Danial Paterson of Paramedics.net.au is a paramedic who has transitioned from the state based ambulance services in NSW to managing his own event medical and private ambulance service in Queensland. In this article, Daniel takes us on his personal journey, discussing his personal reflections on pre-hospital care and paramedic experiences to compare and contrast, as he sees it, or weigh up the “pros and cons” of working for NSW ambulance or private ambulance services, or as it is sometimes referred to as the event medical services and what it is like for those considering a paramedic career change or job options.
What are the Private Ambulance services in Australia like?
When I worked for Ambulance Service of NSW (ASNSW) it was generally accepted amongst the paramedic ranks, that you aren’t accepted, as an experienced paramedic until you had 5 years on the job. The event sector has a similar mentality, except, in my experience, I find people adjust after 2 years.
Working as an emergency paramedic for a state-based ambulance service can be a fun, exciting and rewarding job. That’s how I initially found it. Then at some time, I’m not sure of the precise moment, but I hated the idea of going to work. It happens and I am not sure why it happened to me. However, it is at this point that I encourage you to leave the ambulance service before you burn out altogether. Recognising in yourself the early signs can help you make the lifestyle and personal changes you need to make before you really hate things.
The transition to working as an event paramedic was, on reflection, one of the best decisions I have ever made. It has taken me around Australia for different job opportunities and around the world. Internationally I have worked as a paramedic in Peru, New Zealand and quite possibly I am off to Hati shortly. Across Australia I have picked up paramedic jobs in diverse areas like Cockle Creek, TAS – Larapinta Trail, NT – Bamaga, QLD – Shark Bay, WA and all over Outback Queensland and Rural NSW.
Working as an event paramedic is a better work/family balance as you are generally home every night for dinner or home every morning to take the kids to school, In my days with the Ambulance service in NSW, as most current and former paramedics would know, the 000 calls never seem to stop. Our motto was “never order hot chips, unless you like them cold”. As paramedics you spend a lot of time with what I called my second family, eating dinner and then breakfast with our second family inside or near a roughly idling ambulance vehicle attached to a radio all the time seems normal. On the positive side, you did get a good break between shift blocks.
The frustrations of being an event paramedic
Lack of clinical management/consult services
As a private paramedic, you don’t have clinicians on the radio like with NSW Ambulance, you don’t have the 1300 number like Queensland Ambulance to support you. This makes things like if you needed to work out of your scope of practice to support clinical need, like extra drug dosages etc, impossible
Lack of clinical discretion – freedom to work
I don’t know who developed the Commercial Paramedic licencing system in Queensland, but it certainly could not have been a paramedic. Our licences in other states allow us to freely give any ambulance drug in accordance with protocols, procedures and pharmacology, provided it is reported on a regular basis to the Health Department. However, in Queensland, you have to call Clinical Management for permission to give morphine, midazolam, metoclopramide (QAS banned private services from carrying Ondansetron), Ipratropium bromide, atropine etc. Imagine standing over a convulsing patient for 2 – 3 minutes on the phone waiting for approval to give the drug you hold in your hand is frustrating to say the least.
Lack of professional paramedic recognition
Due to the cowboy market for event medical coverage, it has affected the image of reputable paramedic services. We all suffer when someone is unprofessional. As such, you can be seen as a first aider. So when things go wrong, everyone else is suddenly an ICP with 30 years’ experience (slight exaggeration but you get the point).
You will have debates over the necessity of fairly standard paramedic procedures (i.e. giving a GCS 3 child IV Glucose instead of Glucose gel – actual argument from a parent during an ANZAC day dawn service) or the lack of procedures (i.e. for a conscious dehydrated patient the family may be asking why you aren’t putting a line in and taking them to hospital).
A different type of paramedic pressure, it’s more immediate
I am not saying for a moment being an emergency paramedic was a walk in the park, but the stress you are under during an incident is greater than any you would have felt working 000. You are right there at the time, no delay until you arrive at the scene. So you may have a glassing/stab wound to deal with while trying to de-escalate the aggressor until police or security can eliminate the threat. Apart from this you will have 10 or so people putting additional pressure on you as the trauma of the witnessed event is still so fresh.
My best advice to have people respect your authority as a paramedic, as simple as it sounds, pull out a Lifepak, Zoll, Contec etc. and just start doing NIBP and SpO2 and start your clinical work. Once you are performing “clinical” skills it calms the crowd and they will start listening to you.
Also an added benefit now you are in the private sector, you need to think about the future and a display of clinical aptitude and great scene management gives your company a boost and your employer’s reputation, and shows the organisation who hired you how much you are needed. It makes them feel better when they get the invoice and may well, in a business sense open other doors for you.