Physicians on ambulances? As a career?

[mikeymedic1984]

Unfortunately the real truth is that all things are driven by insurance company reimbursement (yes it sucks, but its true). Ambulance services can not get reimbursed any further on the transport if you are a Doctor or a Dog Catcher, so there is no reason to spend the extra big $$$ on you; when there is no reimbursement model for doing so. There is no reason to put you on the ambulance unless you agree to Paramedic pay. It would be like offerring MRI Scans on the ambulance, if you cant get reimbursed from the insurance companies, there is no reason to endure the expense.

[EpicMedic]

You could be a physician on a fixed winged aircraft. Essentially a super paramedic.

[zippyRN]

mikey's post reflects the unfortunate reality for the US

elsewhere in the World the presence of Physicians on ambluances or as an ambulance resource is rather more developed

the 'French' system sees the majority of ALs providers as Physicians - however a significantp roprtion of these Doctors are junior doctors ( interns and residents to US ears)

the German system has higher specialist trainnee and Specialist docotors in EMS roles the Notarzt system

the UK has limited roles for physicians often tied to the Major Trauma System and Emergency departments or volunteer / sessional posts for Emergency medicine / Critical Care or Anaesthetist Consultants , there are also Surgeons and GPs with additional Pre-hospital care training ( e.g. dipIMC) who work in these roles.

[mikeymedic1984]

No offense, but ask Princess Diana of Wales how her "physician ambulance trip" went. I really do not see the advantage of doctors on a transport ambulance. I can see the advantage of a first-responder house-call type of setup, if the physician had the ability to do mobile labs and xrays.

[systemet]

No advantage, really? How does an extra decade of education make a worse provider? How is a paramedic better than a physician? Cheaper, perhaps, but that's about it.

After racking my brain, I've got about two things I'm better at doing than the average EM doc; (1) Not getting myself killed in unsafe situations, (2) MCI Triage - not that this is particularly difficult, I've just done it for real, more than most of them have. Other than that, I can't think of anything else? Maybe I see more people with hypoglycemia? I doubt a board-certified EM doc is going to miss that one, though.

[Just Plain Ruff]

No offense, but ask Princess Diana of Wales how her "physician ambulance trip" went. I really do not see the advantage of doctors on a transport ambulance. I can see the advantage of a first-responder house-call type of setup, if the physician had the ability to do mobile labs and xrays.

Actually, I would say that Princess Diana's injuries were non-conducive to life so unless you had Jesus Christ there and Diana was going to be raised from the DEAD then her physician ambulance trip was pretty much doomed from the start. You just don't hit a bridge pillar at such a high rate of speed and expect to survive those types of injuries. Well not many do at least.

[zippyRN]

No offense, but ask Princess Diana of Wales how her "physician ambulance trip" went. I really do not see the advantage of doctors on a transport ambulance. I can see the advantage of a first-responder house-call type of setup, if the physician had the ability to do mobile labs and xrays.

this is nearly 20 years ago and also reflects the physician centric model of of the SAMUs and healthcare in France in General

plenty of dead end in 'stay and play' in other Systems

No advantage, really? How does an extra decade of education make a worse provider? How is a paramedic better than a physician? Cheaper, perhaps, but that's about it.

After racking my brain, I've got about two things I'm better at doing than the average EM doc; (1) Not getting myself killed in unsafe situations, (2) MCI Triage - not that this is particularly difficult, I've just done it for real, more than most of them have. Other than that, I can't think of anything else? Maybe I see more people with hypoglycemia? I doubt a board-certified EM doc is going to miss that one, though.

so you have at least a full years of anaesthesia and Intensive care Medicine training do you ? ( Registrars in EM in the UK have that as part of the Acute Care common Stem PGY 3-5) plus the potential to have done an anaesthetics job in their FOundation programe (PGY1+") and anaesthesia stuff in higher specialist training

surgical skills ? chest drain , surgical airway, amputation, crash Section , surgicla control of bleeding , when was the last time you got a ROSC from traumatic arrest by opening the chest on a pub table ?

full prescribing powers ?

[systemet]

so you have at least a full years of anaesthesia and Intensive care Medicine training do you ? ( Registrars in EM in the UK have that as part of the Acute Care common Stem PGY 3-5) plus the potential to have done an anaesthetics job in their FOundation programe (PGY1+") and anaesthesia stuff in higher specialist training

surgical skills ? chest drain , surgical airway, amputation, crash Section , surgicla control of bleeding , when was the last time you got a ROSC from traumatic arrest by opening the chest on a pub table ?

full prescribing powers ?

Zippy, take a deep breath and read what I wrote again. We're making the same point.

All the best.

[ERDoc]

Actually, I would say that Princess Diana's injuries were non-conducive to life so unless you had Jesus Christ there and Diana was going to be raised from the DEAD then her physician ambulance trip was pretty much doomed from the start. You just don't hit a bridge pillar at such a high rate of speed and expect to survive those types of injuries. Well not many do at least.

I'm curious as to what would have happened it this wasn't Princess Diana. Would they have still worked Joe Q Public in this situation?

Zippy, take a deep breath and read what I wrote again. We're making the same point.

All the best.

I think it's your accent systemet.

[mikeymedic1984]

Excuse me for my error if it exists -- but I believe the Physician based ambulance team for Princess Diana sat on the scene with her dying body for at least 45 minutes -- maybe an hour, instead of using the golden hour rule of getting to a trauma center. I am not saying she would have survived her injuries, but i am guessing that her odds would have been dramatically increased had she got to an O.R. 30 minutes earlier. Again, with the limited diagnostic resources available in an ambulance, a Physician is not any better than a Paramedic, unless you just need sutures or a prescription.

http://www.coverups.com/princess-diana-death/princess-di-french.htm

It seems my estimated on scene times were a bit underestimated !!!!! Google for yourself.