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Mon, 23 Jun 2003 16:27:33 +1000

Procedure does not equal skill. The ability to merely implement a procedure
is not the measure of theskill of the practicioner. I am not referring to
dominance of one group over another, but the knowledge, experience,
accountability and professional ethos of the clinician.
These are indicative of the difference between a technician and a clinician.
It matters little if that clinician is a Doctor, Paramedic, Nurse, Dentist,
or Surgeon. It is not who does what procedure when. It is about the
acquisition and development of the all round skills to effectively deliver
the highest standard of care applicable to profession.
It is a common mistake by those who measure their stature by what procedures
they are able to carry out. What I am suggesting is that we examine our
overall level of clinical skill not by procedure but by knowledge.
Sure, I can open a chest but does that make me a Thoracic Surgeon. I can
pass an endotracheal tube, so am I an Anaethetist. I manage critically ill
patients for an hour or so, am I an Intensive Care Nurse. If they attend a
patient outside of Hospital does that make them a Paramedic. No, and I'm
comfortable with that, as the knowledge and skills and accountability and
professional ethos that I possess is applicable to my profession. It
allows me to deliver the highest standard of care that I should, doing what
we do. I don't measure my effectiveness by procedure but by outcome
parameters as you correctly pointed out.

I admit that my post was pointed. I meant it to be.

BTW Chris, I spent a few hours with Hugh Grantham the other day. His session
was to the State Clinical Governance Committee and espoused similiar views.

regards
Paul Stewart
Paramedic ASNSW

----- Original Message -----
From: Cotton, Chris (SAAS) <cotton.chris@saambulance.com.au>
To: <trauma-list@trauma.org>
Sent: Sunday, June 22, 2003 12:45 PM
Subject: Cracking chests/WAFTAMs

> This is an interesting debate. My opinion is an overview, FWIW not so much
> about the actual procedure being talked about below, but about my
profession
> and its direction about how it achieves best practice and sets its
> directions on what procedures are necessary and which are WAFTAM's:
>
> Some people discuss "medical dominance" by doctors over what we do as
> paramedics, ambulance officers, etc.., - Procedures being "owned" by one
> discipline and not others... To be honest i think that this is at best a
> side issue of what can be provided as best practice.
>
> When deciding which procedures give best, demonstrable improvements in
> outcomes i think we should be looking at what is an "appropriate"
> intervention for certain patients. If it can be proved (by quality
research)
> that a patient poulation does better when procedure "Y" for example is
done
> as early as possible after an insult (accident, whatever...), then if the
> cost/benefit ratio works in favour of instituting that procedure it should
> be implemented. Of course there will be issues of practicality, training,
> safety, etc.., that need to be weighed up too, but i don't think too many
> people would disagree that if the ratios were clearly in favour of the
> procedure, that it should be done. If that is then decided to be the case,
> training pre-hospital providers/givers to perform the intervention should
> then be thought of creatively with a "can-do" approach, rather than an
"it's
> all too hard" approach. It was a huge culture shock when the first
> defibrillators went on ambulances. Now they're in shopping centres...
>
> We shouldn't just do a procedure because we can, but because the glaring,
> undeniable evidence says that outcomes can be significantly improved as a
> result of its inception as early as possible post insult.
>
> What we need is to have constructive and collaborative dialogue between
the
> various arms of emergency medicine to set the agenda as to where and what
> those procedures/techniques are. This can only occur when we all
understand
> the basic precepts of good evidence AND practicallity in their
> consideration.
>
> Just my thoughts.   ;o)
>
> Chris Cotton,
> Intensive Care Paramedic
> South Australia.
>
>
>
> Paul Stewart wrote:
>
> Think about what you are suggesting.
> I am a Paramedic with 25 years , been an Instructor etc etc.. BUT I =
> understand and am comfortable with limitations placed upon my =
> profession. I didn't attend Uni and obtain a degree in Medicine- my =
> decision. I didn't go on to do a surgical or trauma or emergency =
> specialisation- my decision.=20
> And I didn't undertake Veterinary studies to treat animals then attempt =
> to transpose that level of intervention on animals to humans. I don't =
> want a vet operating on my children, but I do want a competent =
> professional provider, be it Paramedic, Nurse, Registrar or Consulting =
> Specialist to use the extent of their knowledge and skill to provide the =
> treatment that their expertise permits and expects. And that does not =
> mean someone that did a fast-track lab on chest cracking. Anyone could =
> open a chest,  but if you think that the procedure makes the difference, =
> I'd like to talk to you about a bridge in Sydney that I have for sale... =
> On the other hand, I don't want any of the abovementioned people =
> treating my Golden Retriever... for that I want a Vet ( with or without =
> the EMT quals..)
> Paul Stewart
>
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