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In the UK and New Zealand the ambulance service and HEMS are separate entities. In some, but not all, cases some clinical crew come from the ambulance service but some employ their own staff. Pretty much everywhere it's either a ground or helicopter response. The trick is deciding which one...

The best way I've seen, and what is used in many places, is centralised, clinically-led air ambulance dispatch be it fixed wing or helicopter. London uses it and has done for almost thirty years, Scotland uses it, Australia uses it, Ontario uses it, New Zealand now uses it (early days) and I am...

We have very unambiguous national criteria for calling a helicopter (the ANTS criteria) and now have a national Air Desk where experienced helicopter Intensive Care Paramedics decide whether or not to send a helicopter and if so, which one to send. Gone are the days when Control sent one just...

You might be better served going to London provided you can prove to the HCPC your education is equivalent.

Oh dear, this bloke looks very sick. He needs to go to STEMI centre quickly and let the experts determine what the cause of his ticker badness is.

Hence why I said I would not. I'd leave him at home or send him down to the A&M if he hadn't taken the insulin and unknown other medicines. If he just needed a bit of IV fluid and somebody to give him a lookey loo for a couple hours then the A&M could do it fine. Most patient's don't want to...

PMHx/SHx/FHx as appropriate HPI/CO O/A O/E Impression/diagnosis Plan If it is decided to both refer somewhere AND transport there then "enroute" too.

Easy as pie. Simply based on his unrelenting tachypnoea and tachycardia and the fact has says he took an unknown quantity of insulin means I cannot leave him in the community or send him on down to the GP or local A&M .. the GP or A&M doc would run a mile at the sight of this bloke. Now, as to...

If somebody is obviously doing this deliberately it can be flagged via the Clinical Hub in Control so a specific response plan can be made up for this patient including either enhanced triage, downgrading of the response or no response at all depending on the particular circumstances. I am told...

Those places I know who have a doc all have the following: - They are all Sr Reg or Consultant from ED, ICU or anaesthesia - They all do it routinely (either permanently regular part-time, or full-time) - They work with dedicated ICPs who are full time with the team (usually a helo) - They only...

Fists, bit of wood, bottles, bat, those sorts of things; mainly blunt trauma with a very low rate of penetrating injuries but mostly from domestics or some blokes have a bit of biffo and somebody picked up a knife but they're usually short kitchen knives. Every now and then somebody gets...

With the understanding I have never seen or treated a patient who has been shot, nor would 99.9% of ambulance personnel ever see it in their careers, nor would most hospital personnel (except maybe for somebody who has had a slug pellet accidently fired at them) hmm I would hazard a guess at the...

Auckland HEMS has a Doc/ICP and can respond by road/air, and AFAIK all medical helos in AU have a Doc/ICP too. The question is not if you should do it, but why shouldn't it be done, or if appropriate, why is it NOT being done? Of course not for the majority, but a Doc can do a bunch of stuff...

So what you are saying is America is not a developed first world nation which wants its ambulance personnel to be able to look after their patients if they are not at Paramedic or ICP equivalent levels ... right. Well, you're not saying that obviously (I am joking) so ....

What about the following? Entonox or methoxyflurane (I can't believe you guys don't have either of these!) GTN 12 lead ECG acquisition Salbutamol and ipratropium IM midazolam for status epilepticus IM adrenaline (from a syringe - why bother with a bloody autoinjector?) IM and IN naloxone (you...

I've been to Los Angeles, specifically past Skid Row and it's disgusting, it's like the after-effect of a nuclear war or something. I've never seen anything like it, I can't understand how these folk aren't somehow you know, in subsidised housing or being looked after by some sort of agency...

1. You did not pass 2. What you think or feel accounts for absolutely zero 3. See number 1 and 2 then study some more so you can pass or forget it. And if you think you can defibrillate AF, you are incompetent and possibly dangerously inadequately educated to work as an Ambulance Officer and...

If you are keen you can attempt to ascertain which part of the brain has lost its blood supply by relating it to changes in vision, motor power, speech, gait etc. The limitations are (a) it only works for ischaemic strokes, (b) it is not at all sensitive and only kind of specific and (c) in no...

I don't think "having a degree" is the answer, it's what you put into the degree. We've had a degree for years but it teaches next to nothing lots of things. It is called a "three year degree" but in reality it's really about one and a half years of full-time education taught over three...

I honestly don't think more time in ICU or CCU would be overly helpful. Significantly more time in mental health, community, general medicine and geriatric or older persons would be immensely helpful. The level of clinical decision making around treat and refer is higher than its ever been. I...