BASICS Blog

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MrBrown

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I happened across a blog out of the UK from a BASICS Doctor and am just loving it.

BASICS, or the British Association for Immeadiate Care Schemes, is a voluntary program where physicians (mainly anaesthetists and emergency medicine consultants) assist the Ambulance Service in providing care above what a UK Paramedic can ... which seems to be advanced analgesia and RSI mostly (skills our Intensive Care Paramedics have here)

A BASICS Doctor recieves no payment for thier time or expertise but they do get an awesome orange jumpsuit :D :D

http://basicsdoc.blogspot.com
 
No offense but what can a doc provide outside of a hospital with pre-hospital equipment on an ambulance an advanced Paramedic can not?
An orange jumpsuit is something a prisoner wears.... :P
 
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schulz said:
No offense but what can a doc provide outside of a hospital with pre-hospital equipment on an ambulance an advanced Paramedic can not?
An orange jumpsuit is something a prisoner wears.... :P
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In the UK drugs such as ketamine and suxamethonium are not avaliable to Paramedics, and as such are doctor only drugs. I don't believe that is 100% of the reason that HEMS and BASICS use Doctors although it may have something to do with it.

You raise a valid point and one I have thought of many times myself as New Zealand has done away with Doctors being used prehospitally for thier "value added" concept as our Intensive Care Paramedics have RSI and advanced analgesia.

I'm not sure you can compare a Paramedic with some sux in a hip pouch to an anaesthetics consultant in his orange jumpsuit.
 
schulz said:
No offense but what can a doc provide outside of a hospital with pre-hospital equipment on an ambulance an advanced Paramedic can not?
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Assuming that you just have the same tools that are on a normal paramedic ambulance (after all, physicians don't have scope of practice restrictions). Things like simple dislocation reductions, amputations, on scene medical direction, and many other things. Its not useful often, but when EMS associated physicians (in contrast to random physicians) are on scene are, they really are. A perfect example would be the MCI in Wake County a few months ago. 40-50 some odd high school students came down with varying degrees of food poisoning. Instead of transporting everyone, they (including one of their medical directors) treated most of the students on scene with IV fluids and antiemetics and only ended up transporting something like 5 students.
 
JPINFV said:
Assuming that you just have the same tools that are on a normal paramedic ambulance (after all, physicians don't have scope of practice restrictions). Things like simple dislocation reductions, amputations, on scene medical direction, and many other things. Its not useful often, but when EMS associated physicians (in contrast to random physicians) are on scene are, they really are. A perfect example would be the MCI in Wake County a few months ago. 40-50 some odd high school students came down with varying degrees of food poisoning. Instead of transporting everyone, they (including one of their medical directors) treated most of the students on scene with IV fluids and antiemetics and only ended up transporting something like 5 students.
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Cmon JP, what does a doctor know that a paramedic doesn't ;)
 
That I'm not a paragod in the emergency room like this dude..

http://www.emsresponder.com/article/article.jsp?id=3008


Favorite quote from that:
Every now and then he'll let a resident do an ET tube, but they have to be quick to ask. In those instances he'll stand behind the resident watching every move, ready to take over in an instant.
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For what ever reason, I just get this picture of this guy trying to tell a 3'rd year EM resident how to intubate a patient.
 
JPINFV said:
That I'm not a paragod in the emergency room like this dude..

http://www.emsresponder.com/article/article.jsp?id=3008


Favorite quote from that:


For what ever reason, I just get this picture of this guy trying to tell a 3'rd year EM resident how to intubate a patient.
Click to expand...

So the guy with a year of training is watching "Closely" over the medical student with six or seven years of education?

How about when I enter a trauma room after an MVA and rack up two hundred thousand dollars in bills you assure me the guy/gal working on me has a f'n degree in something.
 
Not a medical student, a resident who has completed medical school and is now specializing...
 
JPINFV said:
Not a medical student, a resident who has completed medical school and is now specializing...
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Oh even better.

Well at least their saving a few bucks. :wacko:
 
JPINFV said:
Assuming that you just have the same tools that are on a normal paramedic ambulance (after all, physicians don't have scope of practice restrictions). Things like simple dislocation reductions, amputations, on scene medical direction, and many other things. Its not useful often, but when EMS associated physicians (in contrast to random physicians) are on scene are, they really are. A perfect example would be the MCI in Wake County a few months ago. 40-50 some odd high school students came down with varying degrees of food poisoning. Instead of transporting everyone, they (including one of their medical directors) treated most of the students on scene with IV fluids and antiemetics and only ended up transporting something like 5 students.
Click to expand...

Amputations? Please explain to me what the M.D. can do for an amputation outside of a hospital with our equipment?

Dislocation reductions can be done by Paramedics when its a true emergency in most areas, for example... if no pulse is present. Although yes a simple shoulder dislocation could easily be set back by the doc... it could also be properly transported to him for the procedure to take place at the hospital.

MCI, It makes sense to bring an M.D. to that, but they can bring him/her from the hospital, just like they can bring the surgeon to a person who needs a field amputation.

While a doctor is always the best choice and the ultimate definitive care choice, they do not grow on tree's. Otherwise Paramedics, nurses, tech's, would not exists as they do today. To me it seems like a perfectly good waste of a physician, but then again he is doing this in his spare time it appears, as a volunteer.
 
Yes the BASICS Doctors are all volunteers who recieve no payment for thier services or expertise.

Most of them are anaesthetists or emergency medicine consultants who will see more severe trauma and critically sick people in a week than your average Paramedic sees in a year, as BASICS only go to critically sick or injured patients.

In these cirumstances a true expert in anaesthesia, airway and circulatory support is going to bring a wealth of knowledge and experience that an ambulance crew does not have.

Intubating somebody in VF who is as good as dead is no where near the same as gaining adequate airway and circulatory assistance in a patient who is still conscious and needs knocking out and intubating.

Would you trust an ambo to do a prehospital thoracotomy?
 
schulz said:
Amputations? Please explain to me what the M.D. can do for an amputation outside of a hospital with our equipment?
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I think the idea is that the M.D. can /perform/ an amputation where indicated. For example, if the patient is trapped and can't be extricated.
 
EMSLaw said:
I think the idea is that the M.D. can /perform/ an amputation where indicated. For example, if the patient is trapped and can't be extricated.
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Gotcha, that makes more sense.
 
Makes Decisions

Everytime an EMT-B starts spouting about how adding a few skills, like IVs or ET tubes,makes them just as capable as a medic this board lights up with posts about limited knowledge and skills.

A physician can perform more "skills" than a paramedic in any environment. I am not yet a physician and I can make the scalpel in an OB kit go a long way. I can also mix and match the medications already available on most ambulances in ways paramedics would never get orders for.

But just like the basic/medic argugment, it is not the skills a physician performs. Which is all people see so they think they can simply emulate "in a monkey see monkey do" fasion like ACLS. It is the knowledge of a physician coupled with an unlimited license to practice medicine that makes a physician valuable in any environment.

It is why when disaster strikes the powers that be don't ask to take medics to Haiti, SE Asia, Africa, or anywhere else. They ask for Physicians. The IRC doesn't post positions for paramedics for hire. But they have a special help wanted page for those always in demand. Those posts are for Physicians.

As far as field amputations, they are very rare, and it is not a tough skill to master. Nor is the seemingly larger than life RSI, that many EMS agencies use as the measure of their capability and medical mastery, particularly difficult.

A physician is not beholden to xray or lab values to function. I can't speak for all schools, but at mine we are taught to function without them. Not only can I read radiology and know what all those values on the lab page could be, I can add water to partially filled blood tubes, run the test and calculate the difference to acheive a value when the lab says the quantity is insufficent. I can prepare and read my own microscope slides, I don't need a lab tech to do it. On some patients I can even DX a kidney stone by palpating the abd. We are taught and tested on how to localize the area of a stroke or neural deficit with physical exam techniques. If you can't do it you don't pass neuroscience.

I can tell not only when a patient is sick or not sick, but I can determine how sick and how long they might be able to go before needing medical care as well as what kind. So a fully functional physician has a far greater ability to disposition than a medic could ever hope for. A physician who can direct admit to a needed service and skip the time and diagnostics of the emergency room can save a lot of resources.

Having worked at places with a physician on the ambulance, even many of the "routine" calls can be better dealt with than a ride to the ED. Need a prescription refil? Done! Missed dialysis? They can call and get you a spot. IV or PO antibiotics for your infected wound site? Change your Catheter? I could go on for pages.

Now in the US we simply don't have enough physicians to put them on every or even some ambulances. But it certainly is not a waste when one is on an ambulance for any reason.

It is the knowledge of a physician that makes them valuable. That same knowledge allows them to diagnose and treat patients in ways that make the few procedures most paramedics can do look quite pathetic.
 
I think Vene hit the nail on the head; you cannot compare a Technician to an Intensive Care Paramedic nor can you compare a[n Intensive Care] Paramedic to a Physician.

Most of the BASICS Doc's work seems to be at RTAs, shootings, stabbings and falls from height where theier anaesthesia and airway/circulatory support expertise is put to good use over and above what the Paramedic crew can do.

Hey guess what I remembered we have a simmilar scheme here in the Wellington region .... but they where red jumpsuits tho. Red? I mean come on :D

Resize%20of%20EMS%20trauma%20059.jpg


www.kapitiems.org.nz
 
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schulz said:
While a doctor is always the best choice and the ultimate definitive care choice, they do not grow on tree's.
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As stated by me, a physician is always the best choice and the ultimate definitive care choice. The whole ultimate goal of the Paramedic on every call is to transfer care to the M.D.
I am not in anyway saying a Paramedic is like a physician.( although I bet some ICP in south Africa and aus would argue with me lol) You can not compare 1-2 years of training to 8. I can see what your saying buy cutting out the middle man, there just is not a real reason to. Lets say the doc does 5 runs a day on the chopper. How many more patients could he have helped in the ED that day? There are just simply not enough doctors. There are not even enough doctors at hospitals. Which is why we have Paramedic's in the first place. Latin for "Para" is also Greek (beside) Latin for "medic" is physician. Together meaning beside a physician.
 
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I don't think there's anyone here advocating for physicians to replace paramedics. What I, personally, will advocate is that having a physician available for field responses for special circumstances is beneficial.
 
MrBrown said:
Hey guess what I remembered we have a simmilar scheme here in the Wellington region .... but they where red jumpsuits tho. Red? I mean come on :D
www.kapitiems.org.nz
Click to expand...

I like the red, but I think I would rather have a good pair of boots than the running shoes this doc seems to fancy.

Too much time for me as a medic I guess...
 
Well to elaborate on Mr. Brown's jumpsuit with "Doctor" on the back. One thing is for sure, (G rated version) The guy has to be a babe magnet, prob why he really does it. Flying in from above in his chariot of the sky, jumping off looking fly "saving the day" with "DOCTOR" in huge print on him.
I recommend he grow his hair out though so it can flow majestically through the air as the rotor blades spin. Maybe even some music playing from the helo when he arrives.
 
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