At 05:12 PM 08/08/00 +0100, Kath & Al wrote:
>Anyone else noticed that:
>
> >1.12 <snip> Ambulances will be equipped with video and monitoring
> >equipment so that victims of accidents can get the most appropriate
> >care while they are being taken to hospital. <snip>
>
>Interesting spending priority. I wonder if anyone has done a Cost-
>Benefit analysis....
It's right up there with the first 3 lead 52 lbs portable telemetry.
http://www.jems.com/paramedics/index2.html
A tad of a luxury, probably more useful in the Q/A process
Than on an actual call.
Sorry I have been there, I appreciate guidance on a tuff call as much as
anybody else
... but it's amazing how much you can relay through a simple cell phone.
For the Q/A,a cheap shoulder mounted camera would do just as well.
Not to disparage the MDs nor the Medics but the foreseeable benefits are
minimal.
Some rich system care to try it out fine.
Let some rich Volies from the States have the first swing at it.
The whole thing is more of a technological crutch.
They actually intend to use it here for BLS ambulance ! ?
I am not sure this going to be relevant to you guys
.. to anybody for that matter !
> >14.21 At present, thousands of lives are unnecessarily lost each year
> >because of delays in treating heart attack patients. Clot-busting drugs
> >(thrombolysis) should be given within 60 minutes of calling for
> >professional help yet this only happens in about one case in ten. There
> >will be three reforms to improve 'call-to-needle' times:
>
> >-the immediate priority is to improve ambulance response times because
> >every minute counts - arriving one minute earlier after heart attack
> >gives an extra 11 days of life. By 2001 the ambulance service should
> >achieve a first response to 75% of Category A calls within 8 minutes.
> >This progress on ambulance response times will save up to 1,800 lives a
> >year
>
>Nothing new here.....
8 minutes ?
Not good, not for a first response in an urban area.
8 minutes for the medics/docs perhaps
4 minutes for first responders & this not just in the urban areas
That would be more like it
> >-by 2003, 75% of eligible people will receive thrombolysis within 20
> >minutes of hospital arrival as services are redesigned
>
>But I thought the NSF said 30 minutes......
30 minutes is more realistic.
20 minutes is merely achievable.
> >-there will be a three year programme to train and equip ambulance
> >paramedics to provide thrombolysis safely for appropriate patients. On
> >average, patients will get thrombolysis an hour sooner than if they
> >were taken to hospital first, saving up to 3,000 lives a year once
> >fully implemented.
>
>Mmmm. I'm sure there will be an interesting debate.....
Please keep track of numbers...
Saves & complications
Appropriate transport to specialized cardiac care centers.
The priorities & the Pts are the same, may they be in hosp or out of hosp.
Local, resources & caregivers are not the same, in itself it's a good
reason some treatments be delayed.
Some threshold should be therefore identified.
We have identified a slew in Trauma call
I.E. 10 min scene times Xceptions for intubation & extrication.
Let say for example:
Airway control 15 seconds
D-fib 30 sec.
Intubation 1-2 min (varying scenarios)
Epi for acute anaphylaxis 1 min
Cardio version 2-3 min
Pacing for persistent bradycardia 4-5 min
Thrombolysis 40-50 min (Pt contact - Hosp. door)
This in itself will not serve up all the answers.
But seems a sound basis to further evaluation of risk/benefice.
Premium nocere can be carried so far.
Let's remain objective with the prehospital care also.
Charles Brault EMT-P
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