SooC Posted October 30, 2006 Posted October 30, 2006 In some parts of this province we dont have enough Drs to staff Emerg let alone have them riding out on the ambulances! Might be a nice thing to have someone to transfer the patient care to when arriving at the hospital!
JohnnyEMT Posted October 30, 2006 Posted October 30, 2006 I have done a few transfers with doctors in our unit (I was working with a basic life support services at the time) and the doctors were great when would come across an MVC on the way back. The doctors stepped aside and let us do our work, and we worked together as a team very well. This being said, I have also had doctors show up on the scene of an MVC and have had to deal with their swollen ego's as well as 2 critical patients. You can imagine my total shock when the doctor actually requested the the patient have x-rays done on scene :roll: The service that I now work with is an Advanced Life Support service, and we work very well with the doctors at the hospital. Up here there is a severe shortage of doctors (there is only 3 left in the community) so we are called to assist the hospital should they have a critical patient. I guess that there are pros and cons to having a doctor on the unit...but they have to realize that when they do step into out units they are out of their element and that we do things differently than they do. Can't see this happening up here.
Asysin2leads Posted October 30, 2006 Posted October 30, 2006 Its funny you know, lowering EMS standards, well, that's okay, but an MD who actually went to college and medical school working on people in the field? Perish the thought! Oh lord it would be anarchy. Nah, let's stick with our 50 volunteers on an ambulance with 2 certifications and 300 patches amongst them model of medicine. Actually, I don't think MD's are really necessary on day to day 911 operations, it just cracks me up some of the responses. Volunteer First Responders, good, MD's, keep them away. Where are our priorities? On major MCI's our physician medical director does respond and is part of the incident command system, as well as being able to give class orders, or temporary adjuncts to protocols. In addition, he has also been dispatched to scenes that warranted it, such as a protracted pin job that needed definative care initiated in the field. We are lucky in that our medical director was also a paramedic at one point, so he really knows his stuff. And he doesn't even get to wear a patch!
zippyRN Posted October 30, 2006 Posted October 30, 2006 Doctors are meant to be just that, doctors. Nurses are meant to be just that, nurses. Want someone of higher education on the truck? Increase the quanitative education standards for current field level staff. apoint is reached where the cost / benefit analysis stops paying off for a small percentage of jobs havign a Doc at scene is invaluable, e.g. - anaesthesia - entrapment where amputation is the best extrication option ( that said you could do a through joint with a scalpel, a suture kit and a pair of shears) - medical management role in mass casualty incidents in event work havign the full range of health professionals is very useful particularly where event safety regulation ask you to minimise the impact on local regualr EMS and ED services ...
paramedicmike Posted October 31, 2006 Posted October 31, 2006 There are places in Europe where having a doc on the ambulance is standard practice as well. They, too, see an increased on scene time with the docs trying to do more with/for/to the patient instead of taking the patient to the ER. A point is reached, rather quickly at that, where you just need to pick up and go. Unfortunately, in these cases, the docs are thinking more long term. In a sense that's good. In a sense, they need their head smacked. The balance is to get them to start moving while letting them think it was their idea. -be safe.
Asysin2leads Posted October 31, 2006 Posted October 31, 2006 Okay, everyone repeat after me... The reason scene time is increased is because the doctor is treating the patient. The goal of EMS is getting treatment to the patient, not getting the patient to the hospital as quickly as possible. Scene time is a measure of the delay to the hospital, and to definative treatment. If the doctor is doing definative treatment in the field, then scene time isn't a factor. Man I feel like I'm beating my head against a wall!
p3medic Posted October 31, 2006 Posted October 31, 2006 what difinitive tx is this doctor providing in the field? he's not doing surgery, he's not placing a stent, he's not bringing much more to the table on the vast majority of calls that i can think of....sure, a prolonged pin job, mci's great, but honestly there is not much that is going to be done in the field that isn't already, sure, the very rare curbside thoracotomy to "save" the tamponade or ventricular stab victim, or the once in a lifetime perimortem c-section....sure, a cx tube can be helpful, but really doesn't need a MD education, maybe I'm missing something here....
somedic Posted October 31, 2006 Posted October 31, 2006 In our system we have very few occaissons that a doctor wants to interfere with a job we are working. Our MC has given us expressed encouragement to dismiss anyone claiming to be a doctor and trying getting in the way. Most of the times if you do get a doctor on scene, its at public places and there is a crowd to impress. Nurses and those who claim to be nurses are the bigger embuggerance in our area. To make my point, I responded to a MVA half a block from a nursing school during lunch time...Every every nursing student and the instructors was on scene with stethoscopes and bright ideas on what to do. SOMEDIC
zippyRN Posted October 31, 2006 Posted October 31, 2006 Okay, everyone repeat after me... The reason scene time is increased is because the doctor is treating the patient. The goal of EMS is getting treatment to the patient, not getting the patient to the hospital as quickly as possible. Scene time is a measure of the delay to the hospital, and to definative treatment. If the doctor is doing definative treatment in the field, then scene time isn't a factor. Man I feel like I'm beating my head against a wall! the only time scene time is bad is when the 2 indicated drugs are oxygen and diesel = i.e. the patient needs to be i nthe operating theatre or the cath lab ... sometimes even when this is the optimum outcome it ain't going to happen - absolute entrapment is one , that said on occaision bringing the doctor to the patient has worked even when not absolutely entrapped - the chest that London HEMS cracked open on a pub floor - then there is the issue of how safe is prehospital RSI when performed by someoen who doesn't have hundreds to thousands of anaesthetic done as their skill base ( i.e. the specialist qualified ( consultant or attending) medical anaesthetist , the very nearly specialist qualified medicla anaesthetist ( the final year or coupleof years of specialsit training ) or the CRNA )
zippyRN Posted October 31, 2006 Posted October 31, 2006 In our system we have very few occaissons that a doctor wants to interfere with a job we are working. Our MC has given us expressed encouragement to dismiss anyone claiming to be a doctor and trying getting in the way. Most of the times if you do get a doctor on scene, its at public places and there is a crowd to impress. Nurses and those who claim to be nurses are the bigger embuggerance in our area. To make my point, I responded to a MVA half a block from a nursing school during lunch time...Every every nursing student and the instructors was on scene with stethoscopes and bright ideas on what to do. SOMEDIC and the relevance of interference of bystander Health professionals to a discussion aobut the role of suitably skilled health professionals as a planned part of a system's response to calls is ???
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