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gingernut
22nd Nov 2010, 12:48
Hi, hope this is the correct forum.

I was wondering if air ambulance paramedics "do" (ie have skills), that there ground based buddies don't.

Or, indeed, should they (both ground and air crew) have skills, that they haven't, and how would that benefit the patient. - Medical rather than airmanship.

Fact or opinion is ok, if you can distinguish between the two, even better. I thought I may be able to get it straight from the horses mouth here.

It's for a talk I'm doing on extended roles, the audience is made up of paramedics.

Cheers, Ginge.

902Jon
22nd Nov 2010, 18:26
What country are you talking about?

In London the HEMS paramedics are chosen & trained specifically for the trauma calls that is the aircrafts primary role. They work as a team with the doctor that is always carried to perform the on-street medical interventions that are not normally carried out.

MarcK
22nd Nov 2010, 18:31
What country are you talking about?

Where I live (California) the (some) air ambulances are staffed by MICN (Mobile Intensive Care Nurses), who are trained to a different level than Paramedics.

gingernut
22nd Nov 2010, 18:43
Thanks chaps, I'm talking about the UK (and thanks T the Torque for the PM).

These are exactly the sort of things I'm trying to tease out.

A couple of questions,

1) In the UK, what interventions does the doc do that the paramedic doesn't. (And could the paramedic do it if he or she expand his role)?
2) What does the MICN do that the paramedic doesn't?

cheers,
ginge.

Bertie Thruster
22nd Nov 2010, 18:43
Apart from London with its 2 pilot operation, UK helicopter paramedics are qualified HEMS crewmembers and at least one has to be on the helicopter for any HEMs CAA exemptions and permissions to be used by the pilot.

Not a medical skill as you asked, but a point worth noting.

Bertie Thruster
22nd Nov 2010, 19:11
Sorry to harp on but UK air ambulance paramedics (except London) are required to have extended aviation skills, a point worth making to a paramedic audience:


1. When the crew is composed of one pilot and one HEMS crew member, the latter should be seated in the front seat (copilot seat) during the flight, so as to be able to accomplish the tasks that the commander may delegate, as necessary:
a. assistance in navigation;
b. assistance in radio communication/ radio navigation means selection;
c. reading of check-lists ;
d. monitoring of parameters;
e. collision avoidance;
f. assistance in the selection of the landing site;
g. assistance in the detection of obstacles during approach and take-off phases;
2. The commander may also delegate to the HEMS crew member tasks on the ground:
a. assistance in preparing the helicopter and dedicated medical specialist equipment for subsequent HEMS departure;
b. assistance in the application of safety measures during ground operations with rotors turning (including: crowd control, embarking and disembarking of passengers, refuelling etc.).
3. When a HEMS crew member is carried it is his primary task to assist the commander. However, there are occasions when this may not be possible:
a. At a HEMS operating site a commander may be required to fetch additional medical supplies, the HEMS crew member may be left to give assistance to ill or injured persons whilst the commander undertakes this flight. (This is to be regarded as exceptional and is only to be conducted at the discretion of the commander, taking into account the dimensions and environment of the HEMS operating site.)
b. After arriving at the HEMS Operating Site, the installation of the stretcher may preclude the HEMS crew member from occupying the front seat.
c. If the medical passenger requires the assistance of the HEMS crew member in flight.
d. If the alleviations of 3.a, 3.b or 3.c are used, reduction of operating minima contained in Appendix 1 to JAR-OPS 3.005(d), sub-paragraph (c)(4) should not be used.
e. With the exception of 3.a above, a commander should not land at a HEMS operating site without the HEMS crew member assisting from the front seat (copilot seat).
4. When two pilots are carried, there is no requirement for a HEMS crew member provided that the pilot non-flying (PNF) performs the aviation tasks of a HEMS crew member.

gingernut
22nd Nov 2010, 19:53
No, you're not harping on, all good info, but it's the clinical stuff I'm trying to focus on, cheers, ginge.

helisdw
22nd Nov 2010, 21:11
If you want to know what a paramedic can (or can't) do, then you need to look at the JRCALC guidelines:

http://jrcalc.org.uk/guidelines.htm (http://jrcalc.org.uk/guidelines.html)l

Essentially this outlines the drugs and procedures UK paramedics are capable of doing (although each ambulance trust will choose to what level their paramedics are trained/can operate).

If paramedics are to use drugs or carry out procedures that are not contained within the above guidelines then a "Patient Group Direction (PGD)" needs formulated. This allows expansion of an individual's remit, usually strictly applicable in specific circumstances.

Patient Group Directions in the NHS : MHRA (http://www.mhra.gov.uk/Howweregulate/Medicines/Availabilityprescribingsellingandsupplyingofmedicines/ExemptionsfromMedicinesActrestrictions/PatientGroupDirectionsintheNHS/CON009688)

Or, indeed, should they (both ground and air crew) have skills, that they haven't, and how would that benefit the patient. - Medical rather than airmanship.This questions is so broad and multifaceted that I don't think there is a simple answer I'm afraid. The medical literature continues to debate the merits of pre-hospital care and what interventions are (or are not) beneficial.

If you want further specifics about what skills/procedures a doctor possesses then I am happy to elaborate...

Simon

gingernut
22nd Nov 2010, 21:40
Thanks Simon, useful link.

I'm coming at this, mostly naive of aspects of emergency care. I'm trying to ascertain what gaps there are between the knowledge and skills of a paramedic, and that of, say, a doctor. I've been asked to talk about how Advanced Practice (in my own field of primary care nursing) has helped patient populations.

I'm trying to draw some parallels with that of emergency medicine. Would some of the aspects of Advanced Practice (history taking, clinical examination, prescribing, risk management, critical appraisal etc) be beneficial to casualties? And I guess some paramedics are already operating at, or near this level already. But if it was true Advanced Practice, why have a doc and a paramedic in the chopper/ambulance.

I notice a lot of stuff on the JRCALC site is protocol driven, for example, (not always a bad thing in emergency medicine I expect), but are there times when this constrains paramedics at the expense of the quality of care given to the casualty?

Helinut
22nd Nov 2010, 22:15
I am not precious about it (ask anyone) but I cannot help but think that you are asking the wrong people about the things you want to know. We are (mainly) helicopter pilots here. Anything we know about our walk-on freight is very second hand. I don't now if there is one, but I wonder whether there is not a better place to ask the question you want answered?

From what little I know as a pilot, there seem to be significantly different standards of the medical crews in air ambulances even if we just look at the UK. A major difference is that more and more air ambos carry a doctor and a paramedic. Some of the docs are trauma specialists and some are not.

In my simple (non-medical) way, it may be a response to the different roles that different HEMS units fulfil. The one extreme is the London where jobs attended are limited to serious trauma type incidents: the aim seems to be to get really specialised trauma care to the scene. In more rural areas the HEMS is more akin to a flying ambulance where its speed and ability to go direct A to B at speed and get the patient to hospital is the driving force. Some of the latter are gently moving more to the London model as time goes by.

On that basis your medical crew skill sets are chosen to fit the role selected for the particular air ambulance. Its a response to the demand which varies.

23rd Nov 2010, 05:30
I suspect a major difference is time available for treatment - the whole point of air ambulances is that you get the trauma patient to hospital as quickly as possible; stabilisation and packaging need to be done swiftly or they may as well go in a land ambulance.

We then come back to the dilemma of 'stay and play' or 'scoop and run'.

206 jock
23rd Nov 2010, 08:50
Don't quote me as I'm not 100% sure of all the facts, but I believe that earlier this year, air ambo paramedics were effectively stopped from administering some classes of drug, that previously they had been able to (my hazy recollection is some of the morphine-based painkillers).

So a properly trained doctor can for example intubate, perform RSI's and administer classes of drug that the paramedics are not trained for or cannot legally do.

It's not (just) a question of skills, but also legality. All of the air ambulance paramedics I have met are highly skilled individuals, but there is a glass ceiling of what they are allowed to do, imposed at national or local ambulance service level. And to a man (or woman) they do not regard the doctor as an inconvenience, they recognise that having a A&E trained registrar (in the case of the charity I know well) adds a whole new dimension to the service.

And Crab, I disagree with you. The point of an air ambulance is to get the patient appropriate treatment as quickly as possible. With the right team and equipment on board, this might be at the scene. Often the stabilised patient is then moved by ground ambulance - but effectively their treatment may have already begun. The doctor often travels with the patient in the land ambulance.

902Jon
23rd Nov 2010, 09:34
206 jock

Spot on. The level of drugs that a doctor can administer are completely different than that of an independent paramedic. However when they are working with a doctor they can give them under their strict supervision. Likewise a London HEMS paramedic can do an intubation under supervision.

A doctor can use a scalpel on the street for invasive procedures such as thoracostomy, chest drains, surgical airways, and in extreme cases thoracotomy.

gingernut
If you want to pm me I can put you in touch with an ex London HEMS paramedic who now flies county air ambulance. He will be able to tell you what he is now allowed to do compared to working with a doctor.

sss
23rd Nov 2010, 09:43
Likewise a London HEMS paramedic can do an intubation under supervision.

Do you mean assist with an RSI as most para's can intubate without supervision.

That said I had heard that the LAS are phasing out paramedic intubation, but that is a separate issue.

sss
23rd Nov 2010, 09:45
I was wondering if air ambulance paramedics "do" (ie have skills), that there ground based buddies don't.

If you had time you could also add in AA/HEMS Para's that have skill loss in their non trauma paramedic skills base.

Epiphany
23rd Nov 2010, 09:47
And Crab, I disagree with you. The point of an air ambulance is to get the patient appropriate treatment as quickly as possible. With the right team and equipment on board, this might be at the scene. Often the stabilised patient is then moved by ground ambulance - but effectively their treatment may have already begun. The doctor often travels with the patient in the land ambulance.

Good point 206 and one that many people do not appreciate. UK HEMS has advanced considerably in recent years but is still lagging behind other countries.

Having experience of a few HEMS operations around the world I would say that the best model I have seen is one where the medical crew are 2 advanced care (ICU) paramedics who have many years experience as ground based paramedics before moving to HEMS.Their training and expertise includes intubation and infusion of a variety of pain relief drugs. They are also trained in casualty access techniques.

A combination of doctor and paramedic can also work well as each can compliment the other's level of skill and knowledge.

When the medical crew have this level of expertise then they are able to assess, treat and stabilise casualties on scene before loading and transferring them to a hospital or trauma centre.

There should be no such thing as 'swoop and scoop' in HEMS these days.

jayteeto
23rd Nov 2010, 10:03
Crab, our task in the north west is to get a paramedic to scene. The move to hospital is secondary. True, we normally do carry trauma, but often we leave the follow up to land crews.

Thud_and_Blunder
23rd Nov 2010, 10:58
Crab has achieved his aim - he loves to stir up the HEMS world with his outsiders views, based on out-dated snapshots seen from a SAR perspective. Don't encourage him!

23rd Nov 2010, 13:16
Ah yes those outdated snapshots where we still see, on a regular basis, casualties spending far longer on the ground than they need to whilst the valuable AA asset is shut down beside them.

As I recall the establishment of AA was predicated on the Golden Hour concept of ops which, if you have an appropriately qualified and experienced doctor on board, may mean just getting the AA to the casualty - but, certainly in this part of the world, there are paramedics, not doctors in the AA and so the cas needs to get to hospital quickly.

It seems to be a case of mission creep where both land and air ambulances pitch up to the same job or is it just to meet NHS response time targets - get the paramedic on scene and the clock stops, regardless of how long it subsequently takes to get the patient to hospital?

I suspect that most AA callouts are not golden hour trauma cases requiring surgical or anaesthetic skills but I am sure the casualties would far prefer to be treated in hospital instead of in a field.

Flaxton Flyer
23rd Nov 2010, 15:02
"Ah yes those outdated snapshots where we still see, on a regular basis, casualties spending far longer on the ground than they need to whilst the valuable AA asset is shut down beside them"

So now you're a HEMS specialist too, Crab? Just a wild guess on my part but I would imagine that the doctors / paramedics are probably better qualified than your good self to decide when a patient is ready to be moved. It doesn't matter what interventions the doctor or paramedic makes on scene, the aim is simple - stabilise the patient enough to get them to hospital. That may be five minutes or 45 minutes. It takes what it takes.

HEMS isn't about moving the patient ASAP, it's about getting resources on the scene quickly - and that may only be more powerful painkillers than the landcrews have - and then using those resources in whatever way best serves the patient.

As for the valuable asset being shut down on scene, you'd be better focusing on the turn-round times at hospitals where I can often spend an hour waiting for the paras to deliver the patient, get the kit back and try and thumb a lift back to the HLS if we've landed at a secondary site. A lot of time to lose during these short daylight winter days.

FF

Epiphany
23rd Nov 2010, 15:07
I am sure the casualties would far prefer to be treated in hospital instead of in a field.

Well in that case I will make sure that the paramedics ask the patient next time. Crab you really have no idea about pre-hospital care or HEMS. The 'Golden Hour' - another outdated snap shot - refers to getting suitable medical care to the patient not necessarily the other way around.

HEMS in UK hopefully leave the prehistoric 'swoop and scoop' concept to SAR crews. Your comment 'stay and play' demonstrates (if any more are needed) your ignorance of the subject.

flyingmedic
23rd Nov 2010, 16:09
The difference between air and land Paramedics will depend on the local air and land ambulance service. All UK Paramedics are bound by the guidelines in JRCALC but, these are only guidelines, if you follow them word for word and it all goes wrong then the Paramedic will be held responsible.
A lot of UK air ambulances carry a Doctor on board and the Paramedics employed by that air ambulance service will be expected to assist that Doctor with certain procedures, RSI and chest drains being two examples.
The huge difference with putting a patient on to a helicopter (135, 109E or Explorer) is that everything needs to be done BEFORE you load. There is no room on these aircraft to change the way a patient is packaged so you have to stay and play, if I took a patient into an A+E dep't who was not properly packaged and without all the relevant procedures done I could be struck off.
Remember though that the majority of guys on here are pilots, and although they have a huge amount of experience they are not medically trained, just as I am not a trained pilot.

gingernut
23rd Nov 2010, 20:37
902 thanks for the offer, I may well take you up on your offer. I've already gleaned a better insight, just from this forum.

A quick and dirty evaluation tells me that emergency docs are performing stuff (eg RSI and intubation) that paramedics aren't (for various reasons).

Does anyone have any idea if there are any studies that demonstrate a difference in outcomes depending on who is on board?


Thanks for the contributions, and realise this forum focuses on aviation issues, rather than medical issues. (Sometimes feel like I gain a better feel for a subject on here though).

I'll bogg off on Thursday, as I would have done the talk then:)

helisdw
23rd Nov 2010, 21:44
Gingernut: Whilst an aviation forum may not be the optimum place to glean medical opinion, there has certainly been a good spread of responses!

The debate over the 'golden hour', 'stay and play', 'scoop and run', etc. has still to find a definitive answer. As with much in life, it often depends on the exact situation/circumstances - a hypothermic survivor from a hillside or the sea probably needs to be in the nearest hospital as soon as possible to get re-warmed in the most timely manner; the head injured patient needs an RSI and transfer to a neruo-surgical centre. Delays on scene may or may not be justified.

Essentially it boils down to getting the correct resources to the correct patient who must be transferred to the correct hospital in the correct time frame. Thus, air ambulances play their role in either getting expert resources (paramedics or doctors) to the incident scene or over flying 'local resources' to transfer the patient to definitive care (i.e trauma centre). Morbidity and mortality is known to increase for every subsequent transfer a patient is subjected to after reaching the first place of medical care...

London (and other large metropolitan districts) provide specific challenges - e.g getting expert care on scene in a timely manner. Getting to definitive care may well be most effectively achieved by then utilising road transport - this does not negate the need or usefulness of an air ambulance but requires a different mind set. It is certainly less dramatic arriving at hospital by ambulance than a helicopter, but this doesn't mean the HEMS system has not played a part!

Careflight in Sydney have been undertaking a trial with head injured patients which (from my understanding) attempts to address the question of the role of physicians in pre-hospital care. I believe that whilst the teams are flown to scene, the subsequent transfer is often (but not exclusively) by road. More details on their website:

CareFlight - Head Injury Retrieval Trial (HIRT) (http://careflight.org/medical/hirt/)

Does anyone have any idea if there are any studies that demonstrate a difference in outcomes depending on who is on board?

There are studies looking at this area but they generally recruit small numbers with an associated difficulty in reaching statistical significance - there was a recent thread which touched on this area with a link to some medical articles. Trying to 'match' trauma cases for research purposes is notoriously difficult, costly and thus limited.

If you want more details or specific answers to the questions you posted regarding protocols/advanced practice/etc. I suggest you PM me - after all, as has been pointed out, it is a helicopter forum!

Simon

24th Nov 2010, 10:07
Epiphany - helisdw's post seems to indicate that things are far from clear cut in HEMS/EMS and calling one organisation's protocol prehistoric is surely a clear indicator of lack of understanding of the complexities of the issues - petulance doesn't become you.

The consultant anaesthetists who frequently fly with us are quite clear that getting the patient to definitive care is paramount - maybe because our aircraft is large enough to permit continued work on the casualty and maybe because the situations we are usually called to mean the casualty is in a hazardous environment, but stay and play is very rare.

A new protocol for cardiac patients is quite clear that scoop and run is the way forward as the best treatment for the condition is only available in hospital.

Epiphany
24th Nov 2010, 11:13
Yawn.....:rolleyes:

Thud_and_Blunder
24th Nov 2010, 11:20
There you have it in a nutshell, Crab - your aircraft is suited to one kind of patient care, so that's where your area of knowledge is centred. Occasionally you fly with a consultant from a nearby hospital (who also flies with the local Air Ambo) - he has made his very valid opinions clear.

Other contributors here have explained why treatment on board their aircraft is less likely to achieve the optimum patient outcome, which is why pre-hospital-medicine specialists travel on those aircraft to help produce the best result for the patient. These specialists, especially on aircraft operating in the Home Counties where they are actually employed by the Air Ambulance Trust, are in contact with duty consultants who also provide weekly clinical governance; top-cover that your volunteer consultant does not have.

It has been explained to you in the past that a RSI'd, stabilised patient does not require a trauma team to meet the aircraft on arrival at hospital (your anaeshetists will be able to explain the advantages this confers). In fact, several things have been explained to you but you still cherry-pick the snippets which appear to match your viewpoint. It may simply be that you don't realise that comments like:

We then come back to the dilemma of 'stay and play' or 'scoop and run'.

are the conversational equivalents of a hand-grenade. Or you may just enjoy muck-spreading for the sake of it. I can't be sure.

BobbyBolkow
24th Nov 2010, 11:27
Crab
A new protocol for cardiac patients is quite clear that scoop and run is the way forward as the best treatment for the condition is only available in hospital.

Total B@ll@cks!

The main changes within the 2010 guidelines for resusitation (I've just read them, which I think is MORE than you've done!) are :- The withdrawal of Atropine treatment and, once resusitation is started, a full cycle of 20mins is required (CPR & drug therapy) before the Paramedics can recognise 'life extinct' (recognise because they can't certify death, only a Dr can). THAT'S only 1 of the reasons AA crews 'stay and play' (Oh man - that is SO 60's). :ugh:
Others would include entrapment RTC's (bit difficult NOT to wait then!), difficult extrication from scene, physically getting some (large) patients out of their house etc. etc. the list is endless (well almost).

As already stated in this thread doing CPR in the back of a smaller (but much more modern and capable) helicopter is hard work! Paramedic crews agree that better to do the 20 mins on scene. If you get a result take the patient to hospital for definitive aftercare. If no result.......well!

If your consultants are saying such things perhaps it's no surprise that that hospital has such a dubious reputation. I wouldn't send my MP there, let alone someone I actually liked!

Gingernut...

Apologies for the above rant! But getting back to your original thread.
As already stated, there are national guidlines for what a Paramedic can and cannot do. Obviously these skills are less than a Doctors, so they can pay the Paramedics peanuts (IMHO). However, there are local agreements which allow AA Paramedics enhanced skills which fall outside the national guidelines. These skills are taught, monitored and audited by hospital doctors, usually consultants.
There is also a move towards a CCP degree (Critical Care Practictioner) for Paramedics. This would probably equate to an ICU Paramedic elsewhere, where these enhanced skills would come under their normal remit.

A point to remember is that ALL practicing Paramedics have to be registered with the HPA, as do Doctors and Nurses. If they lose their registration, or are not registered they cannot practice anywhere, and face legal action if they do.

I have the highest regard for Air Ambulance crews wherever they are for their skill, dedication and commitment, and whoever said "self loading freight".........
Great CRM point! MUST bring that one up at my next annual.

So in a nutshell.....If you're in a bad way, get an Air Ambulance to get you to the right hospital within the right timeframe. :ok:


If you want a lift to hospital, don't care where or when, phone ARCC Kinloss and ask for CrabAir! :{

Lioncopter
24th Nov 2010, 11:39
From my understanding the main role of a SAR aircraft in the UK is to take a person who is in a hostile area/situation to a place of safety. That place of safety can be considered the helicopter as that is normally a safer place than where they were (if a SAR aircraft is required). Thats not to say that the aircraft it is not used in other roles.

I know its allitle off topic but just to give the idea of why more often than not the SAR paramedics tend to package them for lift and treat them as best they can on the way to the hospital rather than "stay and play". ( a term i'v heard used by a few SAR paramedics and not just Crab).

Thud_and_Blunder
24th Nov 2010, 15:49
Lioncopter, good of you to try and act as interlocutor for us. However, Crab has form in this forum. You may not be aware that a lot of people in the HEMS/AA world used to do SAR for a living too (some in rather more senior positions to Crab). We also know which words, phrases or expressions 'flick people's switches' and are generally polite enough not to misuse them.

24th Nov 2010, 16:30
Ah then Bobby the ranter - I didn't say it was a JRCalc protocol or even a national one but maybe in your ivory tower you haven't heard of the National Infarct Angioplasty Project.

The aim is to get MI patients into a hospital with a cardiac catheter lab for angioplasty within 150 mins from the call for help. Our hospital of choice for this is Royal Devon and Exeter, bypassing NDDH if the patient meets the criteria.

Given the distance from said hospital that most of Devon is, a scoop and run is the probable weapon of choice.

As already stated in this thread doing CPR in the back of a smaller (but much more modern and capable) helicopter is hard work! Paramedic crews agree that better to do the 20 mins on scene. If you get a result take the patient to hospital for definitive aftercare. If no result.......well! so the tail is wagging the dog here - if the helicopter was bigger, you could do the 20 mins CPR on the way to hospital but you can't, so you don't and if the patient dies in a field.....well!!

As for the resus protocols, not only am I aware of them but have done them for real which I suspect you might not have - the advantage of a bigger helo with 2 pilots.

Thud - I think the medical standards in SAR aircraft have significantly risen since you and many other ex mil AA pilots did SAR.

Oh and while we are being so precious, exactly who goes out to do this stuff in the dark in UK?

Dantruck
24th Nov 2010, 17:02
Just a quicky reply as I do not have time to read the whole thread...I beg forgiveness therefore if this has already been mentioned...but as for 'medical extended experience' think atmospheric pressure changes to the body due altitude changes during flight.

This, I understand, is a significant factor when considering all things anaesthesia and when dealing with internal bleeding, especially with head trauma.

A good sideline of enquiry, I suggest, is the care of 'patient accompanying' passengers:, ie: child patient accompanied by terrified but otherwise uninjured mother. Both need careful handling, but the latter is not sedated, is maybe in shock, is half scared out of her mind, has never been in a helicopter before, etc, etc. Now there's a challenge for the airborne EMS professional, especially when their hands are already full.

Dan

Bertie Thruster
24th Nov 2010, 18:00
A good sideline of enquiry, I suggest, is the care of 'patient accompanying' passengers:, ie: child patient accompanied by terrified but otherwise uninjured mother. Both need careful handling, but the latter is not sedated, is maybe in shock, is half scared out of her mind, has never been in a helicopter before, etc, etc. Now there's a challenge for the airborne EMS professional, especially when their hands are already full.


In my experience the mothers never notice the flight; they invariably focus totally on the child! (Fathers on the other hand almost always end up looking out of the window, for at least part of the flight.)

Smallish helo (902) but we carry out CPR in flight and defibrillation if required. (also chest decompressions.) Most difficult piece of airborne ballet for the 2 paramedics seems to be dealing with a vomiting patient strapped to a spine board. (also gets quite slippery in the cabin):yuk:

Epiphany
24th Nov 2010, 21:48
Seems Mandelson has lost his title to Crab - the Lord of Darkness.

helisdw
25th Nov 2010, 00:03
Crab, et al. - apologies if my previous post wasn't clear and has lent fuel to the fire...

In an attempt to clarify matters:
I have yet to see any published evidence that fully supports or fully refutes the concepts of 'the golden hour', 'scoop and run' or 'stay and play' to give them their colloquial titles. This does not mean that the evidence does not exist and is yet to be discovered, or that a Type II error (false negative) has not occurred in previous research.

Most would agree that it would seem self evident that some medical conditions mandate rapid transfer to a hospital and others require treatment at scene - there are an endless list of examples. However, as this has not been proven beyond reasonable doubt in any scientific literature I have seen, the conclusion reached is that the evidence base is lacking. You may use this lack of proof on either side of the debate, but ultimately it adds little to the weight of your argument.

On the whole, modern UK pre-hospital care is increasingly moving towards centralisation of trauma resources (and cardiac resources). Therefore patients are likely to face longer journeys to hospital - the earlier instigation of treatment(s) would theoretically seem to be beneficial. However, again, there is no concrete evidence as this is an emerging concept and as previously mentioned, a difficult field to do research in.

Ultimately within the UK, SAR and HEMS are very different - whether they should or shouldn't be is another debate. Perhaps in time this will change, but until my crystal ball comes back from maintenance, I'm afraid I shall have to remain in the dark... Based on Epiphany's last comment, at least I shall know who is accountable for the lack of illumination!

Simon

gingernut
25th Nov 2010, 21:13
Thanks very much for the feedback chaps, really interesting day, and I'll report back soon.

flyingmedic
26th Nov 2010, 09:07
Crab how do you know if someone is having a STEMI and is suitable for PPCI? In my local area we take a full patient history and a 12 lead ECG, based on this we administer the appropriate drugs and transmit a 12 lead ECG to the receiving PPCI unit. The PPCI unit will then call back to tell us where to take the patient, this ensures that we get the right patient to the right place at the right time and is obviously not a load and go scenario.
20 min CPR on the way to hospital? Why are you taking dead people to hospital? The reason the 20 min asystole protocol exists is so we don't take dead patients to hospital. Do you have different protocols because you are not health care professionals?