> I can foresee a time, not far off, when there will be links to the Trauma
> Centre with a doctor and paramedic in contact by voice and
> pictures with the patient being looked after by remote control.
I'm a strong beleiver in better on-line medical control (I use it myself by
phoning for consultant advice on difficult calls). Once the new generation
of mobile phones with high speed data transfer appear, I think on site video
will finally become a viable option.
> I think that
> there should be something of a combination of the American
> and German systems. As the entire country is now covered by helicopter rescue
> services, each of these should now also carry a doctor
> as in London HEMS.
This is the way forward. Considering the expense of having these
helicopters in service, it's seems sensible to use them to full advantage by
having experienced medical cover.
> Rotation from anaesthetic/Emergency Unit middle grade staff
> is the obvious choice. I am starting to get quite
> worried about how a traditional GP provider (I'd welcome Robbie Coull's views)
> can keep up and validate the advanced skills that will
> now be required to provide a service to seriously ill and injured patients.
I don't think current GP/BASICS training can compete at this level.
As I mentioned in my last post, we need proper recognition and funding for
this area. There are quite a few experienced pre-hospital GPs who could be
trained up to a higher level of medical skills and plenty of highly trained
A+E people who could be trained to work in the pre-hospital environment.
This would require significant input of money - both for the initial
training / clinical attachments and frequent re-training. In this respect
it is cheaper to train A+E people in pre-hospital skills than it is to train
GPs in A+E skills. From a GP point of view I'd like to see a six month
attachment to anaesthetics/ITU/A+E for skill aquisition.
I think there will always be a role for the less intensively trained BASICS
GPs involved in remote and rural areas (where skill aquisition / retention
for even basic skills remains a major problem).
It should be remembered that preventable pre-hospital deaths are mainly
related to airway problems. It is here that we need to concentrate our
attention, whoever ends up providing the care.
Although, my own view is that the Dutch system of training A+E nurses as
paramedics combined with a German helicopter and rapid response trauma
doctor service is the ideal, I don't actually mind who is providing the care
as long as the availability and quality of the care is of a high standard.
Considering the current shortage of doctors, I think the argument for
extending the training of paramedics further rather than extending the use
of pre-hospital doctors (either A+E or GP) will continue to carry weight.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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