People who abuse or threaten nurses and doctors in England will face fines of up to £1,000.

I just hope that it extends to everyone in the NHS.

Like ambulance workers.

More on a case of ‘abuse’ towards my crewmate and I tomorrow…

My brother let me know about this story and when I got home Mariamne had emailed me the link (as well as telling me about some awful nursing homes in America).

 Manchester United and Liverpool have issued a joint statement condemning the fans who attacked the ambulance taking Alan Smith to hospital at the weekend. Smith, 25, suffered a broken leg and a dislocated ankle during United's 1-0 FA Cup defeat at Anfield.

Reports in several newspapers on Thursday claimed the ambulance was surrounded by people who threw stones and bottles at it and even tried to rock it from side to side. The two paramedics - both Liverpool fans - were described as being "horrified" by the hostility shown once the culprits realised the occupants of the ambulance were Alan Smith and Manchester United's club doctor Mike Stone.

You can read more about it at the Guardian.

It really beggars all description, attacking an ambulance is just evil – even warring nations tend to not attack Red Cross ambulances, yet these ‘fans’ wanted to do serious harm to the people inside.  I’m just hoping that there is plenty of CCTV footage for the police to look at.

When I saw the picture of the footballer’s injury I instantly recognised it as a fractured dislocation, which is a very nasty injury.  He should be very grateful to the doctor that he was unaware of what was happening to him (I suspect that the doctor gave him some Ketamine).

Just a nasty business all round.

Further to my last post I was sent this link by Lianne (Thanks Lianne)

This article reports on a story in the BMJ, saying that the elderly in NHS nursing homes should not receive CPR.

Writing in the British Medical Journal (BMJ), Simon Conroy, a clinical lecturer in geriatrics, called for a review.
He said: "Given the likely low chance of success, it may be that the institution should not offer resuscitation at all.
"Resources saved by not spending time in training and the subsequent discussions could be better used in improving the quality of care.

(The full article is behind a paywall here)

Please note, I haven't read the full article - I may try to sneak down to Newham Hospital library to have a peek at it.

But I can see a couple of problems with the thinking from just the Daily Mail piece.

First - All NHS nurses are trained in CPR as part of their basic training. It doesn't cost much to keep those skills updated. As I wrote in the previous post, the London Ambulance Service will come out for free and teach you how to perform effective CPR.

70% of cardiac arrests happen outside hospitals, and before the introduction of defibrillators in public places the survival chance was 1%, after the defibs were in place the chance of survival was 3%.

Given the cost of Defibs, was this a worthwhile spending of money? Does the doctor who wrote the article think that putting Defibs in Tesco while removing them from nursing homes is a good idea?

Secondly - Why should we put any money into a treatment that only has a 3-6%(depending on source) success rate? If it is a waste of money to resuscitate the elderly because it has such a low chance of success, then that would apply to any out of hospital arrest.

I'm sorry, but it smacks too much of "let the old ones die" to me - and that is just distasteful. If we start heading down that route, then we may as well stop treating the unemployed or chronically ill because they don't contribute anything to the economy.

My personal view is that CPR is inappropriate in a large number of nursing home cases - but that it should be an individual choice not to be resuscitated and not the default option.

I would have like to have written more, but I'm at work and time/computing resources are limited.

UPDATE: A couple of people have sent me a copy of the article - I'll not mention any names in case it gets them in trouble - but thanks to those who helped. Once I've read it I may post about this subject again.

Some patients with chronic lung disease need oxygen, and rather than keep them in hospital, these patients often have cylinders of oxygen delivered to them at their home.

Until recently it was the pharmacist who supplied these cylinders, but the government in it’s infinite wisdom has decided to privatise the supply of oxygen.  This means more paperwork, which NHS Blog Doc has already covered.

And now a patient has died, possibly due to a delay getting her oxygen delivered.  It drives me crazy that I spend my time in my ambulance going to 23 year old men with coughs, yet apparently no ambulance was called for this woman.

It all comes down to the government wishing to run the health service like a business.

I know that some people believe that the free market will constantly provide superior service to anything run by the government.  Unfortunately healthcare isn’t a ‘market’ and this market view of the NHS  leads towards some very silly initiatives.  It’s why ‘failing’ hospitals get less money than ‘successful’ hospitals, who would want to throw money into a failing business?

Why are hospitals so dirty?  Because of the free market contracting of cleaners to the cheapest supplier – regardless of the quality of the cleaning.

It’s also why, despite increasing numbers of patients, increasing calls, very few new staff and all the other reasons why we may not meet our government ORCON target this year, we’ll get less money to be spent on improving our service.

But what do I know – I’m a van driver not an economist.

This week the round up of medical blog posts “Grand Rounds” is up at Science and Politics.

As Neil Gaiman just wrote…

Writing away on about three different deadlines right now, so the blogging is probably going to suffer for a week or so. (Traditionally I either follow a post like that by disappearing completely or by posting twice as much.)

I never thought I’d share anything with him, but the first draft of ‘da book’ needs to be in by the end of the month, so blogging may be a bit light for the next two weeks or so.  I’ve got some stuff to write about last nights ORG meeting, some in private emails, some of which may end up in this blog.  There also may be some scribbling over a little project I’m doing – this may however remain private.

If I get something really interesting in the next two night-shifts I’ll let you know, but I may be a little to busy to turn belly-aches into interesting posts.

The Amazon adbox (the only ad I’ll ever have) has been turned into a “what I’m reading now” box.  Do with it as thou wilt.

The regular round up of medical blogs, ‘Grand Rounds’ are up at Barbados Butterfly.