In article <[log in to unmask]>, Michael
Bjarkoy <[log in to unmask]> writes
>Dear all,
>
>As I read through Jon Nicholls, Sue Hughes, Janet Turner & David Yates
>report 'The costs and benefits in paramedic skills in pre-hospital care'
>published in the Health Technology Assessment 1998 - I question my current
>working practice and try to solve the shortfalls which have been brought
>into question from the report. Like many people in our profession you see a
>problem and one seeks ways around it or confront it head on.
>
>Are there any reasons anyone can think of that we shouldn't go down this
>road?
'cos I dont think it's the *right* road. But going down the road is
almost certainly the right thing to do!
>Any other thoughts on the subject.
>
>
I got a bit lost in your questions Mike - so here is me just sounding
off generally.
In my experience scene times are too long - almost every time.
This is a result of various factors but there is nearly always a CFAT
factor (ok, I will translate otherwise some will moan - C-ompulsory A-
bout T-ime)
We need to shift the entire emphasis - away from procedures and away
from protocols.
If our pre-hospital providers are educated correctly then why can we not
trust them to use their judgement? Why do they have to have protocols
that say thou shalt and thou shalt not?
Is it not complete nonsense that someone with chest pain with probably
cardiac cause has to cannulated at scene - taking 12 minutes - when the
run to hospital is 5 minutes. All that is achieved is that the patient
loses more myocardium. .....and we not only teach this, but the poor
paramedic fears disciplinary action if s/he doesnt do it. Has the world
gone completely bonkers?
Why not tell 'em it makes the patient worse in some situations but may
be worthwhile in others- and then they can choose to do it or not - or
on the way (nudge, nudge - yes I do this fairly regularly before someone
tells me it is not realistic - it is) - and expect them to be
accountable for their decisions and actions ......and audit it ?
Another thing that drives up scene times is the need for folk to 'get
their cannulas' (or other procedure) ie tick the boxes that they have
done so many or whatever (saw this particular one last week). Sure, we
all need practice - but couldnt it be in back of the ambulance or in
casualty (I guess all the A+Es here encourage the involvement of the
pre-hospital team when they arrive ;-) Again, we can't blame the ground
troops for this - it has to be in the training and whole operating
structure.
We really need to keep shouting about getting patients to definitive
care asap - and doing only what is necessary before then. I am not sure
that muddying the picture with details such as cannula size will really
help to achieve this objective and may distract us from it.
Cheers
--
Jel Coward
..take a look at the Wilderness Emergency Medicine and Command Physician courses
http://www.wildmedic.org
[log in to unmask]
'There's no such thing as bad weather - just bad clothing"
Anon Norwegian
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
