Clinical Procedures and Guidelines - Comprehensive edition 2019 - 2022

Sep 23, 2026

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Clinical Procedures and Guidelines (CPGs) for St John New Zealand’s emergency ambulance sector provide standing orders for authorised clinical personnel. The guidelines support clinical decision-making when delivering patient care, including treatment principles, calling clinical support, documentation, and key assessment steps such as primary and secondary survey. Coverage spans respiratory, cardiac, shock and trauma, altered consciousness and metabolic conditions, infection, paediatrics, and pregnancy. The CPGs incorporate governance structures and specify review and expiry timelines through February 2022.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages562

Reading Time23 h 36 min

AccessFree to download

Introduction

General treatment principles

Authority to practise and practice levels

General principles

Providing treatment that differs from that authorised in these CPGs

Analgesia

Advance directives and advance care plans

Patient competency

Calling the Clinical Desk

Personnel on the Clinical Desk providing advice

Crew resource management

Handover

Informed consent

Initial management of a major incident

End of life care

Verification of death

Oxygen administration

Status codes

Requesting a helicopter

Treatment and referral decisions

Vital signs

Documentation

The primary and secondary survey

Respiratory

Asthma

Chronic obstructive pulmonary disease (COPD)

Foreign body airway obstruction

Positive end expiratory pressure (PEEP)

Stridor

Croup

Cardiac

Assessment for myocardial ischaemia

Myocardial ischaemia

ST elevation myocardial infarction (STEMI)

Fibrinolytic therapy

Inter-hospital transfer of patients with STEMI

Clinical Proceduresand Guidelines Comprehensive edition 2019 – 2022 © St John New Zealand, 2019 Except as provided by the Copyright Act 1994, no part of this publication may be reproduced or stored in a retrieval system in any form or by any means without the prior written permission of the copyright owner. Clinical Procedures and Guidelines-Comprehensive Edition | Issued by: Dr Tony Smith, Medical Director | Issue No: 8 | Document No: CDT508 | | --- | --- | --- | | Authorised by: Norma Lane, Director of Clinical Operations | Issue date:
June 2019 | Expiry date: February 2022 | Introduction These are the Clinical Procedures and Guidelines (CPGs), incorporating standing orders for use of personnel within the New Zealand emergency ambulance sector. These CPGs are for the use of St John personnel with current authority to practise, when providing clinical care to patients on behalf of St John. These CPGs have been developed by the National Ambulance Sector Clinical Working Group and are issued to individual clinical personnel by Dr Tony Smith, the Medical Director for St John. These CPGs will be reviewed at the end of 2020 and 2021, with updates being issued at that time if required. These CPGs expire at the end of February 2022 at which time they will be formally updated and reissued. They remain the intellectual property of the National Ambulance Sector Clinical Working Group and may be recalled or updated at any time. Any persons other than St John personnel using these CPGs do so at their own risk. Neither St John nor the National Ambulance Sector Clinical Working Group will be responsible for any loss, damage or injury suffered by any person as a result of, or arising out of, the use of these CPGs by persons other than authorised St John personnel. National Ambulance Sector Clinical Working Group Members Pete Collins, Patient Safety Manager, Wellington Free Ambulance Dr Craig Ellis, Deputy Medical Director, St John Hannah MacLeod, Clinical Innovation and Learning Manager, St John Daniel Ohs, Assistant Director of Operations-Clinical Practice, St John Dr Tony Smith (Chair), Medical Director, St John Adam Stevenson, Intensive Care Paramedic, Wellington Free Ambulance Dr Andy Swain, Medical Director, Wellington Free Ambulance Comments and enquiries Personnel should send an email [to](to clinical.excellence@stjohn.org.nz. Others)[ clinical.excellence@stjohn.org.nz](to clinical.excellence@stjohn.org.nz. Others)[. Others](to clinical.excellence@stjohn.org.nz. Others)[ ](to clinical.excellence@stjohn.org.nz. Others)wishing to make formal comments or enquiries should contact Dr Tony Smith at [tony.smith@stjohn.org.nz](tony.smith@stjohn.org.nz). Dr Tony Smith Medical Director Dr Ian Civil Chair of the Clinical Governance Committee Contents 1: General treatment principles 1 1.1 Authority to practise and practice levels 1 1.2 General principles 4 1.3 Providing treatment that differs from that authorised in these CPGs 6 1.4 Analgesia 11 1.5 Advance directives and advance care plans 21 1.6 Patient competency 23 1.7 Calling the Clinical Desk 26 1.8 Personnel on the Clinical Desk providing advice 27 1.9 Crew resource management 28 1.10 Handover 31 1.11 Informed consent 32 1.12 Initial management of a major incident 34 1.13 End of life care 38 1.14 Verification of death 40 1.15 Oxygen administration 43 1.16 Status codes 47 1.17 Requesting a helicopter 49 1.18 Treatment and referral decisions 54 1.19 Vital signs 59 1.20 Documentation 63 1.21 The primary and secondary survey 68 2: Respiratory 70 2.1 Asthma 70 2.2 Chronic obstructive pulmonary disease (COPD) 78 2.3 Foreign body airway obstruction 85 2.4 Positive end expiratory pressure (PEEP) 88 2.5 Stridor 90 2.6 Croup 92 3: Cardiac 93 3.1 Assessment for myocardial ischaemia 93 3.2 Myocardial ischaemia 101 3.3 ST elevation myocardial infarction (STEMI) 104 3.4 Fibrinolytic therapy 111 3.

FAQs

Who are the Clinical Procedures and Guidelines (CPGs) intended for?

They are intended for St John personnel with current authority to practise, providing clinical care to patients on behalf of St John within the New Zealand emergency ambulance sector.

How often are the CPGs reviewed and when do they expire?

They are reviewed at the end of 2020 and 2021, with updates issued if required. They expire at the end of February 2022 and are then formally updated and reissued.

What major clinical topics are included in the Contents?

The Contents cover general treatment principles and specific clinical areas including respiratory, cardiac, shock and trauma, altered consciousness/metabolic conditions, infection, paediatrics, and pregnancy.

Sep 23, 2026

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