> and do not feel that an open discussion group is the place
> for this sort of analysis or "post-mortem".
I agree that it is important to maintain anonymity, but I disagree that this
is the wrong forum to discuss issues surrounding difficult calls.
> 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.
I have huge respect for the experience of the paramedics I know and work
with. However, paramedic training is still inadequate in this country
compared with the US and Canada and Ray as the doctor called to the scene,
clearly outranked the paramedics (no matter how experienced they were).
I agree that "ordering" a paramedic to follow medical directions is a last
resort, but it is a legitimate resort that I have had to take myself on rare
occasions previously.
Ray remained with the patient in the scenario he describes, and as the
senior clinician at the scene the treatment decisions and responsibility was
his until he handed the patient over to another MEDICAL practitioner
(paramedics work under the medical standing orders of their medical
director).
Should a doctor at scene request a course of action contrary to those
standing orders, then it is reasonable for the paramedic to request that the
doctor travels with the patient, however if a paramedic refused to comply
with my orders on scene their feet would not touch the ground.
I would be interested to know if you have online medical control of the
paramedics on your air ambulance, what extended training they receive, what
role your medical director plays, and what your medical director's views are
of this.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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