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  • 26 Jul 2012 12:06 PM | Anonymous member
    FREE All-inclusive Learning
    Holiday in Malta






    Would you be interested in a free all inclusive learning holiday in sunny Malta?

    Soteria Ltd has just been granted 3 courses to be listed under the Grundtvic Scheme which offers the opportunity to any member from the EU to apply for a study trip outside their country.
    The Grundtvic Scheme will sponsor all the costs including:

    *  Flights;
    *  Accommodation/spending money up to €650;
    *  Training fees.

    To make it even easier, Soteria Ltd. has also arranged with a local hotel for a good accommodation package with an average cost of €350 (depending on the season). This will result in an excess of €300 to be used as spending money during your 5 day learning holiday.

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  • 25 Jul 2012 10:24 PM | Anonymous member


    R. Scott Boots

    Article Contributor






    After moving to Boston in 1987 and volunteering with local AIDS organizations, HCEI Founder R. Scott Boots began to compare notes about resources in his native Iowa. The Health Cares Exchange Initiative, Inc. was founded in 1992. Without formal funding, HCEI built networks and held focus groups nationwide, while the HCEI office consisted of a voicemail, post office box, and two filing cabinets.

    A graduate of Interlochen Center for the Arts and the University of Iowa, Scott has studied wellness at Boston's Beth Israel Deaconess Mind-Body Clinic and massage at the Touch Therapy Institute in Cambridge. He has given HCEI Stress Management Workshops to caregivers from the Midwest to the East Coast and presented at the 1997 United States Conference on AIDS. In addition, Scott has served as Chair of the AIDS Support Committee and Co-Chair of Pastoral Ministry at Trinity Church in the City of Boston.

  • 25 Jul 2012 1:09 PM | Anonymous member

    Comparing the Caring

    by

    R. Scott Boots

     






    Chicago
    , IL
    January 16, 2012

     

    I sat next to David’s bed in the AIDS hospice the last week of his life and told him that he was a beautiful man.  “Thank you”, he said, and I closed the door and softly sang hymns he had in the choir.  “Take from our lives the strain and stress, and let our ordered lives confess the beauty of thy peace” I sang.  The next day David died, and I began experiencing symptoms of burnout first-hand.

    Twenty years ago in Boston I volunteered for a variety of community based organizations and at one point was the chair or co-chair of three committees simultaneously at the city’s largest Episcopal church.  But the demands of meeting the needs of so many others began to take its toll and I stopped volunteering while experiencing great emotional exhaustion and a lack of any feeling of personal accomplishment.

    In response to my experiences and a concept which came to me while meditating, in 1992 I began an educational public charity designed to support and educate care providers.  The Health Cares Exchange Initiative, Inc (HCEI) creates supportive networks of caregivers in diverse geographic areas and then educates them about the best ways to provide care for others and, not least important, for themselves.

    HCEI created its own moderator’s guide and hosted the first-ever nationwide focus groups with both paid and nonpaid care providers.  We use a broad based definition of care provider so it could be a paid or unpaid person – anybody who cares for and about others and gives of their resources and selves.  Focus groups held from Kansas to Boston revealed, not surprisingly, that most care providers do not feel supported or celebrated.  As a result of these focus groups we developed a dynamic stress management skills building seminar which has been given for thousands of caring persons in the US and UK.  The session, which usually lasts 60-90 minutes, encourages participants about ways to identify stressors in their lives and then respond in healthy ways.  Audiences have included teachers, clergy, nurses, EMTs, research administrators, advocates, family members, and persons living with chronic conditions.

    Our first paid seminar was presented to the Kansas Department of Health and Environment in 1998 using a flip chart, magic markers and boom box.  I have since spoken at a large number of conferences and I recall many successes and some challenges.  The conference where I looked out and saw an audience member inhaling a helium balloon.  The conference where, during a quiet meditation exercise, a marching band began to play in the next room.  The conference of funeral planners where I could look out beyond my audience into the exhibit hall to see rows of caskets and glass necklaces with the ashes of your cat (or spouse) inside.

    Although the majority of people I come into contact with have giving and gentle hearts, some are very wounded or angry.  Some people I have invited to network on the Linked In internet networking site have “blocked” me from any future contact (am I trying to sell used vacuums?)  At one exhibit hall highlighting senior services I walked from booth to booth introducing myself and collecting business cards.  The woman who had coordinated the event called security and asked them to throw me out because I was trying to market my services and had not paid to rent a booth.  Several people, listed as designated contacts on the website of their organization, respond to emails from me asking me to take them off my spam list and never contact them again.  For a small but unmistakable group of people, something about providing support for caring people can really piss people off.  I believe the issue sometimes stirs up deep needs, fears and resentments.

    And yet should I be surprised at a general lack of support and enthusiasm?  A few years ago when I began writing a book version of my workshop I realized oh my, I have chosen to advocate for a group of people whom (in general) nobody cares for.  Perhaps I should be doing stress management for professional athletes or contestants on televised talent shows?  Certainly there is great interest and support for those people.  And so, in the United States, which espouses individualism rather than collective thought, home to the highest rate of infant mortality for an industrialized nation, and which quite intentionally has no national health plan for its citizens, what sort of support can I reasonably expect?

    Perhaps in the United Kingdom, where the nation cares for all residents, there would be interest and support in my efforts?

    Because HCEI is a volunteer-based effort, I work at jobs for income and benefits and do this work evenings and weekends.  In September, 2011 I took a two week vacation and traveled to England and Scotland to visit relatives and see palaces.  Using email several months prior to my visit, I contacted dozens of centres for carers in a variety of cities and towns in the UK.  I introduced myself and HCEI, and asked them if I could present my seminar when I visited.  Four organizations were innovative enough (and brave enough) to build communications and invite me to present.

    These pioneering groups included Northumbria University, Orkney Carers Center, Derbyshire County Council, and Lancashire County Council.  The first seminar was held for a group of family carers at the public library in Kirkwall, Orkney Islands.  I knew my seminar was “universal” when I saw heads begin to nod in understanding.  The day before I had walked the Ring of Brodgar, a 5,000 year old Neolithic stone circle, and realized this is a culture that over thousands of years has come to understand how to care about each other.

    Although seminar participants in the UK were involved with supportive networks for carers, many had never been to a session about compassion fatigue or burnout prevention.  I joked that I was becoming their “airplane friend” because for 90 minutes we connected over issues which were very personal and challenging, and then the next week I would be safely 4,000 miles away!  I recall the woman whose parents had died, both unexpectedly, six weeks apart earlier that year and kept mementos from both on the dashboard of her car.  I felt admiration and also concern for the young man who moved into the house with his mother eight years ago after she had a stroke.

    Surveys given to participants before and after the UK seminars indicated respondent gains of at least 20% (at least one point on a scale of 0-5) on three out of four question items.  For the question “How well do you identify stress?” the pre-presentation mean was 3.2 and the post-presentation mean was 4.9, a difference of 1.7.  Asked “How well do you understand options for responding to stress?” the pre-presentation mean was 2.8 and the post-presentation mean was 4.2, a difference of 1.4.

    Similar to the hospice movement and national health care, the UK appears better coordinated, and willing, to invest resources to care for family carers and others than the US.  Seminar participants were extremely involved and appreciative, and appeared to be somewhat more self-sacrificing than those in the US.  During one exercise where I asked participants to think of the three people they cared for most, NONE of the UK participants were cheeky enough to list themselves.  And in both our Anglo cultures, we all smile through our anger and our disappointments while our leading cause of death for men and women is cardiovascular related.  One thing we have in common, in general, is that we all smile and say no I’m fine, I’m not mad, I don’t need anything, thanks.  And then our hearts break.

    Following my trip I began to research the NHS, a daunting task as there is no national health policy in the US for me to compare to.  So many changes in structure, authority and leadership, plus I read the electronic Guardian’s coverage on social and health care.  I intend to continue to network and build collaboration in places where care is seen as an important necessity for all.  I will continue to give my skills building sessions to groups of paid health and social care providers, administrators and family carers in the UK and beyond in order to reduce staff turnover, medical errors and reduce hypertension in most participants.  And I have so much to learn!  But now I know what mushy peas are.  Now I know if I accidentally spill food on my trousers NEVER to complain that I’ve just soiled my pants.

    My great great grandparents left Durham County, England in 1882 in search of something more.  The world and opportunities they were given were not adequate, they did not want to “settle” with the status quo and go without.  They had the restlessness and courage to look beyond what they knew and look across oceans for meaning and new life and new hope.  Ironically I am looking east at their land, eager to spend more time, eager to be part of the systems already there, eager to tell nurses and administrators and family carers “well done”.

     

    R. Scott Boots

    773-509-6402

    Rsbkc@yahoo.com

    www.HCEI.org


    -------------------------------------------------------------------------------------------------------------

    Editor's note: please read the letters of support below to see how much appreciation Scott has had for his presentations in the UK.  Please contact Scott if you would like him to present for your organisation. Email him at Rsbkc@yahoo.com or leave your comments on this post.

    Letters of Support:

    Lancashire County Council - Letter of Support.pdf

    Crossroads Orkney - Letter of Support.pdf

    -------------------------------------------------------------------------------------------------------------



    MISSION... Founded in Boston in 1992, HCEI's mission  is to create supportive inclusive networks for caregivers, including AIDS caregivers, in diversely affected geographic areas and then foster information and personnel exchanges between them. HCEI works to encourage caregiver collaboration, enhance community-based care, and educate caregivers about stress management. 

  • 17 Jul 2012 12:05 PM | Anonymous member

    Medical Emergencies
    within the
    Dental Practice

    Epilepsy

    by Wendy Berridge




    DEFINITION  A group of chronic neurological conditions that present as seizures.

    Epilepsy is a general term for a range of conditions which cause a chronic brain disorder resulting in recurrent seizures (fits), and as many as one person in 20 will experience a seizure at some point in their lives.

    The flow of information within the brain is precisely controlled. A seizure occurs when brain transmissions begin to malfunction, sending rapid, uncontrolled messages. This disorganisation can last for only seconds, or can take minutes.

    Seizures are classified into two main groups: partial or generalised.

    Partial seizures involve only one area of the brain, and do not result in loss of consciousness. Partial seizures are divided into two groups: simple (the casualty remains fully conscious and aware of what is happening) and complex (the consciousness is impaired and the casualty is unaware of where they are, or what they are doing).

    The effects of a simple partial seizure vary, depending on which area of the brain is affected. The casualty may experience visual disturbances, stiffening of one part of the body and abnormal sensations such as tingling. These may also be accompanied by a strange smell, such as burning. These sensations are described as an “aura” and in people who progress onto generalised epilepsy this aura will give warning of an imminent attack.

    Those who witness the partial seizure may also see unusual movements, such as twitching of the face, jerking of an individual limb, or lip smacking. The casualty may appear to suddenly start daydreaming, even in mid sentence.

    Although the effects of partial seizures are of short duration they can still cause considerable distress to the person affected, and if the seizure is complex they will have no memory of what has taken place.

    Generalised seizures involve most of the brain which causes aggressive fitting, usually of the whole body. The commonest of this type of seizure causes the casualty to lose consciousness and exhibit tonic-clonic contractions, resulting in uncoordinated jerky movements which can be accompanied by emptying the bladder and/or bowels.

    The tonic phase is caused by the contraction of all the muscles so the casualty becomes very stiff, and breathing becomes irregular. An audible cry may be produced by the contraction of the respiratory muscles forcing air out of the lungs and over the vocal cords.

    This is then followed by the clonic phase. The muscles now independently relax and contract resulting in violent jerky movements throughout the whole body. This is accompanied by profuse salivation, bruxism and occasionally vomiting. Shortly after the clonic phase all movement ceases, and the casualty remains unconscious and unresponsive. Recovery is gradual and can take considerable time – usually between 10 and 15 minutes although it can sometimes take longer. It may take an individual up to 2 hours for their cognitive function to return to normal.

    Tonic-clonic seizures are usually short, lasting less than 5 minutes.

    If the casualty does not enter the recovery phase, then it is likely that they are developing status epilepticus which is a potentially life threatening condition and is a result of a generalised seizure lasting 30 minutes or longer, or can be repeated tonic-clonic convulsions occurring over a 30 minute period without recovery of consciousness between fits. This requires hospital treatment as soon as possible.

    It is of utmost importance, therefore, to note the time at which the seizure starts, and in the dental practice any convulsive phase of a tonic-clonic seizure that lasts for 5 minutes or more should be treated as status epilepticus.

    POSSIBLE SIGNS AND SYMPTOMS

    As mentioned earlier a generalised seizure usually follows a pattern:

    AURA

    The warning sign that some patients experience before the tonic-clonic phase of the seizure. This is helpful if it happens, as the patient can inform the dental team of an imminent attack, giving them time to summon help, clear a safe area and lay the patient on the floor.

    TONIC PHASE

    Sudden loss of consciousness, the muscles become rigid, the back may arch and the patient may let out a cry (they are not in pain). The lips may go blue (cyanosis). This phase usually lasts less than 20 seconds.

    CLONIC PHASE

    The limbs make sudden, violent jerking movements due to the muscle contractions. The eyes may roll, the teeth may clench and frothy saliva may be seen (it may be blood stained as a result of biting the tongue). The breathing will be irregular and may be loud and “snoring”. Bladder and/or bowel emptying may occur. This phase usually lasts less than 5 minutes.

    RECOVERY PHASE

    The body relaxes, although the casualty is still unresponsive. Levels of response will improve within a few minutes, but the casualty may not be fully alert for 20 minutes or so. They may be unaware of their actions, uncertain of where they are, complain of tiredness and may have a headache.

    REMEMBER

    If the casualty is having repeated seizures or one seizure is lasting longer than 5 minutes then it is likely that they will go into status epilepticus.

    “TRIGGERS”

    There can be many factors that can precipitate seizures and some examples are listed here:

    Forgotten or incorrect medication

    Sleep deprivation and fatigue

    High temperature

    Stress

    Infection

    Photosensitivity

    Menstruation

    Alcohol and drugs

    Monotonous tones/sounds

    MANAGEMENT

    All treatment must be stopped immediately. As mentioned earlier it is very important to make a note of the time the seizure started and to monitor its duration. Make the area as safe as possible - if the casualty experiences an “aura” act immediately by laying them on the floor, removing glasses if worn and clearing away all moveable objects if possible, prior to the seizure starting. Blankets or clothing can be used to cover immoveable objects on which the casualty may injure themselves, such as the spittoon. During the seizure itself, do not attempt to restrain the casualty or put anything into their mouth (such as an airway or mouth prop) whilst they are fitting. All staff must be aware of their own safety also and ensure that they keep a safe distance from the casualty to avoid being bitten, or kicked.

    When the seizure has finished place the casualty into the recovery position and administer high-flow oxygen via the non-rebreathing face mask. Monitor ABC (airway, breathing, circulation). Allow the casualty to recover slowly in a private, quiet environment to ensure that their dignity is maintained. It is important that all staff appreciate the importance of gentle reassurance and understanding of the casualty’s disorientation and confusion during the recovery phase.

    When the patient has recovered sufficiently they can go home with a suitable escort; they should never be discharged unaccompanied, and a competent adult should stay with them for some hours afterwards.  It is not usually necessary to send a patient to hospital following a seizure. However, the emergency services must be called for the following reasons:

    • One or more tonic-clonic seizure lasts longer than 5 minutes
    • One tonic-clonic seizure lasts longer than normal for the individual
    • Several seizures occur with no recovery of consciousness in between
    • An injury has been sustained
    • It is their first ever seizure
    • Difficulty monitoring casualty’s condition

    As mentioned earlier, when one or more seizures continue for 5 minutes or longer, there is a danger of status epilepticus developing. When status epilepticus is suspected the emergency services must be called immediately and the casualty transferred to hospital. Other than high flow oxygen (if possible) the only other interventive treatment to be considered within the dental practice is the administration of 10mg midazolam (adult dosage) by a transmucosal route – buccally or intranasally.

    (For clarification please see the pages from the Resuscitation Council (UK) Medical Emergencies and Resuscitation appendix (viii) (Emergency use of buccal midazolam in dental practice) http://www.resus.org.uk/pages/MEdental.pdf)

    Intravenous diazepam/ midazolam or rectal diazepam may be administered by the paramedic.

    The doses of transmucosal midazolam advised by the Resuscitation Council (UK) for children who have status epilepticus are as follows: 1-5 years 5mg, 5-10 years 7.5mg 10 years and above 10mg.

    PREVENTION

    As for all dental patients a full medical history is essential but it is also important to have a record of detailed information if the patient has a history of epileptic seizures. It is also worth remembering that the nature of the condition can change, so the history must therefore be updated before each course of treatment as the pattern of the illness may vary. The following information should be obtained from patients who suffer from epilepsy in order that a risk assessment can be undertaken:

    • The type of seizures experienced, and normal duration
    • How well the seizures are controlled including the frequency and date of most recent seizure
    • Normal recovery process for the individual, including normal length of time
    • Which triggers normally precipitate a seizure
    • Does the patient experience an “aura” before a seizure, and if so what is its description
    • Has the patient ever had status epilepticus, and if so how many times
    • Has the type of anti-epileptic medication changed recently
    • Has the patient taken their medication as usual before treatment

    The answers to the above questions will enable the dental team to assess the likelihood of a seizure occurring at the dental surgery and how best to recognise and manage it. If the patient with a dental anxiety knows that stress is a trigger for their seizures then the team may consider it more appropriate to offer any treatment under sedation. If the patient has recently changed their anti-epileptic medication or their seizure control is poor they are more likely to be at an increased risk of a seizure developing.

    Tweet


    Wendy Berridge delivers CPR, Medical Emergencies and AED training to dental practices throughout Yorkshire and Lincolnshire.



    Contact details:

    tel: 07771590513

    email: info@berridgemedicaltraining.com

    Website: www.berridgemedicaltraining.com

  • 10 Jul 2012 4:06 PM | Anonymous member

    The Ambulance Services Memorial Service
    The National Memorial Arboretum, Staffordshire

    20 September 2012




    AMBULANCE SERVICES BENEVOLENT FUND
     IS PLEASED TO HOST

    THE AMBULANCE SERVICES MEMORIAL SERVICE,
    at

    The National Memorial Arboretum,

    Alrewas, Staffordshire, DE13 7AR

    Thursday 20th September 2012 at 1400hrs.

    A WARM WELCOME TO ALL WHO WISH TO ATTEND

    The format is a short service in the Chapel of Peace lead by the Rev. Clarke before moving off to the Ambulance Garden of Remembrance when the ‘Roll of Honour’ of all known personnel killed or who died whilst on duty will be read. This will be followed by an opportunity to lay wreaths at the Memorial.

    Applications to lay wreaths should be made to

    The Secretary of the ASBF – enquiries@asbf.co.uk by 20th August.

    Those laying wreaths may bring their own or may arrange for a wreath to be supplied at a cost of circa £23 by arrangement with the Secretary as above.

    The day concludes with an informal gathering with tea and biscuits in the National Memorial Arboretum Visitor’s Centre.

    There are approximately 90 seats on a ‘first come, first served’ basis within the Chapel but there is plenty of standing room.

    Key roles will be covered by uniformed Ambulance service staff from across the United Kingdom.

    Dress Code: Uniform or formal with medals.

    For further information please contact the ASBF Secretary.

    “The Ambulance Services Benevolent Fund is Caring for the Carers.

    Together we can make the difference.”


    Registered Charity # 800434.

    Patron: Simon Weston OBE.

    (words 237)

  • 09 Jul 2012 11:19 PM | Anonymous member (Administrator)


    CPDme go HTTPS Secure on Webpages on our New Look Portfolio Building Website




    As part of our ongoing commitment to security and privacy. CPDme made all our servers and website HTTPS Compliant. As you may have noticed, the website has become much cleaner looking and easier to navigate. This is due to new legislation regarding disability and compliance with the new cookie legislation. We are also preparing to trial our new IPhone app that is due to launch in August.

    The most important change takes place last weekend when we secured our entire site, meaning better security for you and your details. 

    "You wouldn't write your username and passwords on a postcard and mail it for the world to see!" Every time you log in to any website service that uses a plain HTTP connection that's essentially what you could be doing.

    Our New upgrade includes the secure version of HTTP undefined HTTPS. That extra "S" in the URL means your connection is secure and it's much harder for anyone else to see what you're doing. Its costing us thousands of pounds to secure the website. Our privacy and security is of the upmost importance to both our staff and our members. All our staff use CPDme to manage their own CPD and so rely on safety and security of information stored. Unlike some free CPD builders available, we ensure that your information is 110% safe. Sadly this comes at a cost and thus we need to charge membership fees. 

    What we can say is that since 2009 when CPDme was born, we have never lost a single piece of information or had anyone attempt to hack us. Sadly this was the failure of other Online Portfolio Builders who failed due to lost information and hacking from web invaders. We already implement HTTPS security on our online forms, but this new update will ensure even our front page, back page and anywhere you view is kept secure. You may notice a pop up at the top of your screen warning some content is insecure. This is because we use external codes from sources like twitter and advert providers. Be assures that we are 100% safe and so you can accept the popup with our personal assurance that all our content is safe for you to view.

    HTTPS has been around nearly as long as the Web, but it's primarily used by sites that handle money i.e your bank's website or shopping carts that capture credit card data. Even many sites that do use HTTPS only use it for the portions of their websites. However, we believe that by securing our site with added security measures, we defend ourselves against any web attack, hackers or other online threats.


    Question? Contact Us Here

    Thankyou


    The CPDme Management Team

  • 05 Jul 2012 8:32 PM | Anonymous member (Administrator)



    CPDme Welcome the first 100 Social Worker
    to start building their portfolios.








    After nearly 16 months in the planning, CPDme have finally welcomed our first 100 Social Workers. Our feedback from the first 20 users were really impressive with no teething problems at all (or expected). The social workers have been converting their old paper portfolios by scanning the certificates and testimonials and uploading these to their personal profiles. 

    "I am really impressed at the simplicity of building my portfolio and collating evidence for the migration from the Social Care Council to the Health and Care Professions Council' Commented Miss H Hollingsworth.

    "WOW, I didn't know that I could use a powerpoint that I presented to my students as ongoing CPD, Thankyou CPDme" Said Mr T K Bradley.

    CPDme have been helping Health Professionals since 2009 to collate and manage their CPD with ease and peace of mind knowing that all their development is logged safely and organised for their development portfolio. If you have any questions about CPDme or indeed would like to know more, please visit our about us page.

    We are planning to hold monthly webinar to demonstrate the website and its features. These dates will be published in our CPDme Free Newsletter - You can sign up free by clicking here.

    Remember, we have a team of degree level social workers on hand to answer all your questions about CPD and what you need to consider for your future development.

    Thankyou for all your ongoing support.


    The CPDme Social Care Team

  • 01 Jul 2012 12:30 PM | Anonymous member (Administrator)

    CPDme Welcome Social Workers

    As a welcome to our Social Work Colleagues. CPDme are offering 18 months membership for the price of 12 months*. This offer is available to Social Workers and Social Care Support Staff.

    If you are from a profession related to Social Work or Social Care and you are unsure if CPDme is suitable for you please email our support team and we will answer any questions you may have. All our Social Work Support Staff habe at least a BA or MA Degree and are leading professionals in their fields.

    We have a specialist team of qualified Social Workers on hand to offer advice and help in relation to your Continuing Professional Development (CPD) Portfolio and offer advice regarding CPD and the transition to the Health Professions Council (HPC) or the Health and Care Professions Council’ as it will be known from August 2012. Visit http://www.hcpc-uk.org/ for more details on the change

    Try CPDme today and if your not happy within 7 days, we will offer a no quibble refund. Join here.

    For more information, email us at socialworkers@cpdme.com

    *Discount offer ends end July 2012
  • 29 Jun 2012 4:19 PM | Anonymous member (Administrator)


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    How can we do this all our revenue comes from advertising on the site.

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  • 23 Jun 2012 10:41 PM | Anonymous member

    The Mental Capacity Act 2005 and the
    use of Lasting Powers of Attorney

    by David Thornicroft





    The Mental Capacity Act 2005 and the use of Lasting Powers of Attorney.

    A couple of months ago I gave some guidance on the use of Advance Decisions under the Mental Capacity Act. I hope you found it useful.

    So here's a follow up on Lasting Powers of Attorney (LPA), which were also introduced by the Mental Capacity Act.

    Whereas an Advance Decision allows an individual to state in advance the kind of treatment that they would not want to receive, should they lack the capacity to make that decision at the time, an LPA enables an individual to give someone else the power to make decisions for them.

    Let's use similar scenarios to last time to try to clarify. Scenario 1 concerns Katya, a thirty-something female who is being driven along a main road by her husband Ian. They are involved in a head-on collision with an articulated lorry. The ambulance arrives to find Katya is unconscious with serious head injuries. Her husband, who is also injured but conscious, tells the paramedics that he has Lasting Power of Attorney and that Katya should not be resuscitated, as those would be her wishes if she were conscious.

    Scenario 2 concerns Alf, a ninety-something resident of a nursing home for people with dementia. He has just suffered a suspected heart attack and the ambulance is called. His daughter Gemma is with him, and, just like Ian, she tells the paramedics that Alf should not be resuscitated. She claims to have Lasting Power of Attorney.

    The question, as last time, is whether you should resuscitate Katya, or Alf, or both of them, or neither of them - and why?

    Once again the Mental Capacity Act should give clarity to these dilemmas.

    And once again the first issue to resolve is whether or not Katya or Alf have capacity to decide for themselves whether or not to receive treatment. If they do, then they should make the decision themselves. But as they are both unconscious, and therefore unable to communicate, it's safe to assume here that both of them lack capacity on this issue at the moment.

    Next we have to consider whether or not Ian, or Gemma, do indeed have a Lasting Power of Attorney. Be careful here, because there are two types of LPA. A Property and Affairs LPA gives the attorney (i.e. Ian or Gemma) the power to deal with solicitors, bank accounts, pensions, savings, insurance policies etc on behalf of the donor (i.e. Katya or Alf). However a Property and Affairs LPA does not allow the attorney to make any decisions about the donor's health or personal care. That requires a Personal Welfare LPA.

    Assuming that Ian or Gemma do indeed have a Personal Welfare.LPA, the next issue is whether it enables them to make decisions about resuscitation. The LPA must state what it covers. It could say something like "Ian is authorised to make decisions about any aspect of Katya's personal welfare, in any circumstances". Or it could say something like "Gemma is authorised to make decisions only in relation to Alf's cancer treatment". It is up to the donor, when making the LPA, to decide the scope.

    The final issue is whether the LPA is valid and authorised. A donor (Katya or Alf) can make an LPA at any time from age 18, and it could then lie dormant for many years until it is needed. When it is needed the attorney (Ian or Gemma) must activate it by sending the document away to the Office of the Public Guardian, along with a fee. A Property and Affairs LPA can be activated at any time, but a Personal Welfare LPA can only be activated when the donor has lost capacity to make decisions about his/her personal welfare.

    The LPA document, when activated by the Office of the Public Guardian, will come back with an official stamp on every page.

    To return then to the original question - do you resuscitate Katya, or Alf, or both or neither?

    The answers, actually, are very similar to the previous article concerning Advance Decisions. I hope I have shown that the LPA is a serious matter, with quite a lot of paperwork involved. In Katya's case, are you going to sit down with Ian, and ascertain whether he does indeed have an LPA, and if so whether it is a Property and Affairs one or a Personal Welfare one, and if it is a Personal Welfare one whether it covers car accidents, and whether it has been properly registered with the Office of the Public Guardian? With Katya lying unconscious in the car, I would suggest this will all take too long. So you are going to resuscitate.

    In Alf's case, however, things are very different. Assuming it is a well-run nursing home, these issues should have been discussed and clarified well in advance for all residents. If Gemma has a valid LPA over her father's Personal Welfare then she is perfectly entitled to decide that Alf should not be resuscitated in the event of a heart attack. And her decision should be clearly recorded in Alf's notes, and easily accessible. So in the event that he has a heart attack the home may not even call the ambulance in the first place.

    Incidentally, Gemma should make such a decision in Alf's best interests only, i.e. she must believe that that is what Alf would want if he were able to make the decision for himself. If for example her motive is to save money on Alf's nursing home fees then she is breaching the Act, for which she could be sent to prison for up to 5 years.

    Anyone can make a Lasting Power of Attorney, as soon as they reach 18, and as long as they have the capacity to do so. It's a serious issue, and you should therefore think very carefully about whom you would entrust with such power over your life. Ultimately you could literally be giving them, rather than the professionals, the power to decide whether you live or die.



    David Thornicroft
    St Thomas Training
    02380 970 914


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