I'm also in favour of dispatching "an appropriate resource" to a
pre-hospital event.
If the paramedic is faced with an entrapped patient then they should have
the facility to call us out EARLY if they consider our skills necessary. The
latter usually means the use of ketamine in a difficult extrication or
airway problem. In the 11 years at Lancaster I've "saved" two lives by using
RSI at the roadside, so a life saved isn't a common occurence and one of
those died weeks later from post operative complications.
Regarding pain relief. Cumbria ambulance service have been able to use
opiates for a decade, but Lancs is still not using morphine. So there is
still a problem with RTA's occuring in the latter's catchment area.
The opposite extreme for call-outs is the ambulance service using the A&E
doctor as a backup and calling the doctor at the same time as the 999
ambulance. This system can ,of course, improve the ambulance response times.
Such a system is wasteful in manpower as the doctor is not needed for the
majority of calls and does effect the working of an A&E dept (I refer to the
2nd paper now).
Ray McGlone
A&E Lancaster
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, December 01, 2001 6:12 AM
Subject: Re: Flying Squads
> Sorry, been away. I am strongly in favour of having the ability to
dispatch an appropriate resource to a prehospital event.
> I am unimpressed by the Lincoln study as it is so small that it is at
risk of a type 2 error (Failing to find a real difference
> because your study population was too small for it to be noticeable) and
the tasking seems to be poor. These are some of
> the same criticisms I aimed at Helen Snook's paper into HEMS in London,
although the tasking has improved greatly
> since then. Having said that, there is a 5% deterioration in mortality in
patients seen by the flying squad, which if they
> were only performing limited interventions throws the skills being
deployed into question as well.
>
> Unfortunately the second paper has made no attempt at all to quantify the
effect of advanced prehospital care on
> patients, and does not advance things one bit. I would not attempt to draw
the conclusions they have from their data. If
> Gareth or Alistair are still on the list they should be able to quote the
London HEMS paper that does show a clear
> improvement.
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
> http://www.emergencyunit.com
>
>
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