zippyRN

What exactly is this "cultural imperialism" nonsense you keep spouting like a brainwashed mantra?

Somebody's forcing Britons to buy US goods and services?

the suggestion that 'most of the innovations in current use ' are American we'll give you USS and hell yeah let's throw electronic TV in as TV as is is close the Farnsworth than Logie Baird...

see also the links ref U571 etc...

also the habit of turning up 2 to 3 years late and requiring hand holding through it all ...

or i suppose it was the long game funding irish republican terrorism so the British Army were the world Experts on OBUA/FIBUA/FISH

http://en.wikipedia.org/wiki/Cultural_imperialism

http://en.wikipedia.org/wiki/Overseas_expa...ral_imperialism

Timmy, are your rave events different than those in the us? Usually when someone says Rave they mean an undergroud party with drugs and sex and all that.

I think our terminology is different as we in the states would never know when a rave was goin on until either a dead guy call came in, the police raided it or one of our kids needed to be picked up and brought home.

Tell me what your rave's consist of?

Uk point of view

musical event usually in a building / circus tent thingy, electronic music not performed live one or more genre of 'house', nominally drug free but full of people ripped to the tits on speed, MDMA or Ketamine

usually legit these days although the illicit party scen is up and running i nthe uk again

ROSC / ROSR by EMS is a proxy for EMS success

ROSR and concious on arrival to the ED is a success for EMS

survival to Discharge is one measure of whole system performance, as is survival to 6months, 1, 5 ,10 years, and return to work ...

Yes

Because St John wouldn't over inflate their presence and the coverage in order to stroke their own ego's :roll:

it's an appropriate level of coverage to minimise the impact on statutory services ...

Large event cover should equal or exceed the cover available to the ordinary person on the street, while also not depleting that cover for the local population.

Perhaps the UK is the only Nation to have guidance for event licensing that works to this idea.

would you be happy to have a town of 48k people with 3 first aiders as it's sole EMS provision?

the challenges posed by crowd events should not be underestimated, even with good maps on site you will generally only be albe to give a rough location for an incident and have to guide additional resources in... never mind the difficultues of achieving safe and sensible provision while relying on external provision

<snip>

As far as the event was concerned it was a car festival with a crowd of 48,000 each day. There was only 3 first aid staff for the duration of the event, no ambulance or anything only a room with basic first aid supplies. No it wasn’t with St John. I was privately employed by the event to be there first aider.

crikey mate!

48 k on site and 3 FAs

just plugged it through the algorithm SJA in the UK uses for event cover requirement calculations and got 42 points out

which puts the cover required as up to

4 ambulances + 4 extra crew members , 40 Personnel, 3 doctors, 6 Nurses, 2 Ops managers and a Equipment support tender

that would cover up to 60,000 though you could/ would get away with fewer FA personnel if you knew that there would 'only' be 48 k

if you can get the score below 40

3 ambulances + 4 extra crew members ,20 Personnel, 2 doctors, 4 Nurses, 1 Ops managers

scored as

- Public exhibition (3)

- in 'other outdoor' location (3)

- mixture of standing and seating (2)

- full mix of ages attending, predominantly not family groups (3)

- past Hx of low casualty rate (-1) - (medium = +1 , high = +2, no data =+3)

- expected attendance 30-60000 (28)

-queueing less than 4 hours(1)

- time of year spring / autumn (1) - Winter / summer =2

- nearest Emergency Dept <30 minutes(0) (>30 minutes +2)

-Choice of Emergency dept (1) - Large ED (2 ) small ED only (3)

- additional hazard -motorsport (1)

- no on site extras(0) (wound closure, Plastering, X ray, Primary care, minor ops / mobile surgical team)

That said UK event licensing guidelines require that you minimise the impact on the Statutory NHS services from any event. The general crowd event rules are less onerous that the Sports stadia rules which are 'tombstone' follwing Heysel (crowd crush), Bradford City (stand fire) and Hillsborough (crowd crush, 90 + fatalities) in the 1980s

agree with what the previous posters had said

a 12 hour epistaxis even with pretty light bleeding is going to have knock on effects

what meds was the patient on?

i'd be inclined to transport this patient unless it was such a big event we had the personnel and kit on site to properly assess them ... which i'm guessing you didn't

the crew were utter, utter tools in this case... i'd be inclined to go through your chain of command to get a full investigation of the situation and hopefully get the crew 'educated'

who were you working for at the event? as this can have implications

8 hours a day * 5 days a week * 4 weeks =160 hours so not inconcievable

certainly when i was in the (UK) reserve forces we'd regularly work 10 or 12 hours on a training day - even a 'day conference' we had fo rthe Nurses and student nurses was 0800 on site and didn't finish until 1800 hours - most if not all the people with mil experience (of any service or nation) will tell you long days and 5 1/2 or 6 day weeks even when 'at home' are not unknown

Short and simple .. We have a failed system. Does every call and everyone need ALS personnel .. ? No. Does every trauma patient need to have a surgeon in house .. no; but does our patients deserve such? Yes!

We have always attempted to place a band-aid on an arterial bleed and have done nothing but bled out the system, with the patient making the sacrifice.

Can any EMT actually state that their patient should not have at least ALS capability on every call? No.. If they can, they are in it for themselves and self ego's and not for the patient sake.

Should we require a medic/medic combination.. you bet! Our patient deserves at least the highest level to perform care, and at this time it is the Paramedic. Do basic's have a role YES! But; not in the ALS transport system. Their role should be only as a first responder approach.

what happens when you increase the training for your most basic Emergency ambulance personnel to 250 -350 contact hours for clinical, plus the driving course + 12 months probationary period with actual teeth ( mandated field based assessments, further academic work ... ) vs 120 hours ...

as has been said before, volunteer crew in the UK and so called 'middle tier' crew do 200 + contact hours and especially in terms of middle tier NHS crews have quite a set of limitations to their practice compared even to the NHS tech, and both groups have major restrictions on the meds they can give and on their cardiac care interventions, Technician training (where it still exists rather than HE paramedic training and middle tier as driver) is around 300 contact hours on the clinical stuff, even the none emergency crews do around a month's training (150 hours) although - one week of that is driving

Ever person employed on an EMS providing unit should be a degreed paramedic.

I really don't care what training ambulance drivers do or do not have. It has nothing to do with EMS.

overkill

realistic answer

All calls recieve assessment face to face by a higher education qualified Health Professional Paramedic , Paramedic advanced practitioner or Registered Nurse Pre-Hospital Advanced Practitioner - still gives the option for that person to turf to better trained than EMT-B BLS / middle tier ambulances or Paramedic and (better trained than EMT- Tech ALS Ambulance

Here's a puzzler for you, if the world hates the United States so much, how come we see so few returned foreign aide checks? If you really want to make a statement, don't go with the cliche burning of Uncle Sam in effigy, return our foreign aide money with a "No thanks!" attached. That'll really show us.

pretty much irrelevant to Europe, the 'old' Commonwealth, and industrialised and industrialising Nations outside those groupings ... which was where the concerns over cultural imperalism are being voiced from ...

I'm not quite sure what your arguement is here. Yes, I made a comment about billing, so what. My point is that while anyone can make a diagnosis, only certain people can bill for that diagnosis (pretty much the same there on your side of the Atlantic I would imagine, unless you let lay people bill for things).

it's the tail wagging the dog of clinical practice, it;snot clinicians deciding who can diagnose and therefore bill for that diagnosis - it;s thelaw makers and or lay management / insurers

As far as my comment about legal grounds, no there is not a staute that says exactly what you said, but we do have laws that prevent people from practicing medicine without a license. Seems like a pretty good idea, but I guess you feel otherwise.

this seems to be a recurring cultural difference between the so called 'land of the free' and elsewhere - in the UK most our health care legislation is drafted in such a way as to leave boundariesa little blurred and let professional regulators and the health service define exactly where the boundaries stand.

practising without a licence / registration iin the uK is seen as a problem foof those who aren't part of the recognised structures of healthcare - i.e. frauds,

we don't have legislation that says only 'X'can do something - lots of primary legislation has terms like 'appropriate practitioner' and the determination of that is left to secondary regulation which changes pretty frequently or even to the professional regulators. the ionising radiation medical exposure regulations talks about 'referrers' , 'operators' and 'practitioners' without reference to professional status

referrers is pretty much self explanatory, but 'operator' isn't necessarily a radiographer and 'practitioners' aren't just radiologists - there are radiogrpahers who are practitioners as advanced practioners (started with doing their own reporting and giving contrast under patient group directives severla years ago m but is getting increasingly interventional ) but there are also other speciality COnsultants who are 'practitioners' under IR(ME)R such as the hand surgeons who use the mini -C-arms which are designed to be surgeon operated and the interventional cardiologists

there also seems to be aspects of exclusivity where certain groups of practitioners have skills, interventions or therapies ring fenced and other groups of practitioners can't do these roles without becoming licenced/ registered in that profession as well. The UK tends to look more from proving equivalence in education and preparation for practice - a lot of this follows the original publication ofthe UKCC's " scope of professional Practice " document for nurses and Midwives in early 1990s which opened up practice development considerably

Other than that, I'm not sure how to address your arguements, as I am not sure exactly what your arguement is. Some of your statement make no sense. If you'd like to have an intelligent debate, I'd be more than happy to, but you need to clean your post up so that I can rebuttal your agruements.

i hope the above makes it a little clearer ?

As for socailized medicine vs US medicine, each has its good and bad. I would hate to have to wait a few months to get a CABG with a ticking timebomb in my chest in some countries that have socialized medicine.

for acute MI we are increasingly seeing primary PCI - most of London is now a primary PCI area and more and more urban areas are becoming primary PCI areas, rural alreas as usual lag behind, but most of those are delivering pre-hospital thrombolysis and the few that aren't are delivering very good pain to needle times in for ' in -hospital' thrombolysis (current record where i work is 7 minutes "door to needle "and i think somethign like 35 minutes "call to needle" - pain to needle depends on perople actually calling for EMS ...

elective CABGs usually come faround through increasingly unstable angina or post thrombolysis - it's a numbers game and it's suboptimal but this gets into the realms of philosphy and economic theory - it also depends where the money is thrown - how do you quantify primary preventions impact on the numbers who need treating for a condition ...

US medicine does have problems with insurance companies and drug companies that are out to make huge profits, but with all the good that goes on, I guess you have to put up with some evil. We can attempt to minimize the evil as much as we want, but there will always be some there.

i think no one would dispute this

in answer to other posters there would still be a huge amount of medical research going on without the US commercial interests - i'm not sure how much US federal or charity money is psent on medical research , as well as many european nations are spending 7 figure dollar / euro sums each year on medical research as well as the R+D spending of 'european' pharmaceutical business - plus the money being spent by India, China, east asian and AUS /NZ ...

Indeed! Sunk by Australians! Sunderland "D" from 461 SQN RAAF!

http://en.wikipedia.org/wiki/Unterseeboot_571

http://en.wikipedia.org/wiki/U-571_%28film%29

http://en.wikipedia.org/wiki/U-110

Maybe, but has historical british imperialism gotten jealous?

most europeans get pretty sick and fed up with American commercial and cultural imperialism - which generally ignores the efforts of European and /or Commonwealth innovators , not to mention historicla revisionism or the perversion of history to suit the aims of USAmerican big business ( U- 571) ...

that little list included common imaging modalities ( plain X ray, CT, MRI and USS), joint replacement surgery, 2 of the most common families of antibiotics and the productionalistion of antibiotics , innovators in emergncy care including pantridge's 'invention' of the portable defib and chamberlain's work which pretty much paraleeled US work on paramedic ddevelopment.

Not even touched on NORAID or americian initiated blue on blue

Ahhh... but you miss the point.

The question is, can we really determine that is the case on the telephone? Case after case tells us the answer is 'no.'

this issue arises with telephone triage - but the system issues other than telephone vs face to face traige are ery valid - however this also means transforming 'ambulance' care ...

<snip>

Not to mention that if it weren't for free enterprise in the American healthcare system, the rest of the world wouldn't have most of the innovations they are currently using. Without financial rewards, there is no incentive for progress.

You cannot possibly be so naive as to actually believe that any of that is "free," so why would you be so dishonest as to say it is?

what innovations would those be?

Fleming - British (Scottish) , Florey -Australian, Hodgkin - British, Brotzu - Italian

Roentgen -German

San Baw -Burmese, Charnley - British

Hounsfield - British (first CT scanner in clinical use in England 1972)

Ludwing was Amercian but Ultrasonography appears to have had parallel development in several places at similar times ...

Mansfield - British , Lauterbur -American

Chamberlain - British (http://www.sussamb.nhs.uk/newsandpubs/folder.2005-12-13.0378101187/pressrels/folder.2005-06-07.4845241509/folder.2006-03-01.7390676526/copy6_of_copy2_of_AAAtemplate)

Pantridge - British http://www.telegraph.co.uk/news/main.jhtml...9/ixportal.html

or has American cultural imperalism struck again ?

The alternative being to "bill" the entire country for healthcare, whether they need it or not, as with the UK national insurance system.

personally i think NI is a pretty good deal

http://www.hmrc.gov.uk/faqs/nicqc1.htm

http://www.hmrc.gov.uk/employers/e12-non-contr-out.pdf or http://www.hmrc.gov.uk/employers/e12-contacted-out.pdf

'contracted out' refers to whether you have an employer run pension scheme and are therefore 'contracted out' of the state second pension

at 9.4 % of gross wages between the LEL and UEL and 1 % on earnings above the UEL (contracted out) slighly more if you are i nthe state second pension

given that provides

free primary care , free EMS and Emergency department care , free emergency inpatient care, free elective inpatient care if you are prepared to wait a few months , free inviestigations related to any of the above

subsidised prescriptions ( flat fee of 6.65 gbp per item for primary care and hospital outpatient prescriptions in patient and discharge prescriptions are free) , dental and optical services

plus providing free versions of the subsidied services to chidlren, the elderly and those on low incomes

no one falls out of the net

NI also contributes to a proprotion towards social security type benefits

As I have said, the US system isn't perfect, but neither is the UK's. Money (or lack thereof) is the big problem with the NHS. Companies such as BUPA and BMI would not have survived in the UK, had there not been a demand for private healthcare.

private healthcare is based in three areas in the Uk

- vanity / impatience of the individual - vanity in doing procedures that are not funded by the NHS unless there are wider implications ( a lot of cosmentic stuff) - impatient peopel who want things NOW! NHS waits are much reduced from the figures in the past certainly no more waits f years unless there are clinicla reasons why (e.g. need to deal with other problems first like the overweight smokers with vascular problems - stop smoking and loose some weight before assessing their need for surgical intervention)

- a perk used by employers to recruit / retain and reduce theamount of time key staff may be off work

- providing protected capacity for NHS funded elective work

look at some of the emergency care practitioner schemes in place in the UK ...

there is also the aspect of making sure that EMS staff have the training and education to identify patients who

a. may be better served by this kind of service

b. are fit to be left at scene to be followed up

c. are happy to do this

some times this may be identifiable from the original call, especially if there is secondary triage by a Health professional clinical advisor with appropriate skills, knowledge and experience once MAPDS has identified it as a lower priority call.

in other cases it may be appropriate to send the closest provider to make a face to face assessment and then confirm the priority and organise follow up at home, or organise Middle tier or Patient transport service transport to the approrpaite recieving facility ( not necessarily an major ED - minor injuries unit / urgent care centre / ealk-in centre etc as appropriate ...

EMS are already finding dead people at home becasue of system failures such as the family doctors who diagnose over the phone and book admission and transport 'within 4 hours' .. middle tier crews turn up withinthe 4 hours and find the patient has deteriorated and end up calling for A+E vehicle or transporting and coming to the resus room rather than the booked inpatient unit

- do we really need to haul grandad across town if it;s clear he slipped on the frosty path and is an isolated ankle injury? ( needs a trip to the closest X ray machine and a POP if he has broken it , as well as a mobility assesment to check what if any walking aids are needed )

- do we really need to haul grandma across town when it's clear she got the pre-tibial laceration on the nail sticking out the corner of the table ? ( needs someoen to come and sort the pre tibial lac, do a brief mobility assessment and organise follow up to make sure the wound is healing nicely and change dressing etc.)

Let's face it, anyone that can read a book can make a diagnosis. It doesn't take an MD to be able to look at a constellation of symptoms and say that a person has X. Google the symptoms and you will likely get your answer. Simply making a dx just takes some basic reading. However, you can't bill for making the diagnosis

Once again the inherently messed up nature of USAmerican healthcare comes to the fore - the best patient care we can bill for - tail wagging the dog ...

and you will legally have no ground to stand on should you tell someone how to treat their problem.

is there statute which says " only these people can make a diagnosis" ?

to the none USAmerican " nursign diagnosis " and the like seems extremely convuluted and a " we've got to have it but it;s got to be different' system , certainly in UK Nursing practice careplanning is driven somewhat differently becasue there isn't a made up tset of terminology to creat the

Someone who has read a book also can't treat the diagnosis, only someone with a license (usually requiring some additional knowledge) can treat diseases. Anyone in the field can make a differential diagnosis, you just don't have the tools (and in some cases the knowledge) to confirm the diagnosis and treat all of the time. Hell, there are plenty of diagnoses I cannot make in the ER. I'm sorry if this is a little confusing, it's 3am and I am quite tired.

valid points

it's also the progress from possible bony injury / clinical signs of bony injury - 'oooh that's broken' (when reviewing the triage requested X ray ) - that a doohicky type A fracture and it's going to need plating let me ring the orthopods

You crack me up reporting me? That made me smile, get a life.

well enjoy another report for personal attacks against members

I only replied to this thread to counteract your utterly appalling attitude, I was ashamed by your comments regarding American EMS.

What people should know is that many your comments are based on fantasy,

right

sorry 'paramaniac' glad to see you consider that frontline NHS Emergency Care Professionals are 'fantasists'

I am a registered Health Professional

I do work in pre -hospital care - i also have pre -hospital care delivery management responsibilities

I work in an Emergency Department and have responsibility for Major incident and CBRN activity

You are not a State registered Paramedic,

No I'm not and I have never clained to be, I am however a registered Nurse, with both in-hospital and pre -hospital Emergency care qualifications and aexperience . My Degree Dissertation was about Pre-hospitalcare and as I say above i have roles in both Acute hospital care and pre-hospital care ...

Part of my work in pre-hospital care includes response to incidents instead of NHS Ambulance resources - both 'ambulance support' supporting the training of VAS Ambulance crew and unddifferentiated work as part of a town centre project

you do not work for the NHS Ambulance service,

Have I ever claimed that? I don't think you will find i have, but as a n experience Emergency Department Nurse i have quite a bit to do with the Ambulance service ... and when undertaking pre-hospital work a significant proprtion of that work is either contracted to the NHS Ambulance service (support) or augments/ replaces the NHS ambulance response ( town centre , event cover etc)

I assume you have never trained as a US medic? (correct me if I am wrong) never worked as a pre hospital care provider in the US? So what gives you the right to criticize the system?

no i have not worked i nthe USA but i have worked with US trained providers who have had to be completely retained to work in the Uk

as Dustdevil says the stink sois so bad from some aspects of US systems it can be smelt across the atlantic, especially if you spend any time looking into how systems are run

Why do you insist on coming on Ambulance forums, gobbing off, criticizing everything?

You do not have any credibility on many of the UK forums mate, is that why you are lurking here?

in your opinion ...

as your posting in another thread alludes,perhaps you have the credibility gap, given that the BWTS is still on the radarof a number of services to discipline those behind it for bring the services and profession into disrepute...

/

Im sure theres a joke i dont get here zippy...forgive me for sounding dumb (it is midnight and im shagged out) but if the aim is to get these codgers to call 999 when they are having a heart attack, how are kebabs and fags gonna assist in this campaig?

so far we've seen maybe a coupel of people who might have written off their cardiac suggestivechest pain becasue of theadvertsand tensif not hundreds of people with musculo skeletal, URTI or hyperventilation related 'chest pain' - the problem being that anyone who presents with chest pain is meant to be rushed through the system and Assessed completely with sufficient time for them to be thrmbolysed within 20 minutes of booking into the ED ... and any 'failure' to achieve that regardless of the patient's age an/or final diagnosi is subject to 'investigation'

I was looking at the Indianapolis star's web page & it talked about the mayor consolidating the fire departments, or better yet that he is trying to.

The only question I have is about the new "civilian" ambulance workers that IFD is starting.

What is the advantage of this? I'm not trying to be coy or smart or anything I just am curious if anyone knows why go this route and not just let Wishard Ambulance service take over like they do other IFD areas?

I've seen online that IFD is paying 40K a year starting for Medics & I think that is slightly above what Wishard pays. So I guess the question is if this is about cost savings why the added expense for Ambulance service?

Also, & I'm not trying to get into a "fire department vs. non-fire department" ems thing, but if you hire "civilian" EMS and only the word "fire department" is on the patch & on the trucks then what is the point of having a fire department EMS?

Also, and this is just for morbid curiosity on my part, but does anybody work as a civilian EMS worker for a fire department on this board? If so are you treated like any other fireman or member of the department or is it something else.

I do have a friend who inquired about being an IFD Medic & he was told that he had to move within Marion County in less than a year. I don't know if he was right or not, for all I know he was lying just to make an excuse as to why he didn't get the job. But if it is true my guess is they are getting around the residency rule for firefighters in Indiana because they are not real firemen & thus are not protected by this rule. If that is then how does anyone feel about this?

Sorry for asking something so regional on here, but I was curious.

simple answer = money

money stays within the FD if they manage the EMS system

if ambulance staff who aren't FFs are cheaper to employ ( i.e. not covered by the FF contract and the FF unions) then money 'saved'

also can pick from a wider pool of people as they only need to be fit for role as ambo bods and not as FF ( how strict is the US on eyesight and any hx of breathign problems for anyone who may have to wear SCBA - it excludes quite a lot of people from FF careers i nthe UK )

*Timmy has chest pain*

smoke fewer fags, eat fewer kebabs!

currently the british heart foundation has the roadside hoarding advertistment of a person with a belt tight round their chest with the caption

"chest pain is your body telling you to call 999"

sadly they forget to warn the Ambulance service and the EDs - huge number of NAD or mild URTI patients presetning as 'chest pain' at present

direct action has been suggested 'editing' the posters to read " chest pain is your body telling you to smoke fewer fags and eat less kebabs"

http://newsimg.bbc.co.uk/media/images/4233...982_belt203.jpg

Hello all, another Brit Medic here, working for the mighty EEAS.

I hope the usual suspects don't show us up here :roll:

Remember, we see everything :twisted:

Best Watch The Spelling

That explains a lot...

thankfully the idiot fisher hasn't appeared here yet ... now that would be worth selling tickets for ...

Zippy, you eternal wannabe, there really is no escape from you.

This Zippy guy lurks in many UK Ambulance forums trolling for an arguement, mostly we ignore him.

I make £32500 without overtime. My wife is on band 8 at just under £40k, what post do you hold that would necescitate at £10,000 pay cut my delerious little friend?

band 6 to band 4 ...

Crawl back into a Nursey forum.......Oh, sorry, forgot, they all banned you for being such a pain in the arse!

Libel is legal issue in most juristictions , it's also against the terms of use for the forum, hence the reason your post has now been reported.

Apologies to any of our colonial friends who were offended by our cretinous bretheren, the genuine frontline NHS Ambo bods do not share his attitude.

as A "genuine, frontline " NHS Emergency Care Professional , i think you'll find that what NHS Ambulance Staff think is generally not reflected by the attiudes portrayed on such sites by those who claim to be NHS Ambulance Staff.

it's not going to happen in the USA until you can bill for it ...