Mike Replies:
>Interesting; more die if paramedics attend them, but the morbidity is
>lower in those who survive, an effect they seem unable to explain.
As an OK paramedic I find observations like this strange and difficult to
come to terms with.
I agree totally with the statement but would expand on why this phenomenon
exists.
I think I am right in saying that the majority of our country (not all) has
50% paramedic cover and therefore 50% technician cover. Therefore every call
is attended by a Technician and a Paramedic (or thats how it should be). The
only difference between the two is a couple of invasive techniques.
So the statement above doesn't say that when a paramedic is involved the
outcome is worse. It just says that when paramedics perform an extended
skill the outcome is poorer.
Of course it is...
Look at the skills we have in our repertoire.
ET tubes. IVI. Defibrillation. Drugs
Thats the extent of our paramedic program in the UK in a nutshell - apply
this to a multi system trauma patient and you have the following -
ET tubes - This can only be performed on non-gag reflex patients. Before
they loose their gag reflex they've probably had severe hopoxic insult prior
to our arrival or as a lack of a patent airway. These people will probably
die !!
IVI - Most paramedics worth their salt identify people who are suffering
massive blood loss and go like hell to A&E. The only time you can't do this
is if they're trapped and unless you have a surgical team there the patient
will die !!
Defibrillation - if you have to defibrillate a trauma patient then the odds
are stacked against you - this patient is going to die !!
Drugs - The only drugs you should be giving a trauma patient is analgesia.No
other drugs we have will be of help to trauma patients and if you do have to
give them -Atropine, Adrenaline then... this patient is going to die !!
Should the statement be 'unfortunatley people die and sometimes paramedics
are not able to attend their needs with the training and skills available to
them'.
Answer - Give us the tools and we'll do the job.
We need the knowledge and support to initiate peer driven quality
improvements.
The facility to introduce new protocols and guidelines to put forward to our
committees
Direct access to teaching resourses outside of the ambulance services
(hospitals and universities)
The freedom to trial new skills, tecniques and drug protocols in the field
within a laid down framework of research and data collation.
We, the technicians and paramedic can affect patient outcomes.
The paramedic of today is the result of what consultants thought we should
be doing out there and it is they who have formulated the protocols. If you
don't like them, change them or let us have a go. Please do not blame
paramedics for naff protocols and poor patient outcomes - blame yourselves
for writing these protocols in the first place.
Mike Bjarkoy
paramedic
Sussex
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