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Ambos left without key drugs

Paramedic interns in rural NSW say they are being forced to respond to emergencies alone and without access to potentially life-saving medicine because they have not been trained how to use it.

''It puts you in an awful position,'' said one recent graduate, who waited 14 months before being trained in the use of drugs. ''It forces you to try and manage till you get to hospital, but you might be 70, 80 or 100 [kilometres] away.''

Fairfax recently identified two stations in regional NSW staffed exclusively by interns, who have completed a year's training but require up to two more before becoming qualified paramedics.

But Fairfax has learnt of four other stations in southern NSW where on one night this month just one intern was on duty. Usually two paramedics are required per ambulance, so one can treat a patient while the other drives.

Drugs that interns say should be made available to them earlier in their training include:

- Adrenaline, for severe allergic reactions;

- Fentanyl, a pain killer; and

- Benzylpenicillin, a meningococcal treatment.

Ambulance policy is to offer rural interns voluntary training in the drugs and recognises them as "integral" for interns working in "isolation". But six paramedics have contacted Fairfax to say their managers discouraged the training, or disputed its usefulness.

Ambulance NSW said of the 80 interns sent to rural areas over the past two years, only about 30 have been trained in administering the drugs. An Ambulance spokeswoman said a "majority" of interns who applied for training received it.

The head of education for Ambulance NSW, Alan Morrison, said there were no obstacles to applying for training and said it should not be mandatory.

Mr Morrison said that people with anaphylaxis (severe allergic reactions) carried their own epi-pens, reducing the need for interns to carry their own adrenaline.

But opposition health spokesman Dr Andrew McDonald said: "People often do not know they have [anaphylaxis] until they are stung by a bee. Adrenaline is the definitive treatment. This could, quite simply, mean life or death."

Without access to fentanyl or morphine, the strongest analgesic available to interns is methoxyflurane. One intern said this was insufficient, citing the case of a man seriously injured in a farm accident.

''You just look them in the eye and say 'that's all I can do for now','' the intern said. "I am often left solo and have to wait approximately 30-60 minutes for back-up paramedics to arrive.''

A 2008 study undertaken by the NSW Ambulance service found that methoxyflurane was ''significantly inferior'' to fentanyl ''at all pain severities''.

Wayne Flint, the head of the Emergency Medical Service Protection Association, which represents paramedics, said he would not usually support giving interns access to such drugs before they were qualified.

''But they have been placed in a situation where they need it; where the patients need it,'' he said.

Mr Flint said he also knew of paramedics who had been prevented from doing the training by station managers.

Health Minister Jillian Skinner said Ambulance funding had increased more than 5 per cent.

7 comments

  • how kind of the health minister to show such a caring reaction to the paramedics and the health and well being of country people.

    Commenter
    David
    Location
    central coast
    Date and time
    January 27, 2014, 10:29AM
    • Adrenaline for anaphylaxis is a first aid intervention with volunteer St John Ambulance responders (appropiately) able to independently administer adrenaline auto injectors to suspected cases of severe allergic reactions. The irony is that these personnel call triple zero with the expectation that the responding paramedics would have more to offer. Interns should not have to opt in to provide acceptable care - if NSW Ambulance puts interns in this position they should train them to provide life saving interventions that can not wait for qualified help to arrive. Any ambulance responding to anaphylaxis without adrenaline is unacceptable care Minister even in the budget has increased by 5%.

      Commenter
      Jay
      Location
      NSW
      Date and time
      January 27, 2014, 11:34AM
      • This is plain dangerous. As a critical care specialist I know how valuable adrenaline can be in resuscitation scenarios... and fentanyl for pain relief? Very valuable I think most will agree. Send them out properly resourced or not at all!

        Commenter
        cb
        Date and time
        January 27, 2014, 12:22PM
        • Sending one person, the driver, is unbelievable. May as well get a taxi for all the medical attention the patient will receive for the trip duration.

          Commenter
          mutt
          Date and time
          January 27, 2014, 3:36PM
          • It is not only the drugs but the skills that are a problem, not to mention they are responding with one paramedic, you can't drive and look after a patient at the same time. We don't allow this to happen when people do an apprenticeship such as a plumber but it is being allowed in life threatening situations. This sounds like short term budget saving to me. Disgraceful!

            Commenter
            Concerned
            Date and time
            January 27, 2014, 5:01PM
            • I can only imagine the outrage if Paramedics were sent out alone and without adequate training in the Kuringai electorate of Premier Barry O'Farrell on Sydney's upper North Shore.

              If it is not good enough for folks on the upper North Shore, Barry, then it is not good enough for country folk.

              Commenter
              Paul01
              Location
              Riverina
              Date and time
              January 27, 2014, 8:48PM
              • Ripping the guts out of services but charging the same price - this is exactly what people mean when they say "Australia must adjust its standard of living".

                Commenter
                Payback
                Location
                Sydney
                Date and time
                January 27, 2014, 11:30PM
                Comments are now closed
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