If I may put my paramedic two-peneth worth in.
On a patient by patient basis there is an informal assessment undertaken. If
paramedics bring a patient into A&E or a dept where treatment is dubious,
the nursing or medical staff are usually effective enough to pick up on
shortfalls or inappropriate treatment and report to the paramedics line
manager. Some ambulance services tend to treat these incidents in the form
of disciplinaries but most will use this as an educational tool for the
individual and also circulate the conclusions to whole service.
Unfortunatly we do not have a formal QA programme. When I became a paramedic
in Brighton ALL my patient interventions were scrutinised by the consultant
in charge of the dept. The PRFs would be returned with red writing on them
with "well done" or "please see me!".
This form of clincial control no longer exists and I for one would like to
see it re-introduced.
So who (out of all you docs) are prepared to QA ALL prehospital clinical
I vote for more clinical control over paramedics.
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