Lots of ICU time recently.
A few thoughts 🧵
1/ There is a discomfort in “doing nothing.” But sometimes the most skillful thing we do is support. Resist the urge to add or subtract just to feel like progress is happening. Patients often need time more than they need novelty.
@bilalksheikh@ross_prager Also an excellent idea! Out of the way for chest compressions and airway management and probably easy to identify and scan for most paramedics with basic US skills.
@DrDiGiorgio Working in a different country/system here but we have “break the glass” for elite sports players or famous people purely because the clinicians caring for them need a higher level of medical malpractice insurance.
@searchy_boy CRM - Moulage and simulation of how to take control of a scene, allocate resources and delegate effectively. Understand your cognitive load and shared decision making.
@simontutt88 @jbrannan23 I am open to be corrected here. IGel is the first line option for advanced airway, but if that fails and basic airway is challenging too, what’s the harm of having a not-so-competent intubator try? The patient is hypoxic in either scenario.
@plasterapplier1@JamesOz1 and @expensivecare recently covered breaking bad news in their podcast. Great opportunity to brush up on the frameworks, even as a critical care practitioner myself having difficult conversations frequently. Highly recommend it!
“Competency is what is important for a (block) procedure, not what title is on a name badge” - My take home message from this report
https://t.co/0t1iStPzcr
@paulajmc1@ES_News_@obbsie Unlikely, I would suspect that the ambulance crew were offered training and support to improve their skills when dealing with suicidal patients. Coming from an ambulance background, I find this case shocking.
@AlisonGeorge10@pa_StephenNash @TomStocks1982 @Paulscriven Just pointing out here that paramedics lead arrests daily, without doctors. A title alone does not imply competence.
@TheLeeMcLaren A classroom gives you a safe space to focus and build your knowledge. Placement then compliments that with the hands on approach. Paramedicine is taught in the classroom and practiced on the streets. You need to know what to do before you go out and do it.
@moribunddr Wouldn’t call it micromanagement. It’s the pressure filtering down unfortunately. I can imagine that in those 15 mins, they’ve had ten bleeps themselves from discharge coordinators, bed managers, matrons, PTS booking managers etc. Don’t blame the nurse, blame the system.
@Ryanharris2021 I did a PGDip in clinical education as NQP and a couple years later started a critical care MSc. On both courses, I had colleagues who struggled to adapt to academia after gaps with their studies.
@Aidan_Baron@EdinburghUni has been offering HCP-Med for a couple years now. It’s former of 3 year part time (while still working as a clinician), followed by 2 years of full time studies. Brilliant idea and would love to see than expanded across the whole of the U.K.
@rosiedoddjones Most arguments have already been made, but I’d also highlight the analgesic properties of Aspirin. Used a lot more as an analgesic in other countries and is part of the care bundle for ACS.
@FFAFrances @DaveSwart7@ParamedicsUK Indeed, a prefilled syringe (posiflush) is actually a medical device thus anyone can use it. If you draw up sodium chloride for the purposes of flushing a line or otherwise, you are using the S17 exemption which is only valid for registered paramedics.