treat & discharge....

crackcrack30

Looks like this is comming down the line, what do people think of this?

Doctors duties for a porters wage?

Bang Bang

I think it's a good idea. But why do you think we're doing a Doctors job? Paramedics are at the forefront of delivering emergency care and we all know the volume of calls that just don't require transport to hospital. This is another step in the right direction in gaining recognition for our qualification. With the decision of no transport being made this will free up space in the Emergency Department thus leaving staff available to treat and care for those who do need to be there. It will also free up ambulances too.

Part of the implementation of the new command and control centre in Tallaght will involve Omega graded calls being passed over to the doctor on call/nurse-line services. So 'refer to another facility' will begin with the controller.

crackcrack30

Agreed but...........I have on alot more than one occasion brought in doctor referrals to A&E that should/could have been treated at home
........also I have taken patients unnecessarly to A&E that have been referred to A&E by doctors over the phone, without having been seen by anyone.

........I have, like most of us, taken patients from their warm beds in nursing homes to A&E that needed... Err..Oh.. Ya what do you call them ? oh ya 'nursing homes':rolleyes:.
My point being that Some Doctors and co-ops havent been that great at keeping the A&E free themselves & (importantly) at no risk to themselves....

Most worryingly and to a much lesser extent..... I have heard of, and witnessed patients being discharged from A&E in error, having gone thru their extensive triage and assessments methods.

Don't get me wrong, Im all in favour of change and progression......but...

drkpower

What is the relevance of doctors sometimes getting it wrong to the rights & wrongs of paramedics having treat & discharge option?

Isn't there an advanced paramedic car doing a 40 week trial in limerick at the moment? I assume it's idea is to treat people and then leave them?





(or am i harping on about something completely different, now?).

Does this not make Doctor on Call a bit redundant?

Bang Bang

Deleted User wrote: »

Does this not make Doctor on Call a bit redundant?

No it doesn't. Most people call 'Doctor on Call' so they can be treated at home or are too ill to attend the surgery. The doctor then calls to the home and treats the patient, this is what happens, most of the time. But yes we have all attended the house where the doctor did little more than write a note for the hospital, that's another story. But there's also the story where a person requires hospital following examination by the doctor, then you may be called out to transport that person to the ED.

What you will be treating and referring are the minor injuries, possibly things like the 12 month long non traumatic back pain, the minor cuts and ailments. Don't get too caught up in the complexities at the moment. When the treat and refer programme is up and running you can be sure there will be guidelines to follow, just like we have guidelines for every other call we do.

KKV, the role of the Advanced Paramedic car is not to treat and leave, the role of the Advanced Paramedic RRV is to bring advanced skills and ALS to the patient.

Bang Bang

Bang Bang wrote: »

KKV, the role of the Advanced Paramedic car is not to treat and leave, the role of the Advanced Paramedic RRV is to bring advanced skills and ALS to the patient.

Just to pick on another point above, what are these 'advanced skills' that would be required on a call out? (and is the car fitted with enough gear to be able to use these advanced skills without an ambulance arriving on the scene with it's gear, first?)

Now, I'll be the first to stand up and say that I'm no paramedic and have very little insight into the world, work, qualifications or restrictions of Paramedics in Ireland.

When I seen that car, and read it was an Advanced Paramedic car, I got confused because, from an outsider's perspective; it doesn't seem to accomplish anything.

If the driver of that car is more advanced or allowed to use more drugs or techniques such on patients than your average ambulance driver*, does it not make more sense to put him in the back of an ambulance instead, and scrap the car altogether?

If the car responds to a call where the patient needs to be brought to hospital, then they'll be waiting on an ambulance to arrive anyway. The car just seems to accomplish the same thing as if the Gardaí showed up to the scene and administered first aid (albeit with a fancier first aid kit and more knowledgeable driver).

Again, I've no real insight into how the Irish Paramedic scene works, but the car just strikes me as an ambulance without the equipment or ability to transfer patients?


*I know "Ambulance driver" is a term that's generally frowned upon, but im just trying to differenciate the difference between car and ambulance paramedics.

stretch00

Hi,

I may get shot for this..... Whats the difference. Loosely - Significant additional clinical education, range of additional medications for conditons such as cardiac arrrest, sepsis, seizures, respiratory conditions et al. Access to more invasive / aggressive techniques. Greater level of autonomy in practice, coupled with significant accountability and responsibility. It can, but is not designed at present to lead to hospital avoidance......

Warrior011

Generally the Advanced Paramedics are qualified in more procedures than paramedics, in that they are qualified advanced cardiac life support (ACLS) providers and are also qualified to administer more medications.

Edit: The AP's are able to perform more procedures for airway support etc (part of the ACLS)

McWotever

The AP is more advanced as posted, but in relation to the car; it's to do with speed and spreading resources as far as you can.

The car carries one AP and a mondeo can reach a scene faster than a 5 tonne van can. So to reach time targets cars were introduced, the AP can treat the patient and wait for the ambulance to arrive. 9 times out of 10 the AP is no longer needed and can be made available for the next call.

In my opinion the APs are getting used just to meet time targets because of the lack of ambulances, but that is another argument. Now, that said, if APs were used the way they were supposed to be used, at incidents were their advanced skills are required, the AP car in invaluable.

Bang Bang

To answer some questions on the differences in medications, interventions and skills of the Advanced Paramedic and the Paramedic.
Currently in the PHECC Medications Formulary there are 36 medications listed. The Advanced Paramedic is trained, skilled and licensed to administer all 36 medications, the Paramedic is trained, skilled and licensed to administer 12 of those medications.

In cardiac arrest the AP can administer intravenous adrenaline and anti arrhythmic drugs like Amiodarone for example. The AP can also administer drugs via the intraosseous route which is direct into the bone, a useful route when the veins are shut down.
Medications for seizures can also be administered by AP's, along with drugs for serious complications in maternity calls like prolapsed cord amongst other life threatening conditions.
The 12 drugs that Paramedics can administer are also extremely useful and life saving in some instances like life threatening asthma, anaphylaxis, diabetic emergencies amongst others.

I hope this gives a better understanding to some of the differences between the Advanced Paramedic and the Paramedic.

flazio

I think this little leaflet would explain a lot.
http://www.phecit.ie/Documents/Clinical%20Practice%20Guidelines/AP%203rd%20Edition%20CPGs/AP%20Appendix%202%20Medication%20and%20Skills%20matrix.pdf

Cheers for the insights, everyone.


I still don't understand why the advanced paramedic can't sit in an ambulance, though. I realise someone above mentioned the car can get around faster, which is fair enough if you're on a motorway, but through towns and villages, is it really going to be notably faster than the ambulance?

Hooch

Deleted User wrote: »

Cheers for the insights, everyone.


I still don't understand why the advanced paramedic can't sit in an ambulance, though. I realise someone above mentioned the car can get around faster, which is fair enough if you're on a motorway, but through towns and villages, is it really going to be notably faster than the ambulance?

The ideal scenario would, I assume, to have one AP on every ambulance. If advanced interventions are needed the AP can deal, if not then just revert to every second patient. Then again why not up skill all to AP......???

Response cars are much faster in cites.....you'd be surprised how hard it is to squeeze through traffic in a bus the size of an Ambulance and they aren't great with the pick up. An RRV can be one scene two/three minutes before an Ambo which can be life saving in a cardiac arrest.

Bang Bang

Deleted User wrote: »

Cheers for the insights, everyone.


I still don't understand why the advanced paramedic can't sit in an ambulance, though. I realise someone above mentioned the car can get around faster, which is fair enough if you're on a motorway, but through towns and villages, is it really going to be notably faster than the ambulance?

Not all Advanced Paramedics are in cars, in fact most AP's are crewed on ambulances. The AP RRV's can be despatched to calls prioritised by the AMPDS and often they get there before the ambulance. The car based AP's can also respond to calls where a Paramedic has requested AP assistance. If AP interventions are not required then the RRV AP can go clear and become available for another call. If interventions are required then the car can be left at scene or the attending Paramedic could drive the car to the hospital. Yes there are times when you have to get back to the car before you're clear and available again but in the interim the Advanced Paramedic and Paramedic may have saved a life or lessen suffering so the delay can be justified. Also if the AP is getting a lift back to the car in the ambulance they are still available to respond in the ambulance with the paramedic crew. Many calls present different scenarios.

Tango Alpha 51

Deleted User wrote: »

Isn't there an advanced paramedic car doing a 40 week trial in limerick at the moment? I assume it's idea is to treat people and then leave them?





(or am i harping on about something completely different, now?).

Does this not make Doctor on Call a bit redundant?

KKV,
It's a response vehicle crewed by an AP, not an AP car. This vehicle could easily be crewed by a paramedic if people are out sick. As for what an Ap can/can't do, the question was answered for ya