Yes, I think you should never let things degenerate to that sort of level.
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of Robbie Coull
> Sent: 19 March 2002 16:26
> To: [log in to unmask]
> Subject: Re: so who is in control at the roadside?
>
>
> > Suppose the medical director of your Trust phoned up and asked
> your advice
> > about his patient. Would you find it bizarre if, having asked
> he then didn't
> > take your advice? I don't think you are in any different a
> situation. The
> > ambulance officer is in charge of the scene and the disposition of
> > casualties from the medical point of view. You are able to make
> suggestions,
> > but it is his job day in, day out to organise the transport of
> patients, and
> > with respect, he is likely to know as much as you do about the
> capabilities
> > of various hospitals and departments. It is definitely his
> responsibility.
>
> Mode of transport/extrication are what the ambulance service is best at.
> Triage can be tricky, but there are set guidelines that we should all be
> following.
>
> However, when it comes to the actual medical care of the patient
> the doctor
> has primacy, eg: does this person require an RSI prior to (or early on
> during) transport.
>
> It's interesting to compare the situation in North America from the one
> here. In North America many of the paramedics are very highly
> trained, and
> often have online (radio) medical control. When I was
> transferring patients
> in Alberta, the paramedics had 3 year instruction courses and did
> RSI, chest
> drains, 12 lead interpretation, thrombolysis, 'treat and street' and had
> good background medical knowledge. They often made suggestions, but never
> went anywhere near over-riding one of my decisions. If they had any
> concerns about a physician in the field they took it to their medical
> director.
>
> In the UK the paramedic course is 3 MONTHS. A 'base' NHSTD paramedic just
> does not have the background medical knowledge or training that
> they should
> have to do arguably one of the most difficult jobs in medicine.
>
> Now, I am not criticising the overwhelming majority of excellent
> paramedics
> in the UK who do a great under-paid job, and know their strengths and
> limitations, with ridiculous under-funding of their training -
> many do extra
> training in their own time with their own money - and anyone who
> has worked
> with me will hopefully be able to vouch for me on this.
>
> I'm also aware that problem paramedics are a minority, and that UK
> pre-hospital physicians have had a variable history as far as training and
> delivery of care is concerned.
>
> However, I'm very concerned by some ambulance services in the UK that seem
> to have swallowed their own propaganda, and believe that doctors have no
> place in pre-hospital care (either on the scene or as strong medical
> direction).
>
> I think as doctors we really do need to keep an eye on what the ambulance
> services are doing - we need to maintain strong medical control
> through good
> medical directors, and we need to make sure that we keep up the
> pressure to
> increase funding for improved paramedic education.
>
>
>
>
> Robbie Coull
>
> email: [log in to unmask] website: http://www.coull.net
>
> =============^====================================================
> ==========
> LOCUM123.COM Frequently
> Asked Questions
> How can you afford to provide this service without charging commission?
> ------------------------------------------------------------------
> ----------
> The software was written by a full-time GP, there are very few
> overheads and
> telecom companies give a discount for bulk sending of SMS text messages.
>
> This means practices and NHS trusts save staff time and agency
> costs, locums
> gain a simple, free system that allows them to take control of how they
> receive offers of work, and the whole thing pays for itself with the
> discounts achieved by sending the text messages from one central source.
>
> Visit the world's first automated locum service at http://www.locum123.com
> =============^====================================================
> ==========
>
|