Hartmanns solution and canulars

[stovie]

My apologies, I stand corrected.

I couldnt get through the the NMC, so phoned the RCN and asked. They told me thier is no legal obligation to follow the code of conduct.


I should spend less time looking at knife law and more time looking at professional law.

Thank you Martyn. I respect you for that. To err is human. To forgive, divine

Hey! I got my figures wrong the other day...now that could be catastrophic in our game, which basically puts this whole subject into context. Outside of work, get it wrong, and it's your **** on the line. At work your covered...says it all...

 

[charliefox]

I think you are on very thin ice with this. You are not a prescriber and you cant prescribe medications outside of your sphere of work. The JRCALC guidelines (which are thin at best), say...



I'm not sure those specified circumstances extend to off-duty. I would think not. Can you provide some clarity or cite some legal document or context which says it's appropriate for you to do this?

Sorry Martin, can't quote any legal documentation on this. Maybe I'm too trusting I have spoken on seperate ocassions to both our Clinical Governance Director and our Medical Director regarding the administration of "our" POMs when not on duty. Both have assured me that this is fine, provided I behave in the same manner as I do at work. As a registered Health Professional with the HPC I'm covered for our POMs & non-POMs, also under certain PGDs.

Think we've thrashed this one to death now

As long as we're all happy with our own seperate advice and spheres of practice, that'll do for me

I admire anyone that does your job, by the way, couldn't do it myself

 

[Keith_Beef]

Sorry Martin, can't quote any legal documentation on this. Maybe I'm too trusting I have spoken on seperate ocassions to both our Clinical Governance Director and our Medical Director regarding the administration of "our" POMs when not on duty. Both have assured me that this is fine, provided I behave in the same manner as I do at work. As a registered Health Professional with the HPC I'm covered for our POMs & non-POMs, also under certain PGDs.

As quoted by Martyn, from JRCALC:

Drugs administered by ambulance staff fall into two categories, non- prescription drugs such as aspirin and those that are controlled under the Medicines Act 1968 and are designated prescription only medicines (POMs). Under normal circumstances, POMs can only be prescribed by a qualified doctor (or dentist), but exemptions exist which allow suitably trained ambulance paramedics to administer these drugs in specified circumstances.

Would it be the case that the POMs that you have at your disposal in the ambulance are only those which the crews have been trained to use?

In this case, provided that off-duty you administer only those POMs as are available on-duty, and you are acting with the same care and consideration for the patient as you would do when on-duty, then your training would be considered sufficient to fall within the exemptions "which allow suitably trained ambulance paramedics to administer these drugs in specified circumstances".

In over-simplified terms: if you're trained to administer prescription-only [insert name here] when on-duty, and that is available in the ambulance, then you can also administer it when off-duty. If you only carry what you have been trained to use, you are in the clear when you use it in a professional manner.


Keith.

 

[BOD]

This is a very interesting thread even though it has evolved into a question of what liability or duty rests on paramedics while off duty.

I didn’t see any explanation of what a duty of care is but more on the standard of care applicable which is cart before the horse. Only at the end did Stovie point out that there is no obligation to become involved.

I searched the BCUK forums and did not find any clear explanation about how the law now stands on the matter for the “non—professionals”. I also searched the internet and a quick look suggests there has not been that much change to the general principles over the past 20 years but that attitudes and the social context has changed.

Since bushcraft is so closely associated with first aid and it seems that much bushcraft is done with other people, maybe a Sticky is in order with contributions that have been verified to be correct (like with the knife law one) so that those who occasionally dive in don’t go away with the wrong idea (no duty of care here just moral responsibility). Is there a BCUK honorary solicitor by any chance?

No intention to criticize, I’d like to point out that many people I have met in emergency services are confused by the concept, both volunteers and bureaucrats alike, sometimes even fairly senior supervisors. This was in Oz but I think it may apply in the UK too. The public feed off horror stories like plaster glue and allergies and often are confused further. This can only erode our ability to help others. Now a quarter of those in Oz who have witnessed heroin overdoses, non users as well as users do not call the ambulance services.

I have a general interest in this since we deal with many young and not so young Britons who come out here for adventure in somewhat remote areas or potentially hazardous pursuits and it is good to understand where they are coming from, so to speak.

 

[charliefox]

As quoted by Martyn, from JRCALC:



Would it be the case that the POMs that you have at your disposal in the ambulance are only those which the crews have been trained to use?

In this case, provided that off-duty you administer only those POMs as are available on-duty, and you are acting with the same care and consideration for the patient as you would do when on-duty, then your training would be considered sufficient to fall within the exemptions "which allow suitably trained ambulance paramedics to administer these drugs in specified circumstances".

In over-simplified terms: if you're trained to administer prescription-only [insert name here] when on-duty, and that is available in the ambulance, then you can also administer it when off-duty. If you only carry what you have been trained to use, you are in the clear when you use it in a professional manner.


Keith.

Keith - correct for 10 points. Should've made it clear - Paras can "prescribe" only from our range of approved POMs NOT anything that takes our fancy

On duty or off, the training covers us for those drugs. Although trying to explain what you're doing wondering round with Class A drugs whilst off duty could be interesting (I am joking by the way - mine are in a locked box, in a locked room, in a locked building, guarded by a grumpy badger with caffeine withdrawl.)

Finally cleared up Duty of Care on my side of things as well.... it only starts if I decide to attend a casualty, otherwise, in the words of a song, I can just walk on by.

Right, I'm off to poke the Badger now

 

[MattW]

Great thread!
As well as some sound, well founded advice from those who know what they're talking about, it's also put a few urban myths to bed.

I'm constantly in awe of paramedics - I had reason to dial 999 due to a medical emergency for the first time this February (walking at Langdale in the lakes this Feb - friend fell in icy rock and broke his leg). Although I've had basic first aid training, this really illustrated to me, the difference between training and doing - after the 999 call to mountain rescue I had to wait with the casualty. He was lying on his side in the snow where he fell (more or less in the foetal position), screaming in agony and would *not* be moved. I was fairly sure he had broken his leg (he said he heard/ felt his tib / fib snap), but to all intents and purposes it looked normal - all the stuff about getting him off the ground, extending the fracture etc went to pot - we just piled coats etc on top of him (managed to work a goretex underneath him, for all the good it did) gave him sips of warm fluids in his lucid moments (he was semi delerious) and tried to reasure him. If he'd started to get hypothermic we'd have had to move him, but it wouldn't have been easy due to his pain.

I have *never* been so happy to hear the sound of a helicopter in my life (Blackpool air ambulance) and the feeling of relief when the paramedic got to us was overwhelming - he was an absolute star - took control, stabilised him and administered IV pain relief. We then got him onto a stretcher with the help of the mountain rescue who the heli ferried up to us - the carry to the heli (300 yards) took 1/2 an hour (ice rock and a 16 stone bloke screaming every time he was jostled). The consultant told us later that it was a good job we hadn't moved him as he had a complex spiral fracure of his tib (together with two breaks to his fib) which could have easily caused severe vascular damage if disturbed.

I'm going to update my first aid training, but the professionals get my vote every time.

Matt

 

[bogflogger]

Agreed, this has been a really interesting thread!

I also agree about the Professionals, but lets not forget about the Mountain Rescue Teams, who are all Volunteers.

So either, stick some Folding Money in the MRT box when you see one, or arrange a Standing Order with your Bank for a couple of Quid a Month.

It all helps!

 

[bogflogger]

I see that someone has given me "negative rep" last Saturday night, for the last three lines in post no: 53.

That's fine, give me more if you like, it really does not worry me.

What does worry me, is that in spite of a Qualified Doctor, a Paramedic and a Nurse, telling you that you are breaking the Law by administering POM by IV line unless you are Qualified to do so, you STILL think that you can.

Perhaps, You will have time to reflect on this, during your time in the dock at your Manslaughter Trial.

 

[wingstoo]

Yo, Bogflogger,

As you say your not worried about it...I had the same problem a while back...so what, someone don't like what we post... No need to shout about it or someone else will do it to you...

LS

 

[Minotaur]

As a qualified First Aider you are not obligated to perform first aid. You have the right to walk on by and I for one would not cast blame if you did.

There is talk of them getting duty of care as well. Not just the US but also parts of Europe have the same thing, it is being discussed by some MPs.

If you want to put something in a Kit that is going to save a life, an AED is the thing. You need one in three minutes or less, to make the biggest diffrence.

 

[Wayne]

Great thread with some very interesting information. It has cleared up confusion regarding the law and duty of care. Something i was unclear of.

AEDs are certainly great bits of kit and the price is coming down. I can't see myself carrying one in the back of my car just yet. Although i wouldnt hestitate to use one if avaliable.

Bogflogger. You can't please all the people all the time. You obviously pressed a few buttons if they bothered to leave bad rep.

 

[bogflogger]

Yeah, guess I must of done.......Can't see the point of it myself.

Has anyone got a link to this making First Aiders liable to Duty of Care proposal?

Sadly, I can see that backfiring and people refusing to train as First Aiders at work!

 

[Keith_Beef]

Great thread with some very interesting information. It has cleared up confusion regarding the law and duty of care. Something i was unclear of.

AEDs are certainly great bits of kit and the price is coming down. I can't see myself carrying one in the back of my car just yet. Although i wouldnt hestitate to use one if avaliable.

I had to go looking to find out that an AED is an Automated External Defibrillator.

Don't forget, you med people, that some of your jargon and abbreviations can leave the rest of us floundering.

Anyway, these things look small enough to be carried around easily, but still cost in the region of $900 for the smaller units to $1500 for mid-range, up to about $2000 for the most sophisticated of the compact, portable units I've seen.

Phillips and Welch-Allyn seem to be respected names in this market.

Any idea what OS the devices run?


K

 

[BOD]

Guys, its clear that there still is some fuzziness about what the duty of care is.

A first aiders duty of care only begins once he/she decides to assist unless they are a workplace first aider under workplace legislation in which case they are under an obligation to treat fellow employes or persons injured on the premises or the first aiders own actions caused the injury in the first place.

I found this which incidentally also refers to AEDs and since it ideals with the UK situation the non-professional person ought to read.

http://www.resus.org.uk/pages/legal.htm

It stresses that there have been no reported (ie. law reports) cases at all where a casualty has successfully sued someone who came to his aid in an emergency.

Incidentally for those thinking of buying an AED, it mentions that it provides the shock only when the heart is in fibrillation. this would give a responder and extra level of protection from negligence as the "decision to shock" therefore is the machines and its manufactuers not the first aid providers.

 

[BOD]

In the last paragraph it should read "protection from legal actions for negligence "

 

[mark a.]

Forget whether you can use Hartmanns or not. I have a "Worst Case Scenario" calendar in my office, and today's top survival tip is "How to Perform a Tracheotomy". Now we're talking!

Looks easy too - seems I just need some scissors for the cut, and a biro for the tube, both of which are in plentiful supply in the stationery cupboard. Now all I need is a victim... I mean volunteer to try it out on.

 

[Goose]

Forget whether you can use Hartmanns or not. I have a "Worst Case Scenario" calendar in my office, and today's top survival tip is "How to Perform a Tracheotomy". Now we're talking!

Looks easy too - seems I just need some scissors for the cut, and a biro for the tube, both of which are in plentiful supply in the stationery cupboard. Now all I need is a victim... I mean volunteer to try it out on.

Scissors?
You should have a swiss army knife with a scalpel attachment just for this emergency!

 

[bambodoggy]

Military medicine is for the army and the battlefield and has no business in civillian life.

Seems to work just fine over the road to me at Frimley Park Hospital. They closed down the Cambridge military hospital (more or less) in Aldershot and most of the military staff now work in the civvi hospital but are still military.

The hospital is now a mix of NHS, Military and Private care and everybody I have spoken to would rather be seen by military staff, certainly the last time i was in there I got treated by Military staff and they were outstanding.

This is the same hospital where the Countess of Wessex had her baby....with military nurses in attendance.

The QARANC is the last bastion of traditional nurse training and disapline.....and it shows.

I'm not saying they are all perfect and clearly it's only the doctors and nurses that work at the hospitals and not the combat medics but it's not quite as black and white as you say Martyn

Having said all that....I totally agree about use of said items in civvie street

Cheers,

Bam.

 

[Goose]

I agree with you Bam, been to Frimley it is a strange set up!
I have used both military hospitals and civi and found the care in the military system is far far better than civvies. Care might be the wrong word maybe service?
This doesn't mean I am knocking the NHS, far from it, but the military system seems to have a greater sense of urgency, the NHS doesn't seem to have this.

I think the main problem with military medics, meaning first aiders really, is that there a lot of people trained to a very high standard, but very few have anywhere near the experience of a paramedic. It is one thing knowing what to do and another being experienced enough to do it confidently. I think this is what Martin is referring to rather than the specialist job done by the various "medic" capbadges.

 

[bogflogger]

QARANC, Discipline?

Have you been in "The Starlight" on a Saturday night!