Emergency medical services in New Zealand (more commonly known as Ambulance) are provided by Hato Hone St John, except in the Greater Wellington region where Wellington Free Ambulance provides these services. Both have a history of long service to their communities, St John since 1885 and Free beginning in 1927, traditionally having a volunteer base, however the vast majority of response work is undertaken by paid career Paramedics. Strategic leadership of the sector is provided by NASO (the National Ambulance Sector Office) which is a unit within the Ministry of Health responsible for coordinating the purchasing and funding of services on behalf of the Ministry and the Accident Compensation Corporation.
Funding occurs by means of billing part-charges for medical callouts (except Wellington Free) and charitable funding such as donations, bequests and corporate sponsorship to supplement Government funding. In recent years, the government has begun to examine more sustainable funding for ambulance services; however, there is still significant exertion within the sector that the level of funding provided falls far below what is required to cover the actual cost of service delivery.
Organisation Since the age of the motor vehicle many Hospital Boards ran their own services. From 1957 to 1990 the Hospital Act stipulated that Hospital Boards had to provide an ambulance service. Many contracted that out to St John or had ad hoc arrangements with them, often for after hours staffing. When the Hospital Act was replaced by Health Boards, many of these Boards saw this as a chance to avoid being responsible and subsequently St John took over from many Boards (e.g. Thames, Bay of Plenty, Wanganui, Palmerston North, Waipawa, Dannevirke, Nelson, West Coast, Ashburton, Southland). Marlborough stayed a Hospital-based service until 2007 and Taranaki until 2011. Wairarapa was the last region with a hospital-based service, ceasing in March 2012 and being taken over by Wellington Free Ambulance.
While both land ambulance service providers do have paid staff, they also rely very heavily on volunteer members. In most cases, paid staff tend to be concentrated in urban areas and in the management of rural areas, with rural response staff being largely volunteer-based. St. John Ambulance reports a total of 2,211 paid staff in New Zealand, supplemented by 7,647 volunteers. By contrast, Wellington Free Ambulance currently staffs 108 paid paramedics and 35 volunteers, not including the 21 paid staff and 21 auxiliary (volunteer) staff previously from the Wairarapa DHB service.
Land ambulance St. John provides service to approximately 88 percent of the population of New Zealand and 17 district health boards (DHBs), through a network of 553 ambulances and 183 ambulance stations. St. John Ambulance reports the completion of approximately 274,108 emergency responses for the year ending 1 July 2008. By contrast, Wellington Free Ambulance provides service to 12 percent of the population of New Zealand and three district health boards (Capital & Coast, Hutt Valley and Wairarapa), providing service to more than 500,000 residents. They respond to an estimated 40,000 calls per year.
Air ambulance
Air ambulance and helicopter rescue services are vital given the low population density of New Zealand and the significant distances between tertiary hospitals. There are three organisations contracted to operate air ambulance helicopters, this could be reduce to just one in 2025. Each is owned by various location organisations that operate the helicopters. Covering the upper North Island is Northern Rescue Helicopter Ltd, owned by Northland Emergency Services Trust, and Auckland Rescue Helicopter Trust. The rest of North Island is covered by Central Air Ambulance Rescue Limited (CAARL), which is owned by five regional charitable Trusts. Helicopter Emergency Medical Services Ltd (HEMS), covers the whole of South Island, it is owned by GCH aviation and HeliOtago. The New Zealand government funds $140m that covers most, but not all, of the air ambulance costs. The remaining costs are covered by fundraising from charitable trusts. Most of the trusts or individual helicopters are sponsored by a commercial entity and bear its name for marketing purposes; for example Auckland, Waikato, Wellington and Christchurch helicopters are sponsored by the Westpac Banking Corporation and branded as "Westpac Rescue" while others include the Taranaki Energy Rescue Helicopter, Eastland Helicopter Rescue Trust (EHRT), Bay Trust Rescue Helicopter, etc. Clinical crew (typically Intensive Care Paramedics) for the helicopters are full time employed Intensive Care Paramedics.
Domestic fixed wing air ambulance and patient transfers services, are provided by four organisations. Skyline Aviation, that is supports Starship Hospital. Life Flight Trust that is part of CAARL for its rescue helicopter service. GCH Aviation operates flying doctor service. Stewart Island Flights are also used for patient transfers. Typically use pressurised and converted Fairchild Metro aircraft, equipped as flying Intensive Care units. and it has been estimated that after corporate sponsorship and government subsidy, it is necessary to raise approximately NZ$2,500 (around US$1,400 in 2009) in donations for each mission.
Fire and Emergency New Zealand Fire and Emergency New Zealand (FENZ) provides a medical 'First Response' in smaller communities where there is no local ambulance service. These fire personnel are trained to a higher standard than regular firefighters and are equipped with basic ambulance equipment.
As of Christmas 2013, FENZ 'Co- Responds' to all "Code Purple" (typically cardiac or respiratory arrest) emergencies St John Ambulance and Wellington Free Ambulance attends nationwide. The standard FENZ response to a medical emergency is one fire appliance equipped with an automated external defibrillator and oxygen therapy kit.
Military The New Zealand Defence Force has personnel and equipment available at short notice to assist in civilian matters including medical emergencies.
Models of care The New Zealand system functions on the Anglo-American model of care, with most care in the pre-hospital setting being conducted by paramedics. Other practitioners, including local physicians and midwives, do appear at calls from time to time, but spend much less time responding to emergency calls than the Franco-German model. The Royal New Zealand College of Urgent Care (RNZCUC) oversees urgent care practitioners in New Zealand.
Clinical Education The clinical education of Ambulance staff in New Zealand historically draws parallels to the Anglo-American development of the Paramedic profession generally but has undergone radical transformation in the past decade closely mirroring developments pursued by nations such as Australia, South Africa, Canada and the United Kingdom.
Historical (pre-1977) Prior to 1977 the "training" of Ambulance Officers was arranged in an ad-hoc fashion to a varying degree of first aid preparation to enable passage of a national examination administered on behalf of the Department of Health by an Examination Board of the Order of St John; a requirement established by the Ambulance Transport Advisory Board in 1963. Despite the content of this examination being described as "very basic" Dare, A. O. (1977). Ambulance Services in New Zealand. Retrieved from Ambulance Transport Advisory Board website: http://www.moh.govt.nz/notebook/nbbooks.nsf/0/FBED37F694813C494C2565D70018F243/$file/12232.pdf the requirement for some degree of formal Ambulance Officer education and training is one of the earliest in the world; in contrast the Ambulance Service of New South Wales established the Ambulance Education Centre at Rozelle (Sydney) in 1961 – although the first graduates were not until 1966,Ambulance Service of NSW (4 February 2011). AEC 50th Anniversary. Retrieved 15 June 2013, from http://www.ambulance.nsw.gov.au/Media-And-Publications/Latest-News/AEC-50th-Anniversary.html Geelong & Districts Ambulance in Victoria (Australia) began a training school in 1962 Monash University Department of Community Emergency Health and Paramedic Practice (n.d.). A Brief History of Ambulance Education in Victoria. Retrieved 15 June 2013, from and the province of Ontario (Canada) implemented a requirement for a five-week, 160-hour "Fundamentals of Casualty Care" course for ambulance attendants in 1967.Ontario Paramedic Association (n.d.). History of Paramedics and EMS « Ontario Paramedic Association. Retrieved 15 June 2013, from http://www.ontarioparamedic.ca/paramedics/our-history/
Into the 1970s there was considerable development of local training amongst ambulance services over-and-above the basic DOH/ATAB requirement; this training particularly focused on defibrillation to treat cardiac arrest and was most notable in Christchurch, Wellington and Auckland; with Auckland introducing the first Mobile Intensive Care (Life Support Unit) on the North Shore in 1970 however other subjects covered included the administration of entonox (nitrous oxide) for pain relief and the taking of a patient's blood pressure.Rice, G. (1994). Ambulances and first aid: St. John in Christchurch, 1885–1987 : a history of the St. John Ambulance Association and Brigade in Christchurch, New Zealand. Christchurch [New Zealand]: Order of St. John. The introduction of out-of-hospital defibrillation by civilian Paramedics to New Zealand (1970) is again among the earliest examples in the world; predated only by the original 1966 Pantridge Experiment in Belfast (Northern Ireland) Geddes, J. (2007). Pioneers in Cardiology: Frank Pantridge, CBE, MC, MD, FRCP, FACC. Circulation, 2007(116), 145–148. Retrieved from http://circ.ahajournals.org/content/116/25/F145.full.pdf and its earliest direct replication projects by the Miami Fire Department ("Rescue 1" in March 1967 under Dr. Eugene Nagel) The Virtual EMS Museum (2 August 2011). 1967: City of Miami Fire Department Paramedic Program. Retrieved 16 June 2013, from http://www.emsmuseum.org/virtual-museum/history/articles/399754-1967-City-of-Miami-Fire-Department-Paramedic-Program and New York City with the Mobile Coronary Care Unit established by Dr. William Grace of St. Vincents Hospital) also introduced in 1967.The Virtual EMS Museum (10 June 2008). 1968: William Grace, MD. Retrieved 16 June 2013, from http://www.emsmuseum.org/virtual-museum/history/articles/398198-1968-William-Grace-MD
National Ambulance Officers Training School (1977–1999) The National Ambulance Officers Training School (NAOTS) was established in 1977 using funds raised from the earlier 1975 Telethon and was administered by the Auckland Centre Trust Board of the St John Ambulance Association to fulfill its requirement to the Government (through the Ambulance Transport Advisory Board) to establish a national system of training for Ambulance Officers. NAOTS formalised training into three distinct levels of "Ambulance Aid" with each was a Certificate issued jointly by the Department of Health (through the ATAB) and the National Training School under the auspices of the Order of St John.Offenberger, W., & Walton, R. J. (1984). Review of New Zealand Ambulance Officer Training. Retrieved from Ministry of Health, Wellington website: http://www.moh.govt.nz/notebook/nbbooks.nsf/0/53D05EA7BCFA934A4C2565D7000E2DFD/$file/img-607125013-0001.pdf Hunt, G. J. (2010). First to Care: 125 years of the order of St John in New Zealand 1885 – 2010. Auckland, New Zealand: Libro International.
Basic grade certification as either six weeks full-time for paid officers or taught in two three-week blocks for volunteers over two years (three weeks each year) provided they had completed at least 400 hours of service in the year prior to commencing and in the year between blocks.