Tom Nettleton

@ParaAndy90 As others have said it is around IV access and the possible difficulty with this and affecting future venous access.

Need help clever people. Why should morphine not be given IV for sickle cell patients ??

Chickenpox is now a notifiable disease. Treatment and management protocols remain unchanged: bit.ly/4lNjvKq

@MattBal70 @NatashaMDay 2/2 - and are just going to be a side room and see. This might not be any safer than them being in their preferred place of care and avoiding pressure areas / increases confusion / hospital acquired infection. This isn't a decision everyone's is experienced to balance

@MattBal70 @NatashaMDay Is this so much a risk factor for ICH or a risk factor for poor prognosis? If the patient is really asymptomatic there is a reasonably body of evidence that would support this. Ahead 2 for example in warfarinised patients. In some patients who are not a candidate for surgery 1/2

@NatashaMDay This is interesting. bmjopen.bmj.com/content/7/1/e0…

Good to be back with @SJA_Sussex . Some great admission avoidance and ophthalmology teaching.

Change of shoulders for today's day out 🚑 🚑

@Scott_War1 @2Quirk The only thing I've seen documented is to reduce the number of times these patients get vascular access to make sure veins are preserved for life threatening presentations.

@2Quirk Really useful recap, do we know the reason why morphine should not be administered via the IV route to patients in sickle cell disease crisis?

🚑🚨🩸#RapidRecap: Sickle Cell Disease. It's most common in people of African or Caribbean origin; take two minutes to refresh underpinning knowledge and recap the red flags 🩸🚨🚑 #paramedic #studentparamedic #nurse #studentnurse #ambulance #FOAMed

@BHECCS I'd be really cautious about having exposed shears across your chest wall. In the event you are in an RTC shears may be caught by a tensioning seat belt, forcing these into your chest wall. Plus very easily grabbed. Much safer in a pocket.

#BHER01 was out again last night responding to multiple calls in the local area. Clayton and Daniel both work for @TfL but volunteer for BHECCS in their spare time. #VolunteersWeek

@kieran_robinson @NJL_Blancq I think it seems a great idea appropriate paramedics could have parity with the other listed AHPS - mental health nurses, LD nurses, social workers and OTs. If they can meet entry requirements and be supported in this role.

@kieran_robinson @NJL_Blancq An ambulance Trust could not sponsor this. You need to be approved and warranted (on completion) by a local authority with a placement portfolio completed during the pgcert or pgdip programme. Like NMP you cannot access training without employer support.

Poll of the week for Paramedics, Student Paras and anyone else who fancies getting involved - should Paramedics be able to train as AMHP’s?

@DonnchadhaD We have to move away from no one's been sacked for just doing what the patient wants." no ones been sacked for taking a patient to hospital". If we want to keep progressing as a profession. We need to be confident decision makers seeking support as needed. 2/2

@DonnchadhaD No is no. Just the same as I want to go to hospital doesn't guarantee a trip. Healthcare is not a supermarket. Everything we do needs to be based on a history and assessment. A considered assessment, history and shared decision if needed will support you saying no. 1/2

What do ppl think about giving morphine to morphine seekers I’m not talking just someone you suspect, I’m talking you open prev records and see they call 2x week and when they get to hospital they just get up and DC themselves To give or not to give?

@DonnchadhaD Untill we toughen up the criteria to use acp too this will always be variable. Is this someone with 5 years post reg experience an msc and proper clinical supervision. Or is this someone with a level 7 minor illness and an NMP course.

Again I am generally pro ACPs But I want to see the OOH GP referral acceptance rates pre and post ACP introduction I would guess my rates are Referring to GP 75% acceptance Referral to ACP 25% acceptance I’m getting so sick of this Taking old ppl to hospital HAS RISKS!!! And just to pile onto that for the ppl that click read more Shoulder pain with clear msk cause is NOT an indication for 12lead ECG You can be elderly and have an infection that’s not sepsis And just generally “think horses not zebras” - slow onset generalized weakness is more likely to be infection than stroke Maybe I’m just ranting and I’m just too inexperienced idk but I feel like when I call a GP and say there is mild SOB normal obs and productive cough with bibasal crackles they would go oh sure sounds like they need abx, give some worsening advice. But I give exact same handover to ACP and I need to do a 12 lead then percuss the chest and then they still say pt needs ED for CXR incase it develops into pneumonia Sorry rant over I’ve just been frustrated the past few weeks Just to reiterate I’m not against ACPs generally the ones that work in my local ED are amazing, just seems the ones working for OOH GP are terrified of patients staying at home

@Stanfield72 @ParamedicsUK I can definitly recall summers having vehicles with no AC and choosing either being very hot or driving on lights with the windows open. I think this probably isn't something happening us much now.

@GlenwrightCook If you set a precedent and start doing this where does it stop. ED clinicians under under huge sustained pressure. I can see no one wants to create something that becomes an unofficial pathway when they operate at or above max capacity daily.

@tomamedic @MallinsonT @NJL_Blancq 1 + 1 and the safe shock

Poll off the week: Paramedics, student Paramedics and ambulance peeps - should all Ambulance Paramedics have RCUK ALS certs?

@PaleyAlistair @samdharrison @Aidan_Baron Diarrhoea Instructions Are Run Run Hurry Or Exploding ...

@samdharrison @Aidan_Baron Dining in a rough restaurant, hurry or expect accidents

Confession: I can’t spell diarrhoea without spell check So I end up writing “frequent LBMs” in the medical notes 🥲

@loddyy24 LAS do

@Sharpscratch75 There is no restriction on paramedics administering antiemetics with or without analgesia. They can prescribe these if an NMP or administer or obtain these under s17 HMR exemption for organic disease or the imidiate and necessary treatment or sick and injured 2/2.

@Sharpscratch75 Physios can prescribe 7 cds, paramedics 5. This is for organic disease not just pain. All paramedics can obtain and supply autonomously morphine and dizepam regardless of prescribing status. All paramedics can autonomously obtain and supply ondansetron and metoclopramide 1/2.

🔴 NEW: IT blunder allowed PAs at Calderdale and Huddersfield to "illegally" prescribe drugs inc opiates and sedatives PAs prescribed oxycodone, codeine, lorazepam, diazepam and midazolam, despite being "instructed they are not legally able to prescribe” telegraph.co.uk/news/2024/02/2…