Paramedicine: beyond 2020

Nuanced trauma care by the Queensland Ambulance Services High Acuity Response Unit (HARU). A brief outline of the capabilities of HARU and some key principles that make it successful. Could this be a model for other ambulance services to follow in the future?

[@benjaminasack4518]

EMS in America has such a long way to go...

[@chrisiseppi8136]

this is well and good, you may as well replace Paramedics completely with Doctors only....I do have to ask how far we take Paramedics, i acknowledge the change as time goes by we do need to go forward, your not treating the Patient to me your treating machines, what would happen if you had multi failures of machines you then have to return to basics. its all good in a metropolitan area where your 20 minutes or so from a hospital and you have ample resources when you get into rural and remote areas where you don't have good communications you don't have the resources, Limited stock of meds, limited equipment, I like what i was listening to but a lot more needs to be done to think about rural and remote areas. but my question remains how far do we take Paramedics??? the more drugs fluids etc. you may as well be doctors not Paramedics, to me its more like stay and play rather than stabilize get to the hospital in a metro area Please do not take this the wrong way but you can see where i am coming from best patient outcomes yes definitely....just how far do we take Paramedics or would it be better to be a doctor instead.

[@kevingill5867]

In the 1700s something remarkable happened in the history of medicine, that was the incorporation of a paramedical profession in to one that in less than one hundred years would become part of the standard physician training, that paramedical vocational profession was surgery. These days we have a funnelling of paramedics, advanced nurse practitioners and physician associates into a group called advanced care practitioners, some countries are looking at these professions being regulated by the medical councils. I’ve been a Paramedic for twenty years and I’m now practicing as an Advanced Care Paramedic with aspirations to go into critical care. How I envisioned the role when I started vs what I can actually do now is staggering and reflects that my initial view of things was extremely limited. The benefits of what we do regardless of being in a metro area or a rural area can benefit the patient immensely, the definitive care has started and that allows flexibility in where you bring the patient. You made reference to a statement we used to hear regularly back in the day, which gives me a clue to you being an old hat like me, I.e “your treating the machine not the patient” that fits with the vocational method of education we used to have, however paramedics are now trained substantially in physiology and pathophysiology, therefore they are able to interpret the physiological signs differently and the machines become confirmation tools. We don’t have ultrasound as yet prehospital but I can tell you that I can recognise a patient in hypovoleamic shock, the difference is that an ultrasound may guide my therapy in a more nuanced way. I think that HARU is an excellent example of where the profession can go. As for where does it end up ? Possibly another discipline of medicine.

[@scottlancaster5812]

Nothing done here that I didn't do more than once as a paramedic in a rural area on a HEMS unit.

[@sonny9741]

@@scottlancaster5812 In Canada, Critical Care Paramedic training takes between 6-7 years of school and residency training. They're trained to perform advanced emergency medical care, such as roadside ultrasound, blood administration, Advanced RSI, and invasive procedures on the chest and throat.(e.g pericardiocentesis)

[@hughman3241]

Paramedics do not replace doctors. These HARU teams are filling a very specific niche, which is stabilising critical patients at the scene and bridging the gap to keep them alive before they reach definitive care at hospital. They are using existing highly experienced paramedics and giving them a small set of very specific skills to increase their scope enough to bridge that gap. They cannot and do not replace doctors. As you can see from the timeline in the video, they are not spending all that much additional time on scene. I would not call this staying and playing. They are generally not doing anything definitive on scene, they are merely buying time for the patient and as they explain, spending a couple of extra minutes on scene can make a world of difference further down the line. As for rural areas, that is where a program like this excels the most. If you are a significant distance from a hospital then these type of advanced interventions need to be performed to keep the patient alive otherwise they won't make it to definitive care.

[@prequel1592]

simple to me. dokters are overqualified for the job. paramedics can be trained to a specific set of actions. Only a few actions make a BIG difference. The rest is like the 1%. The real problem is... Who likes the job most? Both can say yes. But dokter wins anyways because the group is stronger in writing.