News

The Victorian Ambulance Union Incorporated (VAU) has been contacted by Non-Emergency Patient Transport (NEPT) members with clinical concerns regarding cases they are being dispatched to under the State Health Emergency Response Plan (SHERP), Code Orange and Code Red.

What does a crew do when they dispatched a job they can see is ‘out of their scope’?

In the first instance it is important for the crew to have their ‘wheels rolling’ and begin making their way towards cases you have been dispatched to. At all times they can have access to the on-shift AV Duty Manager (DM) or Clinician to discuss the case and any clinical concerns there may be. This can be done on the way to the job or upon arrival and assessment of the patient.  Notify the dispatcher that you would like to speak to your AV DM or Clinician, and they will notify the AV communications staff and/or Clinician as appropriate. First, let them know that you are responding to the case and are currently travelling towards it. Then, clearly and politely, articulate your concerns on the clinical nature of the case, as well as your limitations regarding scope and availability of drugs. If you follow these steps, regardless of whether the crew is a Medium or Low acuity crew, this will assist the AV DM or Clinician in reviewing the case and making further transport and treatment decisions. Crews should never be denied access to clinical advice from a registered medical practitioner, nurse or paramedic where you raise concerns about the job being outside of NEPT scope. Should this occur, please report it immediately on the VAU ‘Report a Workplace Issue’ tab on our website and to your employer.

We have been directed to ‘attend and assess’ despite raising concerns as a Medium acuity crew.

If the crew have spoken to the DM or Clinician and have been directed to attend and assess the case, you need to do so. Once an assessment has been made, if the patient is out of your scope, the crew must speak to the AV Clinician and seek further clinical advice. If the Clinician directs you to transport the patient it is important to note their CSO number on the paperwork and under which conditions the direction to transport is occurring., no resources, resources ‘x’ amount of time away, code orange, code red etc. If there is concern that the crew are being required to perform work beyond your knowledge and ability express this to the clinician and ask if an ALS crew can assess the patient before transporting. This may be denied but it is a good idea to establish that you feel overwhelmed by the case, especially if it is outside of NEPT scope.

We have been directed to ‘attend and assess’ despite raising concerns as a Low acuity crew.

Double Patient Transport Officer (PTO) crews or ‘low acuity’ crews can transport low acuity jobs to Emergency Departments (ED) as a normal part of your role. Under SHERP, Code Orange, Code Red and the current resourcing crisis low acuity crews are more frequently being directed to attend, assess and transport cases out of NEPT scope (Medium or ALS coded cases), to the closest or relevant ED. You can only assess a patient based on the low acuity scope within the NEPT Clinical Practice Protocols (CPPs). Use the skills you have been trained with to make an assessment and relay all clinical concerns to the on-duty Clinician (e.g., lack of pain relief). You may be the only crew available to assist this patient, but crews can and should maintain continued dialogue with the Clinician on concerns you have with your case. Many clinicians and DMs are unaware of the exact scope that NEPT work under and are frequently unaware of the difference between ATA and PTO in terms of scope and knowledge.

When handing over (using IMIST-AMBO) to Triage upon arrival at an ED, make the triage nurse aware you are a low acuity crew directed to transport by the AV Clinician. This should assist with the hospital’s expectations of you in this environment.

As low acuity crews will have had little or no experience of a ‘direction to transport’ prior to the pandemic, some of your relevant skills that are not utilised on a regular basis may have become ‘rusty’. The VAU recommends engaging experienced ATAs at your workplace, CIs and your employers training team for refreshers should you think you need it. This may include filling in low acuity PCRs or the low acuity section of the VACIS. It is important that you be able to utilise the skills you were trained for in your Certificate 3/4 in NEPT, some of which are:

• Clinical approach (including scene safety, dealing with patients’ families)
• Vital Signs Survey (VSS) including Respiratory assessment, perfusion assessment (incl BP) and GCS assessment.
• Time critical guidelines
• Mental state assessment
• Automatic/semi-automatic Defib
• Oropharyngeal airway
• Bag Valve Mask
• O2 sats monitoring and O2 administration
• BGL and Glucose paste
• Stroke assessment
• Epi pen (auto injector Adrenaline)
• Traumatic injuries, falls, cervical collars, arterial tourniquets, pressure dressings, pelvic splinting

Reviewing the NEPT CPPs may assist you in determining which areas of your scope you require refreshers or hands on practice in. Click the link at the bottom of the bulletin for Version 5 of the NEPT CPPs. If you feel that you need refresher training in specific areas within your scope, approach your training dept. and your line manager and ask for help. Explain that ordinarily you do not use these skills and that your confidence is lowered as a result – there is no shame in this. The VAU can assist you if necessary in making this approach, but it needs to start with you.

Free with your membership is access to the VAU ParaED Clinical Professional Development (CPD) Program. Go to the VAU webpage and login through your member portal. The CPD Program, which meets AHPRA registration standards for our Paramedic members, contains multiple study units that are of great value to our NEPT members. We have recently added three NEPT specific units:

• Foundation Cardiology and ECG Interpretation
• Foundations of Pharmacology and;
• Stress and Adaption

In addition, amongst many available, other useful units to complete would be:

• Covid19 in the pre-hospital space
• PCR Writing
• Anaphylaxis Recognition
• Clinical Case Presentations – Sepsis

Attending and assessing as a low acuity crew, using appropriate language.

Ensuring on scene safety of yourself and your crew member also extends to managing family members of the patient, and their expectations.  Rapport, rest and reassurance, form part of your Clinical Approach and Basic Care in the NEPT CPPs. Using alarmist language with patients or families will not assist any of you. For example, reassuring language when presented with a patient in pain you may use instead of, ‘We are only low acuity, we don’t even have any pain relief drugs’ would be something like:

‘Our dispatchers knew we were the closest non-emergency ambulance; we will complete our assessment and talk to our Clinician regarding appropriate action for your (the patients’) pain’

Low acuity PCRs

The VAU have been made aware that low acuity crews have been directed by their employer to note these outside of scope jobs as ‘low acuity’ on your PCRs. These jobs are not low acuity and should not be noted as such, rather, they are medium or ALS coded jobs the low acuity crew have been directed to transport. This, as well as the CSO number should be noted on your paperwork.

Other concerns and Code Orange/Red

Members have also reported to the VAU that low acuity crews are being dispatched to out-of-scope jobs when they have knowledge of a Medium acuity crew available. If you have such knowledge, it is important to relay this to your DM and allow them to assist dispatching the case more appropriately. The VAU will be following up on these occurrences. We ask that all such instances be reported on our website using the ‘Report a Workplace Issue’ tab, additionally linked at the bottom of this bulletin. This assists us in a more streamlined and job specific manner for reporting.

The NEPT sector continues to play a vital role in the ambulance industry. Ambulance staff, at all levels, are under excessive strain due to excessively high workload, COVID and chronic under-resourcing. The impact is being felt by everyone in the industry. If you have any concerns, contact your NEPT Organisers:

• Kerry McLean [email protected]      0480 194 783

• Bruce Fine [email protected]      0480 194 711

Click here for Version 5 of the NEPT CPPs:

Report a Workplace Issue

You can also report a workplace issue by using the button located in the toolbar above. It will take you directly to an online form where you can enter in all the details of your issue. Those details are then received by the VAU via email and we can act on them.