zippyRN

unless your chosen method of delivering the health professional to the call was the RRV to assess, triage and then hand off to an approrpaite transport unit ... i know ALS RRV has a bad reputation in parts of the US - particularly the NJ system economies of scale and appropriate management of the service if you look at the UK and Aus you have big ( hundreds of units , thousands of staff) services run by / as a part of the Health System the old county services in the UK were considered 'too small' yet many were 10 times the size of some US services

an escorted ALS transfer only needs and ambulance and an emergency driver if the escorts know what they are doing - some of our Neonatal and Paed ICU transfers i nthe Uk work on this basis of 'retrieval' where the team goes ahead with their kit in an RRV and prepares the patient for transfer while their dedicated transfer ambi follows on driver only and unescorted ALS transfers would be done by paramedic ambulances as part of their general role it's a matter for the service planners whether they choose to dedicate vehicles or not there. depends - in the perfect system a propertion of the paramedics/ PHRNs and advance providers would be in RRVs so if you don't have a paramedic ambulance a transfer vehicle could come out and transport with the Healthprofessional crewing and the other crew mwmber of the transfer vehicle following in the rrv ...

a 'perfect' EMS system? let's see the obvious aim is to deliver the right provider, in the right vehicle to the right patient in a timely fashion it means having a Calltaking system which has greater sensitivity and specificity than AMPDS - or we have to accept the over triage that AMPDS provides. the perfect system would also have triage advisors in control who can upgrade or downgrade questionable calls - traige advisors would be pre hospital Health Professionals ( probably mainly Paramedics, Nurses and the advanced practice versions of same) the perfect system would aim to get first responders to truly life thereatening calls in 4 or 5 minutes and those first responders would be dvanced first aiders with AED + medicla gasses or EMT-Bs the perfect sytem would aim to deliver an Ambulance and a Paramedic or other prehospital Health Professional ( i.e. PHRN ., Advanced practice Paramedic/ PHRN or field physician) within a suitable time frame - the UK uses 14 / 19 minutes based oan an arbitrary 'urban ' or 'rural' standard ... the perfect syem would have a number of types of ambulances ranging from ACA/ EMT-B transfer buses controlled by the Emergency control ( rather than PTS control) through middle tier vehicles, to Technician vehicles (QAT / PCP / EMT-i with fewer invasive intervnetions) and Technician and emt-I 99 / Paramedic vehicles... some of the paramedci ambulances i nthe service may no have wheels instead be helicopters the perfect system would also be able to deliver care at the point of need where this is most appropriate and cost effective e.g. wound care for those who would require transport back home as well as to the ED the perfect system would empower all it's health professional staff to make some direct referrals to speciality and to take patients to the most appropriate recieving hospital not the nearest one with a decent ED and allow advanced practice providers and field physicians freedom to organise direct admissions for the majority of patients who need admission and don't require resus room care. the perfect system would support not transporting patients whose clinical condition does not warrant transport, ED attendance etc... the perfect service would offer alternative transport methods after face to face assessment by the health professional provider - (hence the ACA/EMT-B transfer trucks mentioned earlier) The perfect syem would be able to provide full critical care 'at the roadside' where it;s indicated e.g. MCI , entrapment RTC, other entrapment scenarios and be able to contribute meaningfully to technical rescue and USAR

that is SOOOO wrong!

sez the man with the picture of the cat hugging the boy as an avatar yeah, i know hobbes is different !

garbage men, to quote an old yorkshire saying - where there's muck there's brass! meter readers - utilities are businesses and it's in their interest to make sure that they bill for what they do ... mailman - again it's business delivering letters and in populous areas there's money to be made from providing the service ...

every call an ALS provider attends recieves an 'ALS level intervention' -i.e. patient assessment and examination by an ALS provider... once again the debate has become intervention centric rather than considering the global skill set of the provider this becomes very noticable when one considers systems which use Higher education prepared Paramedics ( e.g. more and more of Canada, Oz and the UK) or Post-graduate specialist practitioner RNs (i.e. Dutch / Scandinavian systems ) as the ALS provider on ambulances ...

in the evil socialised medicine world of rightpondia Ambulance Service Emergency Drivers spend 120 hours on driver training alonge on top of the 150 -200 or so hours for middle teir or 250 -350 hours for the tech grade of training. Thiose driveing for the volunteer sector are assessed against the standards so often wil spend similar amounts of time on driver training and similar amounts oif added up time on clinical training, needless to say there are none emergency patient transport crew or first aiders with extended roles who have more than 120 hours of clinical training ... Please find me one single quote from here where anybody said anything even remotely approaching that silly statement. It hasn't happened. And your failure to see and think this through rationally does nothing to make anybody feel more comfortable that you are a critical thinker, qualfied to assume responsibility for the lives of our most vulnerable citizens.

a lot of places start from NEXUS criteria or increasingly the Canadian C-spine guidelines for choosing whether to immobilise or not - it's in JRCALC v4 (which is directly relevant for us rightpondians) the question is - it is geneuinely a case of 'clearing the C-spine' depends on a number of factors -is this patient ever going to get Irradiated for it? quite possibly not if they have no distracting injury as NP/Doc in the ED is going to use the exact same rules to rule in /rule out ... for the interest of the leftpondians, antipodeans and anyone else the JRCALC guidelines can be found at http://www2.warwick.ac.uk/fac/med/research...006/guidelines/ http://www2.warwick.ac.uk/fac/med/research...trauma_2006.pdf

blue angel - pretty irrelevant to Uk based OP who regardless of whether they choose a Nursing of paramedicine programme will come out the other end if successful with at least 1. 2/3rd of a honours degree 2. registration as a health Professional ( either NMC for nurse or HPC for Paramedic) 3. a good chance of a AFC band 5 job in the NHS as for the ridealong stuff - join SJA or BRC and get some real exposure to EMS work ... ( the major events can provide more expeirence in a couple of days than a week or even a month of the rubbish calls that pervade EMS world wide )

sit down scott... need a cup of tea mate????? spot on with your observations and in terms of the stuff aobut Uk paramedics being actual real proper Health professionals they really are... "mother may i" never happened in the UK and was buried competely in 1999

UK paramedics are paid the same as other registered health professionals ( as Uk paramedics are registered health professionals) the NHS has a far better profile than the fire service who are best known i nthe Uk for going on strike, tumble drying recruits and polishing their helmets and poles ;-) ... Higher education preparation for practice in UK paramedicine is however still relatively new ( that said the first UHerts direct entry cohort started in 1998 and graduated in 2001/2 so they will now be 5 or 6 years post registration, there are direct entrants fro mthe even earlier Sheffield uni course who are out and aobut but they had a hard time due to poor course design and failure to meet certain criteria so effectively 're started' on entry to a service - that said one of the guys is now a fairly senior training officer )

epends on hjow the law views 1. competence 2. saying some one is not competent 3. who can say someone is not competent (police? Health professional? - does EMS caount as a health professional;? specific mental health trained health professionals / social workers?) and finally whether other legislationcan be used initially to detain and treat someone who is intoxicated ( i.e. nick them 'drunk and incapable' and take them to theEmergency dept where they can be assessed )

intoxication is normally a reason for mental health services to refuse to assess someone and you have to rely on 'common law' powers or the legislation relating to drunkenness to detain / treat etc the intoxication

this is not a management decision a decision on whether sonmeone can or cannot undertake a role is ultimately down to to the occupational Health Doctor , in the case ofthe OP i'd expect the decision to be taken after the OP had been assessed in 9simulated) practice by a training officer and an ergonomicist ( preferrably a Physio or OT ergonomicist) ...

or perhaps none backwards by restricting the practice of none professionally qualified 'trainers' ( i.e. not a physiotherapist or a qualified teacher with subject specialism as a Sports / phys ed teacher) from attempting to practice as a professional that said the fact the trainer 2 ticket referred to is a FE qualification indicates a degree of attainment even if the practical role is felt to be limited

Rid you're the muppet here a temporal temp is not a tympanic temp qand it falls down from there what is the evidence base you fail to cite and the 'power' of that evidence the temporal artery is pretty close to the surface over the temples - there are thermometers available which take advantage of this to provide a quick, simplenone invasive but more accurate than tympanic , less prone to PEBKAC than oral temps we use the exergen (www.exergen.com) in all settings in the trust I work for although Critical Care areas do have invasive temp measurement available ... there are also other things to consider when advocating invasive tests as a baseline ...

the obvious answers - advanced practitioners - to maintain parity with advanced practice in other none Physician Health care jobs ... - educators - to demonstrate backgeound knowledge in excess of the degree or nearly degree preparation for practice of operational staff - managers -not necessarily post grad clinical qualifications but instead MPH / MBA in healthcare management etc...

real life job RN in 'unscheduled care' directorate - was in the ED now working assessment unit ... another commonwealth type who began EMS volunteer career at 10 years of age with SJA although you aren't properly operational as a First aider until you are old enough to take the 'adult' FA cert

standard advice to drunks or diabetics treated at events - go and sget something proper to eat - remind the daibetics about complex carbs and bafle the drunks ...

living reasonably close to both UVG and Angloco plants at present I tend to see odd glimpses of quite a few of the UK's new Emergency vehicles a current vogue for ambulances is notto have grille ligths but have dash lights - the whole eye levle thing - and 'corner' lights at bumper level ( so they are visible when you poke the nose ofthe vehicleout of a junction... realistically driver training needs to be there - at least an advanced / defensive driving course and some supervised mileage building for none emererncy drivers and for emergency drivers that plus some instructed mileage building with a proper emergency driver trainer over at least acouple of days if not a week or more - much in the way that the added up time for most Uk emergency drivers is somewhere between 2 and half and four weeks of driver training

Uk practice is generally diesel powered vehicles, usually renault masters or Merc sprinter 414/ 416

refusing or delaying transport requires approrpaitely educated providers in the Uk one of the main benefits of the ECP role is that inapprorpaitetransports can be minimised , andsome services are now extending this to paramedics and event QATs, the important thing to remember is that Uk paramedics are 'proper' Health professionals , ECPs anre generally either RNs or Paramedics and even the UK tech has a hell of a lot more training and education than US EMTs... i am involved with a town centre project on friday and saturday evenings - two pronged strategy 1. provide emergency care quickely 2. minimise inapprorpaite ambulance and ED use ... refusing or delaying transport is again down to a n RN , Paramedic or Doctor to decide ( depending which health priofessionals are available to the scheme )

i think bushy's description of 'retained' working is apt in the uk we have retained FFs - they are paid a certain amount for training and being available forcall and then paid by the hour when called out ...