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Island may recognise paramedics

New legislation could be on the way to enable paramedics to attend life-threatening emergencies in Bermuda.

The law currently doesn't recognise the profession, meaning the one qualified paramedic who works for Bermuda Hospitals Board is unable to practise as a paramedic or use his paramedic skills when responding to 911 calls.

The same restriction applies to a Bermuda Fire Service officer who was recently trained and certified as a paramedic but cannot use the qualification yet.

King Edward VII Memorial Hospital's ambulances are crewed by emergency medical technicians (EMTs) with more basic life-saving skills than paramedics — but that could change, according to a Bermuda Hospitals Board spokeswoman.

She told The Royal Gazette that BHB was part of a working group set up by Government to look at changing the law and regulating the emergency medical service provider profession. The fire service is also involved, as its officers receive EMT training and respond to medical emergencies.

If the changes happen, they will fulfil a pledge made almost five years ago by the late Nelson Bascome when he was Health Minister. He told The Royal Gazette in February 2009 that the Island's EMTs would get paramedic training that year.

The promise came shortly after an inquest into the death of Norman Palmer, 57, heard criticism about the ambulance crew which dealt with him when he got into breathing difficulty at his home. BHB strenuously denied allegations that the two EMTs who attended Mr Palmer's home were not adequately trained.

Mr Bascome said the plan for extra training for EMTs was unrelated to Mr Palmer. He said paramedic training to “sharpen and enhance” the skills of Bermuda's EMTs had been mooted since about 2002 but the cost of the high-tech simulator needed had been prohibitive until then.

Mr Palmer's sister Marion Bishop said yesterday she wasn't surprised the promise had yet to be fulfilled but welcomed the news that training could be coming.

“Of course it would be a good thing,” she said. “It's too late for Norm and how many other people? The fact it hasn't happened yet just goes to show that we don't put much value on life here.”

Lynn Spencer, whose 25-year-old heroin addict son Christopher died in October last year, said she was also very interested in the news “because there's just a better chance of saving someone's life when you are a paramedic”.

She added: “I just don't understand why they don't try to give the best they can give. There are surely many, many life and death situations that a paramedic [would be useful in]. They are able to do more life-saving procedures.”

There are three EMT levels: basic, intermediate (EMT-I) and paramedic (EMT-P).

BHB's emergency response team consists of 12 basic EMTs and ten EMT-Intermediates on full-time staff. The fire service has 20 EMTs and 60 EMT-I's.

Chief Fire Officer Lloyd Burchall said the fire service would welcome a change in the law to allow paramedics to use their skills, adding that firefighter David Duperreault recently completed paramedic training in the US.

Mr Duperreault told this newspaper: “There's an astronomical difference as far as the skills you can perform.

“There is a vast difference between EMT-I and paramedic.”

The BHB spokeswoman said: “BHB has one trained paramedic, but due to current legislation he cannot practise as a paramedic. Paramedics are not, at present, recognised as a ‘specified profession' as set out in the First Schedule of the Allied Health Professions Act 1973.”

In answer to further questions, she said in an e-mail: “BHB is very pleased to be part of a working group that was formed within the last year under the auspices of the Bermuda Government to establish standards for emergency medical services providers in Bermuda and regulate the profession.

“It is hoped that this will be the first step in drafting all-encompassing EMS legislation.

“BHB believes that a paramedic (EMT-P) response would enhance the overall level of pre-hospital care available; however, the additional procedures and medications that paramedics are able to deliver are required relatively infrequently in Bermuda.

“This means Bermuda is unable to provide adequate paramedic training locally and it will be difficult for practising paramedics to maintain advanced technical skills and knowledge, as they will not be used on a regular basis.

“There are potential solutions, such as periodic skills testing in a simulation lab. This type of ‘virtual reality' testing would be costly but could prove helpful in addressing the low numbers of high acuity emergency calls that require a paramedic response locally.”

The spokeswoman said for the “majority of emergency cases in Bermuda” the current EMT service was “adequately trained and prepared”.

She added: “EMS transport times [to the hospital] are relatively short — generally less than 20 minutes once the patient is reached. The focus is often on ensuring that the patient reaches the emergency department quickly, as there is mounting international evidence that this results in the best outcome for patients, rather than delaying the time to carry out interventions in the field.

“Additionally, the most important pre-hospital interventions that save lives are effective CPR, rapid defibrillation and non-invasive maintenance of an airway. All of these procedures can be performed by all of our current EMT staff.

“The trained EMT-Intermediates (EMT-Is) in Bermuda can also establish intravenous/intraosseos (direct bone) access and can administer IV fluids, as well as a limited number of medications, in the field.”

Carlton Crockwell, chairman of the Road Safety Council, said the lack of paramedics had never been flagged up to him as a concern in relation to traffic accidents.

But he said the council would embrace the idea and “support BHB 100 percent” if it introduced paramedic training for EMTs.

“If it means that someone gets extra qualified to save a life, well, who would not support that?”

Health Minister Patricia Gordon-Pamplin and the Ministry of Health declined to comment for this article.

A Bermuda Police Service spokesman said its officers received training in basic first aid and CPR only.

Paramedics for Bermuda? A working group is considering changing the law and regulating the emergency medical service provider profession.

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Published November 21, 2013 at 8:00 am (Updated November 20, 2013 at 10:52 pm)

Island may recognise paramedics

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