I'll have to look this John Crippen bloke up. He sounds like a person of
rare intellect with a particularly witty turn of phrase.
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Martyn Hodson
Sent: Wednesday, 6 December 2006 9:19 PM
To: [log in to unmask]
Subject: Re: Emergency access - Clinical case for change: Report by Sir
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Paul Bailey
> Sent: 06 December 2006 12:22
> To: [log in to unmask]
> Subject: Re: Emergency access - Clinical case for change:
> Report by Sir George Alberti
> It's got a certain attraction to it.
> Get critically unwell patients to roam around the countryside
> for a couple of hours in the back of an ambulance having a
> trial of viability. Those that respond favourably to a bit
> of bouncing around, normal saline and morphine survive their
> 'trial of viability' and are admitted to hospital after the
> window of opportunity for any meaningful intervention has passed.
> Those that require more serious and / or time urgent
> intervention who fail their trial of viability can just go
> straight to the morgue, thereby saving everyone a whole lot
> of hassle and expense.
> Sure, a few people who might have survived with rapid high
> quality care will not make it, but I'm sure this will be
> viewed as some sort of Darwinian natural attrition and the
> cost savings by not having to treat them all will more than
> make up for it.
> Paul Bailey
> Western Australia
Has Dr. John Crippen of blog fame invaded Paul's Email account?
A little too much of the debate has surrounded the maintainance of
the system as is and the the continued throwing of money at that
For much of the urban Uk there is an overwhelming choice of Emergency
From where I sit at home now in a former Metropolitan County I have a
choice of a good number of Emergency Departments, - the one i currently
work in is 25- 30 minutes walk away ( and 5 -10 minutes in the car)
beyond that within 10 miles I have 6 other major Emergency Departments,
3 of which are in reasonably sized DGHs and 3 of which are part of
'large' hospitals ...
Sat in my old house in a considerably more rural area I had a Major
Emergency Department a couple of miles a away ( where I used to work)
and a choice of 4 major Emergency departments and a Medically staffed
MIU/A+E within 30 miles...
Many of the existing areas with limited provision will not see that
provision get a deal worse and assuming the changes aren't made in
splendid isolation there is a great deal of potential to see fit for
purpose services of a different model provided...
From the point of view of the bean counters why pay for ECPs when
you have the choice of half a dozen major Emergency Departments within
10 miles - lowest common denominator ambulance care is all that is
needed ( van drivers with first aid certificates to quote ken clarke)...
Why expand walk in centre provision when there is a major emergency
department which has swallowed the rising attendance figures and
hasn't yet reached total saturation despite the comprehensive
'realignment' of the Nursing and ENP service in that department ..
I think there is validity to questioning would such radical change
damage the speciality , it does however assume that consolidation of
the resuscitation service would reduce the number of Senior posts in
A+E - despite the fact that changing provision may change the role
but not the need for Emergency medicine doctors - consider the
increased need for 'flying squad' type services if scoop and run is no
longer a 'safe enough' option for difficult to manage patients - who is
going to provide that service and/or support, clinically manage and
educate non -physician providers in that role... - Emergency Medicine
If more and more work is pushed to the Ambulance service and the PCTs
won't those organistions need more Emergency medicicne docs on their
There are two options for all the staff involved in Emergency medicine -
try and make the changes work for us or "do a Gilchrist" and be faced
with the changes imposed by government and our employers without
consultation as the fire service have seen
The grim industrial North
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