"I was definitely thrown in the deep end"

When paramedic Krystelle Syme first arrived in Samoa in 2018 on a placement with Australian Volunteers, the lack of basic ambulance equipment available came as a shock.

Working as an Emergency Medical Services Advisor with Samoa Fire and Emergency Service (SFESA), her primary role was to develop a comprehensive training program for the EMTs. At the time, there was no paramedic on staff, with the ambulance service commander, the only registered nurse in the service, studying overseas. Procuring equipment rapidly became a priority.

“It took a while to get on the ambulance” Krystelle said. “Eventually when I got on a couple weeks later, my first job was to someone that had collapsed just around the corner.

“We pull up, and as I'm going to get out of the side of the ambulance, the back doors are flung open and this woman is honestly thrown like a rugby ball on to the stretcher. I'm like looking at her and I'm like, oh, she’s in cardiac arrest. One of my good mates turns around and said she's got a pulse of 75 and saturations of 90. I was thrown! She had put a pulse oximeter on her and obviously it was a very bad-quality one, because she was very much in cardiac arrest.

“We started CPR. The defib was in a cupboard, but you had to open the side door. So, as I’ve tried to grab the defib, the driver has jumped back in and started driving so I couldn't open the door any more. I finally managed to get out the defib. I open it up. Batteries are flat. The defib pads were burnt and hairy and just unusable. The whole job took us less than 10 minutes from the time we got the call to the time we arrived at hospital. It was incredibly quick. This is where we started.”

The patient died, but it opened her eyes to the pressing need for new equipment. She said she needed new defibrillator pads, batteries and oxygen, but was told that the yearly budget was 2,000 tala (roughly AUD $1,000), which was insufficient to cover the expenses involved. She pushed for more funding, and was successful in lifting the budget cap.

“One of my brags is that I increased the budget by so many thousands of dollars rather than decreasing our operating costs. We spent loads of money, which was great, but sourcing all the equipment - it had to come from Australia, New Zealand and the UK - was another challenge in trying to navigate import legislation and taxes. The shipping costs were extraordinary. I hadn't had to do budgets and procure new equipment before. I was definitely thrown in the deep end.”

While re-equipping the ambulance service, Krystelle’s focus was on building the capacities of Samoa’s EMTs through improved training and professional accreditation, with the overarching goal of accredited training for EMTs.

Initially she began spontaneous weekday trainings that then developed into a two-week EMT 1 course, which she is currently developing into a new EMT 2 program. The EMT 1 training, which she conducted six times in her three-year placement, primarily focused on building basic first responder capabilities through theory and practical skills development. That further developed into training the trainers.

“The EMT 2 program will be an extension of EMT 1. It's one of the things they're really keen for, and formal accreditation, which is quite a challenge. So, we’ll probably rejig it a little to get that formal accreditation and then build on it to hopefully get to a diploma level. That's the goal.”

The training is designed to be an in-house SFESA qualification accredited through the Samoa Qualifications Authority to enable it to be sustained in the longer term.

“It's going to be a bit of a process but the sustainability part of it is the only way that this makes any lasting difference.”

Despite the challenges she faced along her journey, her efforts paid off. By the time she left Samoa, the EMTs had successfully resuscitated several patients and their reputation had improved.

“Before it was just scoop them up, chuck them in the back, and drive them really fast to hospital, but now they do observations, interventions and they have some medicines, so there's been a lot of growth in the service.”

In July this year, Krystelle returned to Samoa for her first professional visit since ending her volunteer placement to conduct a two-day, College-supported refresher training in advance of the Commonwealth Heads of Government meeting in October with Dr Amy Cui, a Fellow of Australasian College Emergency Medicine. It followed the signing last year of a memorandum of understanding between the College and the SFESA to collaboratively advance paramedicine and patient-centred care in Samoa by supporting the education, training and credentialling of the country’s pre-hospital clinicians.

The SFESA Ambulance Operations team is now led by Commander Apelu, who completed his Bachelor of Paramedicine in Victoria, and includes approximately 30 EMTs and, just recently, a cohort of nurses who are all working hard to develop themselves and the ambulance service.

“Our bespoke program was focused on medical emergencies. We delivered two, two-day intensive medical emergency workshops, covering topics from anaphylaxis to floppy babies. The students had case studies, practical skills and an exam to complete, and new skills including laryngeal mask airway insertion were taught with the equipment already in place, ready to be added to their scope going forward.

“For me, this was an important trip back to a special place. Having worked with SFESA for almost three years, it was humbling to be back and working with the people who made my experience so exceptional. SFESA has certainly come a long way, with only more progress and big plans to come.

“Delivering the training was one side of it. It was also about building relationships and getting a really good idea where we’re heading next. It gave us the foundations to now go away and put together what next year is going to look like and how we build on this. I’m really excited to see where we end up.”