I think that one of the key issues here relates to the amount of specific
training and experience that a doctor has in pre-hospital care. These are
difficult decisions in very testing situations, and cannot simply be made by
any individual with a medical degree.
Anybody who has worked in the ambulance service for more than a few months
will have collected stories about "helpful" doctors who happened to be
passing a pre-hospital incident and felt that it was their duty to assume
control, order the paramedics around and demonstrate their complete lack of
experience and understanding of what is actually going on. This can be a
very tricky situation for ambulance personnel. Even experienced
anaesthetists may have significant difficulties intubating pre-hospital (I
once met a consultant anaesthetist in the back of an ambulance who couldn't
intubate a patient in cardiac arrest because, they said, there wasn't a
pillow to support the patient's head).
You don't call a dermatologist to an in-hospital cardiac arrest and expect
them to make key resuscitation decisions. Doctors do have a place in
pre-hosptial care, but they need formal training and/or real experience in
order to play a useful role in this environment. Unfortunately paramedics
often do not know what kind of doctor they are dealing with (or even if they
are really a doctor at all!)
Jonathan Benger.
SpR, Bath.
(In fact, working for Steve Meek at the moment, who started this whole
thread off)
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Robbie Coull
Sent: 19 March 2002 16:26
To: [log in to unmask]
Subject: Re: so who is in control at the roadside?
Mode of transport/extrication are what the ambulance service is best at.
Triage can be tricky, but there are set guidelines that we should all be
following.
However, when it comes to the actual medical care of the patient the doctor
has primacy, eg: does this person require an RSI prior to (or early on
during) transport.
I'm also aware that problem paramedics are a minority, and that UK
pre-hospital physicians have had a variable history as far as training and
delivery of care is concerned.
However, I'm very concerned by some ambulance services in the UK that seem
to have swallowed their own propaganda, and believe that doctors have no
place in pre-hospital care (either on the scene or as strong medical
direction).
I think as doctors we really do need to keep an eye on what the ambulance
services are doing - we need to maintain strong medical control through good
medical directors, and we need to make sure that we keep up the pressure to
increase funding for improved paramedic education.
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