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Trial of roadside trauma treatment

Discussion in 'The Pub' at netrider.net.au started by taymaishu, Sep 3, 2013.

  1. G'day all,

    This one has caused a lot of interest in the health area recently.

    Victoria are going to trial an injectable that can clot internal bleeding for road trauma victims. The drug is currently only used in hospitals, but it's thought earlier access from paramedics will save many lives

    http://www.news.com.au/national-news/victoria/new-drug-to-slash-annual-victorian-road-toll-by-70/story-fnii5sms-1226708622615

    This reminds me a LOT of Narcan (and how successful it has been in saving the lives of heroin users who OD).

    Thought it might be a bit of interest.

    Cheers


     
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  2. Sounds interesting. My only concern would be regarding the practicalities of doing health history checks before administering the clotting agent. My wife had a routine op go horribly wrong a couple of years ago and as a result can't safely receive most clotting drugs anymore... Unless it's a new drug which can be used more universally?
     
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  3. Interesting ... they tout it as savings lives prior to gaining ethics committee approval for the trial? Considering that there has already been other studies internationally one must question the need for a double-blind placebo controlled trial plus wonder at the ethics of using placebo therapy in a trauma situation.
     
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  4. #4 Doch, Sep 20, 2013
    Last edited: Sep 20, 2013
    Our Ambo's are the highest qualified of any Ambo's in the country.
    Qualified Vic Ambo's can pronounce death and can perform drug induced coma's prior to transportation. I've personally seen them perform both tasks, and the level of checks and double checks and care that they do as part of the procedure are awe inspiring. The decision to perform these tasks are not taken lightly, so believe me they would only use this new or any treatment in the field after all the boxes are ticked.

    Also remember that our Ambo's are the lowest paid in the country.
     
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  5. Going out on a limb here (which I don't normally do). Your post is misleading, if not wrong. If you would like me to show how and why, let me know. I'd need to look up legislation.


    Justus.
     
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  6. Please do. I would be intrigued to know what it was that I have witnessed on at least 6 occasions.
     
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  7. What is an unqualified ambo? Jill Stark of the Melbourne Age seems to have the same idea as you that ambulance officers or paramedics have legal power.

    April 15, 2012: Erring paramedics 'vilified'

    What you have witnessed on 6 occasions counts for little because you have missed the point I'm making.

    I can declare someone dead if I wanted to, and did so twice in the time I was in prison, to a 19yo boy and 33yo. Anyone can pronounce someone deceased, but do you, me or as you and Jill Stark says, paramedics, have the legal power to?

    The answer must be No, and I will intend to show you the same.


    Justus.
     
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  8. Umm not sure if you understand how health carers work. We are constantly upgrading our skills to be able to provide the best for our victims and until we can get into a course to update and / or increase our skill levels we cannot perform tasks that we are not qualified in. What was meant by "Qualified Ambo" is one that is a MICA paramedic with qualification's in for mentioned tasks.

    Quote "Changes brought in 2009 mean paramedics now have legal power to declare patients dead, whereas previously it was a doctor's responsibility." En Quote

    I first found about this when i was talking to a MICA friend of mine, it what was around mid to late '09. He was disgusted of having this task forced upon them with the soul reason for being to free up doctors at hospitals. What aggravated him, and I believe most Ambos, is that they don't get paid any extra for taking on the responsibilitiesThis very different to arriving on scene and finding a person suffering from obvious signs of death and realizing there is no point starting resuscitation.

    I repeat Vic "MICA" Ambo's have the qualification's to place a victim in a drug induced coma.:popcorn:
     
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  9. Irrelevant.

    No need to repeat something which is not in contention. See below.


    I have little idea of how carers work because I'm not medically trained. My knowledge is in law which is why I said your post is misleading. In turn I refer you to relevant provisions within the statutory laws of your state:

    Coroners Act 2008
    Human Tissue Act 1982
    Births, Deaths & Marriages Registrations Act 1996

    s 37 of the Births, Death and Marriages Act clearly states that a person's treating doctor or any doctor who"examines the body of a deceased person after death" must report the fact of the death and cause to the Registrar. A doctor is also required to report a death to the state coroner if it is a 'reportable' death as defined in s 4 of the Coroners Act 2008. This also includes any death where a Certificate under s 37 hasn't been signed because the doctor is not certain of what caused the death.

    There is nothing in either Acts of Parliament that refers to "qualifed ambo's" or paramedics. Nothing.

    The 3rd relevant statute, Human Tissue Act, refers to human tissue for donation. Where there is intent to remove body parts and "the respiration or the circulation of the blood of the deceased person is not being maintained by artificial means" then their death must be certified by a doctor. If artificial resources are being used to maintain circulation or respiration, certification by two doctors is required, as per s 26(7) of the Act.

    Furthermore, the Act defines death for the purposes of ALL state law:

    s 41 - Definition of death
    Once again, no where in this Act is there any mention of paramedics, so I ask you, Jill Stark and co, what is your basis for the claim that paramedics have the legal authority to declare patients dead? The reality of your 6 observations and my personal experiences, is that a declaration of death is not formally required. What the law does require is notification to the Coroner or Registrar, or both, that death has occurred, and where possible, the cause of death.

    It is still the case that only a medical practitioner can do this.

    Where you have a person who is obviously dead eg. decomposition or dismembered corpse, there is no requirement to locate a medical practitioner to certify that the person is dead or for ambulance officers to pretend to perform life saving measures until one arrives. Police who come upon a murder scene are able to determine whether someone is dead or not. Eventually the deceased person will be subject to an autopsy to confirm the cause of death, but the reality of death, that is that they have an "irreversible cessation of circulation of blood" or an "irreversible cessation of all function of the brain" may be pretty obvious. It may also be clear when a person is not dead. A person with a pulse and a slow respiration rate may be close to death, but they are not dead.

    Failure to determine that a patient with a pulse is in fact alive has nothing to do with the law, and everything to do with appropriate professional practice and competency. In other cases death may not be obvious. This is the reason why where a person’s circulation and respiration are being artificially maintained, two doctors are required to certify death before any steps can be taken to remove bodily organs for transplantation.

    Where a person has collapsed and members of the public have started to administer CPR, it will most likely not be clear whether the cessation of circulation is irreversible or not so the best option is of course to treat them as if their circulation can be restarted but at some point, the decision has to be made whether to continue with treatment or not. This was usually the call of doctors and perhaps that is what Jill Stark meant. Who knows.

    Without access to the treatment protocols of Victoria Ambulance Services, I would infer that what is meant is that paramedics, having completed their treatment protocols, could cease further treatment if the patient failed to respond so the inference could be made that their cessation of circulation was irreversible and they were, in fact, dead. If that is the case you are making, I would quibble whether that was in fact the creation of a legal power to declare patients dead. It isn't.

    It may be overly pedantic, but I again put it to you that no law in the state of Victoria says that "qualified ambo" or paramedics can declare a patient dead and furthermore, they cannot do so for the purposes of the Births, Deaths and Marriages Registration Act 1996, the Coroners Act 2008 and/or the Human Tissue Act 1982.

    If, as I have inferred, paramedics can terminate treatment that is not able to achieve the desired result, then that is a power we ALL have. Do we try to save the obviously deceased? No we don't, so the protocols must rightly give paramedics guidance on when to terminate treatment in those cases where death is not obvious.

    Pedantic or not, saying that "Qualified Vic Ambo's can pronounce death" or that "paramedics now have legal power to declare patients dead, whereas previously it was a doctor's responsibility" is misleading, if not, wrong because no legal power whatsoever exists for "qualified vic ambo's" or paramedics in statutory &/or common law in this regard. None at all.


    Justus.
     
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  10. I read the points that you have raised and agree that it there are no points mentioned about ambo's in fact the majority are points where the victim is under a doctors care, we re talking about pre hospital care which, going by the points you have raised are not mentioned.

    http://www.resus.org.au/policy/guidelines/section_8/cardiopulmonary_resuscitation.htm

    Appoligies but it wont let me insert a url.
     
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  11. I have specifically referred to the comment in #4 that "Qualified Vic Ambo's can pronounce death". Forget everything else in #4.

    Whether a person is under doctors care or pre-hospital is not really relevant to the above comment, as is the URL to cardiopulmonary resuscitation guidelines.


    Justus.
     
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  12. I have a question. I was under the impression that only a medical practitioner can complete a death certificate. This being the case would a medical practitioner take the word of an ambo that the person was dead and therefore sign the certificate ?
    In an attempt to answer my own question I would suggest no is the answer.
    It follows, in my mind at least, that the medical practitioner is then the one who legally pronounces the person dead by signing the certificate and would be unlikely to do so without sighting the body.
    If these assumptions are correct then it follows that an ambo can say "he's dead" but it is not a legal pronunciation of the death any more than it would be if I said it.
     
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  13. Bravo, we have a winner.


    Justus.
     
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  14. I'm sorry but where are the mods. I this really worthy? This definitely belongs in a more specialized forum, such as fwits reporting slightly inappropriate threads as defined in the rules. Sorry Justus this just isn't on topic. Wish you luck on your moderator aspirations. It doesn't pay anything but by golly the power rush beats tiding anything over a 250! Best of wishes!!!!
     
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  15. My understanding is that they can declare that someone is dead meaning that further treatment or attempts at resuscitation may cease and there is no further legal issue about a failure to render assistance etc.

    That's a very different issue from signing death certificates. Usually a formal death certificate needs to show cause of death. In fact, doctors can't sign unless they know the patient's history and can certify the cause of death (eg heart or other disease) or the cause is obvious such as massive trauma. Otherwise there needs to be an autopsy before the certificate is signed.
     
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  16. Exactly. By being able to pronounce death, the hospital is then bypassed and the victim is taken directly to the coroner.
    I know this may irk some people but this has got way off topic and there for I won't be responding to any further posts on the topic.
     
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  17. Discussion is good and your input is valued mate.


    Justus.
     
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  18. Wow talk about a derailment :)

    I'm keen to see how this treatment goes. As I said in the OP, it reminds me a lot of Ambo's being able to administer Narcan. Narcan is absolutely amazing in what it does for overdose. 'Victims'.
     
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  19. So your patients need your help, but become your victims instead? I hope that was just clumsy wording... :p
     
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  20. It's simply a matter of perspective. Some people just don't appreciate the handiness of an extra arm or two.
     
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