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> No, > Paramedics are not out of control. As with doctors the vast > majority of us > are fully competent. Looking at the obs you give, I would suggest you > contact the local ambulance liaison officer for a review of > the case as > there is no apparent justification for the administration of > adrenaline. The original question was not whether paramedics are competent, but whether they were out of control. i.e. not what the majority do but what procedures are in place to pick up the occasional person who acts particularly dangerously. Post Shipman looking at procedures is more of a concern. The fact that a number of experts in emergency medicine nationally have been expressing doubts as to some of the procedures performed by paramedics suggests that this may be an issue; as do the studies showing at best no benefit from use of paramedics as opposed to technician crews for critically ill patients; and at worst (statistically) significantly worse outcomes. It appears from some of the posts here that there is a large amount of reliance on reporting of adverse events from other trusts (BTW, can anyone from an ambulance service let us know the process for dealing with this and feeding back to the trusts concerned?), which I imagine would result in significant underreporting. Arguably a case like this suggests that the ambulance service's computer should be set up to flag up cases where a drug or procedure was carried out out of hospital after a longer period than the transfer time. (In the majority of cases this will be entirely appropriate, but it ought to be a sensitive way of picking up the odd individual who is a bit out of control and tries to treat the patient themselves when it would be more appropriate to transfer the patient to someone with greater expertise, which seems to be the commonest problem). Do ambulance trusts have a way of picking up whether some paramedics have significantly longer scene times than others? Does a paramedic's annual appraisal include looking at how many of each procedure they have done in the last year and whether this deviates significantly from the average for their trust? Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error please notify the sender. The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000. Unless the information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.