A vehicle for transporting sick or injured people that is staffed by trained personnel who can provide emergency treatment during the journey.
For more detailed information about bandaging, the reader is referred to First Aid Manual, the authorised manual of the St John’s Ambulance Association, St Andrew’s Ambulance Association and British Red Cross Society.... bandages
As their title shows, A&E departments (and the 999 and 112 telephone lines) are for patients who are genuine emergencies: namely, critical or life-threatening circumstances such as:
unconsciousness.
serious loss of blood.
suspected broken bones.
deep wound(s) such as a knife wound.
suspected heart attack.
di?culty in breathing.
suspected injury to brain, chest or abdominal organs.
•?ts. To help people decide which medical service is most appropriate for them (or someone they are caring for or helping), the following questions should be answered:
Could the symptoms be treated with an overthe-counter (OTC) medicine? If so, visit a pharmacist.
Does the situation seem urgent? If so, call NHS Direct or the GP for telephone advice, and a surgery appointment may be the best action.
Is the injured or ill person an obvious emergency (see above)? If so, go to the local A&E department or call 999 for an ambu
lance, and be ready to give the name of the person involved, a brief description of the emergency and the place where it has occurred.... emergency
Initially, automatic contraction of a muscle at the entrance to the windpipe, a mechanism called the laryngeal reflex, prevents water from entering the lungs; instead it enters the oesophagus and stomach.
However, the laryngeal reflex impairs breathing and can quickly lead to hypoxia and to loss of consciousness.
If the person is buoyant at this point and floats face-up, his or her chances of survival are reasonable because the laryngeal reflex begins to relax and normal breathing may resume.
An ambulance should be called and the person’s medical condition assessed.
If breathing and/or the pulse is absent, resuscitative measures should be started (see artificial respiration; cardiopulmonary resuscitation) and continued until an ambulance or doctor arrives.
Victims can sometimes be resuscitated, despite a long period immersed in very cold water (which reduces the body’s oxygen needs) and the initial appearance of being dead.
In all cases of successful resuscitation, the person should be sent to a hospital.... drowning
Most GPs work in groups of self-employed individuals, who contract their services to the local Primary Care Trust (PCT) – see below. Those in full partnership are called principals, but an increasing number now work as non-principals – that is, they are employees rather than partners in a practice. Alternatively, they might be salaried employees of a PCT. The average number of patients looked after by a full-time GP is 1,800 and the average duration of consultation about 10 minutes. GPs need to be able to deal with all common medical conditions and be able to recognise conditions that require specialist help, especially those requiring urgent action.
Until the new General Medical Services Contract was introduced in 2004, GPs had to take individual responsibility for providing ‘all necessary medical services’ at all times to their patient list. Now, practices rather than individuals share this responsibility. Moreover, the contract now applies only to the hours between
8.00 a.m. and 6.30 p.m., Mondays to Fridays; out-of-hours primary care has become the responsibility of PCTs. GPs still have an obligation to visit patients at home on weekdays in case of medical need, but home-visiting as a proportion of GP work has declined steadily since the NHS began. By contrast, the amount of time spent attending to preventive care and organisational issues has steadily increased. The 2004 contract for the ?rst time introduced payment for speci?c indicators of good clinical care in a limited range of conditions.
A telephone advice service, NHS Direct, was launched in 2000 to give an opportunity for patients to ‘consult’ a trained nurse who guides the caller on whether the symptoms indicate that self-care, a visit to a GP or a hospital Accident & Emergency department, or an ambulance callout is required. The aim of this service is to give the patient prompt advice and to reduce misuse of the skills of GPs, ambulance sta? and hospital facilities.
Training of GPs Training for NHS general practice after quali?cation and registration as a doctor requires a minimum of two years’ post-registration work in hospital jobs covering a variety of areas, including PAEDIATRICS, OBSTETRICS, care of the elderly and PSYCHIATRY. This is followed by a year or more working as a ‘registrar’ in general practice. This ?nal year exposes registrars to life as a GP, where they start to look after their own patients, while still closely supervised by a GP who has him- or herself been trained in educational techniques. Successful completion of ‘summative assessment’ – regular assessments during training – quali?es registrars to become GPs in their own right, and many newly quali?ed GPs also sit the membership exam set by the Royal College of General Practitioners (see APPENDIX 8: PROFESSIONAL ORGANISATIONS).
A growing number of GP practices o?er educational attachments to medical students. These attachments provide experience of the range of medical and social problems commonly found in the community, while also o?ering them allocated time to learn clinical skills away from the more specialist environment of the hospital.
In addition to teaching commitments, many GPs are also choosing to spend one or two sessions away from their practices each week, doing other kinds of work. Most will work in, for example, at least one of the following: a hospital specialist clinic; a hospice; occupational medicine (see under OCCUPATIONAL HEALTH, MEDICINE AND DISEASES); family-planning clinics; the police or prison services. Some also become involved in medical administration, representative medicopolitics or journalism. To help them keep up to date with advances and changes in medicine, GPs are required to produce personal-development plans that outline any educational activities they have completed or intend to pursue during the forthcoming year.
NHS GPs are allowed to see private patients, though this activity is not widespread (see PRIVATE HEALTH CARE).
Primary Care Trusts (PCTs) Groups of GPs (whether working alone, or in partnership with others) are now obliged by the NHS to link communally with a number of other GPs in the locality, to form Primary Care Trusts (PCTs). Most have a membership of about 30 GPs, working within a de?ned geographical area, in addition to the community nurses and practice counsellors working in the same area; links are also made to local council social services so that health and social needs are addressed together. Some PCTs also run ambulance services.
One of the roles of PCTs is to develop primary-care services that are appropriate to the needs of the local population, while also occupying a powerful position to in?uence the scope and quality of secondary-care services. They are also designed to ensure equity of resources between di?erent GP surgeries, so that all patients living in the locality have access to a high quality and uniform standard of service.
One way in which this is beginning to happen is through the introduction of more overt CLINICAL GOVERNANCE. PCTs devise and help their member practices to conduct CLINICAL AUDIT programmes and also encourage them to participate in prescribing incentive schemes. In return, practices receive payment for this work, and the funds are used to improve the services they o?er their patients.... general practitioner (gp)
Treatment This is urgent. If the skin has been contaminated with the lysol, it must be washed with water, and any lysol-contaminated clothing must be taken o?. Do not make the victim vomit if he or she has swallowed a corrosive substance such as lysol or phenol. Call an ambulance and say what the victim has taken. See APPENDIX 1: BASIC FIRST AID.... lysol poisoning
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