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