Did ‘Casualty’ (BBC last Saturday) inaccurately portray the guidance for 999 Paramedics in ‘Ruby’s Story’, or did Casualty correctly highlight a serious problem?
There was a story about the first day of Ruby, a newly-qualified 999 paramedic, in last Saturday’s episode of Casualty on BBC1.
I am trying to discuss part of the story with 999 paramedics, and I have been tweeting about the issue I’m interested in – for example;
https://twitter.com/MikeStone2_EoL/status/1018858719810121735
https://twitter.com/MikeStone2_EoL/status/1019505435030810630
https://twitter.com/MikeStone2_EoL/status/1019198980578832384
For a few weeks the episode can still be watched via the BBC’s website, but I have included all of the necessary details in the PDF attached to this post.
In essence, a couple of the 999 paramedics I discuss things with on Twitter, have suggested [without having seen the TV show] that it probably incorrectly represented the current guidance for 999 paramedics, and consequently that, to use my own words, ‘in real-life Ruby wouldn’t have attempted CPR’. I’m not so sure – however, it is very difficult to actually find the CPR guidance and training for 999 paramedics, so if the current guidance and training would definitely mean that the Casualty story ‘could never happen’ then I would very much like to see that guidance and training.
So far as I can see, Ruby was certainly ‘applying the wording of’ the guidance/training for 999 paramedics as it existed a few years ago: since then, there has been a recognition of the problems with CPR at Home, but so far as I can see the emphasis has mainly been on improving the recording of DNACPR decisions.
The issue which Casualty raised – and I am interested because it is something I bang on about endlessly – is more subtle: Casualty effectively ‘investigated’ the difference between ‘we shouldn’t attempt CPR – because I MYSELF KNOW that this patient has forbidden CPR’ and ‘I can see in front of me a ‘DNACPR Document’ and I MYSELF DO NOT KNOW THE PATIENT ‘PERSONALLY’’.
So – if any 999 paramedics come across this, and/or did watch that episode of casualty: did Ruby ‘breach the guidance for 999 paramedics’ or not? Please point me/readers of this to any relevant openly-viewable guidance for 999 paramedics, which would make it clear that Ruby DEFINITELY acted incorrectly.
Associated files and links:
I have just posted the PDF in the form of screengrabs attached to a series of Tweets and you can find them at:
https://twitter.com/MikeStone2_EoL/status/1019871786165469185
I will be REALLY INTERESTED in any replies I receive from paramedics, which go into detail (include the actual guidance they have) and prove that 'in real-life Ruby would not have done that', if I get any such replies - at the moment, I'm not confident that I will get replies [but I hope I'm wrong].
I'm getting some discussion of this on Twitter.
Jessica, a paramedic, contributed these rather interesting tweets:
https://twitter.com/jw_bagpuss/status/1019910113195446272
It sounds like this is a question of Ruby's inexperience and she is following the letter rather than the spirit of the policy. As has been said, Ruby needs supporting, not accusing of assault.
https://twitter.com/jw_bagpuss/status/1019913177360945152
If the colleague was a junior non paramedic grade - then ultimately, yes, you could tell someone to stop. Paramedics are professionally responsible for their own practice so you can't really order someone. Even as a senior clinician it is far better to discuss than order people.
I have just pointed out in response to those, that various 'medical groups' - notably the RC(UK) - persist in asserting that 'the senior clinician makes the decision':
https://twitter.com/MikeStone2_EoL/status/1020220653688033280
Mark Taubert, a palliative care consultant doctor, has I think stated the common-sense perspective on Ruby:
https://twitter.com/DrMarkTaubert/status/1020221168962457600
when she commenced CPR, she was alone, therefore the most senior person on site. If the other two were parking, they were off site.
https://twitter.com/DrMarkTaubert/status/1020222162513391616
if her senior then arrived and said 'stop, I have seen her DNACPR form' then she should have stopped, unless she had severe doubts about her seniors credibility
I have just tweeted a response to Mark's tweet a few minutes ago - I'll be interested to find out if paramedics agree with me or not:
https://twitter.com/MikeStone2_EoL/status/1020223986607841285
I agree with you. Now - do we all agree that if we change it to 'a clinician and a normal family-carer being present', that there is NO legal basis by which the clinician can order the family-carer to not attempt CPR? However senior the clinician is.