The original question related to cardiac arrest experience. I can only speak
from experience of my current department, which sees around 60,000 new
patients per year. Although the department and equipment are new, the IT
sucks, so I can only guesstimate the incidence of various conditions. But it
feels like we get 3 to 4 cardiac arrests per week, and probably similar
numbers of "significant trauma". Most of the latter end up only having ISS <
16, but as Matthew states, we get the experience of "going through the
motions" quite frequently with such patients.
Some thoughts about London; the resident population is around 7 million but
"swells" to over 10 million with commuters and tourists. Furthermore our
unit, like several others, receives HEMS trauma from a large area (in our
case most of North West Thames) during daylight hours, or up to 7.00pm in
the summer. So although our resident catchment population is around 400,000,
the catchment population for severe injury increases to several million
during the day. In any case our SHOs get to play with trauma on a fairly
frequent basis. The SpRs and consultants even more so as they attend all
"blue" calls, while the SHOs do not.
In short therefore I don't see any problem with medics getting enough trauma
or cardiac experience in this type of unit. I am of course a firm believer
in rationalisation of this type of service, as discussed in previous
posts...
The original question also related to credibility or feasibility of
instructor status for ALS courses. While I believe that regular real life
experience is important for such courses, I accept Robbie's point that
special experience, including prehospital experience, is very valuable for
such courses, and that other qualities, including teaching skills,
enthusiasm and tea-making ability are equally valid!
Regards
Adrian Fogarty
----- Original Message -----
From: Dunn Matthew
> Presumably the definition of serious injuries used is ISS >15. Last time I
> looked, the incidence was about 1 patient per 10,000 population per year,
> but it may well have dropped since then (deaths from injuries certianly
> have). By this, London Ambulance Service (example taken as it's easy to
get
> data) covers 7,000,000 plus population with 2,000 plus front line
personnel.
> Works out at one case per front line personne per 3 years. Two per
ambulance
> seems to agree with the figure of one per 18 months.
> The question is whether this is enough. Is there any difference in
training
> and experience between treating a patient with ISS over 15 or treating a
> patient with AIS 3 tibial fracture, suspected (but later disproven) spinal
> injury and suspected (but disproven) chest and abdo injuries. From the
> ambulance crew viewpoint, probably not- the relevant assessment and
> treatment skills apply regardless of the final diagnosis.
> It does raise the interesting question of how many patients with major
> trauma a doctor should see a year. If we achieve the BAEM staffing
> recommendations, there should be one case per SHO per 6 months; 8 cases
per
> consultant per year (and dropping). Probably works out to a bit under one
> case per nurse per 18 months. Don't know whether we should be having some
> consultants dropping out of trauma call, sabbaticals to countries with
more
> trauma (build up experience so that we get it right when we treat British
> patients) or reduce the number of consultants.
>
> Matt Dunn
> Warwick
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