Hey, Tim, MUCH respect for throwing this into the bear pit. You certainly
aren't the first to query the sense of the ORCON stuff - Mike Bjarkoy has
made the same point. However, you have put out a really interesting and
controversial case that has made us all think - thank you.
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Tim H-H
Sent: 21 November 2006 09:10
To: [log in to unmask]
Subject: Re: 48 y/o male 1st fit
I asked the question because I am that paramedic!!! It saddens me to have to
admit it, but even monkeys fall out of trees. Now that is a fairly flippant
remark, because in my opinion, although ambulance technicians & paramedics
have come a long way in the past few years; we are still only ambulance
personal with a relatively much smaller amount of training.
When one thinks about what paramedics specifically can do, in their own
right, compared to the length and depth of training of nurses and doctors, I
think it really does need improving.
I work for a very rural ambulance service, where resources, like most
services I imagine, are thinly spread. With the main focus being on ORCON,
how quickly one gets there is what matters, not what one does when one gets
there. If the ambulance gets to the scene in 10 minutes and saves a life, it
s a failure. If the ambulance gets there in 6 minutes and the patient dies,
it's a success. It's arse!!
By posting my question I have learned a valuable lesson. Not just about
people and fits, but about the whole thought and care planning process in
general. At the time I made my decision I genuinely thought I was doing no
harm. More and more we are being asked to assess on scene and not transport
unless really necessary. That way, more vehicles are available to 'stop the
ORCON clock'. I am not trying in any way to put down my craft, I am
intensely proud of what I do. However, when I joined the service in 1990,
the main aim and the focus of my training was to provide emergency
pre-hospital care, and transport to hospital. Now the focus appears to be on
providing primary care, and determining the most appropriate care pathway.
That was not what I joined the job to do, but things change and I accept
that. However, if my role is to change, I really think I should be given
appropriate training to perform that function.
Now there are supports in place such as a clinical advice line, or
contacting the pt's GP or the OOH service. If I can't make the appropriate
decisions off my own bat, I would spend most of my time at work on the phone
I have done the Certificate of Higher Education in Emergency Medical Care
(Cert HE EMC) through the University of East Anglia, and that has augmented
my knowledge greatly, and I now feel I really should have known better and
transported the 48 y/o male. As an already established paramedic I didn't
need to do the Cert HE, but I was glad to be given the opportunity to do it.
I think all existing paramedics should have their knowledge base increased
to diploma level at least, if we are going to be asked to make these new
sorts of decisions.
Thank you all for your input on my original posting, it has been very
helpfull.
Tim H-H.
PS. Sorry about the HTML posts. Plain text only now...promise.
Can I ask the original correspondent (Tim H-H) why he asked the question?
AF
Helen Deborah Vecht <[log in to unmask]> wrote:
I am going to act like the old woman I am becoming and repeat:
The patient might seem 'all right'.
He is NOT 'all right'
He has an unexplained tachycardia and has just had an unexplained seizure.
In my opinion he merited an ambulance to hospital.
His next seizure occurred in A&E more by luck than anything else.
Are we really willing to accept disastrous consequences should this kind
Of episode recur?
Am I overdramatising?
--
Helen D. Vecht: [log in to unmask]
Edgware.
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