All about the drivers…

Greetings to those joining us from other disciplines! It’s been discussed that our qualification structure is a little daunting and/or confusing, so a small crash course is below. To truly confuse you, there’s a big difference in all the terminology above, so I have done my best to clarify these. Any questions, please ask either in the comments, or ask a staff member.

Qualifications are the externally accredited qualifications of an individual. Think diplomas, degrees, accredited courses. These are linked to, but separate from ATP.

ATP (Authority to Practice) which is the official delegation by a medical director to operate autonomously at a certain level. Internships are the pathways to the level, so someone wearing paramedic intern is able to operate at paramedic skillset, but isn’t fully autonomous in the role.

First Responder

Are generally volunteers or community responders (such as firefighters), who have advanced first aid training. The qualification required to be a first responder is a L3 Certificate, delivered by St John.

Autonomously, they bag mask, operate AEDs, OPA and NPA, and OTC medicines such as paracetamol, ibuprofen, and aspirin. They’ve got access to call and ask for permission to use the other tools of the ambulance should they see fit.

Emergency Medical Technician

The bulk of the workforce, especially the rural areas. EMTs are qualified with a national diploma, and are then issued with an ATP by the Medical Director.

Key skills for an EMT to use autonomously are: IM adrenaline (asthma and anaphylaxis), LMA, nebuliser bronchodilators (CORDand asthma), GTN, and methoxyfluorane, laryngoscopy (airway obstruction).


There’s more than one way to have to paramedic level in the past. ‘Grandfathering’ or, ‘internally’, is where someone has sat an internal course facilitated and provided by St John, where they have them been provided an ATP. This stopped around 2015, and the only way to become gain ATP at paramedic level is undergraduate degree – BHSc (Paramedic) and apply for the internship pathway.

Key skills for paramedics autonomous use are: IV access, IV pain relief, midazolam (agitation and seizures), IV adrenaline and amiodarone (in cardiac arrest) and manual cardioversion.

Intensive Care Paramedic (old term: advanced paramedic)

Much like paramedics ICPs have got to their positions either by grandfathering, or an internship. The qualification that backs this now is rapidly approaching postgraduate diploma level, but is currently a PG cert.

Their key skills are: intubation, IO access, cricothyroidotomy, IV adrenaline, atropine, finger and needle chest decompression, pacing, and sedation level analgesics. You can study and apply for an RSI endorsements as an ICP, however this isn’t part and parcel.

For a full breakdown on the drugs and skills, ask one of our staff to see their procedures- more than happy to share the information. You could probably stop reading from here, but for those who are observing with us, you might be interested in the additional roles and call signs.

eps example

Roles are exactly that- a description of what someone is there to do, instead of, or sometimes in addition to, being there as an ambulance driver officer. Most prominently these are our managers, who have a crown on their shoulders, or the shift supervisors, who have three ‘pips’. Roles expand a little further than this, as there are different types of vehicles which achieve different aims. Often referred to by their call signs as they align, You can differentiate them by their call signs:

Christchurch [number]: ambulances, which may have two or three crew members, with a mix of ATPs on the truck. Different numbers differ in roles slightly- transfers, events, frontline emergency work.

Tango: A designated rapid response vehicle, these are single crewed. Usually crewed by an ICP, tango cars are assigned to either first respond, or back up, frontline ambulances.

Sierra: Usually crewed by a paramedic, Sierra is sometimes referred to as urgent care paramedics. Sierra cars are aimed at facilitating community care pathways and delivering non-acute care.

Oscar: the shift supervisor, who has epaulettes with three pips. Does the day to day (or night to night) shift management, solves problems and helps run scenes. Their car has a few more toys in it than most to help them do this.

Prime: short for ‘primary response in a medical emergency’ these are rurally based GP and RNs who correspond to workload. Their scopes are a little wider than my knowledge, because they can do their day job on top of the skills provided to them by St John. I would imagine it’s fairly rare to see a prime doctor or nurse in the emergency department.



4 Comments Add yours

  1. Blane says:

    Great article and list. I was especially interested in hearing about Sierra and what sounds like mobile urgent care. I keep wondering how big these types of non-acute care services are going to get.


  2. jumbodulator says:

    Nice article!


  3. Tatsu Kuwasaki says:

    Thanks Andrew for the post to introduce who we are for the ED staff coming on the observer shifts.

    Thanks Sarah for the correction.


  4. Sarah Werner says:

    Hi Andrew – small correction, the First Responder qualification is a level 3 certificate.

    Happy New Year!


    Sarah Werner
    Clinical Learning & Development Manager | National Headquarters
    St John New Zealand | Hato Hone Aotearoa
    [st john logo]
    T +64 9 526 0528 x 8466 | M 027 265 6619
    10 Harrison Road I Mt Wellington I Auckland 1060 I New Zealand
    Private Bag 14902 I Panmure I Auckland 1741 I New Zealand
    Please consider the environment before printing this email


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s