PRIMEtime Keeweedoc: Part One What is PRIME?

PRIME (Primary Response In Medical Emergencies) is New Zealands answer to the problem of how you should respond to accidents and medical emergencies when an ambulance with advanced paramedics is not able to be provided in a timely manner. Its a bit like BASICS in the UK.

History lesson time!

Before the 1990s if there was an MVA, asthmatic attack ect in a rural area the local response was based on goodwill and people knowing who to call ect. This lead to inconsistencies and in 1993 the government felt this needed to be addressed. After a few difficult years PRIME was set up and trialled in 1998 and rolled out NZ wide in 1999. Other than updates on the manual and a few little tweeks the PRIME setup has performed well in NZ. Funding wise medical cover is capitated to the PRIME GPs/Nurses and ACC covers accident/trauma responses.

So where do PRIMEs cover?

“The PRIME scheme utilises the skills of rural GPs and/or rural nurses (RNs) in areas where an ambulance crew (two ambulance officers, where one is a paramedic) is more than 20 minutes away (40 minutes in the South Island). There are currently 266 PRIME service providers in New Zealand (including both rural GPs and RNs). The PRIME network is activated via a pager, in most cases, by the regional communications centre (RCC) following a 111 call, where the nearest paramedic response is more than 20 minutes away” (From paper 2003)

 

Each star is a Prime site. As you can see they cover the length an breadth of NZ. The south island is particularly PRIME.

 And what do PRIMEs do? (other than sounding like sweet transformers)

PRIMES respond to emergencies in rural New Zealand, they will usually meet the local ambulance crew there. The crew will have BLS skills and may have some additional skills such as cannulation. It is expected that PRIMEs will assume control of the scene and when required/indicated use there more advanced skills. They will then decide on the best site for transfer and/or mode of transfer of their patients. The intention being that the PRIME service will provide a higher standard of care that was previously available.

The reality of day to day work:

If you are a PRIME provider you carry a pager and carry on with your regular practice/clinics ect. but you need to be able to drop everything and go if there is a call out. You get a sweet green flashing light for your car (which no-one recognises) So you call back to say your responding at goto the scene. Triage/treat and usually return to your normal work.

Its not perfect

Now there are a few things that most of the PRIMEs I have spoken find difficult. Often the pages are somewhat cryptic and lacking in information so you may respond to something you do not need to or would be best brought to you at your medical center. You can call the operator about the calls and attempt to get more information and decide if you need to go. St Johns NZ have introduced a new computer triage system which can be a bit hit and miss. Its very frustrating when you arrive and are not needed after driving for half and hour and closing you practice. Also as its a 365 days a year 24 hours a day call and in many cases there is only one PRIME at a site you are permanently on call. This has been improved somewhat but is still an ongoing issue.

Finally people are very positive about the training course which i will get onto in Part 2 next week.

Ref:

Is the PRIME (Primary Response In Medical Emergencies) scheme acceptable to rural general practitioners in New Zealand?Todd Hore, Gregor Coster and Janne Bills Journal of the New Zealand Medical Association, 02-May-2003, Vol 116 No 1173 http://journal.nzma.org.nz/journal/116-1173/420/

Comments

  1. Haydn Drake says:

    Great write up! However, the triage system is not new. The Emergency Ambulance Communications Centres (EACC) are still using an international system ProQA, which they have been using now for many years. What has changed is the response system. ProQA is limited by the fact that it’s only as good as the information given by the caller to the EACC. There is now a Clinical Desk in each of the three EACC’s with an Intensive Care Paramedic, but they can only upgrade the priority of a response, not over-ride ProQA to downgrade a response.

    http://www.emergencydispatch.org/articles/whatis.html#ProQA

    http://www.wfa.org.nz/comms

    Terms Priority 1, 2, or 3 have been replaced with a new five colour coded response system – purple, red, orange, green and grey. The new colour coded system is supposed to focus on allocating the closest resource to high acuity calls (purple and red) rather than on crew qualification. It’s also supposed to focus resources on fewer high acuity calls, in a shorter time frame and to provide fewer responses to low acuity calls which are better handled by alternative pathways such as GPs or medical centres.

    • I sit corrected, cheers Haydn. Your a city boy mostly but do you bump into PRIMEs from time to time?

      • Haydn Drake says:

        No worries, minor & trivial details. We often do respond into rural areas on the out skirts of the cities greater region, but I’ve only had contact with PRIME doctors on a couple of occasions, none of which were recent.

        I’m looking forward to hearing about your experiences, and about your interactions with the ambulance service.

  2. Awesome insight into the PRIME system. I’m familiar with the UK’s BASICS, but NZ PRIME looks excellent.

    Many rural docs in Australia are already being tasked to prehospital events – but without formal arrangements, training or equipment (see http://rrh.org.au/publishedarticles/article_print_2127.pdf)

    So, in Australia, where rural docs have airway skills (often doing elective anaesthesia) and distances for retrieval services to arrive can be HUGE, why don’t we have a similar scheme

    I appreciate the days of ‘enthusiastic amateur’ are over and the best response is a retrieval practitioner – but rural docs are ALREADY being tasked to these incidents…so why not formalise arrangements, equip them and train them in this challenging environment?

    I cannot really understand why not having a down under PRIME / BASICs

    Can anyone enlighten me?

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