> Suppose the medical director of your Trust phoned up and asked your advice
> about his patient. Would you find it bizarre if, having asked he then didn't
> take your advice? I don't think you are in any different a situation. The
> ambulance officer is in charge of the scene and the disposition of
> casualties from the medical point of view. You are able to make suggestions,
> but it is his job day in, day out to organise the transport of patients, and
> with respect, he is likely to know as much as you do about the capabilities
> of various hospitals and departments. It is definitely his responsibility.
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.
It's interesting to compare the situation in North America from the one
here. In North America many of the paramedics are very highly trained, and
often have online (radio) medical control. When I was transferring patients
in Alberta, the paramedics had 3 year instruction courses and did RSI, chest
drains, 12 lead interpretation, thrombolysis, 'treat and street' and had
good background medical knowledge. They often made suggestions, but never
went anywhere near over-riding one of my decisions. If they had any
concerns about a physician in the field they took it to their medical
director.
In the UK the paramedic course is 3 MONTHS. A 'base' NHSTD paramedic just
does not have the background medical knowledge or training that they should
have to do arguably one of the most difficult jobs in medicine.
Now, I am not criticising the overwhelming majority of excellent paramedics
in the UK who do a great under-paid job, and know their strengths and
limitations, with ridiculous under-funding of their training - many do extra
training in their own time with their own money - and anyone who has worked
with me will hopefully be able to vouch for me on this.
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.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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