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  1. #1451
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    Quote Originally Posted by Graylion View Post
    Quick question: One of my pet ideas is to use air ambulances for transfers between hospitals. Let me explain the rationale

    - aer ambulance can not always land due to roadside over head electricity cables
    - hospital functions are being very centralised in this country

    I would like us to be able to quickly transfer patients from one hospital to the other and have a helipad at _every_ hospital. Now I am wondering whether anything relevant would be gained by making those helipads IFR capable? (never mind practicality, that's a diffrent conversation.) Planning laws of course would have to be changed so that noise concerns do not apply for emergency services.
    What sort of patients are you thinking of sending by air?

    While there are certain classes of patients who one might need to get to a tertiary centre ASAP, and there are even circumstances when getting a stable patient to another hospital ASAP would be benticial (eg if an ITU bed is not available), the vast majority of inter-hospital transfers would not need the resource-heavy investment of Air Ambulance to get them from A to B.

    If they are fit enough to lie on a trolley in A&E, they are fit enough to lie on a stretcher for an hour or two to transfer.

    The investment might be better put into more boring but essential areas.
    'He died who loved to live,' they'll say,
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    Quote Originally Posted by Flamingo View Post
    What sort of patients are you thinking of sending by air?

    While there are certain classes of patients who one might need to get to a tertiary centre ASAP, and there are even circumstances when getting a stable patient to another hospital ASAP would be benticial (eg if an ITU bed is not available), the vast majority of inter-hospital transfers would not need the resource-heavy investment of Air Ambulance to get them from A to B.

    If they are fit enough to lie on a trolley in A&E, they are fit enough to lie on a stretcher for an hour or two to transfer.

    The investment might be better put into more boring but essential areas.
    You do realise how many people die on trolleys every week, right? But it is an interesting question. I wish I had statistics.

  4. #1453
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    As a layman can someone please explane the difference between a bed and a trolley.
    The only difference I can come up with is that a bed has a Curtain around it and is not in a corridor.
    Well, government doesn't stop just because the country's been destroyed! I mean, annihilation's bad enough without anarchy to make things even worse!

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  6. #1454
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    Quote Originally Posted by Graylion View Post
    Quick question: One of my pet ideas is to use air ambulances for transfers between hospitals. Let me explain the rationale

    - aer ambulance can not always land due to roadside over head electricity cables
    - hospital functions are being very centralised in this country

    I would like us to be able to quickly transfer patients from one hospital to the other and have a helipad at _every_ hospital. Now I am wondering whether anything relevant would be gained by making those helipads IFR capable? (never mind practicality, that's a diffrent conversation.) Planning laws of course would have to be changed so that noise concerns do not apply for emergency services.
    Air ambulance flights (hospital to hospital) flights are completed ... the major issue apart from aircraft availability (helicopter, aircrew and ground crew) is so few hospitals have a helipad (never mind a IFR one)

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    Quote Originally Posted by CTU View Post
    As a layman can someone please explane the difference between a bed and a trolley.
    The only difference I can come up with is that a bed has a Curtain around it and is not in a corridor.
    I have had the unfortunate experience of having to spend the night on both a hospital bed and a trolley. A bed is as is stated a bed with a certain level of comfort. A trolley is designed for moving patients around from point A to point B and I can attest to the fact that they lack the necessary comforts (padding) that make an overnight stay in hospital comfortable.

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    I’m sure they do, but they don’t all die. My point is that if there are limited resources, then fixing the number of beds and looking at where needs them (both in terms of geography and speciality) might be for the greater good.

    The health service in Ireland needs a root and branch reform, free from special interest groups (although that’s one for a separate thread). Tinkering at the edges is akin to rearranging the deckchairs on the Titanic.
    'He died who loved to live,' they'll say,
    'Unselfishly so we might have today!'
    Like hell! He fought because he had to fight;
    He died that's all. It was his unlucky night.
    http://www.salamanderoasis.org/poems...nnis/luck.html

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  11. #1457
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    A bed is on a ward a trolley is where ever they can fit one

  12. #1458
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    Quote Originally Posted by CTU View Post
    As a layman can someone please explane the difference between a bed and a trolley.
    The only difference I can come up with is that a bed has a Curtain around it and is not in a corridor.
    Bravo gave a pretty good personal view, to which I can (unfortunately) agree with from my personal experience.

    From a clinical standpoint, patients can be cared for better in a bed than a trolley in a number of ways. Taking their clinical condition into account (and dragging up 15 year-old information from my memory), in no particular order

    - elderly or immobile patients are at high risk of tissue breakdown on pressure areas (Sacral area, heels, elbows, ankles, knees, back of the head even). Two hours can be enough to do damage. It’s easier to move a patient regularly to distribute the weight/pressure on a wide bed than a narrow trolley. Also, special pressure relieving mattresses can be put on beds, as a rule they are not designed for trollies. (and in a corridor there is nowhere to plug them in).

    - Staffing levels and skill mix is designed around an establishment that generally does not include the extra staff (skilled or otherwise) required to cover a population that varies considerably.

    - Following on from the above, its more challenging to assess the needs of patients on a trolley in a corridor, and decide if their condition is improving or requires further intervention, and from who. It becomes a game of triage more akin to a Field Hospital rather than a modern clinical setting.

    - Patient dignity is less, which can be upsetting to some, and exacerbate conditions in others. If a patient is confused because of infection, for instance, they will have an increased risk of injury from the narrower trolley, as well as confusion because of the constraint. This may also upset other patients.

    - It’s harder to do practical areas of patient care on a trolley (not even mentioning lack of privacy). Getting a patient on a bedpan, washing them (which may involve rolling them - where do you roll them to if you need to wash their back and bum?), rolling them to change sheets (see above), suddenly lots of basic care gets harder and more time consuming and labour intensive - just when most pressure is on in terms of time and numbers.

    - going back to sheets, they rumple up under patients on trolleys. These ridges cause localised pressure, increasing the risk of pressure sores.

    - cross-infection is a greater risk, as patients are closer together. Also, a risk of pressure areas getting infected, necessitating even longer in hospital -assuming sepsis doesn’t set in

    - Getting elderly patients off trolleys to sit out and mobilise is very difficult. This increases risks of chest infections, constipation, pressure sores, joints seizing up, etc.

    - if on a trolley in a corridor, physio therapy, dietician requirements, OT, all become more difficult - both in terms of the practical job, and getting the input in the first place. I can’t comment on Irish hospitals, having not worked in one since 1987, but in my experience, patients don’t exist until they are on a ward in a bed.

    This is far from an exhaustive list, but just some of the problems that can exist even from a purely practical standpoint. I’m not even going there about the whole can of worms that is patient dignity and relatives experiences.

    Edited to add; Sorry, not wishing to drag the thread off-topic. Back to helicopters.
    Last edited by Flamingo; 3rd December 2019 at 22:47.
    'He died who loved to live,' they'll say,
    'Unselfishly so we might have today!'
    Like hell! He fought because he had to fight;
    He died that's all. It was his unlucky night.
    http://www.salamanderoasis.org/poems...nnis/luck.html

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  14. #1459
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    Quote Originally Posted by CTU View Post
    As a layman can someone please explane the difference between a bed and a trolley.
    The only difference I can come up with is that a bed has a Curtain around it and is not in a corridor.
    Trolley is as good if not better then a bed once you get a dark quite spot with no skobbees, junkies and drunks wandering around, but unfortunately the trolley is usually in the middle of the A&E floor.
    Last edited by sofa; 4th December 2019 at 00:32.

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    Quote Originally Posted by Flamingo View Post
    Bravo gave a pretty good personal view, to which I can (unfortunately) agree with from my personal experience.

    From a clinical standpoint, patients can be cared for better in a bed than a trolley in a number of ways. Taking their clinical condition into account (and dragging up 15 year-old information from my memory), in no particular order

    - elderly or immobile patients are at high risk of tissue breakdown on pressure areas (Sacral area, heels, elbows, ankles, knees, back of the head even). Two hours can be enough to do damage. It’s easier to move a patient regularly to distribute the weight/pressure on a wide bed than a narrow trolley. Also, special pressure relieving mattresses can be put on beds, as a rule they are not designed for trollies. (and in a corridor there is nowhere to plug them in).

    - Staffing levels and skill mix is designed around an establishment that generally does not include the extra staff (skilled or otherwise) required to cover a population that varies considerably.

    - Following on from the above, its more challenging to assess the needs of patients on a trolley in a corridor, and decide if their condition is improving or requires further intervention, and from who. It becomes a game of triage more akin to a Field Hospital rather than a modern clinical setting.

    - Patient dignity is less, which can be upsetting to some, and exacerbate conditions in others. If a patient is confused because of infection, for instance, they will have an increased risk of injury from the narrower trolley, as well as confusion because of the constraint. This may also upset other patients.

    - It’s harder to do practical areas of patient care on a trolley (not even mentioning lack of privacy). Getting a patient on a bedpan, washing them (which may involve rolling them - where do you roll them to if you need to wash their back and bum?), rolling them to change sheets (see above), suddenly lots of basic care gets harder and more time consuming and labour intensive - just when most pressure is on in terms of time and numbers.

    - going back to sheets, they rumple up under patients on trolleys. These ridges cause localised pressure, increasing the risk of pressure sores.

    - cross-infection is a greater risk, as patients are closer together. Also, a risk of pressure areas getting infected, necessitating even longer in hospital -assuming sepsis doesn’t set in

    - Getting elderly patients off trolleys to sit out and mobilise is very difficult. This increases risks of chest infections, constipation, pressure sores, joints seizing up, etc.

    - if on a trolley in a corridor, physio therapy, dietician requirements, OT, all become more difficult - both in terms of the practical job, and getting the input in the first place. I can’t comment on Irish hospitals, having not worked in one since 1987, but in my experience, patients don’t exist until they are on a ward in a bed.

    This is far from an exhaustive list, but just some of the problems that can exist even from a purely practical standpoint. I’m not even going there about the whole can of worms that is patient dignity and relatives experiences.

    Edited to add; Sorry, not wishing to drag the thread off-topic. Back to helicopters.
    You clearly do this for a living and I hit a nerve. My question is specific, I don't want to roll up the whole thing. If we assume that helipads at hospitals are a good thing, not least for moving patients from a general hospital to a specialised one, especially in a rural setting, is it worth while to have said helipad(-port?) IFR capable? Would it add much, or can pilots with NV goggles cover a satisfactory percentage? I know there are assumptions in here. can we please accept them for the moment?

    Thanks!

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  18. #1461
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    Quote Originally Posted by Graylion View Post
    You clearly do this for a living and I hit a nerve. My question is specific, I don't want to roll up the whole thing. If we assume that helipads at hospitals are a good thing, not least for moving patients from a general hospital to a specialised one, especially in a rural setting, is it worth while to have said helipad(-port?) IFR capable? Would it add much, or can pilots with NV goggles cover a satisfactory percentage? I know there are assumptions in here. can we please accept them for the moment?

    Thanks!
    I used to do it for a living, but not the past few years.

    The nerve is actually more to do with the misuse of air ambulances, as I have been involved in situations where the mindset of “We have it, we’d better be seen to use it”, have resulted in negative patient outcomes where the wait for the air ambulance resulted in the patients death.

    Sorry, I can’t answer your specific questions, that is not my area of expertise.
    'He died who loved to live,' they'll say,
    'Unselfishly so we might have today!'
    Like hell! He fought because he had to fight;
    He died that's all. It was his unlucky night.
    http://www.salamanderoasis.org/poems...nnis/luck.html

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  20. #1462
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    Quote Originally Posted by Flamingo View Post
    I used to do it for a living, but not the past few years.

    The nerve is actually more to do with the misuse of air ambulances, as I have been involved in situations where the mindset of “We have it, we’d better be seen to use it”, have resulted in negative patient outcomes where the wait for the air ambulance resulted in the patients death.
    Yes, one of the things that riles me is how long it takes for the AA to get places. Partly I think that is because it only has one base, but also, at what readiness is that chopper kept? IMO it should be at +10 or so.

  21. #1463
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    Quote Originally Posted by DeV View Post
    A bed is on a ward a trolley is where ever they can fit one
    Nope..a bed is a is bed a bed.... a trolley is used when you have no more bed!s
    Time for another break I think......

  22. #1464
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    using a trolley means that the ambulance can go nowhere, as they have to wait to get their trolley back.

  23. #1465
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    Quote Originally Posted by Graylion View Post
    Yes, one of the things that riles me is how long it takes for the AA to get places. Partly I think that is because it only has one base, but also, at what readiness is that chopper kept? IMO it should be at +10 or so.
    It's a helicopter.....not Doc Browns DeLorean!!!!

    The base is centrally located which is probably best positioned for a single asset at the minute. With the Cork base open now there may be an argument for moving Athlone further West (most calls to West or North west) but then flight times to North East of country increase so you lose that way.

    Remember 112 is covering much longer distances than many comparable UK air ambulances...and has relatively further hospital capable of accepting major cardiac, cva, trauma patients also.

    The answer to reduce response times is more helicopters.
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    The cork base, funded from charity is not at the same medical level as the air corps service. It is crewed by AP and not Trauma doctor. This is a huge capability gap, more or less insisted on by the HSE.
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  25. #1467
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    Quote Originally Posted by na grohmiti View Post
    The cork base, funded from charity is not at the same medical level as the air corps service. It is crewed by AP and not Trauma doctor. This is a huge capability gap, more or less insisted on by the HSE.
    Disagree na grohmiti......both services are to same clinical level, AP and EMT. On Medevac 112 EMT is provided by Air Corps, HSE EMT on Helimed 92.

    Although ICRR wanted doctors on Helimed 92 HSE wouldn't agree to dispatch it unless HSE medical crews on it (from colleagues in HSE) Political bun fights over patient care.
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  27. #1468
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    That's even worse. Why can't we do anything right here?
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  28. #1469
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    Take your pick:

    1. NIMBYism
    2. Parish pump politicians
    3. Media unable / unwilling to have a reasoned open debate about any grown up issue
    4. Public who are apathetic to the fact they live in a country blessed by no significant natural disasters / large scale wars / etc. in living history
    5. Public who have an entitlement culture without owning any responsibility
    6. A hard left movement who have been given un-opposed voice repeatedly
    7. An institutional fear at political level to say our organisations / structures / are generationally outdated and questionably fit for purpose anymore.

    You can apply all of the above to any area of public service or civil inclusion......ambulance services, fire services, Gardai, Defence Forces, public transport, social welfare, health....etc. etc.

    Sometime I think Ireland is the Kevin and Perry of Europe.....grumpy teen in the corner opposing everything, not because its a bad idea (it might actually be a good idea!) but just because they can
    Last edited by X-RayOne; 5th December 2019 at 22:40.
    Fate whispers to the warrior, "There is a storm coming"

    And the warrior whispers back "I am the storm".

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  30. #1470
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    Quote Originally Posted by X-RayOne View Post
    It's a helicopter.....not Doc Browns DeLorean!!!!

    The base is centrally located which is probably best positioned for a single asset at the minute. With the Cork base open now there may be an argument for moving Athlone further West (most calls to West or North west) but then flight times to North East of country increase so you lose that way.

    Remember 112 is covering much longer distances than many comparable UK air ambulances...and has relatively further hospital capable of accepting major cardiac, cva, trauma patients also.

    The answer to reduce response times is more helicopters.
    Oh indeed But readiness is also a factor. Do we know what readiness the current AA is at?

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    Quote Originally Posted by X-RayOne View Post
    Take your pick:

    1. NIMBYism
    2. Parish pump politicians
    3. Media unable / unwilling to have a reasoned open debate about any grown up issue
    4. Public who are apathetic to the fact they live in a country blessed by no significant natural disasters / large scale wars / etc. in living history
    5. Public who have an entitlement culture without owning any responsibility
    6. A hard left movement who have been given un-opposed voice repeatedly
    7. An institutional fear at political level to say our organisations / structures / are generationally outdated and questionably fit for purpose anymore.

    You can apply all of the above to any area of public service or civil inclusion......ambulance services, fire services, Gardai, Defence Forces, public transport, social welfare, health....etc. etc.

    Sometime I think Ireland is the Kevin and Perry of Europe.....grumpy teen in the corner opposing everything, not because its a bad idea (it might actually be a good idea!) but just because they can
    Ireland is suffering from postcolonial hangover and a firm, belief that it can't do anything right in the older generation. Read "The damned of the Earth". And power structures that are fundamentally still colonial and undemocratic. Way too much power in the executive, no democratic control thereof. And some eejits who call us who want to change this "hard left" and accuse us of obstructionism ;o)

  32. #1472
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    Quote Originally Posted by Graylion View Post
    Oh indeed But readiness is also a factor. Do we know what readiness the current AA is at?
    EAS is under 5 mins I think

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    Quote Originally Posted by Graylion View Post
    Ireland is suffering from postcolonial hangover and a firm, belief that it can't do anything right in the older generation.
    I'm fed up listening to the mantra of post colonial "the Brits enslaved us for 800 years".

    We are three or four generations removed now from anybody even remembering the British in power. And what makes it worse is people now in their 20's, 30's, 40's spouting on about it as if they were traumatised by a despotic invasion!! Most under mid 40s or maybe 50 didn't even suffer old catholic Ireland and its societal / personal damage post independence but have the privilege to grow up in a ever increasing pluralistic and open country.

    Time to stop blaming ancient history and anything else for every woe and take some personal and collective responsibility for ourselves as a country.

    I will caveat all the above with acknowledging the NI situation....but that doesn't give an excuse for citizens of our independent country to abdicate civil responsibility because of outside factors.
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    And the warrior whispers back "I am the storm".

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  35. #1474
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    Quote Originally Posted by X-RayOne View Post
    I'm fed up listening to the mantra of post colonial "the Brits enslaved us for 800 years".

    We are three or four generations removed now from anybody even remembering the British in power. And what makes it worse is people now in their 20's, 30's, 40's spouting on about it as if they were traumatised by a despotic invasion!! Most under mid 40s or maybe 50 didn't even suffer old catholic Ireland and its societal / personal damage post independence but have the privilege to grow up in a ever increasing pluralistic and open country.

    Time to stop blaming ancient history and anything else for every woe and take some personal and collective responsibility for ourselves as a country.

    I will caveat all the above with acknowledging the NI situation....but that doesn't give an excuse for citizens of our independent country to abdicate civil responsibility because of outside factors.
    Really because the Constitution still is not reflective of equal rights for all in many ways

    Look at the patronage of the National Maternity Hospital and many schools

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  37. #1475
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    Don't get me started on Dev's total abdication of civil responsibility to the catholic church

    Yes the constitution does need a radical overhaul to reflect a proper Republic.

    However, the past twenty years have brought a sea change in attitudes, acceptance and freedom of expression for many. The State/social structures just need to catch up to reflect this.
    Fate whispers to the warrior, "There is a storm coming"

    And the warrior whispers back "I am the storm".

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