>
> > Colin wrote, "Cumbria Ambulance do take some unusual views when it comes
> to
> > selectively interpreting guidelines!"
> >
> > Ray McGlone
> > A&E Consultant
> > Lancaster

> Ray,
>
> I was referring to the unusual method of pulse checks employed in Cumbria
> where the 10 seconds was interpreted as 5 seconds at each carotid and the
> decision not to use Amiodarone despite the current guidelines.
>
> Colin Hendry
> Resuscitation Officer
> Barrow

I think in fairness to Cumbria, they have taken a wise decision. The
story on Amiodarone is far from definitive and there has been much
unhappiness in the US about the inclusion of Amiodarone on the basis of
what was essentially a single study sponsored by a drug company. The
debate has spread far wider, with major journals such as Lancet, JAMA,
etc., issuing public statements about potentially not publishing drug
company sponsored studies without clear disclaimers being issued about
academic autonomy.

The evidence in Amiodarone did not suggest a better long-term survival,
placing it almost in the same category as the by-now much discredited
mega-dose adrenaline.

Returning to the UK, the subcommittee of JRCALC reviewing the guidelines
took the line that use of Amiodarone should be in the context of a few
services initially to assess its impact in the UK where response times
and outcomes vary substantially from the US.

In addition, there are significant legal implications for ambulance
services to bypass the MCA process for drugs approved for paramedic
administration and embark on a wholesale use of PGDs to permit
paramedics to use a wide range of drugs not authorised by the MCA. The
PGD route has been taken for bolus thrombolytics but streptokinase was
approved by the MCA after lengthy discussions about the merits of
paramedic initiated thrombolysis.

I think there is a valid point that a mechanism needs to exist to allow
ambulance services to respond more rapidly to medical advances, along
with the adoption of year post-proficiency training cycles rather than
the traditional 3 yearly.

In Staffs, where data is being collected on pre-hospital Amiodarone
through the use of a PGD, the ROSC at hospital door rate for Amiodarone
patients at present is 14% - this compares to an overall rate ROSC rate
for ALL cardiac arrest patient (including those were resus is
contra-indicated) of about 20% at present. We know from previous data
that about a third of ROSC patients leave hospital alive.

I don't pretend to speak for Cumbria, but have a lot of sympathy for the
delicate line tread by many ambulance services - the Sword of Damocles
is very sharp!!

Anton van Dellen
Medical Advisor
Staffs Amb Service