 |
 |
In message <009d01c4da04$dac674e0$9d74353e@Souix> Michael Bjarkoy <[log in to unmask]> writes: > Hi Rowley > I have been thinking about this for a while and here are a few observations. > > AMI arrested patients are usually in VF in the first instance. Non shockable > arrests are often (but not always) due to other mechanical causes such as > trauma, OD, hypovolaemia (basically the 4 Hs and 4Ts). > > If we accept that in a hospital setting the patient has a better prognosis > for the non-shockable side of the arrest flowchart than in a prehospital > setting we should not just accept that it is a fact of life (or death) but > challenge the flaws in the system which allows this to be. > > Since the ambulance dispute in the late 1980s we have had to accept the > notion that there must be one paramedic on each ambulance. The result is > mediocrity in education and application of care. If look toward a system > (Medic One, Seattle) where success for non-shockable arrests are better we > could learn some of valuable points. > 1. Educate paramedics along side physicians in hospital by experienced > physicians > 2. Reduce paramedics to less than 20% of the workforce > 3. Have 2 paramedics on a Medic Unit > 4. Release paramedics from protocols and guidelines and allow autonomous > practice > 5. Reduce the type of incidents that paramedics go to ALS only > 6. Give them the range of drug and invasive skill interventions that reflect > an A&E dept > 7. Offer a comprehensive in hospital continuing education > > If the above is implemented then the success rates from out of hospital > arrests for non-VF/VT patients will increase. > I disagree (now there's something unusual!!). Success rates increase with increased bystander CPR and increased access to early defibrillation - neither related to paramedic education. And not sure that an in-hosp education programme is the way to go ... ? And think that "ALS-only" calls is not the way to go either - what exactly is an ALS-only call? Some of the "minor" calls need far more experience to be left at home safely. No evidence that a second ALS staff member on a unit improves outcomes. ;) Cheers Anton