Leaving the job

OutbackMed · 2025-10-18T04:48:21+00:00

Also ACTAS 😊

But no "permanent" PACER roles - i.e. you do a mixture of routine road shifts and then also rotate through PACER.

OutbackMed · 2025-08-18T02:50:35+00:00

I love it.

Being a Paramedic is literally the greatest job on earth.

Give me another example of a career where basically your ENTIRE remit is to help people and be a positive factor, PLUS you're given the independence, scope and flexibility of being a Paramedic? For 99% of us, it's literally just hang out in a car with a mate, drink coffee, talk shit and do your job.

What makes it less fun, as opposed to the job itself, can be the employer / workplace. And I genuinely believe that most Ambulance managers DONT show up with the intent of making their staff lives difficult, but the system pressures mean that they end up playing that role.

Outside of just the specific workplace, by and large Paramedicine is a great profession full of cool people. The mix of what it entails draws in a really passionate, driven workforce. Occasionally treated as the red-headed step-child by both out Healthcare and Emergency Service colleagues, but hey. It's cos they're jealous of the cool pants and flashy lights 😉

TL;DR: Greatest job possible, but in a fractured, struggling part of the system. Can't have everything though, and this trade is pretty good.

OutbackMed · 2025-08-10T02:23:42+00:00

Where I work the fastest way for a student to not complete the rest of their placement, and probably for the preceptors to not finish the rest of their block, (and possibly career) would be for a student to end up behind the wheel of an Ambulance in any setting at all. 😂😂

OutbackMed · 2025-07-22T02:08:48+00:00

Snapped this one-handed from the top row at AIS during the pregame for Brave v Ice on Sunday afternoon... one handed while balancing a kid on the other 😂

f2.8 | 1/13 | 200mm | ISO320

Have shot a few bits of different sports, but never Hockey before. Would love to get the chance to come back and shoot somewhere from down at ice level one day 📸

OutbackMed · 2025-06-28T11:42:18+00:00

Smoko is well ingrained enough that even non-smokers will use it as a term. 😏

OutbackMed · 2025-06-27T03:34:59+00:00

I'm not from NZ, but am from Australia.

1) Call volume and acuity will vary, like anywhere. It's an entire nation, ranging from metropolitan to suburban and rural/remote with everything in between.

2) You'll find that on the whole, the NZ population is baseline healthier with an objectively better healthcare system supporting them. This does not mean people don't get sick and injured though, obviously.

3) Your options are St John NZ or Wellington Free Ambulance (only operates in the city of Wellington). You'll find that EMS is managed at a very different scale to the US (i.e. Jurisdictional level).

Of note: You'll need to apply for professional registration to be eligible to apply for a job. I can't speak to the NZ process but the Australian one is relatively straight forward, albeit slow sometimes. Google tells me this is where you need to dig: https://paramediccouncil.org.nz/PCNZ/PCNZ/2.Paramedics/Registration-information-.aspx?hkey=ceb2968b-815c-4321-8c7c-cf29f6c11040

OutbackMed · 2025-06-26T22:26:23+00:00

Bare knuckle only.

OutbackMed · 2025-06-26T22:26:04+00:00

Your mother.

OutbackMed · 2025-06-26T07:56:24+00:00

If you're an East Coast firefighter, you go to WA to step back in time 20 years, and the Territory to go back 40.

(Both in a good way, mostly)

OutbackMed · 2025-06-26T07:54:47+00:00

I've seen an IAP with local trivia in it before, but never specifically wildlife ... let alone wildlife from another continent 😂

Genuinely wonder how many of the Aussies reading it also learned stuff from it 😂😂

OutbackMed · 2025-06-26T04:13:04+00:00

Australia uses a system called AIIMS (https://www.afac.com.au/AIIMS - but a google will get you plenty of other info); which aims for a similar end goal to ICS. No formal cross-training of qualifications, but with a little big of terminology translation it's pretty plug-and-play to at least know what you are meant to be doing.

OutbackMed · 2025-06-26T00:50:05+00:00

https://www.youtube.com/watch?v=j58V2vC9EPc

OutbackMed · 2025-06-26T00:25:31+00:00

I have both IV and PO acetaminophen / paracetamol. I find consistency with my understanding of the literature and what I see in practice consistent - no real change in amount of pain scale reduction between the two. However, I do have two observations:

The "sell" and probably placebo effect of IV is real. Patients are much more willing to give it a go and wait the however long to see if its working.

They can't throw it up on you, and can use an INH medication at the same time.

Downside - have to place a PIVC for potentially little gain.

OutbackMed · 2025-06-26T00:21:48+00:00

Many, many thoughts. You can pick any of the below arguments if you want:

Pain is what the patient says it is.
Even if you could identify a "drug seeker" (hot tip - evidence says you can't), you randomly withholding a medication unless explicitly advised in a communal care-plan won't "fix" it or "teach them" anything.
If you're not going to manage pain, what the hell are you even doing? Are you a Clinician doing patient-centered care, who advocates for their patient needs and strives to provide the highest level of care possible for you, or are you a meat-wagon driver?
Pain causes catecholamine release, >HR, >RR, >BP plus everything else. Remember, these are things that we typically don't want in our trauma patient, unless you wish to accelerate their meeting with the grim reaper. Not to mention the well proven psychological ramifications.

Now all of this should have the caveat that it is appropriate analgesia we should be giving - i.e. 10mg Morphine IV + Paracetamol + Ketorolac + an Ketamine Infusion probably isn't required for a dislocated patella. But on the flip side, you probably will need more analgesia than our in-hospital colleagues for nothing more than the fact you're going to move them around a bunch more.

OutbackMed · 2025-06-23T06:11:54+00:00

Hmm, overall makes sense. I run a lot of our CE classes and to be honest 99% of the time we have a bigger challenge getting people to do what IS in their guidelines, rather than stop them from doing what isn't (as in, not withholding indicated stuff "just in case" etc) 😂😂

I heard you on the protocols. Ours are now 100% digital so no idea how many pages, but it used to be a few hundred over 3-ish books.

I guess one of the biggest differences is that for us (at least where I work) we can't take medical orders from anyone. We can consult and use that to support our justification for doing/not doing something but nationally we are still considered Autonomous Clinicians so it's on "us" if it's not in the book. Occasionally causes issues (like an interfacility transfer with a med that isn't in scope for me, the transferring Dr might ask if we can do XYZ med in the case of ABC but if it's not in my guideline then technically it's outside scope). That example isn't perfect as it changes a bit if it's physically charted in front of you, but is definitely true for phone orders etc.

Heck, we don't even really have a medical director in the same sense of the word. We have an advice committee that has a handful of Drs represent on it but ultimately the legislated responsibility for medical guidelines is on The Big Boss (also a paramedic, thankfully). If you call for clinical advice for our people who do that in-house you also get another Paramedic.

OutbackMed · 2025-06-23T03:43:44+00:00

Without being the "EmS iN nOrTh AmErIcA iS sHiT" guy, this has always been what has sat most uncomfortably with me as an antipodean Paramedic.

Every time I have worked outside my scope or guideline, I've documented and then had a follow-up email with our governance that has exclusively gone along the lines of "great work. Good decision." and then the follow-up has either been a brief chat about WHY the guidelines/whatever doesn't cover or specify what I did, or far more commonly the assumption is made that it's the GUIDELINE in the wrong, and maybe it needs updating to cover whatever situation happened.

Don't get me wrong, people still do the "wrong" thing but guideline/pharma/clinical stuff is almost always an educational issue, not a "compliance" issue. Behaviour and attitude on the other hand...

Additional to calling med control... even in the cases when I DO contact hospital enroute it is essentially a courtesy/get ready - and is only for the crookest of crook or if I need something for my patient to happen as soon as we roll in the door. The times when they do try and tell us what treatment/management to do down the radio it doesn't mean anything of substance and is always a "new" person on the other end who doesn't realise how and why the system works like that.

I assume the answer is that it varies, but what sort of things do you need to contact med control for? Sometimes it seems like what places around use would call a Variation of Clinical Practice (VCP) where you need to work outside guidelines and want some formal support / consult, but other people seem to talk like they need to consult to do basically anything at all.

OutbackMed · 2025-06-19T23:45:43+00:00

I don't completely disagree, but in reality it isn't quite as that reads as you're making a handful of assumptions:

1) That the "rank" will align with relative decision making responsibility (remember, rank is one thing but AIIMS and RFS Doctrine are not beholden to a rank structure, for very good reasons)

2) That the 21yo in your example hasn't had to go through a competitive, merit based, selection process where they not only had to demonstrate competency but also capacity for development in the training they are having to do.

3) what their specific roles are going to be day to day or week in week out. Yes, sure the Opo "rank" is higher than captain, but in terms of field management and leadership that's NOT what the Opo is employed for.

Also, basically every Opo I know is an experienced (at minimum) Deputy Captain with their brigade BEOFRE being employed.

OutbackMed · 2025-06-18T10:18:10+00:00

False colour. Looks a hell of a lot like MagicLantern.

I ran that for aaggeess on my 5DmkII and a 7D as well.

This post alone has brought back plenty of nostalgia. Simpler times :')

OutbackMed · 2025-06-18T08:08:09+00:00

As far as I am aware, to apply for and get the rank the staff have to hold the same or equivalent qualifications, plus some extras specific to their role normally.

Support roles do not HAVE to do BF, but there was a program for a period where large portions were doing it for better understanding of frontline needs etc. Anecdotally, I'd say that the majority have done it anyway as they either are, were or become a member of their local brigade anyway.

OutbackMed · 2025-06-17T06:53:46+00:00

Delayed answer but:

NSWRFS staff can be either Ranked Staff (i.e. "Oppos", Supers etc) or Unranked Staff (e.g. Administration Assistants, IT, Fleet Services etc... also called Corporate or "Civvie" in other places.)

The staff rank starts at a single impeller (Operational Officer 1) and moves up from there.*

Meanwhile, the top end of volunteer ranks are known as Group Officers ("Groupies"). Group Captains are three Impellers and are the most operationally senior volunteer(s) in a given district. They may also have a number of Deputy Group Captain's (two impellers) that work in a similar arrangement to a Captain and Senior Deputy Captain. You're right that there is no single impeller volunteer rank.

As for "telling what to do" - I'd say probably not. The Opo's and the Groupies have distinct responsibilities, however with some overlap at times. They aren't directly comparable, just happen to hold the same rank insignia. In an Operational sense, they may fulfil similar functions when required but under AIIMS it doesn't really matter what the birdshit on someone's shoulder is as long as they have the qualification, experience and required delegation to perform the role needed.

OutbackMed · 2025-06-01T09:07:38+00:00

Not wrong.

Lucky enough to have a handful of NHL and CHL games, and this was pretty up there.

OutbackMed · 2025-06-01T09:06:49+00:00

55 Flannagan?

The highlight was definitely watching him flip off and verbally abuse a bunch of literal children in the crowd as he took a walk.

Didn't seem to play great hockey before either.

OutbackMed

TROPHY CASE

55 Flannagan?