Intended for healthcare professionals


How much to do at the accident scene?

BMJ 2000; 320 doi: (Published 08 April 2000) Cite this as: BMJ 2000;320:1005

This article has a correction. Please see:

Paramedic agrees with most of comments about prehospital care

  1. John Warwick, paramedic/work based trainer (
  1. London Ambulance Service NHS Trust, London SE1 8SD
  2. Shackleton Department of Anaesthetics, Southampton General Hospital, Southampton SO16 6YD
  3. Department of Hospitals, County of Roskilde, Postboks 170, 4000 Roskilde, Denmark

    EDITOR—I agree with most of Cooke's comments about prehospital care by paramedics in the United Kingdom1 but would liketo raise a few points. As a paramedic in London, I realise that my remarks may not have national generalisability, but their essence should travel across regional boundaries.

    Cooke is correct in his assertion that “Changes are needed if the paramedic is to be an independent practitioner.” Paramedics are the product of doctors; we are what they made us. The idea of having extended role ambulance staff began during the 1970s and '80s. Unfortunately, the original aspirations of our worthy fathers were overtaken by political posturing.

    The original concept was for a small cadre of highly trained paramedics who would be targeted at the small percentage of 999 calls where the patient would benefit from extended skills before reaching hospital. The emphasis was initially on calls for patients with cardiac problems; later this was extended to patients with trauma. When the ambulance dispute in 1989 was eventually concluded a promise was made that there would be a paramedic in each vehicle. This went against the original concept of sending a paramedic to every call made about a life threatening condition—which would have required accurate and effective assessment and deployment.2

    Cooke is correct that paramedics need the underpinning knowledge to make appropriate decisions about patients' treatment. Degree programmes will help provide this knowledge, …

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