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Sat Aug 23 10:37:02 BST 2003

Hi Richard
Thanks for the reply.
This may expand the trauma lists insight into why something like this is
happening. First of all let me say that this is not some mad paramedic
wanting to do inappropriate prehospital care - this is one of 14 pilot
schemes in the UK which has been thought up (rightly or wrongly) by the
government!

There are basically three drivers to this programme...

1. In the UK we are nearing saturation point with patients visiting ER
(A&E).
There is a push toward EMS systems to initiate more treat and release
programmes OR finding alternative pathways for the patients other than the
A&E depts.

2. At the same time our community doctors (GPs) in the UK have had a change
of contract. As of next April the GPs do not have to work out of hours.
Their pay will drop by six thousand pounds but many are prepared to absorb
this loss rather than do night shifts.

3. The last is that the EMS system is being swamped with inappropriate calls
from patients for minor conditions simply because of the difficulties in
accessing their own GPs (GP receptionist - 'make an appointment in two weeks
time sir...' type of thing). This is having a knock on effect on the
resources the EMS system has available for Cat A calls and as a result many
systems are not hitting their performance targets.

So, what the government has decided to do is set up this new breed (for the
UK anyway) of paramedics called 'Paramedic Practitioner'. They will be based
in Minor Injury Units (MIU) and work from there and occasionally from
Community Doctor Surgeries. Their role will be that of a Paramedic and a
minor injury nurse with a few extra skills on top of that.

If a call comes into the surgery or MIU then the Practitioner can go out in
the response car and treat and release on scene rather than take the patient
back into their MIU or GP surgery and treat there.

At the same time the Practitioners will also be on call for the ambulance
service for all Cat A calls and may also start identifying Cat C calls so as
to release the ambulances and placing more resources back into the system.

I hope this clarifies some of the reasons behind the question.

On the point of battery systems - our vehicles do not go flat. But when
looking at the amount of electronic wee carry nowadays in EMS units it is
wise to plan ahead in case of battery failure. I think so anyway.

Mike

----- Original Message -----
From: "Richard Wigle MD FACS" <rlwigle at yahoo.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Saturday, August 23, 2003 5:06 AM
Subject: Re: kepping Tetanus cold on car units

> I was afraid that might be the answer
>
> that now enters into a huge area of what is appropriate in
> a prehospital environment and how best to use limited
> resources. Indeed it sounds like a return to making house
> calls albiet with the expense (although not the entire
> expense) of activating the EMS system. Don't know whether
> its a great idea or not but I guess you will help us find
> out
>
> If it was me I would use a small picnic cooler and one of
> those frozen gel packs and peplace them every shift- should
> be more than adequate
>
> LTC R Wigle
> --- Michael Bjarkoy <bjarkoy at kernowserve.co.uk> wrote:
> > Hi James
> > It is part of an expanded scope paramedic programme.
> > Reducing A&E (ER)
> > visits by crews. I am on a course as a paramedic
> > practitioner and will be
> > dealing with a whole range of minor injuries on a treat
> > and release program.
> > Mike
> > ----- Original Message -----
> > From: "James A. Johnson" <J.Johnson at Valley-hosp.com>
> > To: "'Trauma & Critical Care mailing list'"
> > <trauma-list at trauma.org>
> > Sent: Friday, August 22, 2003 8:22 PM
> > Subject: RE: kepping Tetanus cold on car units
> >
> >
> > > why would you ever need tetnus in an paramedic vehicle?
> > >
> > > > -----Original Message-----
> > > > From: Michael Bjarkoy
> > [SMTP:bjarkoy at kernowserve.co.uk]
> > > > Sent: Friday, August 22, 2003 10:22 AM
> > > > To: Trauma & Critical Care mailing list
> > > > Subject: kepping Tetanus cold on car units
> > > >
> > > > Hi all
> > > > I am exploring a way to keep Tetanus vials between 2
> > and 8 degrees
> > celcius
> > > > in a Rapid Response Paramedic Unit (car).
> > > > The unit must be VERY small and take into account
> > fluctuations in
> > outside
> > > > ambient temperature and overstretched battery systems
> > that occasionally
> > > > fail.
> > > >
> > > > any ideas
> > > >
> > > > Mike Bjarkoy
> > > >
> > > >
> > > >
> > > >
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> >
> >
> >
> >
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kepping Tetanus cold on car units