> John's case has revealed my own inadequacies! Having been in
the situation
> of being as helpful as a wet lettuce a year or two ago, I would like to
> avoid a repeat.
>
> In pre-hospital emergency care, anaesthesia is frequently desirable if not
> essential. Full of conscious incompetence, I am going to do the Madingley
> course and DIMC RCS Ed this year.
>
Do not be too distressed. Until we have a (funded) national system
for medical pre-hospital care that allows anaesthesia to move into
the pre-hosptial phase on a national basis it will be impossible to
give optimum pre-hospital treatment. I guess that most pre-hospital
care doctors in the UK are not able to give an anaesthetic, so you
are not alone in being in a situation in which you cannot perform an
intervention that you know your patient needs. (The more we teach
paramedics the more that they find themselves in the same
distressing situation).
How should a General Practitioner maintain anaesthetic skills? This
takes a major committment of time. These skills have to be
frequently practised (ITU is probably not the place to learn
emergency anaesthesia). Those not able to make this committment
should probably not try to develop or retain anaesthetic skills.
How should we develop pre-hospital medical care? Who should
ideally be doing this in the future? Should GPs be emergency pre-
hospital care doctors? Should we develop a system that delivers an
anaesthetist to the roadside where possible? Do different situations
require a different response?
Tim.
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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