What an interesting comment.
So IHCD, PHEC, PHTLS and other BASICS courses have no standard?
I think the Royal College of Surgeons of Edinburgh, who academically
accredit PHEC and other courses, would beg to differ!
The problem with training in Pre-Hospital Care is not really the initial
training, Matt, but the skill retention. I understand you have similar
problems within A&E Departments.
Paramedics, Pre-Hospital Nurses and Doctors all find that there are not
enough opportunities to apply skills to enable retention.
But I'm delighted you're going to welcome them all into your hospital to
perform these skills under your supervision.
Just one question - if they are practicing there, how will you keep your
skills up?
Andrew
-----Original Message-----
From: The list will be of relevance to all trainees including
undergraduates and [mailto:[log in to unmask]] On Behalf Of Dunn
Matthew Dr. ACCIDENT & EMERGENCY - SwarkHosp-TR
Sent: Tuesday, April 24, 2001 10:41 AM
To: [log in to unmask]
Subject: Re: Scenario - Intubation and IV access
> > 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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