Mark Tehan

Emergency medicine & PHEM doctor. Interests in med ed & human factors. He/him.

[Mark Tehan @mark_tehan]

@TJCoats @jabberwock951 Do medical directors usually get involved this sort of policy?

IME, usually left to individual specialities to manage their 'criteria'.

[Mark Tehan @mark_tehan]

@brionytheliony I think what's not often made clear is the difference between signing an ECG to say it's not an immediate life threat and actually interpreting it.

We know know the doc who signs it does the former and the doc who sees the patient assumes they did the later.

[Mark Tehan @mark_tehan]

@telocker @TJCoats ED won't be emptied.

The hossie will delay and doubt and see how little they can get away with.

[Mark Tehan @mark_tehan]

@EM_Dr_Jacklin I prefer the reduction of working hours, feels much more sustainable.

[Mark Tehan @mark_tehan]

@Nat_O_Byrne @TheRealRead Srsly tho, I cannot think of a single case where a GCS hasn't required a more specific explanation of *how* it is abn.

A GCS of 10 in an aphasic 18 year-old girl is very different to a 3 in a collapse outside a pub is very different to a 13 in an agitated head injury.

[Mark Tehan @mark_tehan]

@Nat_O_Byrne @TheRealRead What's the evidence base for it being important in improving the outcome of medical patients? 😉

[Mark Tehan @mark_tehan]

@Nat_O_Byrne @TheRealRead GCS exists to prognosticate traumatic brain injury.

Not to debate whether Doris' longstanding cognitive impairment loses her 1 for voice.

[Mark Tehan @mark_tehan]

@MaxMarsden83 @rachelgemma90 In my mind, we need to educate, train & empower clinicians at every level to use their brains and think about why someone is in arrest.

But, I think we need to be mindful that the basic (and advanced) life support drills need to keep your options open.

[Mark Tehan @mark_tehan]

@MaxMarsden83 @rachelgemma90 It's difficult cos the label gets applied early; who hasn't been dispatched to an "RTC, traumatic arrest" when a car has rolled to a gentle stop against the central reservation?

[Mark Tehan @mark_tehan]

@MaxMarsden83 @rachelgemma90 Do we count positional asphyxia or impact brain apnoea as 'traumatic' arrests?

[Mark Tehan @mark_tehan]

@Roseberrykate @mancunianmedic @DrNeenaJha But 111, the ambulance service, an EM clinician and a medical one have all decided not to discharge...

I don't think it will be a huge percentage.

[Mark Tehan @mark_tehan]

@Shanghai_Rose @mancunianmedic @DrNeenaJha In order to get to post-take, they've been through a triage and at probably two clinicians. If all of those people thought they needed to be in...

[Mark Tehan @mark_tehan]

@KadeF96 Switchboard even screen some *internal* calls all the time!

[Mark Tehan @mark_tehan]

@Dr_JSA Yer, and your rationale is perfectly reasonable, but in what other specialities would that behaviour be appropriate?

[Mark Tehan @mark_tehan]

@Dr_JSA Or, if you'd prefer it more GP oriented, if a GP reg turned up at your practice and decides that they were going to initiate penicillamine for RA or offering ear syringing & microsuction, how would you suggest that be managed?

[Mark Tehan @mark_tehan]

@Dr_JSA That can only effectively work when employees of those services work within those constraints.

So, in that context, when do you think it's appropriate to go off piste and disregard your employers direction on what can and cannot be offered?