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

[flight-lp]

You are right, but I am referring to my neck of the woods where you are lucky to have a level 4 trauma center anywhere nearby. There is only one level 2 in East / Southeast Texas. In these cases I do disagree, it would be much better putting these patients on a helicopter than going to a local ER which will delay their care and have a high probability of an unfavorable outcome.......

[Eric]

i guess we are just luck here we have 2 level 1trauma ER's and a level 1kids er in town so i guess we are lucky in ky

[Ace844]

Not necessarily. See the previous post about Fla where they have L/S...if this is how things were done during residency, then they weren't getting themselves into. I'd hate to be be on call with not much to do, especially if I had kids and a family.

"Anthony,"

Perhaps this is just pandemic to my area, although I believe if one were to research it, they would find it is not. For example. In RI there is a city adjoining Providence with a Level 2 Hospital. They have General Surgery, with the specialties available with an approx 15 min.. & Anasthesiologists and 1 CRNA 24/7.. The surgery portion is covered via the Brown/RIH surgical residents who take the O/N call. The attending is called in as necessary for procedures. The Anasthesia people stay in the Hosp and there is 1 attending and one CRNA who take 'call.' Next at the level 1 everyone is in house including at least one attending for each surgical specialty.... In talking with the 'surgical residents and attendings about this recently, they all anecdotally state that they knew that this was the lifestyle they would be getting into and that taking call and having to stay at the Hosp would be part of the package which came with the specialty. I've had similar experiences in talking with the intensivists, and ER docs as well... They all say pretty much the same thing, that getting into the Critical care- surgical specialties means having this type of lifestyle...Part of the package if you will. {**NOTE:: This is my experience in dealing with physcians whom I know well. As always [this is for you squint & Hammer] YMMV.} They are all compensated for this and the attendings and fellows all have 'taking call' & it's associated overnight in-house coverage mandated in their contracts. So thus the idea of 'OH I HAVE KIDS I NEED TO STAY AT HOME' isn't a justifyable excuse not to be there when expected during one's call time.

In addition, "Anthony" then supposses and adds that 'while that is in FLA' and may be endemic to there. It may very well be. Again as I steted previously here this may be as a result of the 'closing' of a # of level 1 ER's there, or downgrading to level 2's. IIRC, a couple of months ago in JTrauma, they had an article about this; {NOTE:: I don't have it handy, if anyone could post it that would be great} which cover the 'Trauma Surgeons professional crisis' which is taking place in FL, PA & other places. Now it seems to me in Philly where they have had the same issues they don't have Trauma surgeons responding from home L&S. Also, seems that most other places don't either. WHY? Most likely because they take call AT THE HOSPITAL!!!

Lastly, to have a doc responding L&S from home to a hospital as I've stated previously opens up a huge can of Litigous & personal liability worms... Whose liable the hospital because they compeled the MD to respond? The doc because they were operating in an unsafe fashion? Remember there are 'DUE REGARD' laws in most states of the union here..!!!! Remeber just because this may be happening in FL, or elsewhere doesn't make it a correct action or answer it just maybe like alot of things we see in our profession a stop-gap band aid which is no more acceptable for them than it is for us!

out here,

ACE844

[RiderRob89]

It seems this is a problem in more rural areas. Do you of your departments/ units/ squads have clear guidelines on this issue? Here in NY, we call for an Air Transport if we can save 15 minutes or more over ground travel time or the pt. requires specialty care that is only available at a facility 15 minutes or more away (For example, we have 1 level trauma center within a mile and a half of our usual response area, and a pediatrics trauma level 1 within five miles, but if it's a diving accident or burns, we medevac to the county medical center.)

[AnthonyM83]

If they planned to work in a position/place that doesn't require them to be on-call for the type of work they're doing (or even that they're already doing, for the ones finished with residencey & already hired there), then why would they be so sure that being on-call is what they were getting themselves into. Maybe they did, but if things are already being done a certain way and then change, maybe they were looking forward to the old way. You listed some specialties that ARE on-call...well then they obviously would expect to be on call for that specialty. My supposition was that there were more hospitals in Fla that had docs responding L/S. Could be wrong.

[Ace844]

If they planned to work in a position/place that doesn't require them to be on-call for the type of work they're doing (or even that they're already doing, for the ones finished with residencey & already hired there), then why would they be so sure that being on-call is what they were getting themselves into. Maybe they did, but if things are already being done a certain way and then change, maybe they were looking forward to the old way. You listed some specialties that ARE on-call...well then they obviously would expect to be on call for that specialty. My supposition was that there were more hospitals in Fla that had docs responding L/S. Could be wrong.

Why not do some research, and let us know what you find?

[AnthonyM83]

Why not do some research, and let us know what you find?

*Smile* Because it would be ridiculous to spend so much time surveying doctors and residents and hospital from Florida on such a minor side point that doesn't even have that much to do with the main argument, which in itself is not that important, b/c it's just our opinion on an issue that's happening outside my geographical area. Duh :roll:

[MedicNorth]

This thread has been an interesting read. There are EMS units in Europe that are staffed by MDs, which means that they are in station and on duty when the calls arrive. The programs are extremely well received, but are obviously very expensive. The question would have to be "Do the results improve enough to justify the increased costs?" Obviously, if EMS in North America is to go this way, a major shift has to take place, which seems highly unlikely. In my (admittedly personal) opinion, we would be better off spending that additional money on upgraded training, qualification, and equipment.

I am strongly opposed to the concept of doctors speeding to the scene in their personal vehicles. These men and women are trained to work miracles, but they need the equipment, environment, and assistance only available in a modern ER. I feel that they would be better off heading directly to the ER to prepare for the patient, and leave the stabilization and transport to the capable ALS workers. If we need docs on scene we have to make them part of the response system, with specialized training and clearly marked emergency vehicles.

I don't like the thought of BMW's, MB's or Vipers screaming through town at adrenaline-prodded speed by people who are not trained to drive emergency vehicles. Lights and sirens do not make enough difference to make this safe.

[zippyRN]

This thread has been an interesting read. There are EMS units in Europe that are staffed by MDs, which means that they are in station and on duty when the calls arrive. The programs are extremely well received, but are obviously very expensive. The question would have to be "Do the results improve enough to justify the increased costs?" Obviously, if EMS in North America is to go this way, a major shift has to take place, which seems highly unlikely. In my (admittedly personal) opinion, we would be better off spending that additional money on upgraded training, qualification, and equipment.

physican delivered EMS - where the LAS provider is the physician or has to work underthe direct supervision of a physicina

physician incorporated EMS where physician response is targetted e.g. RSI/ surgical airway, prolonged extrication, absolute entrapment

I am strongly opposed to the concept of doctors speeding to the scene in their personal vehicles. These men and women are trained to work miracles, but they need the equipment, environment, and assistance only available in a modern ER.

London HEMS, BASICS schemes , SJMR/WYMAS24-7, CARE, ATACC etc in the UK would suggest otherwise as would the Physician members of dutch MUGs and the Notarzts in Germany.

or ask the patients who have walked out of hospital following on scene anaesthetic oand /or surgicla intervention from these field physicians

targetted interventions and support to service delivery , the biggest thing any EMS provider knows is when the best treatment is Diesel /avtur.

it;s fine to have a brilliant level 1 trauma centre if the gold hour dissapeared in response, and extrication... also things like helimed availability can impact

- in the Uk most Helimed can't fly at night as the Civil avaition laws mean primary transfer is virtually impossible , plus the risk profile is felt unaccpetable, without the larger aircraft and technology available on the military SAR helos ( which struggle to land at scene unless it's a motorway or a field)

I feel that they would be better off heading directly to the ER to prepare for the patient, and leave the stabilization and transport to the capable ALS workers. If we need docs on scene we have to make them part of the response system, with specialized training and clearly marked emergency vehicles.

I don't like the thought of BMW's, MB's or Vipers screaming through town at adrenaline-prodded speed by people who are not trained to drive emergency vehicles. Lights and sirens do not make enough difference to make this safe.

yet many people in the USA support bubba the VFF screaming through town in his beat up pickup

it's all about training - oddly enough there's very few problems with physicians responding to hospitals on lights as they are allowed to .... however green lights give few exemptions ,

are you suggestign physicians and surgeons couldn't be taught emergency driving?

comments aobut drinking are fatuous as when on call you don't drink ... or is this a symptom of the craxy way in which theUS system works where peopel can demand their choice of personal physician / surgeon regardless of the time of day and the fact the hospitla has a more than adequate acute system ? ( UK has a system where acute take is the on call consultant and patients known to consultants ( as prevoious in patient or current outpatient) or who need subspeciality care are handed off the next morning )

[BillEMTP]

Hey Zippy, On behalf of all the "Bubba" volunteer firefighters(of which I am one), I resent that remark. Much of the US is covered by volunteer fire AND EMS. We are authorized too use emergency equipment beacause we respond from home or work most of the time. Rural areas cannot afford the luxury of a paid, full time staff. These "Bubbas" take time from work, family, and other events to provide a needed service to their community because they want to, not for the money or glory. They may have a "beat up truck" because that's all they can afford. I would put some of their driving skills against some high dollar physician any time.We are not all rich over here.

Granted we have a few yahoos, but we take care of them in house. Try disciplining a doctor. They have such a network that it is sometimes impossible to bring one up on any kind of complaint, let alone their driving.