H&S ON PREMISES
MEDICINE WITHOUT BOUNDARIES
Loreen Lock, Clinical Operations Director, Remote Medical International discusses how using medical protocols can help businesses to provide appropriate levels of care to workers wherever they are in the world.
Many medical protocols are written for developed countries and areas where access to hospital care is relatively easy. They vary from country to country and some are stricter than others but, in the main, they are proven for the areas in which they are used. Such protocols, however, have not necessarily been considered for use in regions such as remote parts of Africa; isolated, harsh industrial environments, or offshore installations. To ensure high quality care and to avoid unnecessary medevacs or recordables in these places, medical guidelines need to be environment-specific.
Medical protocols are a set of rules followed by an emergency medical technician or nurse. They provide a clear, logical structure for clinical management and are a vital part of ensuring consistent, high quality patient care. For Emergency Medical Services (EMS) they are now an excepted and proven method of increasing the level of medical care in a community by providing paramedics with a way to administer medicines and make best choices without the support of a fully-qualified doctor. For medical support in some of the most remote parts of our planet, however, it is vital these protocols reflect the options and conditions that are available to the clinician.
When definitive hospital care is distant, even seemingly simple medical concerns can be complicated and quickly escalate if not handled correctly. ‘Cookbook’ medicine is not a practical approach and to ensure best outcomes, paramedics may need to go beyond their normal limits of practicing medicine as seen in cities and developed countries. Having the correct, location-specific, Remote Health Care Provider (RHCP) protocols in place standardises the quality of medical care provided, regardless of what resources are available locally, and helps ensure highest quality, evidence-based patient care while avoiding unnecessary case escalations and evacuations. These guidelines, combined with expert remote medical support (topside), result in safe implementation of treatments to the same level as a physician and to modern care quality standards.
In remote regions, local medical care may already be in place, but the standard of treatment may vary dramatically. In such circumstances, experts in remote medical services can offer an HSE oversight and provide appropriate, workable, RHCP guidelines so local physicians can provide the necessary level of care.
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Through oversight, auditing, 100% chart review, and providing guidance to local doctors, local resources can be fully integrated into a comprehensive, high quality care package of an assured standard.
RHCP guidelines need to be available for different patient presentations and provide onsite medics the information they need to make the right decisions. These guidelines, however, should not be proscriptive and require appropriately trained medical staff in place who can use the guidelines, interact with the patient and make an active judgement on the required course of action. With the right protocols and suitable medical providers available locally, patients can be placed into well-defined risk groups, additional topside support sought if needed, and evacuation to hospital only becomes an option when it is appropriate to do so. Generalised or outdated protocols and poorly trained staff, on the other hand, often make medical evacuation the default option, even if it is not required.
Of course, this approach only truly minimises escalation and evacuation if onsite medics have the topside support of experienced, board-certified physicians trained in both emergency medicine, occupational medicine, injury management, and operational medicine. RHCP guidelines need to clearly advise when tele-consultation is required. Circumstances will include the prescription of certain medicines or specific symptoms or injuries that indicate complex cases. Even if not required by the guidelines, the onsite clinician can still obtain a second opinion from these experts if they have any doubts whatsoever. This gives remote, highly-trained, local medical practitioners the freedom to make judgements against the guidelines while setting clear thresholds for consultation. This team approach has been proven to ensure appropriate decisions are made and patient outcomes are consistently improved.
Beside the need for medical protocols to be location- specific, they also need to be continually renewed and updated in line with latest knowledge, ongoing learning from field cases and medical advances. Along with the peace of mind that an employer is working with a remote medical expert, this regular review of guidelines ensures employees working in harsh, industrial settings get the best and most appropriate medical care at that point in time.
www.remotemedical.com
www.tomorrowshs.com
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