I would agree with much of what you have said Mike but
there are serious concerns as highlighted by the large
number of postings.
Pre-hospital thrombolysis is/will be upon many of us
over the next few years. We need to have
multi-disciplinary systems in place to address:
a) Making sure that paramedic training in such areas
is properly quality assured (this does not always
happen)
b) Recognising the worth of the paramedic who takes on
these extra skills and making sure they want to take
them on
c) Deciding on systems which will allow skill
retention and/or support systems from the local ED(eg.
telemetry)
d) Deciding who and when to thrombolyse (even in urban
settings)
e) Developing good feedback and QI systems which are
constructive and supportive.
We have been doing some work in West Yorkshire on this
with a RCT evaluating the role of a pre-hosp 12 lead
ECG on call to needle time ( PACE - Paramedic
Assessment of Cardiac Emergencies). We hope to present
this work at the Faculty this year in Nov.
regards
Taj
--- Michael Bjarkoy <[log in to unmask]> wrote:
> Hi Robbie
> US EMT-B are less qualified than UK Ambulance
> Technician (looking at their
> basic syllabus vs. ours)
> The US EMT-P takes into account their time on the
> road reinforcing their
> theoretical knowledge. We have not done so, but if
> we did it would be
> comparable.
> The US EMT-P syllabus does not take account of
> thrombolytic care ours does.
>
> The UK Thrombolytic care educations system is a 3
> day ECG familiarisation
> (US is 5 but includes thrombolyitc education)
> We (UK) then have to correctly interpret 5 correct
> 12 leads without
> physician intervention and this needs to be
> corroborated by a cardiologist
> or someone appointed by him/her. If at any time we
> get ONE wrong we go back
> to start.
> We then have to administer TNK in the A&E dept
> under physician control.
> Then the paramedic has to sit an exam before going
> into the field and
> practicing
> Once this is done we are allowed to administer
> thrombolyitcs on the road BUT
> not autonomously. The 12 lead has to be transmitted
> to A&E for physician
> approval and all the JRCALC questions have to be met
> to rule out
> contraindications.
> When and if the paramedic feels comfortable
> administering thrombolytics
> he/she then has to sit final exams before preceding
> to true autonomous
> practice.
> This process takes about two years or so.
>
> People like Dave Fletcher, who has posted on this
> list, were trained on six
> month cardiology courses by cardiac consultants, has
> been performing 12 lead
> ECGs for over 20 years. Do not assume that the
> paramedics that come through
> your A&E doors reflect the standard throughout the
> UK.
>
> In the Westcountry Ambulance Service we have over
> 500 paramedics who have
> been trained in 12 lead ECGs and many of them have
> been given authority to
> thrombolyse. This debate (as Jeremy stated) is
> academic. Your concerns have
> been addressed many years ago by people who at the
> top of the medical
> evolutionary tree. I believe the only real debate
> that should be continuing
> here is the one that Rowley has highlighted -
> paramedics need support when
> it does go wrong - that does not exist at present.
>
> Mike Bjarkoy
>
>
>
>
>
> From: "Robbie Coull" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Thursday, September 25, 2003 5:26 PM
> Subject: Re: ECGs at the scene for thrombolysis
>
>
> > > Not at all comparable, Martyn. Chest pain nurses
> have mostly been "bred"
> > > from CCU backgrounds, where they've spent years
> dealing solely with
> cardiac
> > > patients, and interpreting 12-lead ECGs to a
> high degree of competence.
> This
> > > is a world of difference from a general
> paramedic's experience of chest
> pain
> > > and ECG interpretation.
> >
> > ...and this brings us round nicely to the fact
> that paramedic training
> needs
> > to be beefed up considerably.
> >
> > Compare with Holland where you need to have been
> an A&E nurse for at least
> > ?2 years before you can train to be a paramedic.
> >
> > And of course, I still believe that you need to
> have grades of paramedics.
> > Ours single grade is roughly equivalent to US
> EMT-Bs, we also need a breed
> > of paramedic equivalent to EMT-Ps, preferably
> providing ALS response only
> to
> > selected calls so they can keep their skills up.
> >
> > --
> > Robbie Coull
> > email: [log in to unmask] website:
> http://www.coull.net
> >
> > https://www.locum123.com contact locum doctors by
> SMS and email
> >
> >
> >
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