For anyone who has ever had a "Doctor" show up on scene

[Hockey]

Print out these cards and keep em in your pocket

http://www.co.marin.ca.us/depts/hh/...s/May08FinalDrafts/GPC06A_MD_onscene_card.pdf

 

[reaper]

A lot of services have those. But the policies would be system and state specific.

Just follow you system SOP for dealing with a Dr on scene.

 

[Simusid]

I don't know all the details but apparently we had someone show up to a bad MVA and asked if he could help. The medic allegedly whigged out with "who the &*)(^^&$%^ do you think you are??? get out of my scene!!" and the response was "I'm your medical director"

 

[medicRob]

I don't know all the details but apparently we had someone show up to a bad MVA and asked if he could help. The medic allegedly whigged out with "who the &*)(^^&$%^ do you think you are??? get out of my scene!!" and the response was "I'm your medical director"

I find that quite hard to believe that a medic, especially one who has worked with a service for a while would not know who their medical director was. At my service, we see our medical director in the ER almost every shift. He stops in to say hello at the station, we have lunch with him sometimes. Then again, my service is allowed to RSI, Needle Cric, etc. so it is quite obvious why he would want to be actively involved as much as possible.

That being said, it was probably just a physician who arrived at the scene. In these situations, if they are not your medical director, you do not have to turn treatment over to them. If you do turn treatment over to them, they are required to ride with you to the hospital.

 

[fast65]

Print out these cards and keep em in your pocket

http://www.co.marin.ca.us/depts/hh/...s/May08FinalDrafts/GPC06A_MD_onscene_card.pdf

They forgot to put the first "t" in State on the back of the card...just sayin

 

[abckidsmom]

We used to have those stuck in the bottom of the clipboard, and called them "Doctor Go Away" cards.

Never used one, and only a handful of times had a doctor on scene. They were always completely appropriate and didn't overstep any bounds. Plus, if they had a vested interest in the situation (their family) they were eager to ride along to the hospital, and our protocols and skills were sufficient to keep them quiet and helpful.

 

[MSDeltaFlt]

I find that quite hard to believe that a medic, especially one who has worked with a service for a while would not know who their medical director was. At my service, we see our medical director in the ER almost every shift. He stops in to say hello at the station, we have lunch with him sometimes. Then again, my service is allowed to RSI, Needle Cric, etc. so it is quite obvious why he would want to be actively involved as much as possible.

That being said, it was probably just a physician who arrived at the scene. In these situations, if they are not your medical director, you do not have to turn treatment over to them. If you do turn treatment over to them, they are required to ride with you to the hospital.

That's not necessarily the case. If they can provide documentation that they are a physician with a license in your area, then they trump you hands down. If they do not wish to relinquish care, then they must ride in with you. If they do wish to relinquish care, then they must document so or at least call your offline medical control and do it that way.

Which is why I absolutely hate it when a MD/DO shows up on scene. The ones I've seen want to help, but don't want to go in with the crew. That really tends to muck up the works.

 

[abckidsmom]

That's not necessarily the case. If they can provide documentation that they are a physician with a license in your area, then they trump you hands down. If they do not wish to relinquish care, then they must ride in with you. If they do wish to relinquish care, then they must document so or at least call your offline medical control and do it that way.

Which is why I absolutely hate it when a MD/DO shows up on scene. The ones I've seen want to help, but don't want to go in with the crew. That really tends to muck up the works.

What kind of help do they want to do that mucks up things when they don't ride in? I tend to treat them like a glorified bystander, who is able to either provide or elicit a really detailed history from the patient. I've never had one who wanted to do any ALS skill, and the only time they tweaked the ALS plan it was more like, "did you consider XYZ?" and it's a reasonable suggestion, I either do it or not. I guess I haven't encountered and crazy off the wall takeover guy.

 

[medicRob]

That's not necessarily the case. If they can provide documentation that they are a physician with a license in your area, then they trump you hands down. If they do not wish to relinquish care, then they must ride in with you. If they do wish to relinquish care, then they must document so or at least call your offline medical control and do it that way.

Which is why I absolutely hate it when a MD/DO shows up on scene. The ones I've seen want to help, but don't want to go in with the crew. That really tends to muck up the works.

My service specifically states that unless they are authorized DIRECTLY to take control by MY medical director they cannot take over my patient without me asking them to do so. Otherwise, they have to act as another pair of hands. If my medical director gives them permission to take over, they must accompany the patient. It is given unto me the authority by authorization of my medical director to ask an on scene physician to stand down.

"Thy Medical Director is a jealous director, thou shalt put none other before him"

 

[reaper]

Yes, every system I have ever worked, is the same way. I do not have to turn over care, even if they ask. The Pt is mine, till I decide to relinquish care to them.

Have had a few help on scene. Only had one that try to take over and was escorted off the scene.

This is all a system by system SOP.

 

[Shishkabob]

Same with me. The only doctors license I use is my med control... if another doctor comes on scene I have the ability to refuse. If I DO decide they can help (totally dependent on the situation, so it's unrealistic to say if I would or would not), and they want me to do something not in my protocols, they are to get on the phone with my med control and talk it out... if they can't agree then I stick with my med control, as again, his is the only license I use. That is per my protocols about on scene physician intervention.


I have had to tell a doctor off before, not because he wanted to help, but because he thought he had the right/ability to tell me to hurry up on scene...

 

[medicRob]

Same with me. The only doctors license I use is my med control... if another doctor comes on scene I have the ability to refuse. If I DO decide they can help (totally dependent on the situation, so it's unrealistic to say if I would or would not), and they want me to do something not in my protocols, they are to get on the phone with my med control and talk it out... if they can't agree then I stick with my med control, as again, his is the only license I use. That is per my protocols about on scene physician intervention.


I have had to tell a doctor off before, not because he wanted to help, but because he thought he had the right/ability to tell me to hurry up on scene...

I feel the same way. For instance, if I have a pt with radiating chest pain, ST elevation in 2 or more leads, and all the sudden the local professor of interventional cardiology comes up knocking on my ambulance doors, you best believe I am letting him take over. However, if an emergency dermatologist comes knocking, I will not. It is all situation dependent. Remember, our jobs are to facilitate the continuation of care to the best of our abilities by treating life threatening injuries and transporting our patient to definitive care.

Also, when I arrive to a hospital until I sign my run report over, that patient is still mine. If for one reason or another I don't feel like my patient will receive the best care at the facility, it is my right to load that patient back up and to divert to another facility. Mind you, I will have a lot of questions to answer to my medical director, supervisor, and service directors and I sure as hell better have a good reason for doing what I did.

 

[AtlantaEMT]

...if I have a pt with radiating chest pain, ST elevation in 2 or more leads, and all the sudden the local professor of interventional cardiology comes up knocking on my ambulance doors, you best believe I am letting him take over. However, if an emergency dermatologist comes knocking, I will not...

I knew an EMT for his EMT-I trauma assessment when asking "what resources do I have" the examiner said "you have all the recources you want" or something along those lines. I told him he should have said that he had an orthopedic surgeon, cardiologist, intensivist, and some pararescue jumpers who overshot their drop zone and are providing scene safety.

In reality and also if we set our egos aside, is there anything a doctor could do in a medical emergency that a paramedic couldn't do with the supplies on an ALS truck? And assuming the doctor is qualified for whatever emergency you are on.

 

[Veneficus]

In reality and also if we set our egos aside, is there anything a doctor could do in a medical emergency that a paramedic couldn't do with the supplies on an ALS truck? And assuming the doctor is qualified for whatever emergency you are on.

Having done both, any doctor is considerably more qualified than a paramedic. It is not so much a matter of qualification than comfort.

All of the skills you learn are taught to physicians in medical school. There is nothing a paramedic has or can do that hasn't been covered in considerably more breadth and depth.

If a physician is actually willing, there is considerably more that can be done with what is on the average ALS vehicle.

The medications alone have more uses and effects than what is taught in medic school.

as some examples,

Use Mag sulfate no only to treat eclamsia, but also to sedate a patient, or stop labor. Administer epi prior to knowingly give somebody another medication they are allergic to if the benefit of them having it outweights the risks. Use a scalpel to cut any part of the body, not just an umbilical cord. Dilute IV infusions to come up with different concentrations. Stick an ET tube into a bleeding artery and inflate the cuff in order to stop bleeding. provide sedation/analgesia to terminal patients not going to be transported. Administer any available dose of medication on hand. Mix medications to potentiate effects. Lidocaine for local anesthesia. I could go on.

But most important, a physician can do a considerably better assessment and dx, which can lead to instant recognition to deviation from protocols that are medically questionable, like high flow o2 and long boarding, or driven by epidemiology, like not using epi as the primary arrest medication, which could give the patient a better chance at survival as well as more complete recovery.

I will admit some physicians are real jerks, some are uncomfortable performing outside of their daily routines or specialty, but it is not because one kind is lesser than another.

Keep in mind that a physician is recognized by people as the highest medical provider all over the world. A US paramedic is lucky to function at such level outside the US or a lawless warzone.

It is foolish for paramedics to claim they can do anything a doctor can do in an emergency. It is simply ignorance.

 

[Shishkabob]

It is foolish for paramedics to claim they can do anything a doctor can do in an emergency. It is simply ignorance.

Medical cardiac arrest h34r:


Wel... 99% of it, atleast.

 

[AtlantaEMT]

Having done both, any doctor is considerably more qualified than a paramedic. It is not so much a matter of qualification than comfort.

...

It is foolish for paramedics to claim they can do anything a doctor can do in an emergency. It is simply ignorance.

Cool deal. I've always understood that a doctor is going to know much more than a paramedic (especially an EMT-I like me) but didn't know how it'd translate outside of a hospital setting with limited supplies. One thing I did think about later is a doctor could do a tracheotomy.

 

[medicRob]

Cool deal. I've always understood that a doctor is going to know much more than a paramedic (especially an EMT-I like me) but didn't know how it'd translate outside of a hospital setting with limited supplies. One thing I did think about later is a doctor could do a tracheotomy.

Critical Care Paramedic can do surgical cric and needle cric.

 

[medic417]

Critical Care Paramedic can do surgical cric and needle cric.

Our intermediates do that.

If a doctor is able to assist I let them. If they are in the way I kick them off scene. I do not obstruct them doing their work at their office and I will not let them obstruct me at mine.

Some doctors are great on scene yet others really are not comfortable with out of hospital care and are just in the way. Comply with your local policy and keep in mind it is about what the patient needs not ours or the doctors egos.

 

[jjesusfreak01]

I know it isn't done a lot and isn't in everyone's protocols anymore, but I am wondering if anyone has ever been sued for doing a tracheotomy as a layperson? It seems to me that it is commonly thought (due to movies and TV) that anyone can do a tracheotomy with a pen knife and a straw.

Its my opinion that in the realm of airways, there should be few skills, if any, that EMTs are not trained and certified to do. I can understand how I as an EMT lack the skills to give proper IV meds to a cardiac patient or read an EKG, but if I run into someone with a complete FBAO and I can't get it out using the heimlech maneuver or chest compressions, then that person dies right there, when it only takes a minute to do a tracheotomy (of course EMTs also aren't allowed to visualize and remove obstructions with a laryngoscope and forceps, which would be preferable to a surgical airway if possible).

The same thing goes for an anaphylactic patient...trachea is starting to close up, and I am not allowed to intubate or use a surgical airway, and the patient may die if there is no epi-pen available.

What are you going to do when you are sitting there in front of the patient and everyone expects you to pull out your trusty pen knife and save the day...or worse, a bystander pulls out a knife and decides to do the tracheotomy. Am I going to stop them, probably not...

/end daily rant

 

[medicRob]

I know it isn't done a lot and isn't in everyone's protocols anymore, but I am wondering if anyone has ever been sued for doing a tracheotomy as a layperson? It seems to me that it is commonly thought (due to movies and TV) that anyone can do a tracheotomy with a pen knife and a straw.

Its my opinion that in the realm of airways, there should be few skills, if any, that EMTs are not trained and certified to do. I can understand how I as an EMT lack the skills to give proper IV meds to a cardiac patient or read an EKG, but if I run into someone with a complete FBAO and I can't get it out using the heimlech maneuver or chest compressions, then that person dies right there, when it only takes a minute to do a tracheotomy (of course EMTs also aren't allowed to visualize and remove obstructions with a laryngoscope and forceps, which would be preferable to a surgical airway if possible).

The same thing goes for an anaphylactic patient...trachea is starting to close up, and I am not allowed to intubate or use a surgical airway, and the patient may die if there is no epi-pen available.

What are you going to do when you are sitting there in front of the patient and everyone expects you to pull out your trusty pen knife and save the day...or worse, a bystander pulls out a knife and decides to do the tracheotomy. Am I going to stop them, probably not...

/end daily rant

I am authorized as a Paramedic to take such interventions in the state of TN, provided my medical director allows and I have a very good reason for backing up why I could not get an airway by any other means. However, I would NEVER attempt anything like this off shift without an ALS ambulance with all the bells and whistles + the drugs + medical director readily available by phone or radio to back me up in my decision to carry out such a measure.

Also, I don't carry an OB/KIT or a Pertrach kit etc, and I am not going to get my pocket knife dirty, hell no.