1. Where are our risks?
Matt Green @MLG1611
Ambulance staff are fairly risk-averse practitioners; sometimes taking people to hospital `just for
a check up` to make sure they were not the last professional to see the patient alive, using
painkillers that are safe but not always strong enough to effectively manage severe pain
because of concerns about the side effects of something stronger or leaving patients with
insecure airways because we can’t manage the risks associated with intubating the living.
On the other hand, some of the things that happen because of the things we don’t do are quite
risky. Systolic of 70, ventricular tachycardia and upstairs? Sometimes we must sit them up on a
carry chair and just hope they don’t arrest on the way down because we don’t have the right
techniques to stabilise them before moving.
Frail, lack capacity and so agitated they could really hurt themselves? We put them on our
unfamiliar stretcher in an alien space and use seatbelts to imperfectly restrain them, balancing
the need to stop them falling with not restricting their ventilation or breaking the law. If a few
gentle words or holding hands doesn’t placate them, there’s nothing left to offer and they are
still at risk of massive injury.
At a cardiac arrest with a patient in pulseless electrical activity? Unsure if there is any cardiac
movement, and therefore hope for survival, without ultrasound? You may be forced to place the
patient, 3 clinicians and a relative in a heavy, lumbering ambulance and do 85mph to the
nearest Emergency Department to find out. Just one misjudgement by the best driver could
send all 5 of you into a horrific crash; not to mention the family car or pedestrians struck as the
ambulance barrels out of control.
Generally speaking, ambulance staff do not give inotropes or provide cardioversion, do not
sedate those at extreme risk in appropriate circumstances and lack imaging technology,
meaning clinical decisions are forced. It is obvious that every medical procedure is associated
with risk but education and training has improved enormously over the last 20 years meaning
arguably those hazards could be competently managed.
Is it time to re-evaluate what the safest thing for ambulance staff to be doing is and do we know
where our real risks lie?
@MLG1611