SA Firefighter
General Discussion => SAAS => Topic started by: Knackers on February 17, 2008, 04:19:48 AM
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How about us ambos/paramedics get some clinical topics/discussions going. Can be on anything, from experience of jobs (what would you do etc), to new treatment/management options etc.
I can't think of anything at the moment as it is 5.45am but if someone what's to kick it off that would be good.
Thanks,
Knackers.
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Hmmm i hear leaches are good :-D
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now that would just be upsetting the applecart...this is after all the SAFIREFIGHTER forum...
....on the other hand...a good excuse for more wind-ups!!
:evil: :evil: :evil: :evil: :evil: :evil:
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Hmmm i hear leaches are good :-D
Actually they are... as are maggots.
How about the talk regarding the statewide retrieval service? You read the discussion paper yet, Matrix?
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haven't seen it yet squid....you got a copy of it?
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Everyone is welcome here! Ambos do support fire and rescue activities so chat away! :-D :-D :-D
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Its ok Boredmatrix, the firefighting aspect of this site was lost long ago.
Any intelligent discussion ends in "Call the SES we're bored and need a reason to exist"
Ahem... Continue, I'd be interested in clinical stuff to be honest.
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What about the pro's and con's of certain strategies or equipment like ,Stiches versus Staples, Handcuffs versus Leather..... oops sorry I digress!
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jaff - with the latest stats showing that SAAS's workforce is over 45% female - I don't think it's out of line!!
others may however- disagree on the grounds of innapropriate sexual content!
I guess thats the end of that digression of topic then! :-P
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Its ok Boredmatrix, the firefighting aspect of this site was lost long ago.
Any intelligent discussion ends in "Call the SES we're bored and need a reason to exist"
Ahem... Continue, I'd be interested in clinical stuff to be honest.
Ah Numbers - you have a cruel streak :roll:
And I'm interested in What's better - Hadcuffs or Leather too!
Seriously some info on clinical stuff would be good - after all we are bored and need something to do :-D
cheers
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I'm more of a fan of Leather, the wide straps are easier on the wrists.
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Ok no worries thanks
Thats the first useful thing I have learn't on this forum :wink:
cheers
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Well off to a good start, found out leather is preferred, and leaches will soon be in all medical kits.
Not sure about the Retrival Team thing. As far as I gather they work from the Harbour Town base during day and on-call during night. Inc an SOT, Dr and Nurse.
How about hydrocortisone, which ICP's will soon be using. any other ideas?
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And now back to the topic.
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And now back to the topic.
Can a seperate SAAS agency forum be created like SES, so that they are seperated & can grow....hint to moderators.
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How about we change the name of the site? It certainly isn't "For SA firefighters" anymore ;)
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Not sure about the Retrival Team thing. As far as I gather they work from the Harbour Town base during day and on-call during night. Inc an SOT, Dr and Nurse.
How about hydrocortisone, which ICP's will soon be using. any other ideas?
the retrieval one is an ongoing political hot potato. Most other states use a paramedic and Dr for retrievals - SA is the only state that uses nurses for primary trauma - but the SOT is always dispatched for primary (airborne rotary wing)trauma responses. Usually results in some doozy arguments! got to love politics!
hydrocortisone? nothing to it really besides being long overdue! - tis something that should have been on the cars about 5 years ago!
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Time they looked at having a chopper based here in the SE for all medical emergency's and that it is staffed by a DOC and a SAAS paramedic would work well and I am sure they would get lots of work....RFDS is always too busy and that is why we are seeing the chopper come into Naracoorte a lot more than it used to...
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Time they looked at having a chopper based here in the SE for all medical emergency's and that it is staffed by a DOC and a SAAS paramedic would work well
Not wanting to cause any issues, but why do we need a Doctor on primary trauma retreval??
This may be a loaded question, and very open to interpretation and personal view, but what can a Doctor add that a ICP cant.
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Well other state run it like that,so was just putting in my 20 cents worth..
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Sorry Rescue5271, reading it again, it does look like my post was directly referenced to yours (which i suppose it is in part), was more interested in peoples thoughts on use of ICP's V Doctors in the pre-hospital environment.
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Not wanting to cause any issues, but why do we need a Doctor on primary trauma retreval??
This may be a loaded question, and very open to interpretation and personal view, but what can a Doctor add that a ICP cant.
um...yes - a very loaded question! ICP's don't spend the better part of 10 years (ie: 6 of med school and another 4+ years of post-grad study) specialising in Intensive Care Medicine!
yes - there may well be the argument for utilising ONLY paramedics on choppers - but the Doctor usually has more bags with more tricks up their sleeves than an ICP! (you can argue til you're blue in the face - but ICP's still have protocols!!)
......The point I was making was more along the lines of why is a nurse on a chopper?
The pre-hospital environment is obviously largely uncontrolled and susceptible to many forces as we all know.....so why is a nurse being put in it?
you may argue the point that a Dr is not a pre-hospital specialist either. I argue that a Dr with a paramedic alongside him/her is much more useful than a Doc AND a nurse! The ICP is capable of working with the Doc - not FOR the Doc as is the case with the majority of nurses.
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Matrix: read the paper at work the other day... it has certainly caused a few waves. Basically it says that they want two retrieval teams working out of the airport with three permanent ambulances stationed with the choppers. A third retrival team would be hospital based. They are talking about having retrieval nurses undertake ambulance driving courses, and having nurses train ambos in aspects of retrival nursing. Apparently nurses are over-represented in retrievals.
As it currently stands, There is a team based in FMC and each shift there are three retrieval teams based in the RAH. If a retrieval is called, the chopped either flies to the RAH or FMC and picks up a crew, or an ambulance picks up a crew, depending on whether they want a road or air retrieval.
You ask why a nurse is present for retrievals. I think a lot of people underestimate just how much training a retrieval nurse goes through. After at least two full years experience as a registered nurse (three years at uni) in an ICU, they must do a post-grad diploma (another 2-3 years) in Critical Care, then they must pick up retrieval nursing (another couple of years at uni) or be doing the course before they can go out. They are trained in pre-hospital care and all facets of retrieval work. We no longer live in the dark ages where a nurse is subserviant to a doctor and only wipes bums and gives out pills. Nurses have protocols to follow and can make certain decisions, just like ICPs.
The reason a doctor is on a retrieval is because they are Intensive Care doctors. They are fully trained in keeping the sickest people alive. These people go to university for a great many years and then do time in hospitals looking at different facets of medicine and surgery, then they go and study to work in intensive care and have to work their way through the ranks there before they can work on retrievals.
As much as SOTs and ICPs have their place in a retrieval, they certainly wouldn't be jumping on an international flight to retrieve some poor filtered like the Bali Bombings or Jose Ramos Hortas when he got shot. Retrievals are also done through RFDS, and they happen every day for any number of reasons. Quite often all three retrieval teams are out at the RAH. I honestly don't think that the ambos could do it without the nurses, due to the fact that there are about 50 retrieval nurses in this state who work side-by-side with ambos. There is currently a shortage of ambos (and yes, there is a shortage of nurses, but not retrieval nurses) and if the nurses stopped going, it would pull ambos from other areas where they are already in short supply. We need our ambos out in the field for the calls made by the public. They do a great job, and I know that a lot of nurses certainly wouldn't want to be ambos and do their job. I know that 99% of the retrieval nurses I spoke with the other day with the discussion paper certainly don't want to learn to drive an ambulance...
Just my two cents worth... hope it answers some questions about how retrievals work...
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I watched one of the retrieval nurses run a job one night because the doctor that came on the chopper could barely grasp the english language and had no idea what she was doing. Have to say though the nurse did a brilliant job. :|
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Very interesting posts ,its great to get an insight into something different,could you medical types give us non medical types, some help with your acronyms. SOTs ,ICPs - intensive care paramedics?
What are the ,allowable treatment, differences between ambo's and paramadics and years of study/training?
In saying that i'm a non medical person I should qualify that by letting you know that ,I'm a legend in putting on wiggles bandaids, my kids think so anyway :-D
Cheers Jaff
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Jaff,
To be a Paramedic now you pretty much have to do a Degree, then follow up with an internship. There used to be an internal Diploma but that is now gone from SAAS and most other services.
So you do 3 years at uni (Paramedic degree, there about 8 in Aust), then an internship of 1-2 years.
With SAAS they now have an RSDP (Regional Sponsored Degree Program) in which people from ATS and Volunteer apply and then (if get in) do the Flinders degree externally while working with SAAS full time. This takes about 5 years to complete the Degree and Paramedic Qualification.
The ICP course is 12 months long and you must be a Paramedic to apply. They have a higher skill set and are more autononomus. The course I think is about to change within the next 2 years, heard rumors, but not sure what going on.
An SOT, which stands for Special Operations and Tactics Paramedic (Referred to as a Special Operantions Team Paramedic) is an ICP who has done Aeromedical and rescue training, such as verticle etc. There guidelines are same as an ICP, they just have specilist training and a whole lot of experience.
As for treatment options, difficult to discuss on line, but an ICP has more options and additional skills like intubation (airway), pacing (increasing heart rate), cardioversion and some more drugs. A Paramedic has more than an ATS (transfer services) and volly, inculding cannulation, IV morphine, IV adrenaline (cardiac arrest), fluid for trauma etc.
at the end of the day though, no matter who you are and what whiz bang skills and drugs you can use, the basics still apply.
Am sure the more experience ambo's like boredmatrix can add or fix if I missed something.
Hope this sheds some light.
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And now back to the topic.
Can a seperate SAAS agency forum be created like SES, so that they are seperated & can grow....hint to moderators.
Your wish is my command! :-D
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squiddy - thank you for your comprehensive reply, which to most would be informative.
as for me - you may well have thrown an egg at me and told me how to suck it! filtered
yes - the RN's on retrievals may be experienced and qualified, but can still not initiate immediate measures such as intubation or IVT (Infusions OR Drugs)for example - of their own volition!
while I haven't read the paper- the anecdotal evidence is all around us - you only need to open your eyes and see it.
You only need to speak to Retrieval Docs from much larger companies such as Careflight - who will unanimously agree that PRIMARY TRAUMA retrievals (yes - as my previous post clearly stated) shouldn't be the domain of retrieval nurses!
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Would I be correct in saying that the retrieval nurses do more medical retrievals, than primary trauma retrievals?
Pip
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Would I be correct in saying that the retrieval nurses do more medical retrievals, than primary trauma retrievals?
Pip
A retrieval job comes up, a doctor and nurse go out the door. Sometimes we don't get specifics until they are up in the air or on the road.
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squiddy - thank you for your comprehensive reply, which to most would be informative.
as for me - you may well have thrown an egg at me and told me how to suck it! filtered
yes - the RN's on retrievals may be experienced and qualified, but can still not initiate immediate measures such as intubation or IVT (Infusions OR Drugs)for example - of their own volition!
while I haven't read the paper- the anecdotal evidence is all around us - you only need to open your eyes and see it.
You only need to speak to Retrieval Docs from much larger companies such as Careflight - who will unanimously agree that PRIMARY TRAUMA retrievals (yes - as my previous post clearly stated) shouldn't be the domain of retrieval nurses!
Don't get snippy, Matrix... the answer was intended in part for you, and in part for those who had asked questions. After all, this is a forum where people ask questions. Just because you know the answers, doesn't mean you need to have a go.
And I suggest you find a copy of the paper and read it before you have a go next time... as it states that nurses are an integral part of retrieval, but the current situation of having three teams in three places is not working, so they need a smaller team based in one spot with a broader skill mix. It is the skill mix that is causing problems, because the paper is blurring the lines between emergency pre-hospital care and retrieval nursing.
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Let's play nice in the sandpit :-P
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well when you get to the job you could always push the nurse out and put the ICP in the chopper..... :roll:
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well when you get to the job you could always push the nurse out and put the ICP in the chopper..... :roll:
If it is certain nurses, can we push them out of the chopper on the way?
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squiddy - now I'm thoroughly convinced you can't read......or at the very least - don't understand what you read!!
nowhere in the paper does it talk about cross-training paramedics or nurses in each others roles! In fact - the paper only discusses creating an entire new role in which each will bring their own expertise and clearly defined clinical guidelines for both, while the domain of rescue (sic - of rotary wing response) will still remain solely with SOT. credence to this again when the question was asked- why should nurses be doing primary trauma retrievals?
it's been clearly identified in this paper that there are roles for both nurses and paramedics which need to be far more acutely focused in order to deliver appropriate service in a much more efficient manner! Is this not what you slammed in my former comments?
This paper has been a long time coming - and there are those out there who've been empire building who don't like it because now their Lego Castles are coming tumbling down! for too long has SA managed most of their health system in a primarily Ad Hoc fashion - but I guess this happens when you put people in roles who focus purely on the immediate issues, and give no thought for sustainability and longevity of any project.
as for pushing certain nurses out of the chopper - where can I send the list?! :evil:
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as an ambo i have seen retrieval nurses stop ambos and paramedics from decking doctors. i had a job last Saturday near stockport which we had three ambulances on scene two ambulance and one Intensive care paramedic crew. then we also had retrieval come to play along with the Special operations team intensive care Paramedic and a few times the nurse had to stop some ambos from smacking the doctor one so sometimes it is good to have a nurse to keep a bit of a buffer between the doctor and ambos.
in saying that i have worked with some great doctors and nurses oh and keep the nurses on the choppers as it keeps my mate in a job.
(used the big words for those that are not quite sure what some things mean)
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yeah fair call - but we all know there are clowns in every circus, and then there's EGO's in medicine!
I know there's some ambo's out there who have much maligned ideas about their capabilites, and don't know when to sit back and take direction!
at the end of the day, it's still about working together, but more importantly - being aware of your capabilities and knowing what you can contribute as part of a much larger "system".
The biggest change in retrieval services in the past 15 years will be what this paper has discussed...IF the RP role comes to fruition! granted, there will be loads of politics involved, but as I've maintained - nurses are not good at dealing with primary trauma in the pre-hospital environment and it's time for a change.
A broad statement I know, and probably primarily anecdotal - But I'm yet to see one retrieval nurse who could do so effectively without losing their cool at some point!!
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Boredy ,how many ambulances are there in metro Adelaide? How many Ambos And Paramedics? Do you Guys have a GPS in your vehicles?
Adelaide airport plane splatters onto runway, possibly hundreds requiring immediate transport and care, could SAAS and Local hospitals cope?
Cheers Jaff
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There is a Taxi Rank, at the airport :evil:, dont forget about the buses to the city that do happen to go near the RAH.
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There is a Taxi Rank, at the airport :evil:, dont forget about the buses to the city that do happen to go near the RAH.
Yes I have been involved in a number of mass casualty exercises at Adelaide Airport and buses are always used for the "walking wounded" after triaging at the scene with normally a dozen ambulances for stretcher cases and SAPOL for overall command. They normally hold a full practical exercise every second year and a "desktop" on the in-between year. Same as Parafield AP in a smaller scale (normally 5 to 10 casualties size).
cheers.
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RFDS send a nurse and a pilot on the plane for retrievals and if really bad a doctor will also come.
The nurse is there to organize and make sure that he the patient is stable enough for flight, and obviously monitor the patient during flight.
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It depends Sam where the Retrieval team is activated from. - I have been involved with some that have had 2 Nurses, 2 RAH retrieval members (1 was a Doctor) and a Pilot.
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erm - depends on the context and location.
Retrieval generally(sic) refers to a Doc and Nurse from an ICU (FMC or RAH) going out to retrieve a patient - be it either from the roadside or a medical facility in order to get said pt safely back to ICU.
This is not to be confused with primary response - which is the role of SAAS and RFDS. SAAS is most often primary, with exception of remote locations or stations in which case RFDS is.
Retrieval generally happens in conjunction with SAAS and/or RFDS being the transport mediators(ie: taxi)
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Yep, when we get retrievals up here its the whole road show RAH or FMC retrieval crew ,like Bored said to provide Intensive Care (but they dont happen that often), but in most cases the RFDS flyouts (prob 2-3 a week) are just a RFDS nurse, due to the fact the patient needs services RDMC cant provide but doesn't need Intensive Care or treatment.
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Are RFDS restricted by Adelaide Airports curfew or exempt?
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exempt - trust me on that one! many a cold windy winter night spent on that tarmac at 3AM!