ATLS is not the most important reason for having consultants in the
Department 'out of hours' - many other things work much better if a
consultant is there. Less hassle, less argument, more support for
juniors and nursing staff, less delay to decision. All these are
difficult to quantify - I don't think that a RCT would show better
outcomes!
From my experience of resident on call:
Presence up to midnight or 01:00 seems worthwhile. After midnight
I find it more convenient to be resident in the hospital than to go
home late and get up early. When you do get called it is much less
disturbance to sleep to walk a few yards, sort out a problem and go
back to sleep than to drive in from home. More than one night a
week resident on call is probably too hard and more senior
consultants may need a different working pattern.
Tim.
> 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.
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Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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