Ambulance paramedics are not currently registered health care professionals under New Zealand legislation. Therefore it is imperative to the leadership and paramedics in the Service that clinical governance and clinical standards within the Wellington Free Ambulance Service are as high as possible.

A Clinical Governance Group (CGG) provides the clinical governance to the organisation. This group consists of the Service’s part-time Medical Director (also an Emergency Physician in a busy urban Emergency Department), ambulance managers, Intensive Care Paramedics and Advanced Life Support Paramedic peers. Meeting every two months, the group look at clinical issues including clinical complaints, skill competence, application of clinical practice guidelines and professional standards.

Any new clinical treatment provided by ambulance paramedics in Wellington must first be supported by research and/or empirical evidence-based medicine, and sanctioned by the CGG and our Medical Director.

Hospital specialists will be consulted before any new treatment is initiated, to ensure the ambulance service is part of the continuum of primary health care and to ensure resourcing implications are considered. A robust peer reviewed clinical audit process is in place to ensure colleagues get feedback on clinical issues.

Wellington Free Ambulance as a service is extremely committed to continuing medical education of paramedic staff, with a significant in-service education programme run annually as well as clinical skill revalidation completed both operationally in the field and in a skills lab.

Clincial Practice guidelines

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.

Click here to view our current Clincial Practice guidelines