In message <[log in to unmask]>, Mike Bjarkoy <[log in to unmask]> writes
> 1. can a paramedic determine extend of injury (in this case
> hypothermia)
I like to think you can! Having said that, a lot of the elderly ducks you leave with
us non-specifically off-legs have multiple causes for their off-legedness, and over
the winter hypothermia is a common component, oft not immediately obvious.
> 2. are there benefits bypassing one hospital to another which is
> presumed to
> be better.
There are numerous anecdotes where Dr. Cock-up has been on duty in the local cottage
hospital, ably hindered by nurse Bodgit, but my completely unbiased and independent
opinion is that most times a local DGH IS able to assist ambulance patients
effectively, if needs be prior to early transfer out.
I could quote you many cases where the ambulance crew's understandable inclination
has been to cart a burns victim or partially amputated digit straight off to our
local plastics place instead of letting us do the boring, but important stuff 1st
(analgesia, wound cleaning, tetanus, fluids, antibiotics, dressings etc.). This
could all be done at the tertiary referral place, but we do it SOOOO much better (!)
and the practicalities of tertiary specialities means that as much stuff should be
done elsewhere as can be done.
I absolutely agree that DGHs shouldn't be doing things they don't see regularly
(e.g. CP bypass, skin grafting), but the basics of immediate resus, assessment,
stabilization and early management planning should be well within our capabilities.
Dr G Ray
Staff Grade
A&E
Sussex
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