Ambulance airs on Tuesday's at 9pm

The new BBC series takes a look at London Ambulance Service's frontline and control room staff, showing the daily decisions they have to make when caring for the capital.

In this forum offers an opportunity to ask questions and discuss the themes that appear in the show. These can be both positive and negative opinions, where we can seek to find out the reasons why decisions were made, or how those involved in prehospital care can seek to improve the service provided.

For example, I felt the show demonstrated well the complexities of resource allocation, and how at times it isn't easy to source an immediate ambulance response. However I also felt the show mainly focused heavily on trauma and cardiac arrests, which may be to hook the viewer in, and something to see if the show continues to mainly this one aspect of front line services.

Please don't be afraid to write your thoughts!

This question was posted to me... so the first one to discuss

I had a discussion topic/question regarding this week's episode (S01E01) but not sure where to post it.

The subject is about the crew requesting an APP for the post rosc ?MI patient at the GP surgery, where the APP was Dan, stuck in traffic and more than 30 minutes away.

The question is: is it justifiable to wait an additional 30 minutes on scene with a post rosc ?mi patient when a ppci/heart attack centre is potentially nearer, and where the patient needs to be?

I am aware that the camera may be concealing other aspects of the situation, but thought it was worth discussing.

So I will reply from my point of view and my experience and look forward to hearing other peoples views/experiences.

Good Question
The paramedics & ambulance crew on scene will have updated control with the patient condition in from of them and the advanced paramedic may have either interrogated the call 'listened' in or had a direct update from the crew as you saw on the programme and at that point the advanced paramedic may have been automatically dispatched to the call or from crew request.

The programme obviously doesn't show these scenarios in real time which is probably the first point to make. I have only watched the show once. The patient in ROSC is in a very unstable condition and the crew may have not achieved ROSC until the APP arrived or just arrived. I can understand the question but also there is not going to be a definitive answer in all situations. It is a judgement call at the time. Of course 'minutes is myocardium' so the sooner transportation has begun to the specialist centre then the better however patients that are having MIs may rearrest, may need sedation drugs or added pain or potentially you may need or require the lucas device.

Many Times a crew has left scene before an APP and that is fine providing every piece of treatment we do and decision we make will be beneficial for the patient.

So in my experience, I know what the advanced paramedics can offer so I weigh up the benefits regarding this and make a decision also based on how far I am from the hospital and other factors. Its always advisable to see how far the senior clinician is from scene.

Any other discussion or comments regarding this please go ahead.

Following on from the above in regards to the question APP vs transport to Cath Lab, I found some additional reading with a few figures that may give more light to the potential benefits of an APP's attendance.

Information I have managed to have source comes from the Resuscitation Council UK on post-ROSC following cardiac arrest.

While it does not taylor the direction of this information to the pre-hospital APP specifically, there is some statistics and evidence to support sedation post-ROSC. This is alongside the associated risks of myoclonic seizures. It suggests that sedation may help to reduce metabolic rate thus the need for glucose and oxygen, with seizures doing the opposite. I couldn't find much specific to what APP's can do re-their specific guidance and protocols, however I am away they are able to sedate with Midazolam.

Its interesting to note that while there is this information published, the resuscitation council UK have still put an increased emphasis on "urgent coronary catheterisation and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest of likely cardiac cause."

Source: Resuscitation Council UK Guidelines - Post Resuscitation Care

In regards to the potential use of the LUCAS 2 devise, I believe a trial conducted by the University of Warwick showed that while these devises are effective in replacing the manual CPR, they perform no better and provide no notable better patient outcomes. Simply a devise that allows rescuers a hands-off approach to CPR. While with this, there is an argument to be had about rescuer fatigue, on 'Ambulance' BBC1 S01E01 there appeared to be 4 people on-scene at least - it also raises the potential question that how effective would compressions be in the 30mins travel time for the APP to arrive to fit a LUCAS 2 vs. potential transportation to Cath Lab for PCI?

Source: The lancet - Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial.

My initial impressions/opinion is that I can't see massive evidence as to support a delay to use the APP who is 30mins away on this job, although granted this is TV and who knows what might have been edited out!?

Thoughts?

PS. Sorry it wouldn't let me post the url's to the sources! Apologies.