zippyRN

I ain't never got no college edrucation.

But how does my dismal, shameful, utter lack of education, training and experience diminish the inappropriateness of FAKE emergency runs in the UK?

so you aren't actually in a position to comment about training and education then are you?,

as Phil points out to deliver training in the Uk you are required to have a at the very least NQF level 3 or 4 training qualifications and with those qualifications you can only deliver training and education upto NQF level 3 - and for many training and education roles in preparation for healthcare professional practice it's going to be NQF 6 or 7 award that is required

as a comparision a level 3 qualification is university entry , level 6 is Bachelors degree (1st cycle Bologna completion) and level 7 is post graduate

I have a level 6 training and education qualification specific to Healthcare Education - this particular 30 credit ( 1/4 of a year of university) is known as 'Supporting Learners in Practice'- however this doesn't make me 'an Educator' what it does allow me to do is supervise students and conduct assessments ... and becasue i hold a full Bachelors as well act as a sign off assesor up to degree level.

those in education roles have or are working towards 'full sized' training and education qualifications and for health professionals this will be a Post graduate certificate in Education or a Masters in healthcare education

as for 'most english citizens don't know fake emergency runs take place' only if they live in a cave , don't watch the TV, listen to the radio or read Newspapers ... plenty of coverage on the issue inthe UK as we work to reduce the already pretty low RTC rate involving emergency vehicles and the police work on ending pursuits sooner and safer ...

including doing live 'practice' TPAC when the only 'stooge' is the vehicle that is going to get PACked ...

Scott has posted the facts - now if the antis wish to rebutt .... bring it on

Are your medical educators going out on FAKE runs with paramedic students? Or are they being sent out with field medics for that experience?

If it works for medicine, why doesn't it work for driving? Sounds to me like you guys have simply invented a level of bureaucracy that you now cannot imagine ever living without, even though it serves no valid purpose.

which 'medical educators' ?

Lecturer, Lecturer-Practitioner, and Practice Educator staff working for the service or a HEI provding pre and post reg courses for the service ? of course they are out in the field with students and with competent practitioners - how do they maintain their clinical currency otherwise,

but equally students aren't always going to be with lecturer - a fair chunk of the time they will be with the Paramedic equivalent of my training education role as a Nurse - An experienced practitioner with a Supporting learners in practice award - different titles exist but quite a few UK services call the clinical team educators or field based assessors ... similar.

emergency driving specialist instructors ? - they are going to have generally come from an emergency services background and hold the ADI award as well as the education and training qualifications - they may not be paramedics, they may not even be qualified beyond first responder if their emergency services background was police or fire ...

EU generic Answer

If the vehicle has a MAM of greater than 3500kg the driver needs a cat C1 or cat C licence - and therefore has to meet the higher medical standards for commercial vehicles,

if the MAM of the vehicle was to exceed 7500kg then a Cat C licence would be mandatory

if the vehicle has an MAM less than 3500kg the driver needs a cat B licence which is a standard car licence,

Uk specific points

those of us with grandfather rights to C1 will be held to those medical standards by the employing agency if it's any good ( certainly the NHS and the VASes do)

the NHS and the VASes hold people to the 'vocational driver' medical standards for cat B driving

insurers will specify training in the legal gap of exemptions ( i.e. other than S.19 Road safety Act speed exemptions when the secondary legislation is passed)

they will also as othershave stated refuse to insure people with valid licencnes but insufficient experience to too many / wrong types of penalty endorsements/ driving offence convictions

<snip>

As a personal kit though, we can beat the horse all we want and say it is crazy, because well it is. Where I live, it is ILLEGAL to carry any ALS type equipment on your person or in your vehicle, besides when you are working and on the clock, ie.. 6:30am and you shift starts at 7am driving to/from work, you cannot have say, an IV catheter on you. Let alone having surgical type equipment, and narcotics. It just boggles the mind.

<snip>

which is a symptom of how messed up the system in where you live, and why trumpton needs to get out and stay out of EMS

dustdevil

with regard to the point of can't experienced medics act as supervisors on real runs

whereare we expected to find the funding and the time to take experienced medics off the road for up to a year to become educationalists and a driver trainers or Approved Driving Instructors and develop their skills at instructing emergency driving ? Yes CTEs are educationalists to a degree but they are not emergency driver trainers

there's a horrid little point here called " the level of skill of the ordinary man professing to hold the special skill"

Suburban / urban issue - traffic volumes and densities across the UK are much higher than they are elsewhere - there are 'Cities' in the USA who would barely register as a Town in the UK...

in terms of training runs being terminated if you are driving safely and to the System of car control the decision to terminate a particular manouvere of decision can be made at the go / no go point ...

in terms of a lack of proof i think he road safety statistics from the UK tell all ...

Nonsense, Zip. You're just choosing to ignore the obvious to suit your own argument. Intelligent "reasoning" tells us these facts:

1. There is no emergent or medical justification for these runs, which classifies them as FAKE. Call them practice or training if the terminology offends you, but they are still FAKE. And calling them anything less is nothing but semantics which do not change the facts.

2. Previously cited numbers show that there is no shortage of real emergency runs to be made in the UK, where new drivers can obtain requisite experience. This is not rural America, where there is very little opportunity for practice.

3. FAKE runs does not in any way result in the stated purpose, which is to give drivers emergent driving practice before unleashing them upon the public roads. These FAKE runs ARE on public roads. Therefore, the entire attempt at a justification is a lie.

4. Civilians are put into at least as much danger from these FAKE practice runs as they would be from any other real emergency run. Probably more, since the driver is inexperienced. So if we are putting inexperienced drivers on the public roads -- which is unavoidable -- then should not it at least be for some medically justifiable reason?

you don't even need to move the roller clamp - just make sure it's shut before filling the drip chamber by squeezing

LOC is not an indication to immobilize. If they did have a loss of consciousness but are now A&OX(whatever number you use) then you can rule them out depending on other findings. I would agree that the changing stories is concerning as is the hypoglycemia. I would say that based on these we could conclude that he has an AMS.

it's a decision the intelligent provider will make case by case ... depending o nthe what else found there are strong arguements either way and no amount of armchair quarterbacking will make the right decision ...

there is also the issue of immobilisating the elderly becasue of the age related physiologicla changes ...

to the rest of the board i apologise if this seems to be personalised and instrusive towards Mr. gift , but his repeated inability to enter into meaningful debate leads to the need to ask these questions

so Mister ( or is it Master ?) Gift

do you actually have the slightest clue what you have been spouting about , because i strongly suggest that you don't

your answers strike me as those of someone who those with experienced and knowledge of the theory of education and training delivery would call an 'unknowing incompetent' in that you do not understand that there is a awider field beyond that of your own limited training and experience and do not understand the processes underpinning the preparation for practice of those in other places or whose scope of proactice is different to your own

you state that you are an emergency driving instructor

are you

1. some who holds the necessary professional and legal accreditations to deliver ab -initio driving instruction for reward ?

2. someone who holds a nationally recognised teaching and assessing qualification which allows you to teach in post compulsory education?

3. someone who holds a nationally recognised teaching and assessing qualification which allows you to teach in Health professional education ?

4. do you hold a bachelors Degree from an internationally recognised Higher Education Institution or Higher Education Qualification awarding body which would be recognised as a First cycle completion award under the Bologna Process ?

4a. if you don't hold $ above do you hold a vocational or technical award from a recognsied educational awarding body which fits into the National Qualification Framework at the higher education level ( e.g. the UK BTEC 'Higher National' awards ?

or are you just a proof by assertions 'Training Officer' ?

Driving emergent is decision-making, which can be practised (English spelling) in normal everyday driving.

Regardless of whatever you wish to name your legal loopholes permitting it, FAKE runs are FAKE runs and are unnecessary.

this is not legal loopholes, this is well drafted legislation that you appear to be unable to comprehend

You can observe such driving while responding to REAL emergencies.

can you ? when

EMS - during a shirt period of third manning on an ambulance prior to being let loose as part of a 2 person crew with your preceptor?

Fire - from the back row of seats in an appliance?

Police - during a short period of working with an experienced officer before gettign independent status

And now, with videos, you can also rehearse such decision-making in the classroom.

Since 1989 I have been recording videos for teaching and criticism.

if it's not your driving it's 'armchair quarterbacking' and not of a huge amount of value - certainly not of as much value as 'real' practice whether as part of real as possible simulation or in actual practice

The medical clinicals are invaluable. There is little substitute for practice on (a) patient who needs the proceedure

or practising on deceased patients upon which you can cause no harm.

Practising on (a) patient in the hospital is not comparable to driving FAKE emergencies in the nonconsenting public.

you really are an utter tool if you think practicing procedures on cadavers is appropriate ...

you continue to use the word 'fake' , which demonstrates that you have little or no understandign of what you have been told aobut the liegilsative position in the UK

My English acquaintences, who never considered that anyone would ever do FAKE runs, agree thathis tradition of malpractice should cease.

interesting definition of 'malpractice' as well

No need to impose unnecessary risks, inconvenience and annoyance on the public.

if the risks were not acceptable then it would not be undertaken, especially given the maturity of Health and safety legislation in the UK and the EU as a whole compared to the Leftpond

inconvenience measured in seconds and compared to some of the ignorant fools driving o nthe road far less inconveniencing ... you also seem to forget that as has been repeatedly stated because 'live training' using warning devices and claiming exemptions does not have the imperative of the clinicla and or organisational pressure to reach scene, that it can be stopped dead instantly if the the supervising Instructor feels that tthat is the most approrpaite course of action at that time.

'annoyance on the public' is only an issue in the kind of messed up system where senior managers have to win publicity contests ...

Okay, if this is such a valid educational theory, let's just go ahead and carry it over to the rest of our duties.

Let's just start intubating people without medical indications, just so the first time we do it on an actual emergency patient, we have plenty of "real" experience behind us.

it's called the 'anaesthesia placement' - anaesthetists spend their days intubating patients without a medical need for airway control to facilitate surgicla procedures

Wait, why waste time with intubation on those people? Go big or go home! Cricothyrotomies for everyone!

Reductio ad absurdum to trolling at best - 2 /10

Chest tubes on everyone. After all, you wouldn't want your first one to be on someone who actually needed it, would you?

Reductio ad absurdum to trolling at best - 2 /10

Are those suggestions absurd? They are exactly the same suggestion as FAKING emergencies to practise emergent driving in public. It's no better than the Nazis performing medical experiments on the Jews. It is unethical and totally unjustifiable.

Godwin's law time

there is no 'fake emergency' there is closely supervised and regulated practice of driving while usin g warning devices and/ or claiming exemptions, the legislation in the UK permits the claiming of exemptions where not claiming the exemptions would ' hinder the purpose of use' there is

So show me the math. How many accidents have resulted from these dry runs? How many injuries? And have the accident rates shown any significant decrease since the implementation of this programme that can be PROVEN to be the result of the programme?

if you knickers are in that much of a knot make a UK FoI act enquiry to the respective driver training departments ( all 70 or so across police / fire / ambulance for the stat services will cover the vast majority ) about the number of RTCs they have had in training and how many of those were not the usual 'RTCs' found in the UK emergency services community of the endless toll of low speed oops when manouvering

I can't remember a documented training RTC of any significance ... given that an Emergency vehicle RTC that results in a strategic route closure, hospitalisation of of crew/ patient / detained person or a fatality will be national news for day or two and regional news for several more days ... i'd suspect the figures are low.

These FAKE runs need NOT be done. They should be made illegal to end this ridiculous tradition.

ridiculous tradition ?

or valid training model ?

you have so far failed to provide any reasoning why the model in the Uk should be changed and many of your arguements display ignorance of the realities of the situation in the UK,

You can train as you drive NORMALLY, anywhere - as you approach ANY intersection, travel ANY street, encounter ANY traffic congestion, you can discern/discuss what is best to do.

and many of us do so , but how exactly do you practice claiming exemptions if you can't claim those exemptions

<snip>

Most, if not all, of the variables can be encountered making use of everyday trips such as returning from calls.

there's only one or two 'returning' in most EMS shifts inthe UK - returning for your longer break if you return to a station rather than taking the break at hospital or 'as a visble part of your community'

same for police officers

your hose monkey background shows

No need to make special trips, no taking right of way from others, no disrupting traffic, no annoying everyone, no endangering others with FAKE emergent runs.

you have hung on to the concept of 'fake emergent runs' a concept which simiply does not existin the UK becasue of the way in which the road traffic and warning devices legislation is written, there is no requirement for an 'emergency' for designated emergency vehicles to be able to claim exemptions and /or use warning devices ... only a burden of proof on the operator and organisation to satisfy the bench that the purpose the vehicle was used for would be hindered if exemptions weren't claimed and warning devices not used.

ai also note how the lissue of the widespread use in the US of warning devices on POVs to respond to station hs been skirted around along with the far greater use of POV as emergency vehicle to respond to scene ...

What most needs to be practiced is learning vehicle clearances, maneuvering and backing on courses with cones and cone obstacles.

This can be conducted in parking lots where no one is exposed to any danger and inconvenience.

which as phil pointed out - good basic driving and the 'advanced' / 'defensive' driving techniques that is what the first week or so of 3 week driving courses is for and what the 'basic driver training' that none response / limited response trained personnel undertake is for.

people keep puitting great stock by EVOC

how long a course ?

how many hours on the road?

how much time spent getting people used to the dimensions of the vehicle etc?

how much time spent making sure people can drive these vehicles according to The System Of Car Control before being let loose in even none emergency conditions?

how long in as controlled as can be emergency conditions ? ( which in the UK is achieved by the accepted and acceptable use of warning devices and the claiming of exemptions for training purposes as recognised by the law)

if nothing this thread has demonstrated how much someone don't know they don't know.

The "correct" way to do it would be not to do it at all. The math speaks for itself. There are plenty enough REAL emergency runs to be made that one need not FAKE them just for the opportunity to practise emergent driving techniques. This isn't rural Hooterville, where they have fifty vollies fighting over who gets to drive on the three runs they make a week. It's pointless and totally unjustifiable.

all of which a strictly against the clock, the 8 min cat A response standard and 14/19 minute hot send other Emergency response standard is from when the exchenge provider connects the call to Comms, not from dispatch, not from pressing 'red mobile' on the terriblefix ...

the main advantage of live emergency driver training is that it can be stopped at any time by the instructor , the driving student or other students for safety reasons ( using dgood CRM techniques), there is 'no against the clock 'pressure

I appreciate every one of your and others' points.

I suffer enough REAL emergent responses that I am not envious of anyone who would risk FAKE ones in public.

Do you really believe that drivers and pedestrians notice and comprehend any "TRAINING" markings?

it's some what irrelevant

If so, why would anyone interrupt their rightful progress and willingly make risky evasive maneuvers?

'right of way' is a set of rules for agreeing who goes first , not an absolute rigid code

Uk emergency vehicles 'request' the right of way by use of warning devices and their positioning

what happened to the rule of 'space and time to stop'

All they know is there are operating emergency lights and sirens compelling them to

stop for their green signal,

pull over and stop at the side of the street,

accelerate down the street to get to an area were they can get out of your way (smart move by that autoist seen in a video!)

or perform whatever obligations necessary to yield or nervously squeeze out of your way.

for the umpteenth time the use of warning devices is a request for other road users to allow the emergency vehicle through ...

United States emergency vehicles are also "asking" for right-of-way.

But a driver can receive a 4-point Failure to Yield Right of Way to an Emergency Vehicle citation.

but not in the UK unless they willfully obstruct a specificed Emergency worker or Police Constable in the execution of their duty ...

You can practice emergent driving without imposing upon others.

Are you sure the claim of over 100,000 emergent responses in the UK daily is correct?

11 or 12 regional Ambulance services undertaking 2000 -4500 emergency and urgent details a day - a significant proportion of which will attract at least one if not more emergent responses ( one scene = one detail whether it;s a cut finger or 60 casualty Mass casualty incident with 20 front line vehicles, control and equipment tenders etc etc)

30 odd regional fire and rescue services, 30 odd regional police services plus coastguard, search and rescue, national blood service , various military vehicles ...

plus the private and voluntary sector in EMS and Fire 100 k is a ball park figure, possibly a little optimistic.

Don't be silly, Scott. The proof burden swings both ways. You have failed to show that the risk-to-benefit ratio of this practice justifies its use. We can't even prove that the use of lights and sirens is justified in real emergencies. In fact, multiple studies contradict that belief. So how exactly do you intend to prove that it is justified in practice?

are any of these studies relevant to the UK setting ?

as has been posted in this thread previously individual Uk ambulance services run several thousand calls / day day in day out across the dozen or so Uk services , an emergency driving related fatality in the Uk is National News becasue iot happens so infrequently

But I'd like for you to cite some credible references that this practice results in a significantly better outcome than the same amount of training done without faking emergencies. The burden of proof is not on us to disprove it. The burden of proof is on you to prove it.

how can you do the same training without live emergency conditions runs

do you really feel confident aobut the prosepct of the first time someone uses warning devices and claims exemptions on the public road being aginst the whatever arbitrary figure your service wishes to see on the stopwatch in Comms ?

if these 'fake' runs were 'joy rides' and were being undertaken by unsupervised staff rather than being supervised by Training officers or Specialist instructors ther might perhaps be some justification in the criticism, but for anyone from the vast majority of the USA to suggest that any Uk practice regarding warning devices is excessive is living in a dreamworld.

and the Ambulance run in the you tube clip is not in the UK looks to be France , based on

-LHD vehicle

-French Registration plates

- the type of bus that passes the other way ...

the EFAD run is in the Uk

the maximum speed noted on the video i saw oin the first stretch of single carriageway road is 67 mph

the speed limit for a car on that road would be 60 , for a none emergency vehicle HGV 40 mph, the average UK fire appliance even if it; is Volvo or Scania is a custom designed and built vehicle and enginerred to perform appropraitely under EFAD conditions

aslo note that the heavy, standing traffic at 2:58 they Stop dead, and switch off warning devices rather than blow through the temporary traffic lights ( no exemption same as when you reach a railway crossing)

it is also notable that the in town stretch following the temporary traffic lights is condiucted at below the speed limit although other exemptions are claimed

6:02 another dead stop

as for the camera view , that is the camera you would get from any Operational vehicle in the locla fire service fleet as they all have them ... to aid accident investigation and provide evidence against those who obstruct them

I used the term, FAKE.

Is it a REAL response to a fire or emergency?

No?

Then it is a FAKE.

I hate to break it to you but UK emergency vehicles and warning devices legislation doesn't require an 'emergency' for a driver of certain classes of vehicle to permitted o claim exemptions and/ or use warning devices , only that the purpose the vehicle is being used for would be hindered by not using warning devices and/or claiming an exemption.

The Services, CPS and Courts accept that live training is an appropriate purpose.

if you have a collision while claiming exemptions whether training or real you will be prosecuted to the fullest extenent of the law and the accident investigation from a criminal point of view will be exemplary becasue the Specailst crash investigators from the the Raod policing Unit will investigate it in the fullest becasue they realise that their investigations are a significant part ofthe evidence base of what is and isn't acceptable behaviour when claiming exemptions and driving using warning devices.

I also used "Joy Ride".

which is patently untrue

You expose the public to NEEDLESS risks and annoyance.

sadly the services, CPS, courts and professional bodies feel otherwise

You impose taking right of way from others. (obligating others to "give" you right of way)

You force others to stop and yield and move out of your way. (making others "volunteer" to give way)

i'd go and read the relevant legislation or even the Uk Highway Code, the Uk does not have mandatory yield legislation, instead relying on intelligent use of Obstruction legislation

You blare noise into homes and businesses.

As MedicRN stated, you may desensitize the public to sirens.

rather less than every whackerin the township running lights and noise to fire house or scene for a 'cat up tree'

If there or here, it is still wrong.

Matters not if some unenlightened bureaucrats made it "legal".

My English acquaintances, who had no idea such is done, oppose the imposition.

Perhaps they will start an effort to get this "malpractice" stopped.

they will get laughed out the courtroom,

We do need to practice on closed courses to learn vehicle clearances and maneuvering, etc. (We use parking lots and cones.)

irrelevant to the discussions, yest we all spend part of our basic none-operational driver training on a car park with cones and that

But emergent driving proficiency can all be gained driving normally and using just a little imagination and thought.

can it ?

well in Whackersville where 16 hours training is considered excessive ...

And now you also have videos from which to learn.

irrelevant

Even my English friends are appalled.

They never suspected - how would they know?

They had no idea that a fire truck, ambulances, too?, may be speeding down a street with lights and sirens operating, taking right of way from drivers and pedestrians, going through red traffic signals, passing in opposing lanes, imposing noise pollution, on FAKE emergent runs.

Do any other countries allow such moronic nonsense?

so real as possible simulated training is moronic is it ? so it's moronic for give you supernumerary ride time with preceptor in the back as well ?

the main benefit of this training activity is that the plug can be pulled there and then by the supervising instructor with no disbenefit to service ...

perhaps it's Moronic for your first live emergency drive to be a simulation or tasked as an supernumerary resource, and with a qualified Emergency Driving Instructor in the passenger seat and 2 other students observing your performance for their own and your benefit.

and as an FYI UK emergency vehicles do not 'TAKE' right of way it is given by other traffic ,

if you'd done a little research you've also know that UK Emergency vhicles treat Red (permanent) traffic signals as 'give way' signs and many services have a policy that the stop line must be crossed at <10 mph or even that the vehicle must come to a stop before crossing the line.

Firefighters will practice driving with lights and sirens by doing it on public streets.

They are NOT en route to any fire or emergency.

Just joy rides in public.

funny definition of 'joy ride'

-planned training excercise

-OiC the vehicle is a driver trainer / driving instructor

- routes, safety camera activitations and any near miss or actual incident has to be logged with control and with the police. any actual incident (training or real) when warning devices are used and /or exemptions claimed will be fully investigated by the service and the Roads Policing Unit.

I would prefer no one drove lights and sirens. Is there any actuall proof that more lives are saved because of this dangerous action than lost in acidents caused by it?

depends if we are talking about whackers with little or no training or people with several weeks of drver training in addition to a full EU Driving licence for the class of vehicle ...

You're overcomplicating it. Keep your hands on the steering wheel and off the switches. The partner riding shotgun should be doing all that. Why would it take hundreds of simulated runs to learn that?

or you have properly specc'd vehicles with single button/ switch / slider emergency warning system controls and foot pedal/ horn ring siren tone change controls

I see your points but disagree. Sorry. I think you dull the publics perception of emergency by over playing in public. I could be wrong but just disagree based on my opinion.

3 to 5 days of the three week driving course undertaken by full time emergency services is emergency driving the first two weeks are aobut good basic driving and good 'davanced' driving ... the course spread far and wide my brother is a police officer on his police response course they touched both coasts ina day beginning from pretty near the middle of the country

i currently live approx 5 miles away from my local police force driver training and development centre ... on average 1 or 2 days a week ( but not every week) i see driver training cars on blues for perhaps an hour or so vs, the several hundred emergency responses a week from the local police station and the Roads Policing unit based there

I agree that anyone that is on a fentanyl patch daily, will have a high tolerance for any pain medication that you choose to administer, but you still have to worry about OD. I would remove the fentanyl patch, and continue with Fentanyl IV. Since it is shorter acting, you have less risk of OD, than you would with piling MS on top of the fentanyl and whatever other pain medications are already in their body. If you had a long transport time and the fentanyl wasnt working, you could then move on to the next med in your arsenal.

DO NOT REMOVE THE PATCH !

any predominatly agonist opiate / opioid couldbe used for breakthrough / additional pain relief

If this agency plans to regulate non-911 services, or even recognise their existence, they are already teh fail!

who would you rather regulate the use of ambulances ( and ambulance like vehicles) and ambulance techniques for none emergency work ?

Perhaps it's your grandfather having the CHF exaccerbation, or whatever breathing problem we're referring to. The ambulance has a 12-15 minute response time, and the fire piece(engine, ladder, whatever) has a 2-3 minute response time. Sounds good.

Now lets say the Engine has a firefighter/paramedic in the jump seat, and a monitor/drug box/cpap/ all that nice ALS stuff on board.

Sound like a bad idea sending the fire engine to the EMS call?

well other than the resource implications of tying up 5 personnel ( 3 or 4 of whome are extraneous on scene , but the appliance is offthe run becasue it's tasked) and a 250 thousand GBP piece of apparatus ...

a Community FR responding ( at raod speed) in their own vehicle costs the cost of kit, training and comms

a response vehicle costs around 30 - 40 thousand GBP and delivers a provider in the same manner as the fire appliance but with no extraneous personnel , no loss of fire + rescue asset and with a smaller carbon and financial footprint

replace your one misused fire appliance with 4 or 5 EMS response vehicles, a mixture of EMS response vehicles and ambulances or tens of CFRs to provide essential early links ofthe chain of survial ...

This looks to be a much more stable, secure system. Unfortunately I don't think it's available in North America. We seem to be behind in most other ways so why not this one too :roll: .

usual factors

local legislation may make it hard to get novel systems approved

the inbuilt resistance there appears to be on the left pond to changing working practices, and becasue USAn manual handling legislation has nothing to say on ambulance trolleys ....

cost is an issue as the system runs to something like 9000 gbp for cot and mount (pennies compared to the kind of settlements people get i nthe Uk for manual handling related injuries ) but becasue EN1789 compliance is often specified in contracts iot's a price that has to be paid.

Out of curiosity do you still have physicians delegating tasks to you? In other words, are you allowed to give all treatments and medications under your license or do you need a doc to have signed a piece of paper somewhere for you to do it?

answered as a Nurse

a direction to adminster is organisationally required for certain classes of medication, and legally required for other classes of medication and Blood and Blood products - this direction to adminster can be in a number of forms , not all forms require the 'signature' of a registered medical practitioner ( a patient specific direction generated by someone with independent prescribing rights stands as regardless of the profession of the prescriber, certain of the organisationally required guidelines do not require a medical signature, where a patient group direction does at present but the legislation surrounding PGDs pre dates the exapnsion of prescribing )

other 'treatments' Nursing guidelines are written by Nurses for Nurses, Medical staff are involved in writing some of of these guidelines but equally other professions are involved where the guideline is applicable to those other professions. the UK does not have the (billing related) requirement for medical devices to be sold 'by or on the order of a physician'

a simialr situation applies with regard to who is authorised as a medicla imaging referrer although the 'practitioner' responsible for the overall management of imaging may well not be a physician as it is possible for a number of other professions to obtain 'practitioner' status under IR(ME)R it's most commonly Radiographers and dentists who are practitioners other than radiologist doctors

If you have never seen an ambulance that has been through a frontal substantial collision, let me paint you a picture:

1. The cot goes through the Captain's chair. It can be rated for all the "Gs" you want, but if it is bolted through 3/4 inch plywood (as most are), it doesnt stay locked to the floor.

2. All the plexiglass and supplies comes out.

3. The monitor and O2 tank come flying to the front to hit the medic that was killed by the stretcher.

4. The box will often collapse the cab of the truck (in the typical pick-up truck chassis).

5. If you roll over, the box will fall apart as if it were made of paper.

6. If you are on the squad bench, you can expect the safety net to slow your body down just enough to say one last oh-sh*t before you crash into the ALS compartment and die.

whivch is why in the civilised world EN1789 requires proper construction standards for ambulance vehicles including all strucural elements of the body and that all locker facings and closures and equipment mounts must withstand 10 g impacts

Let's start with a more secure system for mounting cots. I'm sure most of us have seen the videos where the cot launches right into the 911 seat.

Ferno CEN 6 series cots and 'lock and load' mounts solve many of the manual handling issues in one was well with decents cots a ramp / lift as wellas a 10 g crash stable locking system

http://www.ferno.co.uk/products/ambulance/Trolleys

http://www.ferno.co.uk/viewproducts/ambula...ing-Systems/25/

The nurses pretty much run my area EDs... of course the Doc will always have rank above them but we mostly see them when its a serious call. I have no problem doing a med patch or handing care off to a nurse vs. a doc... these hospitals are out med control and if they feel then nurses are responsible then I hope thats good judgement.

a Physician does not 'outrank' a Nurse or any other health professional in civilian life unless they are a General Manager or Executive Director of the organisation in addition to being a Physician ...

in terms of radio Nurses it;s a pure symptom of the messed up way Pre hospital care in the USA is organised, professionalise paramedics and put them in a position to work to proper clinical guidelines on the strength of their own professional registration rather than under the licence of another health Professional ...

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The hospital can do more in way of advanced procedures that only doctors can do....

like what ? nothing that any other Als provider can or can't do with suitable operational guidelines for SCA

central lines....

of no value compared to an EJ perpherial line or IO

cardiac massage....

open cardiac massage has no place in SCA with a 'medical' aetiology ... there may be a place in trauamtic cardiac arrest but you really need a field physician to do that ( e.g. successful field thoracotomies on patients with pentrating chest trauma as performed by london HEMS ... )

etc...... no one really questions it we just do what our protocol says to do....

which is why leftpondian healthcare is so messed up

We are actually not limited we our one of the more open ems systems in that we can do alot with out ever asking its really nice..... as i said protocol is protocol is protocol

banjos is banjos, doctors is doctors and paramuppets don't need none of that book learnin'

How about the amount of money we waste on 911 Centers. Why do we need one for every county and city ? If microsoft and dell can handle all of their customer calls from one center in India, why cant we cut down the 911 centers to maybe 2 or 3 mega centers per state ?

it's just the bass-ackwards way things are done on the left pond , here in rightpondia, there's one police comms centre per force area, one or two ambulance comms centre per service ( bearing in mind that services cover 3 ,4 or 5 UK counties) and the hosemonkeysare going to regional comms centres becasue they do that little compared to EMS and police

does the Istat magically detect a reliable troponin level far sooner than any other test ?

it has to be a system wide view which is where the 'evils' of socialised healthcare are extremely beneficial .

if the paramedics are able to interpret and communicate findings send a copy of the 12 lead to the recieving facility then forget door to needle for ither lytics or PPCI and start thinking 'call to needle' or 'pain to needle'