>[log in to unmask],Net wrote at 15:48 on 03/12/98
>about "Re: Not attending a Cardiac arrest - Breach of T.O.S?":
>-----------------------------
>>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 resuscitation and request a GP's attendance to assist, is it a
>>breach of our Terms of Service to refuse?"
Adrian Midgley replied:
>Yes. Unless prevented by a substantial reason.
>And liable to be regarded dimly by the GMC and raise little support
>within the BMA.
A cardiac arrest is by definition an emergency and we are not and have
never been an emergency service.
I understand that an absolute refusal may perhaps bring your ToS around your
neck. My suggestion to any docs asking my opinion in our Co-op is to tell
ambulance control to take patient to AEU stat. You have assessed and
referred on. If they still request attendance then agree but ETA 45 mins or
so.
Now I know that our circumstances, being only 10 mins from AEU in most
areas, are good and if I were in North Yorks for example I may be more
interventive.
To those who feel I am callous I ask when did you last hone your CPR ALS
skills??? Me ALS 3 years ago and last intubated (a prem) in 1983. I do not
consider myself a person who would be too useful in a Cardiac Arrest.
As for diagnosis of death contentious.
An expected death would be unlikely to trigger CPR and could wait for own GP
to certify next morning if circumstances permitted.
An unexpected death I would contend should not be a GP problem!! (Ducks
down) Good article in Pulse a month or two back where some forensic guy was
suggesting in an era of large Co-ops that the role of the Police Surgeon
should be extended to include unexpected deaths.
I can recall many a death I have attended where I have been uncomfortable
about certifying as the whole circumstances of the death have been worrying
and me being forensically naive.
Paul Attwood
GP Ramsgate
Med Director EKDOC
www.ekdoc.com
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