Prehospital emergency care: why training should be compulsory for medical undergraduates

John Henry George Antrum; James K H Ho

doi:10.1136/emermed-2014-204214

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Prehospital emergency care: why training should be compulsory for medical undergraduates

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ANTRUM AND HO (EMJ 2015;32:171-172)
Colville Laird
Published on: 29 April 2016
Re:Prehospital care is not for amateurs
John H G Antrum
Published on: 29 April 2016
Prehospital care is not for amateurs
Kate Clayton
Published on: 29 April 2016
Serious about change
Eva F Howard
Published on: 29 April 2016

Published on: 29 April 2016
ANTRUM AND HO (EMJ 2015;32:171-172)
- Colville Laird, Chairman of The Faculty of Pre-hospital Care RCSEd
Dear Editor
ANTRUM AND HO (EMJ 2015;32:171-172)
Antrum and Ho (EMJ 2015;32:171-172) identify an important issue in identifying the deficiency in medical education due to the lack of formal training in pre-hospital medical care at most medical schools in the UK.
There are obvious benefits of increasing the number of trained professionals able to provide pre-hospital care it is important that all medical gradua...
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Dear Editor
ANTRUM AND HO (EMJ 2015;32:171-172)
Antrum and Ho (EMJ 2015;32:171-172) identify an important issue in identifying the deficiency in medical education due to the lack of formal training in pre-hospital medical care at most medical schools in the UK.
There are obvious benefits of increasing the number of trained professionals able to provide pre-hospital care it is important that all medical graduates have knowledge of twenty first century management of emergencies in the pre-hospital situation. However in this area of medicine, where any medical practitioner can unexpectedly be required to help, it is important to ensure all medical graduates have knowledge of what interventions should not be undertaken as well as these that should be undertaken.
With a new GMC recognised sub-speciality of Pre-Hospital Emergency Medicine it is timely that the teaching of undergraduate of pre-hospital emergency medicine is standardised within the undergraduate curriculum.
Yours sincerely
Dr Colville Laird,
Chairman of The Faculty of Pre-hospital Care RCSEd
Email: claird@basics-scotland.org.uk
Mobile: 07768855798
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 29 April 2016
Re:Prehospital care is not for amateurs
- John H G Antrum
The authors thank Dr Clayton for her comments.
However, they point out that her critique of their paper is largely inconsistent with what was actually written and can only assume a misunderstanding of the article.
The article does not state, nor even imply, that the GMC require students to provide expert or definitive care as she asserted in her response. Indeed the article talks about basic skills an...
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The authors thank Dr Clayton for her comments.
However, they point out that her critique of their paper is largely inconsistent with what was actually written and can only assume a misunderstanding of the article.
The article does not state, nor even imply, that the GMC require students to provide expert or definitive care as she asserted in her response. Indeed the article talks about basic skills and basic prehospital care verbatim, and as such is not culpable for the points outlined in her comments.
Whilst BLS and first aid may be essential components of prehospital care, the authors disagree that it is 'the best any practitioner (or student) can offer'. As detailed in the article, other aspects of care (and not just treatment) will benefit both the injured and those assisting, not least in ensuring personal safety. Furthermore, whilst BLS may be taught in medical schools, such teaching has been reported as inadequate, and it is the authors' suggestion that its compulsory and regulated integration into the undergraduate curriculum would ensure that it is taught to the correct standard.
Finally, the authors thank Dr Clayton for pointing out the training that paramedics receive. Nonetheless, they feel they must again emphasise that the article has never once suggested that over-zealous students (and junior doctors) should interfere with and hinder these paramedics, which she wrongly implied in her response. Quite the opposite. As the article states that ambulance response times have been reported as substandard, i.e. are taking longer to reach an emergency than they should, its emphasis is thus that of care prior to the arrival of these paramedics, a time when a student is first on the scene and might improve patient outcome. The authors had hoped that this could be understood from the lines "transferring relevant and detailed information to a 999 operator" i.e. what to say when calling 999, and "on-scene handovers to emergency services" i.e. telling paramedics what has happened as they arrive and take over.
The authors therefore do not agree with Dr Clayton's suggestion that "everyone else should stand well back" as this implies that no care would be given, the injured may deteriorate and the GMC guidelines are disregarded.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 29 April 2016
Prehospital care is not for amateurs
- Kate Clayton, Retrievals Registrar
The very fact that the author has written this article at all demonstrates to me a profound lack of understanding on his part of the complexities of prehospital care.
Firstly, the obligation mentioned by the GMC to help victims of accidents is not a requirement to provide expert or definitive care - it is simply a moral duty to provide what help one can given ones own skill set and available resources. As the...
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The very fact that the author has written this article at all demonstrates to me a profound lack of understanding on his part of the complexities of prehospital care.
Firstly, the obligation mentioned by the GMC to help victims of accidents is not a requirement to provide expert or definitive care - it is simply a moral duty to provide what help one can given ones own skill set and available resources. As the author rightly points out, opening an airway or stabilising a cervical spine may indeed be life-saving.
Furthermore, the inability to provide expert or definitive interventions does not reflect inadequacies on the part of medical school curricula, but more the reality that, without equipment (which no-one caries with them except BASICS doctors), the best any practitioner (or student) can offer at the road side is basic life support/ first aid - and this is already taught in medical schools.
Most importantly of all, there already exists a body of prehospital care experts who spend on average of three years training to provide assistance to accident victims - they are called paramedics, and trust me, they do not appreciate over-enthusiastic medical students/ junior doctors 'helping' them on scene - whether or not their medical school has provided them with prehospital care training.
Prehospital care is highly specialised, and those that practice within the speciality have extensive experience within the critical care domains and (assuming they have the right equipment available) can sometimes offer the trauma victim an extra survival advantage. Everyone else should stand well back and let the paramedics do what they do better than anyone else.
Conflict of Interest:
I am a registrar in retrievals medicine, involving primary and secondary retrievals.
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Conflict of Interest:
None declared.
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Published on: 29 April 2016
Serious about change
- Eva F Howard, Undergraduate Chairperson
I agree with Antrum and Ho (EMJ 2015;32:171-172) that formal Pre- Hospital Training should be included in all Undergraduate Medical Curriculums. They will be pleased to hear that a nationwide Faculty of Pre -Hospital Care Undergraduate Committee has been set-up, aiming to springboard ideas and information about events, funding and training in pre-hospital care, to all healthcare students. Antrum and Ho quite rightly realis...
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I agree with Antrum and Ho (EMJ 2015;32:171-172) that formal Pre- Hospital Training should be included in all Undergraduate Medical Curriculums. They will be pleased to hear that a nationwide Faculty of Pre -Hospital Care Undergraduate Committee has been set-up, aiming to springboard ideas and information about events, funding and training in pre-hospital care, to all healthcare students. Antrum and Ho quite rightly realise that some form of compulsory pre- hospital training in all medical curriculums is only likely to happen if the General Medical Council specifically requests it. However at present, evidence to illustrate to the GMC the real value of such training is lacking. This must change if it is to be a credible competitor for precious curriculum time. The Undergraduate Pre-Hospital Care Committee hopes that through co- ordination of student pre-hospital care events, sharing of information and literary review, as well as a now standardised and followed-up feedback system for pre-hospital training, the evidence-base will grow. I urge anyone involved in student pre-hospital care activities throughout the UK, to get in touch with the Committee and together let's make sure the necessary evidence for such vital training actually exists.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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