You raise a large number of interesting and pertinent points there, Iain. I carry etomidate, propofol and ketamine. However I do not
carry suxamethonium as it needs to be kept in a fridge, and you either risk flattening the car's battery or have to remember to collect it
from the fridge - not very helpful if you are in WHSmith when the pager goes off. So I carry Vecuronium (Rocuronium and atracurium
also need refrigeration) as a paralysing agent. I still worry a little about finding a Grade IV larynx at the side of the road.
However, how many other immediate care doctors do likewise? In some respects I wonder if the traditional GP immediate care doctor
model is not becoming obsolete in most parts of the country. The new Edexcel paramedic training programme is really pretty extensive,
and the only things that a paramedic is not now trained to do that will be useful at the side of the road is administer a general
anaesthetic, crack a chest, perform a cut-down or obtain central venous access (As far as I can see from a perusal of the documents.)
with a validated and updated training programme.
I can foresee a time, not far off, when there will be links to the Trauma Centre with a doctor and paramedic in contact by voice and
pictures with the patient being looked after by remote control. I think that there should be something of a combination of the American
and German systems. As the entire country is now covered by helicopter rescue services, each of these should now also carry a doctor
as in London HEMS. Rotation from anaesthetic/Emergency Unit middle grade staff is the obvious choice. I am starting to get quite
worried about how a traditional GP provider (I'd welcome Robbie Coull's views) can keep up and validate the advanced skills that will
now be required to provide a service to seriously ill and injured patients.
Best wishes,
Rowley Cottingham
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