Thursday 21 November 2013

Perhaps we should stop calling them paramedics?

In May 2007 an ambulance was called to a young woman, Sarah Thomas, who was having trouble breathing. Miss Thomas was recovering from a brain tumour and was lapsing in and out of lucidity, but she knew she was ill and called the ambulance at 1am. She was known to have diabetes and to have had her pituitary gland removed after surgery for the tumour. She also thought she had a gastric infection as her father had also experienced a tummy bug a few hours earlier.

You do not need to be a paramedic to know that if someone's brain is being treated and they are calling an ambulance, and they can't breath reliably, are dehydrating and have diabetes and no pituitary gland, the place to go is a hospital and let the grown-ups deal with it.  Common sense tells you that this is way out of one's own league. 

Instead, the paramedics carried out an incompetent assessment and persuaded the parents to sign to say that they had done their job. They persuaded the patient not to go to hospital.   The parents were there and were fully able to explain that their daughter had recently had brain surgery. Note that Miss Thomas, a 30 year old woman, was apparently not in a condition to sign, which is another clue that she should have been removed to a hospital. Had she gone to hospital the doctors and nurses would have been in a position to give her the stabilizing treatment she needed.

After only six years the coroner managed to return a narrative verdict in February 2013, in which he noted discrepancies between the accounts given by the ambulance crew and the family.  He gave the  medical classification for the death 
Mr Philip Rogers said he would record the medical cause of her death as:
 1a circulatory collapse as a result of gastroenteritis, with
 part two, panhypopituitarism and adrenal insufficiency.
The adrenal insufficiency in particular would have been treatable with an injection. Due to the limitations of what a paramedic can be expected to know about, he ruled that 
...this cannot be labelled as gross failings
Yes it is gross failing and obviously so.  They did not carry out a competent assessment.  They persuaded the patient and her parents not to go to hospital when it was apparent that the patient was losing the capacity to take decisions at all.  If she had called a cab instead of an ambulance, Miss Thomas would have stood a better chance of survival because at least the cab driver would not have played at being a doctor.
After a further ten months disciplinary action was finally taken.  The paramedics were removed as it became clear that the 'discrepancy' was more than just two different view of the situation.  The disciplinary panel revealed that not only had they failed to carry out a proper assessment but they then
colluded to fabricate a patient record.  
 They tried to cover up the error.

But why did they not do the the obvious thing and just take her to the hospital that night?

Below the line in the Mail (usual caveats) is an interesting comment:
Unfortunately, ambulance staff have been pushed towards not taking people to hospital to ease pressure on the hospitals. This practice of using them as "poor mans doctors" is widespread because you have almost no chance of getting doctors out in the evening. .......Increasingly the ambulance service is led away from its primary duty ,which is to promote life by giving aid and getting you to hospital.This is an unfortunate case but is one that we will probably see more of in the future unless someone" grasps the nettle" and gets back to basics.
The names of the paramedics are not relevant here and are available from the links. They certainly made a willful and serious mistake and compounded that by trying to fiddle the records. The latter, in my view, should be a criminal matter and not just a disciplinary one.
However, if  hospitals are pressuring ambulance staff to not bring sick people to hospital in order to hit admission time targets, then it is even more important to know that a political decision is being made which results in unnecessary deaths.

Sunday 10 November 2013

Remembrance 2013

We Will Remember Them

Much has been written about the misunderstanding of the poppy.
Locally, churches are holding services this evening to pray for peace in order to give people of a different perspective a way to express an earnest desire that bloodshed be averted.  

Friday 1 November 2013

A free and pluralistic media to sustain European democracy

I can't face wading through all this so let's concentrate on one feature:

There should be a provision of state funding for media which are essential for pluralism (including geographical, linguistic, cultural and political pluralism), but are not commercially viable.
The state should intervene whenever there is a market failure leading to the under‐provision of pluralism, which should be considered as a key public good
Tax payers will be obliged to fund dreary publications such as pro-EU propaganda, union self-congratulatory bumf, anything vaguely leftist such as the extinct Spare Rib magazine, and perhaps a whinge-sheet by groups such as Hacked Off.

It is obviously a market failure that people don't rush out and spend their own money on this, so we'll have to have it delivered to their houses anyway, in defiance of the EU rules about not creating waste. It's not waste when we do it. 

Pluralism does not mean funding the UKIP newspaper or anything which puts forward the view that the state has a primary over-riding duty towards its own citizens.  

This is all to show how democratic the EU is, even though it isn't.