----- Original Message -----
From: Adrian Fogarty <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, January 23, 2001 2:01 AM
Subject: Re: Consultants for ATLS at night
> ----- Original Message -----
> From: "Doc Holiday
> > Rowley, Adrian, etc...
> > Would it suit you both, as a compromise, for a consultant to be within
> 30-40
> > mins away at home, available for advice by phone and to come in for
> NOTHING
> > LESS THAN A MAJOR INCIDENT and for your good ol' registrars to cover
> nights
> > on site.
> > I have no stats to back it up, but I'm sure many would agree that a
> > registrar can be trained (by consultants during day hours) past mere
> > ALS/ATLS to exert the necessary controlling influence/motivation over
the
> > multi-disciplinary team. And new registrars can accumulate experience in
> day
> > shifts, with consultants on site, before undertaking their nights alone.
>
> Yes Doc, I don't really want to be resident 24 hours either, and I
probably
> don't need to be at the moment, but being resident until midnight reaps
huge
> benefits for the service I believe. Our recent London-wide audit showed
that
> trauma is commonest in the capital at 7.30pm, remaining frequent until
> 1.00am. And these patients don't come neatly packaged by HEMS, as HEMS
> doesn't fly that late. I only do one evening per week (and one weekend per
> month) but this, combined with attending at resus for the rest of the
week,
> is more than enough to keep me "sharp". Having 6 consultants would make a
> huge difference to the quality of our service for the remaining nights but
> would not dilute my experience by much - I'd still do my one evening per
> week, and help with some resus during daylight hours. And although I'm a
> believer in a systems approach, I do agree that having a consultant (or a
> senior SpR) leading a trauma case makes a big difference to how it runs.
The
> same goes for any critical "resus" case.
>
> Your views, Doc, on registrars running trauma at night is a little
> old-fashioned i.e. the service fodder view. We can no longer fill our
> departments with registrars just to keep the service running - that's what
> consultants should be doing, and registrars should be there for training
as
> much as for service. If your department has 6 registrars then it should
have
> at least 6 consultants. And what's the point of having all those trained
> guys if they all knock off duty at 5.00pm? I'm not saying consultants
should
> be queue busting in minors at night, hell no, but they should have a
greater
> presence in the department out of hours to supervise SHOs (and SpRs) and
to
> run the critical cases. And phone call advice from home is a complete
waste
> of time; SHOs will do anything before disturbing a consultant at home, and
> when they do phone you, advising about a patient you haven't seen is a
very
> risky business indeed.
>
> I don't think we can get away from this type of working pattern, not if we
> want to be taken seriously by our colleagues and by the government. The
> smaller units and the rural units may be able to avoid this type of
working
> pattern for another 10 or 20 years I suspect, but the larger units in
urban
> areas are already changing the way they work. Nevertheless I realise these
> views are not welcomed by many of my colleagues...
>
> Adrian Fogarty
> A&E Consultant
> Royal Free Hospital
Hi,
I just noticed your letter regarding consultants for A.T.L.S at night.
At the end of lastyear I was privileged to be asked to join the Royal
College of Surgeons of London for the A.T.L.S/A.T.N.C. joint instructors
course.(of which there are only four nurse places per year)
My microteach session was to lead a discussion of five minutes duration on
the vague subject of A.T.N.C.
After much dliberation I bit the bullet, sat in front of ten
consultants/S.P.Rs/registrars, and in my wisdom uttered the following
statement,
"I believe the A.T.N.C. nurse should be the trauma team leader in the
absence of anyone better" It had the effect of light the blue touch paper
and stand well back!!,however the final result was far better than I could
have dreamt of and the support from my medical colleagues was overwhelming.
What are your thoughts on this??
regards
Jim Thompson R.G.N, R.E.M.T-P
Staff nurse A&E. Diana, Princes of Wales Hospital
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