Medical CPGs 3rd edition

Hooch

3rd edition Clinical Practice Guidelines for anyone whos interested.

http://www.phecit.ie/DesktopDefault.aspx?tabindex=0&tabid=1352

Elessar

Good stuff, thanks.

Some of the layout of the EMT looks different to the pre-printing copy I have, but I can't see any actual changes?

E: Is it actually signed off now?

Elessar

Good overall CPGs but some of their decisions regarding EMTs baffle me. For example EMTs not being allowed to use pressure points to control hemorrhage?

boomer_ie

There is one that has me chuckling namely the EFR can only assist a Practitioner to deliver a normal childbirth, they wont have a choice if they are the only one there!

I have noticed that EFRs can no longer check pupils and Blood Pressure, by looks of things they cannot use de-esclation and breakaway skills (surely they too run the risk of coming across difficult patients to put it politely)!

Can anyone tell me what the "Authorised subject to special authorisation as per CPG" means? Who gives this authorisation? Why is a BVM included in this?

Having said that the new skills / med document is a good document to have in that it spells out exactly who can do what so there can no longer be any confusion over who can do what. (leaving aside the Special Authorisation thing above which is from what I can see already being abused by some places).

DubMedic

Dare I say it's about bloody time.

.

boomer_ie

DubMedic wrote: »

Dare I say it's about bloody time.

.

It takes time to create something like this but I agree with you it is/was badly needed. At least now everyone will be singing from the same hymn sheet with little / no variations based on intrepatations which Ive noticed on one course taught by a voluntary org lately.

The next stage is to properly protect the titles and create a register for EFRs, just pray that the same mistake thats been made in the UK is not made here in that in the UK its an offence to claim you are a registered paramedic but not to claim that you ARE a paramedic.

DubMedic

boomer_ie wrote: »

The next stage is to properly protect the titles ,in the UK its an offence to claim you are a registered paramedic but not to claim that you ARE a paramedic.

At least the UK has a justice system that works.

.

Hooch

Elessar wrote: »

Good stuff, thanks.

Some of the layout of the EMT looks different to the pre-printing copy I have, but I can't see any actual changes?

E: Is it actually signed off now?

Yep up and running....nothing really changed for EMT. Its listed what changed for Paras and A/Ps. Check out intro in EMT CPGs for good abrevation list.

boomer_ie wrote: »

I have noticed that EFRs can no longer check pupils and Blood Pressure, by looks of things they cannot use de-esclation and breakaway skills (surely they too run the risk of coming across difficult patients to put it politely)!

Can anyone tell me what the "Authorised subject to special authorisation as per CPG" means? Who gives this authorisation? Why is a BVM included in this?

EFRs can still check B/P by Palp but not ascultation. (it must be ascultation for practitioners as A/E and PHECC want a higher level....EFRs B/P would not be looked at)

Special Authorisation means that certain CPGs authorise EFRs to use the BVM. And other CPGs where practitioners can use it, EFRs cannot.

boomer_ie wrote: »

The next stage is to properly protect the titles and create a register for EFRs, just pray that the same mistake thats been made in the UK is not made here in that in the UK its an offence to claim you are a registered paramedic but not to claim that you ARE a paramedic.

There is a register for EFRs held by PHECC but no PINs are issued as EFRs are not considered practitioners.

Hope this helps
NGA

Hooch

Elessar wrote: »

Good overall CPGs but some of their decisions regarding EMTs baffle me. For example EMTs not being allowed to use pressure points to control hemorrhage?

Afraid of their life that EMTs would have the ''POWER'' of these magical skills!!!:rolleyes::rolleyes:

boomer_ie

DubMedic wrote: »

At least the UK has a justice system that works.

.

Pop over to ambulance999.co.uk and you will see a lot of the registered paramedics are unhappy with the way any HPC registration complaints are dealt with by the HPC so sadly even that does not work properly. By the sounds of things its being used by vested interests to censure people inappropriately.

boomer_ie

nice guy always wrote: »

EFRs can still check B/P by Palp but not ascultation. (it must be ascultation for practitioners as A/E and PHECC want a higher level....EFRs B/P would not be looked at)

My reading of it is they cant do BP at all either by palp or asculation, granted I havent looked at all of the documents yet so there could be mention of palp elsewhere, is there?

nice guy always wrote: »

Special Authorisation means that certain CPGs authorise EFRs to use the BVM. And other CPGs where practitioners can use it, EFRs cannot.

Thank you for that explanation I was thinking it ment something else entirely!, namely that the organisations MD could give the authorisation to use the skill.

nice guy always wrote: »

There is a register for EFRs held by PHECC but no PINs are issued as EFRs are not considered practitioners.

Hope this helps
NGA

Sorry I should have clarified that I ment register with issueing of PIN numbers which a lot of people were / are being led to believe was to be the case.

Hooch

boomer_ie wrote: »

My reading of it is they cant do BP at all either by palp or asculation, granted I havent looked at all of the documents yet so there could be mention of palp elsewhere, is there?


Thank you for that explanation I was thinking it ment something else entirely!, namely that the organisations MD could give the authorisation to use the skill.


Sorry I should have clarified that I ment register with issueing of PIN numbers which a lot of people were / are being led to believe was to be the case.

Palp isnt mentioned but will still be thought on the EFR programme.

No, there is a myth within some voluntary organisations that their medical director can allow the or give them permission to use extra drugs/equipment. To do this is working ourside you remit and could leave you in serious trouble, trouble that PHECC will walk away from if it has nothing to do with CPGs for your level

Not much talk of an EFR register at the moment but then again the CPGs and one or two other things are taking full attention of PHECC. Might be reviewed next year, espically when new transport guidelines are signed off

Elessar

NGA do you know if the medications are signed off aswell? I.E. can EMTs give Paracetamol for pain relief now?

E: Some confusing things in those medication documents too. According to http://www.phecit.ie/Documents/Clinical%20Practice%20Guidelines/EMT%203rd%20Edition%20CPGs/EMT%20Appendix%202%20Medications%20&%20Skills%20Matrix.pdf

EMTs now not allowed to administer Paracetamol PR? No mention of this is the formulary?!

Also, chest auscultation has been moved up to Paramedic only?! Anyone I know who has done recent EMT courses has been taught to auscultate under certain conditions?!

Oh PHECC, the mind boggles.

Hooch

Elessar wrote: »

NGA do you know if the medications are signed off aswell? I.E. can EMTs give Paracetamol for pain relief now?

E: Some confusing things in those medication documents too. According to http://www.phecit.ie/Documents/Clinical%20Practice%20Guidelines/EMT%203rd%20Edition%20CPGs/EMT%20Appendix%202%20Medications%20&%20Skills%20Matrix.pdf

EMTs now not allowed to administer Paracetamol PR? No mention of this is the formulary?!

Also, chest auscultation has been moved up to Paramedic only?! Anyone I know who has done recent EMT courses has been taught to auscultate under certain conditions?!

Oh PHECC, the mind boggles.

The CPGs are fully active from 3 weeks time, but are being phased in at moment.

In regard to your questions on Paracetamol i'll honestly have to check that, wouldnt want to miss lead you as I havint been fully briefed on it yet. Just have done what I told you before in the PMs im afraid. Im awaiting a detailed list of differences between old and new EMT CPGs, its there for Para and A/Ps....so why not EMT!!!!

As far as im aware auscultation is still a skill used by EMTs for certain CPGs (and OSCEs for those in training). Wouldnt pay much attention to the skills matrix yet until everyone has reviewed it. There will aways be faults in publications even when the clinical proof reading was done by the very best man in the country

Does anything PHECC impliments have to have sense???:D

Elessar

I guess it was too much to ask of them!

DubMedic

Elessar wrote: »

I guess it was too much to ask of them!

Bunch of PHECC-ers.

.

boomer_ie

One question regarding the CPGs across a few of the levels, the definition of an adult is put down as 14 and above, yet the decision trees for Paed pads is still set at 8 is this intentional or a mistake?

Has anyone found the Adult Pain CPG?