I am certainly not advocating that we hold on to certain treatments for
"clever doctors and nurses only" as that goes against all my principles
of openness, and best care as soon as possible. My point is only that
this treatment is now one that can and will kill even when used
appropriately by paramedics, and that we must ensure that we have good
support in place for when that happens.
It is something that we as writers of protocols and advocates of
expansion of service have a duty to think of and implement.
R.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Martyn Hodson
Sent: 24 September 2003 13:23
To: [log in to unmask]
Subject: Re: ECGs at the scene for thrombolysis
----- Original Message -----
From: "Adrian Fogarty" <[log in to unmask]>
To: "Martyn Hodson" <[log in to unmask]>
Sent: Wednesday, September 24, 2003 8:30 AM
Subject: ECGs at the scene for thrombolysis
> I agree with Rowley; I still foresee many problems. For example, our
> SHOs have had several years' training on normal and abnormal ECGs
> (plus
variants)
> before being let loose on MI treatment - and they still need help with
most
> of their MI patients!
have they ? can we objectively measure this - ofr is just they have been
exposuedduring medicla education and had some questions in some of
their assessments on the topic?
> Paramedics have little or no experience of 12-lead ECG analysis, as
> far as I'm aware, although it could be argued that future training
> might include this.
and logically in the current clinical governance driven systems we are
seeing the trainign will be there before the schemes go live
> But when a department of our size only
> thrombolyses a couple of MIs per week, it's going to take a long time
> to build up experience and confidence among our local paramedic
> population.
hence the approaches certain services have taken in targetting their
training and then changing their systems to ensure someone with the
training is dispatched
>
> But performing ECGs at scene for MI patients means performing ECGs at
scene
> for all chest pains. There would then be further delays for non-MI
patients
> receiving opioid analgesia etc,
most services already give opioid analgesia ( after all nubain for all
it's faults is an opioid) and morphine sulphate is on the paramedic drug
list now ( although few services have implmented it AIUI)
>unless paramedics are going to take this on
> too. Basically this needs to be carefully thought through. At the end
>of
the
> day these are very expensive drugs with very serious side-effects; I
> just don't see paramedics in my patch taking on this level of
> responsibility,
at
> least not when judging by the levels of decision making that they're
> currently required to undertake.
i suppose the same arguements were trotted out when acute chest pain
specialist nurses were first proposed ?
---
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