zippyRN

the ones you don't keep getting called to unless you do admission to acute hospital transfers...

Hiogh school and uni Sports seems to have a far bigger pull in the US than it does elsewhere .. but then again look at the NBA, NFL and top line professional baseball - limited numbers of franchised teams vs say the Uk (soccer) professional and semi -pro football leagues - 5 leagues wwith truely locally based teams ( the only team that's moved more than a couple of miles is the old Wimbledon now MK Dons ) 110 or so teams just in Soccer then there's both codes of rugby and the County cricket cicrcuits - a lot more access to 'professional' sports when you look at the gates for some high school and definitely college teams in the US they are comparable with lower and mid flight professional soccer gates in the Uk and some of the really big college teams in the US have as much if not more pull than professional games so you have the morbidity and mortality of the spectators as a much more relevant factor in cover calculations sounds aobut par for the course in everythign except club / semi-pro motorsport particuarly bikes and side cars where the offs are a big part of the 'fun' - equally banger racing can be fun as well from that point of view motocross is very very different ...

timmy's list sounds good to me as well spot on also does the event have a med dir / hon. MO ? quite a lot of events we provide ambulance cover for have their own Docs / seperate arrangements, after we got caught out we now ask for the professional registration number of any health professional supplied by the event unless we know theindividual personally or it's one of our 'preferred ' contractors ... valid points all valid points also do you have fall back arrangements for things like oxygen ... some events of this nature include podiatrists and physios i nthe event medical team wrt comms - if you havea 'repeater in a trailer' type set up this is ideal for these kindof events as you can optimise location and and the antenna rigging for the geography

DIN compliant stryker M1?

with 40+ casualties why has not one requested MIO, MMT and MST ?

the primary purpose of a olice force is to 'protect life and property' - welfare checks are part of that EMS is Emergency MEDICAL Services - also realistically the police or whoever provides technical rescue are more likely to have methods of entry tools never seen an ambulance with a 'big red key ' (enforcer door ram) but most MoE trained police officers will have one in the boot of their patrol car

i'd agree with that one of the things i gradually changed practice over at the last ED i worked in was - if you immobilise someone at triage - you do it 'properly' i.e. maintain neutral alignment , a properly sized collar and transfer them onto a trolley at triage then sandbag/ HEAD blocks and tapes before moving to a exam room

the simple answer is 1. you weren't at the scene - therefore you are relying on the descriptions of others 2. seatbelts and airbags do work - don't forget EU spec airbags are different to US ones in activation criteria , size and inflation pattern due to the fact that seatbelt wearing is legally mandated and generally followed ... also EU standard lap and diagonal intertia reel with pyrotechnic pretensioner seatbelts are of a higher standard than some US seatbelts 3. JRCALC GUIDELINES do not 'require' spinal immobilisation just because someone has been in an RTC and the airbags deployed if the crew at scene were able to apply the immobilisation decision algorithim documented in JRCALC and satisfy themselves that the patient does not require immobilisation ( and the consequent risk of airway compromise, raised ICP, pressure damage, and the other iatrogenic sequalae of immobilisation ) http://www2.warwick.ac.uk/fac/med/research...006/guidelines/ 4. the uk has legislation that requires medical exposure to ionising radiation to be justified, if the ambulance crew ( remembering that UK paramedics are clinicans in their own right by virtue of their professional registration with the HPC) and the emergency department were able to adequately clear his neck BY CLINICAL EXAMINATION then x- rays or a scan are not indicated ... current UK head injury imaging guidelines were adapted from US guidelines to limit the number of CT scans performed - but have increased substantially the number of scans performed in the UK ... 5 . some chest wall discomfort is quite common following an RTC where airbags and /or pretensioners fire ...

with the notable exception of physicians mosrt health professionals in the USA spend a farir amount opf time saying that either the legislation controlling that profession or another ring fences certain interventions for certain professions rather than the open ended approach to scope of professional practice seen elsewhere

how about no volunteers on 911 calls , unless 1. it's out i nthe sticks where volunteer Ambulance crews back up the paid, health professional paramedic / emergency care proactitioner ( i.e. advanced practice paramedic /PHRN) 2. it's solely as COMMUNITY first responders and strict no whacker / wanker rules over POVs doesn't work - paramedic or other Pre-hospital specialist Heal;th professional on every call, other roviders are there to act under his /her direction also a single license mentality limits the possibly of developing advanced practice

god forbid the medical director might actually want to support service delivery or support his /her crews during / in the immediate aftermath of a really nasty call ... also what about the medical incident officer at MCIs - a logical role for the service MD epsecially if s/he isn't one of the senior docs at a likely recieving ED

most Uk Ems personnel NHS, private and volunteer wear green either trousers and shirts which are simialr to BDUs in cut and construction those not a camo pattern 'tellytubby suits' had their day aobut 10 -15 years ago ( my spare SJA greens are a telly tubby suit) it's really just helimed that wear them now for aviation type reasons rather than anything else retroreflective bands, beading even embrodiery / screen printing is entirely possible however to meet the visibilty and reflectiveness standards you tend to need a garment specifically designed to do the job - the European standard is EN471 which is simialr to the old BS6629

You cannot enter the ETA course without the underpinning First aid skills and knowledge - however they are part of the competencies required. the ETA course is not 'six evenings' long the minimum permissable time for PTA to ETA is 6 days ... the minimum times given are inadequate in many cases or rely on the whole course being extremely well motivated and to havedone most if not all of the theory learning in their own time baseless and unreferencable information is exclude and ignored wrong ! I am a registered Nurse,. I hold a number of emergency and pre-hospital care sepecific additional qualificatiosn and certifications the thousand plus hours i have spent over the last few years doing A+E ambulance work as a contractor for NHS ambulance services must be an illusion, as must the several hundred hours of town centre project work where i am seeing ( and often disposing without reference to the NHS ambulance service ) undifferentiated Emergency patients must be an illusiuon as well, as must the large events where we 'footprint' cover and see St john ambulance does allow nurses to adminster drugs withon the bounds of UK law several NHS services have had their fingers burnt over technician drugs ... SJA is heading the same way i don't see many techncians referring on SJA duties, neither do i see them requesting X rays at large events , closing wounds, nor caring for level 2 or 3 critical care patients ... I don't see any techncians on SJA duties undertaking clinical manager roles, neither are they allowed to undertake a number of other Health Professional only interventions or procedures... you only need to read some of the stories and experiences posted my memberso f the forum of their volunteer all EMT-B or even not EMT services with paramedic backup suppled by helimed flying from upto an hour away ... just becasue big city ems based fire services saturate their coverage areas... as for not involved in EMS - you are entitled to your opinion ... but opinions are like rectums , most people have one and a good proportion ofthe time they're full of faeces

an SJA crew has considerably more than 120 hours of training zero to hero... the minimum required by the USDOT EMT-B curriculum is somewhere in that area EDIT: sorry i over egged the 120 hours for the USDOT curriculum it's 110 as can be seen in the nhtsa EMT-B currciulum document ( pg 7) http://www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pdf Uk PTS crews whether NHS or VAS, or reputable PAS have in excess of 120 hours training and only do PTS work given that SJA crews have access to the nHS service for support , assuming there aren't HCPs on duty with them rather than being potentially 'the help' for tens of not hundreds of miles ... 200 + hours training and can call on help which will arrive in 14-19 minutes if not 8 vs 120 hours and potentiall no help for hours ... in terms of the equivalence or otherwise of SJA ETA to QATs - the standards expected of ETA crews when assessed in practice or in other assessment is equivalent ( IHCD) question bank isn't used for theory assessments anymore, but the questiosn are equivalent - per the Senior registered Paramedics who wrote the SJA question bank... the principle differences in scope are drug therpaies and AED vs manual defib, there are other stumbling blocks usually down to the more developed clinical governance structures in place within SJA ( e.g. issues surrounding glucometry are down to percieved (and in some localities actual) inability to assure best practice is maintained ... ) HQC14/07 demonstrates current SJA training doctrine and given induction trainign which doesn't actually qualify anyone to do anything is a 'full weekend' (16 -20 hours ) ... the 'Total First Aid ' course is 28 contact hours or 6-8 hours completion onto top of a FAW (24 contact hours) and doesn't include the casualty handling and AED competencies required ... currently the Ambulance training courses are required to be overseen by a Registered paramedic as well as the requirement for all counties to have Medical, Nursing and Paramedic Senior volunteers to fulfill the clinical/ medical direction functions...

the Uk does not have staff as poorly, inadequately and briefly trained as EMT-bs ... even our PTS staff have the 120 -160 hours of training middle tier and volunteer secotr crews have 200 or so hours of clinicla training + driver training the rapidly heading toward extinction technician grade has 300 + hours clinicla training + driver training and has few invasive skills ... Paramedics in the Uk are registered health professionals it is exrememly hard for none EU residents to get jobs in the Uk health service at present ... priamrily due to work permit rules

interestign that no-one has mentioned supraorbital notch pressure as a painful stimulus and one that doesn't leave marks!

40 weeks on top of the 3 year / 4600 hr RN adult pre-reg as per the EU directive IIRC

the six years is the minimum zero -to -hero in the dutch / scandinavian system an EU directive compliant 4600 hours in 3 years (2300 practice hours) general / adult Nursing pre-reg programme, some past basic consolidation in emergency and critical care areas and then a Masters degree to get the advanced practitioner status forthe 'paramedic role'

don't forget i nthe scandinavain, /dutch systems the RN as paramedic is considered an advanced practitioner in his /her own right and from what i've seen have more options that UK / Aus types who are paramedic as health professional

mature services are generally larger services if you consider the UK there are now about a dozen services covering the land mass of 'great britain' - often covering 4 or 5 English counties and i nthe case of Wales and Scotland a single national service , NIAS is a single service for the whole of ulster , Iom, Guernse, jersey each have a single servicei Australia is in a similar position with each state having one or two services ( IIRC it's VIC that has 2 services metropolitan and rural)

there are no excuses for on duty personnel to be drinking or to have consumed alcohol within a sensible period before duty (at least 8 hours , quite probably more and themore you've had the longer theperiod needs to be ... little or no point getting wound up a bout a beer or a glass of wine ar 2200 when you areo n duty at 0700 - but a serious drinking session ending at midnight when you are on duty at 0800... ) there are no real excuses for off duty personnel to consume alcohol on station etc ... 'on the premises' might be a little different - imagine a service with a community hall on the same parcel of land - is this on the premises or not ? to be brutally honest there should be no issue with unopened sealed containers of drink being stored in people's own vehicles in the car park ( assuming they don't respond in them - when it becomes part of 'work') or in their lockers ... would you do the same for a sealed packet of cigarettes although you have a no smoking on duity / on station rule ... ?

that pay for a Paramedic would be in pounds anmd the basic pay rates quoted exclude unsocial hours payments and are based arounda 37.5 hour working week

UK model is interesting here effectively obselete standard saying you should be assessed within 15 mins of arrival current standard saying that people should be out of the department within 4 hours either admitted or discharged ... strategies to achieve this 1. empower the RN at the initial assessment - provide initial drug therapies ( analgesia /glucose is almost universal, otherp laces include Nebs etc range and scope varies - often 2 seperate sets for those who are assessment trained and those who are NP qualified - be able to refer to alternative sources of care ( Walk in centre, OOH primary care... ) - be able to fast track certain presentations for specialist consultation ( usually by specialist NPs) ( mental health with no physical health profblem, early pregnancy, cardiac) 2. preemptive bed booking for obvious admissions 3. observation units - where the ED manages the bed base and the beds are ring fenced for patients under the care of the ED docs but can provide a ward bed environment rather than Ed cubicle 4. - order bloods - extremity and in some places CXRs