If the Ambulance Service calls a Senior Doctor out from the "local" hospital
then I would expect the paramedics to take the advice of that person. He or
she then takes the responsibility for the consequences of that advice.
My point for initially sending the mailing was to illustrate the point that
"speed" isn't everything. The patient must be transferred safely. Once the
patient's airway was secured she was safely transferred to hospital.
Emergency surgery was not needed on either patient.
The Flying Squad vehicle from Lancaster is clearly signed and I was wearing
appropriate gear identifying me as a doctor.
Ray McGlone
A&E Lancaster
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, March 14, 2002 9:19 AM
Subject: Re: Suction at the roadside
> > There was a helicopter and an ambulance there when we arrived. There
were 2
> > serious head and chest injuries.
>
> > The helicopter crew wanted to transfer the more seriously injured
patient,
> > because it would only be 9 mins flying time. The patient's airway was
> > compromised so I had to do a RSI at the roadside. I ordered the crew to
> take
> > the other patient who was maintaining his airway, but still needed rapid
> > attention. Does anyone else have this problem with helicopters? Speed is
> not
> > everything!
>
> As with all time critical pre-hospital scenes when the pressure is on,
there
> is considerable room for differing interpretation of the clinical
situation
> and opinion on what is necessary in which timeframe.
>
> I am aware of this event and certainly the view of the helicopter
paramedics
> who were on scene. I have not had the opportunity to discuss the events
> directly with Ray and do not feel that an open discussion group is the
place
> for this sort of analysis or "post-mortem".
>
> I accept that there were two very difficult calls to make regarding the
> timing and location of airway control, with two very different levels of
both
> pre-hospital experience and airway experience. We are in constructive
> discussion with the intensivists within our Region about pre-hospital
> chemical airway control to help with just this sort of problem.
>
> While not questioning his clinical assessment, it concerned me slightly
that
> Ray "ordered" the paramedics, to whom he was an unknown clinician, to
change
> the already decided triage priorities. The potential for conflict and bad
> feeling here is huge and has been the subject of discussion in this forum
> before.
>
> Best wishes
>
> Darren Walter
> Medical Advisor
> Yorkshire Air Ambulance
>
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