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.