Trauma Docs with lights and sirens?? What do you think?

[zippyRN]

:tweety: Medicnorth: I don't think those docs who ride on ambulances in Europe get paid what docs here get. So its not so expensive to pay them over there. Here, on the other hand.....

don't know apbut mainland europe, but the docs who work paid in EMS roles in the UK get paid the same as their in hospital colleagues ,

the volunteer docs iwho work in primary care are trying to get it recognised as a 'specialist interest' so it attracts with practitioenr with specialist interest payment.

but to the question of docs using L&S to get to the ER..... it might be a good idea, if they did all the training that's required to minimize the risk. Sometimes that light can save a LOT of time, like the day I was stuck behind a very slow moving car. I had a five mile drive to the station and was able to pass the car because the driver pulled over when she saw my lights on my aging Forester. Saved me almost 5 minutes responding to GET the ambulance (rural area). This might be the case for the surgeon and in areas where the only hospital for 50 miles can't staff a surgeon to sit around all night, it might be a good idea. Important to remember that a doc is not on call all the time, so keeping his EVO skills honed could be a problem.

in the rurual areas it's probably needed the most i'm sure the on call rotas are going to be reasonably onerous ( a lot of Uk on call rotas are 1 in 4 - 1in 8 for seniors , other than 'general medicien' call which is often 1 in12 or some such because ofthe elderly medicne and specialist medicien consultants who take part to get the on call supplement)

And there's the probationary period to consider. Who's going to supervise said doc as he learns the EVO skills. Its not about driving fast, its about the way we drive fast, and sometimes its not about driving fast at all... When I joined my dep't I couldn't have a light on my car until I had taken the EVOC class, been driving with supervision for 6 mo. and had proven that I understood the skills involved. I don't think there is a system in place to provide the same skills training for the docs.

for response to scene it can fit in with theprobationary period of response to scen - for on call i' don't know unless there is response to scene or they can be persuaded to as part of the training to do some Response vehicle ridealongs as cont ed forthe scene stuff and supervised emergency driving

Besides, most of us might be in this business because we're adrenaline junkies and get a thrill out of the response. In the small hospitals I've been to the surgeons have to take a call rotation whether they want to or not. They like their scheduled surgeries and take the rotation so they can keep their privileges. So maybe its a moot point and just a great way to discuss why we can drive in emerg. mode and they can't.

What about a Spyder with lights and sirens..... or a Lamborghini....just like in the movies....

London Hems has Impreza WRX response cars, as does one of the SOuth coast BASICs schemes, ATACC and SJMR have V70 t5 volvos

[cdemt5710]

:tweety:

don't know apbut mainland europe, but the docs who work paid in EMS roles in the UK get paid the same as their in hospital colleagues ,

I was referring to mainland Europe where my brother lives.

the volunteer docs iwho work in primary care are trying to get it recognised as a 'specialist interest' so it attracts with practitioenr with specialist interest payment.

EMTs (Basic, Intermediate and Paramedic) and 1st responders respond to the scene and bring the patient to the doc. Docs here, on the most part, don't work in prehospital as docs, though I know a few who are paramedics and volunteer with their local fire departments.

[cdemt5710]

:tweety:

"don't know apbut mainland europe, but the docs who work paid in EMS roles in the UK get paid the same as their in hospital colleagues "

I was referring to mainland Europe where my brother lives.

"the volunteer docs iwho work in primary care are trying to get it recognised as a 'specialist interest' so it attracts with practitioenr with specialist interest payment."

EMTs (Basic, Intermediate and Paramedic) and 1st responders respond to the scene and bring the patient to the doc. Docs here, on the most part, don't work in prehospital as docs, though I know a few who are paramedics and volunteer with their local fire departments.

[Asysin2leads]

Not to steer my own thread in the wrong direction, but I was on vacation this past week and couldn't post.

Dust, RiderRob is a Nassau County volunteer. They are their own special breed. The Marines look at them and say "Whoa, you're a little fanatical, you know that?" Nassau County has one of the largest tax bases in the world, yet they have mostly volunteer Fire and EMS. There was a huge Newsday article about these squads, how they have things like million dollar stations and use tax dollars for their own racing teams.

There are volunteers around the country and then there are the Long Island vollies. I deal with a great number of them in my line of work, and I do blame a lot of the problems FDNY EMS has on their attitude. Its really hard to ask the city for a decent wage for paramedics when you have the Long Island volunteer EMT's kicking down the door for the honor of wearing an FDNY patch and doing BLS runs.

To quote the movie "The Terminator", you cannot reason with them, you cannot bargain with them, and they absolutely witll not stop untill you give them a patch.

[chazmedic]

I think it's the doctors responsibility to risk everyone's life and limb to respond to my emergency (ingrown toenail) lights and sirens and noone else's. Just me. And me alone.

[AnthonyM83]

I think it's the doctors responsibility to risk everyone's life and limb to respond to my emergency (ingrown toenail) lights and sirens and noone else's. Just me. And me alone.

You know, you're right, let's get rid of ambulance L&S responses, too, because they're putting all those people at risk just for one person's emergency.

[Doczilla]

Wow, okay, where the hell did THIS thread go?

I'll interject one more comment here regarding the docs going L&S to the hospital, which seems to have drawn a lot of fire related to EMS responding L&S to bulls#it calls...

There is a key difference between the doc driving L&S to the hospital and EMS doing it. EMS goes hot because the patient has not been assessed by anyone but a LAYPERSON. Therefore, patient information is sketchy at best, and there is a decent chance that it is bulls#it and a chance that the person "not eating" is actually not breathing either.

The doc heading to the hospital, on the other hand, is going to see a patient who has been assessed by another doc, who has determined that there is an expedient need for specialty surgery. It's different from taking all comers in an EMS system and seeing if L&S improve outcomes. The patients the doc sees are known to have time-critical injury which requires immediate attention, and the delay in this attention is well-documented to increase (greatly) risk of death. True that the ER doc can do a certain amount of stabilization. I can manage the airway (surgically if necessary), place a chest tube, give blood (if available), even do a certain amount of local exploration to clamp a bleeder. But if the spleen is in pieces, I defer to my surgical collegues, as their skill is the only chance the patient has. And every minute the patient waits is another tick down the survival ladder.

Yes, air transfer to a surgical facility is ideal, but many places are too out of the way, frankly, and bad weather does happen.

How about an alternative: asking the police to pick the doc up at home and drive them in? The driver would be trained and experienced, in a well-marked car, and there would likely be someone close to where the doc lives to grab them. This may alleviate many of the concerns, legal and logistical, about the doc having his own means of emergency response.

'zilla

[cdemt5710]

:toothy8: Or maybe we could send the cops to school to become surgeons and then that would be that! just kidding.

Probably that small town hospital that can't justify a surgeon on staff all night is located in a municipality and can't afford a bigger PD just in case the surgeon needs a lift. Could be the PD is tied up with the MVA that caused the ruptured spleen. Could be a tad unreliable..... just a thought.

[Ridryder 911]

Maybe the facilities should be corresponding on Regional Advisory Committees (RAC's) & develop a trauma system plan, so small hospitals that do not have in house surgical capabilities 1) Do not & should not receive these patients 2) If they do, they should only stabilize enough for transfer to another appropriate facility. Local trauma system plans should had been in place, with diversion protocols and packaging and referring patient to appropriate facilities.

Nice idea of P.D. , yet again it would take them a few minutes to go the the physicians house etc.. again, let us look at the whole picture as a workable system, not placing a band-aid or temporary fix.

R/R 911

[chazmedic]

A couple years ago we had a double shooting where the victims were a cop and a bystander. It was Beagle189 and me on the first in ambulance. Anyway, the local hospital had a surg in house, but needed a second. He was at home. The ER called the PD and they went both ways L&S.. Only time I know of this happening, but it worked fairly well.