Darren,

I'm all for working as a team, which is why I asked you to phone me at home
to discuss the more sensitive aspects of this case...Still waiting.

Regarding the doctor versus paramedic responsibility on scene. If anything
went wrong at the scene with that patient the burden of  responsibility
would be on the doctor... well that's how the lawyers would see it.

Ray McGlone

----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 18, 2002 8:50 AM
Subject: Re: Suction at the roadside


> Please consider this in a spirit of general discussion rather than
specific
> challenge.
>
> > 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.
>
> Yes, I would agree. But this would suppose that the crew knew that the
> Communications Centre had called you! (Specifically here Ray they did not,
> and I suspect that the WYMAS / LancAm split may account for this.)
>
> You say for advice. Absolutely. In general there is a wide breadth of
> pre-hospital experience and clinical skill, and very few doctors have both
(I
> know that in this particular circumstance Ray does - but the crew didn't!)
> Yes, the doctor's decisions are his/her responsibility, but that does not
> mean that they are solely accountable for the whole scene and all the
> decisions made.
>
> >  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.
>
> I would agree. Early optimisation of oxygenation and tissue perfusion
> followed by early definitive treatment are the keys. The ambulance crew
> believed that they were able to maintain the airway and adequately
oxygenate
> for the 8 minute transit to a "neurosurgical" hospital and that this was
> preferable to a 30 minute land transfer to a "non-neurosurgical" hospital.
> The presence of a person capable of chemical airway control clearly
changes
> the available level of scene intervention available, but should it change
the
> triage destination? The conflict is "definitive airway control and 30
minute
> land transfer to DGH" or "ventilation without a secured airway and 8
minute
> air transfer to neuro centre". Difficult!
>
> I was not there and so will not challenge the judgement call by a
colleague
> with experience. In this case, the aircraft and paramedics could not take
a
> paralysed and ventilated patient and it affected the subsequent scene
> disposal. We are working on this.
>
> >  The Flying Squad vehicle from Lancaster is clearly signed and I was
wearing
> >  appropriate gear identifying me as a doctor.
>
> Absolutely, but I stand by the original comment that the crew did not know
> you, even by reputation. They should not take competence in the
pre-hospital
> environment for granted. We have had close calls on this front in other
areas
> of our "patch" before and they are wary as a result. Allowing for this,
they
> should have taken steps to avoid confrontation and utilise the evident
> clinical skill of all persons on scene. Automatic transfer of all
> responsibility to the arriving doctor is not the way.
>
> Best wishes
>
> Darren