> > It would be interesting to see guidelines developed
> > relating to PHC or an advanced practitioners course
> > somewhere. (not the Dip IMC courses). I'm sure that
> > would generate some good, informed guidelines and
> > concensus teaching.
>
> While I would agree with the concept of guidelines and
> standards, they are
> exactly that and, by its very nature, pre-hospital care requires
> improvisation and compromise to best serve the interests of
> the patient.
>
I agree with Darren (up to a point).
1. Guidelines that are not evidence based are not much use, and there is
little evidence for effectiveness of any prehospital intervention.
2. Cases where prehospital interventions are useful are very individual and
may not fit well into guidelines.
However,
3. (the biggie): There is no standard of training for prehospital
intervention. A fairly basic rule could be that if you haven't done
something in a hospital (i.e. in 'ideal' conditions, with someone to bail
you out), you probably shouldn't be doing it unsupervised in poor conditions
with no back up available. There can be few interventions appropriate for
all prehospital docs to do. Even the argument of 'in an emergency, what have
you got to lose' doesn't hold much water if your training was insufficient
to teach you indications, contraindications and complications properly.
Matt
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