-----Original Message-----
From: Robert Coull <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 29 January 1999 21:55
Subject: Re: Trauma Team
>>Hoary chestnut I know, but what is the point of trailing an asystolic 88
>>year old with Ca in?
<<snip>>
>2 possible solutions:
>
>(1) PROVIDE ON SCENE MEDICAL CONTROL by sending a prehospital doctor to the
>scene.
>
>I do this when requested. It is less traumatic psychologically for the
crew
<<snip>>
c. The call out rate if you joint-respond to all collapses may be
>unacceptably high outside of remote areas.
>
>(2) PROVIDE REMOTE MEDICAL CONTROL BY RADIO
>
>Now that ambulance crews are using digital radios with personal repeaters
<<snip>>
We have protocols for not starting or termination of ACLS on scene by
Paramedics and they seem to work pretty well.
ACLS is not carried out if:-
There is rigor mortis or they are obviously dead due to decapitation etc.
OR there is a multiple casualty situation and teatment of patients who have
signs of clinical death would seriously jeopardise other patients.
OR they have fixed, dilated pupils, cyanosis, no pulse, no respiration, and
are extremely cold to the touch
AND no CPR has been carried out before the arrival of the crew
AND the collapse/arrest was not witnessed
AND the patient is asystole
AND hypothermia, drug overdose or drowning can be ruled out.
If they are in VF or PEA, we keep going. If asystole then develops, and you
can exclude drowning, hypothermia and drug overdose and asystole persists
for 10 minutes, ACLS can cease.
If in doubt and in all other cases, ACLS until you get to hospital. Age does
not come into it.
We call for a doctor to pronounce death for us so we can leave the body at
home. This has now been extended to allow us to leave the house before the
doctor arrives and leave the body with the relatives (if suitable
circumstances), expecially if the doctor will be a long time, as can happen
weekends and nights when most GP's delegate to DDS. The doctor will then
normally arrange for the funeral directors to take the body. The police are
informed as necessary for sudden deaths.
This frees the ambulance crew for another job straight away. There is litle
point in us sitting there for an hour.
If the body is in a public place or not at home, we usually convey them to
the hospital, where they are signed for in the ambulance outside the A&E and
then taken to the mortuary. The cardiac arrest team are not called out.
We are, after all, in the business of keeping patients alive, not
transporting dead bodies.
This had thrown up an interesting line of thought. If we are no longer
tubing the number of arrests that we used to, will be begin to lose our
motor skills?
Stephen Dolphin
Paramedic
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