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Service Hospitals

Maxi_77 said:
I hear what you say about the availability of doctors for deployemnt and I can see the logic used, but is it the correct logic. Yes if you have a consultant or a consultant led team you have the ability to deal with almost 100% of the problems expected, but if that means if no consultant is available then you have no doctor at all then you are in a situation where a very low percentage of the problems can be dealt with. Deploying a slightly less qualified doctor will actually give yo a better level of cover than no doctor at all, and in reality with modern communication your consultant supervision is still availlable.

My father was a consultant and in the 60s he supervised in several hospitals up to 4 hours drive away, with modern communications this remote supervision can be done much more effectively.

Perfection is rarely possible, but to effectively give up because of that is in my view foolish.

Peter

I agree with some of what you're saying, but the days of junior trainees being the forward deployed surgeon/anaesthetist are long gone. The consultant 3000 miles away via a satellite link is not going to help with the horrifically unstable trauma anaesthetic, nor with the difficult vascular injury.

I understand that NHS standards of care are the minimum benchmark for the DMS - this effectively means a consultant-delivered service. Are you suggesting we should abandon that on the grounds of expediency? I agree that perfection is rarely attainable; however, is it appropriate to have someone straight out of house jobs (& maybe 6 months' A&E) providing the primary care service for a deployed unit?

Things have changed since the 1960's; things that were acceptable then may not be now, even wit improved communication.

APN
 
all_purple_now said:
I agree with some of what you're saying, but the days of junior trainees being the forward deployed surgeon/anaesthetist are long gone. The consultant 3000 miles away via a satellite link is not going to help with the horrifically unstable trauma anaesthetic, nor with the difficult vascular injury.

I understand that NHS standards of care are the minimum benchmark for the DMS - this effectively means a consultant-delivered service. Are you suggesting we should abandon that on the grounds of expediency? I agree that perfection is rarely attainable; however, is it appropriate to have someone straight out of house jobs (& maybe 6 months' A&E) providing the primary care service for a deployed unit?

Things have changed since the 1960's; things that were acceptable then may not be now, even wit improved communication.

APN

There are some who do question the NHS consultant led service, yes it can reduce the mistake made, but is it an overall life saver, that is a question whcih has yet to be answered fully.

I agree there will always be cases where communication links will not help, but if there is no doctor at all they patient will not be worse off. It is more a matter of setting the level of service to suit the circumstances rather than following blindly a system set up for a completely different problem. It is all about deciding when some one has learnt enough to do the job required, and in some cases that may well be before they hav reached consultant status.

I used to know a vet and he spent a year in northern Kenya, the nearest real quack was over 100 miles away so he provided a limited medical service as well as being the vet. All very much against the rules, but if the choice is a journey which may kill you or visit the vet, whcih would you choose, equally he was not going to stand by and watch people die.

I I was injured or ill on a ship I would far rather have a part qualified doctor than the Jimmy treing to read it out of the book, and I have sat there in the wardroon trying to make sense of the book with the Jimmy.

There is an old maxim that rules are there for guidance so that if you do break them you have thought it out properly and can justify your choice.

In an ideal world a group of ships on deployment would take a full general hospital with them, but we know that this is not practical execpt under exceptional circumstance. Now if you can't provide the requisite consultants do you send no one or the best you can?

Peter
 
Maxi_77 said:
There are some who do question the NHS consultant led service, yes it can reduce the mistake made, but is it an overall life saver, that is a question whcih has yet to be answered fully.

National Confidential Enquiry into Perioperative Deaths?

I'm not proposing to send a general hospital with every deployment, however there is an argument that it would, perhaps, be rather more appropriate to send a fully trained & accreddited GP, rather than someone fresh out of house jobs.

APN
 
all_purple_now said:
National Confidential Enquiry into Perioperative Deaths?

I'm not proposing to send a general hospital with every deployment, however there is an argument that it would, perhaps, be rather more appropriate to send a fully trained & accreddited GP, rather than someone fresh out of house jobs.

APN

Of course if the inquiry is confidential the results do not become widely known.

I would concur that a fully trained and certified GP would probably be a good person to have, but my point is that if he/she is not available is not a wet behind the ears doctor straight from Medical College better than the Jimmy. There seems to be a trend towards the concept that if the 'correct' person is not available you get no one, where as the reality is that some thing is ususlly better than nothing.

Peter
 
Maxi_77 said:
all_purple_now said:
National Confidential Enquiry into Perioperative Deaths?

APN

Of course if the inquiry is confidential the results do not become widely known.

Erm... I think there has been some misunderstanding as to what the 'Confidential' bit of NCEPOD's title refers to - this is a reference to the confidential nature of the data collection, not the report.

NCEPOD is widely publicised, at least in the NHS (and, I presume, in the DMS too) - recent reports include An Acute Problem? and AAA: A service in need of surgery? however, I think the relevent one is Who Operates When? II

APN
 
all_purple_now said:
Maxi_77 said:
all_purple_now said:
National Confidential Enquiry into Perioperative Deaths?

APN

Of course if the inquiry is confidential the results do not become widely known.

Erm... I think there has been some misunderstanding as to what the 'Confidential' bit of NCEPOD's title refers to - this is a reference to the confidential nature of the data collection, not the report.

NCEPOD is widely publicised, at least in the NHS (and, I presume, in the DMS too) - recent reports include An Acute Problem? and AAA: A service in need of surgery? however, I think the relevent one is Who Operates When? II

APN

That at a quick glance does not really answer the point I was making. Many more rural hospitals are losing their A&E cover because it is not reasonable to fund the level of cover now required 24/7. This results in the time to travel to an A&E rising significantly, yes the treatment you get if you get there in time is excellent, but if you have passed one or two redundant A&E facilities on the way does this actually improve patient care or not.

Peter
 
We bought the American message, hook, line and sinker in the move to ATLS training. Centralisation of emergency care facilities follows, but is not necessarily to every patient's benefit. It makes sense to overfly smaller units when you have a casualty that will need the more technical elements of critical care, but that doesn't mean that the lesser injured all need the same.

As the best MAs have always proved, doctors are not always required in order to provide an efficient medical service on board. Although I heard stories about ships' doctors having removed the odd appendix at sea, I don't believe that it happened on anything smaller than a carrier in my career. The advent of the helo on smaller ships meant that, in the majority of cases, a properly equipped hospital was within reasonable travelling distance for the more complex illnesses and injuries.
 
come_the_day said:
We bought the American message, hook, line and sinker in the move to ATLS training. Centralisation of emergency care facilities follows, but is not necessarily to every patient's benefit. It makes sense to overfly smaller units when you have a casualty that will need the more technical elements of critical care, but that doesn't mean that the lesser injured all need the same.

As the best MAs have always proved, doctors are not always required in order to provide an efficient medical service on board. Although I heard stories about ships' doctors having removed the odd appendix at sea, I don't believe that it happened on anything smaller than a carrier in my career. The advent of the helo on smaller ships meant that, in the majority of cases, a properly equipped hospital was within reasonable travelling distance for the more complex illnesses and injuries.

You are, of course, quite correct about MAs, and also about the advent of helicopters.

I feel I ought to point out that ATLS was originally designed to provide a simplified system of trauma management for, essentially, American GP-led rural hospitals. Centralisation is a side effect of the wish to have every possible surgical specialty on site, which essentially means moving the trauma to the big units, e.g. Selly Oak, UHB.

APN
 
I was an observer on the first ever RN ATLS course at INM and the principle is unimpeachable, but it is so ****!

Clinical situations are almost always unique, although general principles pertain to all. My problem with ATLS, as taught and examined, is that it allows no deviation from the mantra, which plays into the hands of those who cannot think outside the proverbial box!

I had hoped that ownership of the training copyright might move to the British colleges for teaching in the UK, but I understand that the American College of Surgeons still has a stranglehold. Not that I think the Americans always get it wrong or that the UK always gets it right, but there are some significant differences in emphasis.
 
ATLS is, as you say, totally inflexible, but this is a symptom of it being designed for people who might not have any other trauma skills/training.

Interestingly, there is a European Trauma management course under development - supposedly, it will be much more multidisciplinary in nature, and also less focussed on the American experience. It will be interesting to see what happens there, and whether there will be Service uptake if it's good, not least because there has been a change in focus for BATLS.

APN
 
Sorry to divert the way the thread is going, but has RNH Stonehouse been turned into a block of housing?
Spent many a good year there.
So do all the casualties from Union Strazza now go to that white elephant Derriford?
Good place to work it was, not far to stagger back! :)
 
Yep, Stonehouse has been converted in to houses.

Emergencies now go to Derriford, which was a great place to work when I was there from 2000 to 2003.
 
drwibble said:
Yep, Stonehouse has been converted in to houses.

Emergencies now go to Derriford, which was a great place to work when I was there from 2000 to 2003.

I'll bet there was barely time for a tea break on that watch :lol:
 
Glad that RNH Plymouth gets another mensh! Visited what used to be A1 Ward a couple of years ago while attending the reunion and it was a show flat, on the market for £250,000 or thereabouts.

Shame! The old place should have been made into a home for retired MOGs, but at least there is a girls school in the old messes. Would have been a challenge for the lads (and some of the lasses, I suppose!) if they'd have done that in days of Yore!!
 
[align=center]“Doctors will have more lives to answer for in the next world than even we generalsâ€
Napoleon Bonaparte 1612-1680, French General and Emperor [/align]


It appears there has been a problem with the medical industry for some time given the comment above. However, to the thread. I recall my first personal experience of a pussers hospital in '52 when in training at HMS Raleigh. Had to spend some time in bed with a chest infection but as soon as I was put in the category of " up patient " I believe it was, I was handed a big pussers " bumper?" to swing around the ward. Incentive to recover more quickly maybe and it works. Question, is the old bumper still in use, I suspect not with electric polishers. The bumper ( is that the correct name ?) was the then modern version of the holy stone I reckon and very effective as a floor polisher. The decks in the mess were like mirrors. Good training though and as a "breaking in" process from civvy to matelot.

:mrgreen:
 

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