Hi-
I was wondering if anybody was aware of any International Volunteer Opportunities for Paramedics. I'm thinking something along the lines of "Doctors without Borders", but they don't accept Medics. I'm *not* looking for disaster relief, rather I'd like to volunteer somewhere with a chronic need for health care. I'd be interested in working either as a medic, in a clinic, or some other healthcare setting.
Thank you for your help,
Yoni Kurland
ykurland@gmail.com

Tags: international, paramedic, volunteer

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This is a difficult one mainly because Paramedics act under the authority of clinical guidelines that are decided locally within the services that you work. So authority to say give drugs, intubate and perform paramedical skills beyond basic first aid wouldn't be widely available internationally. You couldn't just show up and ride around on an ambulance in the same way a doctor could in a hospital.

This coupled with the fact that traditionally paramedics work in an emergency acutely ill setting and run to a hospital whereas organisations such as red cross, save the children ect are looking at long term urgent and social care issues suited to Dr's and Nurses with specialist training, mainly in public health and tropical diseases.

http://www.redr.org.uk/en/ has information about this sort of thing. Although not US based may help.

There seems to be situations where you could work as a health care support capacity assisting nurses and doctors.
First, the best thing I can say is Google it. I just did and found a bunch of sites offering different volunteer opportunities abroad. One I found that seemed interesting was http://www.globalcrossroad.com/. I do want to add that there are hundreds, if not thousands of volunteer opportunities in the US that you can take advantage of. Why not start there? Either way, hope you find something you are looking for.
Yoni,


I'm in the same boat as you, and i can tell you from the extensive research i've done in international EMS that the opportunities are scarce... at the moment. This is for multiple reasons, of which a few i've listed here:
1. In the US, EMS is still the ugly step-child of the medical profession (in my humble opinion), and therefore doesn't get the recognition for the valuable work we do -- we don't get the recognition we are due, and therefore aren't considered capable or qualified to do other jobs we could, and would do very well.
2. The EMS systems abroad that do offer ALS are either MD/RN-run (e.g., non-English-speaking European countries), or really tough to get the working papers for (i.e., South Africa, England, etc.) Most other countries -- underdeveloped -- don't offer ALS, and if they do, they should be stopped because they're wasting their money when they should really be focusing on BLS (in my humble opinion, again ... technology hunger is a terrible, terrible addiction for underfunded EMS systems.)

Nonetheless, you still have several options:
- try to get the papers: South Africa has an AMAZING EMS system, arguably the most advanced in the world (where the citizens can afford it, that is). I've also heard that Australia is actively recruiting foreign paramedics for some type of shortage, though i can't verify that personally.

- move to Tijuana and work on an ambulance there (you'll never regret it)

- work for a US-based company that operates abroad. International SOS, Remote Medical International and some other companies hire medics to work in various capacities overseas. The majority of the placements are on oil rigs, but there are other cool opportunities but you typically need seniority in the company to land them. Typically you need 5 yrs of experience just to get a job with them, but that's not set in stone. There are also jobs with KBR and other defense contractors working in Kuwait, Iraq, etc. on military bases. There's a lot of info on that stuff -- as Jonathan stated, google it, not hard to find.

- Go the NGO route. Again, Medics don't have the pull MDs and RNs do in the medical world -- be it profit or nonprofit -- but that's slowly changing and we can help to change it by doing a bit of trailblazing and making the opportunities ourselves. Many foreign-operating organizations have never considered hiring medics because they don't know what we can do, so with a bit of initiative and persistence, and by selling yourself well, you may very well create an opportunity that didn't exist before. An example of where we don't work, but should, would be in the case of Doctors Without Borders: if you go to their website, "paramedics" are not included (and as I remember once reading, they explicitly stated "we don't hire paramedics"). Maybe this has something to do with the fact that it is a French-based org, and in France they have MDs on the ambulance and don't consider paramedics legitimate healthcare professionals (where they only have "Ambulance Attendants" to drive), or maybe it has to do with some other reason(s) i'm missing, but frankly, it makes little sense to me. I would like to ask, "and how do you expect to get these patients to the OR, or the Field Clinic?" Obviously, they've found an answer to this, (one of which is an excess of MDs available thanks to virtually non-existent medical school tuitions ... but we won't go there). Nonetheless I still believe they are selling their missions short by not tapping into the invaluable resource we offer. (Have the French forgotten that even their beloved Hemingway drove ambulances?)

However, Doctors Without Borders is largely disaster relief and you mentioned you're "*not* looking for disaster relief" so i can assure you that that eliminates about 95% of your opportunities in NGO work. (be mindful that "disaster" is a very large word, encompassing everything from earthquakes to wars to epidemics.) But if you're set on not doing disasters, that will leave you where I found myself ... so a friend and I started our own NGO: Trek Medics International. www.trekmedics.org

However, I'd have to inform you that we don't have positions/opportunities at this time (not that you were asking). But there's plenty of work to be done out there. Outside of Disaster Relief (which we're getting involved in ... tomorrow) the medical-NGO world is 99% clinical-based organizations doing clinical-based work (i.e., cleft-palate surgery, OB/GYN, cataracts, dental, club foot, vaccinations, primary care, education, et al). This is both a good thing and a bad thing for us EMS folk. It's good because it leaves the market wide-open with little other humanitarian "competition" in the prehospital realm. But it's bad because EMS is highly unrealistic in the majority of these locales. As one gentleman who runs a medical mission org said to me, "these people are more concerned with getting food on their plate day to day then they are with making sure they can do CPR correctly." (see my above comment regarding cost-efficiency). There are a couple EMS-based orgs out there i've come across: Medical Teams International (has an EMS "branch"), same goes for INternational Medical Corps, and Global Mission Readiness does some stuff in Guatemala, but most of what they're doing -- outside disaster relief -- is training.

But those will be your two best bets for purely EMS activity:
- training (including, by and large, prevention)
- disaster relief.

Nonetheless, paramedic-level training need not necessarily imply "EMS", as it seems you mentioned above.
In that case, maybe you'd consider getting your MPH or MPA and try to work for WHO, PAHO, IMF, USAID or any other such entity, and help bring EMS more to the forefront. However, again, if you're looking to work in a developed country, your opportunities will be limited, though not impossible. On the other hand, working in an underdeveloped country means disaster relief or BLS, by and large (again, please STOP any ALS initiatives you come across in poor countries ... PLEASE!)

I've heard it said more times than i can count that EMS will bring you to one of four inevitable career outcomes: Management, Nursing, Fire or Burnout. While that's true for many many people, it doesn't have to be that way. It's not that there aren't opportunities in EMS, it's that we haven't created, or unearthed them yet. Healthcare is changing, and we need to make sure we position ourselves so that we're taking a more prominent, recognized role as it changes, as we are able to do. In the end, we're just as useful as nurses (thank you very much), and we're quite flexible too. In fact, we bring an entirely new skills set to the table: prehospital practice (in which case we're often more useful than many MDs, as it were ... with all due respect).

Sorry for the tome, (and the preachy-ness) but i've spent a bit of time researching this stuff... and these are some of the opinions I've formed (though they're liable to change at any time, and often)

One last thing, if you're interested, these two links will give you a bit more of an idea of where i'm coming from:
This from the WHO on Int'l EMS:
http://www.who.int/violence_injury_prevention/services/en/
(download the paper "Prehospital Trauma Care Systems" on the right ... and remember, Prehospital Trauma = BLS ...95% of the time)

and this is what I'm getting after:
http://www.trekmedics.org/why-ems-abroad-is-important/


best of luck,
i'd love to hear where you find yourself,
Jason
Hi Jason-
Wow, thanks for that info. I've read your comment through twice, but haven't had the chance to check any of the websites.
I figure I should share where I'm coming from with all this: I'm a 2 year Medic with 5 years of BLS experience at a private ambulance company. I'm also currently taking undergraduate science classes as part of a post-Bacc program, with the intent of applying to Medical School next year. Due to the application schedules, I am expecting to have a few months of "free time" before I could start school in 2011. I'm looking for this trip to be a temporary escape from the US Medical System before I commit the rest of my life to it.

I'm looking towards undeveloped countries for a number of reasons. First off, the selfish one: I'll be 35 by the time I finish medical school; now it my last chance to travel somewhere without worrying about a mortgage or dependent family members. Second, and more importantly, they are the places that need the most help, and I assume it is where I could make the biggest difference.

After reading your comments, I'm realizing that my "plans" are pretty vague at this point. I'm not quite sure what I'd like to do, but you've helped me to clarify some thoughts. I think I misused the term "disaster relief" in light of recent current events, and I'll look into that area a little more. I would also look towards the NGO clinics, though the idea of working BLS somewhere intrigues me.

Again, thanks for your help. (Btw, I'll be sharing these comments with one of my co-workers who has the same interests).

Regards,
Yoni


Jason Friesen said:
Yoni,
I'm in the same boat as you, and i can tell you from the extensive research i've done in international EMS that the opportunities are scarce...
here's a video i put together from our trip.
http://www.youtube.com/watch?v=-mxebbIutqk

I will be putting up EMS/Health-related posts on my site as soon as i can get them onto my computer with relevant WHO/PAHO/UN information.

http://www.trekmedics.org/projects/projects_haiti_earthquake/

In the meantime, here are a couple articles from the NYTimes that might be interesting:
International SOS and Evacuations (they do more than just man oil rigs)
http://www.nytimes.com/2010/01/19/business/19road.html?scp=1&sq...

Doctors reflect on Haiti after return:
http://www.nytimes.com/2010/02/13/world/americas/13doctors.html?ref...
Jason Friesen said:
In fact, we bring an entirely new skills set to the table: prehospital practice (in which case we're often more useful than many MDs, as it were ... with all due respect).


For the medical missions, what are those skills again? Paramedics aren't going to be deciding which antibiotic to prescribe. Paramedics aren't going to be fixing cleft lips any time soon. Paramedics aren't going to be doing routine health screening including deposition and treatment. What labs are you going to order, especially considering that the ability to run the labs is limited in scope and quantity. Paramedics are great when they're operating in an emergency medical system, however when medical facilities don't even exist to provide basic primary care and screening, then there simply isn't an emergency medical system in place including the hospital based services like an emergency department.
Joe,

thanks for taking the time to point out my admittedly unclarified point. It's clear that you've identified a number of MD-skills that paramedics won't likely be performing any time soon, if ever, and with good reason. Nonetheless, while it seems like you might have taken a bit of offense at that sentence, you're right that I should be a little more clear.

To backtrack (to the sentence preceding the one you quoted), I stated: "In the end, we're just as useful as nurses (thank you very much), and we're quite flexible too. In fact, we bring an entirely new skills set to the table: prehospital practice (in which case we're often more useful than many MDs, as it were ... with all due respect)."

Let me delineate those two basic statements:
"We're just as useful as nurses" - In Maryland, for example, (among other states) Paramedics are being hired to work in the ER as ER Techs, utilizing their full scope of practice to augment the nursing shortage(among other reasons), and they're doing an excellent job.

Likewise, at the 2008 EMS Expo in Las Vegas, Gary Wingrove (an JEMS Connect Member) gave a session entitled "Defining the Second-Generation Paramedic: An International Collaboration." While it would be better suited for you to talk to him directly regarding his own topic, he discussed the emergence of new paramedic protocols in certain rural areas to fill in where traditional physicians/FNPs had left a hole. In particular, he discussed an island in Nova Scotia (I maybe mixing up some inconsequential details) where a doctor had closed up his local clinic -- yet the small population still remained on the island (where the nearest health facility was either a helicopter ride away, or several hours on a ferry, weather permitting.) What their solution was, was to use paramedics to fill the role of a physician who made house calls by expanding their protocols, BUT NOT THEIR SCOPE. So, the paramedics (under the supervision of an FNP) would check up on the local diabetic patients to make sure there sugar was good, and the local CHFers to make sure they were compliant with their meds, and even to help obtain refills for various patients. So, the paramedics, in fact, began to take on a new role in their community where it was merited. They already had the scope of practice, they just needed to expand their protocols. As Mr. Wingrove discussed, this program was being looked at by groups and universities from Canada, the US (michigan, i believe) and even New Zealand (if i can remember correctly) to address the problems of a lack of health care professionals in remote areas. While I can't remember the name of the study group, I'm still interested to find out more about it.

As for my comment about Paramedics performing prehospital care better than many MDs, I stand by that. We move patients better than MDs/RNs, generally speaking. As Paramedics (and EMT-Bs) we are very much acclimated to working in austere and/or dynamic conditions. We understand better than MDs/RNs the effects simple movements can have on Patients in different situations, and under different medical circumstances, and we also identify hazards and environmental threats better than they do (in general). It's not a dig, it's the realities of the opposing nature of our work environments. They are used to static settings with a bed, carts, and endless supplies readily at hand (i.e., if one ET blade doesn't work, get another), while we are used to dirty, cramped homes, raucous crowds, and improvising our "equipment" when needed (without meaning to invite semantic-based arguments). This was also prevalent during my trip to Haiti. While the MDs/RNs were excellent at treating a patient in a static setting, transporting that patient to a more suitable facility (and the inherent complications of transporting) was not something that they were forced to consider during a regular workday. So the idea of putting a backboard under an intubated pediatric to minimize movements was not their first consideration. I wouldn't dare say it would never have been a consideration, I'm just saying it wasn't as prominent as maybe it would have been among people who regularly have to move patients in and out of difficult settings and situations. We move patients, and that is an art form, in many respects, that comes with experience in the field.

Finally, and again, with all due respect to MDs/RNs, Paramedics (should) know how to run codes in their sleep. Just because someone carries "MD" after their name, does not mean I want them at my house running a code on my family member. (But that's not to say all Paramedics are great at running codes.)

In fact, Mr Wingrove's seminar discussed a new, yet unrealized, standard set forth by OSHA (and JCAHO?) that would mandate all hospitals to employ a Rapid Response Team manned by one paramedic and one ER RN, to be able to respond anywhere in the hospital in a certain amount of time to respond to acute problems, including respiratory distress and cardiac arrest. I haven't heard much of it since, but the intent doesn't seem too far-fetched to me. Just think of the last time you did an interfacility transport to a Med/Surg floor.

However, some of your comments may have mis-interpreted my point, and that's my fault.

You made the comment:
"Paramedics are great when they're operating in an emergency medical system, however when medical facilities don't even exist to provide basic primary care and screening, then there simply isn't an emergency medical system in place including the hospital based services like an emergency department."

I completely agree. This is a situation we constantly run into in underdeveloped countries. In fact, right now we're working on a project in Uganda to give BLS trauma care training to Taxi-drivers and other commercial vehicle drivers. The problem is that the local "hospital" doesn't even have the capabilities to treat the injured patient if they were to be brought to the hospital.

What to do?

If you regularly check the message boards (...?), I'll be sure to keep this post updated.
In the meantime, I've attached this article from Ghana for you to look at, which basically addresses the same problem we're looking at in Uganda.


Cheers,
Jason



Joe P. said:
Jason Friesen said:
In fact, we bring an entirely new skills set to the table: prehospital practice (in which case we're often more useful than many MDs, as it were ... with all due respect).


For the medical missions, what are those skills again? Paramedics aren't going to be deciding which antibiotic to prescribe. Paramedics aren't going to be fixing cleft lips any time soon. Paramedics aren't going to be doing routine health screening including deposition and treatment. What labs are you going to order, especially considering that the ability to run the labs is limited in scope and quantity. Paramedics are great when they're operating in an emergency medical system, however when medical facilities don't even exist to provide basic primary care and screening, then there simply isn't an emergency medical system in place including the hospital based services like an emergency department.
Forgive me, i forgot to upload the article. Here it is, with another related one.

Also, I found this on the Community Paramedicine program I was speaking to, which actually has greater implications than what I mentioned, and also for underdeveloped countries without any formal EMS (according to their pre-existing hospital capabilities, of course).

(I was mistaken, they are talking about expanding the scope as well as the practice.)

"Defining the Second Generation Paramedic (G2P): An International Collaboration The Focus and Process of the International Roundtable on Community Paramedicine
The International Roundtable on Community Paramedicine has participants from Australia, Canada, the United Kingdom and the United States. Its mission is to promote the international exchange of information and experience related to the provision of flexible and reliable health care services to residents of rural and remote areas using novel healthcare delivery models, and to be a resource to public policy makers, system managers and others. IRCP is exploring existing and new models that expand both the scope and role of paramedics. This session is tailored to EMS, higher education and policy makers.


And here's their website:
http://www.ircp.info/
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