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ACAD-AE-MED  August 2002

ACAD-AE-MED August 2002

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Subject:

Re: Paramedic practitioners in the ED

From:

Simon McCormick <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Wed, 21 Aug 2002 17:45:28 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (115 lines)

I have to admit to being a bit sceptical about what paramedic practitioners
can achieve in terms of reducing A&E attendances.  We have some paramedics
training with us currently and they are seeing minor injuries and learning
wound care etc but often this involves doing an x-ray, something they won't
be able to do when practising in the field.  Do we believe we can train the
paramedics not to x-ray when they are assessing injuries outside the pub on
a Friday night?  It is difficult enough to train our SHOs not to x-ray in a
warm, well lit A&E department.  Equally, what are the chances of a paramedic
practitioner avoiding bringing up a medical case on the basis of their
assessment in the field.  I suspect the number of attendances avoided will
be a handful a day at most, despite what others may think.  We run the risk
of pressure being applied to paramedic practitioners to reduce our workload
("Why have you brought this up? Couldn't you have sorted this out in the
community").  This pressure will lead to mistakes and the inevitable law
suit.

The problem is, not that many of these people are attending inappropriately
but that they are using an inappropriate form of transport to get to the A&E
department.   We need to stop sending ambulances out to clearly
inappropriate cases or empower ambulance personnel to refuse to transport
these people.  Instead we are sending out the wrong message: Call an
ambulance and the minor injuries unit will come to you!

Simon McCormick

SpR A&E
Sheffield

(All in favour of extended roles, just not convinced they are the solution
to our biggest problems)

Oh I fully agree Craig, we've just gotta improve our balance, that's what I
mean; a few more registrars dedicated to clinical care rather than endless
courses, and a little less reliance on first year SHOs would go a long way
to redressing the balance.

P.S.  Where are these SpR jobs Adrian, sound like fun?


----- Original Message -----
From: Black, John <[log in to unmask]>
To: <[log in to unmask]>
Sent: 21 August 2002 10:38
Subject: Re: Paramedic practitioners in the ED


> I am fully supportive of Cliff's observations of the value of Paramedics
> working within the ED.
>
> I think it would also be useful for all ED staff to spend time with our
> ambulance service colleagues on front line vehicles so that not only the
> realities of prehospital care can be understood but skill mix can be
shared
> and appreciated by all.
>
> John Black
>
> -----Original Message-----
> From: Cliff Reid [mailto:[log in to unmask]]
> Sent: 18 August 2002 23:24
> To: [log in to unmask]
> Subject: Paramedic practitioners in the ED
>
>
> Sounds like a great idea.
>
> Possible benefits:
>
> improved working relationships between pre-hospital and hospital personnel
>
> adds variety to paramedic career - improved staff retention / motivation
> (currently a BIG problem in some areas)
>
> high volume exposure to procedures normally performed - cannulation,
> splintage, airway adjuncts
>
> educationally rewarding in terms of understanding ED diagnostic processes
> and medical care of emergencies
>
> feedback on ED consequences and perception of field interventions
>
> possibility of 'extended role' skills acquisition - wound care, 12 lead
ECG,
> tet tox, minor HI advice, minor soft tissue injury care (ready for
possible
> pre-hospital 'practitioning')
>
> NB I think RSI is unlikely in most EDs - you'd be at the back of a long
> queue!
>
> I don't think it's unreasonable to examine the role of paramedic
assessment
> and discharge at the scene. There's enough data from the UK to show that
the
> majority of 999 callers do not require hospital admission, and a
significant
> proportion don't even wait to be seen once they get to hospital. The
current
> emergency care system is failing in many ways, and novel approaches and
> lateral thinking are required. I don't disagree that ED resources should
be
> optimised, but the Emergency Department is only one link in the chain.
>
> Cheers
> Cliff Reid
>
> (BTW if any aussie/nz EPs have any last minute tips on technique for the
> written part of the Fellowship exam, please e-mail me off list this week!)
>
>
>
> _________________________________________________________________
> Chat with friends online, try MSN Messenger: http://messenger.msn.com
>
>

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