D
Deleted member 33
Guest
Thanks ST,
Its with the MOD at the moment so if they don't have any issues it will be going to print as soon as possible afterwards.
Rich H
Thanks ST,
Its with the MOD at the moment so if they don't have any issues it will be going to print as soon as possible afterwards.
Rich H
Chest drains and thoracotomy
YES I DO. Chest drains should only be done by skilled physicians, Paras, nurses or senior Medics who has a thorough understanding of the underlying pathophysiology and consequences.
Speaking of a thoracotomy: The survival rate of A&E thoracotomies are 1%, most likely done on dead patients. What good would it do to be in the sandbox with a patient and an open chest
YES I DO. Chest drains should only be done by skilled physicians, Paras, nurses or senior Medics who has a thorough understanding of the underlying pathophysiology and consequences.
Speaking of a thoracotomy: The survival rate of A&E thoracotomies are 1%, most likely done on dead patients. What good would it do to be in the sandbox with a patient and an open chest
distantmedic
Longterm Registered User
G.Surgeons
Heck and i thought we were all general surgeons, darn must be googling to much....... That remark was for the benefit of those that have little or no medical education, read to many books, watch to much "How to" on youtube and google reference everything. 26 years in this game and i used to say nothing surprises me anymore. Well chest drain wannados just did it. I'm getting to old for this sh*t.
Heck and i thought we were all general surgeons, darn must be googling to much....... That remark was for the benefit of those that have little or no medical education, read to many books, watch to much "How to" on youtube and google reference everything. 26 years in this game and i used to say nothing surprises me anymore. Well chest drain wannados just did it. I'm getting to old for this sh*t.
Sounds to me Rich H that you are referring to the old school 5 day Army Team Medic course. Whilst I agree that the chest drain is not even in the same league as a 5 day medic, neither are surgical airways and cannulation.
For years Military CP teams were deploying guys as team medics who´d done a 5 day course and yet had cannulated once. OK they did it text book on a live patient with great veins, under supervision with no pressure but could they repeat that skill 5 months later? Probably not but more important why were they doing it?
Where was the A & P training? There was none! The course didn´t even teach taking blood pressure, a key factor in fluid administration.
What about permissive hypotension?? What about coagulopathy? Dilution of clotting factors, blowing out newly formed clots?? Crystaloid or colloid? What temp to administrate fluids at? Some trauma course were teaching infuse 2 litres of fluid as fast as possible for trauma - great, you´ve probably just killed the patient. IV cannulation taught at that level should only be for one reason - to assist a real medic, i.e. to understand the kit, process and terminology so he can assist in the process when the medic has 10 jobs to do at the same time.
Surgical airways should be saved for healthcare professionals with proper training too, relating to the A & P, the associated complications etc.
The biggest fault with any of these short courses is the lack of consolidation through clinical practice and patient contact. Hence the majority of our courses include clinical attachments as ambulance crew, at primary care clinics or an A & E (ER Dept).
A chinese professor (can´t recall his name but will dig it out) once said that a skill can only be achieved through repetition and 2000 times was the optimal number to achieve a level which could be recalled and employed naturally. How many times do guys cannulate on a 5 day course. Once, twice!!!
The basis for granting authority to perform medical interventions must be: Underpinning knowledge, learning of and practising skills, patient contact and clinical practice, along with constant CPD.
Chest drains, surgical airways, cut downs, IVs and fluid administration are serious invasive procedures and should not form part of the scope of practice for a First Responder whom has completed a 5 day course.
I still laugh now that we were taught chest drains on the NI team medic course. It should be re named, team First Responder and pay more attention to the skills which are achieveable, relevent and related to the kit carried.
As for military CP teams whom carry all this kit, I seem to recall we carried it in order that we had the sterile kit to hand in order that we could give it to a local healthcare professional to utilise (rather than them use their own un sterile kit).
M4MED
For years Military CP teams were deploying guys as team medics who´d done a 5 day course and yet had cannulated once. OK they did it text book on a live patient with great veins, under supervision with no pressure but could they repeat that skill 5 months later? Probably not but more important why were they doing it?
Where was the A & P training? There was none! The course didn´t even teach taking blood pressure, a key factor in fluid administration.
What about permissive hypotension?? What about coagulopathy? Dilution of clotting factors, blowing out newly formed clots?? Crystaloid or colloid? What temp to administrate fluids at? Some trauma course were teaching infuse 2 litres of fluid as fast as possible for trauma - great, you´ve probably just killed the patient. IV cannulation taught at that level should only be for one reason - to assist a real medic, i.e. to understand the kit, process and terminology so he can assist in the process when the medic has 10 jobs to do at the same time.
Surgical airways should be saved for healthcare professionals with proper training too, relating to the A & P, the associated complications etc.
The biggest fault with any of these short courses is the lack of consolidation through clinical practice and patient contact. Hence the majority of our courses include clinical attachments as ambulance crew, at primary care clinics or an A & E (ER Dept).
A chinese professor (can´t recall his name but will dig it out) once said that a skill can only be achieved through repetition and 2000 times was the optimal number to achieve a level which could be recalled and employed naturally. How many times do guys cannulate on a 5 day course. Once, twice!!!
The basis for granting authority to perform medical interventions must be: Underpinning knowledge, learning of and practising skills, patient contact and clinical practice, along with constant CPD.
Chest drains, surgical airways, cut downs, IVs and fluid administration are serious invasive procedures and should not form part of the scope of practice for a First Responder whom has completed a 5 day course.
I still laugh now that we were taught chest drains on the NI team medic course. It should be re named, team First Responder and pay more attention to the skills which are achieveable, relevent and related to the kit carried.
As for military CP teams whom carry all this kit, I seem to recall we carried it in order that we had the sterile kit to hand in order that we could give it to a local healthcare professional to utilise (rather than them use their own un sterile kit).
M4MED
Emergency Medicine Course Summary this kind of 'thing' does NOT help..... a 'walts' dream course.
Starlight
Super Moderator
Take an FPOSi course, and add in all sorts of gucci cas teaches and invassive skills, add the words Hostile Environment and hey presto, you've just created the next must do, super-dooper, bayonet fighting, medics 'qualification'. You've also trippled your profits.
However, those that undertake said training, are still only FPOSi, and are not 'qualified' medics.
Argue and disagree all you want, but that's the reality.
Incoming............................
However, those that undertake said training, are still only FPOSi, and are not 'qualified' medics.
Argue and disagree all you want, but that's the reality.
Incoming............................
Mountainman
Super Moderator
Wise words as always Starlight! No incoming from this direction, only cover! 
Scartissue
Longterm Registered User
You will find this course is probably only open to registered medical professionals. The learning objectives also seem geared only to the A&E dept for clinicians to gain extra training and experience during their medical training. I have seen a great many courses like this crop up for hospitals run by private companies... Again NHS throwing money away to private companies rather than developing their own medical training centres.
Chest drains.....foooking ell, ive seen DOCTORS f**k up chest drains...hell, ive even taken RTC casualties into an A&E and seen the SURGEON f**k it up.........FPOS is FPOS...you can call the course title any thing you want....add any kind of training add ons to it..........in the end, you still get a nice little certificate with FPOS and thats all you are qualified to do. you try and do anything out side of that, and your in a world of puppy poo.......
Being ex Inf medic, yep, we carried all sorts of shiney gear.......I had one little silver package that was actualy labelled (RMOs Shiney Gucci bit of kit)but that was for the RMO and the qualified health care practioners ( TA RGN's with 20 years of A&E experience, Doctors, Paramedics) that were attached to the Med Centre on Ops. not for us mere mil medics who had done the old Medics courses...
I am not a Paramedic.....just an ex Inf medic with a lot of experience, and some very useful courses under my belt along the way....But it f*cking grips my dick when lads on the circuit come over and start bringing out all kinds of surgical chest drains, ET tubes, laryngscopes...bags of drugs theyve never even fooking heard of before...after doing a 5 day course.....
I know my limits, what i can and cant do......rant over......time for tea and biscuits....
Oh, and I passed my Offshore Medics course with ExMed.( currently doing the Survival part thingy in Fleetwood)...the 2 week A&E attachment at Northampton was brilliant....it was there that I was taken through the correct way of how to perform a Surgical Chest drain....and even then the skill set involved was something out of the Krypton Factor!....the amount of knowledge those Doctors, Nurses, Paramedics have is something else....Muchos respecto!
Being ex Inf medic, yep, we carried all sorts of shiney gear.......I had one little silver package that was actualy labelled (RMOs Shiney Gucci bit of kit)but that was for the RMO and the qualified health care practioners ( TA RGN's with 20 years of A&E experience, Doctors, Paramedics) that were attached to the Med Centre on Ops. not for us mere mil medics who had done the old Medics courses...
I am not a Paramedic.....just an ex Inf medic with a lot of experience, and some very useful courses under my belt along the way....But it f*cking grips my dick when lads on the circuit come over and start bringing out all kinds of surgical chest drains, ET tubes, laryngscopes...bags of drugs theyve never even fooking heard of before...after doing a 5 day course.....
I know my limits, what i can and cant do......rant over......time for tea and biscuits....
Oh, and I passed my Offshore Medics course with ExMed.( currently doing the Survival part thingy in Fleetwood)...the 2 week A&E attachment at Northampton was brilliant....it was there that I was taken through the correct way of how to perform a Surgical Chest drain....and even then the skill set involved was something out of the Krypton Factor!....the amount of knowledge those Doctors, Nurses, Paramedics have is something else....Muchos respecto!
D
Deleted member 33
Guest
It wasn't a commercial medic course but a pre-deployment CP training - RMP CP!
Terrible I know but when you have either individual in certain positions wishing to 'do things differently' or allowing the RAMC to train whatever they choose then the issue of disclaimers will arise!
Rich H
Terrible I know but when you have either individual in certain positions wishing to 'do things differently' or allowing the RAMC to train whatever they choose then the issue of disclaimers will arise!
Rich H
What ever happened to Keeping It Simple? I think these skills have a place in certain environments but such skills require an in depth knowledge to back them up and should only be taught and practiced by experienced advance level MEDICS.
Advanced Skills are the Basics Mastered!
Advanced Skills are the Basics Mastered!
Oh I so 'like' your view on this Starlight when is an FPOSi not an FPOSi ??? ...........
Take an FPOSi course, and add in all sorts of gucci cas teaches and invassive skills, add the words Hostile Environment and hey presto, you've just created the next must do, super-dooper, bayonet fighting, medics 'qualification'. You've also trippled your profits.
However, those that undertake said training, are still only FPOSi, and are not 'qualified' medics.
Argue and disagree all you want, but that's the reality.
Incoming............................
Scartissue, the problem with this course, as you say 'probably' open to reg med professionals, EMT? the amount of these 'professionals' who have a piece of paper that confirms they are 'professional' . companies like these will take anybodies money, it's not about doing for the right people,, just getting people on the courses.. I know this for certain, the 'better half' works for POST GRAD Medical school in Edinburgh, where all GP's, Dr's, Surg, etc should be organised, alas, they are being priced out of the commarcial market by private companies,. This course is just one of them. look at the syallabus.... all that in a day!!! some learning curve!
Candidates rotate around 7 stations over the course of the day, and will learn over 15 procedures procedures including:
Candidates rotate around 7 stations over the course of the day, and will learn over 15 procedures procedures including:
- Use of a slit lamp
- Chest drains
- Thoracocentesis
- Treatment of a tension pneumothorax
- US guided central lines
- Arterial lines and arterial blood gas sampling
- Fracture reduction
- Plastering
- Local anaesthesia
- Suturing
- Dislocation reduction
- Treatment of epistaxis
- FAST Scanning
- Needle cricothyroidotomy
- Intraosseous access
- Safe defibrillation
Scartissue
Longterm Registered User
I mean't professionally registered as in Doctors who are registered with their respect governing body, Nurses who are registered through the Nursing Midwifery Council (NMC) and Paramedics who are registered through the Health Professions Council (HPC). Also they would have to prove that the training is relevant to their role. I know a lot of these companies as I have had to deal with them in the past... I haven't researched the company in mention but I am pretty confident that people with only an EMT or commercial medic course will not be allowed to access it.
Scartissue
Longterm Registered User
macca10,
The company only offers the courses to doctors and professionally registered medical practitioners. This means that they will be registered with strictly controlled governing bodies such as the NMC and HPC. Your EMT, MIRA Medic, Viper Medic or any other walt medic course for that matter will not be able to access the course.
The course in question is an introduction to the medical procedures mentioned so that students and trainee medical professionals will find it easier when they undertake their Accident & Emergency placements that is why so many subjects covered in a day... It is only an introduction!
The company only offers the courses to doctors and professionally registered medical practitioners. This means that they will be registered with strictly controlled governing bodies such as the NMC and HPC. Your EMT, MIRA Medic, Viper Medic or any other walt medic course for that matter will not be able to access the course.
The course in question is an introduction to the medical procedures mentioned so that students and trainee medical professionals will find it easier when they undertake their Accident & Emergency placements that is why so many subjects covered in a day... It is only an introduction!
Whether open to doctors only or not, there is no way that they can teach all of those skills to a standard where someone can "learn" them in a skill station in one day. Many should already be known from time at medical school, and are required to have been taught, practised and "sign off" as competent before qualification. Considering that being an ALS Provider is required before progression from FY1 to FY2, and almost all medical students are required to pass ILS, I can't see why they need to have a station to teach safe defibrillation when they are busy cramming in FAST scanning and US guided central lines, which have their own courses and requirements for continuing practice and training to maintain currency.
I suspect that this is aimed at non-UK (or non-EU) people who wish to work in the NHS and who are finding that not every bit of paper is the same around the world, or the gung-ho wannabes that we have all met in sooooo many incarnations, including as doctors.
Deep breath - completely with everyone agree on the chest drain/invasive procedures issue. Dangerous procedure, even when you know what you're doing and are in a sterile environment. First, do no harm.
I suspect that this is aimed at non-UK (or non-EU) people who wish to work in the NHS and who are finding that not every bit of paper is the same around the world, or the gung-ho wannabes that we have all met in sooooo many incarnations, including as doctors.
Deep breath - completely with everyone agree on the chest drain/invasive procedures issue. Dangerous procedure, even when you know what you're doing and are in a sterile environment. First, do no harm.
Northerner
Full Registered User
Should the worst happen to the patient, the legal implications following the coroners court investigations also have to be considered. A little knowledge is a dangerous thing so as Hope says, know your limits. As Scartissue also stated, if asked to assist by a qualified professional then the onus of resposibilty falls upon them.
Adrian
Adrian
'Simple Thoracostomy' as devised by London HEMS and now used by other UK HEMS would be a better option. Incision with tube to give any pressure build up a natural vent. You see it quite often with stab wounds to the thoracic cavity as the wound isn't capable of withholding pressure unlike a pneumothorax caused by blunt trauma. But obviously every incident has it's unique circumstances.