What Skills Do Ambulance Crews Have?

tallaght01

So, it has been said that the Irish ambulance service is essentially a glorified first-aid service.

IN particular the ones that are staffed by firemen.

They don't give drugs, rely on automated defibrillation, dont intubate....and essentially perfom the same roles as an experienced first-aider.

what do you guys think.


These are not neccesarily my opinions. This is what I've been told by colleagues. I'm a doctor who's worked in the UK and New Zealand for the past few years.

In both places the paramedics give drugs and can intubate.

I haven't worked in Ireland in a long time, so don;t know what the reality is nowadays.

Can anyone shed some light on what I can expect if I'm picked up by an ambulance in Ireland in status epilepticus, or status asthmaticus, or in VF arrest?

cheers guys.

civdef

Hopefully someone more qualified then I can comment further, but to summarise the current situation:

Advanced Paramedics - New grade, small but increasing numbers, scope equivalent to that of other countries.

Paramedic - Previously called EMT here, the majority of ambulance service crews are at this level. Similar scope of practice to EMT-Bs in other countries, but more extensive training. Additional skills being added gradually.

EMT - New grade, principally envisaged for patient transport services and voluntary organisations operating ambulances. Equivalent to EMT-Bs in other parts of the world.

The ambulances staffed by DFB are all crewed by Paramedics with some Advanced Paramedics, same as HSE ambulances, all DFB firefighters are trained as paramedics.

tallaght01

so they've just started calling EMTs paramedics? Coz they should be two different grades, no?

I guess what I'm wondering is what they can do that skilled first-aiders can't.

I've been teaching first aiders for a long time, and the good ones can do the following....

use neck collars, splints, scoop stretchers, chairs etc

they can use oxygen and entenox

they can use an AED

They can use a guedel airway, and a bag+mask

They can use a sats monitor

They've completed moving and handling modules

They can take a BP

This is in the UK. But can our crews in Ireland do any more?

What drugs can our advanced paramedics give? How competent/confident are they at advanced airway management? Where are they learning to put lines into people?

timmywex

paramedic; former emt, they have been upskilled and this is on going,they can give drugs but not sure on what, the skills are a lot more than first aid,

advanced paramedic, as said, new grade, can intubate, give a wide area of drugs, iv im etc etc

www.phecit.ie for details on drugs etc,,,

the dfb have all paramedics, with a number of advanced in response cars also,

you may have got the idea of first aiders from people getting mixed up with the voluntary ambulances which just cover certain events and give first aid, privates are gloriifed taxi men basically, rarely using lights or sirens, doing routine transfers

any more questions, just ask, cant think of more to post, dont be afraid to ask, alternatively, you can go to www.irishambulance.net and ask there, thats full of current paramedics and advanced paramedics



edit: ok, i thought i had aloada stuff on the drugs and guidelines etc, but theyve been taken offline, and the ambulance training school website doesnt seem to want to respond either.

Dave!

Out of interest, are you in the fire services yourself timmywex?

timmywex

no, i just want to be a paramedic in a few years and know a fair bit about it as a result, im trained first aid and defib and prob know higher than that.

tallaght01

timmywex wrote: »

paramedic; former emt, they have been upskilled and this is on going,they can give drugs but not sure on what, the skills are a lot more than first aid,

advanced paramedic, as said, new grade, can intubate, give a wide area of drugs, iv im etc etc

www.phecit.ie for details on drugs etc,,,

the dfb have all paramedics, with a number of advanced in response cars also,

you may have got the idea of first aiders from people getting mixed up with the voluntary ambulances which just cover certain events and give first aid, privates are gloriifed taxi men basically, rarely using lights or sirens, doing routine transfers

any more questions, just ask, cant think of more to post, dont be afraid to ask, alternatively, you can go to www.irishambulance.net and ask there, thats full of current paramedics and advanced paramedics



edit: ok, i thought i had aloada stuff on the drugs and guidelines etc, but theyve been taken offline, and the ambulance training school website doesnt seem to want to respond either.

so where do they learn to intubate? took me ages to be able to do it. Plus there's some pretty funky drugs you often have to give when ur tubing someone.

Would be interested to know what drugs they can give though.

Can they intubate babies?

Del2005

tallaght01 wrote: »

So, it has been said that the Irish ambulance service is essentially a glorified first-aid service.

IN particular the ones that are staffed by firemen.

They don't give drugs, rely on automated defibrillation, dont intubate....and essentially perfom the same roles as an experienced first-aider.

what do you guys think.


These are not neccesarily my opinions. This is what I've been told by colleagues. I'm a doctor who's worked in the UK and New Zealand for the past few years.

In both places the paramedics give drugs and can intubate.

I haven't worked in Ireland in a long time, so don;t know what the reality is nowadays.

Can anyone shed some light on what I can expect if I'm picked up by an ambulance in Ireland in status epilepticus, or status asthmaticus, or in VF arrest?

cheers guys. QUOTE]

I was doing first aid training with some DFB men and they had recently done the paramedics course, this was a couple of yeards ago now. They where sent to the US to the full US paramedic course and also sent to the UK to get trained on the things the we do different to the US. Our paramedics have the same levels as the UK and US and can also dispense the same drugs. They started with 12, and these are now providing training to the rest and I assume they are still sending some away.

MartinC2006

I have a friend who has worked an EMT in Cork for around ten years.
I have a friend who has worked as an EMT in Belfast for about the same.

We all came through St Johns together and they took it further with careers etc.

It just so happens the friend from Belfast Finishes his Paramedic course next week.
The friend from Cork finished his advanced paramedic course a while ago.

From a lay persons observation the consensus seems to be;

UK > Ireland EMT grades in every way, driving, equipment, training etc.

However the advanced paramedic course in Ireland seems to be much better than the UK version. Training takes 3 times as long (I think), more drugs, more skills, just that little bit ahead in every aspect apparently.

The main problem being there’s not that many advanced paramedics yet.

I’ll be sure to ask my friends for a more detailed response on the differences.

Martin.

tallaght01

Was just out for a jog there and met a guy on my street who's in the fire brigade, and used to be on the ambulances.

He's semi-retired now, but his son is a paramedic (not an advanced paramedic).

He reckons his son "can give drugs".

I don't know what drugs these are, but I presume they're the cardiac arrest drugs, like adrenaline and atropine.

There's no good evidence that these drugs make a huge difference, but they probably do. So, i think it's a good idea that most paramedics can use them.

So, that's progress. This guy was telling me about how years ago when he was on the ambulances, people were just dying in the back, coz all they could do was cardiac massage.

I wonder how good these new paramedics are at getting IV access in somebody who's arrested, in order to get the drugs into the vein.

I know many many times in the UK, people came in flat, but with no IV access because the paramedic couldn't get a drip in. That's no criticism of them, getting a line into somebody with no cardiac output is often a real nightmare.

From my own biased paediatrician point of view, I still think one of the big problems in the UK/new zealand/south africa where I've worked in the A+E environment is that children's emergency care is poor. Paramedics never spend any time in a childrens ward (except the guys in johannesburg spent 5 days in a neonatal unti doing nothing). Very often, the most imprtant, and yet the most difficult thing to do, in a baby/small child is to get a drip in. It's hard enough when they're well, let alone when they're unwell. I think an advanced paramedic should have put lines into chubby toddlers in emergency situations before being let loose.

When these kids go off, they nearly always come in having had no drugs because nobody could get a drip in. Some paramedics are obsessed with intubating these kids, and spend a lot of time trying to acquite this competency, because it's one of the cooler things that you can be seen to do at an arrest. But good airway control without an ETT tube will nearly always suffice. I'd rather a kid came to A+E with a line in, having had drugs and fluid, than with an ETT tube in situ.

It's all very well to walk around with huge belts on, with cool looking equipment hanging off them, but we need to make sure we can do the basics.

MartinC2006

I think your being harsh there, you can't tar everyone with the same brush.
I for one think Paramedic's are hugely under appreciated for what they do.

I've no idea what the procedure is called but if a child was that closed down I beleive they can gain access through the neck some how?

Also from what I've gathered from my friend and he's the first to admit kids scare the hell out of him. Its very much so lift and run, no messing about just get to the advanced car asap. If theres time to tube etc on the way so be it.

Martin.

tallaght01

c'mon dude, read the post. I specifically underlined the word "some".

I don't think I'm being harsh.

I'm pointing out that I've very rarely seen a child arrive in A+E with a line in. Most of the unwell adults that come through the door have one in place.

I think that's because paramedics don't spend enough time training with kids.I think most paramedics would disagree with this.

I think you've proved my point when you say that paramedics just scoop and run with the kids. This, in my experience, happens, even when they would benefit from some on-site treatment.

You can put a line into a kid's neck if they're shut down. You just stick a cannula into a neck vein. I wouldn't really expect a paramedic to do this, though.

What would normally be used is an introasseous needle (which is a needle straight into a leg bone). I have never, ever seen or heard of a paramedic putting one of these into a kid. Of course, that doesn't mean it has never happened.

This is my point, though. There's lack of paediatric training for paramedics.

But I do have to say that the general consensus in hospitals is that the amount of kit hanging off a paramedic is inversely proportional to their competence

Fyr.Fytr

As far as i know paramedics can give gtn, glucogel, asprin, enthonox and some others. AP's can give a whole lot more they can intubate aswell

Not sure what, but i have colleagues who are paramedics and advanced parsmedics so will find out more

tallaght01

Fyr.Fytr wrote: »

As far as i know paramedics can give gtn, glucogel, asprin, enthonox and some others.

That's a pretty decent start, though.

I presume they can give adrenaline/atropine at an arrest too?

!!!!!conor!!!!!

Here's a quick overview of the current standards in Irish EMS:

Voluntary Ambulances: Currently highest level is EMFR which can use AED, OPA, BVM, O2, Entonox, KED, collars, longboard, BP, O2 sats, frac packs, can't think of anything else!

This is soon changing to new EMT being the highest voluntary standard. The standard is here http://www.phecit.ie/Documents/Education%20&%20Training/SectionE%20Edu%20&%20Train%20Standards.pdf

The drugs they will be able to give after this 4 week and 1 week clinical placement course are Asprin, GTN, Glucose Gel, Glucagon, Adrenaline, Salbutamol, Morphine, Cyclizine, Naloxone, Oxygen, Entonox and Paracetamol (some require doctor's order I believe)

Statutory/Private Ambulance: The next level is the old EMT now called paramedic. Drugs that can be given by current EMTs are GTN, aspirin, oxygen, entonox and glucose gel. The EMT/paramedic are due to be upgraded with new skills via CPD such as LMA, salbutamol, glucagon, etc.

The new skills are here: http://www.phecit.ie/Documents/Education%20&%20Training/SectionF%20Edu%20&%20Train%20Standards.pdf

The highest level is Advanced Paramedic which was known as EMT-A for a short period. This includes et tube placement, LMA, IV access, manual defib, sorry can't think of anything else off the top of my head!!

Advanced Paramedic guidleines: http://www.phecit.ie/Documents/CPG%20-%20As.pdf

Meds: http://www.phecit.ie/Documents/Medication%20Formulary.pdf

The training levels can be viowed here: http://www.phecit.ie/DesktopDefault.aspx?tabindex=7&tabid=427

timmywex

ah cool conor, i knew them yokes were on that site somewhere, just couldnt find them

tallaght01

I'm impressed witht he advanced paramedic stuff.

My concerns lie with their diagnostic skills though.

What hospitals are training these guys?

It will be a great service if they pull it off though.

sunnyjim

Some of the Advanced Paramedic lads went abroad to do a Diploma. I think that UCD are accrediting something too.

EDIT

http://www.ucd.ie/genpract/preview/cicsemta.htm

http://www.ucd.ie/pgstudy/news/2006_april/042706_paramedics.htm

Some reading on the UCD side of things.

Tango Alpha 51

tallaght01 wrote: »

I'm impressed witht he advanced paramedic stuff.

My concerns lie with their diagnostic skills though.

What hospitals are training these guys?

It will be a great service if they pull it off though.

Tallaght01,
Let me put your mind to rest. To become an advanced paramedic takes the guts of another 9mths on top of your basic training. Also you have to be 5yrs post qualified as a paramedic before you're even considered to be able to go forward for training. They spend alot of time in theatre & various hospitals in Dublin, Limerick etc learning how to intubate, cannulate etc. The list of drugs that we (Paramedics & Advanced Paramedics) give is undergoing review every year. Yes, years ago, people were loaded into ambulances & taken to hospital without much intervention but things have changed drastically for the better. I can also assure you that my partner (an Advanced Paramedic) would have no problem cannualting a paed if neccessary & he is more than competent to do so. For long enough we had the medical profession holding back our development because "they didn't want us playing" with their toys. We as in Paramedics & Advanced Paramedics don't profess to be doctors but personally I found your colleagues comments about us as a "glorified first aid svce" to be offensive & unprofessional to say the least. Both ourselves(HSE National Ambulance Service) & the DFB Ambulance Service are professional in every respect & you can't equate our role to a first aider. Lastly I can assure you that if you do ever have an arrest in Ireland or a status epilepticus or indeed any other ailment that if an ambulance does come for you, that you will be treated with the upmost respect & professionalism & treated to the best of the crew's ability.

tallaght01

buzzman wrote: »

Tallaght01,
Let me put your mind to rest. To become an advanced paramedic takes the guts of another 9mths on top of your basic training. Also you have to be 5yrs post qualified as a paramedic before you're even considered to be able to go forward for training. They spend alot of time in theatre & various hospitals in Dublin, Limerick etc learning how to intubate, cannulate etc. The list of drugs that we (Paramedics & Advanced Paramedics) give is undergoing review every year. Yes, years ago, people were loaded into ambulances & taken to hospital without much intervention but things have changed drastically for the better. I can also assure you that my partner (an Advanced Paramedic) would have no problem cannualting a paed if neccessary & he is more than competent to do so. For long enough we had the medical profession holding back our development because "they didn't want us playing" with their toys. We as in Paramedics & Advanced Paramedics don't profess to be doctors but personally I found your colleagues comments about us as a "glorified first aid svce" to be offensive & unprofessional to say the least. Both ourselves(HSE National Ambulance Service) & the DFB Ambulance Service are professional in every respect & you can't equate our role to a first aider. Lastly I can assure you that if you do ever have an arrest in Ireland or a status epilepticus or indeed any other ailment that if an ambulance does come for you, that you will be treated with the upmost respect & professionalism & treated to the best of the crew's ability.

I think you're taking this all very personally.

The medical profession are the ones teaching the bulk of the courses listed above. I doubt we ever used the phrase "don't want you playing with our toys".

I think we have to be careful who we let use potent drugs. I'm in favour of first responders being able to give drugs. I've spent most of my career working in countries where paramedics are the norm.

I do, however, understand from the above that you guys spend 6 weeks in hospital. I'm not sure if that's "a lot of time".

I also have always worried about the over-confidence of some paramedics. To say your colleague would have no problem in cannulating a kid is a good example of this.

I'm a paediatric registrar, and have worked loads in neonates and ITU and A+E. My consultants and I would never ever say we would "have no problem" cannulating a kid. If you have ever tried it during a resus, you'll realise what a nightmare it can be. I have taken up to 45 mins getting IV access into a newborn (not even during an arrest!).

The remark about first-aid people having a similiar skill set was probably a reasonable comment, considering the pre-hospital situation at the time. there were no drugs, and no intubations/cannulas a few years ago. Therefore, I don't see the difference.

What drugs can your basic paramedic give (ie not the advanced guys, coz ther'es only like 20 of them in the country isn't there?). We've seen lots of lists about advanced paramedic drugs here. But what about the guys who I'm most likely to meet if I go into status?

Dave!

Might be just my good self, but I'm detecting quite alot of hostility from most of your posts in this thread so far tallaght01... Again, might just be me.

tallaght01

well, you might think I'm being hostile, but I'm in favour of pre-hospital drug admin.

People are easy to accuse others of hostility, when difficult questions are being asked.

All I want to know is...

1) what drugs an I likely to receive if I keel over now. ie what can the current paramedics give me?

2) Why is there not more than 6 weeks of clinical placement in the training course?

3) Why is there not a paediatric placement that last longer than a few days, because a lot of the A+E depts where they do their placements won't see kids presumably.

4) Why don't we focus more on some of the more problematic procedures, such as cannulating babies/toddlers/infants

When people can answer these questions, then they can accuse me of hostility.

Shield

DaveMcG wrote: »

Might be just my good self, but I'm detecting quite alot of hostility from most of your posts in this thread so far tallaght01... Again, might just be me.

Hi tallaght01.

I see where DaveMcG is coming from but I think I know why.

You are obviously very experienced in your field. Perhaps even an expert.

I don't think there's hostility in your posts, but I am detecting some frustration.

In my opinion, questions 2, 3 and 4 can't be objectively answered unless the person/people who designs the course(s) comes in here and answers you directly. Some people who have done the course(s) may be able to suggest answers to you, but I'm starting to think that suggestions are not acceptable to you at your level, or what you're looking for.

tallaght01

Totally agree psni.

I am frustrated about what's coming through the door in other countries.

I don't blame paramedics one iota for this.

The course design is obviously outwith their control.

What annoys me sometimes, though, is that when I raise any kinds of issues like this with paramedics where I've worked, the same replies crop up again and again....

"we provide a VERY prfessional service"

"medical professionals feel threatened by us"

"We can intubate/canulate easy"

I think they should be responding by saying they'll audit how many kids come in with IV cannulas successfully placed (obviously not including those who don't need one) etc etc

I think they should be challenging themselves and looking at their own performance constantly, like the rest of us have to do.

Having said that, it may well happen in Ireland. It may be a great service. i hope it will.

But we have to be open to questions and scrutiny, or else standars slip.

Shield

Yeah you don't have to tell me about being open to standards and scrunity. I'm in one of the most scrutinised police forces in the world. Scrutiny is good, but you can be over-scrutinised too.

Back to your topic - I'm in no way qualified to even speculate. Just as long as you're aware that your frustration is coming through in your posts, and those who are in the job may see that as an affront and go on the defensive as a knee-jerk reaction.

Having said that, I do hope someone can provide you with directions to the answers you're looking for.

tallaght01 wrote: »

Totally agree psni.

I am frustrated about what's coming through the door in other countries.

I don't blame paramedics one iota for this.

The course design is obviously outwith their control.

What annoys me sometimes, though, is that when I raise any kinds of issues like this with paramedics where I've worked, the same replies crop up again and again....

"we provide a VERY prfessional service"

"medical professionals feel threatened by us"

"We can intubate/canulate easy"

I think they should be responding by saying they'll audit how many kids come in with IV cannulas successfully placed (obviously not including those who don't need one) etc etc

I think they should be challenging themselves and looking at their own performance constantly, like the rest of us have to do.

Having said that, it may well happen in Ireland. It may be a great service. i hope it will.

But we have to be open to questions and scrutiny, or else standars slip.

Tango Alpha 51

Tallaght01,
Let's start again. Your right in that standards do have to be maintained.

1) There is over 100 Advanced Paramedics in the svce at the moment out of a total staff complement of 1300 or thereabouts.

2) The AP program has only been up & running for the last 2-3 yrs

3) As for paramedics, upskilling etc, the following is by no means an exhaustive list of drugs:

a) oxygen
b) entonox
c) aspirin
d) glucopaste
e) glucogel
f) salbutamol
g) diazepam pr
h) IM Morphine

+ others. I'm on nights at the moment & have been working for the last 18hrs already so am tired but will dig out the material & post it for you.

The PHECC have decided that cannulating & intubating along with the frontline cardiac drugs are the standard that they want us at in the next yr or so. Personally can't see that happening due to budgetary restraints but we are trying.

I never stated that cannualting or intubating was easy & trust me try to cannulate someone in car that's on it's roof in a mangled condition is far from easy but we do the best we can & yes we are human & miss from time to time.

In relation to my posting about my partner's ability, I can only speak from personal exp of watching this person do their job. The paed placement for paramedics was only 1wk but we are led to believe that the whole paramedic syllabus in Ireland is changing for new entrants into the svce where figures of up to a 1yr in clinical placements are being bandied about.

We are audited here in Ireland by the PHECC inrelation to our PCR's etc & FTP committees are in the process of being set up.

You might have your performance monitored where you work but I can tell you that up to very recently once you qualified as a doctor & if you set up a GP practice in Ireland, there was no further accountability on your part either.

We are advancing the Pre Hospital Emergency Care side of things in the svce in Ireland & like everything else it takes time but we will get there.

I understand your frustrations at times with paramedics but equally we're frusrated by some of your colleagues totally dismissing us out of hand as not knowing what we are talking about. We have the exp of working the road in sometimes very hostile & difficult situations & unlike yourself who has the support of nursing,medical,trauma teams with a full range of diagnostic equipment & ancillary support svces withing the hospital setting, we have only each other with limited equipment to do our job.

tallaght01

I'm sure it will get there, buzzman.

IN fact, it has the beginnings of a good early drug delivery service.

I think the framework for serving adults is already in place,and will be effective.

I'm still concerned about the paediatric side of things. I don't think it's neccesarily a disaster waiting to happen or anything, but I think you'll agree that 1 week of paediatrics isn't sufficient. Presumably we can agree on that much? I'm glad they're talking of extending it.

I've cannulated people in ambulances and in car wrecks (even in a lift with no lights and a pothole :P). But this is all the more reason to have trainee paramedics in A+E literaly doing every cannula in the place for a number of weeks. I even think paramedic trainees should go on-call in hospitals out of hours, whereby they're the ones called when a cannula needs to be replaced on a ward...coz they're often tougher cannulas than A+E cannulas. I know you guys have no control over that side of things though.

Also the argument that GPs haven't been audited over the years cannot be used in this context. You have to be your own advocates here. What would you audit in a GP surgery? It's difficult to know. Hospital docs have always been audited. Many of us meet every month and discuss every patient who has died or has been seriously ill in the previous 4 weeks. We have to stand up and present the case, while a team of our peers question us.Not many health professionals do that.

Paramedics will be easier to audit, as they have a more easily definable role compared to that of a GP.

I'm not sure why you think many of my colleagues dismiss you out of hand. All docs have the golden hour concept drilled into them from medical school. I have to say I've never had the chance to dismiss a paramedic out of hand, because the only time I meet paramedics is when they're handing over a patient at resus, when we're usually not arguing about the skills of paramedics. Other than that, you guys usually hand over your patients to the nurses. But if you look at the paramedic discussion fora in some of the UK sites you will see that there is a cohort of paramedics who think they know more medicine than doctors.

I hear there's now a motorbike in Dublin? Great idea. We need more. We've been using them in the UK for years. Great way of getting a defib to the scene quickly. I was once at a hotel in the UK when a guy arrested. Within minutes the bike was there. Coldn't believe how fast it was. He was had the AED on, and I had the line in and the tube ready within minutes of the fonecall, despite there being crazy traffic outside. It was a great service.

emedd

tallaght 01 - there is a tone in your posts which is confrontational. maybe you don't mean it to be there, but it is.

all the information you want is on the phecc website. only APs an give ACLS drugs at present.

all pre-hospital clinical practice guidelines are drawn up by phecc and continuing professional development (including audit) is becoming a part of this.

audit is important in the context of a GP as any other health professional. if you think the role of a GP can't be audited, you need to go back to college.

do you audit your paediatric cannulations?

it is not possible to train pre-hospital practitioners for every eventuality. a balance has to be struck between what commonly needs to be treated and what is rare enough that it is not worth spending resources and time on.

the majority of paediatric presentations are not life threatening (in contrast to adults) this may reflect the bias towards adult rather than paediatric experience in the AP course.

tallaght01

emedd wrote: »

tallaght 01 - there is a tone in your posts which is confrontational. maybe you don't mean it to be there, but it is.

all the information you want is on the phecc website. only APs an give ACLS drugs at present.

all pre-hospital clinical practice guidelines are drawn up by phecc and continuing professional development (including audit) is becoming a part of this.

audit is important in the context of a GP as any other health professional. if you think the role of a GP can't be audited, you need to go back to college.

do you audit your paediatric cannulations?

it is not possible to train pre-hospital practitioners for every eventuality. a balance has to be struck between what commonly needs to be treated and what is rare enough that it is not worth spending resources and time on.

the majority of paediatric presentations are not life threatening (in contrast to adults) this may reflect the bias towards adult rather than paediatric experience in the AP course.

When you ask tough questions, you're always acused of hostility.

When I present at our mortality and morbidity meeting, the tone taken is somewhat similiar, but I don't keep telling people how hostile they are, I get on with it.

If you think me saying that it's difficult to audit the overall practise of a GP is the same as saying GPs can't be audited, then you need to join me back at college. I've been involved in GP audits. But GPs patient demographics are widely different, and the co-morbidity of their patients are too. A GP in north innner city dublin will loose a lot more patients every year than a GP in Blackrock. How do you audit Gps when they deal with people having emotional crises etc. I just said it was more difficult than auditing the role of the paramedic. I stand by that.

Yes, I have been involved in/been at the presentation of several audits about cannulas and central lines. It's big business in paediatrics. I personally haven't been audited since I was very junior. But it's very rare that a child on a ward who needs a cannula doesn't get one at all. The same can't be said for the pre-hospital environment.

The majority of paediatric nor adult presentations are probably not life threatening. BUT you would honestly be amazed at how sick a baby can be without many symptoms. The signs can be very subtle. My last meningitis case was in a 5 month old baby. Ity was missed by everyone...paramedics...A+E staff...would have been missed by me if I wasn't a paediatrician. I am constanly sent children (babies in particular) who nobody thinks are sick.

Traumadoc

The ambulance service in Ireland has improved in leaps in a very short time,
The service in Australia and Newzealand is very impressive, it is difficult to get into, two years in college followed by a further 2 years training.
Emts are paid very well, and are superb.

The Irish system is changing very rapidly despite huge obsticles placed by various vested interests. It is largely driven by the enthuaism of the ambulance staff to advance the service.

BeardyGit

I attended some medical training recently in the UK that's specifically designed for mountain rescue personnel. The purpose of the training is to enable MR team members administer drugs when appropriate. The course syllabus is decided upon and taught by A&E registrars and consultants from a number of hospitals in the UK where they're only too familiar with the consequences of inadequate pre-hospital care. Unfortunately, this training and certification from the RCS isn't recognised in Ireland, and we're unable to give ANY drug, even if it can make a big difference to casualty care and outcome. We attend the training to ensure we're staying right at the top when it comes to our speciality - It's unfortunate that the training can only be put to use if we're assisting on a job in the UK (incl. NI of course) The drugs I can administer IN THE UK ONLY include Diazepam, Difene/Voltarol, IM Morphine, GTN, Glucogel, some Athmatic meds etc.

Here in Ireland, we can't even legally give an asprin for a suspected MI.

The pre hospital emergency care in this country leaves a lot to be desired to be honest. Unfortunately, until hospital doctors and consultants get off their arses and start making some noise about the widespread restrictions placed on those of us who actually pick up the pieces before bringing them to the A&E, we'll never get anywhere.

Your own interest in paediatrics is distracting you from the bigger picture I fear - and I believe you're getting caught up in your own interests instead of trying to do the most, for the most. I would say that consultants and hospital doctors spend more energy chasing better conditions and contracts for themselves instead of demanding better training and less restrictions at the pre-hospital stage. Sorry if that offends you, but I really believe many of your peers get caught up in the little details and their own circumstances, rather than actually going out of their way to help improve the situation for ALL.

With respect Tallaght01, your replies on this whole thread simply highlights the contempt with which 'the rest of us' are treated by the medical professions. You show little knowledge of what it's like to actually work on the ground in a multi-disciplined unit, in a REAL frontline environment, yet you appear to believe you're qualified to judge the service provided by paramedics and so on. If you disagree, I'd love you to actually state your professional experience, so we may decide ourselves if you're qualified enough to judge. Your credentials alone are insufficient to protect your comments from legitimate and well reasoned criticism, so put aside your ego for a while and actually explain how your professional experience leads you here.

Right now, all I'm seeing in you is arrogance and contempt.

Gil