For a clinical work placement as a part of their studies, Erin Isaacs and Emma Duff headed to the United States with Ms Isaacs stationed in Lafeyette, Louisiana, and Ms Duff stationed in Houston, Texas.

They were just two of 20 CSU paramedicine students who tested their skills while working shifts with the Acadian Ambulance Service in late 2023.

And the experience was vastly different to their NSW stationed placements.

The biggest of these differences? The scope of practice for the third-year students.

While paramedics in the United States only have to undergo four months of study, Australian-trained paramedics have to complete three years to obtain a Bachelor degree.

This meant that at times, the Aussie students had to take the lead in some dire circumstances.

"You have moments where you're with patients and they're dying in front of you, and you're like 'well if I don't do it, nobody else is going to', so you just have to do it," Ms Isaacs said.

"I think that was also a good thing in a way, because being thrown in the deep end, you either sink or swim, and I guess that proves whether you can be a paramedic or not."

One of the moments when Ms Isaacs was faced with a life-or-death situation for a patient, was when she had to attend a gang-related shooting.

"We just had to get out, load him up and then treat him on the way to the hospital," she said.

While for Ms Duff, one of the most intense calls that she had to attend, was that of a patient who had suffered an extreme head wound, which left them with part of their skull on display.

And though some of the call-outs were quite extreme in comparison to what they have experienced in NSW, they also attended scenes that were universally similar.

These included calls relating to the elderly, mental health jobs and general medical episodes.

"The patients were mostly the same, except for the gunshot wounds, obviously," Ms Isaacs said.

But there was one difference that was difficult to ignore.

"The healthcare is very different [in the US]. I found that a lot of the patients I had, just wouldn't have existed in Australia," she said.

"One patient was very, very ill, because they went home when they weren't supposed to, because they couldn't afford the overnight fees at the hospital."

This was something that Ms Duff said she witnessed time and time again during the three-week placement.

"Every second patient you would go to would tell you that they had to deny care because they didn't have health insurance," she said.

"People would rather die than get footed with the bill."

Though the students originally undertook the overseas placement as an opportunity to practice their skills, without any real desire to live or work in the US, that has now changed for the students.

Both Ms Isaacs and Ms Duff said they would consider moving and working in America.

"I don't think we can put it into words, I know it's made me want to be a better paramedic," Ms Duff said.