BBC Article
Overwhelmingly - No they cannot
1) Yet doctors and nurses are constantly being asked to respond in emergency situations because they are, in theory, best qualified to help.
My response: As compared to a paramedic? A nurse is best qualified in the pre hospital arena to care for somebody over a paramedic?!
2) With no access to fluids for another 40 minutes, the doctors had to concentrate on opening airways, controlling bleeding and treating the walking wounded.
My response: How did he managed without fluids?! HOW IN THE LOVE OF GOD?! Can you believe he had to concentrate on airway issues FIRST?! Fucking moron.
3) Dr Holden and his colleagues couldn't save everyone they treated in Tavistock Square on 7/7, but the GPs "instinctively understood they had to do the most for the most," he says.
My response: Thank god they thought of that. If only that was in some part of training somewhere for ambulance staff. It could be really useful.
4) As vice chairman of BASICS, British Association for Immediate Care, Dr Holden says that most doctors are not trained to deal with emergency medical events.
My response: No tahts what paramedics are trained for
5) "Doctors can often be very nervous of performing their skills in front of an audience," he says.
My response: Then perhaps they shouldn't be doctors? That is a day in day out requirement of a paramedic
6) He also knows what it is like to attend major incident scenes with the ambulance service.
My response: Getting in the way?
7) "In an emergency you want someone who knows their job, who can work from first principles."
My response: Exactly fuck off and leave it to paramedics.
How in fucks name does this entire article at no point discuss paramedics. How in the love of christ do you talk about pre hospital care and whats best without discussing paramedics.
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5 comments:
There was an excellent BMJ article on this topic recently - several GPs and physicians coming to the conclusion that if there was "is there a doctor on the plane?" moment, they'd much rather stand by and let a paramedic get on with it.
So within the medical community, the majority know that pre-hospital medicine is, in most cases, left to the paramedic. And as the paramedic skill set develops, this will become the case for more and more medical conditions. Unfortunately there is that still significant minority who think that doctor knows best, and have minimal understanding about what a paramedic can actually do, but they're slowly being replaced... :)
However, there are still cases, especially serious trauma or medical emergencies, where a doctor is the best thing on scene. But in that case we must specify that we're discussing a specially trained and experienced doctor (DipIMC or similar). Physiological control, airway management, anaesthesia - you want an experienced doctor there. Similarly nurse practitioners or critical care paramedics with advanced training can be very useful. But just as with doctors, there are a breed of paramedics who don't acknowledge this.
Don't take the sensationalised BBC article at face value - it's written by non-HCPs by non-HCPs, with added trauma and excitement so that people will read it. I'd look at what Holden says - most doctors have no idea what they're doing at severe out-of-hospital nemergencies. But I think your follow up comment is unfair: If he turned up at that RTC you needed to chop someone's legs off, or to the diazepam refractory fit you were trying to manage, you wouldn't be accusing him of getting in the way.
Doctors need to recognise that paramedics do an excellent job, and are much higher skilled and experienced than they realise. But similarly, paramedics have to recognise their limitations, and when a doctor can augment their skills and abilities.
Lost my fucking original reply cannot be arsed to retype it.
A doctor as you say is there to augment the paramedic at the TINY amount of prehospital incidents that warrant use of BASICs (not taking into consideration the question of whether to delay transportation to await BASICs)
They are not there to take over. The article is based around ridiculous concepts such as "he goes to major incidents with ambulance service therefore he is qualified to state his opinion as an expert"
When BASICs turn up they shouldn't be getting in the way, they should be slotting in supporting the paramedics on site. They aren't turning up to take control of the full incident nor should they be.
If patients are that badly injured you are better off with an air ambulance able to transport rapidly to trauma specialist centre than a GP in his car carrying a few RSI drugs.
I agree, doctors aren't there to take over. They're to augment the skills already on scene, not run the incident (a job actually best delegated to a good tech).
However, your follow up statement is wrong, I'd argue that Holden is qualified to take about major incidents from the doctor's perspective. That isn't what's wrong with the article :)
The stay vs run argument will always be open to debate - I think the key point now is that a delayed run to a trauma centre is often best for esp head injured patients, and for that you need to wait for a doctor to turn up and knock out the patient. Interception en route works quite well around here though.
The air ambulance argument will be changing as EMSC slowly take over more and more groups, forcing a doctor onto each flight. Then it doesn't become an either/or question, you get the skills and the transport ability. The PHC subspeciality for EM/anaesthetics is nothing but good from this perspective. Though what do you do at night?
It has little to do with whether he is qualified rather the reason the article gives for him being qualified.
The problem with the article is the overemphasis on doctors pre hospital. They are almost universally pointless. The small minority trained to be of any real use are practicaly of use in an even more minute set of incidents.
Talking about pre-hospital care without paramedic intervention is laughable.
The overwhelming majority of time when Doctors turn up on scene they get in the way.
I'm not denying the importance of paramedics in prehospital care. I think paras are actually more important than they give themselves credit for (so start leaving more people at home!) ;)
But that isn't the point of the article. It's not a discussion on the state of PHC in the UK, more a question of whether doctors are up to the task. And it reaches the same conclusions as you have in these comments - most doctors are a bit shit in an emergency, especially out of hospital.
"The overwhelming majority of time when Doctors turn up on scene they get in the way" - you having some bad experiences lately?! It's all about appropriate use of the resource - if they're getting in the way, they didn't need calling (though I suppose you can't do anything about those who've stopped at the incident incidentally). Any and good PHC doctor would just help out if they weren't needed, rather than get in the way.
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