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Brufen20 wrote:I disagree Trainer2000 One would persume that the first aiders etc are trained in the equipment they have on site, and witch it being an ice rink etc they should have risk assessed that removal from ice is important. I agree Hypothermia may not set it too quick but still Ice poses many other problems. The Manager should hand over responsibility to the first aider and they act as per their training. Move the pt if required for their safety. But the casualty is not in any danger within the likely time frame of the ambulance arriving. Can we assume that the first aiders are trained AND COMPETENT in the equipment? You want to bet someone's spinal cord on it?
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its hard to comment on anyone posting on this site as we only have one version of events and not the whole picture., One would perusme they are qualified to complete the job two would persume that they only have equipment they are qualified to use three would persume that the casualty on ice is in danger for risk of hypothermia, staff at risk of hypothermia, frost bites etc etc. So my comment relays to the fact if all are qualified and have the approapriate kit there then the casualty should be moved.
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Brufen20 wrote:its hard to comment on anyone posting on this site as we only have one version of events and not the whole picture., One would perusme they are qualified to complete the job two would persume that they only have equipment they are qualified to use three would persume that the casualty on ice is in danger for risk of hypothermia, staff at risk of hypothermia, frost bites etc etc. So my comment relays to the fact if all are qualified and have the approapriate kit there then the casualty should be moved. On your first point I would assume that they have some first aid training, possible FAW at best. This does not include spinal immobilisation to any great degree. On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc. They may have been shown how to use it and possibly have practiced it. On your third point, I don't know where the ice rink was but assume it was fairly close to a centre of population and given that Amb control stated the response was top priority I would not expect a wait of more than say 10 minutes. Firstly there is no danger of hypothermia or frostbite to the casualty or staff in that period. Secondly it would take that long to get the cas safely immobilised anyway It did state that the cas was on her side so a fair degree of movement required. If you do a risk assesment the risk of injury from movement vastly outweighs the risk from hypothermia etc.
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"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent.
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Brufen20 wrote:Lots of Assuming :) Not as much as your presuming 
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arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger
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Trainer 2000 I don't disagree with the analysis you have made. I, too, worry when people who do not train and use such kit regularly want to bring it out and use it given half a chance to actually do so. However, I also agree there are lots of assumptions, and it might be that these are a well-practiced team who bring the kit out at regular intervals and pratice it properly. Also, without seeing the patient at the time and their exact positioning, it is hard to make a judgement whehther this was a spinal case that falls into the acceptable criteria for a log roll, or whether a scoop would have been more appropriate. However, one assumption I have to query is the rapid arrival of NHS services. There is continually increasing pressure in both urban and rural areas, notably at peak times e.g. Friday, Saturday and Sunday nights. There are documented instances of 40+ minutes for a responder or truck with citizen CPR in progress (Hemel Hempstead last August for example), and those in the job will know of many more, and of RRUs on scence crying out for help as they are CPRing and nothing is available. I have heard the GBs going out. My crewmate and I have a record of 1h40m to a job in East of Everywhere. We were told we could be stood down for it as we arrived at the village, albeit the other truck still had 10 minutes to arrival (we kept the job).
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JonAcc wrote:Trainer 2000 I don't disagree with the analysis you have made. I, too, worry when people who do not train and use such kit regularly want to bring it out and use it given half a chance to actually do so. However, I also agree there are lots of assumptions, and it might be that these are a well-practiced team who bring the kit out at regular intervals and pratice it properly. Also, without seeing the patient at the time and their exact positioning, it is hard to make a judgement whehther this was a spinal case that falls into the acceptable criteria for a log roll, or whether a scoop would have been more appropriate. However, one assumption I have to query is the rapid arrival of NHS services. There is continually increasing pressure in both urban and rural areas, notably at peak times e.g. Friday, Saturday and Sunday nights. There are documented instances of 40+ minutes for a responder or truck with citizen CPR in progress (Hemel Hempstead last August for example), and those in the job will know of many more, and of RRUs on scence crying out for help as they are CPRing and nothing is available. I have heard the GBs going out. My crewmate and I have a record of 1h40m to a job in East of Everywhere. We were told we could be stood down for it as we arrived at the village, albeit the other truck still had 10 minutes to arrival (we kept the job). I am willing to stand corrected on arrival times for the ambulance. I hadn't realised that thing were so bad. I have only used an ambulance once in my life and that was in out of the ordinary circumstances. Do you think that the looming cuts will make the situation even worse?
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I'm not sure it will be the cuts so much, but there are a few things coming together that worsen the situation First, the increasing population without a corresponding increase in ambulance resources Second, the closure of A&E units so crews have to take patients further Third, the target culture in hospitals which mean the patient isn't there until they are booked in, and they won't accept the patient until they can clear them through without delay; hence backed-up crews outside A&E. Our record is being 26th in the queue to off-load; after three hours LAS officers wheeled spare ambulance trolleys from the ambulance station over the road and took the patients off us and cared for them in the corridors until the hospital would accept them. Six were transferred to another A&E. Fourth, the difference from when I was a kid, when an ambulance was the last resort; now it's a first resort Fifth, when I started in the job, it was not unusual in a larger scenario to take two or three patients at a time. Now a four patient job is four trucks. I'm sure I could think of some more reasons if I put my mind to it!!!
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trainer2000 wrote:arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger
SJA ETAs ( and techs and paramedics) are trained in the use of such equipment, other grades are familiarised (i.e. able to assist a qualified person to put someone on the board) - other HCPs are trained if they aren't crew competent
leaving this aside
if the work place first aid assessment had indicated a need for such training along with casualty handling training etc then this can and should be provided - plenty of work places with AED + Gases and more than a few with fully functioning fire appliance/RRVs and Ambulances ...
in a large city close to where i live and work the local council arranges for for a large 'protable' open air ice rink to be placed in a large square for around 8 weeks in the winter, some of the the rink staff are trained in the use of collars, spinal boards and the like as are the SJA personnel (including HCPs),
- in fact last season there were few if any sessions where SJA were required to be present that ran without an ETA or HCP present despite the contract not requiring this - (the HCP requirement is for certain evenings , the weekend days and half term sessions) provided to the rink via a well known event medical management company ...
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trainer2000 wrote:arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger
the patient is in immediate danger from their environment i.e. they are laying on a frozen surface
this patient will become hypothermic very quickly
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mph wrote:trainer2000 wrote:arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger
the patient is in immediate danger from their environment i.e. they are laying on a frozen surface
this patient will become hypothermic very quickly Really? How quickly?
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trainer2000 wrote: arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger My reply was to your statement that you knew of no qualification that aplies to use of spinal boards, that was all.
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I agree with ambulance timinings, I was on a truck last night sent to a purple call and sat nav said 53 mins to get there, poor RRV driver had lots of time to dwell over a not too good pt.
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arealhighlander wrote:trainer2000 wrote: arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger My reply was to your statement that you knew of no qualification that aplies to use of spinal boards, that was all. Sorry, I should have qualified that to mean training available to the general (non VAS or Ambo) public.
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OK. There may have been a crack team of highly qualified, properly trained very well practiced and extremely competent first aiders on site who were used to using the equipment supplied. Now all of this training, qualification and practice would have been carried out at the behest of, paid for by or at least with the knowledge of, the manager. He didn't seem too keen to let them swing into highly trained action and use all of the expensive skills and equipment that his company had paid for. Maybe he knew something
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trainer2000 wrote:arealhighlander wrote:trainer2000 wrote: arealhighlander wrote:"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."
BRCS Trauma Management Course? And I assume St John have an equivalent. These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger My reply was to your statement that you knew of no qualification that aplies to use of spinal boards, that was all. Sorry, I should have qualified that to mean training available to the general (non VAS or Ambo) public.
There's loads of that too.
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the patient will become hypothermic within minutes, the pressure sores you are causing by prolonging the time on a hard service will be made far worse by the cold
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trainer2000 wrote:
Sorry, I should have qualified that to mean training available to the general (non VAS or Ambo) public.
this training is available to the public, from a variety of providers, the credibility and quality of some of the training providers may be questionable - we are in ' 5 day EMT course' territory here ... but as far as I am aware SJA course regulations do still permit PHFM to be unbundled from the ETA course and taught seperately ...
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