Treatment at Roadside vs Treatment in hospital

[Text]

I was not involved in the discussion earlier, I was not here and the thread is now closed.

But I hope it's OK if I do this thread, as I feel it's an interesting, far reaching topic, a situation that any of us could personally get caught up in.

It's got nothing to do with the very sad events of the last few days, it's about Princess Diana, no one else.

But admins, if you have any concerns, by all means delete the thread, no worries.

[Text]

I remember that concerns were raised immediately in our national newspapers about the lengthy time the ambulance took to deliver Diana to hospital


So, ATT the British Medical Association settled the argument once & for all by giving a ringing endorsement of the protocols followed by the French system and said they would not have done anything differently to how the French emergency teams handled things.



The paramedics at the roadside are at the sharpest end of resuscitation skills spectrum.
Whereas the medical staff in A&E have more broadly based skills, and their day to day work involves a lot of stuff is unrelated to any trauma or resuscitation work - eg like fishing out stuff that small kids shove up their noses.


In all UK A&E / EM departments a large part of the timetable is dedicated to brainstorming sessions where ''the pursuit of excellence'' is the agenda, it's part of the contract of the staff, the sessions are compulsory. The circs around every death in the department is also carefully scrutinised. The processes of appraisal and reappraisal of protocols never ends. All new ideas/ recommendations are then pooled nationally - and then internationally.

And the protocol for Road Traffic Accidents is the same as it was decades ago ie .....
Don't scoop & shoot, stay & stabilise.

[Maddog]

Shoot?

That doesn't sound very healthy.

[Text]

Hahaha

[Maddog]

But I don't doubt that hospital staff might be trained differently in different countries and hospitals.

I ride with a good friend who works in a trauma unit and used to be a paramedic.

I can assure you that she sees gunshot victims, stabbing victims and people who have been in horrific accidents every shift. Many of these people come from 100 miles away on helicopters that have flight surgeons on board. There is no other place I would rather be treated if my guts are hanging out. They are the pros at saving lives. They have the equipment that won't fit in a truck.

Now, if I broke my arm, I would go to a private hospital, where I would get faster care.

[Maddog]

And with Di, they were calling hospitals trying to figure out which one to take her to. None if the events that night made much sense.

They should already know where they are going as soon as they load the patient up.

I can't help but wonder if they had taken her to the hospital still conscious 10 minutes after they arrived, instead of almost 2 hours later, with a chest cavity full of blood and her heart already stopped, she might have lived.

And people with a hell of a lot more knowledge than me have asked the same question.

[Maddog]

https://www.cbsnews.com/news/was-there- ... diana/#app



The last paragraph is quite telling.

5 years after the death of Di, the French changed their protocol. An accident victim like Di will now be rushed to the hospital to check for internal injuries.

[Text]

Each case is assessed on merit.

Typo: 'scoop & scoot' , sowwy.

Remember that she suffered a cardiac arrest in transit so they had to stop again to resuscitate ('time is muscle' is possibly on google, it's an excellent handbook article for A&E dept's)


One more thing, slightly o/t.
You mentioned about how we are so proud of our NHS.
Cos our NHS is the envy of the world - even with all its inbuilt flaws like eg being open to abuse from so called health tourists ...... but that's more an administrative issue, work in progress. The Brits were responsible for numerous medical inventions and innovations in the last 2 centuries, only the Germans come close.
With collective goodwill and the right political climate - away from tory greed & profiteering - it works very well. (Not vaunting, just the bare facts!)

[Cactus Jack]

I'm going to show my age by saying there was a classic episode of MASH based on this very principle.

Ultimately the answer is a lawyerly - it depends.

Paramedics, the people who will make that decision, train for four year and I don't think you'll find one who says they haven't made the wrong call at least once - usually without too many consequences but situational changes including how much traffic was on the road would have shifted the balance one way or the other for them.

You may recall the class US comedy series MASH showed us how the US Army structured medical interventions - the chain went Medic - essentially a first aider, Battalion Aid gave more advanced but still pretty basic medical care that included pain relief and emergency transfusions, as well as cleaning and dressing wounds before handing onto a MASH unit which had the facilities to handle most cases but might have to forward some to the Evac hospital.

Every link in the chain was there to assess the patient based on clinical need and progress treatment according to their best judgement. Not having done four years as a paramedic I wouldn't judge on any particular case unless or until the full facts were know and in the case of recent events in the UK I have every confidence that the correct processes were followed.

[Maddog]

https://www.cbsnews.com/news/was-there-time-to-save-diana/#app



The last paragraph is quite telling.

5 years after the death of Di, the French changed their protocol. An accident victim like Di will now be rushed to the hospital to check for internal injuries.

"I can't say she definitely would have survived, but it certainly took away all of her chances," Zydlo said.

No official from the French emergency system would comment on Princess Diana's treatment for this report - but in 2002, five years after her accident, the French emergency guidelines were changed. Today, a patient with the same the unstable blood pressure would be rushed to a hospital.

[Maddog]

Each case is assessed on merit.

Typo: 'scoop & scoot' , sowwy.

Remember that she suffered a cardiac arrest in transit so they had to stop again to resuscitate ('time is muscle' is possibly on google, it's an excellent handbook article for A&E dept's)


One more thing, slightly o/t.
You mentioned about how we are so proud of our NHS.
Cos our NHS is the envy of the world - even with all its inbuilt flaws like eg being open to abuse from so called health tourists ...... but that's more an administrative issue, work in progress. The Brits were responsible for numerous medical inventions and innovations in the last 2 centuries, only the Germans come close.
With collective goodwill and the right political climate - away from tory greed & profiteering - it works very well. (Not vaunting, just the bare facts!)

Who told you the NHS was the envy of the world?

[Text]

Each case is assessed on merit.

Typo: 'scoop & scoot' , sowwy.

Remember that she suffered a cardiac arrest in transit so they had to stop again to resuscitate ('time is muscle' is possibly on google, it's an excellent handbook article for A&E dept's)


One more thing, slightly o/t.
You mentioned about how we are so proud of our NHS.
Cos our NHS is the envy of the world - even with all its inbuilt flaws like eg being open to abuse from so called health tourists ...... but that's more an administrative issue, work in progress. The Brits were responsible for numerous medical inventions and innovations in the last 2 centuries, only the Germans come close.
With collective goodwill and the right political climate - away from tory greed & profiteering - it works very well. (Not vaunting, just the bare facts!)

Who told you the NHS was the envy of the world?

A little bird.

[Text]

I'm going to show my age by saying there was a classic episode of MASH based on this very principle.

Ultimately the answer is a lawyerly - it depends.

Paramedics, the people who will make that decision, train for four year and I don't think you'll find one who says they haven't made the wrong call at least once - usually without too many consequences but situational changes including how much traffic was on the road would have shifted the balance one way or the other for them.

You may recall the class US comedy series MASH showed us how the US Army structured medical interventions - the chain went Medic - essentially a first aider, Battalion Aid gave more advanced but still pretty basic medical care that included pain relief and emergency transfusions, as well as cleaning and dressing wounds before handing onto a MASH unit which had the facilities to handle most cases but might have to forward some to the Evac hospital.

Every link in the chain was there to assess the patient based on clinical need and progress treatment according to their best judgement. Not having done four years as a paramedic I wouldn't judge on any particular case unless or until the full facts were know and in the case of recent events in the UK I have every confidence that the correct processes were followed.

Aye.
I like Maddog's devil's advocate type posts. And he raises interesting points, from a USA perspective. The news section would be a lot quieter without him.

[Maddog]

Each case is assessed on merit.

Typo: 'scoop & scoot' , sowwy.

Remember that she suffered a cardiac arrest in transit so they had to stop again to resuscitate ('time is muscle' is possibly on google, it's an excellent handbook article for A&E dept's)


One more thing, slightly o/t.
You mentioned about how we are so proud of our NHS.
Cos our NHS is the envy of the world - even with all its inbuilt flaws like eg being open to abuse from so called health tourists ...... but that's more an administrative issue, work in progress. The Brits were responsible for numerous medical inventions and innovations in the last 2 centuries, only the Germans come close.
With collective goodwill and the right political climate - away from tory greed & profiteering - it works very well. (Not vaunting, just the bare facts!)

Who told you the NHS was the envy of the world?

A little bird.

The propaganda bird?

While I don't put a lot of stock in rankings of healthcare, but for those that do, you won't find the UK near the top of any list.

Won't find the US there either. But I'm not claiming we are the envy of the world.

[Cactus Jack]

Each case is assessed on merit.

Typo: 'scoop & scoot' , sowwy.

Remember that she suffered a cardiac arrest in transit so they had to stop again to resuscitate ('time is muscle' is possibly on google, it's an excellent handbook article for A&E dept's)


One more thing, slightly o/t.
You mentioned about how we are so proud of our NHS.
Cos our NHS is the envy of the world - even with all its inbuilt flaws like eg being open to abuse from so called health tourists ...... but that's more an administrative issue, work in progress. The Brits were responsible for numerous medical inventions and innovations in the last 2 centuries, only the Germans come close.
With collective goodwill and the right political climate - away from tory greed & profiteering - it works very well. (Not vaunting, just the bare facts!)

Who told you the NHS was the envy of the world?

A little bird.

The propaganda bird?

While I don't put a lot of stock in rankings of healthcare, but for those that do, you won't find the UK near the top of any list.

Won't find the US there either. But I'm not claiming we are the envy of the world.

The UK were ranked 13th in 2020, down on 10th previous year as our Conservative government have brought in more and more elements of the US system, in fact the UK have now fallen behind Ireland.

The US are ranked 18th in both years so you're pretty consistent as are Japan one place behind you.