In 2005, Wellington Free Ambulance was the first ambulance operator in New Zealand to move away from patient care procedures to clinical practice guidelines. This enables professional staff to apply their knowledge and education in delivering the best clinical pathway for their patient, rather than uncritically following preset procedures that might not be the best clinical care pathway for the patient. These CPGs are fully reviewed and reissued each two years to ensure continuous improvement and best practice.

This is critical in some situations, such as when cardiac patients suffering an inferior acute myocardial infarction that would not benefit from oral nitrates and might benefit more from a fluid challenge. Following diagnosis using a twelve lead ECG, in conjunction with the history gathered and assessment of the vital signs and other clinical indicators, the paramedic is able to make an informed clinical decision as to what clinical guideline is best for their individual patient’s ongoing care on the way to hospital.