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To briefly put you in the picture we both worked for the
Scottish Ambulance Service between
1990 - 98. Both of us got our paramedic qualification in
1994 and I was also a training officer at Barony for 2 years
before we left for the Hampshire Ambulance Service in 1998.
It was whilst there that we decided to pursue an application to
migrate to Australia.
As Jon (my husband) lived here for over 20 years our
application was made on a 'former resident' basis and so we did
not have to satisfy the points criteria in place for the usual
applicant. As such we're not exactly up to date on how a
UK paramedic would fare other than some friends of ours failed
to gain enough points with just his paramedic qualification.
Before we came over, we did some investigating as to where
would be a good place in Australia to come to. We had some
communications with Queensland, SA, Victoria, New South Wales
and Western Australia. Out of them all, the feel good
factor was with South Australia and whereas they would not
guarantee any employment, they urged us to contact them once we
were here and had an established permanent residency. Also
we knew Adelaide to be a very attractive City which did not have
the problems of high housing costs, traffic and population
problems that some of the other capital cities have. South
Australia government also provides three months of cheap housing
trust rental on a property. Housing trust is similar to
council housing. This proved invaluable to us and gave us
that three-month breather before having to find, or buy,
somewhere.
Within 6 weeks we were offered paramedic (advanced life
support) positions here in Adelaide. This followed a viva
with the medical director, a series of aptitude tests, a
physical and medical.
It is important to understand the differing clinical levels
here in Australia as compared to UK. In brief they are as
follows;
Initially persons join the service in a student paramedic
position.
This takes three years in duration which involves many 'in
classroom' blocks and on the road experience. At the end
of the three years, students graduate with a Diploma of Applied
Science (Ambulance Studies). The Ambulance Service here
has an education unit at Flinders University and there is also a
degree program on offer. Following paramedic
qualification, there is a further period of study and training
to gain the advanced life support qualification. This
allows these paramedics to do laryngeal mask placements, IV
cannulation, IV adrenaline for cardiac arrest, IM adrenaline for
asthma/anaphylaxis, Cardiac monitoring and defibrillation
(including paediatrics) salbutamol, aspirin, GTN, naloxone,
midazolam, fluid replacement for relative hypovolaemia and
penthrane (inhaled analgesia). Paramedics are not permitted to
use atropine/lignocaine or intubate. Whereas this may initially
sound restrictive, the clinical level of knowledge paramedics
has here far exceeds that in the UK and also there are wider
parameters in which these skills/drugs can be used.
Following successful vivas and a training period, this is the
level at which UK paramedics equate to as direct entry
paramedics rather than student paramedics. Unlike the UK,
it is not the highest clinical level here. Both Jon and I have
completed the top clinical level here called Intensive Care
Paramedic (ICP). This is a very competitive course and
entry is gained by submitting a well-researched clinical case
study. Following anonymous marking, if successful, you
then are interviewed by a panel that consists of the Medical
Director, an Intensivist, a consultant Anaesthetist amongst
others. Here you are questioned on your level of clinical
knowledge and attitude/aptitude.
The ICP course consists of 7 weeks in classroom followed by
1-week attendance of lectures at the Children's Hospital.
Following this there is a day of written examination followed
the next day by vivas in front of a small panel, again including
the Medical Director. If successful, there is then 4-5
weeks of placements in hospitals and following that, a 16-week
internship with a senior ICP mentor. Full qualification is
gained after 1 year. The knowledge level of
pathophysiology and pharmacology required for the ICP course is
high. For example we are expected to have a working
understanding of things such as cAMP. cGMP and other secondary
messenger systems, GABA receptors and the role of
benzodiazipines, Glycolysis, Kerbs cycle and the synthesis of
ATP, The role of eicosaniods, cytokines and eosinophils etc, in
altered pathophysiology states. We have to have knowledge of the
rennin-angiotensin-aldosterone feedback systems and the role of
drugs such as ACE Inhibitors and be able to interpret 12 lead
ecgs. The pharmacology, actions and interactions of our, and
frequently encountered drugs such as cardiac glycosides,
Morphine, antiarrythmics, tricyclic antidepressants etc .
The level of anatomy and physiology knowledge far exceeds that
in the UK.
We both feel that we have gained tremendously on a
professional level with this increased knowledge. As ICP's
we can also do more extensive skills such as cardioversion for
conscious VT's, needle decompression, intraosseous cannulation,
crycothyroid jet insufflation, intubation and sedation of
intubated patients, IV adrenaline for conscious, poorly perfused
patients, IV morphine, antiarrythmic drug administration....etc.
We can also certify death here. ICP's also have a
responsibility to educate/train students and provide mentorship.
We also have to attend a number of audits where their cases are
discussed, debated or clinically challenged by their peers. We
are directly responsible to the Medical Director and if we stuff
up, then we can be called in to explain. ICP's work
outwith protocols and are practitioners in their own right.
The skill levels can vary from state to state however South
Australia is considered to be right up there at the top and
Western Australia down there at the bottom.
Here we work a four on, four off roster which consists of 2 X
10hr day shifts followed by 2 X 14 hr night shifts, followed by
4 X days off. The service provides beds at the stations
for the night duties. Some stations follow a 2 X 12-hr early
shift followed by 2 X 12 hr afternoon shift and therefore no
nights.
The main problem that this service has, is that they receive
hundreds of inquiries from UK paramedics and they are reluctant
to formally process any application before a residency visa has
been gained. Indeed our HR dept pass on emailed inquiries
to us so that we can initially reply with a personal
perspective. We have had a couple of UK paramedic's fly
out here to stay with us and see the service but they have all
been unsuccessful in gaining their visas thereafter.
There are many things that we miss about the UK. These
include the beer and pubs (there are lots here but just not
quite the same). The variety of newspapers, certain
supermarket food items, 24hr shopping. Here fruit, vegetables
and meat are very cheap and abundant. Clothes are much
cheaper and things such as childcare are more flexible and half
the price that we were paying in UK. School and Uni education
here is excellent. Secondhand cars are more expensive but fuel
much cheaper. We left a small terraced house in Hampshire and
bought our four bedrooms, study, two living areas plus half size
billiard table room, pool and spa for the same money! We
do get sharks in the sea but also dolphins and whales.
Some of the ants here are an inch long and quite ferocious.
We have had venomous snakes in our garden and quite often
encounter the infamous red back spider. The area is very nice
with lots of wineries around which you can visit and taste their
produce and the Adelaide hills and villages are very pretty.
It is nice to be just 10 minutes from the sea and beach and
Adelaide is full of lovely cafes and bars so everyone does lots
of alfresco dining out. Food is cheap to purchase with abundant
Asian restaurants. All in all, life is pretty good here.
Today (Easter Monday) for example we have been walking through
the Botanic Gardens in beautiful sunshine (29C) and had a couple
of beers in the outdoor spa.
The ambo salaries here are comparable to UK but here we are
considered quite well paid. The professional respect we
get here is fantastic with the hospital doctors. We are
encouraged to become involved in resuscitation and patient
follow-up issues in hospital. We do get the occasional
fourth year medical student who defers to the ambulance service
and such a move is not seen to be detrimental or odd.
Similarly we get ICP's who sit the entrance examination for
medical school. We also get the odd qualified doctor who
take a year or so out of the hospital to come and work on the
road as an ambo. We couldn't go back to the UK and work
for a service such as SAS again having experienced here.
We do not have to put up with the highly regulated, paramilitary
attitude that there was or still is where no one can make a
decision without firstly going through their LAP/Manager or can
not even reverse a vehicle without having someone 'watch you
back'. Here we have far more autonomy, respect and
empowerment. It has been hard study to get to ICP level but we
actively encouraged to undertake degrees, diplomas, attend
symposiums etc. and our professionalism is acknowledged.
Well, I hope that this helps but if you have any specific
questions or need other information, then please drop a line to
the Paramedic Resource Centre and they'll forward any
appropriate mail to us. Good luck.
Clare and Jon.
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