paramaniac

Not suprised she lost the child

Always on the cards given the symptoms of shock you described.

As a UK medic who is USA bound I read with interest the progress made in the North East, a 14% pay rise is stunning.

I'll certainly be signing up upon my arrival.

You had me going good style there

Brilliant.

I want to RSI, cric, chest tube, pace, cardiovert, have 70+ drugs, ummmm c-section, amputate, operate, and diagnosis and send people home with 200 hours of education.

No 300 hours. But then I can bilat amputate...and transplant ape hearts (look it beats)...

Go home.

Sorry for being slow off the mark, I've just read the above & would like you to quantify your comments.

Somedic, you are most welcome.

I'm now state licensed in the US & will be coming over soon

Guys, please tread carefully here.

Nowhere in the UK can you make 40K sterling for 3x12 hour shifts a week, £32k in rural areas, near £35k in London.

Cost of living will cripple you here, a TINY house or apartment in London is £300K plus, everything is expensive, we are known as treasure Island by international companies!

We are not 'desperately short' of medics, on the contrary, there are large numbers of EMT's waiting in the wings for a chance to qualify.

Increasingly, meaningful numbers of Ambulance staff are emigrating, Australia/New Zealand/Canada & USA are all popular destinations.

Before anyone jumps on the bandwagon please do your research thoroughly.

Best regards,

Paramaniac

I concur with the previouly suggested assessment & management, with expeditious transport.

Focussing on the apnoea & specific causes,

Assuming the Airway is now patent we must search for the cause of the ventilatory failure, specifically considering the following,

1. CNS depression ( Narcotics/Alcohol/CVA/head inj etc)

2. Neuromuscular paralysis ( C-spine inj/ Organophosphates etc)

3. Breached integrity of Thorax ( Flail segment/ ruptured diaphragm/ Pneumothorax etc)

4. Ruptured Trachea/Bronchus etc

You need to supply the findings of the primary survey to illicit further diagnostic & management suggestions.

Pro_ EMT, have you even heard of PHTLS, let alone read the manual & completed the course?

What's your rationale for NOT extricating a NON time critical patient with midline pain/tenderness by using the KED?

Nationally we have an extensive network of CBRN (Chemical, Biological,Radiological, Nuclear) teams. Every geographical area has these teams on 24/7 standby.

EVERY frontline EMS worker has a personal Dosimeter ($800) with the relevant education.

All this in a service that's almost bankrupt, draw your own conclusions, when, not If.

Can I ask a follow-up question?

Say I'm on scene treating a severe SOB with wheezing via ventolin. I see that the ventolin has little to no effect but realise the patient is on ventolin. Woudl I looked at as if I was crazy if I were to patch to the doc and ask for direction (possible epi?) on this case? I'm asking more in an Ontario perspective.

Here in England, given your scenario, we would go ahead with 500 MCG of Epi I.M, with a further 500 MCG 5 minutes later.

As someone else mentioned, steroids can be useful, however, the benefits may not be immediately apparent, particularly if transport times are < 30 minutes.

We give Hydrocortisone (Glucocorticoid) 200MG I.V for any prolonged transport time.

Adrenaline 1:1000

Adrenaline 1:10000

Amiodarone

Aspirin

Atropine

Benzylpenicillin

Chlorphenamine

Diazepam

Entenox

Frusemide

Glucagon

Glucose 10%

GTN

Heparin

Hydrocortisone

Hypostop

Lignocaine

Metoclopramide

Morphine

Nalbuphine

Naloxone

Paracetamol

Salbutamol

NACL

Hartmanns (Ringers?)

Syntometrine

Tenectaplase (Thrombolytic)

perhaps a little more about those favourite fire fighter pastimes of polishing their helmets and poles ... what does that make them yes... you guessed

Is that not you're area of special interest Zippy? Polishing Firefighter's Helmets & poles? :twisted:

Those hourly rates are very poor guys, can you have a decent standard of living as a medic?

My hourly rate is approx $30, & I'm always broke :oops:

That was truly entertaining

I'm emigrating to the US & was beginning to wonder whether my sick & twisted outlook on life would cause me problems, I'm not worried any longer :wink:

It's true, Dust, I had to marry an Irish girl

Irony, dear boy, irony....the post was in jest.

Here's the link

www.personneltoday.com/Articles/2007/01/02/38687/nhs-trains-emergency-care-practitioners-to-ease-pressure-

I was involved in trialling the Community Paramedic scheme (GP surgery based) in the East of England

I no longer work in primary care, now back on the Truck.

have u ever seen this video before?

do UK PARAMEDIC have the chance to learn the rescue technique? they will have chance to use these technique when they are on duty ?

PS i hope someone will correct my grammatical errors so that ii can get a chance to lean english~ THX~

You are doing fine with the English, for God's sake don't Bastardize it like our colonial friends here!

Aas for the extrication kit, if you EVER see a UK medic with hydraulic equiptment in their grubby little hands, RUN, RUN for your'e life!

A very interesting article from the BMJ on the role of "Emergency care practitioners"

http://emj.bmj.com/cgi/content/full/21/5/614

Hello mate,

Hope this is of interest,

Any questions PM me.

Accidental heroes: training emergency care practitioners to handle non-critical conditions could save the NHS £51m a year.

The challenge

Calls to emergency control rooms continue to rise by between 7% and 15% each year, and each call-out costs the ambulance service £120. Many 999 calls are not true medical emergencies, coming from patients with relatively minor medical problems or with social needs.

The solution

To meet the increase in call-outs, Skills for Health has introduced a new role to support Primary Care Trust (PCT) emergency response teams.

Emergency care practitioners (ECPs) were introduced to the NHS in 2004. There are now nearly 650 working in 41 PCTs throughout the UK, delivering care and treatment within pre-hospital, primary and acute care settings. They provide rapid response to minor injuries in different environments: in general practice, minor injuries units, out-of-hours services, rapid response, walk-in centres, and busy accident and emergency (A&E) departments.

The Career Framework Team in Skills for Health has developed the role of the ECP to cover competencies that include providing emergency assessment, diagnosis, treatment and aftercare.

ECPs complete 1,000 hours of designated study time, of which a minimum of 300 hours is designated as theory learning (delivered at a minimum standard of degree level) and 700 are clinical learning hours in appropriate clinical settings. This enables them to practice as part of the clinical team, within a range of primary and secondary healthcare settings.

Employer benefits

Sending an ECP to respond to a call costs £80, saving the NHS £40 per call-out. It is also hoped that by using ECPs, 70% to 80% of patient visits to A&E could be treated elsewhere, saving the NHS a further £75 per patient. The use of ECPs also means the ambulance service should be more responsive to those patients with acute or life-threatening needs.

The future

Within the next five years, there will be between 2,000 and 3,000 ECPs in the UK, rising to 5,000 in 10 years. Currently, the Department of Health (DoH) is rewriting its Urgent Care Policy for England and other areas, and further development of the ECP role will depend on how emergency patient care is structured in this policy. In the meantime, ECPs will continue to provide essential support to emergency teams and generate cost savings for the NHS.

ECPs are currently being recruited from nursing, paramedic or other regulated healthcare professionals who have completed the competency-based education programme developed by the NHS Modernisation Agency's Changing Workforce Programme in partnership with Skills for Health.

There are now 215 ECPs undertaking programmes at 17 higher education institutions and, in two years, it is envisaged that there will be a direct entry available for school-leavers.

Hundreds of nationally qualified clinicians will emerge with the knowledge, skills and professional behaviours to function as an ECP and the personal and intellectual attributes necessary for life-long professional development.

Employer involvement

Hull PCT, facing a shortfall in GPs due to the high number of single-handed GPs approaching retirement, has employed ECPs in its area since November 2004. Nursing and residential care homes now contact ECPs directly for patient assessment to medical interventions, such as X-ray requests and stitching wounds. The ECPs also support custody nurses in police charge cells and healthcare staff in prisons.

Other parties involved in promoting the use of ECPs include the NHS Modernisation Agency, the DoH, 22 higher education institutions, 12 ambulance services, 11 strategic health authorities and associated PCTs.

Key facts

1 In Avon, using ECPs has saved the county's employers and associated health communities more than £84,000 per ECP, which is more than twice their employment costs.

2 If all ECPs deliver this level of benefit, it would equate to national efficiency savings of £51m based on last year's costs.

3 In Hull, only 309 patients out of 1,614 seen by ECPs between January and July 2006 were referred to Hull Royal Infirmary's A&E, paediatric or acute assessment units.

Employer view

"ECPs are not only carrying out a valuable service in helping to look after the community, but have taken the strain off the NHS. It is an example of what can be achieved with common sense, assessing what's needed and giving people the opportunity to use their skills and knowledge outside the box."

ukcanuck, your response was very appropriate! No offense taken here, in fact, I thank you for taking the time to answer so thoroughly!

paramaniac, ukcanuck,

It sounds like your situations suck! I'd imagine the management is beating you over the head with this press...Given your situation, man, I don't know what the hell is best to do. Answer the calls and nothing changes, in fact it most likely gets worse for you in the long run. Don't answer and this situation arises and the unwashed masses believe you would trade a life for a lunch break.

I wish you good luck, with hope that this is resolved well, and soon!

Dwayne

Spot on there, the public are screaming blue murder, already reports are coming in of staff being abused & harassed over response times.

Paramaniac: You know two American medics working over there? I bet they have an interesting story to tell. Do you know how they ended up working there and why?

Somedic

Both fell for the allure of the pretty English Rose Both blokes got involved with English nurses working in the US, got married & moved here.

Very hot topic this, essentially this meal break issue was thrust upon us, the vast majority of frontline staff rejected the principle but were overruled.

This whole mess is completely attributable to NHS management lacking the foresight to prepare for these mandatory working directive rules. They knew it was coming, yet have singularly failed to increase capacity to cover the eventuality.

Essentially, all the management have done is save money by docking 30 minutes per shift from our paypacket, yet still want the full 12 hours of cover.

Hello mate,

Reciprocity is a real pain, I know two US medics over here, both really good blokes, both had to re-train

Average salary is £33-35k sterling. Property is ridiculous, £250k+ for a Very small flat (apartment) a reasonable house is £350k plus.

Cars are expensive, a Ford Focus 1.6 4 cyl is approx £13k.

Petrol (gas) is £4.50 a gallon.

Tactical medicine is generally the reserve of the police, they have their own blokes. Technical rescue is the reserve of the Fire service.

Sorry I can't be more positive.

Here is the link for the website.

http://www.niamb.co.uk/home.htm

A ride out should not present a problem.

Regards

Paramaniac