There are a number of ambulance services which have "diagnosis of death"
protocols in their system, including Cleveland. These are aimed primarily
at preventing inappropriate resuscitation being started, and therefore the
attendance of a doctor to stop it. The crew do not have to remain on scene,
but supply documentation and a confirmatory copy of the steps taken to
arrive at the diagnosis plus flat ECG trace.
The protocol excludes children, drowning, hypothermia etc., and anyone
showing signs of recent life - including witnessed collapse followed by
bystander CPR. These are dealt with by "resuscitate and run" rules. The
protocols do not include a "call your local GP" option, (though persons
trapped may be a special case for a doctor to attend, and not necessarily a
GP.)
Advanced Life Support (ALS) is not a basic skill of a GP. They *may* have
this, but it is not expected of the average practitioner. Nor is it
compulsory to carry a defibrillator in your car (for example). There may be
other reasons for the attendance of a doctor, but not to perform ALS. It
*is* a core subject for paramedic crews, who therefore should be able to
deal with this. They have well equipped vehicles with lots of blue lights.
Under the current complaints rules, any complaint about non attendance to
perform ALS would have to come before an Independent Review panel before any
consideration of a breach of TOS could be made. Each case would have to be
heard on its own merits, but my professional advice to an IR panel would be
that GPs do not attend scenes to perform ALS or CPR.
A complaint regarding other reasons for the request to attend might be
different. We often have to go to pick up the pieces left behind, don't we.
Bill Beeby
GP - Middlesbrough UK
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-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Rob Johnson
Sent: 03 December 1998 15:48
To: [log in to unmask]
Subject: Re: Not attending a Cardiac arrest - Breach of T.O.S?
In article <000001be1eb3$e62646c0$9c5eac3e@laptop>, Trefor Roscoe
<[log in to unmask]> writes
>The LMC in SHeffield have now managed to get the ambulance service to agree
a
>protocol
Lincs LMC are going down this road and I believe that a protocol will
soon be released.
The question I am keen to hear peoples views on is
"If the ambulance crew have responded to a 999 call and become involved
in a resussitation and request a GP's attendance to assist, is it a
breach of our Terms of Service to refuse?"
Rob
Dr R I Johnson
The Family Practice, Church Lane, Sleaford, NG34 7DF
Tel. 01529 305595 Mobile 0378 206475 Fax No 01529 305589
Single handed GP. Send email to [log in to unmask]
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