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What Skills Do Ambulance Crews Have?
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I've really no idea what I've said to cause such umbrage here. If anyone cold quote it (in context) I'll take it on board. Usually we just get "well, it's your tone" etc. If you think I'm grilling anyone here, you should see what those of us who work in hospital have to put up with
But very doc in the world hears tired comments about arrogant docs every day, whenever we question any other health professionals. This isnt a new thing. And yoiur stereotypes aren't new.
People can say what they want about us, with free abandon though.
If anyone can highlight what Ive said that's offensive then fine. I've tried to highlight the poor pre-hospital situation, then I'm told we're self interested because we're not interested in the pre-hospital situation.
All my research is in public health, which is, by definition, the attempt to do the most for the most. Improved paramedic care is far from the most pressing issue if we're trying to "do the most good for the most people" to be honest.
It doesn't take away from the fact that paediatric pre-hospital care leaves a lot to be desired.
I'm not all that up to date with how things are in the world of adult pre-hospital care. So, I confine myself to paeds.
Having said that, If it makes everyone feel better, I'll agree that one week's paeds training is enough, and that the lack of practical skils is acceptable.
And I'll leave you guys to it.
Take care, and good luck with your respective careers.0 -
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I know I've left this forum, but if I've offended you with the statements you've highlighted, then I should explain their context, so as to reduce any offence.Ive really no idea what I've said to cause such umbrage here. If anyone cold quote it (in context) I'll take it on board. If anyone can highlight what Ive said that's offensive then fine.
Ok... here goes...
So, it has been said that the Irish ambulance service is essentially a glorified first-aid service.
Who said this? Why do you say it? Your opening line is already getting people's back up. If i'd opened a thread saying paediatricians are just glorified GPs you might understand.
IN particular the ones that are staffed by firemen.
Same again.
I never said any of the above. People had raised concerns with me about the pre-hospital service in Ireland run by the DFB (as opposed to the EHB one) so I quoted what they'd said and put it to you guys for opinion.They don't give drugs, rely on automated defibrillation, dont intubate....and essentially perfom the same roles as an experienced first-aider.
You are misinformed - as previous thread have shown.
The drugs issue is what I was asking about. One of the reasons I started the thread. The rest is true, except for 100 of your 1300 ambulance personell as far as I can make out.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.
In hospital! "Funky drugs"... whatever, displays a lack of respect for paralysing agents if you ask me. Besides, prehospital drug assisted intubation has not been shown to be beneficial so why be worried about it?
I've a lot of respect for paralysing agents, and sedating agents. I use them all the time. How you equate a turn of phrase with a lack of respect for a drug is beyond me. But fair enough.
The fact that something hasn't been show to be of benefit doesn't mean paramedics wouldn't do it. Adrenaline and atropine haven't been shown to be of benefit at arrests, and you still give them. I wasn't aware that you only did non-drug intubations. I am now. It doesn't change the big picture.He reckons his son "can give drugs".
Why the Quotes?
Because I was quoting him?? I was also highlighting that was exactly what he said to me...ie he didn't know what drugs his son could give....in the context I was asking what drugs firemen can give.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.
Why be pessimistic? Why not assume they are good at it? I/O is a fairly failsafe back up.
You can't just assume people are good at things. You have to question. That's all I did. Maybe it's a cultural difference betwen hospital and pre-hospital medics. Nobody ever "assumed" I was good at practical procedures in hospital. I had to prove it.I will definitely continue to question. I have never seen an IO put in by a paramedic at a paeds arrest. They can do it, but it's scary. If you've ever had to reduce a fracture in order to give the drugs after you've broken a tibia with an IO (like I have) then you'll know it can go wrong.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.
It's no criticism. I have failed to get a line into cardiac arrest patients too. If it's no criticism, why bring it up?
I think this was one of the simpler-to-understand-points that I made.
Like I have said several times, I think it's a good idea that you guys can give drugs. Then I said I wondered about IV access training. I didn't say it was crap, I said I wondered about the training. The point was that drugs are no use unless you can get them into the patient. As paramedics spend 6 weeks in hospital, I quite justifiably questioned how competent they are at difficult IV access. I think it's a fair question. It wasn't an accusation, it was a question.Paramedics never spend any time in a childrens ward
Wrong.
Yes, it appears they spend a week in a childrens ward. I am suitably chastised
because it's one of the cooler things that you can be seen to do at an arrest
Maybe you think so. I think the "coolest" thing you can do is save a life, but perhaps your priorities lie elsewhere.
Yea, that's the obvious conclusionIt'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.
Deroggatory statement.
I think it's a statement most people would agree with. But fair enough,c'mon dude, read the post. I specifically underlined the word "some".
Patronising.
Maybe you need to be patronised. I specifically underlined the word "some" and was then treated like I'd accused all paramedics of genocide through incompetence.[Most of the unwell adults that come through the door have one in place.
Eh... not they don't. Only 100 APs in the country, so most adults don't get a line. Just showing your ignorance of pre-hospital care in Ireland.
The context was the UK. I haven't worked in Ireland in years. I've said that several times. It doesn't change the point. The point was a general one about competencies in cannulating adults vs cannulating small kiddies.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
Not in any hospital I've been in. In fact, the best place for your kit is in your bag not on your belt. Most Paramedics keep the bare minimum on their belt. But obviously it suits your argument to gloss over this.
Most paramedics do, but some don't. I accept that was something I shouldn't have said to paramedics. But, whether you like it or not, it's a standing joke in many A+E departments/retrieval teams. But it's probably not so relevant to the overall bigger picture, so fine.My concerns lie with their diagnostic skills though.
Why? Have you any experience of this. In my opinion, their diagnostic skills are excellent and his is a reflection of the AP course which encourages a broad foundation in physiology and anatomy, not rote-learning.
[B[/B]
A lot of paramedic paediatric diagnoses are wrong. That's becuase they don't spend enough time doing on-call paediatrics. I would suggest that paramedic trainees should go on-call with the paeds reg/SHO in a hospital, except I'd be afraid of offending you guys.
The other thing that's often wrong is the grading of severity. I get called a lot to "code 2 " emergencies, where the ambulance radios in and we're expecting somebody pretty sick. But, they're often not particularly unwell. Having said that, I have no problem with erring on the side of caution. I'm just making the point that, in my experience, paediatric training may not be what you think it is. Part of the problem too is lack of feedback for paramedics.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?
Again, this is on the PHECC website you've been directed to already. There aren't about 20 of them either. "Coz"
so, there's 100, rather than 20. Fine.Thats why you've got my back up. I tried to find some positives, but there weren't any.
I'm sorry I offended you. I think I just asked questions. You shouldn't take quotations out of context.
I still think my concerns are valid. That makes me an arrogant doctor.
You think I have no right to question. I don't think that makes you arrogant, but I believe it makes you less professional.
But this wil degenerate into an argument, and my questions about experience with IV access in kids/experience doing on-call paeds are never going to be answered here.
So, I'm definitely out of here now.
Happy xmas, and I hope you're not too busy over the next few weeks.0 -
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....I'm not a paramedic, I'm a doctor. I take offence at what you said because I know it to be untrue for the vast majority of my paramedic colleagues. If you really care about prehospital care in Ireland try to have a positive influence rather than sit on the sidelines criticising.
Bye
Oh dear. I think we just found your kryptonite Tallaght01 0 -
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Moderators, Category Moderators, Arts Moderators, Entertainment Moderators, Social & Fun Moderators Posts: 16,586 CMod ✭✭✭✭
Join Date:Posts: 15331
Call it what you want, it doesnt change the responses (or lack thereof) to the OP's questions.
then again, maybe tallaght01 has a grudge against paramedics because one of them stole his orthapedic girlfriend. But sure they're only pretend doctors anyway! 0 -
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Moderators, Category Moderators, Arts Moderators, Entertainment Moderators, Social & Fun Moderators Posts: 16,586 CMod ✭✭✭✭ Join Date:Posts: 15331
Faceman,
Am just curious. Are you an emt/paramedic/advanced paramedic working either for the HSE National Ambulance Service or the DFB Ambulance Service.
no im not and while my opinion is limited to what i do know, i am a tax payer concerned about the treatment and health of our children. Its about time someone asked the difficult questions of the vested interest groups.
Anyway, it christmas day. No more arguments today.
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....no im not and while my opinion is limited to what i do know, i am a tax payer concerned about the treatment and health of our children....
That old chestnut, eh? :rolleyes:
I'm not looking to pick a fight, but you'd do well to educate yourself a little more before trying to get into this little discussion. This isn't the type of discussion in which the taxpayers point of view will be considered a contribution. This is a thread dealing with a doctors approach and comments (second hand or not) regarding the professionals who deliver pre-hospital care.
I'm not trying to be a pratt, so don't get annoyed, it's just what it is. You're not a professional, so you can't play right now with the big boys as such.
Sorry, and happy christmas!
Gil0 -
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