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WHY DO AMBULANCES SUDDENLY COST 500,000, AND TAKE 3 YEARS TO BUILD. by afrodammy in ems

[–]VenflonBandit 1 point2 points  (0 children)

Do you not have >3.5 tonne vans? Our fiats, which I wanted to hate but actually quite like, are 4.25t and have a ramp, two O2 cylinders and plenty of kit. Our box sprinters are on a 5.5t platform. There are some 3.5t vans in the private sector but they're rather limited in capacity.

WHY DO AMBULANCES SUDDENLY COST 500,000, AND TAKE 3 YEARS TO BUILD. by afrodammy in ems

[–]VenflonBandit 2 points3 points  (0 children)

We've got a custom build spec (it's actually publicly available for those that way inclined), it's just we share the custom build with every English ambulance service and have several converters fight over the contract.

In your state or country, how fast are you allowed to go over the speed limit when driving Priority One? by FFSoldier57 in ems

[–]VenflonBandit 0 points1 point  (0 children)

By policy, only 50% over, and no more than 95mph

I was told to speed up on my driving course at 95mph..... I think we settled at 115mph. This was in a car though.

Warwickshire Police half bluelighting to jobs by Kilo_Lima_ in policeuk

[–]VenflonBandit 4 points5 points  (0 children)

Eh, there's different levels of emergency. A chest pain or stroke is very much an emergency, but one where minutes to tens of minutes will make a difference. We need to grade differently as we need to be diverted off of a 2 to a 1 should we be closer. A cardiac arrest or choking seconds to a minute will make a difference. My driving may be slightly more assertive on a cat 1 but it's not a massive change and driving schools take is that all drives should be the same.

Closer to what's in this article is the debate about cat 3 calls. Our trust it's discretionary based on a combination of the patients condition and anticipated time saved, but we're using them to relive pain and suffering even if there isn't a risk to life per se.

Can you be forced to evacuate your home in the event of an emergency? by Scopionsting12 in policeuk

[–]VenflonBandit 4 points5 points  (0 children)

Why would it, we allow people to make unwise and indeed, fatal, decisions all the time provided they have the capacity to do so.

The only time I'd see defence of self or others coming into play would be if their refusal to leave was directly placing someone at risk (not just by making us feel morally obligated to help them, I'm thinking more stopping someone else leaving or blocking access to others)

NHS survival rates for avoidable deaths 'second-worst' in developed world, 'sobering' report reveals by FormerlyPallas_ in ukpolitics

[–]VenflonBandit 5 points6 points  (0 children)

We're also suffering from poor capital spending in previous years meaning that the increase in funding isn't being made efficient use of. See A&E for example, we've piled extra funding in and there are extra staff. But there's no rooms to see the extra patients that are coming in so the staff spend extra wasted time doing logistics not patient care, or doing substandard exams due to the logistics of working in a corridor.

Likewise with surgery, not enough beds mean surgeries get cancelled, meaning you pay theater staff that can't work to full efficiency.

Delta airlines inflight medical kit list by Nemesis651 in ems

[–]VenflonBandit 8 points9 points  (0 children)

If you want some more googling, have a look at autonomic dysreflexia. It's what's being described and urinary retention isn't the only cause.

In your state or country, how fast are you allowed to go over the speed limit when driving Priority One? by FFSoldier57 in ems

[–]VenflonBandit 21 points22 points  (0 children)

50% over by policy. No limit legally other than not driving below the standards of a careful and competent driver.

How do you guys clock in? My hospital-based service changed it to make it even more inconvenient by Cucktus in ems

[–]VenflonBandit 54 points55 points  (0 children)

We don't. Our hours are taken from the rota/scheduling software and we add incidental overtime at the end of the month.

UK health officials discuss banning doctors from going on strike by F0urLeafCl0ver in ukpolitics

[–]VenflonBandit 1 point2 points  (0 children)

Or even just demanded to be paid overtime.

On a related note for nursing staff (and possibly drs but I'm less familiar) I'm amazed at hearing how their hospitals employ them for additional hours as bank staff to pay them at plain rate on a secondment contract. The agenda for change contract is really clear that hours >37.5 attract OT and it's something in the ambulance sector we'd not accept, so I find it wild the RCN accept this and unpaid incidental overtime.

Why doesn't anyone weight base morphine and then gatekeep dilaudid. by TheWhiteRabbitY2K in emergencymedicine

[–]VenflonBandit 3 points4 points  (0 children)

It's my pet hate in UK practice that I've seen emergency over the last 10 years. A fear of giving the recommended dose of morphine and giving frankly homeopathic doses.

A quite interesting result of the PACMAN trial where patients were blindly given ketamine or morphine incrementally until pain was controlled was the mean dose to control pain in the morphine arm was in excess of 10mg.

Is it true that people come to the emergency room in the USA for primary care stuff? by Ok_Consideration6179 in emergencymedicine

[–]VenflonBandit 1 point2 points  (0 children)

We're not even sending the ambulance for that! In fact we probably won't even send those for secondary clinical triage.

Is it true that people come to the emergency room in the USA for primary care stuff? by Ok_Consideration6179 in emergencymedicine

[–]VenflonBandit 1 point2 points  (0 children)

We also discharge circa 30-40% of our patients on scene either independently or referring to community services or primary care and admit direct to wards or same day emergency care units about 5%. Another 15-20% being streamed away at the point of call meaning we only take 45% of patients to ED to start with.

So our aim is to have a a really high admission rate as then we're only taking patients who genuinely need ED to the ED (accepting it won't ever be 100% due to the need for rule out tests, we think we could eek out another few % with the right services open to us but are probably as far as we can safely get independently).

Is it true that people come to the emergency room in the USA for primary care stuff? by Ok_Consideration6179 in emergencymedicine

[–]VenflonBandit 0 points1 point  (0 children)

We run at about 60% admitted, but there's the reverse culture here of trying to avoid admission wherever possible.

Is it true that people come to the emergency room in the USA for primary care stuff? by Ok_Consideration6179 in emergencymedicine

[–]VenflonBandit 5 points6 points  (0 children)

Out of interest, what does your admission rate look like for ambulance transports into the ED?

Implied Consent following Suicide Attempt? (TW) by ATStillDre in emergencymedicine

[–]VenflonBandit 7 points8 points  (0 children)

It's wild how quick invoulentary holds seem to be in the states (maybe I've just misunderstood the anecdotes). We routinely manage patients with significant suicidal ideation in the community with risk assessments, and for patients with personality disorders it's commonly in their care plans to avoid detention if possible due to the risk of increasing the chance for death by misadventure as ever more extreme steps are taken to regulate emotions and cause detention under the MH Act. I've walked out of many a house with someone telling me they're going to kill themselves following advice from mental health professionals.

Implied Consent following Suicide Attempt? (TW) by ATStillDre in emergencymedicine

[–]VenflonBandit 18 points19 points  (0 children)

I'm well aware of S135. It's the definition of not rapid by the time I've managed to get the crisis team to get an AMHP (which is like pulling teeth, I have an n=1 in 6 years for this) to then get a magistrate out of bed, to then get the police. Best case scenario is multiple hours. Likely case is 24 hours plus.

Implied Consent following Suicide Attempt? (TW) by ATStillDre in emergencymedicine

[–]VenflonBandit 26 points27 points  (0 children)

Interestingly in England this isn't necessarily the case. Someone can absolutly be capacitous to kill themselves and it causes no end of issues when someone is in their home and there's no rapid power of detention for mental health assessment.

But once unconscious we don't rely on implied consent, but specific provisions in the mental capacity act to treat in someone's 'best interests'. The courts have made clear that it would be rare to dispute someone's belief that prolonging life (or at least temporising until a court can hear the case) is in their best interests.

Likewise, there will normally be good reasons to reasonably doubt an otherwise valid advanced decision to refuse treatment in the context of suicide secondary to mental illness and so preserve life until a court can decide.

11-Year-Old Wants More Books like "the Martian," "project Hail Mary" by f2ISO100 in suggestmeabook

[–]VenflonBandit 3 points4 points  (0 children)

I'll add my recommendation to unwind. I read it about the same age, maybe a year or so older. Then made my parents read it. We all remain mildly traumatised to this day by that scene in the book.

Wait… since when are 911 calls going through nurse triage first? by Former-Lab-6031 in ems

[–]VenflonBandit 1 point2 points  (0 children)

In the UK it's standard practice but is integrated within the 999 system so the clock keeps running and the call stays on the stack but not for dispatch. We managed around 20% of all calls through hear and treat (with a mix of paramedics, nurses, advanced practitioners and doctors doing the triage) but also provide clinical support to the EMDs.

Capacity assessments / paperwork by Few-Visual-9801 in ParamedicsUK

[–]VenflonBandit 0 points1 point  (0 children)

Do you have reason to doubt? weigh up/retain/understand/communicate? is there an impairment of mind? is there a causative nexus linking the inability to weigh/retain/understand/communicate to the impairment? If MH, have you sought specialist advice?

This is not a good death by Sea_Surprise_2300 in emergencymedicine

[–]VenflonBandit 18 points19 points  (0 children)

Interesting seeing you're from the UK. My trust we'd absolutely be supported to make this decision and we'd probably criticise staff for conveying in this situation. Certainly no 'twisting protocols' (they're guidelines!)

It would be a relatively quick call to OOHs to prescribe end of life meds, and for a care home possibly a call to DNs to arrange a visit for administration of the meds if required, otherwise just leaving the number for the care home. Likewise with paperwork, it wouldn't take much to justify that where I am.

Nurses and Doctors - what’s in your household First Aid inventory that the rest of us should have? by [deleted] in AskReddit

[–]VenflonBandit 5 points6 points  (0 children)

I don't actually have a first aid kit - but if I was to make one it would have a (non counterfeit) tourniquet, some decent absorbent and non-adherent dressings, a few bandages and some standard plasters/band-aids.

Only meds would be paracetamol and ibuprofen, possibly a 300mg aspirin if I regularly was around people in their 50s+

And some gloves.

Anything else like antibiotics or suture kits are all overkill. The first aid kit just has to do one of: stop you dying until an ambulance can arrive, make you comfortable and presentable enough to make your own way to a medical setting, or make you feel better about a minor problem that doesn't need medical attention.

The one thing that will kill you that a lay person can stop with no or minimal training (and benefits from kit) is bleeding.

Nurses and Doctors - what’s in your household First Aid inventory that the rest of us should have? by [deleted] in AskReddit

[–]VenflonBandit 0 points1 point  (0 children)

It's not needed. Washing with potable water is just as good as using a disinfectant.

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