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I find this discussion interesting because we are moving towards a system which desires less face to face attendances for emergency calls, more assessment at the scene if attended and ultimately fewer patients transported to hospital. Clearly there are concerns about the system's ability to do this. Simon -----Original Message----- From: Prescott Mark (RLZ) [mailto:[log in to unmask]] Sent: 17 November 2006 13:44 To: [log in to unmask] Subject: Re: 48 y/o male 1st fit I think that I would have to be convinced that the ambulance crew have the clinical skills and competence to decide whether the patient is a "single fitter" or has a more sinister underlying cause for the convulsion (dysrrhythmia, meningitis, hypoglycaemia etc) Currently I do not have that confidence and would support the concept - called to scene - therefore transport the fitter. Mark P > -----Original Message----- > From: dave.j.fletcher [SMTP:[log in to unmask]] > Sent: 17 November 2006 12:10 > To: [log in to unmask] > Subject: Re: 48 y/o male 1st fit > > Whether the public call for any ambulance is quite another question. > Having called for an ambulance the dispatcher should send an ambulance > response and the ambulance system should transport, provided the patient > will go of course. > What doctors do or say may be different. > Regards > Dave > > ----- Original Message ----- > From: "McCormick Simon Dr, Consultant, A&E" > <[log in to unmask]> > To: <[log in to unmask]> > Sent: Friday, November 17, 2006 10:30 AM > Subject: Re: 48 y/o male 1st fit > > > So, are we saying that in any case of fit (unless a known epileptic) the > correct course of action is to call an ambulance? Or are we saying that > if an ambulance attends they should always transport? Or, if a member > of the public calls for advice and says, I have a person here who has > fitted but 'seems' to have recovered fully, should I bring them to > hospital myself or should I use an ambulance an ambulance should always > be sent? > > Simon > > > -----Original Message----- > From: dave.j.fletcher [mailto:[log in to unmask]] > Sent: 17 November 2006 09:51 > To: [log in to unmask] > Subject: Re: 48 y/o male 1st fit > > I agree. Not to transport was unacceptable. > Whilst an elevated pulse rate at 1 hour may suggest a cerebral event > there > are many non-cerebral causes of seizures including arrhythmias.... that > include self-terminating VF. > I remember bringing in an AMI to Rowleys hospital many years ago who > arrested just outside the A&E. It was a 20 second tonic-clonic event > where > blood shot out of his nose and hit the back doors of the ambulance 5 > feet > away! Following successful defibrillation, the following day in CCU he > had 2 > most impressive peri-orbital haematomas! Hardly the 'classic' > hypoxic/anoxic > fit. > A pulseless VT with minimal cerebral perfusion can cause seizures for > over a > minute. > > Seizures - cause unknown - transport! > Regards > Dave Fletcher > > > ----- Original Message ----- > From: "Rowley Cottingham" <[log in to unmask]> > To: <[log in to unmask]> > Sent: Friday, November 17, 2006 8:12 AM > Subject: Re: 48 y/o male 1st fit > > > > What was the cause of his seizure? > > > > The most likely reason he vomited blood was he had a fit. There is > > always a differential diagnosis, and with a tachycardia he may easily > > have had a GI bleed sufficient to drop his blood pressure so that the > > fit was as a result of a poor brain perfusion. A pulse rate of 120 AN > > HOUR after the fit is not usual. I acknowledge his blood pressure was > > now normal, but he has had an hour to compensate and I bet it was not > > performed standing. > > > > I find nothing to criticise in the crew's actions until bizarrely, > they > > decide not to transport. Although I understand the rationale of making > > the ambulance clear for further calls in my view it is at the expense > of > > this patient - the one they already have. > > > > Perhaps the most worrying feature is that nothing they did explained > the > > fit, and the risk of subsequent fitting is high in this acute phase. > > Expecting a member of the public to protect the airway is quite > > unacceptable. I do not find they acted safely or in the patient's best > > interest. > > > > /Rowley./ > > This electronic message may contain information from Shrewsbury and Telford Hospital NHS Trust which may be privileged or confidential. The information is intended to be for the use of the individual(s) or entity named above. If you are not the intended recipient be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this electronic message in error, please notify us by telephone or email (to the numbers or address above) immediately.