedic program at the certificate or associate degree level.
The British Columbia Ambulance Service (BCAS) is an ambulance service that provides emergency medical response for the province of British Columbia, Canada. BCAS is one of the largest providers of emergency medical services in North America. The fleet consists of 658 ground ambulances operating from 183 stations across the province along with 283 non-transport support vehicles. Additionally, BCAS provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities for treatment. BCAS also operates a medical evacuation program that utilizes both fixed-wing and rotary aircraft.
NSW Ambulance, previously the Ambulance Service of NSW, is an agency of NSW Health and the statutory provider of pre-hospital emergency care and ambulance services in the state of New South Wales, Australia.
The Scottish Ambulance Service is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health and Social Care Directorates of the Scottish Government.
In the United States, emergency medical services (EMS) provide out-of-hospital acute medical care and/or transport to definitive care for those in need. They are regulated at the most basic level by the National Highway Traffic Safety Administration, which sets the minimum standards that all states' EMS providers must meet, and regulated more strictly by individual state governments, which often require higher standards from the services they oversee.
Winnipeg Fire Paramedic Service (WFPS) provides fire and EMS services to the City of Winnipeg, Manitoba. It operates from 27 fire stations, and 3 administration offices across the city.
Australian mobile intensive care ambulances (MICA) are well-equipped ambulances staffed by highly trained paramedics dispatched to emergency situations where patients require a higher level of care than a regular ambulance can provide.
Since 1 July 2008, Ambulance Victoria has been the sole provider of emergency ambulance services in Victoria, having been formed from the merger of the three previous providers of emergency ambulance services: the Metropolitan Ambulance Service (MAS), Rural Ambulance Victoria (RAV), and the Alexandra District Ambulance Service (ADAS).
The Trauma Hawk Aero-Medical Program provides air ambulance services for Palm Beach County, Florida. On-scene paramedics will decide whether or not a Traumahawk is necessary in a situation. On average, a Traumahawk is dispatched between 1 and 5 times a day for traumatic injuries, including those from vehicle accidents to sports injuries, as well as transport for stroke and cardiac patients. Operated by the Health Care District of Palm Beach County, the service uses two identical 1999 Sikorsky S76-C+ helicopters as air ambulances.
Emergency Medical Responders (EMRs) are people who are specially trained to provide out-of-hospital care in medical emergencies, typically before the arrival of an ambulance. Specifically used, an emergency medical responder is an EMS certification level used to describe a level of EMS provider below that of an emergency medical technician and paramedic. However, the EMR is not intended to replace the roles of such providers and their wide range of specialties.
Emergency medical services in New Zealand are provided by the Order of St John, except in the Greater Wellington region where Wellington Free Ambulance provides these services. Both have a history of long service to their communities, St John since 1885 and Free beginning in 1927, traditionally having a volunteer base, however the vast majority of response work is undertaken by paid career Paramedics. Strategic leadership of the sector is provided by NASO which is a unit within the Ministry of Health responsible for coordinating the purchasing and funding of services on behalf of the Ministry and the Accident Compensation Corporation.
The Queensland Ambulance Service (QAS) is the state emergency ambulance and patient transport provider in Queensland, Australia. QAS is part of the Queensland Government under the Queensland Health portfolio and is one of the largest ambulance services in the world.
Ambulance Victoria (AV), a Victorian agency of the Department of Health, is the statutory provider of pre-hospital emergency care and ambulance services in Victoria. Ambulance Victoria was formed on 1 July 2008 with the merger of the Metropolitan Ambulance Service (MAS), Rural Ambulance Victoria (RAV), and the Alexandra District Ambulance Service (ADAS). Ambulance Victoria has undergone significant reform since 2008.
