I am sorry, but I feel I must interject here. I have been partly
instrumental in setting up our paramedic practitioner course in Sheffield.
Unfortunatley my esteemed colleague Dr McCormick has not, although he is
entitled to an opinion. Can I first state that the service we plan to run
will be subject to an RCT next year that will evaluate the effect of a
community paramedic service on A&E attendances and waiting times as one of
the outcomes measured. In addition, this serice will be focussed on OLDER
PEOPLE in their place of residence (ie not drunks in pubs!!) who have
suffered a minor event. We have found that in Sheffield, there are older
people in this category for whom an ambulance is called where assessment and
in some cases treatment in the home may be beneficial. We estimate this may
be up to 20 patients per day in Sheffield - potentially quite an impact on
our service in A&E given the resources these patients often take up once
they arrive (not just in treating thier condition, but time to organise
after-care). We realise that the community service may be more expensive,
hence the need to perfom a trial to answer many of the questions being
raised.
I must say that there is a LOT of talk nationally (see recent AMBEX
conference) about extending the role of paramedics that does concern me -
namely in getting them to do degree courses and develop skills in RSI,
insertion of chest drains, management of mental health problems......the
list goes on. There has been little dicsussion of how individuals will be
trained, supported or re-validated. If you are to voice concern, then I
suggest it is corrently placed. I feel as a specialty we should be raising
these issues with our pre-hospital colleagues and if necessary working with
them to ensure that goals set are maintainable and achievable.
Sue Mason
Senior Lecturer in Emergency Medicine,
----- Original Message -----
From: "Jel Coward" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, August 21, 2002 6:29 PM
Subject: Re: Paramedic practitioners in the ED
> In article <003e01c24933$0886b1c0$8209883e@LocalHost>, Simon McCormick
> <[log in to unmask]> writes
> >
> >The problem is, not that many of these people are attending
inappropriately
> >but that they are using an inappropriate form of transport to get to the
A&E
> >department. We need to stop sending ambulances out to clearly
> >inappropriate cases or empower ambulance personnel to refuse to transport
> >these people. Instead we are sending out the wrong message: Call an
> >ambulance and the minor injuries unit will come to you!
> >
> >
> An astute observation IMHO. Workload depends on the messages sent out
> (why else would businesses advertise?). If Simon's' last statement
> reflects the service that we want to provide then fine - if not then
> reflection is needed. Often we are caught up in the tide without there
> being clear forethought
>
> Additionally, one of the big problems for road staff is getting enough
> experience - they attend so many calls that do not contribute to their
> continuing development that it becomes clear that they will need to
> access experience by some other means to be safe making the sort of
> triage decisions that are being discussed - this surely would involve
> A+E and Primary Care working
>
> Cheers
> --
> Jel Coward
>
> The UK Wilderness Emergency Medical Technician and Command Physician
course is
> 10-16th November 2002 at Glenmore Lodge, Aviemore, Scotland
>
> http://www.wildmedic.org
> http://www.wemsi.org
>
> [log in to unmask]
>
> 'There's no such thing as bad weather - just bad clothing"
> Anon Norwegian
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