Your comments

COPD service success

Following the article ‘NICE puts Physios centre stage in COPD management’ [Frontline 2 January], I am proud to say I work as a respiratory specialist physiotherapist at North Bristol Trust, Southmead Hospital, nominated “Team of the Year 2018”, respiratory specialist team. This physiotherapy and nurse team includes four physiotherapists and three physiotherapy technicians. Alongside our respiratory nurse colleagues, we have been instrumental in fulfilling the National COPD audit, NACAP; seeing every COPD patient within 24 hours of admission and timely completion of the COPD bundle. This patient pathway feeds into our extensive physiotherapy-led LEEP pulmonary rehabilitation programme and, if required, follow up in our clearance clinic. This approach has achieved significant above-average reduced hospital length of stay and patient re-admissions with support of the early supportive discharge arm to our service and subsequently we have been recognised as a leading COPD service. GRIFT, “Getting it Right First Time”, a clinically led national programme of NHS excellence, have asked us to share with other trusts our COPD management. Recognising the importance of respiratory physiotherapy within COPD management has never been so crucial, sharing knowledge and skills has helped improve the overall wellbeing of our patient caseload. 

• Lucy Tomalin 

Concern about heat pack use

I was amazed to read the Advice Line article [Frontline 2 January] concerning heat packs and would suggest that this is yet another example of how our profession is rapidly reverting to heat massage and exercises, but without the knowledge or training of how to apply heat.

The longer the pack is applied to the patient the colder it gets – not hotter. (See Newton’s first laws of thermodynamics – heat can only pass from a hotter to colder system) So how is it possible to cause a third degree burn without noticing that the pack was far too hot when it was first applied? The physio would have noticed and the patient certainly would. Sensation may be diminished in the lumbar spine but not enough to fail to register that amount of heat, unless the patient had complete analgaesia across the whole area! This raises the question ‘were these patients simply paid off because the claims were small?’

I have used Hydrocollator heat packs since the mid-1970s and recommended wheatbags to patients on very many occasions – using heat as a small part of the overall treatment programme. I have never skin tested anybody pre application of heat, preferring to rely on knowledge of their specific condition and medical history and I have never burnt anybody. Burns of this nature happen immediately, unlike poor applications of shortwave and Interferential Therapy. 

I have also been a medico legal expert witness for more than 25 years and have yet to see any case where a patient has suffered this level of burning from a heat pack. Maybe we should be running weekend courses in how to apply heat packs, or how to heat up a wheatbag in a microwave. 

• Wendy Emberson MCSP, director/consultant Chartered physiotherapist