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134 The Australasian Mine Safety Journal Summer 2011/12 Products and services banner PARAMEDICS PARAMEDICS: WHEN FIRST AID JUST ISN'T ENOUGH F We all know we live in a lucky country, but there are some things that have been taken for granted for so long that we have forgotten that the rest of the world is not so lucky. Take paramedics for example. ollowing the lessons learned in the Korean and Vietnam Wars, the importance of trauma as a "disease" was recognised. Trauma (especially from motor vehicle accidents) killed more people than died from other diseases combined, and it became recognised in its own right. The best "medicine" for trauma was identified as early intervention by skilled personnel, who could treat the two major killers following injury: airway blockage and life-threatening bleeding. So it was that advanced life support (ALS) was born in countries that could afford it (like ours). Beyond "the basics" of CPR (cardiopulmonary resuscitation) to keep someone alive, modern systems recognised advanced airway protection procedures to ensure oxygen could travel to the lungs, and used intravenous (IV) drips, fluid replacement and haemorrhage treatment to keep the heart pumping blood around the body. These ALS procedures were placed in the hands of highly-trained, full-time professionals called paramedics, and the key to survival was based on another war-time trauma lesson: intervention within "the golden hour". To ensure survival following trauma, you have to get ALS paramedics with the right equipment to the scene of the injured person/s and let them do their life-saving work within the first hour of injury. Far beyond what is possible with a first aid course (three days), the skills of a paramedic are learned over several years at Diploma, Advanced Diploma and now Bachelor's Degree level; then practiced as a full-time professional for best results. To date, the word "paramedic" has been ill-defined. Anyone with a 7-10 day EMT or "industrial medic" course on top of a first aid certificate could claim to be a paramedic, because there was no accepted definition. However, in 2010, the Emergency Services Registry of Australasia (www.esra.com.au) created a reliable and consistent framework to credential paramedics. For the first time, certification was linked not only to qualifications but also to skills and, critically, experience. It isn't enough to just learn ALS skills on a manikin, it is vitally important to practice them in real life on real patients and for this to become second nature. The basic qualification to be designated a Paramedic (ESRA Level IV) is a Diploma of Paramedical Science (Ambulance), a minimum one year's full time tertiary study level, which then needs to be followed by clinical placement within a hospital or ambulance service and meaningful, "real-world" experience. Advanced life support and intensive care paramedics (corresponding to ESRA Levels V and VI) require a minimum two years of study at the Diploma, Advanced Diploma or Bachelor of Science level and then clinical experience. In addition to qualifications, private Paramedics can only operate within an effective Clinical Governance model, comprising oversight, poisons licensing and legislative responsibility. Effectively, this means they must be employed by an organisation that provides all of these elements, in exactly the same way as a state or territory ambulance service or health department. There are no "solo paramedics": paramedics must remain part of a continuum of care, commencing with a Medical Director, clinical governance model, ongoing education, case-audit and review, legally compliant medical record-keeping, up-link to assistance, insurance coverage, professional development and support. Companies that contract medical staff directly without approved clinical governance expose themselves to significant risk. Best practice in emergency response is enabled only after management accepts that given the real risks of remote industrial environments, the highest standard of response must be afforded to and implemented across all operations. Additionally, management are protected from OHS and legislative standpoints. It is clear in these resource industry environments that the risks of injury are significantly higher than first aiders can satisfactorily address. The long-anticipated OHS harmonisation threatens more scrutiny, fines and (conceivably) individual criminal prosecution and imprisonment. Everyone from the board room down to the boiler room, including managers, need to critically review the standard and capability of emergency response in place and ask the hard questions. So "whoyagonnacall"? A professional paramedic.