# EMT or Athletic Trainer



## dbitt54 (Aug 9, 2011)

I am a football coach with emt-b cert.  I have another coach who is a emt-p.  We were just discussing different scenarios and this one came up.  Say one of our players gets hurt on the field and needs assistance.  Does the athletic trainer have more say so than the emts present?  I know athletic trainers are trained specifically on sports injuries and emts are more trauma/medical, but where is the line.  I guess all in all, how does the pecking order go?


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## DesertMedic66 (Aug 9, 2011)

Who ever is going to be taking over all care of the patient is the one incharge. You can make suggestions but they dont have to listen.


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## Akulahawk (Aug 9, 2011)

dbitt54 said:


> I am a football coach with emt-b cert.  I have another coach who is a emt-p.  We were just discussing different scenarios and this one came up.  Say one of our players gets hurt on the field and needs assistance.  Does the athletic trainer have more say so than the emts present?  I know athletic trainers are trained specifically on sports injuries and emts are more trauma/medical, but where is the line.  I guess all in all, how does the pecking order go?


Athletic Trainers are going to be far better educated in caring for sports injuries than even a medic. On top of that, chances are your team physician is the doc your ATC works with and under. In essence, you have a closed medical system. Your ATC will be the one calling the shots unless your team doc says different OR turns the player over to EMS. You coaches are "off duty" as far as your EMT/EMT-P certs are concerned anyway. Also, chances are quite good that your ATC could pass the EMT-B, and possibly EMT-P exams, without breaking much of a sweat. Put one through ACLS/PALS/PHTLS and I'd say the odds of passing EMT-P written would be extremely high. Becoming an ATC takes at _minimum_, a 4 year degree. The curriculum and internship experiences will be very similar in any program nation-wide. So says the NATA-BOC.

When it comes to evaluating exactly what broke, your ATC will be a LOT more specific about what broke, how bad it broke, how to rehab it, and who to refer to than a medic. Trust me on this. Knee or Leg pain can be determined to be something MUCH more specific... I've had all the education that an ATC gets. I _know.

_Don't get me wrong: There are things that an ATC doesn't learn in the normal course of their education that a medic does. Without further education in the Pre-Hospital stuff, an ATC can't replace a good medic.


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## JPINFV (Aug 9, 2011)

To the OP, get together with the senior staff at your local EMS agency and hammer out a plan ahead of time. We're dealing with two different providers who are going to have a very different idea of what is appropriate and different ways of approaching an injured athlete. 




firefite said:


> Who ever is going to be taking over all care of the patient is the one incharge. You can make suggestions but they dont have to listen.




Who ever is in charge is making patient care decisions and until the trainers turn over care to the paramedics, or God forbid EMTs (I'd love to see some EMTs claim that they are a "higher level of care" than the trainers), my opinion is that they are in charge and can decide to initiate any treatments that they deem fit. 

Oh, and if you want to take that statement literally, the ED physician is "in charge" since they will ultimately receive care


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## DesertMedic66 (Aug 9, 2011)

JPINFV said:


> To the OP, get together with the senior staff at your local EMS agency and hammer out a plan ahead of time. We're dealing with two different providers who are going to have a very different idea of what is appropriate and different ways of approaching an injured athlete.
> 
> 
> 
> ...



Yes the trainers can initiate any care they want as long as the patient is under their care. But once the patient is handed over then it's different (at least for me. If someone is going to be doing anything to my patient while under my care they have to get it cleared by me first.)

And as for me if I'm going to be transporting then the patient is going to be under my care and not the trainers. If there is a doctor on the team and he wants to take over all care of the patient then that's fine by me as long as I get it cleared from my sup and the receiving facility (so basically unless they are a well known doctor then that's not very likely). 

By in charge of patient care I mean at that time. Yes the physician will ultimately take over patient care but that is done at the hospital and not out in the field.


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## JPINFV (Aug 9, 2011)

firefite said:


> Yes the trainers can initiate any care they want as long as the patient is under their care. But once the patient is handed over then it's different (at least for me. If someone is going to be doing anything to my patient while under my care they have to get it cleared by me first.)
> 
> And as for me if I'm going to be transporting then the patient is going to be under my care and not the trainers. If there is a doctor on the team and he wants to take over all care of the patient then that's fine by me as long as I get it cleared from my sup and the receiving facility (so basically unless they are a well known doctor then that's not very likely).
> 
> By in charge of patient care I mean at that time. Yes the physician will ultimately take over patient care but that is done at the hospital and not out in the field.



The problem is that this isn't what you said. You said that it was "who ever is taking over care." The problem is that until the trainer transfers care, the trainer is in charge, not the EMS team, regardless of if the EMS team is transporting. The trainer is similarly free to make any treatment decisions he sees fit, regardless of anything the EMS team suggests.


Regardless, though, this sort of brinksmanship is silly. How about collaboration between two different fields that overlap with the current patient? Providing appropriate care is more important than 'who's on first.'


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## DesertMedic66 (Aug 9, 2011)

JPINFV said:


> The problem is that this isn't what you said. You said that it was "who ever is taking over care." The problem is that until the trainer transfers care, the trainer is in charge, not the EMS team, regardless of if the EMS team is transporting. The trainer is similarly free to make any treatment decisions he sees fit, regardless of anything the EMS team suggests.
> 
> 
> Regardless, though, this sort of brinksmanship is silly. How about collaboration between two different fields that overlap with the current patient? Providing appropriate care is more important than 'who's on first.'



That is what I said. "who ever is taking over care" means who ever is going to be taking over care for the patient. The trainers took over control when the injury happened. When EMS arrives/transfer of care is done then the EMS crew will be taking over control of the patient. And this will happen again at the hospital. 

I'm sorry that I didn't describe it the exact way you were looking were and use the exact words that you would have used.


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## bstone (Aug 9, 2011)

http://www.nata.org/sites/default/files/education-overview.pdf

They get good education.


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## Akulahawk (Aug 9, 2011)

bstone said:


> http://www.nata.org/sites/default/files/education-overview.pdf
> 
> They get good education.


Yes, they most certainly do... That PDF is a good overview.


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## Akulahawk (Aug 9, 2011)

JPINFV said:


> To the OP, get together with the senior staff at your local EMS agency and hammer out a plan ahead of time. We're dealing with two different providers who are going to have a very different idea of what is appropriate and different ways of approaching an injured athlete.
> 
> 
> 
> ...


What needs to be done is a sit-down with Coaches, Trainers, EMS/ED folks, and perhaps the Team's Designated Surgeon(s) to hammer out a plan of when and where an injured athlete gets transported. This should include not just emergent situations but also those situations where a delay in care by a physician or surgeon needs to be minimal. 

This should also include agreements with ED's to accept ill/injured athletes as an IFT type of transfer so that they're never closed to you and so that they'll accept reports directly from the ATC about the athlete as well as from the Paramedic because the ATC will have a VERY good idea what happened, and likely has a VERY good idea what the injury is. 

On days where an ambulance stand-by has been arranged, a meeting with the ambulance staff and team medical staff should also happen. 

For the OP: If you have an ATC on staff, you should turn over medical clearance/care to the Trainer. You, as an EMT-B and the other Coach who is a Paramedic, do not possess the requisite knowledge to adequately care for sports injuries, even if you did take a "Care and Prevention of Athletic Injuries" course as part of your Coaching Credential. Think of your ATC as a "Medical Coach" who has the authority to keep athletes from practice and or competition. ATC's in general want to keep athletes doing what they do best, and will work hard to keep or return those athletes back to competition. Don't override their decisions. 

JP: Very different ideas about what's appropriate and how to care for an injured athlete doesn't do the differences proper justice. Much severe friction can develop because of those differences.


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## Tigger (Aug 9, 2011)

As noted above, make sure these issues get worked out before the season starts. Everyone involved in injury management needs to be on the same page. At every hockey game, our program has an ATC, 2 student-trainer/EMTs, 2 paramedics, a GP, Ortho, and Dentist. The visiting team as an ATC and sometimes a doc as well. They all know their roles during injury management, and we've yet to have a situation with serious headbutting with the EMS side (the Doctors can be a bit different since there are many of them and they are not working in their usual environment).

At our program, the trainer is "in-charge" at all times, unless the injured player, coach, or official has sustained a life threatening injury. We are lucky in that we have the same paramedic crew (or at least one of them) at every game, so we do not have to hash it out with a new crew weekend.

The paramedics are an essential part of our medical team. They help us with our c-spine protocol on the ice, provide supplies and equipment that we don't generally have access too, and manage the life threatening injuries that our Sports Medicine staff don't have experience dealing with. It's also great to have someone able to start a line and give zofran to a player that's been battling illness and is dehydrated and nauseous before the game.


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## Chimpie (Aug 9, 2011)

And whatever plan you have decided on, make sure it's in writing.


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## EMT11KDL (Aug 10, 2011)

I have not read all the replies to the OP.  If an injury happens to an athlete that requires the athlete to be transported to the hospital, the EMS agency assumes medical control over the patient once they arrive on scene.  

To the OP: First are both of you Licensed in the state to practice at your current level? also, are you allowed to "practice" while you are "Off-Duty." I am unsure on your state laws, I do know in Idaho, We are limited on what we can do when we are not working on an Ambulance/Engine/Rescue ext.  More towards your question, I would have to say Yes and No.  Depending on the injury.. and even than as I think back to my ATEP program, there truly isnt any difference in handling a sports injury.  Fractures you are going to stabilize.  Concussions you are just going to assess mental status.  Sprains and Strains: RICE.  it truly comes down to is the injury Life Threatening or not.  Also, as an Off Duty Paramedic or EMT, you wont have the Medical Equipment to preform any procedures, and the equipment that your AT has, he or she is already trained on how to use that equipment effectively.   

I guess I am truly not seeing the type of injury that would require you as a First Responded to assume Medical Control over? Can you give me an example of an injury...


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## EMT11KDL (Aug 10, 2011)

JPINFV said:


> The problem is that this isn't what you said. You said that it was "who ever is taking over care." The problem is that until the trainer transfers care, the trainer is in charge, not the EMS team, regardless of if the EMS team is transporting. The trainer is similarly free to make any treatment decisions he sees fit, regardless of anything the EMS team suggests.
> 
> 
> Regardless, though, this sort of brinksmanship is silly. How about collaboration between two different fields that overlap with the current patient? Providing appropriate care is more important than 'who's on first.'



I have to disagree with this, Once the EMS crew has arrived on scene it is there patient.  the Athletic Trainer has already determined by calling 911 or calling over the EMS Standby Crew that this injury needs further care than what he or she can provide.  Therefor the EMS crew assumes Medical Control as soon as they arrive.  Just like when ems crew gets called to a nursing home, when EMS arrives they are in charge. there is no difference.


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## JPINFV (Aug 10, 2011)

EMT11KDL said:


> I have to disagree with this, Once the EMS crew has arrived on scene it is there patient.  the Athletic Trainer has already determined by calling 911 or calling over the EMS Standby Crew that this injury needs further care than what he or she can provide.  Therefor the EMS crew assumes Medical Control as soon as they arrive.  Just like when ems crew gets called to a nursing home, when EMS arrives they are in charge. there is no difference.




So on an emergency IFT, once the crew arrives at the hospital the crew is now has medical control?


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## EMT11KDL (Aug 10, 2011)

JPINFV said:


> So on an emergency IFT, once the crew arrives at the hospital the crew is now has medical control?



You are taking that patient to another facility correct? Using your Rig? You have to assess the patient correct? you have to confirm that all procedures that are currently in place are done correctly.. because if something is not done correctly who's A** is on the chopping block.  YOURS not the staff that had the patient before... and if something is done incorrectly you have to document it. therefor when you arrive to "receive" that patient, than its your patient.  

Lets put it this way, you are transporting a patient to the ER.  You go into the ER with the patient, are you allowed to tell the ER techs or RN or Doctors what procedures they can do while you are in the room? NO, its there patient now.  by you bringing that patient there, you have involuntarily gave that patient to them and they assume medical control.


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## JPINFV (Aug 10, 2011)

The problem is that you don't assume care or relinquish care until report is given. Just because you show up at the ED to transport a patient doesn't mean that you are immediately in charge of that patient's care. Similarly, just because you walk through the doors of the ED doesn't mean you relinquish care. That occurs after you properly transfer care to the ED. Similarly, a patient under the care of a trainer is the trainer's patient until they transfer care to you, which doesn't occur just because you show up.


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## EMT11KDL (Aug 10, 2011)

JPINFV said:


> The problem is that you don't assume care or relinquish care until report is given. Just because you show up at the ED to transport a patient doesn't mean that you are immediately in charge of that patient's care. Similarly, just because you walk through the doors of the ED doesn't mean you relinquish care. That occurs after you properly transfer care to the ED. Similarly, a patient under the care of a trainer is the trainer's patient until they transfer care to you, which doesn't occur just because you show up.



I agree but disagree at the same time.  If you have shown up and are with the Patient than care is being relinquished.  We are going to play a quick what if situation.  I do know that this WHAT IF will NEVER HAPPEN.  and if it does, you are a freaking idiot.  

So if I am transporting my patient to the ED and I go through the doors and stop in the hall way, I can tell the Doctors, Nurses and Techs or anyone else to NOT touch/treat the patient? and get away with it... 

yes I know this sounds stupid, but I cant think of another situation to describe it...


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## JPINFV (Aug 10, 2011)

EMT11KDL said:


> So if I am transporting my patient to the ED and I go through the doors and stop in the hall way, I can tell the Doctors, Nurses and Techs or anyone else to NOT touch/treat the patient? and get away with it...



...if you're holding the wall? Sure. Similarly, if you're holding the wall with the patient and decide to mentally check out, if something bad happens the hospital is going to say, "Well, we never accepted care over that patient." Once you transfer care, however, all bets are off. Otherwise, it's like a crew arriving at a dialysis clinic and demanding that their patient is immediately removed from the dialysis machine for no better reason than the fact that the crew is there. 

Similarly, let's go back to the emergency transfer. If you have assumed care as soon as you arrive, then you should be able to just start disconnecting lines and immediately preparing the patient for transport, even before report is given?

That last scenario actually gets to the heart of the situation. Collaborating between the transferring and receiving team is more important than either team arguing that their proverbial penis is larger than the other team.


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## DesertMedic66 (Aug 10, 2011)

For me as soon as I make patient contact then I am in control of all care. If I show up to the ER to do an IFT and the nurses are not ready to give a report and have me take control of the patient I do not make patient contact. 

As soon as the report is given then I make patient contact and the patient is now under my care. 

And then as soon as I give my report to the receiving facility about the patient, that ends my care of the patient.


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## Shishkabob (Aug 10, 2011)

Though, to be fair, I have walked in to a clinic, found the patient I was called for in peri-arrest, didn't agree with what the doc was doing, and took over doing what I had to do to keep the patient alive.  Honestly, the doctor appeared more than willing to let me do what I had to do, even though there was no 'transfer of care', and he was actively 'running' it even while I was doing my thing.   Legally is it my patient?  Not really.  However I'm not going to stand idly by and watch someone die through inaction  due to a technicality.


I am more than willing to defend my actions in that situation


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## EMT11KDL (Aug 10, 2011)

JPINFV said:


> That last scenario actually gets to the heart of the situation. Collaborating between the transferring and receiving team is more important than either team arguing that their proverbial penis is larger than the other team.



That is exactly the point, these situations should Never happen, we should all be working together.. If I see that an ATC is in the middle of stabilizing a limb, im not going to tell he or she to stop.  If I am at a Clinic, I am going to ask if they are in the middle of a treatment how long they are going to be to finish that procedure, but any new procedures I do need to approve of because some procedures that they might be able to do at the clinic or where ever I might not be able to sustain that treatment, continue the treatment, or have the equipment to monitor that patient... 

and what i wrote directly to the OP Which is below.... there shouldnt be a fight between who is makes the decision because they should be the same, and if they are not, there needs to be a discussion on what both parties are seeing.  One provider might have missed a sign or symptom that the other provider caught...

"Depending on the injury.. and even than as I think back to my ATEP program, there truly isnt any difference in handling a sports injury. Fractures you are going to stabilize. Concussions you are just going to assess mental status. Sprains and Strains: RICE. it truly comes down to is the injury Life Threatening or not. Also, as an Off Duty Paramedic or EMT, you wont have the Medical Equipment to preform any procedures, and the equipment that your AT has, he or she is already trained on how to use that equipment effectively. 

I guess I am truly not seeing the type of injury that would require you as a First Responded to assume Medical Control over? Can you give me an example of an injury..."


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## nwhitney (Aug 10, 2011)

I get that the knowledge base of an athletic trainer is greater than a Basic or a medic.  With that aside what would/could an athletic trainer feasibly do that a EMT-B/P could not?  For example would they treat a femur fracture any different than a Basic?  

I seriously don't know, I'm not trying to be an a$$.  Then again if you ask my wife she'll tell you I don't need to try, I'm a natural a$$.


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## EMT11KDL (Aug 10, 2011)

nwhitney said:


> I get that the knowledge base of an athletic trainer is greater than a Basic or a medic.  With that aside what would/could an athletic trainer feasibly do that a EMT-B/P could not?  For example would they treat a femur fracture any different than a Basic?
> 
> I seriously don't know, I'm not trying to be an a$$.  Then again if you ask my wife she'll tell you I don't need to try, I'm a natural a$$.



We treat it the same.. Traction splint.. we treat sports injuries the same.. Stabilize the effected area.. we both have Sam Splints, we both have tape.  we c-spine the same.. wound care is roughly the same.. direct pressure and packing.. I am one semester away from sitting for the BOC for ATC.  and I have been working in Fire and EMS for the last 3 years.. when it gets down to the basics we treat the same


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## nwhitney (Aug 10, 2011)

EMT11KDL said:


> We treat it the same.. Traction splint.. we treat sports injuries the same.. Stabilize the effected area.. we both have Sam Splints, we both have tape.  we c-spine the same.. wound care is roughly the same.. direct pressure and packing.. I am one semester away from sitting for the BOC for ATC.  and I have been working in Fire and EMS for the last 3 years.. when it gets down to the basics we treat the same



That's what I figured thanks.


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## Shishkabob (Aug 10, 2011)

Aside from surgery, trauma is pretty much treated the same universally, regardless of certification.


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## EMT11KDL (Aug 10, 2011)

Linuss said:


> Aside from surgery, trauma is pretty much treated the same universally, regardless of certification.



unless we get into Military vs Civilian and order of operations between the two... which i do not want to start haha


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## Tigger (Aug 10, 2011)

EMT11KDL said:


> I have to disagree with this, Once the EMS crew has arrived on scene it is there patient.  the Athletic Trainer has already determined by calling 911 or calling over the EMS Standby Crew that this injury needs further care than what he or she can provide.  Therefor the EMS crew assumes Medical Control as soon as they arrive.  Just like when ems crew gets called to a nursing home, when EMS arrives they are in charge. there is no difference.



If the ATC calls 911, then I think it's reasonable to assume that the trainer _wants_ the responding EMS crew to take care and responsibility of the patient. 

However, a standby EMS crew has no business in deciding that the scene is now theirs once they have been "activated." That does a disservice to the athlete in question. The ATC and Paramedic have a tremendous combined knowledge base that should be utilized, and the ATC should certainly be able to consult the paramedic without necessarily turning the patient over to them, just as the ATC can consult with a doctor on the ice but not have the doctor assume care.

Furthermore, a lot of times with orthopedic injuries, the Sports Medicine staff just needs extra hands to get the player off the ice/field. Just because I or my ATC chooses to bring the medics onto the ice does not mean that the patient must now go the ER. Many times the medics will help us get an injured player into the training room  for care and the ambulance will never be used. At least where I work, withholding a life threatening injury, the ATC is always responsible for the patient and he can consult with whomever he sees fit.


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## Akulahawk (Aug 11, 2011)

EMT11KDL said:


> We treat it the same.. Traction splint.. we treat sports injuries the same.. Stabilize the effected area.. we both have Sam Splints, we both have tape.  we c-spine the same.. wound care is roughly the same.. direct pressure and packing.. I am one semester away from sitting for the BOC for ATC.  and I have been working in Fire and EMS for the last 3 years.. when it gets down to the basics we treat the same


Yes, lot of the emergent treatment is the same... however the decision-making skills are not. By now you should be pretty much at the point where you can determine whether or not your athlete can be cared for in-house or needs to be referred out for immediate injury care, such as wound closure or stabilization of a fracture of a weight bearing or other large bone. Immediate wound care is about the same, however, you should also know how to take care of wounds longer-term than just that instant. You should know by now what you can splint with tape and return to play vs take the athlete to the training room for further evaluation, and possible referral out. 

In real-world terms, you have an athlete who plants, extends, and twists a knee when he gets tackled. He's complaining of knee pain. EMS will simply determine that it's possibly fractured, splint, and transport to the ED. The ATC determines that the player has a Grade 2 MCL, no Medial Meniscus (cuz he's lucky) and a Grade 1+ ACL... and nothing appears to be fractured. Given the findings, do you now think that immobilization and transport to the ED via 911 is appropriate? I guarantee you that most Paramedics will NOT have the knowledge to make those determinations... and unless they're appropriately authorized, NONE will have the actual ability to do the testing required to make those determinations. 

Out of curiosity, have you seen an isolated Gr 3 ACL from the plant & twist mechanism, like say, from a high jump?

Out of sheer Murphy's Law, I wasn't able to sit for the NATA-BOC - and not because I wasn't qualified or ready for it.


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## JPINFV (Aug 11, 2011)

Akulahawk said:


> and unless they're appropriately authorized, NONE will have the actual ability to do the testing required to make those determinations.



Since a lot of orthopedic testing is manual, I'll bite. What's stopping a paramedic from doing orthopedic tests like anterior/posterior drawer, Apley, McMurray, etc? Granted, there's not much they can do with the information since they aren't often authorized to do much in terms of disposition besides transport to the ED, but that doesn't necessarily stop them from being able to test.


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## Akulahawk (Aug 11, 2011)

JPINFV said:


> Since a lot of orthopedic testing is manual, I'll bite. What's stopping a paramedic from doing orthopedic tests like anterior/posterior drawer, Apley, McMurray, etc? Granted, there's not much they can do with the information since they aren't often authorized to do much in terms of disposition besides transport to the ED, but that doesn't necessarily stop them from being able to test.


Show me where a Paramedic actually GETS that education...


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## JPINFV (Aug 11, 2011)

Akulahawk said:


> Show me where a Paramedic actually GETS that education...




Touche, however life long learning and CMEs? After all, what's the purpose of going to a continuing education course if you can't implement what you actually learn?


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## Akulahawk (Aug 11, 2011)

JPINFV said:


> Touche, however life long learning and CMEs? After all, what's the purpose of going to a continuing education course if you can't implement what you actually learn?


Don't get me wrong, but the CME needed to learn how to do the orthopedic exams is not going to be a short course. Knowing _how _to do the exams is one thing. Knowing how to do them _competently _is another. Acquiring the feel necessary takes time that Paramedics won't have to complete the CME. 

One of the issues is that while detecting the gross laxity that a Gr 3 sprain is relatively easy, it's making the distinction between a Gr 1 and Gr 2 (and sometimes 1+ and 2) injuries that gets difficult. How about a Gr 2 in a patient whose joints are already a little lax? That may feel a LOT like a Gr 3. 

I'd be glad to have a Paramedic who has taken the time to learn to do Ortho exams well evaluate my athlete, especially if I'm a Coach. The problems start when the Paramedic has no mechanism for a Paramedic-initiated refusal of transport and/or the athlete is a minor...


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## Engine66 (Aug 13, 2020)

Akulahawk said:


> Don't get me wrong, but the CME needed to learn how to do the orthopedic exams is not going to be a short course. Knowing _how _to do the exams is one thing. Knowing how to do them _competently _is another. Acquiring the feel necessary takes time that Paramedics won't have to complete the CME.
> 
> One of the issues is that while detecting the gross laxity that a Gr 3 sprain is relatively easy, it's making the distinction between a Gr 1 and Gr 2 (and sometimes 1+ and 2) injuries that gets difficult. How about a Gr 2 in a patient whose joints are already a little lax? That may feel a LOT like a Gr 3.
> 
> I'd be glad to have a Paramedic who has taken the time to learn to do Ortho exams well evaluate my athlete, especially if I'm a Coach. The problems start when the Paramedic has no mechanism for a Paramedic-initiated refusal of transport and/or the athlete is a minor...



If it is an emergency, then AT steps back once 911 crew arrives. Period. Is collaboration important...yes! Bottom line though is ATs don’t administer IV fluids for dehydration, glucagon or D50W for low blood sugar, intubate for airway, inject morphine for pain, and ATs don’t have a clue to local EMSA protocols on which hospitals accept concussions as Nuevo receiving centers. ATs are awesome at identifying which anatomical structure is possibly injured and a treatment such  as ice, compression, elevation, Etc. and rehab, but not the emergency life procedures that medics employ and yes...it pisses ATs off. Once at the hospital, the doctors simply want to stabilize a patient...if patella is dislocated or a sprain determined to be in the ankle then all is well. The paramedics make sure the patient survives and knows local EMS protocols...not AT. Bottom line as a parent/patient/athlete...save my life if it’s that bad...MEDIC!!!


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## PotatoMedic (Aug 13, 2020)

Dam near 9 years on the nose for this resurrection!  I'm kinda impressed.


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## E tank (Aug 13, 2020)

Interesting to see how many names fade off into the distance on these forums never to be seen again...and the die hards that persevere...


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## CANMAN (Aug 13, 2020)

It's kinda concerning the amount of people talking about IFT and "in control"..... Apparently some people need a lesson on EMTALA and Physician responsibility when still inside their facility.


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## PotatoMedic (Aug 13, 2020)

CANMAN said:


> It's kinda concerning the amount of people talking about IFT and "in control"..... Apparently some people need a lesson on EMTALA and Physician responsibility when still inside their facility.


And duty to act.  The college football games we do standby for we don't even think about going on the field till coaching staff or whoever calls us over.  So in that case the teams athletic trainer makes the decision if EMS is needed or not.

And yes.  It is crazy to see the names that have faded.


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## Akulahawk (Aug 13, 2020)

Engine66 said:


> If it is an emergency, then AT steps back once 911 crew arrives. Period. Is collaboration important...yes! Bottom line though is ATs don’t administer IV fluids for dehydration, glucagon or D50W for low blood sugar, intubate for airway, inject morphine for pain, and ATs don’t have a clue to local EMSA protocols on which hospitals accept concussions as Nuevo receiving centers. ATs are awesome at identifying which anatomical structure is possibly injured and a treatment such  as ice, compression, elevation, Etc. and rehab, but not the emergency life procedures that medics employ and yes...it pisses ATs off. Once at the hospital, the doctors simply want to stabilize a patient...if patella is dislocated or a sprain determined to be in the ankle then all is well. The paramedics make sure the patient survives and knows local EMS protocols...not AT. Bottom line as a parent/patient/athlete...save my life if it’s that bad...MEDIC!!!


Not quite. Care must be transferred from the AT to the 911 crew. That transfer of care can be very quick but it must be done or the AT could be considered to have abandoned their athlete if you simply assume scene control upon arrival. The venue may look like an open athletic field but it's really a closed medical system that is inviting EMS in. One of the big differences between EMS and the ATC is that the ATC doesn't need to follow EMS protocols. They follow their own that are developed between them and the supervising physician (Team Physician). As an AT, if my athlete gets concussed, I'm going to evaluate that and if I determine that my athlete needs to be transported to an appropriate ED, I'm going to call for that transport to occur. Within a very few moments, I'll know what kind of care my athlete is going to need and arrangements may have already been put into motion by me for care of that athlete and I might simply need the ambulance for transport to a specific facility. 

In my AT role, you're right that I can't administer IV fluids, glucagon/D50W, perform tracheal intubation, or administer morphine. I can't run a code with all the ACLS stuff either. That being said, a good AT is going to know which hospitals do ortho and which do neuro because their athletes may end up needing those services. 

I'm also a Paramedic and an ED RN. Guess what? Because of the extremely thorough education I received as an AT, I rarely had to crack open the book during Paramedic School and I did quite well. Literally EVERYTHING you listed that a Paramedic can do is a monkey skill. Paramedics do get an education about when and when not to employ those skills. Teach those same skills to an AT and then authorize them to perform those same skills, and they'll do a VERY good job employing those skills when needed. In my role as an ED RN, none of that is out of my scope of practice, all it takes is development of a standardized procedure and then going through the requisite course to authorize me to perform that procedure in the ED. Even then, most of the didactic stuff I learned in RN school was covered in AT school, so I still rarely had to crack the book for that, passed the program with honors, and crushed the NCLEX at minimum questions. 

Bottom line, if it's "that bad" then the AT is going to call 911, transfer care to the arriving crew by giving report, and the AT will then step back and allow the 911 crew to begin their work.


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## hometownmedic5 (Aug 13, 2020)

Engine66 said:


> If it is an emergency, then AT steps back once 911 crew arrives. Period. Is collaboration important...yes! Bottom line though is ATs don’t administer IV fluids for dehydration, glucagon or D50W for low blood sugar, intubate for airway, inject morphine for pain, and ATs don’t have a clue to local EMSA protocols on which hospitals accept concussions as Nuevo receiving centers. ATs are awesome at identifying which anatomical structure is possibly injured and a treatment such  as ice, compression, elevation, Etc. and rehab, but not the emergency life procedures that medics employ and yes...it pisses ATs off. Once at the hospital, the doctors simply want to stabilize a patient...if patella is dislocated or a sprain determined to be in the ankle then all is well. The paramedics make sure the patient survives and knows local EMS protocols...not AT. Bottom line as a parent/patient/athlete...save my life if it’s that bad...MEDIC!!!



Wow. You hit the trifecta on this one. 
Necroposting. 
Being dead nuts wrong. 
Being aggressive about it. 

Awesome work. Keep it up.


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## Akulahawk (Aug 13, 2020)

And with that, I'm going to nail this necropost down so that it doesn't rise again unless appropriately summoned from the dead.


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## Tigger (Aug 13, 2020)

Engine66 said:


> If it is an emergency, then AT steps back once 911 crew arrives. Period. Is collaboration important...yes! Bottom line though is ATs don’t administer IV fluids for dehydration, glucagon or D50W for low blood sugar, intubate for airway, inject morphine for pain, and ATs don’t have a clue to local EMSA protocols on which hospitals accept concussions as Nuevo receiving centers. ATs are awesome at identifying which anatomical structure is possibly injured and a treatment such  as ice, compression, elevation, Etc. and rehab, but not the emergency life procedures that medics employ and yes...it pisses ATs off. Once at the hospital, the doctors simply want to stabilize a patient...if patella is dislocated or a sprain determined to be in the ankle then all is well. The paramedics make sure the patient survives and knows local EMS protocols...not AT. Bottom line as a parent/patient/athlete...save my life if it’s that bad...MEDIC!!!


Well uh, no.

Things we did in the training room while I was in college: started IVs and gave fluids. Gave PO opiates and antibiotics (among others) on standing orders from team physician. Developed a plan for a single hospital and its neurology department as the receiving hospital for all athletes needing further neuro treatment. Also I am not sure there is any ED out there that cannot evaluate a concussion. 

Guess you gotta bone to pick?


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