State Registration Ambulance Technicians

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A Consultative Document concerning proposed alternatives for the State Registration of ĎParamedicsí alone in the UK, based on the ĎAlberta Regulations for Emergency Medical Technicians Registered under the Health Disciplines Acts of Canada

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British Ambulance Services Panel

19-21 Bassenhally Road, Whittlesey, Peterborough, Cambridgeshire. PE7 1RN

Phone Number 01733-350916 Fax Number 350112 Date: 17th April 1999

E-mail BASP@ambulanceservices.co.uk

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Table of Contents

Part Ć Background Page 3

Part ć Executive Summary Page 3

Part é Introduction Page 4

3a Statement of Problem/Need Page 4

3b Project Scope and Objectives Page 4

Part Ź Action Plan Page 5

4a Activity One Page 5

4b Activity Two Page 5

4c Activity Three Page 6

Part ź Management Plan Page 6

5a Project Organisation Page 6

5b Costs Page 6

5c Schedule Page 7

Part Ď Results Page 8

Part í Evaluation Page 8

Part " Qualifications Page 8

Part " Conclusions/Next Steps Page 9

Appendices Page 10-20

 

BACKGROUND

Following considerable opposition from the Private Ambulance Sector, to the Ambulance Service Association (ASA) proposal for the ĎState Registration of NHS Paramedicsí alone. A considerable search was undertaken by the ĎBritish Ambulance Services Panelí to find an alternative proposal that would give the General Public greater protection than Paramedic Registration alone, and one that may be more acceptable to all sectors involved in Ambulance Operations.

ē A brief study of the California Code of Regulations was undertaken this consisted of some 31 pages devoted to Paramedics alone and complicated references to Codes and Cited Authority, which complicated appraisal it was American Based and the steering committee chairman felt that this was not applicable in the UK

ē A number of other projects were studied by the chairman, these included the NREMT requirements, Holland Collage of Technology (USA), Graduate Chippewa Valley Technical Collage Vocational Diplomas, and the Hertfordshire University B.Sc. Honours Paramedic Science. These projects all run over a number of years and are not consistent with current UK practice or requirements. Proposals needed simplicity.

ē An in depth study was undertaken with regard to the Ď Alberta Regulation 48/93 for Emergency Medical Technician Registration under the Health Disciplines Act of Canada. This appeared to be a front runner as most of its contents appeared to be loosely based on the ĎUK Miller Requirementsí and it covered greater numbers, as registration is allowed within three grades of competence. It was also simplified.

EXECUTIVE SUMMARY

The ĎAlberta Regulationsí consisting of nine pages were placed before the British Ambulance Services Panel for comment, with the intention of amending these to take into account current UK practice, so that they may provide a basis for acceptance by all sectors.

ē The need was for something simple and as uncomplicated as possible.

ē the need was to ensure wherever possible it embraced all Ambulance Sectors.

ē The objective is to provide a proposal base, in preparation for full Consultation.

ē Any final proposal must however be acceptable to all before implementation

INTRODUCTION

The British Ambulance Services Panel is a joint NAPAS / DTI Associated program

Developed under the UK Governments ĎForesight Programí The Steering Committee

Consists of Expertise drawn from Ambulance Service backgrounds, who all have many

Combined years experience in NHS, Private, Voluntary and Military Ambulance Services

Ì Statement of Problem/Need

ē This proposal is being submitted in order to provide the British General Public with Greater Protection than,,, that which is currently available.

ē The original proposal for State Registration of Paramedics alone would not give that desired protection, as the perception of members of the Public is ĎA Paramedicí is any person who is in an Ambulance uniformí.

ē During the past 10 years there have been 5 complaints concerning ĎParamedicsí treatment? Yet there have been in excess of 200 reported incidents concerning ĎAmbulance Staffí who may have exceeded their individual levels of competence

Ì Project Scope and Objectives

The project will not be enacted overnight, as it will require considerable wide consultation

ē BASP intend to involve all sectors, services, and even individuals involved in Health.

ē Consultation will take at least three months

ē Once the process has been concluded, another Ambulance Educational Organisation will have to be formed, one which will embrace membership from all Ambulance sectors.

ē This organisation will have to then form an ĎAmbulance Technicians Boardí who will decide the criteria for admission, prior to any application for State Registration.

 

ACTION PLAN

Premature application for State Registration of Ambulance Technicians will not achieve any objective. Other than to satisfy an urgent desire of some, and the possible alienation of others, who the panel believe would all welcome the same objective, provided that it allowed all sectors involved in Ambulance Operations to meet the criteria and requirements

ē BASP have studied but one possible acceptable solution the ĎAlberta Regulationsí

ē Any proposal must be kept simple and be understandable to all concerned. Any proposal must also be adaptable to existing UK practice and training.

Ì Activity One

BASP have considered the ĎAlberta Regulationsí and have made individual changes so as to bring these into a current UK format. They have retained three grades, and considered the training practice requirements. The question of continual educational credits will be left to an appropriate Association when it is formed. This may be an existing one, or a new one, however it must have the support of all sectors and allow for admission from all sectors, so that it commands the support of all sectors. The draft is now included for consideration by all sectors involved in Ambulance Operations

Ì Activity Two

BASP is inviting all known Ambulance Operators and their staff to contribute towards a final document, which will be submitted to the industry for adoption. BASP will also be inviting expressions of interest from Educational Organisations who will be invited to form ĎAn Associationí This excludes Employer Representative and Trade Union Organisations, but does not exclude these Organisations from making suggestions as to which Organisations might be suitable to form a Professional Association for Technicians.

Ì Activity Three

The final activity will be for a vote by all Ambulance Technicians as to: -

(1) The Acceptability of the ĎAssociationí to which they should all be allowed to be admitted, after its constitution has been promulgated and

(2) The formation of thatís ĎAssociation Boardí which must have a majority of Individual Members who are registered within the respective grades of Ambulance Aid

MANAGEMENT PLAN

BASP have undertaken a overview of the ĎAlberta Regulationsí in preparation for adoption by the Industry as a whole. These are now promulgated to all interested parties for comment and consultation; this will be conducted by post, fax, telephone and e-mail

Ì Project Organisation

This project is being promulgated to all Organisations involved with Ambulance Service Operations, these Organisations will then be requested to consult with all their members, and employees who are involved in Ambulance Duties at whatever grade of Ambulance Aid. Additional comments will be requested from the Medical, Nursing, and Social Services and other related professions these will be coordinated by BASP and the DTI. We welcome comment however radical, but it should be based on tried and tested methods best practice, and if at all possible be kept as simple as possible.

Ì Costs

As we are receiving no grants for this project Organisations and Associations will have to bear their individual costs, however we will be applying for grant aid to assist in this essential process, which if forthcoming will assist in off setting some, if not all of the costs.

Ì Schedule

May 1999 the BASP amended ĎAlberta Regulationsí to be promulgated for consideration to all interested parties.

September 1999 the closing date for all submission, objections, proposed changes amendments. Current and any new Educational Associations to consider constitutions for expanded membership to include all persons engaged in Ambulance Aid

December 1999 Promulgation of the revised Document, voting by all involved in the process as to acceptance or rejection.

March 2000 Promulgation of the Accepted format, and invitation for proposed formation of an ĎAmbulance Technicians Associationí, proposals from all involved

June 2000 Formation of Ambulance Technicians Association and creation of a Board, criteria determined for Technicians Acceptance based on final accepted document, recruitment, application vetting, and acceptance of Technicians, Register on going.

November 2000 Formal Application to the Minister for ĎState Registrationí of Ambulance Technicians.

April 2001 Ambulance Technicians Regulations enacted?

 

RESULTS

The results will hopefully be an achievable objective, based on tried and tested methods, brought about through the concern and consensus of all who are engaged within our industry, which will hopefully give the British General Public the greater protection that they deserve.

EVALUATION

At each stage BASP will evaluate progress, and if required it will seek assistance from the Ministries concerned to ensure that, each stage is reached, and that a broad as a consensus as possible is reached

QUALIFICATIONS

The qualifications and requirements for the State Registration of Ambulance Technicians are to be based on the principle of ĎAmbulance Aidí The care and treatment of Patients prior to and during the course of transportation. This BASP feel is the Art and Calling, and it is above First Aid and other such levels. It is something that can be achieved through existing training Organisations, including Public, Voluntary, Military and Private services.

The criteria can be based upon the existing Green and Blue books published by the NHSTD. And Registration will be open to all that meet the criteria, by Training and also those by experience. It will cover some 40,000 plus Ambulance Operatives, and it can include other medical sectors such as State Registered Nurses and others who by reason of other qualifications of an equivalent nature, who wish to pursue a career in the Art of Ambulance Aid may be so Registered. This includes equivalent qualifications from other Countries.

 

CONCLUSIONS/NEXT STEPS

This proposal is promulgated and we invite suitable comments, these must be returned by the latest 30th August 1999

APPENDICES

ē Attached the ĎAlberta Regulationsí as amended by the British Ambulance Services Panel Steering Committee. A DTI / NAPAS Associated ĎForesight Programí

ē The Health Bill Clause 47 ĎRegulation of Health Care and Associated Professioní presently before Parliament. In brief the 1960 PSM Act will be repealed and replaced by new regulatory powers to be sorted out through an order in Council. A Health Professions Council, initially covering 9 Professions will replace the CPSM. The CPSM Register covers some 100,000 staff. If Ambulance Technicians are added to this number it will exceed 140,000 staff.

 

The Alberta Regulations as Amended by BASP

Table of Contents

ē Definitions 1.

ē Emergency Medical Technicians 2

ē Registration 3

ē Temporary Registration 4

ē Annual renewal 5

ē Powers of Registration Committee 6

ē Renewal Date 7

ē Register 8

ē Emergency Medical Technician Responder 9

ē Emergency Medical Technician - Ambulance 10

ē Emergency Medical Technician - Paramedic 11

ē Specialised Services 12

ē Duties of Registered Members 13

ē Change of Name Etc. 14

ē Use of Title 15

ē Board of Governors 16

ē Registration Committee 17

ē Conduct and Competency Committee 18

ē Annual Report 19

ē Repeal 20

ē Coming into Force 21

 

Definitions (1) in this Regulation

(a) Ď Actí means the NHS Health Acts (undergoing enactment)

(b) ĎAssociationí Means the Association formed and designated under the Act.

(c) ĎBoardí means the appropriate Health disciplines Board established under the Act

(d) Ď Emergency Medical Technician Responderí means a registered member who is registered in the Emergency Medical Technicians Responder area of practice.

(e) ĎEmergency Medical Technician - Ambulanceí means a registered member who is registered in the Emergency Medical Technician area of practice.

(f) ĎEmergency Medical Technician - Paramedicí means a registered member who is registered in the Emergency Medical Technician - Paramedic area of practice.

(g) Ď Employerí Means:

(I) An Operator as defined ĎíAs someone who is providing Ambulance Transport services to or from a place of medical treatment, to a sick or injured person, in a vehicle which is specially designed for the purpose of carrying sick or injured personsí

(ii) Any person who engages a registered member to provide Ambulance Aid services.

(h) Ď Medical Audití means an assessment by the Medical Director of the health services provided by a registered member and the protocols under which the registered member operates;

(I) ĎMedical Controlí means orders within the registered member's scope of practice that define patient management and are issued by the medical director or a person designated by the medical director

(I) Prospectively through the development of protocols (ii) directly by oral or written orders, or (iii) retrospectively by medical audits;

(j) Medical Directorí means a Registered Medical Practitioner, who is designated by an employer to provide medical control to registered members

(k) Not Applicable

(l) ĎRegistered memberí means a person who is registered as a member of the designated health discipline of Emergency Medical Technicians

(m) ĎRegistrarí means the registrar appointed under the Act

Emergency Medical Technicians (2)

The designated health discipline of Emergency Medical Technicians is divided into the following areas of practice

(a) Emergency Medical Technician-Responder.

(b) Emergency Medical Technician - Ambulance

(c) Emergency Medical Technician- Paramedic

Registration (3)

In accordance with the Act, the Registrar shall register a person as the case may be within any of the respective areaís of practice, as the case may be if;

ē (A) the person has satisfactory completed a program of study

(I) That is approved by the Board, or

(iii) That is substantially equivalent to a program approved under sub clause (I)

ē (B) or the person has satisfactory completed an examination approved by the Board

ē (C) or the person has,

(I) Within the 5 years immediately preceding the date of application, has been employed in a manner that indicates that the person is competent to act in the area of designated practice, EMT-A or

(ii) Within one year immediately preceding the date of application, met the requirements of clause (a) for EMT-R or

(iii) Within one year immediately proceeding the date of application, satisfactory completed a refresher program approved by the Board, EMT-P

ē(D) and the person has completed and submitted to the registrar the applicable forms prescribed by the Minister and

(e) And the person has paid the fee prescribed in the by-laws.

Temporary Registration (4)

(I) A person is eligible to be temporarily registered, as an Emergency Medical Technician Responder, or in a higher grade than an Emergency Medical Technician -Ambulance. If with respect to the area of practice in which the person is to be registered temporarily, the person has met the requirements of section 3-(a) (c), (d) and (e).

ē (ii) A temporary registration under subsection (I) expires 30 days after an examination of post proficiency approved by the Board and referred to in section 3 (b) is held

ē (iii) A temporary registration under subsection (i) may not be renewed

ē (Iv) A person who is registered temporarily as an Emergency Medical Technician Responder (EMT-R) may practice only under the supervision of an Emergency Medical Technician- Ambulance (EMT-A) or an Emergency Medical Technician Paramedic (EMT-P) except in the case of patient transport, where it is unlikely that the patient is expected, to become an emergency patient.

ē (V) A person who is registered temporarily as an Emergency Medical Technician -Paramedic, may only practice under the supervision of an Emergency Medical Technician - Paramedic (EMT-P)

Annual Renewal (5)

(A) In accordance with the Act, the Registrar shall annually renew the registration of a registered member if, with respect to an area of practice. The registered member has,

ē (I) In the case of an Emergency Medical Technician - Ambulance within the 3 years immediately preceding the date of submission of the application for renewal of registration,

ē (A) satisfactory completed basic life support certification

ē (B) been employed in a manner that indicates the person is competent to provide Emergency Ambulance Aid and the Care and Treatment of Accident and Emergency patients prior to and during the course of transportation.

ē (C) Obtained 120 educational credits as determined by the Association and approved by the Board.

ē (ii) In the case of an Emergency Medical Technician-Paramedic within the 3 years immediately preceding the date of submission of the application for renewal of registration,

ē (A) satisfactory completed an advanced life support certification examination approved by the Board

ē (B) been employed in a manner that indicates the person is competent to provide extended advanced life support services, and

ē (C) Obtained 120 educational credits as determined by the Association and approved by the Board

ē (B) the registered member has completed and submitted the applicable forms prescribed by the Minister, and

ē (C) the registered member has paid the renewal of registration fee prescribed in the by-laws

POWERS OF REGISTRATION COMMITTEE (6)

For the purposes of the Act, the programs and examinations that the Registration Committee may order are:

(a) Any or all of the programs of study referred to in section 3(a)

(b) An examination approved by the Board and referred to in section 3(b), and

(c) A refresher program referred to in section 3(c) (iii)

RENEWAL DATE (7)

For the purposes of the Act, the date of submission of an application for renewal of registration is December 31st of the year immediately before the year in which the renewal of the registration is to be effective.

REGISTER (8)

The Registrar shall enter in the Register the names, places of employment, registration numbers and areas of practice of the persons to be registered as registered members. And, pursuant to the Act, shall issue to each registered member an annual certificate stating the area of practice in which the member has been registered and the expiry date.

EMERGENCY MEDICAL TECHNICIAN - RESPONDER (9)

An Emergency Medical Technician -Responder may, under medical control and with an ongoing medical audit, (and under the supervision of a Emergency Medical Technician - Ambulance whilst employed in an Emergency capacity) provide the following health services,

(a) Conduct primary and secondary surveys, including scene assessments,

(b) Use basic methods of managing medical, traumatic and obstetrical emergencies,

(c) Use airway management techniques, including orpharyngeal airways, oral suction devices and oxygen supplement mask devices, bag-valve mask devices, to assist ventilation

(d) Administer oxygen using basic delivery devices including masks,

(e) Administer nitrous oxide/oxygen inhalation analgesia (except in maternity cases)

(f) Basic bandaging,

(g) Perform cardiopulmonary resuscitation

(h) Patient extrication,

(I) Use basic splinting techniques, including spinal immobilisation in long spine boards and cervical collars

(j) Automated and semi-automated defibrillation.

EMERGENCY MEDICAL TECHNICIAN - AMBULANCE (10)

An Emergency Medical Technician -Ambulance may, under medical control and with an ongoing medical audit, provide the following health services:

(a) Primary and secondary patient assessments,

(b) Basic management of traumatic medical disorders,

(c) Airway management including using orpharyngeal airways and suction, bag-valve mask devices, and all UK acceptable and approved resuscitators (auto - Vol/Time and pressure cycle)

(d) Administer oxygen.

(e) Administer nitrous oxide/oxygen inhalation analgesia (except in maternity cases)

(f) Bandaging and splinting

(g) Use spinal immobilisation devices

(h) Emergency childbirth

(I) Psychological support measures

(j) Maintain intravenous infusions without medications or blood products

(k) Glucose testing and oral administration of glucose

(l) Assist in paramedic invasive situations

(m) The health services described in section 9

EMERGENCY MEDICAL TECHNICIAN - PARAMEDIC (11)

An Emergency Medical Technician - Paramedic may, under medical control and with an ongoing medical audit, and (in the case of a Temporary Registration under the supervision of a fully registered EMT-P) may provide the following health services:

(a) Airway management including: nasotracheal suction, tracheal suction, endotracheal intubation, and use of Laryngeal mask airways, and intermittent positive pressure breathing adjuncts.

(b) Cardiac monitoring, defibrillation, cardioversion, carotid sinus massage and telemetry transmission.

(c) Topical, oral, sublingual, rectal, subcutaneous, intramuscular, intravenous, endotracheal and nebulised drug administration as authorised and listed by a medical director

(d) Establish peripheral intravenous lines, and administer fluids as authorised by a medical director

(e) Venipuncture, for venous blood specimens.

(f) The health services described in sections 9 and 10

SPECIALISED SERVICES (12)

(1) An Emergency Medical Technician - Ambulance who has received Registration Committee approval under section (4) may, under medical control, with an ongoing medical audit, may undertake the health services described in section (11) provided that they are directly supervised by a Registered Emergency Medical Technician - Paramedic.

(2) An Emergency Medical Technician - Paramedic who has received Registration Committee approval under section (4) may, under medical control and with an ongoing medical audit, provide the following Health services:

(a) nasotracheal intubation,

(b) Use pacemakers,

(c) Monitor chest tubes,

(d) Monitor and maintain blood and blood product transfusions

(e) Intracardiac drug administration

(f) Use Traction Splints

(g) And such other functions that the Registration Committee may approve.

An application for approval to provide health services referred to in subsection (1) or (2) shall be made to the Registration Committee, by the medical director and the application shall:

(a) Name the registered member and the registered member's place of employment,

(b) Describe the training received by the registered member with respect to the health service for which approval is sought, and,

(c) Provide evidence that the registered member has satisfied the medical director as to the registered member's level of skill with respect to the health service for which approval is sought

The Registration Committee may grant approval for a registered member to provide the health services referred to in subsection (1) or (2), but the approval shall be limited to the particular employment situation described in the application submitted under subsection (3)

DUTIES OF REGISTERED MEMBERS (13)

A registered member shall:

(a) Execute duties in a safe and competent manner being guided at all time by the welfare and best interests of the patient;

(b) Work within the scope of practice and the registered member's ability and within the limitations or conditions placed on the provision of service by the medical director;

(c) Conduct affairs with respect to the discipline so as not to bring discredit to the discipline;

(d) Maintain current knowledge and skill in the practice of emergency care and Ambulance Aid, and upgrade knowledge and skill with the development of new procedures and equipment;

(e) Work to promote high standards of research, training and performance for registered members;

(f) Work in co-operation with colleagues and other health care personnel;

(g) Refer any incompetent, illegal or unethical conduct by colleagues or other health care personnel to the appropriate authorities;

(h) Hold in confidence all information learned in the health care setting respecting the patient, unless failure to disclose would endanger the patient or a third party or the disclosure is required by law.

CHANGE IN NAME, Etc. (14)

A registered member shall forthwith inform the registrar in writing of a change in name, home address, place of employment or employment status.

USE OF TITLE (15)

(1) A person who is registered as an Emergency Medical Technician - Responder may use the name "Emergency Medical Technician Responder" or the initials "E.M.T.-R"

(2) A person who is registered as an Emergency Medical Technician-Ambulance may use the name " Emergency Medical Technician-Ambulance" or "Emergency Medical Technician" or the Initials "EMT-A" or "E.M.T."

(3) A person who is registered as an Emergency Medical Technician - Paramedic may use the name "Emergency Medical Technician -Paramedic" or the initials "E.M.T.-P"

BOARD OF GOVERNORS (16)

The governing body of the Association shall be a Board of Governors consisting of:

(a) No fewer than 3 Emergency Medical Technicians - Responder

(b) No fewer than 3 Emergency Medical Technicians - Ambulance

(c) No fewer than 3 Emergency Medical Technicians - Paramedic and

(d) The persons appointed by the Council under the Act (which will be less than 50% majority)

REGISTRATION COMMITTEE (17)

The Registration Committee shall consist of:

(a) No fewer than two Elected Members from each Grade Registered (Total six)

(b) Medical Persons appointed by the Council under the Act (which will be less than 50%)

CONDUCT AND COMPETENCY COMMITTEE (18)

The Conduct and Competency Committee shall consist of:

(a) No fewer than two elected Members from each grade registered (Total six) and

(b) The person appointed by the Council under the Act

ANNUAL REPORT (19)

The date on or before which a report under the Act must be submitted is March 31st.

REPEAL (20)

The 1960 Professions Supplementary to Medicine Act

COMING INTO FORCE: (21)

It is anticipated that this Regulation will be ready to come into force by 1st of April 2001