Airborne medics save lives
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Very interesting thread. which has shot off at so many tangents it would be nigh on impossible to comment on them all.
As for the initial thread re doctors on the AAs I'm intrigued by Mr. Philpott's call for more Government funding to "reflect this shift in practice".
Is there really a shift in practise going on? How many air ambulances are we talking about here, 5 out of 23? (Likely more, I'm sure that the soon-to-be-introduced second aircraft at YAA wasn't counted here) Hardly a ground swell of support. AND if you consider that London HEMS and Great North have had doctors on for a long time anyway (so no shift there) , and Mr. Philpott, Grand Wizard of this plan runs two of the other aircraft then I don't see this being a runaway train of support.
Crab asked whether CHAS was still in existence..interesting question. The short answer to that is "YES" . Interestingly, the main proponents of this "shift" are, shall we say, not CHAS' greatest supporters. Perhaps a little bit of rival empire building going on?
As for the initial thread re doctors on the AAs I'm intrigued by Mr. Philpott's call for more Government funding to "reflect this shift in practice".
Is there really a shift in practise going on? How many air ambulances are we talking about here, 5 out of 23? (Likely more, I'm sure that the soon-to-be-introduced second aircraft at YAA wasn't counted here) Hardly a ground swell of support. AND if you consider that London HEMS and Great North have had doctors on for a long time anyway (so no shift there) , and Mr. Philpott, Grand Wizard of this plan runs two of the other aircraft then I don't see this being a runaway train of support.
Crab asked whether CHAS was still in existence..interesting question. The short answer to that is "YES" . Interestingly, the main proponents of this "shift" are, shall we say, not CHAS' greatest supporters. Perhaps a little bit of rival empire building going on?
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In the interests of healthy debate:
Add a couple of weeks to the Paramedic course for a PPL(H)
What skills can a CPL bring to the stick that a Paramedic PPL cannot?
Add an hour on the end for winching, what do you think Crab?
Sometimes I think I stick my neck out just too far.
Just off to count the savings.
Add a couple of weeks to the Paramedic course for a PPL(H)
What skills can a CPL bring to the stick that a Paramedic PPL cannot?
Add an hour on the end for winching, what do you think Crab?
Sometimes I think I stick my neck out just too far.
Just off to count the savings.
Heliport - I would pay them more because they don't get an awful lot for what they do anyway so taking on extra responsibilities should be rewarded with extra dosh (or is that an old fashioned concept).
AoG - don't forget to fit floats so they can do over water stuff as well and give them powers of arrest like a copper - then you have the ultimate multiskilled airborne asset. I hope you have phoned the Home Office to let thme know you have sorted their problems out. Now, about world peace...........
It doesn't seem as though anyone except Mr Philpott, Thud and his A&E consultant is actually in favour of this 'shift in practice'.
Empire building amongst ambitious doctors and pilots.....surely not. Anyway if they get too big the MCA will want to take them over
AoG - don't forget to fit floats so they can do over water stuff as well and give them powers of arrest like a copper - then you have the ultimate multiskilled airborne asset. I hope you have phoned the Home Office to let thme know you have sorted their problems out. Now, about world peace...........
It doesn't seem as though anyone except Mr Philpott, Thud and his A&E consultant is actually in favour of this 'shift in practice'.
Empire building amongst ambitious doctors and pilots.....surely not. Anyway if they get too big the MCA will want to take them over
UnconflictedInterest
I gave up on this thread a while back: clearly 'mules' and 'helicopter pilots/winchmen' have something in common. There's only point in having debate if there is at least a willingness to listen.
Paramedics who think they are doctors...there's a scary thought.
If you are who I think you are, see you later ;-)
I gave up on this thread a while back: clearly 'mules' and 'helicopter pilots/winchmen' have something in common. There's only point in having debate if there is at least a willingness to listen.
Paramedics who think they are doctors...there's a scary thought.
If you are who I think you are, see you later ;-)
It doesn't seem as though anyone except Mr Philpott, Thud and his A&E consultant is actually in favour of this 'shift in practice'.
BTW just in case anyone thinks I reckon this is the be-all-and-end-all solution, I still think that units like Wilts and Sussex have a thing or 3 to show the Air Amb world. An aircraft that can react to calls after dark AND bring the expertise of a pre-hospital-medicine specialist; that's an Air Ambulance system I'd pay to see working! Plus an aircraft with a ground (and noise) footprint the size of an Explorer but the cabin-space of a 412... There's always room for improvement.
ps Crab, I finished my CtoI on 2 Sqn at 2FTS in Mar 84 - prob know you but have been told you're not the fella I orig thought, one "TS"...
unconflictedinterest said;
,
Not true. I know of at least one unit where the paramedics have been NHS funded since the unit was formed in 1994.
...only if an individual charity wants the extra funding for it......
.....and some of those charities trustees are very much in agreement with Crabs sentiments.
Let's not forget that paramedics were not funded until 2002
Not true. I know of at least one unit where the paramedics have been NHS funded since the unit was formed in 1994.
Within the next year to 18 months all air ambulances will have doctors
...only if an individual charity wants the extra funding for it......
.....and some of those charities trustees are very much in agreement with Crabs sentiments.
Ah well, glad to see everyone is pulling in the same direction on the air ambulance front - no wonder CHAS nearly went into meltdown earlier in the year.
Thud - a be-all-and-end-all solution would be 24/7 air ambulance cover across the whole country with standardised crew composition and medical protocols and big enough helicopters to do inter-hospital transfers whilst allowing the medical teams to work on the casualties. By declaring UDI you run the risk of further fragmenting what should be a national service into the haves and have nots.
I hear what you say unconflicted - you seem very sure that ALL AA will have doctors on board - that means that unless all the charities agree to fund them then the NHS trusts will have to do so - back to my argument about how the money would be best spent I think.
PS Thud, who is TS? I am JE
Thud - a be-all-and-end-all solution would be 24/7 air ambulance cover across the whole country with standardised crew composition and medical protocols and big enough helicopters to do inter-hospital transfers whilst allowing the medical teams to work on the casualties. By declaring UDI you run the risk of further fragmenting what should be a national service into the haves and have nots.
I hear what you say unconflicted - you seem very sure that ALL AA will have doctors on board - that means that unless all the charities agree to fund them then the NHS trusts will have to do so - back to my argument about how the money would be best spent I think.
PS Thud, who is TS? I am JE
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Whilst there are undoubtedly times when the additional skills of a doctor are needed on scene, the aim should still be to use those skills to get the patient away to hospital as quickly as possible. Unfortunately it seems that this is not always the case, with patients being worked on for a considerable length of time when they are less than ten minutes away from a hospital.
It seems from their publicity that the Kent/Surrey/Sussex charity consider that the Golden Hour is the time to get the doctor to the patient, not the patient to the hospital!
It seems from their publicity that the Kent/Surrey/Sussex charity consider that the Golden Hour is the time to get the doctor to the patient, not the patient to the hospital!
Last edited by Bearintheair; 10th Sep 2007 at 11:15.
The very word "paramedic" translates into so many variations of protocols and definitions, even across state lines let alone international ones, that it is hard to come up with one model that suits all resource bases or discussions on protocols.
I say "resource base" because that is what should be driving this argument. It stands to reason that having a trauma hospital ED on each traffic intersection would (in a resource unlimited world) be the ideal solution. From that ideal to having just one ED in a city of 20 million for a resource poor situation is simply a matter of the individual cost benefit analysis. And as armed with all the facts and figures as we like to think we are, we rarely get to decide on the resource allocations that settle arguments like this.
Resource base expansion enabled the ground ambulance in the first place. What a great idea to get initial medical help to the patient, then retrieve that patient back to the hospital. By doing that we don't have to build multiple r trauma centres - cost effective for the gummint and patient outcome positive.
Same argument for the advent of the helicopter air ambulance. Only now it is possible to cover a much larger area too. It has three sudden advantages:
1. The rapid transport - aka golden hour advantages as pointed out numerous times in this thread already.
2. The ability to concentrate higher medical resources quickly.
3. The ability to access (by speed or environment) patients that previously could not be accessed either at all, or in time to prevent a poor outcome.
Forgetting the rescue elements of the third point which are not really being debated here, it is this second one that could be included in our considerations. Do we spend millions of dollars on providing a rapid transport vehicle to bring more paramedics to a scene that already has paramedics, OR do we try and multiply the benefits of the expenditure by throwing on a higher level of medical capability?
I note that even where non-doctor models are the norm, it seems most operations would ascribe to this point because they already put the highest trained or "level" of ambulance officer on board - ie paramedic. And most of this thread calls for increased training and a higher level of protocol for the paramedics.
SO what is the difference between the doctor and the high level of paramedic? Dollars?
NOT ONLY. The typical paramedic has an enormous amount of scene experience and pre hospital medical experience that just cannot be learned from a hospital ED, and the doctor brings an enormous amount of medical experience that cannot be learned pre-hospital. Surely the most appropriate model is a combination?????
It seems this thread has not discussed the fact that a paramedic/doctor can operate as an effective team bringing all the attributes that each side of this argument has so forcefully put forward.
In NSW, that is how the Sydney basin runs. The helicopters are manned by the highest level of paramedic who runs scene management, rescue situations, and enables the doctor to be protected, safe, and able to perform the medical intervention. He is also able to maintain the situational awareness re curing on roadside V getting back to the ED. He can also effectively manage medical interventions on patients in multiple casualty situations, provide a higher level of care using the scene doctor's protocols and liaise effectively with ground ambulance assets (he understands the system) to produce the most effective outcome.
The doctor is a senior trauma or anesthetic registrar or consultant who can manage the medical intervention, and rapidly provide triage. Given enough equipment, he can bring the golden hour care to the patient in a majority of cases. AND they get trained to listen to the scene experience of the paramedic and to take that advice - something that is not always part of their hospital backgrounds.
Great model if you have the resources. But it only takes one or two casualties experiencing a poor outcome per year for this resource expenditure to become viable - let alone the human value aspects!
I say "resource base" because that is what should be driving this argument. It stands to reason that having a trauma hospital ED on each traffic intersection would (in a resource unlimited world) be the ideal solution. From that ideal to having just one ED in a city of 20 million for a resource poor situation is simply a matter of the individual cost benefit analysis. And as armed with all the facts and figures as we like to think we are, we rarely get to decide on the resource allocations that settle arguments like this.
Resource base expansion enabled the ground ambulance in the first place. What a great idea to get initial medical help to the patient, then retrieve that patient back to the hospital. By doing that we don't have to build multiple r trauma centres - cost effective for the gummint and patient outcome positive.
Same argument for the advent of the helicopter air ambulance. Only now it is possible to cover a much larger area too. It has three sudden advantages:
1. The rapid transport - aka golden hour advantages as pointed out numerous times in this thread already.
2. The ability to concentrate higher medical resources quickly.
3. The ability to access (by speed or environment) patients that previously could not be accessed either at all, or in time to prevent a poor outcome.
Forgetting the rescue elements of the third point which are not really being debated here, it is this second one that could be included in our considerations. Do we spend millions of dollars on providing a rapid transport vehicle to bring more paramedics to a scene that already has paramedics, OR do we try and multiply the benefits of the expenditure by throwing on a higher level of medical capability?
I note that even where non-doctor models are the norm, it seems most operations would ascribe to this point because they already put the highest trained or "level" of ambulance officer on board - ie paramedic. And most of this thread calls for increased training and a higher level of protocol for the paramedics.
SO what is the difference between the doctor and the high level of paramedic? Dollars?
NOT ONLY. The typical paramedic has an enormous amount of scene experience and pre hospital medical experience that just cannot be learned from a hospital ED, and the doctor brings an enormous amount of medical experience that cannot be learned pre-hospital. Surely the most appropriate model is a combination?????
It seems this thread has not discussed the fact that a paramedic/doctor can operate as an effective team bringing all the attributes that each side of this argument has so forcefully put forward.
In NSW, that is how the Sydney basin runs. The helicopters are manned by the highest level of paramedic who runs scene management, rescue situations, and enables the doctor to be protected, safe, and able to perform the medical intervention. He is also able to maintain the situational awareness re curing on roadside V getting back to the ED. He can also effectively manage medical interventions on patients in multiple casualty situations, provide a higher level of care using the scene doctor's protocols and liaise effectively with ground ambulance assets (he understands the system) to produce the most effective outcome.
The doctor is a senior trauma or anesthetic registrar or consultant who can manage the medical intervention, and rapidly provide triage. Given enough equipment, he can bring the golden hour care to the patient in a majority of cases. AND they get trained to listen to the scene experience of the paramedic and to take that advice - something that is not always part of their hospital backgrounds.
Great model if you have the resources. But it only takes one or two casualties experiencing a poor outcome per year for this resource expenditure to become viable - let alone the human value aspects!
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At the risk of setting myself up for some large calibre incoming…
One common misconception that the air ambulance charities like to throw around is that they, with doctors on board can get patients to the appropriate care where land ambulances have to go to the nearest hospital. I don’t know any trusts (certainly not the one I work for) that still insist on this. If we (and I’m a lowly technician) think a patient need to go direct to a burns, trauma, neuro or cardio (PCI) centre then that’s where we take them. Granted it would sometimes be a lot quicker with the aircraft but that’s not the issue. The time docs are really useful is actually with the patient that don’t really need to be in A&E at all, such as those whose optimum pathway would be to go direct to a general medical ward, or a re-hab ward, but you don’t often get an aircraft for a generally unwell 80 year old!
Does that mean doctors are not required? Not at all, but I think they are often needed for simpler reasons than people think. If we assume that the doctor/paramedic model air ambulance is targeted at the most serious jobs then we have to think what we need at those jobs. The main feature of such jobs is that they often need more than one ambulance crew to manage the very ill patient. That’s where the problems starts, since we always work in pair or at most as a three. Where I work I average about 30 calls a week, 50 weeks a year. In the last year I have been to six jobs with London HEMS, and those have been all my serious jobs. In other words, i have seen 6 very ill people this year. All of these have involved at least 3 HEMS staff (doctor/paramedic combo), an ambulance and two response cars, and five had had a duty manager on scene. Several had additional resources such as hazardous area team, more vehicles and crews, etc.
That’s at least eight clinical staff working on the patient. Who exactly is supposed to manage that team? One of us? What training do we have to do that? In fact, what training do we have at all? My training on scene management lasted precisely three hours, and was in a section of my training course that some ambulance trusts don’t actually run at all, since it’s not required. Helmet Fire made the often quoted point above that paramedics are supposedly good at managing the situation at the roadside and doctors are good at treating patients. Well, sometimes it’s true, but it isn’t because the paramedic has had any training, it’s dependent on experience. If a HEMS doctor goes to six serious jobs a day then he will equal a paramedic of ten years experience in less than three months in this specific regard. Plus he will have a background of working in large teams from his in hospital experience. In addition, because he is a doctor, and the NHS is required to continue training him, he will have attended multiple other courses such as vehicle rescue that very few paramedics ever go on.
Yes, occasionally a doctor is required at a scene to treat a patient with an intervention that can not currently, nor is ever likely to be done by paramedics, such as thoracotamy (opening the chest to repair direct damage to the heart). However usually they are just required to turn up and get the on scene ambulance crews to work effectively together and carry out the interventions they should have been doing before the doctor got there or realistically could be trained to do, while making the general decisions about patient management (stay/scoop, awake/sedated, land/air, etc)
I’m not trying to have a go at ambulance staff, especially since I am one, but we just don’t see enough ill patients to actually know what to do when one comes along. Equally we have no effective form of clinical governance, so we never know if what we are doing is good, bad or out of date. We need doctors on these jobs to bring their management and leadership skills out to play, not because we need to be doing loads of thing to patients before they get to hospital.
One common misconception that the air ambulance charities like to throw around is that they, with doctors on board can get patients to the appropriate care where land ambulances have to go to the nearest hospital. I don’t know any trusts (certainly not the one I work for) that still insist on this. If we (and I’m a lowly technician) think a patient need to go direct to a burns, trauma, neuro or cardio (PCI) centre then that’s where we take them. Granted it would sometimes be a lot quicker with the aircraft but that’s not the issue. The time docs are really useful is actually with the patient that don’t really need to be in A&E at all, such as those whose optimum pathway would be to go direct to a general medical ward, or a re-hab ward, but you don’t often get an aircraft for a generally unwell 80 year old!
Does that mean doctors are not required? Not at all, but I think they are often needed for simpler reasons than people think. If we assume that the doctor/paramedic model air ambulance is targeted at the most serious jobs then we have to think what we need at those jobs. The main feature of such jobs is that they often need more than one ambulance crew to manage the very ill patient. That’s where the problems starts, since we always work in pair or at most as a three. Where I work I average about 30 calls a week, 50 weeks a year. In the last year I have been to six jobs with London HEMS, and those have been all my serious jobs. In other words, i have seen 6 very ill people this year. All of these have involved at least 3 HEMS staff (doctor/paramedic combo), an ambulance and two response cars, and five had had a duty manager on scene. Several had additional resources such as hazardous area team, more vehicles and crews, etc.
That’s at least eight clinical staff working on the patient. Who exactly is supposed to manage that team? One of us? What training do we have to do that? In fact, what training do we have at all? My training on scene management lasted precisely three hours, and was in a section of my training course that some ambulance trusts don’t actually run at all, since it’s not required. Helmet Fire made the often quoted point above that paramedics are supposedly good at managing the situation at the roadside and doctors are good at treating patients. Well, sometimes it’s true, but it isn’t because the paramedic has had any training, it’s dependent on experience. If a HEMS doctor goes to six serious jobs a day then he will equal a paramedic of ten years experience in less than three months in this specific regard. Plus he will have a background of working in large teams from his in hospital experience. In addition, because he is a doctor, and the NHS is required to continue training him, he will have attended multiple other courses such as vehicle rescue that very few paramedics ever go on.
Yes, occasionally a doctor is required at a scene to treat a patient with an intervention that can not currently, nor is ever likely to be done by paramedics, such as thoracotamy (opening the chest to repair direct damage to the heart). However usually they are just required to turn up and get the on scene ambulance crews to work effectively together and carry out the interventions they should have been doing before the doctor got there or realistically could be trained to do, while making the general decisions about patient management (stay/scoop, awake/sedated, land/air, etc)
I’m not trying to have a go at ambulance staff, especially since I am one, but we just don’t see enough ill patients to actually know what to do when one comes along. Equally we have no effective form of clinical governance, so we never know if what we are doing is good, bad or out of date. We need doctors on these jobs to bring their management and leadership skills out to play, not because we need to be doing loads of thing to patients before they get to hospital.
