 |
 |
wise words as always from Simon. However, I would like to sound a note of caution to others who call for the specialty as a body to be more belligerent - this is likely to be counterproductive. Biers blocks, sedation, RSI, this argument comes down to clinical credibility, and that has to be earned. You can earn it as an individual, and you can earn it as a department. You can only earn it as a department after showing, for a period of time, that you can cut the mustard, 24 hours a day. This is another reason why 24 hour senior staffing (by which term I include registrars & staff grades) is so crucial to everything in our universe. If you still work in a department with unsupported SHOs for much of the darkness hours, ITU will be needed much more ( I assume we are all agreed that SHOs should not sedate children), and may feel they have the right to dictate how certain proceudres are carried out. It is far better to work with intensivists, attend their ward rounds, let them supervise your registrars doing RSIs in the ED, then they feel involved rather than cuckolded, and after a couple of years, if it has gone smoothly, they'll lose interest and simply ask that you call them if you have a problem. That's what happened here anyway. Ultimately, its workload that someone is offering to take off them and as we demonstrate, without arrogance or a fanfare, that we can do these things,there will be no more argument. It is happening piecemeal around the country and the process is and will continue to be, locally not nationally driven. And anyway, regarding ketamine, the fact a drug isn't licensed doesn't mean we can't use it, simply that we can't blame the drug company when things go wrong. Nasal diamorphine is a good example - If the evidence is there that it is safe, one can seek to change the licence. Steve Meek Bath __________________________________________________ Do You Yahoo!? Check out Yahoo! Shopping and Yahoo! Auctions for all of your unique holiday gifts! Buy at http://shopping.yahoo.com or bid at http://auctions.yahoo.com