When the treatment is not an authorised medicine or intervention
For example, the administration of blood.
This is only permissible when personnel are instructed to do so by the on call doctor for the service, or their delegate.
When the treatment is not an authorised medicine or intervention for the person administering it
For example, an EMT is administering midazolam, or a Paramedic is administering ketamine for dissociation.
This is only permissible in the following circumstances:
1When instructed to do so as a result of seeking clinical advice, or
2When instructed to do so by a registered health practitioner (see later in this guideline), or
3When treatment is provided by a student under the direct supervision of personnel (see later in this guideline).
When the treatment is an authorised medicine or intervention, but the administration differs from that described in these CPGs
For example, administering higher doses than described or using alternative indications.
This is only permissible in the following circumstances:
1An ICP or CCP may do so when there is an urgent indication and it is in the best interest of the patient, or
2When instructed to do so as a result of seeking clinical advice, or
3When instructed to do so by a registered health practitioner (see later in this guideline).
When the treatment is being provided by personnel with an additional scope of practice
For example, a Paramedic who is also a registered nurse is replacing a urinary catheter.
A registered health practitioner with a scope of practice in addition to paramedicine, may choose to provide a treatment that is not within their paramedicine delegated scope of practice, provided all the following criteria are met:
1The treatment is within their additional scope of practice as defined by their registering authority, and
2There is an urgent indication to provide the treatment, and
3The treatment is consistent with the principles contained within these CPGs.
When the treatment is being provided following instructions from a registered health practitioner who is external to the service
For example, an EMT is administering adrenaline following the instructions of a PRIME responder on scene, or a Paramedic is administering medicines following the instructions of hospice personnel.
This is only permissible in the following circumstances:
1When a patient has pre-supplied medicines for administration in the event of an emergency, for example a patient with a palliative care plan. All personnel should administer such medicines, including providing treatments outside their delegated scope of practice, provided:
aThe medicine appears to be indicated, and
bThere are clear written instructions, and
cPersonnel have sufficient knowledge and skill to provide the treatment.
2When a patient has written instructions for a specific care plan. All personnel should follow such instructions provided:
aThe instructions are from a registered health practitioner, and
bThe instructions are consistent with good practice, and
cThe instructions are clear and apply to the current circumstances, and
dPersonnel have sufficient knowledge and skill to provide the treatment.
3When instructed to do so by a registered health practitioner involved in the patient’s care, including via telehealth consultation. All personnel should follow such instructions, including providing treatments outside their delegated scope of practice, provided:
aThe instructions are consistent with good practice, and
bThe instructions are clear, and
cPersonnel have sufficient knowledge and skill to provide the treatment.
When the problem is immediately life-threatening and it is not possible to seek clinical advice
Rarely, a patient may have an immediately life-threatening problem and personnel may be unable to seek clinical advice to gain permission to provide treatment that is immediately life-saving, but is outside their authorised medicines or interventions
Personnel may administer treatment in this circumstance, provided they have made all reasonable attempts to obtain clinical advice and they have sufficient knowledge and skill to provide the treatment. In addition, as soon as practical they must:
Complete a comprehensive PRF and refer the PRF for clinical audit, and
Notify personnel on the Clinical Desk to have a comment added to the incident notes, and
Speak to the on call doctor (or delegate) for that service to discuss the incident.
Examples of immediately life-saving treatments: There are very few treatments that are considered immediately life-saving, but examples include:
Antibiotic administration for meningococcal septicaemia.
Chest decompression for tension pneumothorax.
Examples of treatments that are not considered immediately life-saving:
Endotracheal intubation.
IV medicines during cardiac arrest.
When the treatment is being provided by a student
Examples include:
Personnel enrolled in the New Zealand Diploma in Ambulance Practice.
Personnel enrolled in an approved paramedicine degree programme.
Student doctors, student nurses and New Zealand Defence Force medics undertaking clinical placements and/or electives.
Students may administer treatment under the supervision of personnel provided all the following criteria are met:
The student has been taught how to provide the treatment, and
The supervising person has the treatment within their own delegated scope of practice, and
The supervising person takes responsibility for provision of the treatment, and
The supervising person provides direct supervision in such a way that they can immediately intervene if required, and
The patient (if competent) is asked to consent to have treatment provided by a student.
Audit
The PRF must be sent for audit whenever treatment is provided that is not described within these CPGs, except when treatment is provided by a student under supervision.
The person providing the treatment is responsible for ensuring the PRF is sent for audit.
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Update: Multiple changes.
22/11/2022, Version 1.0.1
I
Identify yourself: state your name, practice level, vehicle call sign and where you are calling from.
S
Situation: state a succinct reason for calling.
B
Background: briefly describe the background of the incident.
A
Assessment: describe your assessment of the patient. Ensure any information that is likely to be required is available.
R
Recommend and review: state what you think is required and listen to instructions. Review and confirm the plan before ending the call.
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Disclaimer
These are the Clinical Practice Guidelines (CPGs), incorporating standing orders for use of personnel within the Aotearoa New Zealand ambulance sector. These CPGs are for the use of ambulance personnel with current authority to practise, when providing clinical care to patients on behalf of ambulance services.
Any persons other than authorised ambulance personnel using these CPGs do so at their own risk. Neither organisations within the ambulance sector nor the Clinical Working Groups will be responsible for any loss, damage or injury suffered by any person as a result of, or arising out of, the use of these CPGs by persons other than authorised personnel.
Emergency Ambulance Service (EAS) CPGs
The emergency ambulance service (EAS) CPGs have been developed by the National Ambulance Sector Clinical Working Group and are issued to individual clinical personnel by the following directors:
Dr Tony Smith, Deputy Clinical Director for Hato Hone St John.
Dr Markus Renner and Dr Katherine Townend, Medical Directors for HEMS Clinical Limited.
Dr Chris Denny, Medical Director for Northern Rescue Helicopter Limited.
Dr Muir Wallace, Medical Director for Search and Rescue Services Limited.
Dr Andy Swain, Medical Director for Wellington Free Ambulance.
They remain the intellectual property of the National Ambulance Sector Clinical Working Group and may be recalled or updated at any time.
Extended Care Paramedic (ECP) CPGs
The ECP CPGs have been developed by the ECP CPG Clinical Working Group and are issued to individual clinical personnel with an authority to practise at ECP level by the following directors:
Dr Craig Ellis, Deputy Clinical Director for Hato Hone St John.
Dr David O’Byrne, Deputy Medical Director for Wellington Free Ambulance.
They remain the intellectual property of the ECP CPG Clinical Working Group and may be recalled or updated at any time.