Re Ambulance alerts
In Shropshire we get very good alerts from the WMAS and do not feel
abused - but get very poor notification from the Welsh Ambulance Service
who also come here. We have absolutely no idea what to expect from Wales
- and have to be very vigilant when we are expecting trauma from there.
We have experienced many cases with multiple injuries who are clinically
very unstable brought in with no warning of severity.
I am determined to continue to ensure that unstable patients are seen in
the right part of our department - I am old enough to understand the
power of subliminal labelling of cases - ie the patient is in a minor
cubicle therefore cannot possibly be seriously injured!!
We will keep our protocol - but thank you for your opinion
Mark P
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley
Sent: 08 February 2010 11:06
To: [log in to unmask]
Subject: Re: Use of the resus room and consultant call in criteria
Crumbs. We'd never go home. Have you audited how many of these calls
result
in a Consultant attending the department?
I noted from another correspondent the suggestion that a valid reason
for
calling the trauma team was "because the ambulance service asked for
it."
Can I suggest that this isn't a good idea? Calling a trauma team should
not
be seen as a trivial exercise. Firstly, it creates a great deal of
disruption elsewhere in the hospital. The members of a trauma team are
not
standing like guardsmen in sentry boxes awaiting the call, they are busy
with their own work. Secondly, it sets a burden on individual
paramedics. We
don't tell an ambulance service which resources to deploy to an incident
because we don't know what they have available and how it is to be used
-
and the corollary is that the service don't know our resources and their
availability either. An entire hospital can find its operations
disrupted
for some hours at the whim of a gung-ho paramedic. We withdrew it from
our
call-out criteria.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
A &
E - SwarkHosp-TR
Sent: 08 February 2010 09:37
To: [log in to unmask]
Subject: Re: Use of the resus room and consultant call in criteria
Our criteria for calling the consultant at night are:
Patients with pulse rate < 50 or > 110 unless well or stable arrythmia
Systolic BP < 100 Respiratory rate over 30 Oxygen Saturation < 85%
Responsive only to painful stimuli (or GCS < 13) All patients admitted
to
the resus room with:
. Airway problem, respiratory failure or shock not responding to simple
measures . Trauma (major or multiple) . Seriously ill or injured
children .
Patients likely to require Intensive Care . Diagnostic or therapeutic
uncertainty . "VIPs" & patients in resus longer than 2 hours Clinical
or
administrative problems that cannot be resolved by the duty middle grade
doctor or senior nurse.
In particular, a consultant must be called for any critically ill
patient
including but not confined to:
. Patients with systolic blood pressure < 100 mm Hg, . Respiratory rate
over
30, . Glasgow Coma Score < 13 . Acute confusional state especially
associated with pyrexia) . Acute severe asthma with PEFR < 33% predicted
or
failure to respond to nebulisers . Patients post resuscitation . Any
patient
who appears shocked
I'd thought I'd had something about certain drugs in there, but looking
through current guidelines I don't, so must have dropped it a few years
back. Certainly used to have rules that you called a consultant if you
were
using inotropes, aminophylline or doxapram (might have been a couple of
others in there as well). The idea is drugs that are either a bit dodgy
on
the risk: benefit ratio or whose use implies the patient is pretty sick.
Seems to work pretty well. Brought it in over 10 years ago now. When it
started I got a lot of calls saying "I didn't want to call you but the
rules
said I had to", most of which turned out to be cases where I needed to
be
there. The biggest problem is not failure to treat critically ill
patients
correctly but failure to recognise that they are ill so you need
something
that overrides a judgement of "this patient looks pretty OK: refer on
and
forget about them".
There is some debate about what to do about waiting times: consultant
call
for waits above a certain time; for waits in majors above a certain
time;
whatever. Currently don't have that. Thinking about having the
consultant
come in whenever cubicles get too full to decide who can wait in the
corridor/ "transitional ward area".
Matt Dunn
Warwick
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