zippyRN

flying the doc on HEMS or having the doc in a (high powered, professionally driven) response car is a more effective force multiplier and doesn't deprive the service of an Ambulance... the doc primarily brings skills and knowledge to scene , plus a few procedures and drugs (primarily anaesthesia, formal chest driange plus 'salvage' surgical procedures)

the UK has gone down the route of providing 'health' resources for the hot zone as it was felt that the levle of care available under a 'only firebods in the hot zone' model was insufficient especially if it;s not a full blown 4 -service major incident ( police, fire ambulance and the rest of 'health')

all need to balance their books ... here in right pondia the police authority and fire authority will be expected to balance their books ... other local authorirty services are expected to generate a 'profit' whether that is a 'surplus added to reserves' or via the famous 'efficiency savings' ruse ... many of the attempts to decouple none emergnecy and emergency ambulance services i nthe Uk have failed dismally as the private none emergency provider cannot provide the required service in a cost effective manner under competitive tendering... normally becasue they can't provide the emergency / critical care transfers required by the hospitals /PCTs at a viable cost when decoupled from the 999 work ... In the U.S., every single "Public Utility Model" EMS system that set up to monopolise transfers in order to offset EMS expenses has FAILED. It's time we let this silly notion go.

you might think it;s funny, but it is true and accurate. Have i said that - no i haven't ... i have pointed out that 1.professional regulators expect registered Professionals to provide emergency care in line with their skills and competencies ... 2. the presence of another provider does not discharge that duty of care unless the skills and competencies of the other provider are much more, even then it still doesn't ... or perhaps the Nurses and HPC registrants who take the flack for the failures of Higher specialist trainee Doctors (Specialist Registrars - for out left pondian colleagues - the very senior residents or the post board certification fellows) ... 3. there's a great deal of difference between what is expected to be the actions of the 'ordinary man professing to hold the special skill (of being what ever profession)' where that 'special skill' is being a radiogrpaher or clinicla scientist ... and when that specialist skill is being a Nurse, ODP or Paramedic who works in emergency care and has demonstrable skills knowledge and experience in emergency care. I have not stated this , it is an illogical and without basis conclusion you have drawn by extrapolation so you don't have ot admit that you are wrong and well off the mark, because it damages your precious paramuppet ego. You are so full of shit nremtp and that post proved it. You have no credibility whatsoever and on the basis of that one post alone you have proven what an idiot you really are no they wouldn't buy they might beleive that a Nurse or ODP with extensive emergency care experience both in and out of hospital and the qualifications and evidenced professional development to support it is better trained than someone who has had 6 - 8 weeks of clinical training ... have i said that ? i don't think that i have, i have however pointed out that despite whatever you may consider the Rregistered Professional's duty of care is not discharged until a proper , appropriate and in the best interest of the patient plan of care is in place and being carried out. pot and kettle springs to mind there , a response typical of so many paramuppets when faced wit hthe reality that they do not have the ability or right to swan into a situatio nand metaphorically whoop their cock onto the table..

999/911 is direct tax/ subscription funded so 'third' service ... the rest of it is a business with the contracts negotiated with 'health' you njeed to build a sustainable business around the emergency service

third service (obviously) but with good links to 'health' no for good financial reasons build a sustainable business patient transport business unit -patient transport (local) including ED 'take homes' -long distance transfer -critical care transfer -organ /recipient/ team transport emergency care business unit - 911 Ambulance service - 'middle tier' ambulance service (local) - responders both 'first responders' and (ambulance professional) 'rapid responders - Alternative Response (Emergency Care Practitioner model - if can be made to work financially given left pondian setting) - Specialist immediate care (HART/ USAR / Specialist medical team / tactical) -HEMS access and service support business unit - 'call centre' functions - HR functions - overall business management - fleet support training business unit - continuining professional development - PTS training - 'middle tier ' training - EVOC training ( emergency tier training contracted out to Higher education with significant number of joint appointments 'lecturer practitioner') see above - both 'patient transport' and middle tier / emergency tier Guidelines service provided, access available at all times ( both Physician and Clincial traige advisor Paramedic/Nurse) but not required for any routine reasons - would also be available to scene via HEMS and specialist immediate care team -volunteer /retained First responder? - basis of PTS staff training see above in partnership with local higher education institution ...

check the date on that article (1999) crippen really is the worst kind of reactionary ... he is an old scholl doctor who thinsk that nurses shoudl stick to wiping arses and ambulance drivers should stick tp driving and polishing their ambulances ... a five year old document - so how many year old Data ? paramedics i nthe UK have beend doing ROLE for several years without the requirement ofr a physician to attend scene - certification of the cause of death still remains in the hands of Doctors and the Coroner.

competencies are defined by St John Ambulance HQC14/07 , however the syllabi are 'restricted - commercially sensitive' documents time frames are explicitly stated for the contact time delivering the teaching associated with each set of outcomes. it will take several years but at each stage First aider, advanced first aider, Patient transport attendant , Emergency transport attendant you are required to consolidate your experience and to some extent 'repay' the investment that has been made in training you so far. traning to 'first aider' level takes at least 4 full days, topping that up to advanced first aider takes a minimum of 2 more days the PTA course is at least another 4 full days ( and often more depending on the learning needs of the group - the course that ran last year in the county i volunteer with included a couple of extra days for consolidation and scenario based training and this was by no means a 'remedial' group - including At least one Nurse, one 3rd year medical student one (non health or life science )PhD student, and several other graduates ...) the ETA course is a further six full days minimum on top of that ... the PTAand ETA courses are required to have a Paramedic as course leader although specific subject trainers within that and within the continuation training include other health professionals, ambulance technicians and layperson trainers. exactly what interventions compared to core EMT-B would those be that are missing ( charcoal BTW is a none starter as it's not a JRCALC drug ...)

in UK law thart isn't allowed, which is why paramedic drugs are either under the statutory exemption fro mthe medicines act that allows Paramedics registered with the HPC to carry and adminster certain prescription only medicines or by a patient group direction which is a legal mechanism to allow ahealth professional who isn't a prescriber to supply and or adminster a Prescription only medicine please read the following statement carefully , it is from The NMC code of professional conduct: standards for conduct, performance and ethics "1.3 You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional." this document is the core professional standard for Registered Nurses ... "regardless of advice or directions from another professional" means that even if you were told by another registered practitioner ( of what ever profession) to do something or not do something which is in the best interests of the patient you may still be held liable as a Professional. http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=201 your information is incorrect, given there are systems in place to record and recognsie professional registration and post basic development and expansion of roles , and hand in hand with this comes the authorisation (or at least lack of prohibition_ from undertaking interventions, making assessments and adhering to professional standards of practice not lay person standards ... why then are Nurses and other HCPs within SJA required to be present at certain duties or taskings to provide their professional input and make triage, interventions, hospital admission, and discharge decisions... from the previously cited document "As a registered nurse, midwife or specialist community public health nurse, you must: protect and support the health of individual patients and clients protect and support the health of the wider community act in such a way that justifies the trust and confidence the public have in you uphold and enhance the good reputation of the professions." "8.5 In an emergency, in or outside the work setting, you have a professional duty to provide care. The care provided would be judged against what could reasonably be expected from someone with your knowledge, skills and abilities when placed in those particular circumstances." http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1571 makes interesting reading

it depends on their competencies doesn't it ... the point that seems to be being missed repeatedly is ... that a registered practitioner of what ever profession's duty of care is notdischarged by the simple presence of another provider AND, IF the other provider is not registered, the registered practitioner may well beheld accountable until thepatient is delivered into the care of another registered practitioner it depends on how the PGD is written ... they can be as broad or as narrow as the professionals involved in drafting them wish them to be... e.g. the analgesia PGDs i use at work are extremely broad in their scope covering traumatic and non traumatic pain with few if any additional cautions and contra indicatiosn over and above those in the BNF so the choice of a range of analgesia ( and local anesthesia agents) given alone or in accepted combinations isn't autonomy? incorrect . correct but by virtue of the theft act rather than medicines legislation and incorrect if i acting on behalf of a mutally 'employing' trust... incorrect on both counts have i actually said that... except of course when required to do so as part of my role and with the full knowledge and consent of management... you need to recognise your limitations in not acknowledging the scope of practice of your professional peers. incorrect vis PGDs and similar guidelines vis independent prescribing ... (alkthough i am not at present an independent prescriber) if techs can anyone can , there is NO specific mention of Ambulance technicians in any legislation , altewrnatively if others can't techs can't... the primary problem being the lack of case law and wolly worded statements from the MHRA, which can appear to change the meaning of the Medicines Act. only if it is on the statutory exemption list. Incorrect incorrect , no prescriber can issue a direction to adminster a medication to a patient they have never met. Paramedics can NEVER prescribe , they can only adminster in line with the stat exemption and supply / adminster in line with a PGD. administer and supply medication through statute. the exact same statement can be made with reference to any registered health Professional. Chiropodists cannot prescribe they can adminster drugs under a medicines act exemption, this is not prescription. I have nothing further to say to you exacept go away and actually read the legislation in question as your knowledge of it appears to be extremely limited.

you obviously have great difficulty reading to understand , so i will repeat myself once again the NMC code of professional Conduct states the following ""1.3 You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional. " therefore you cannot discharge my duty of care without proper communication ... if you as so many NHS crews try ( and later regret when they get disciplined ) try the 'the REAL ambulance crew are here now' line ... you will be the one in front of management and /or the HPC Incorrect. Incorrect, see below see also the Code of professional Conduct depends if you have trust ID and are known to the trust as CFR/ immediate care scheme ... oddly enough last time i came across an 'off duty' situation ... I was returning the vehicle after the end of a Support shift and came across a patient who had been assaulted. I rang comms and spoke to the comms manager who 1. put us back on duty 2. offered us the option of transporting the patient on the basis of our initial findings. 3. did not activate any additional resources unless we requested them . then there is also the issue of RN containing crews on support work who are sent to do transfers that require 'paramedic' transfer not becasue of their life threatening condition but because of 'the rules' preventing middle tier and technician crews from transferring patients with IVIs or other infusions... so i'm not sure how that fits with your incorrect assessment of the role of the RN /ETA. then there was the bollocking a recieving Emergency department got over an SJA crew on support who had auscultated a chest and taken a Blood sugar reading (few years ago before the current course ref listening to chests) but had failed dismally to note the fact that the attendant ( who wasn't me! ) had documented in the all the appropriate places that she is an RN...

note my emboldening also note that should someone happen to be there when contracted to an NHS organisation... it doesn't apply also you need to consider the situation where the person you claim is 'obstructing' you is already on scene and by virtue of that already has a legally ( and professionally ) established duty of care

one ofthe problems in rightpondia at least is that a nurse will be held to his /her own scope of practice regardless of off duty or on, the only real get out is lack of equipment ... also in rightpondia no health professional can 'order' any other health professional to do anything ... also if a paramedic doesn't turn up to scene the nurse will be held accountable for the patient's care until they reach hospital, regalrdess of whether they travel or not, as it can be held that the nurse delegated care to non-Health Professional provider especially if the Nurse in question has demonstrable emergency care skills, knowledge and experience...

says who ? an independent prescriber can prescribe in any situation, can issue private scripts, can order drugs for their own use i nthe same way docs can... Then you walk round to the Dr and say sign this ....authorising your interventions. Sure, it's not the right way to do things but that's what happens....I know this as my partner works in A&E in a major hospital.

doing 999s and Urgents on support work? i've done One day of PTS for SJA in the last 5 years, i 've done Hundred + shifts of ambulance support and same again or more of event cover ... doing the town centre stuff it;s pure 999 work (or would be if we weren't being used instead of 999 - we are dispatched on the pubwatch/ shopwatch radio system) wrong ! all initial assesment interventions under taken in the ED or on assessment units are undertaken without being authorised by a doctor first , unless you suggest that the fact the consultants are consulted aobut the standing procedures and the content of PGDs ... the chest pain pathway prior to primary PCI in our locality was entirely Nurse led (now certain patients are sent direct for PCI by paramedics and others are being emergency transferred from the ED for primary PCI) and the Cardiac NPs are all independent prescribers... as are an increasing number of the ENPs ... or a PGD, or by virtue of being an independent prescriber ... just like the Nurse background ECPs ... rubbish , RNs can and do intubate , the numbers who are confident to do so are limited partly because we can't get the theatre time to get the practice to be able to provide a bolam /bolitho proof standard of practice i would remind you of the following statement from the NMC code of professional conduct "1.3 You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional. " i would remind you of the following statement from the HPC's Standards of Performance, Conduct and Ethics "As a health professional, you must protect the health and wellbeing of people who use or need your services in every circumstance. ... 6. act within the limits of your knowledge, skills and experience and, if necessary, refer on to another professional; ... 7. maintain proper and effective communications with patients, clients, users, carers and professionals; You must take all reasonable steps to make sure that you can communicate properly and effectively with your patients, clients and users, and their carers and family. You must also communicate effectively, co-operate, and share your knowledge and expertise with professional colleagues for the benefit of patients, clients and users." Nurses here are fully autonomous and work under their own licence. They can practice even when they are not on duty - and, indeed, would be expected to if needed. once again those claiming to be UK paramedics have demonstrated an inaccurate and incorrect understanding of thescope ofpractice of the Registered Nurses, based it seems on the assumption that the core skills of the registered Nurse on registration are the only skills they have and that Nurses some how need the permission of Doctors to do anything ... the only 'permission' that a ( none- prescriber) Nurse 'needs' from a doctor is to administer prescription only medicines not covered by PGDs or other arrangements... virtually everything other intervention is either a matter for the employing body or general professional standards this is why the term 'orders' is not recognised in the UK in relation to the plan of care suggested by a doctor ...

Unless i'm an indepdent prescriber... or have a relevant PGD ... or it;s a schedule 7 drug... or it's 'technician ' drugs which could be given in the same lregally grey means as techs do... or it;s a 'P' list med oe GSLA med ( nitrates are P list ...) you are incorrect in all your assertions here exactly... hmm other than practice placements to consolidate a few skills that i have but can't declare full competence on and access to a small list drugs which could be PGDd or dwarfed by access to the near enough full BNF via indepdent prescribing .. as someone who undertakes invasive procedures on my own initiativate is an IR(ME)R referrer adminsters medication on my own initiatives i really don't see what i gain from your suggestion. the primary issue here which you seem to have ignored is a failure to recognise that Nurses can and do do everything you can do and more ... your lack of insight into nursing is remarkable... iI would remind you of the quotes imade earlier from the code of professional Conduct particularly "1.3 You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional. " the other interestign fact is that despite your assertions that nurses are 'Doctor's bitches' you are required to hand over to Nurses becasue it;s the Nurses who undertake initial assessment and initial management in both the emergency department and Assessment unit setting ...

since you aren'rt prepared ot listen to what a current serving SJA officer is prepared to say there's littel to justify continuing the debate yes youth units get involved in fundraising - generally for their own activities drill is a part of the cadet program but then again it's part of most uniformed yourth organisations program any SJA youth leader attempting to impose religious viewpoints would find themselves on a quick train to outsville... there is no religious basis to the program ... i think peopel are confusing the Order and SJA if they suggest otherwise ... have a look at the current cadet training programme and remember that young members can access adult training from 16 and can in theory be a PTA at 18 ...

not UK SJA ... looks like singapore or possibly Canada let's carefully skirt around uncle sam's misguided children and the 'silent drill team' ]

vision , mission and values http://www.sja.org.uk/sja/about-us/vision-...and-values.aspx not the complete lack of religious reference in the 'mission' Annual review and report http://www.sja.org.uk/sja/about-us/annual-reports.aspx relationship between Order of St John ( which asa british order of chivalry is a 'christian ' organistion and SJA http://www.orderofstjohn.org/sja.htm SJA activities http://www.sja.org.uk/sja/about-us/our-work.aspx Civil Contingencies - http://www.sja.org.uk/sja/about-us/our-work/flood-help.aspx http://www.sja.org.uk/sja/what-we-do/emergency-response.aspx First responders http://www.sja.org.uk/sja/about-us/our-wor...nfield-nfr.aspx http://www.firstresponders.fusiveweb.co.uk/ http://www.wcas.nhs.uk/services/resp_stjohn.htm SJA lay members and medication adminstration http://member.sja.org.uk/hqc/download.asp?...006&doc=PDF http://member.sja.org.uk/hqc/download.asp?...006&doc=PDF training outcomes and current training doctrine (zip file) http://member.sja.org.uk/hqc/download.asp?...007&doc=ZIP civil contingencies/ Ambulance support http://www.sja.org.uk/sja/about-us/our-wor...tim-helped.aspx http://www.sja.org.uk/sja/what-we-do/emergency-response.aspx SJA and peads retrievals -http://www.cats.nhs.uk/pages/meet_team.asp#3 picture of one the cats ambulances http://www.ukemergency.co.uk/ambulance/P1140196.jpg SJA and ambulance support http://news.bbc.co.uk/2/hi/uk_news/wales/5238326.stm http://www.communigate.co.uk/brad/sjab/ other syllabus materials to address things such as traction splint are not freely available on the web, part of the problem of having relevant content secured...

see previous post SJA is not an event EMS organisation SJA does undertake this work and often 'footprints' all EMS activity in the area surrounding the event as well ... attending calls passed on by the statutory service incorrect incorrect members are required to demonstrate competency as a First aider / advanced First aider before progressing to ambulance training , thenyare then required to consolidate experience at the PTA level before progressing to ETA level. this has been determined by the Paramedics, and other Health Professionals who undertook the curriculum design dfor the current Ambulance training package incorrect - traction splints are an outcome for ETA levle crews if thecounty uses them - because not all NHS services use tractionsplints for very good governance reasons , in the same way that not all nHS emergency Ambulance personnel are permitted to undertake this incorrect i'm not aware of any NHS ambulance services giving charcoal either - in part due to shorter transport times and also in light of UK clinical guidelines (it's not a JRCALC drug) LMA not a role undertaken by NHS techs in many services combitube not used in the NHS ... incorrect because there is no legal route for supply at present , in fact NHS use by techncicians is in a legal grey area even if the MHRA have said to individuals that they would not persue the matter . They are however, the masters of the sling and swath. Although their training is limited, SJA will happily take on people who are already health care professionals (HCP's), whether Paramedics, Doctors or RN's. This is where Zippy comes into play, and this is where the truth is fogged about the SJA volunteer's scope of practice. incorrect statement pull t'other one it;s got bells on ...

no it's any time you make patient contact and the case law from UKCC hearings suggests that not getting involved to your level of skill / available resources can result in professional discipline against you , equally there is the potnetial for anyone who 'removes' a registrant from patient care unless there is clear grounds to suggest they are dangerous and /or incapable may have fallen foul of part 4 of the NMC code ( if an NMC registrant) and the equivalent part of the HPC or GMC equivalent documents ( if covered by those professional regulators)

of course not , it;s just another opportunity to slag off Nurses ... oh and captian, so far managed to avoid wrecked semis other than on the training ground ... been involved in plenty of other RTCs as a care provider though

and -Emergency ambulances under contract the NHS Ambulance service (exact arrangements depend on the individual services some services treat SJA vehicles as full A+E vehicles, other treat them as 'middle tier' vehicles and only send to Urgents and cat Cs , but allow Cat A ( by AMPDS but not actually life threatening) or B 'running calls' to be assessed and transported by the SJA vehicle ) -First responders under contract the NHS ambulance service -Alternatives to 999 under contract to local authories / licencees association with the full support and agreement of the NHS Ambulance Sefivce and recieving EMErgency Departments - the Transport side of several specialist neonatal and paediatric retrevial services - Formed Specialist mobile medical teams - additional Resources under trhe provisions of the civil contingencies act to both Health bodies and local authoritis so much so that they clamour hand over fist for SJA members to join the NHS Ambulance service so much so that they use SJA as their preferred source of additional resources in many places so much so that they will 'foot print' areas to SJA cover around events the issues are not with 'professional EMS' they are with a vocal minority of muppets employed by NHS ambulance services ... and play out some ofthe issues seen with respect to leftpondian tensions between volunteer and paid services.