zippyRN

it's not going to happen in the USA until you can bill for it ...

surely this represents one of the problems the fact that Paramedics aren't necessarily working under their own licence / registration ... i think this discussion has not taken up the fundamental differences between the 2 havles of medical direction for EMS /Ambulance services part 1 - strategic - strategic medical direction will remain a Medical only or medically led ( along with providers) function unless and until such time as Paramedic ing is a fully graduate profession and managers / leaders are post graduate prepared part 2 - tactical /operational medical direction - while it's useful to have a physician available for this function a proportion of this - especially if there is any amount of "mother may I ?" left in the guidelines can be carried out by an advanced practice Nurse or Paramedic ( remembering that advanced practice Paramedics are a reality or a near future proposition on the right -pond ( Uk practice both ECPs and a paramedic background critical care practitioners) and dununder as well as Canada... in Uk practice there is a degree of clinical advisor work in many Controls from Registered Paramedic Responder manager / ECPs working as clinical triage advisors, as ECP dispatchers and/or control supervisors , plus a number of Services air ambulance controllers are paramedics with air ops experience

Nursing diagnoses has come up in this discussion perhaps unsuprisingly , needless to say nursing diagnoses as an art form seems to be an particualery American art, although we i nthe Uk do do nursing diagnosis it;s not anal-ised to the point that NANDA seems to be Of course none Medical Practitioner helathcare providers diagnose - what we don't often do is provide the final diagnosis everytime

like most things it depends on how it;s done there is No way a Medical Director should be anyone other than an approrpaitely qualified and fully trained as a Specialist Medical practitioner ( i.e. board certified Attending, CCST holding Consultant/ Qualified UK General Practitioner ) in an appropriate field and have a a pre hospital care award as well ( e.g. DipIMC/FIMC for the Brits) in terms of a 'medical control' bod / Clinical Advisor there is not reason why an advanced practice Nurse or Paramedic ( where paramedics are Higher Education prepared health professionals) or a PA cannot fulfill that role as a sounding board to request advice or authorisation especially it's to go outside the Standing order/ protocol/ clinical guideline.

part of the issue is the fact we are rapidly reaching the point of no further with premature babies, for many years 23 to 24 weeks has been the boundary of viability, and we haven't progressed much further in terms of good outcomes for babies delivered before 23 weeks ...

there is an arguement that neither need a emergency ambulance trip, but then again to take the devil's advocate role there's an arguement that many emergency ambulances in the USA would not count as emergency ambulances elsewhere in the civilised world ... intellignet transport policies is whatitls aobut - what can be transported by the single responder or Emergency Care Practitioner in a car / people carrier/ SUV , what can be transported by PTS or middle tier what requires transport by a 'full' emergency ambulance ... alternative pathways are best designed on a system wide basis with the knowledgeand consent of medical direction, other stakeholders in thehealth secotr ( hospitals, primary care etc ) and theorganisatiosn you will be referring to ...

as we are on a bit of an inhaled analgesia tip nitrous oxide is available pre mixed with O2 50/50 in the Uk under the brand names entonox (boc) and equanox (linde medical gas), the BOC offering includes CD ( carbon wrap ) cylinders which are increasingly usedinstead of D size in portable applications for both Entonox and oxygen ought really to add that both Oxygen and entonox adminstration are add on roles for first aiders, so entonox is in use by all sectors of the UK ambulance business

look at UK practice a lot more 'passive' light through the use of reflective livery film all emergency services personnel have good hi vis overgarments issued ( EN471 class 3 in most cases)

sounds like an error of history taking there was head / neck trauma in the history for that young man rather than the typical pattern of people who wake up one morning with their neck turned and can't straighten it up ... no history of trauma and often very apparent muscle spasm on physical examination as for immobilisation in the ED it's only taken me 2 years to convice people that if you want to immobilise you do it there and then - i.e. collar and inline stabilisation at the initial assessment desk then controlled movement onto a trolley brought to the patient's side ... rather than walking them around the ED and then immobilising ....

keep them all running , possibly cancel the other BLS vehicle once you have an ETA from the ALS vehicle or keep them running and then stand them down once the ALS vehicle is on scene ... as the other driver warrants at least checking over if not transporting if the patient is stable the answer with extraction is let the trumpton do their worse with the extrication kit ... however relative entrapment requiring formal extrication is an indication of the damage sustained

sounds like they do... that said i have been known to remove kit from storage when on site at events and pack the trolley up like is being suggested ... ( particularly trauma intensive events ) one issues with taking loads of kit out of storage / not havign it strapped down is it affects the crashworthy status of the vehicle ( all the locker frames and catches are 10g on the newer vehicles) that said most of us have our own role/skill level appropriate bags which would tend to be the bag that went in to the patient along with defib and Oxygen ...

not a big fan of JS - expensive, and after this i don't think anyone in a uniformed public service role will be too chuffed with them http://www.arrse.co.uk/cpgn2/Forums/viewto...sc/start=0.html tea wise drank PG for ages then got a cracking deal on some typhoo back on thePG from later this week as the typhoo runs out...

most of urban England is never more than a couple of miles from a curry restaurant or takeaway - there's half a dozen within a mile of where i live at present and for the past 10 years i've never lived more than a couple of miles from one ... ( there's also 3 fish and chip shops, 3 pizza places and 2 chinese takeaways within a mile of the current zippy residence)

now now SOMedic it's a valid point - bystander intereference is a problems regardless of who and where you are in the world, it's not entirely to do with this thread though ? there seesm t o be a concept amoung USAn posters that having physician support isautomatically a bad thing - sometimes it definitely is like messing aobut trying to 'stabilise' someone who needs to be in the Operating theatre for their belly opening ASAP ... other times it's a case of bringing appropraite skills to the party or providing skills that in some palces are undertaken by ambulance staff but in a more controlled way and in line with the concept that a patient deserves thesame minimum level of skill from an operator doing a procedure regardless of location unless there's an overwhelming reason to depart from that standard...

and the relevance of interference of bystander Health professionals to a discussion aobut the role of suitably skilled health professionals as a planned part of a system's response to calls is ???

the only time scene time is bad is when the 2 indicated drugs are oxygen and diesel = i.e. the patient needs to be i nthe operating theatre or the cath lab ... sometimes even when this is the optimum outcome it ain't going to happen - absolute entrapment is one , that said on occaision bringing the doctor to the patient has worked even when not absolutely entrapped - the chest that London HEMS cracked open on a pub floor - then there is the issue of how safe is prehospital RSI when performed by someoen who doesn't have hundreds to thousands of anaesthetic done as their skill base ( i.e. the specialist qualified ( consultant or attending) medical anaesthetist , the very nearly specialist qualified medicla anaesthetist ( the final year or coupleof years of specialsit training ) or the CRNA )

first responders are great at first responding ... but they need to be backed up pretty rapidly there is an arguementy that EMT_B is way too low a levle esp if only the bare minimum syallbus is covered ( elsewhere in the civilised world there are foirst aiders with 150 hours of training and who have another 100 + hours of trainign before they get let loose on an ambulance )

apoint is reached where the cost / benefit analysis stops paying off for a small percentage of jobs havign a Doc at scene is invaluable, e.g. - anaesthesia - entrapment where amputation is the best extrication option ( that said you could do a through joint with a scalpel, a suture kit and a pair of shears) - medical management role in mass casualty incidents in event work havign the full range of health professionals is very useful particularly where event safety regulation ask you to minimise the impact on local regualr EMS and ED services ...

rules of trauma teams -no baby docs ! EXCEPT Emergency Dept ones specialities wise - middle grades or seniors or don't play... and we will throw the baby docs - one voice at a time and most of the time that will be the Emergency Doc who is team leader or the Senior Nurse - as few hands on the patient as possible / sensible - if a doc spits the dummy expect to be thorown out by the team leader and spoken with by the senior nurse... - the person with the head calls the shots over moves and hands regardless of 'rank'

at the monet the one i have i got ... chip calibration and storing the machine and strips at room temperature wehreever possible -folliw the guidance the manufacturer gives given the occasions i've foundout of date strips with glucometers on NHS vehicles .... it;s never really presented as an issue as anyone with a significant need for a BM should get it repeated at the ED anyway

as has been said gloves, keys, radio, phone, tourniquet.... depends what level of provider .... i caryy a glucometer becasue it's within my scope , it's not within the scope for 'lay members' therefore they aren't on the vehicles - the QATs and Health Professionals carry their own becasue there isn't one o nthe vehicles ( with one exception - the immediate care team car - but that doesn't go out to play without suitable HCPs on board) a blood glucose is a useful primary observation on collapsed and /or acutely confused patients and any unwell known diabetic and a secondary observation on most unwell patients...

prolonged transport time - especially it the lawyers are going to chase you for pressure sores ... in theory could stay on the vacmat all the way to the OR ...

something to do with the 8 - 10,000 GBP pay cut and unless EMS / ambulance services want to continue to be low status jobs seen as 'van drivers with first aid certificates' to Quote Ken Clarke ... what is the purpose of EMS gettign the right care ofr people or beign the big White taxi service ...

yep - like i said for volunteer providers one of the biggest overheads for the organisation is providing the appropriate level of cover for staff an enclosed private event doesn't necessarily have to becovered by the statutory provider - infact in the UK one of the requirements for event licencing by the local authorities ( city / metro district or County) is to demonstrate adequate EMS and other safety and security measures ( including fire fighting and police/ security) are in place as not to diminish the cover offered to the locality by the general tax / local tax funded services depends o nthe exact situation with responsibility - the Uk event safety guide places the responsibility for safety within an event on the organisers - if the risk assesmsent says thisevent will generate a lot of extra work ( e.g. a music festival with a on site popualtion of 100, 000 people in a rural area) then you have to provide a lot of cover including treatment centres on site with resus trolley spaces and other ED type facilities )- where a small event in an urban area ( say 5- 10 000 people at a concert or a small sports event e.g. local teams in lower divisions of leagues or high school teams) you might only need half a dozen first aiders, an Ops officer and an ambulance or two

maybe it's an area to look at for your agency or even as a business for yourself and ssome of your coworkers or if you wuz real nice and charitable like set up a voluntary agency and fundraise in your locality to enable you to cover 'community' events at cost or even below cost if you have good charitable income and then top up income by charging a competitive price for 'commercial' events there's two models really to consider - core staffing doing mainly the admin and command roles and casual employees of all grades to work at the events ( from first aider,sthrough first responders, basics, intermediates, Paramedics, RNs , NP/ PA/CRNA and emergency / intensivist Doc plus logistics and comms staff) - runs as a business get some vehicles sub contract or dry hire others or all volunteer with kit and vehicles funded from charitable giving ( pay back cheap(er) cover for community events) and from cover for 'commercial' events - where often the biggest overheads will be running the office and paying the insurance