UK Paramedic working standards

[threemilerun]

Hi,

What standards are UK paramedic working to?,,,Is it JRCALC 2006?

[Kiwiology]

JRCALC are the UK's clinical practice guidelines yes, I do believe they are due for a full update this year.

[scott33]

They have been due for an update since April 2011 and JRCALC haven't bothered their arse to make it known (officially) why there has been a delay. They current guidelines will be going on 8 years out of date by the time the new ones are published. Rumour has it that there is nothing earth shattering to look forward to. TXA, IV paracetamol are a given, though already being used in some trusts.

[Kiwiology]

Any talk of pacing, cardioversion, morphine plus midazolam, ketamine or any of the other things which are used elsewhere in the world?

Jeez, our old Coronary Care or Intermediate Care Officers could cardiovert people 30 years ago ....

[scott33]

They have morphine already IV and oral. The jury is still out regarding Midaz and Ket. May be reserved for their CCPs to begin with. Pacing? I don't think so, Cardioversion (Chemical or electrical)? No.

Most of the new guidelines will be things we have been doing for years - bearing in mind you need to be a CCP to use CPAP.

[Arctickat]

Wow, CPAP is a basic skill here.

[Kiwiology]

I am seriously perturbed at the notion that UK Paramedic will not get pacing, cardioversion and may not be getting combination analgesia (I mean real combination analgesia, a bit of entonox before IV morphine is not combination analgesia mmkay)

I mean WTF, I looked it up, our Intermediate Care Officers could cardiovert people in 1977! Although ICO no longer exists (it was turned into the "Paramedic" level which now requires a Bachelors Degree) cardioversion remains in their scope of practice, pacing would be there too if it was feasible but it's an Intensive Care Paramedic thing because they have the options of midaz and ketamine for sedation plus IV adrenaline infusion should the patient not respond to pacing which Paramedic does not. Oh and that reminds me, as far as I know, UK Paramedics have midazolam for seizures only, they do not have the options to sedate people like we do here (and is common in Australia and sometimes in US)

Do you know why this is such?

And let's not even get onto to that whole everywhere-else-in-the-world-is-strengthening-their-base-level-but-heck-in-UK-we-will-just-remove-it-all-together-and-replace-it-with-a-glorified-driver-who-is-not-allowed-to-touch-patients thing that happened with Ambulance Technician.

Edited January 25, 2013 by Kiwiology

[hertzvanrental]

kiwiology, you obviously know all there is too know about us backward medics in the UK!

Let's see:

Prehopistal thrombolysing, been doing this for years. Would of been doing it as far back as the early 80's thanks to prof Douglas Chamberlain but Brighton paramedics were uneasy as it would of meant using stretokinase.

Do you thrombolyse during an arrest! Know any where else that does?

EZ-IO + local anesthetic, my service was the first in the world to have & use this year's ago AND in conscious adults + antibiotics for MS (again first in the world)

CPAP is used by a few services and isn't just a CCP skill, admittedly it should be widespread.

Sedation, well we can sedate various drug ODs just that a lot don't bother looking at the guidelines section with it in so don't know.

Pretty hospital ultrasound

Any where else doing finger thoracostomies.............hmm didn't think so. (maybe MICA)

Pacing, it's in the guidelines but not many services do. And quite frankly I'm not loosing sleep over it. Look at the evidence for using it.

As for cardioversion, if they're in VT with a pulse and then loose it then your dc shock will sort it out any way. Again not loosing sleep over it.

Adrenaline bolus' for compromised pt unresponsive to atropine, it's in the guidelines.

Ketamine & Midazolam are coming. We've always been legally allowed to administer ketamine just not possess it. Crazy drugs law.

And considering the vast majority of 911/000/999/112 calls aren't life or death who else has practitioners who can suture/glue wounds, treat with a whole host of antibiotics, steroids, analgesics and refer to specific wards or back to community services. The only other places that even come close are wake county advanced paramedics & nova scotia community paramedics.

And as scott33 stated IV tranexamic acid will be on all vehicles. We are using it and our lot have had it while anyway along with IV PARACETAMOL which is a brilliant analgesic (we've had that for 3 years).

We also treat and refer patients all the time and have done for years.

And the JRCALC guidelines are just the basis. Each service have their own guidelines. Extra drugs IV Tramadol, cyclizine, ondansetron, diamorph (that was years ago), codeine, co-dydramol etc etc.

Syntometrine for PPH and soon Misoprostol, there aren't many places around the globe able to treat PPH.

Christ, I bet there's still overseas services still using procanamide & bretylium in arrests and for what!

You know alot of what we do is evidence based.

It does piss me off getting comments without really knowing what we do.

[Kiwiology]

Oh don't spit your tea out just yet eh bro

I shall eagerly await the next JRCALC update then ....

[hertzvanrental]

And for the record AUTONOMOUS pre hospital thrombolysis in AMI is old hat now (apart from a few services) opting for direct admission to a cath lab. We actually talk to the cardiologist on the phone, en route if we want.

Everyone keeps banging on about cardiac pacing, cardioversion etc etc realistically how many patients a shift require it? I bet there are far more patients suffering from sepsis, respiratory problems, ACS etc etc.

I mean we are so backwards in anaphylaxis we can only provide:

Oxygen

Adrenaline

Antihistamines IV/IO

Steroids IV/IO

Fluids IV/IO
Salbutamol

Intubation

Cricothyriodotomy (needle, most places - we use quicktrach, CCPs full surgical)

Probably not enough to save a life eh..........

Oh don't spit your tea out just yet eh bro

I shall eagerly await the next JRCALC update then ....

Nothing wrong with stirring it up lol

Oh and how does everyone else treat adrenal crisis.............................