Tom

November was a wonderful month spent on elective placement with @EHAAT_

@oli_m_sims @Dr_Done_ Yes ok. One day is a bit of a joke.

@pt1408 @Dr_Done_ But that’s not the point the OP was making. He reckons it would take a day of teaching for me to be better at your job than you. I have the insight to realise that even with a good chunk of prehospital experience, the gaps in my practice and knowledge are greater than that.

A fully qualified doctor with: - 6 years experience as an ambulance community responder - A BSc in Pre Hospital Emergency Medicine - An elective in Pre hospital emergency medicine - Anaesthetics training States that he absolutely could never do the job of a paramedic …do we see that doctors might be the cause of all our own problems yet?

@Bourne1Isaac @oli_m_sims @NJL_Blancq @TheSnoozeDoctor I’m aware of the gulf in paramedic/medical base training. But here we are talking about an individual at the top of the profession who has down time to train, operates within strict governance structures, and has high levels of exposure. That does not strike me as unsafe.

@oli_m_sims @pt1408 @NJL_Blancq @TheSnoozeDoctor I think trying to claim false equivalence to Dr’s just indicates an individuals level of naivety. I consider myself a good paramedic. My sister is a 4th year medic (a very good one). The gap between my knowledge and hers (with the exception of niche interests) is enormous.

Thoughts? 🧐

@oli_m_sims @Dr_Done_ Oli, what do they teach on a paramedic degree that they don’t teach on a medical school degree? Sure you’d have to get used to the environment, but I doubt it would take you long to be better at my job than me.

@Dr_Done_ I could absolutely do the job of a paramedic. If I studied to be a paramedic. But I didn’t. I’m a doctor. There are avenues for me to work in the prehospital environment, alongside paramedics later in my career if I choose (and I want to.)

@oli_m_sims @NJL_Blancq @TheSnoozeDoctor Sounds like Mark has done a comparable 6 months rotation in Anaesthesia. I don’t think it’s true to say that anaesthesia is bread and butter for senior ED doctors in uk practice. Mark will have significant exposure to PHEA decisions, implementation and maintenance

@oli_m_sims @NJL_Blancq @TheSnoozeDoctor Thanks for your response. I have sympathy with the view that PHEA should be delivered be anaesthetists but I think your arguments starts to hold less water when you have no problem with EM doctors doing PHEA.

@oli_m_sims @TheSnoozeDoctor Oil, do you hold the same reservations about uk emergency medicine trainees doing PHEA?

@TheSnoozeDoctor In other similar healthcare systems, CCP led RSI is a thing and has been for some time. I remain unconvinced by a lack of evidence base on safety, and by differences in practice between other systems and UK practice which impacts on any evidence being applicable.

@thepharmamedic @TheResusRoom @robfenwick @heli_med_james And SC please.

@TheResusRoom @robfenwick @heli_med_james Use of IV versus IM opioids please

Our Roadside to Resus this month is on Sickle Cell Disease🩸🎙️🎧 Let us know any questions or areas you‘d like us to cover 👇🏻

@loddyy24 I feel for paramedic students. Lots of graduates in recent years mean ambulance services are now relatively well staffed. Combine this with an NHS funding squeeze and the landscape you describe with ARRS and advanced practice… very difficult for graduates atm.

@TheResusRoom @robfenwick @heli_med_james @zollemsfire @TRRevents Prehospital discussion around reverse to breathing & “groggy” and convey to hospital under mental capacity act vs fully reverse and discuss patients onward wishes. Interested in a discussion that encompasses medicine, pragmatism, security, law and ethics.

Opioid Overdose, April’s Roadside to Resus episode Let us know and questions or areas you’d like covering below 🎤🎧🎬

@salopcast youtu.be/AljUXGSLWNw?si… A few more GA hints here

@simontutt88 Id like to see course that reflect a bit more of the day to day work. Inclusion of non-major trauma scenarios / big mechanisms. Elderly fallers etc. Trauma with a medical cause. Mechanisms that require precautionary immobilisation but the patient is combative / intoxicated.

Looking for ideas from Paramedic and prehospital colleagues if you could design a bespoke pre hospital trauma course for student para through nqp level. What things would /do you feel would be beneficial: lectures, sims, skills stations, specific topics etc? Welcome ideas.

@EM_RESUS AMI, lateral STEMI, Bifasicur block

Here’s the #ECG of an 80-year-old woman with sudden onset chest pain and shortness of breath who was rushed to the ER by her daughters What’s the diagnosis?

Here’s a video I made breaking down this case of a 50-year-old man who suddenly went into cardiac arrest while in bed with his wife #FOAMed

@DonnchadhaD Con of ACP: The future of the role isn’t guaranteed. See PAs. Con of med: Geographical instability, worse rotas in training, arguably worse pay in training relative to responsibility and exam load, currently extreme high competition ratios to get into speciality training.

If grades etc were not important Which would people recommend to a 22year old and why Doing Paramedic ED ACP Pros; Funded 3 years uni Cons; Only in UK Poor pay progression Going back and doing Med Pros; Greater base knowledge Can work abroad More independence Cons; Cost Time

Here's a video I made breaking down this deadly #ECG case of a 60-year-old man who presented to the ER in shock #FOAMed

@paraacpmarkham @TheResusRoom @heli_med_james @robfenwick @zollemsfire @ZollHospital Thank you. Anything further intra-arrest?

@pt1408 @TheResusRoom @heli_med_james @robfenwick @zollemsfire @ZollHospital Loosely yes and gets fairly easy to treat within the life threatening group. Ie - - strong history, tachycardic, hypoxic, signs of RV strain on ECG and if skilled hands an ECHO - no need for imaging in extremis. All other ?? PE can have formal PTP and work up :)

Pulmonary Embolism, this months Roadside to Resus A pretty big topic, let us know any areas you’d like to hear more about below 👂🏻🎤🎧

@NJL_Blancq I found uni work distracted me from core medical learning. I read JRCALC cover to cover whilst waiting to start, watched mountains of physiology/pathophysiology lectures on YouTube. Feel it really benefited me.

Due to an NHS HR kerfuffle my start date has now been pushed back until the end of Nov. I’m more than a little gutted but trying REALLY hard to see the positives - so any suggestions for meaningful/fun things for an NQP0 to do whilst waiting to start work would be very welcome

@JessicaSpara Forerunner 235, not much more than £50 off ebay these days. Does everything I need. Used it for about 6 years.

Garmin watch wears - would you recommend them and what model do you have? Thinking of investing as my Apple Watch is starting to run out of battery when I’m out on long walks. And honestly if I can’t track it on Strava what’s the point?😂

@NJL_Blancq We don’t have many pathways here. But I attempt a few times per week but due to service closing hours and service capacity I probably only succeed once a month.

Paramedics and other pre-hospital HCP’s (looking at you PHEN’s 👀) How often do you call/refer Pt’s into specialist units directly rather than conveying to ED? (SDEC’s, AU’s, wards and the like)