Absolutely Mike - the point however is that the pre-hospital application of
steri-strips is only worthwhile if that is the definitive treatment, ie the
Paramedic is empowered to decide that the patient does not need a further
assessment in A&E or anywhere else. If the patient is transferred to A&E the
steri-strips will invariably be removed to allow wound assessment making the
proceedure a waste of time, effort and money.
----- Original Message -----
From: "Michael Bjarkoy" <[log in to unmask]>
To: "Bill Bailey" <[log in to unmask]>
Sent: Thursday, March 13, 2003 11:29 AM
Subject: Re: Steri-Strips


> I don't think that any paramedic, or technician would consider treating
RTA
> victims with steri strips if they have several injuries. I didn't think I
> needed to clarify the type of patients that would be targeted in my
original
> text.
> I am obviously wrong... No, I would not waste time steri-stripping
patients
> with other injuries. Yes it would be isolated skin flap injuries and very
> minor cuts (which one would normally place a plaster on) . I hope that
> clarifies the type of patients treated.
>
> I totally agree with you that these patients should not be calling an
> ambulance in the first place. If we accept that it is done then maybe we
can
> accept that it is not worth tying up an ambulance for over a hour to
> transport the patient 10 or 20 miles into a Minor Injury dept if they can
be
> treated safely and effectively in their home.
> I totally agree that correct training is required. As I said, I spent a
day
> with a nurse practitioner, it was great fun and I learned how to clean,
> inspect, apply steri-strips, dress, and give after care advise.
> It doesn't take that much but can save you guys in A&E a lot of time.
Isn't
> this a good thing for the patient and the A&E dept if it can be achieved
> safely and cost effectively?
> Mike
>
> > Can you clarify what patients you are dealing with- are you really
talking
> > about patients with minor lacerations who call 999 ambulances, or are
you
> > talking about patients from RTAs with several injuries of which one is a
> > minor laceration? If the latter, don't delay transfer to apply
dressings;
> if
> > the former, empower your paramedics not to transport. (Although treat
and
> > release has its own problems- if we persuade the public that the best
> > response to a 'minor injury' is to call for an ambulance rather than
> making
> > their way to the ED...)
> > If it is simple 'minors' and failing a see and release policy, I'd say
you
> > shouldn't use steris. It is impossible to examine a wound fully without
> > removal of the steristrips. If the wound does not require full
> examination,
> > the patient should not be brought to A and E; if it does then
application
> of
> > the strips involves increased wound handling (and thus tissue damage and
> > risk of infection) as well as taking up your time (assuming they are not
> > applied in the back of a moving ambulance) and being costly. As a
general
> > rule, if your examination of the patient is not going to influence
> > management, then don't examine the patient. I appreciate your comments
> about
> > the wound drying out- maybe we should consider saline soaks to cover all
> > wounds.
> >
> > Matt Dunn
> >
> >
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