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Florian Breitenbach

Rettungsdienst und mehr

Museum: Anaesthesia Heritage Centre, London

Semester is over. It’s been a particularly hard slog. What better way to sit back on the couch with some chips and an episode of Top Gear? That was last night. Can’t stay indoors all day, especially when its 20 degrees (Celsius, for everyone in the US) and a beautifully sunny day in London! So I continued on my “Museum Mission”, aiming to visit all of London’s Museums of Health & Medicine.

Today, I visited the Association of Anaesthetists of Great Britain and Ireland (AAGBI) – more specifically, the Anaesthesia Heritage Centre. A small museum, nonetheless with some interesting exhibitions and very friendly and helpful staff.

As George Santayana wrote over a hundred years ago:

Those who cannot remember the past are condemned to repeat it.

In other words: learn from the past. And we may as well learn from other peoples pasts while we’re at it. Apart from all the early forms of pain management (and their abuse), airway management and tools, one single thing struck me on this visit: Anaesthesia was initially poorly regarded amongst the medical profession for the first decades since its modern inception in the 1840s. Until 1935, when the Diploma of Anaesthetics was introduced, there was not even a formal way of qualifying as an Anaesthesiologist; indeed, many people who stated they were specialists in the field were ‘optimistic novices’, as Henry Featherstone, the founder of the AAGBI (in 1932) was quoted.

How do you regard the field of Anaesthetics today? Quite a complex and respectable part of medicine, I would hazard a guess.

If modern anaesthesia only began in the 1840s, that makes the entire (sub)profession approximately 170 years old. In the 1930s, when training became formalised and the AAGBI was founded to support its cause and standing, the profession had been around for around 90 years.

Let’s switch over to what this blog is all about: The wonderful world of Paramedicine. Although the concept of out of hospital care dates back to Dominique Jean Larrey in the Napoleonic Wars (around the 19th century), the first modern on road paramedics were trained in the early 1970s. That makes our profession less than 50 years old. And boy, don’t we have similar issues around the world: poorly regarded amongst other health professionals (and governments), and still some ‘optimistic novices’, amongst the unregulated profession. Sure, this was a generalisation, but parts of it are true in very many services – dig deep enough and I’m sure you will find evidence of it near you.

“So what?” I hear you say, “Time will sort it out!”. Well, time and a fair bit of effort – remember to support your profession, and the best way of doing that is by joining your professional body.

I’ll leave you with my favourite display item, a resuscitator from the 1960s. See if you can identify similarities and differences to our commonly used Bag Valve Mask from today!

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RESUSCITATOR, PORTABLE, MARK I

Instructions for Use.

  1. Lay the patient on his back.
  2. With a finger covered with a handkerchief clear his mouth and throat of mucus and any foreign matter
  3. Kneel or stand behind his head, place the face mask on his face with the lower rim under his chin so that his jaw is lifted up. This is important.
  4. Work the bellows steadily at about 16 strokes a minute. The thrust of the bellows should be upwards on his face so that his jaw is kept up.
  5. Watch the patient’s chest. It should rise with each down stroke of the bellows and fall during each up stroke.
  6. After about every 50 strokes of the bellows, clear the patients mouth and throat of mucus with a finger covered in a handkerchief.
  7. Continue resuscitation until the patient breathes naturally, or for at least 2 hours.

Ketamine Firetruck

Feuerwehr Taufkirchen Source: http://www.flickr.com/photos/umeier/5509146474/

 

A recent thought provoking comment was posted on twitter by spanish doctor Alexander Sammel (@socalexmed):

Well…we can’t leave that uncommented, can we?

Ketamine seems to be seriously coming in to ‘fashion’ amongst healthcare professionals in emergency settings, and advocates for a variety of uses are popping up everywhere you look. Applications include pain management (interesting discussion) and (procedural) sedation, Rapid Sequence Induction (RSI) and possibly depression.

But coming back to the initial statement. “Prehospital medicine without Ketamine is like a firetruck without water!!!”

Not every firetruck needs to carry water. Not every paramedic needs to carry Ketamine. For bushfires in rural and regional areas, it would be prudent for the fire brigade to carry water to the fire in order for it to be able to extinguish the flames. In more built up areas, there are hydrants available. And some fires can’t be extinguished by water – foam is needed.

Similarly for paramedic practice, Ketamine can be a great drug in the right hands; for those with the right training, experience, and exposure. This is most likely to be a Intensive/Critical Care Paramedic. The majority of patients don’t need Ketamine, but for those that do, you want a Paramedic in the know. For other jobs without the need for Ketamine, Paramedics that aren’t carrying Ketamine can respond. And if Ketamine is needed – they can be backed up by a Keta-medic.

Personally, I have used Ketamine multiple times for patients in severe traumatic pain, and it has worked a treat. Sometimes, Fentanyl (or Morphine) just doesn’t do it (e.g. severe burns or long bone fractures).

So – in a way, Paramedics without Ketamine are like fire trucks without water. They come in all shapes and sizes, and each ‘model’ has their specialty.

The conversation on twitter can be viewed here: http://twitter.com/socalexmd/status/255232571024216065. Thanks to Matthew Harris (@HarrisCPD) for sharing the initial tweet.