Response to ‘Paramedic treatment—wherever that may be?’

Dear Editor,

I am writing in response to James Price's article: ‘Paramedic treatment—wherever that may be?’ This is a clear and comprehensive description of the HART concept and capabilities; however, I think that some of the challenges that have evolved alongside this new way of working warrant further discussion. I will be talking from experience but will try and give a balanced account of my personal perception and experiences of HART.

Firstly, I would like to agree with the theory that the sooner a clinician is with a patient performing clinical interventions, the greater the chance of survival. However, on balance I would have to question: with regards to hot zone working, how can a clinician deliver degree or even regular paramedic care in a chemical environment wearing a gas tight suit and carrying heavy breathing apparatus? The suit includes thick, sometimes loose rubber gloves and provides limited vision through the visor. I realise that you have the EZ-IO drill which will help you gain access instead of trying to cannulate, but to crack ampoules, draw up drugs, prime a 3-way tap and secure an ET-tube would be extremely difficult and inherently dangerous, e.g. when dealing with sharps that could breach the suit. I would argue that delivering paramedic care in the hot zone is inappropriate and very difficult. I believe that patients should receive only basic intervention such as treatment for major haemorrhage, basic airway management and possibly auto-jet intra-muscular pain relief or antidote before moving to the warm zone. I think it is important to remember that the patient is still in the hot zone and the temptation may be to stay and play and struggle through interventions when instead, you should really be thinking about getting the patient to a respirable atmosphere, and quickly. I think we need to maintain an awareness of the bigger picture and make sure that we can safely add to a situation in order to benefit patients. We need to ensure that what we do not become task focused in the hot zone and delay a patient's journey to their detriment.