Emergency Medical Services in New Zealand - Clinical Practice

Clinical Practice

The revised New Zealand Ambulance and Paramedical Service Standard (NZS8156:2008) defines three levels of practice and gives guidance as to their depth and breadth but it does not however define the specific interventions to be included in each (scope of practice). The specific scopes of practice are set every two years as part of the Clinical Practice Guidelines developed by the Clinical Working Group (part of Ambulance New Zealand) which consists of the Medical Directors, Medical Advisors and Paramedic representatives from both St John and Wellington Free Ambulance as well as the New Zealand Defence Force.

Although the standard is more-or-less correct there are aspects of practice which have evolved since it was written. ECG interpretation is a good example where in-depth 12 lead ECG interpretation is now taught at ILS level as part of the degree where at the time of writing the Standard (2008) this level of skill was generally reserved for ALS practitioners given the number of practicing graduates was smaller at that time.

Like other similar systems around the world such as South Africa, the UK and Australia, and in sharp polar contrast to the United States and (to a lesser degree) Canada, the system of practice is entirely based upon the professional discretion of the attending Ambulance Officers and there is no need for "online medical direction" to obtain approval for drugs or procedures. There is however a strong system of collegial support via the communications centre Clinical Desk (and on-call Medical Advisors) to assist with clinical decision making when required, this however is not a system of seeking permission.