During my first block placement on the ambulances this year, I was confronted with dozens of new words and abbreviations I didn’t understand, and it took me a while to really come to terms with them. Here is a large but incomplete list of common terms used by ambulance staff and pre-hospital healthcare practitioners in New Zealand.
Delegated Scope of Practice
This sounds boring and technical but this is how ambulance crew are able to provide medical care under New Zealand law. The medical directors of the ambulance service who are doctors themselves, write the Clinical Practice Guidelines (CPGs), a huge document that states which skills and medicals can be administered by practicitioners at which level. This is also available in a condensed notebook version that all ambulance crew carry with them (Pocket CPGs). There is a mobile phone version of the CPGs available too, but most crew members rely on the hard copy, which they fill with their own notes, Post-It flags, and which get very dog-eared and worn after a few years of constant use.
Please don’t call them “ambulance drivers” anymore. More and more skills are being moved to pre-hospital healthcare practitioners to let them diagnose and treat illnesses and trauma. The lowest Authority to Practice (ATP) that ambulance crew members would have is a First Responder. The next qualification up is an Emergency Medical Technician (EMT) which requires a diploma (“the diploma“). The next qualification up is Paramedic which now requires a three year degree (“the degree“). When paramedics graduate, they will start working for an ambulance service. In New Zealand, the two emergency ambulance services are St John and Wellington Free Ambulance (“Wellington Free“). New degree graduates will start at an ATP of EMT until they challenge (take practical exam which may take several days) for a higher one. The most advanced qualification is the Intensive Care Paramedic (ICP). Flight Medics that go out on rescue helicopters are ICPs. This requires a post-graduate qualification and allows them to perform all the skills in the CPGs including performing dangerous skills like Rapid Sequence Intubation (RCP) and administering intravenous (IV) ketamine for dissociation (detaching from one’s surroundings and being disconnected from one’s body and the pain is in) as well as analgesia (pain relief).
Why do I never see my friends?
Frontline ambulance crew members work in shifts. The format of these may change in the future but currently these go for four days, and consist of two 11-hour day shifts, followed by two 13-hour night shifts. For example, a shift block could look like: Monday 7am – 6pm, Tuesday 7am – 6pm, Wednesday 6pm – 7am, Thursday 6pm – 7am. They then get 4 days off (plus the final day of their shift), i.e. Friday, Saturday, Sunday, Monday, and then start their next shift block on Tuesday and repeat the cycle. The staff on that particular shift cycle are said to be in the same shift, and these are coloured. Green Shift, Brown Shift, Blue Shift, and Red Shift are the four shifts that Wellington Free and also the fire service uses. You will often see other staff who work the same shift and sometimes those working adjouring shifts as they get ready to start their shifts as you finish, but Green Shift staff will not have much to do with Blue Shift staff, etc. Each shift has a particular culture that develop and of course, think that their own shift is the best.
What kind of ambulance?
Frontline are the emergency ambulance service (EAS) that respond to 111 calls. These are almost always double-crewed (have two crew members in them). This is in contrast to Patient Transfer Service (PTS) ambulances, or Event medics. These are ambulances driven by Patient Transfer Officers (PTOs) that take patients between hospitals, dialysis patients from their homes to the dialysis units, patients from the LifeFlight planes to the hospital, and other non-urgent patient transporting where taxis are not appropriate. In most cases, they look like normal ambulances but generally only have a single crew member in them, who would have some first aid training but only up to First Responder. Some paramedics who are sick of doing crazy shift hours drive these as well. They don’t respond to emergencies and usually won’t turn their lights and sirens on. Urgent Community Care (UCC) cars are single-crewed vehicles with an Extended Care Paramedic (ECP) in them and they respond to lower acuity (less urgent) cases in patients’ homes and are less likely to transport (take patients to hospital).
When ambulances transport patients (take patients to the hospital), they will go straight to the Emergency Department (E.D.) and conduct a clinical handover (telling all the relevant details of the patient’s condition) to a triage nurse. If the patient is in serious condition, the ambulance crew will call ahead and arrange for the patient to be taken straight to resus (a resusciation room full of specialized equipment and staff ready to treat immediately),
What colour is the job?
Jobs are assigned one of several colours by the call-takers that indicate to dispatchers and ambulance crew how urgent the jobs are. These colour codes are sometimes automatically assigned by the system because of what the caller describes, such as a vehicle accident and can also be updated by the dispatchers to indicate more or less urgency.
Purple jobs indicate an absolute emergency like a cardiac arrest where help must get there as soon as possible. Ambulances will travel under lights (fast, with flashing lights and sirens) to get to the patient. It’s stressful and dangerous to drive through red lights and intersections so it’s not something that drivers do unless necessary. Usually, fire engines and police will respond to these calls as well.
Red calls are urgent and ambulances will drive under lights to get there but are slightly less urgent than purple calls. Orange calls are important but ambulances will travel at road speed (the normal speed limit without lights or sirens) to get there.
Green and Grey jobs may not have an ambulance sent to them but nurses and paramedics at the Clinical Desk will often phone the caller back to get more information and give advice. The Clinical Desk is a role operated 24/7 by an experienced paramedic in the comms centre that ambulance crew can call at any time to ask for advice or to get permission to perform a skill or give medication outside of their scope of practice.
Status codes are a way to triage patients and indicate the severity of a patient’s condition. Status 3 (“stat 3“) and status 4 (“stat 4“) patients are the least serious but are less urgent than status 2 or status 1 patients who must be treated urgently and immediately, respectively. Status 0 (“status zero“) indicates that the patient is already dead.
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