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Robbie > I agree that it is important to maintain anonymity, but I disagree that this > is the wrong forum to discuss issues surrounding difficult calls. There were sufficient details in the report to identify this case if you work in the North. We agree discussion needs to be anonymised. > I have huge respect for the experience of the paramedics I know and work > with. However, paramedic training is still inadequate in this country > compared with the US and Canada and Ray as the doctor called to the scene, > clearly outranked the paramedics (no matter how experienced they were). This raises the spectre of pre-hospital accreditation. Just being a doctor on scene should not grant absolute primacy. > I agree that "ordering" a paramedic to follow medical directions is a last > resort, but it is a legitimate resort that I have had to take myself on rare > occasions previously. In general, force of argument would be better ;-) > Ray remained with the patient in the scenario he describes, and as the > senior clinician at the scene the treatment decisions and responsibility was > his until he handed the patient over to another MEDICAL practitioner > (paramedics work under the medical standing orders of their medical > director). For the purposes of discussion, rather than specifically here, does this have to be face to face? GPs are confronted with this all the time when they hand over acute coronary syndromes for transfer to the local ED. > Should a doctor at scene request a course of action contrary to those > standing orders, then it is reasonable for the paramedic to request that the > doctor travels with the patient, however if a paramedic refused to comply > with my orders on scene their feet would not touch the ground. Hmmm. I agree, but the disciplinary panel would need to consider whether the doctor's decisions were appropriate and the paramedic's not. The need for the doctor to travel when deviation has taken place is very important. > I would be interested to know if you have online medical control of the > paramedics on your air ambulance, what extended training they receive, what > role your medical director plays, and what your medical director's views are > of this. We do if they request it. Extended training is given with on-going education, the details would muddy the discussion. We can carry this on privately if you want the full SP. There are two sources of medical on-line control (to give more certainty about being able to reach one). As the vaguely titled "Medical Advisor", I am one, the WYMAS Medical Director is the other. We discuss all calls for advice together to try ensure future consistency. Best wishes Darren