# EMS Physicians responding



## Bullets (Mar 13, 2012)

So one of the ALS projects in NJ is starting up MD-1, an emergency physician who will respond to MCIs and extended extrication traumas. The concept is to provide the highest level of interventions, including field amputations, in the field, as well as on-site medical control to MICU instead of calling them by phone or radio

Thought? How would you feel about a MD showing up on scene?

http://www.jems.com/article/major-incidents/monoc-program-brings-physicians-ems-call


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## Veneficus (Mar 13, 2012)

Bullets said:


> So one of the ALS projects in NJ is starting up MD-1, an emergency physician who will respond to MCIs and extended extrication traumas. The concept is to provide the highest level of interventions, including field amputations, in the field, as well as on-site medical control to MICU instead of calling them by phone or radio



looks like a pet project of minor consequence.

Probably better to have a surgeon who does amputations regularly than an emergency doc if you are considering an amputation though.



Bullets said:


> Thought? How would you feel about a MD showing up on scene?



Has never bothered me in the past, don't have a problem with it now, forsee no issue in the future.


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## MedicBrew (Mar 13, 2012)

Veneficus said:


> Has never bothered me in the past, don't have a problem with it now, forsee no issue in the future.



Agreed. 

Actually I’ve had several good experiences with physicians on scenes. For the most part, their unfamiliar with the dynamics of an emergency scene and will ask you for direction. 

Never had one try to take over, and only heard of 1 that ever tried. Didn’t end well for him.


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## NomadicMedic (Mar 13, 2012)

One of our two medical directors was a medic prior to med school and occasionally shows up on scenes. He usually just watches. Occasionally he gets the itch to get back on the street and will ride third with a crew. It's always nice to have him around.


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## Farmer2DO (Mar 13, 2012)

http://www.sunyabem.org/ems_smart.html

The Emergency Medicine program at the University of Buffalo (with Erie County Department of Health) runs the smart car.  The only way I've seen them used was for MCIs, like a school bus accident, and it was greatly appreciated.  They triage, clear spines, and help clear up beds at receiving facilities.  It seems to work pretty well.


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## bigbaldguy (Mar 13, 2012)

We have MD's that show up on our calls from time to time. We very rarely know they are MD's until after the call since they tend to dress just like students or observers and ride with supervisors. They've all been great.


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## frdude1000 (Mar 13, 2012)

In Maryland, we have the GO-TEAM, composed of trauma surgeons an anestesiologist who will respond to complex scenes (usually prolonged extrications with limbs that may need to be amputated for extrication).  They do not get activated very much but are a great resource when needed.  Read here:
http://www.umm.edu/shocktrauma/ems/go_team.htm


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## 325Medic (Mar 13, 2012)

Our Medical director rides once a week on the squad / or occ. responds to bad calls and I find it refreshing that he does that. He stands back and lets us do our thing and if we need assistance, he will help. He still rides as a medic in a neighboring county so it works out well. Getting feedback is post job is cool also.

325.


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## Jon (Mar 14, 2012)

325... I'm pretty sure I worked under your medical director once.

We've got quite a few EMS docs in my area, some of whom are fellowship-trained EMS Docs.

I really don't understand why this is such a "new" thing. There have been docs in fly cars in NJ for a few years now.


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## Shishkabob (Mar 14, 2012)

All 3 of my agency's medical directors are known to hop in their Medical Control SUVS and join crews on scenes, from the obvious cardiac arrest, to other things such as a sick person or chest pain.  They tend to not take control away from the medic on scene.

Doesn't hurt that our medical director started out as a Paramedic with our agency years ago.


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## DrParasite (Mar 14, 2012)

Bullets said:


> So one of the ALS projects in NJ is starting up MD-1, an emergency physician who will respond to MCIs and extended extrication traumas. The concept is to provide the highest level of interventions, including field amputations, in the field, as well as on-site medical control to MICU instead of calling them by phone or radio
> 
> Thought? How would you feel about a MD showing up on scene?


Know the man, worked along side him, would love to do it again.  Have his email and cell phone number somewhere.....

he has started the MD-1 program at two other major ALS systems before leaving for his new position.  In addition to being an emergency physician, he either is currently a paramedic in another state or was a paramedic prior to becoming a doctor.  He definitely is an asset on scene, and is not afraid to get his hands dirty.

He responds in an MD-1 vehicle (agency issued), with all the bells and whistles of an ALS unit as well as some other cool stuff (bone saw comes to mind), and whatever he feels will help him do his job well.

Would I want any ER doc on a scene?  no, not really.  Especially a doctor who doesn't want to be there, or who is wearing a $1,000 suit, wearing shiney dress shoes, and doesn't want to get dirty.

But a doctor who wants to be there, knows his stuff, trusts his medics, and knows them personally, and is approachable to staff members of all level?  hell ya, I'll got on calls with him.


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## bstogner (Mar 30, 2012)

I think it is a great idea.  It may make the medics on scene feel a bit hurt.  But, as long as the MD brings the equipment he needs to really provide a higher level of cane than the medics can then I see no reason that every service that can afford it should not have a responding MD.


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## Veneficus (Mar 30, 2012)

bstogner said:


> I think it is a great idea.  It may make the medics on scene feel a bit hurt.  But, as long as the MD brings the equipment he needs to really provide a higher level of cane than the medics can then I see no reason that every service that can afford it should not have a responding MD.



It is much easier to replace a hurt medic than a hurt doctor.


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## Handsome Robb (Mar 30, 2012)

Veneficus said:


> It is much easier to replace a hurt medic than a hurt doctor.



Yet plenty of places worldwide use doctors and nurses for EMS rather than EMTs and Medics. 

I see your point but if it works elsewhere why is it more dangerous to do it here?

I've only had a doctor on scene once that I can think of and all he did was identify himself then ask if we needed anything. Turns out he was a neurologist and we were on scene for a "seizure". We asked him what he saw and he pretty much confirmed our suspicions that it was a syncopal episode not a seizure despite other bystander's arguments. That's about all the help he gave us though and it was all we wanted and asked for. 

If it's a recognized program that has gone through the correct channels. I don't see why the medics on scene would get upset about it. From what I can determine from my limited reading about Maryland's GO-TEAM is that they are requested by providers on scene...how can you get grumpy about them being there if you asked for their help? Now if docs start appearing on scene and taking over constantly then I'm sure some medics would have issues with that.


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## Shishkabob (Mar 30, 2012)

Veneficus said:


> It is much easier to replace a hurt medic than a hurt doctor.



Because career ending injuries are a regular occurrence in every system... and because a physicians career ends the moment they can't lift a 200 lb patient...


Oh wait...


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## Veneficus (Mar 30, 2012)

NVRob said:


> Yet plenty of places worldwide use doctors and nurses for EMS rather than EMTs and Medics.
> 
> I see your point but if it works elsewhere why is it more dangerous to do it here?
> 
> ...



I don't think it is more dangerous. I think having a doctor show up is better.

I think the post I replied to meant "hurt" to mean the medic would feel like the doctor was interfering with his authority or responsibility. (basically hurting the medic's ego)

There are many medics looking for work today. There aren't a lot of doctors looking for work. (or if they are it is because of their own selectivity)

I was trying to point out that a medic who gets upset that a doctor showed up on scene can be replaced much faster than an EMS doctor who gets upset the medic is creating a negative work environment or putting his ego above patient care.


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## Handsome Robb (Mar 30, 2012)

Veneficus said:


> I don't think it is more dangerous. I think having a doctor show up is better.
> 
> I think the post I replied to meant "hurt" to mean the medic would feel like the doctor was interfering with his authority or responsibility. (basically hurting the medic's ego)
> 
> ...



I got ya. I misread the first post.


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## zmedic (Mar 31, 2012)

Linuss said:


> Because career ending injuries are a regular occurrence in every system... and because a physicians career ends the moment they can't lift a 200 lb patient...
> 
> Oh wait...



If I'm showing up on scene, I'll help carry. But I have no problem letting the 8 firefighters who also show up carry my 400lb patient. Why else are they there unless my patient is on fire?

I joke. 

But most docs who show up on scene are there to provide medical guidance, they are not the ones physically carrying the patient down the stairs, or repelling off the roof. And if you are only going out once in awhile I'd say your overall risk of injury is less (ie even if the MD puts the patient in the ambulance, if you are doing that twice a month versus 5 times a day less chances of an injury.)

Finally I'd say a good chunk of the MDs who are interested in providing scene response have some experience in EMS, as an EMT or a medic or an EMS fellowship. So it's not like they are wandering around HAZMAT scenes in flip flops or poking the burning gas tanker with a stick.


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