Delete American paramedics.

[EMRRx]

I have been checking out EMTLIFE and have really enjoyed the discussions.

I wanted to make a few comments about this topic.

For those that go though a MD, Pharm.D., DDS program, it is not required to have a BS/BA degree first. I do not know the percentages but my guess is that a very large percent do not have a bachelors.
Infact, many of the above mentioned programs do not require A&P to be accepted, very similar to Paramedic School, however highly recommended.

NP and PA programs are typicallly 16-18 months. PA programs are not considered master level programs. For the NP program, you must 1st be an RN, other than that, the NP/PA programs are nearly identical.

Most nurses out there are RN's from typical Junior College or private nursing programs that run from 3 to 4 semesters. Today, many more are getting their BSN(Bachelors of Science in Nursing) as these programs have become more and more avaialble. Hopefully Paramedic schools with begin to do the same.

The typical RN would not be at the same EMS level as a Paramedic and infact most NP, PA, and BSN's would not be considered equal level providers as Paramedics unless they had additional specialized training in EMS.
Most RN's are not ALS trained unless they work in ICU, ER, or another department that has it as a requirement unlike all Paramedics which are all ALS.

Most RN's will never intubate, needle decompress a tension pneumothorax, etc, during their entire training and career.

Nurses work extremely demanding shifts, put up with a lot of "crap",from patients and higher level providers, etc so they must be compensated well or few would do this job.

I think the idea of moving from Paramedics to MD's, NP's, PA's does not make sense, mainly because all these providers(less and ER/EMS physican), would have to go through a lot of additional EMS training to be an equal of a Paramedic in the Pre hospital setting.

I know if something happened to me or my family that required EMS, I would want a Paramedic to care for me or my family in the field over a general practioner(MD,NP,PA,or RN) any day. Most of them have very little to no EMS training and if they do, they rarely ever, or never get to use the training as to be proficient. Now, if it is a ER/EMS physicain, or NP,PA,RN that I knew had the additonal EMS training, that might be ok, but how would I know that if I did not know the provider personally.

 

[systemet]

For those that go though a MD, Pharm.D., DDS program, it is not required to have a BS/BA degree first. I do not know the percentages but my guess is that a very large percent do not have a bachelors.

This varies widely depending on geographic location. In the US/Canada, most MD / DDS applicants have an undergraduate degree. The numbers I've heard are somewhere around 15% have Master's or PhD's, about the same amount just have 2 years of undergraduate.

In other countries medicine may be an undergraduate program that you enter out of high school.

I have never heard of a PharmD program that doesn't require a Bachelor's or Master's degree to enter. That doesn't mean they don't exist, but I haven't encountered them.

Infact, many of the above mentioned programs do not require A&P to be accepted, very similar to Paramedic School, however highly recommended.

Prerequisites vary by school. Most US/Canadian med schools require you to write the MCAT, and most usually want a minimum selection of science courses, equivalent to two years study.

There are some alternative entry programs that don't require an MCAT or a science background, but most of these require a completed undergraduate degree. These are the minority of programs.

NP and PA programs are typicallly 16-18 months. PA programs are not considered master level programs. For the NP program, you must 1st be an RN, other than that, the NP/PA programs are nearly identical.

Depends on the program. Most Bachelor's PA programs are either a full program or require you to already have a degree. There's an increasing number of Master's programs for entry. Most NPs programs require that you have a BScN/BSN.

Most nurses out there are RN's from typical Junior College or private nursing programs that run from 3 to 4 semesters.

This depends very much on where you are. Some places are setting a Bachelor's degree for entry to practice. Where I used to work, even with a medic cert and a science degree, I was looking at 22 months to get a BScN. (I didn't do it).

Today, many more are getting their BSN(Bachelors of Science in Nursing) as these programs have become more and more avaialble. Hopefully Paramedic schools with begin to do the same.

The typical RN would not be at the same EMS level as a Paramedic and infact most NP, PA, and BSN's would not be considered equal level providers as Paramedics unless they had additional specialized training in EMS.
Most RN's are not ALS trained unless they work in ICU, ER, or another department that has it as a requirement unlike all Paramedics which are all ALS.

Of course not! They're not trained to do EMS, but it's also not like a medic is trained to be an RN. Granted, there's a lot of overlap, but it makes no sense to expect to train for a completely different role, and then be competent at someone else's job.

Most RN's will never intubate, needle decompress a tension pneumothorax, etc, during their entire training and career.

Why would they?

A needle decompression is something you do before you put in a chest tube. When is an RN going to be in a position to need to do this, when a doctor isn't going to be present?

Same thing with intubation. Most of the situations where this is likely to happen you have a physician present. This is their responsibility. In the settings where RNs do intubate, usually they're nurse anesthetists, or they've receive training in prehospital medicine to work flight / EMS, etc.

This is a typical logical flaw in paramedic thinking. We assume because we ram plastic down someone's trachea that because usually only doctors do (or nowadays, PAs, a few RRTs, nurse anesthetists, etc.) that we're somehow better than providers working in a controlled setting with better resources. Our scope of practice is broad because we work in an environment without physicians, dealing episodically with sick people in whom the risk of us performing the technique in an unskilled manner is generally outweighed by the potential benefit, or the anticipated deterioration that will happen if treatment is deferred to a more suitable environment. [An even this is very much in question, see RSI in closed head injury].

Nurses work extremely demanding shifts, put up with a lot of "crap",from patients and higher level providers, etc so they must be compensated well or few would do this job.

I think the idea of moving from Paramedics to MD's, NP's, PA's does not make sense, mainly because all these providers(less and ER/EMS physican), would have to go through a lot of additional EMS training to be an equal of a Paramedic in the Pre hospital setting.

I think an MD from a suitable specialty would need very little extra training to function in the prehospital environment. See: any good flight program.

If you look at the overlaps between nursing and EMS, you're probably not looking at more than a year to cover the difference, if the nurse has acute care experience. Many of the countries that have nurse-based EMS have providers with a Bachelor's degree, a year or two of ICU / ER experience, and then a postgraduate diploma or Master's degree in prehospital care.

I know if something happened to me or my family that required EMS, I would want a Paramedic to care for me or my family in the field over a general practioner(MD,NP,PA,or RN) any day.

Depends on the provider, and their experience with emergency medicine. No fellowship trained EM doc is going to have more than minor teething problems if you throw them in an ambulance. Another specialty, e.g a rheumatologist might be a different story.

If you take an RN from a medical ward and throw them in an ambulance without any training, they're going to drown. But so's a paramedic if you throw them on a medical ward without any training.

Other countries have managed to train RNs to work as paramedics, and MDs to work in ambulances. It is possible. The question is more, whether it's desirable.

 

[systemet]

For those that go though a MD, Pharm.D., DDS program, it is not required to have a BS/BA degree first. I do not know the percentages but my guess is that a very large percent do not have a bachelors.

This varies widely depending on geographic location. In the US/Canada, most MD / DDS applicants have an undergraduate degree. The numbers I've heard are somewhere around 15% have Master's or PhD's, about the same amount just have 2 years of undergraduate.

In other countries medicine may be an undergraduate program that you enter out of high school.

I have never heard of a PharmD program that doesn't require a Bachelor's or Master's degree to enter. That doesn't mean they don't exist, but I haven't encountered them.

Infact, many of the above mentioned programs do not require A&P to be accepted, very similar to Paramedic School, however highly recommended.

Prerequisites vary by school. Most US/Canadian med schools require you to write the MCAT, and most usually want a minimum selection of science courses, equivalent to two years study.

There are some alternative entry programs that don't require an MCAT or a science background, but most of these require a completed undergraduate degree. These are the minority of programs.

NP and PA programs are typicallly 16-18 months. PA programs are not considered master level programs. For the NP program, you must 1st be an RN, other than that, the NP/PA programs are nearly identical.

Depends on the program. Most Bachelor's PA programs are either a full program or require you to already have a degree. There's an increasing number of Master's programs for entry. Most NPs programs require that you have a BScN/BSN.

Most nurses out there are RN's from typical Junior College or private nursing programs that run from 3 to 4 semesters.

This depends very much on where you are. Some places are setting a Bachelor's degree for entry to practice. Where I used to work, even with a medic cert and a science degree, I was looking at 22 months to get a BScN. (I didn't do it).

Today, many more are getting their BSN(Bachelors of Science in Nursing) as these programs have become more and more avaialble. Hopefully Paramedic schools with begin to do the same.

The typical RN would not be at the same EMS level as a Paramedic and infact most NP, PA, and BSN's would not be considered equal level providers as Paramedics unless they had additional specialized training in EMS.
Most RN's are not ALS trained unless they work in ICU, ER, or another department that has it as a requirement unlike all Paramedics which are all ALS.

Of course not! They're not trained to do EMS, but it's also not like a medic is trained to be an RN. Granted, there's a lot of overlap, but it makes no sense to expect to train for a completely different role, and then be competent at someone else's job.

Most RN's will never intubate, needle decompress a tension pneumothorax, etc, during their entire training and career.

Why would they?

A needle decompression is something you do before you put in a chest tube. When is an RN going to be in a position to need to do this, when a doctor isn't going to be present?

Same thing with intubation. Most of the situations where this is likely to happen you have a physician present. This is their responsibility. In the settings where RNs do intubate, usually they're nurse anesthetists, or they've receive training in prehospital medicine to work flight / EMS, etc.

This is a typical logical flaw in paramedic thinking. We assume because we ram plastic down someone's trachea that because usually only doctors do (or nowadays, PAs, a few RRTs, nurse anesthetists, etc.) that we're somehow better than providers working in a controlled setting with better resources. Our scope of practice is broad because we work in an environment without physicians, dealing episodically with sick people in whom the risk of us performing the technique in an unskilled manner is generally outweighed by the potential benefit, or the anticipated deterioration that will happen if treatment is deferred to a more suitable environment. [An even this is very much in question, see RSI in closed head injury].

Nurses work extremely demanding shifts, put up with a lot of "crap",from patients and higher level providers, etc so they must be compensated well or few would do this job.

I think the idea of moving from Paramedics to MD's, NP's, PA's does not make sense, mainly because all these providers(less and ER/EMS physican), would have to go through a lot of additional EMS training to be an equal of a Paramedic in the Pre hospital setting.

I think an MD from a suitable specialty would need very little extra training to function in the prehospital environment. See: any good flight program.

If you look at the overlaps between nursing and EMS, you're probably not looking at more than a year to cover the difference, if the nurse has acute care experience. Many of the countries that have nurse-based EMS have providers with a Bachelor's degree, a year or two of ICU / ER experience, and then a postgraduate diploma or Master's degree in prehospital care.

I know if something happened to me or my family that required EMS, I would want a Paramedic to care for me or my family in the field over a general practioner(MD,NP,PA,or RN) any day.

Depends on the provider, and their experience with emergency medicine. No fellowship trained EM doc is going to have more than minor teething problems if you throw them in an ambulance. Another specialty, e.g a rheumatologist might be a different story.

If you take an RN from a medical ward and throw them in an ambulance without any training, they're going to drown. But so's a paramedic if you throw them on a medical ward without any training.

Other countries have managed to train RNs to work as paramedics, and MDs to work in ambulances. It is possible. The question is more, whether it's desirable.

 

[Veneficus]

For those that go though a MD, Pharm.D., DDS program, it is not required to have a BS/BA degree first. I do not know the percentages but my guess is that a very large percent do not have a bachelors.

Guess again...

Even 6 year medical programs in countries outside the US and Canada, upon completion of the 2nd year are considered a bachelor's of basic science or bachelor's of basic medicine. (I don't know anyone who actually asked for one of these diplomas that actually finished a medical program.

I have never met a US doctor who didn't have a bachelor's prior to matriculation to medical school.

Infact, many of the above mentioned programs do not require A&P to be accepted, very similar to Paramedic School, however highly recommended.

This is because Anatomy and physiology are seperate disciplines and therefore classes.

The depth of the graduate medical education is far more than what is taught in these basic a/p classes. In terms of time, my anatomy class alone is over 700 hours in class and lab. (not including time spent pulling my brains out at home)

For physiology we used 3 texts, the primary being Guyton's medical physiology, for anatomy, I used 2 texts (primary daley and moore's clinical oriented anatomy) and 5 atlases. (sabota 2 volume set being the primary)

Most RN's will never intubate, needle decompress a tension pneumothorax, etc, during their entire training and career.

Neither will most medics or most doctors, what is your point? The ones who do will actually be really good at it.

I think the idea of moving from Paramedics to MD's, NP's, PA's does not make sense, mainly because all these providers(less and ER/EMS physican), would have to go through a lot of additional EMS training to be an equal of a Paramedic in the Pre hospital setting.

:rofl: :rofl: :rofl:

I can't decide if you are trolling or just do not understand medial education. In most European nations, most ED directors as well as ambulance docs are anesthesiologists. Even in America, prehospital and emergency medicine is part of their curriculum.

I have never met a surgeon who could not intubate or defibrillate. Emergency procedures, both field and in hospital are part of the surgical curriculum.

Did you know the airway procedures for trauma patients in EMS were drawn up by the American College of Surgeons?

But wait, there's more...

OB/GYN is the only medical specialty outside the US that is a combination of surgery and medicine. Whether they are removing your appendix, delivering a baby, or using pharmacology to manipulate hormones in a brain and thyroid, these are some of the most capable and underestimated providers anywhere. (the first 2 years of their residency is learning general surgery)

I can't speak for skills outside of Europe, but not only do we have a semester of what amounts to 10 months of paramedic class, we have multiple clinical rotations that require us to get signed off on more skills than any paramedic. (Including intubation)

Ortho surgery are also the original trauma experts. They also still learn all of those "paramedic" skills as part of their curriculum.

I know if something happened to me or my family that required EMS, I would want a Paramedic to care for me or my family in the field over a general practioner(MD,NP,PA,or RN) any day.

No thanks, I'll take the doctor. Particularly any who went through the same curriculum I did. I don't care if they specialized later in diagnostic radiology.

Most of them have very little to no EMS training and if they do, they rarely ever, or never get to use the training as to be proficient..

:rofl: guess again.

Now, if it is a ER/EMS physicain, or NP,PA,RN that I knew had the additonal EMS training, that might be ok, but how would I know that if I did not know the provider personally.

I really think you have no idea what exactly a doctor is or can do.

As for the rest, I have never met a competent PA whos ability was equal the ego.

I know a handful of NPs, none in the emergency field, but if I was having a cardiac problem, or my wife/daughter having an OB/Gyn problem, I would be happy to see the ones I know anyday and twice on sunday.

I know several RN/medics, flight RNs, CCRNs, and Emergency RNs that I would likewise trust anyday. It is readily apparent when they begin acting who works in a discipline equally as valuable as a medic.

 

[tacitblue]

I have been checking out EMTLIFE and have really enjoyed the discussions.

I wanted to make a few comments about this topic.

For those that go though a MD, Pharm.D., DDS program, it is not required to have a BS/BA degree first. I do not know the percentages but my guess is that a very large percent do not have a bachelors.
Infact, many of the above mentioned programs do not require A&P to be accepted, very similar to Paramedic School, however highly recommended.

NP and PA programs are typicallly 16-18 months. PA programs are not considered master level programs. For the NP program, you must 1st be an RN, other than that, the NP/PA programs are nearly identical.

Most nurses out there are RN's from typical Junior College or private nursing programs that run from 3 to 4 semesters. Today, many more are getting their BSN(Bachelors of Science in Nursing) as these programs have become more and more avaialble. Hopefully Paramedic schools with begin to do the same.

The typical RN would not be at the same EMS level as a Paramedic and infact most NP, PA, and BSN's would not be considered equal level providers as Paramedics unless they had additional specialized training in EMS.
Most RN's are not ALS trained unless they work in ICU, ER, or another department that has it as a requirement unlike all Paramedics which are all ALS.

Most RN's will never intubate, needle decompress a tension pneumothorax, etc, during their entire training and career.

Nurses work extremely demanding shifts, put up with a lot of "crap",from patients and higher level providers, etc so they must be compensated well or few would do this job.

I think the idea of moving from Paramedics to MD's, NP's, PA's does not make sense, mainly because all these providers(less and ER/EMS physican), would have to go through a lot of additional EMS training to be an equal of a Paramedic in the Pre hospital setting.

I know if something happened to me or my family that required EMS, I would want a Paramedic to care for me or my family in the field over a general practioner(MD,NP,PA,or RN) any day. Most of them have very little to no EMS training and if they do, they rarely ever, or never get to use the training as to be proficient. Now, if it is a ER/EMS physicain, or NP,PA,RN that I knew had the additonal EMS training, that might be ok, but how would I know that if I did not know the provider personally.

There are some medical schools that in theory only require 90 units prior to acceptance. 90 units is still 90 units of college and includes the pre-req science courses in general biology, chemistry, and organic chemistry. These three core series classes far exceed the basic science background one would learn in an undergrad anatomy/physiology course. Medical students go into graduate level anatomy and physiology in med school, after having been through 3-4 years of college level science.

That being said, it is a de facto requirement to obtain a BA/BS prior to applying to medical school; the overwhelming majority if not every medical student accepted will have at least an undergraduate degree.

PA schools are required by their accrediting body (ARC-PA) to have a curriculum that meets their minimum standards, which is graduate level material. No matter what degree the PA program awards, it will teach to this minimum national standard. Also, PA programs require a pre-clinical year that teaches medical science followed by a clinical year in which the students rotate in every major medical discipline (medicine, surgery, OB/GYN, psych, pedi). On graduation, every PA will have completed this. Contrasted to NP programs where the students are required to only do one or two rotations in their specific area of specialization....

 

[St George]

Dont delete them. Just replace them with degree educated, state registered healthcare professionals with complete clinical autonomy and legal authorisation to prescribe a range of medication (currently 29 different drugs in the UK). Works very well (albiet not perfectly) in countries with such a system.

 

[RocketMedic]

Agree with St. George, but why are we hating the "medical director" concept?


Also, I need to go back to school. What's a useful degree to aim for?

 

[Veneficus]

Agree with St. George, but why are we hating the "medical director" concept??

I voted for upskill the medics, I just prefer the MD better because of the current diversity available in treatment.

As for hating on a medical director, most are only an official signiture, of the ones left, many lack the anatomy/ability to actually provide direction outside of consensus from 40 years ago. Very few are actually useful for understanding/implementing current medicine at all.

Also, I need to go back to school. What's a useful degree to aim for?

MD

(For future reference MD and DO are synonymous and I am not typing both out everytime.)

 

[Maine iac]

I think some services have pretty stellar med directors and some have lousy at best med directors, which is where the dislike comes from. The few that I've worked with have been super helpful, but I have heard stories just like everybody I'm sure has.

Rocketmedic, what interests you? If you are good you can spin almost any degree to your advantage. If you are looking to upgrade to mangt at some point, I am sure any of the Business degrees would be good, or the actual EMS BS degree. If you are gung-ho get an MBA or MHA. All really just depends on what you are interested in.

 

[jjesusfreak01]

No thanks, I'll take the doctor. Particularly any who went through the same curriculum I did. I don't care if they specialized later in diagnostic radiology.

Ehh, for a few years. I don't expect the diagnostic radiologists to remember everything from med school forever, but I do expect paramedics to increase in knowledge the longer they work in the field.


Another thing to note is that there is one really really big problem with moving medics towards 2 and 4 year degrees. Almost all paramedic certs and degrees in the US come from either cert mills, or at best, 2 year degree schools. For us to move towards 4 year degrees as the standard, we need a huge increase in the number of Bachelors in Emergency Medicine programs at our 4 year colleges. The NREMT is going to rid us of the medic mills for the most part by requiring degrees for medics, but its going to take a sea change in the system to allow medics to advance beyond that. Making it a 2 year post-bac program puts it equivalent to PAs, or a bachelors level program puts it at the same level as BSNs. The question really is whether its even necessary for paramedics to have a higher level degree (above associates), and even if they do move to that how are they going to achieve the higher level of responsibility and scope that they will want at that point.

It just seems to me that there are a lot of really strong impediments to the advancement of EMS in the US, from education, to nursing, to fire, to the climate of litigation. I don't know how EMS is going to be able to move past them.

 

[Veneficus]

Ehh, for a few years. I don't expect the diagnostic radiologists to remember everything from med school forever,.

I'll take my chances.

but I do expect paramedics to increase in knowledge the longer they work in the field.,.

You expect a lot.

Next time I am in the US, I invite you to come and see what I do teaching.

clipped for brevity

It just seems to me that there are a lot of really strong impediments to the advancement of EMS in the US, from education, to nursing, to fire, to the climate of litigation. I don't know how EMS is going to be able to move past them.

Never fear, when the system goes broke, change will come. The only question will be whether or not EMS providers position themselves for success prior to the collapse or it becomes an even less sustainable career option because they didn't after.

I made a suggestion to a respected EMS leader that an easy way to change the amount of medics with degrees was simply to require all active medics without one to take specific college courses as continuing ed.

This exact strategy was successful for the fire science degrees in the fire service.

Why reinvent something that already works?

 

[EpiEMS]

The BSN was/is a logical change for the nursing field. A Bachelor's degree focused on emergency care would professionalize the EMT-P further. Makes sense to do it.

 

[St George]

The BSN was/is a logical change for the nursing field. A Bachelor's degree focused on emergency care would professionalize the EMT-P further. Makes sense to do it.

It does, and we did.

 

[medicsb]

Guess again...
I can't decide if you are trolling or just do not understand medial education. In most European nations, most ED directors as well as ambulance docs are anesthesiologists. Even in America, prehospital and emergency medicine is part of their curriculum.

I was unsure, but on a cursory search, EM is a very small component of anesthesia training, if at all incorporated. My school indicates no requirement for anesthesia residents to rotate through the ED. They may be present on trauma or when summoned for the unusually difficult airway, but overall the ED is NOT part of anesthesia's primary domain in the academic setting. And of any physicians that get out into the prehospital setting, almost all are EM trained.

I have never met a surgeon who could not intubate or defibrillate. Emergency procedures, both field and in hospital are part of the surgical curriculum.

In my neck of the woods, it is quite rare for a surgeon to intubate. Actually, I've never heard of it (outside of surgical airways).

No thanks, I'll take the doctor. Particularly any who went through the same curriculum I did. I don't care if they specialized later in diagnostic radiology.

Maybe you were being hyperbolic with the diagnostic radiologist part, but I would disagree with the notion that any physician is better than any paramedic in an emergency. Though I would "take a doctor", I'd probably be VERY careful about which type of doctor. Despite the intense curriculum of medical school, the didactic years cover very little about emergency management of patients. And though I have yet to start my clinical years, from all my interactions with medical students and residents is that though there is exposure to emergency care in the clinical years, it is no where enough to be proficient.

Seeing as we are on other sides of the pond, there are clearly some big differences between medical training in the US and abroad. My medical curriculum has minimal emphasis on clinical procedures. While we will do certain procedures during our clinical years, I don't know of having to be signed off on anything other than CPR and history and physical exam (of which the most invasive would be pelvic and rectal exams).

 

[Veneficus]

I was unsure, but on a cursory search, EM is a very small component of anesthesia training, if at all incorporated. My school indicates no requirement for anesthesia residents to rotate through the ED. They may be present on trauma or when summoned for the unusually difficult airway, but overall the ED is NOT part of anesthesia's primary domain in the academic setting. And of any physicians that get out into the prehospital setting, almost all are EM trained.

I do not suggest they have to rotate through the ED in the US. I also don't think it is beneficial.

I am talking about emergency resuscitation, which is only slightly different than what is done every day in a unit or surgery.

Sure they won't really know how to splint a fx, but nothing an ATLS course will not solve.

Actual emergencies are a very small component of EM. Just like EMS. Anesthesia has no need to determine who gets admitted or treated and released, they need only to be able to take care of a very sick patient.

In my neck of the woods, it is quite rare for a surgeon to intubate. Actually, I've never heard of it (outside of surgical airways).

Not many actually do, they are still trained. Without paralytics. (Sounds rather like many in EMS doesn't it?)

Maybe you were being hyperbolic with the diagnostic radiologist part, but I would disagree with the notion that any physician is better than any paramedic in an emergency.

Not better than any, better than what I experienced as the mean. Radiologists still have to know about anatomy and pathology, the basic medical education (at least here) is more than enough to give them a decent chance to help in an emergency.

For certain not at the level of a highly competent paramedic, but, there is an important adjective there.

Though I would "take a doctor", I'd probably be VERY careful about which type of doctor. Despite the intense curriculum of medical school, the didactic years cover very little about emergency management of patients. And though I have yet to start my clinical years, from all my interactions with medical students and residents is that though there is exposure to emergency care in the clinical years, it is no where enough to be proficient.

That is unfortunate.

Seeing as we are on other sides of the pond, there are clearly some big differences between medical training in the US and abroad. My medical curriculum has minimal emphasis on clinical procedures. While we will do certain procedures during our clinical years, I don't know of having to be signed off on anything other than CPR and history and physical exam (of which the most invasive would be pelvic and rectal exams).

I have a 13 page list I have to perform at an acceptable level and had to get signed off by the respective departments. It does not cover everything I have done though.

I'll spare us both the typing, suffice to say everything a nurse or paramedic does, and some of the more notable ones:

fixation of fx limb
assist in surgery
wound care and suturing
colposcopy
just about every type of exam imaginable (ophtho, psych, pelvic, etc.)
various "first aid" skills,(tube thoracostomy, intubation, surgical cric, burn care and patient ambulance transport)
pleurocentesis
peritoneocentisis

definately I am not an expert at all these things, but I can do the whole list to an "acceptable" level today.

 

[medicsb]

I am talking about emergency resuscitation, which is only slightly different than what is done every day in a unit or surgery.

I think there is a level of complexity added to the resuscitation when the patient is undifferentiated, especially when the patient is wheeled through the doors already circling the drain. By the time the patient is in the ICU or OR, there is a general diagnosis made, which certainly can serve to stream-line further resuscitative efforts (obviously, I'm not speaking of strictly cardiac arrests), especially considering that many of the ICU patients have IV access, hemodynamic monitoring, radiology reports, and blood work to help guide the physician no matter their flavor. Now, certainly, that is not always the case, but as I know it, it is much less common.

Actual emergencies are a very small component of EM. Just like EMS.

I don't disagree with this, but with many EM physicians averaging 1-2 patient contacts per hour, they are sure to encounter critical patients and resuscitation more frequently than those in EMS and more so than most other specialties.

Not many actually do, they are still trained. Without paralytics. (Sounds rather like many in EMS doesn't it?)

I'll Agree.

Not better than any, better than what I experienced as the mean. Radiologists still have to know about anatomy and pathology, the basic medical education (at least here) is more than enough to give them a decent chance to help in an emergency.

Yeah, but how long does that schooling maintain over the long term. If one has spent 20 years in a dimly lit cave, rarely interacting with real patients, I'm not too confident that they'll be of much help other than doing what they're told. But, again this is my American-centric view. Your radiologists may function much differently.

That is unfortunate.

Largely, I agree. This difference may be why EM HAD to become a specialty in the US when it did. Maybe had emergency care been covered better covered in medical training, EM would not have been necessary as we know it now, and maybe it would have taken a route similar to that in Europe (i.e. a subspecialty or anesthesia or another).

I have a 13 page list I have to perform at an acceptable level and had to get signed off by the respective departments. It does not cover everything I have done though.

I'll spare us both the typing, suffice to say everything a nurse or paramedic does, and some of the more notable ones:

fixation of fx limb
assist in surgery
wound care and suturing
colposcopy
just about every type of exam imaginable (ophtho, psych, pelvic, etc.)
various "first aid" skills,(tube thoracostomy, intubation, surgical cric, burn care and patient ambulance transport)
pleurocentesis
peritoneocentisis

definately I am not an expert at all these things, but I can do the whole list to an "acceptable" level today.

I know there are general requirements for clinical rotations, but a lot of the procedures are "do them if you get a chance", because of the competition with residents, who are mandated to get X number of Y procedures. Most of the procedural training comes with residency, where there are specific specialty requirements for which a resident must be signed off on. Our 4th year will likely provide great procedural exposure during sub-internships in the our prospective specialty. Basically our 3rd and 4th year are focused on us developing our skills in performing H&Ps, learning tests to order, interpret lab work and radiographs, forming differential diagnoses, working as part of a team, developing patient-physician relation ships, etc. Anyhow, I could be wrong, it will be another 5 months before I'm doing my clerkships, so I'll be able to provide a far better insight a year from now.

 

[Veneficus]

I think there is a level of complexity added to the resuscitation when the patient is undifferentiated, especially when the patient is wheeled through the doors already circling the drain. By the time the patient is in the ICU or OR, there is a general diagnosis made, which certainly can serve to stream-line further resuscitative efforts (obviously, I'm not speaking of strictly cardiac arrests), especially considering that many of the ICU patients have IV access, hemodynamic monitoring, radiology reports, and blood work to help guide the physician no matter their flavor. Now, certainly, that is not always the case, but as I know it, it is much less common.

I think in your near future you will find that the principles of resuscitation are actually very similar whether the pt is previously DXed or not.

What it really comes down to is supporting vital functions and managing the physiologic response of the body while searching for the underlying pathological process.

In my US experience, on critical patients, the ED tries to provide enough supportive care to get the pt to the required specialist. Which on a critical patient is likely to be surgery, some kind of interventional angio, or an ICU.

Otherwise they are usually using a simplified intensivist formula of maximizing Do2.

Just my thinking, but if a person can do the complex, it often takes them less effort for the simple.

I don't disagree with this, but with many EM physicians averaging 1-2 patient contacts per hour, they are sure to encounter critical patients and resuscitation more frequently than those in EMS and more so than most other specialties.

I'll Agree way more than EMS. Otherwise it depends on the specialist. Surprisingly, nephrology does considerable consults on post op and ICU patients. Ophtho is a near constant presence in NeoICUs.I would hope that intensivists and even surgeons see a large number of critical patients.

BUt I get your point, but I think location plays a big role in that. Since here many docs see their first job in the ED or on an ambulance, they carry that experience/knowledge with them when they move on from it.

Many still pick up ambulance or urgent care work as an easy part time gig.

Yeah, but how long does that schooling maintain over the long term. If one has spent 20 years in a dimly lit cave, rarely interacting with real patients, I'm not too confident that they'll be of much help other than doing what they're told. But, again this is my American-centric view. Your radiologists may function much differently.

In principle I agree with this. But in America being in that cave is likely the only thing that practicioner ever did, from residency on. Definately not much help in an emergency I'd wager.

But it is a bit different for a doctor who spent at least 7-8 months in med school emergency education, who might still work on an ambulance, ed, urgent care, austere environment, in addition to spending 40 hours in a dark cave.

As I mentioned, if the radiologist was educated with the curriculum here, I'll take them. I don't see much difference in a guy who hasn't done something in 20 years and has to recall than a guy (like many US medics) who may never have done something at all. (like intubate something other than Fred the head)

Largely, I agree. This difference may be why EM HAD to become a specialty in the US when it did. Maybe had emergency care been covered better covered in medical training, EM would not have been necessary as we know it now, and maybe it would have taken a route similar to that in Europe (i.e. a subspecialty or anesthesia or another).

I don't think the US system could function without EM for many reasons. like being too hyperspecialized and the ED being the major gateway as access to the medical system. (mostly because of how healthcare is funded.)

The US ED has become the health provider of first resort to many in America. Unfortunately its ability to handle this mission is moving rather slow.

One of the "wow" moments I had in rotations here was a few years ago when the pediatric surgeon (the only doctor) on duty in the ED (and she worked in both the ED and did residency in plastic surgery before becomming a peds surgeon) was scheduling her outpatient follow ups (from plastics and peds)to stop by the ED when she was working there.

I have seen many of the other specialists who work in the ED do the same thing since.

Can you imagine?

"I'll take care of your problem in my specialty clinic today and you can just drop by for your follow up in the ED after you get off work on friday or sunday, whatever works best for you."

Imagine how it would play out in the US if a kid came into the ED for a follow up from peds surgery.

It would probably take hours, maybe an admission, and a host of diagnostic tests to repel potential litigation.

That is why I get so agitated over how US EDs operate. It is a complete waste of time and money in most cases. If the radiologist here can work on an ambulance, an EM doc can certainly learn to do a little more primary care and follow it up.

Basically our 3rd and 4th year are focused on us developing our skills in performing H&Ps, learning tests to order, interpret lab work and radiographs, forming differential diagnoses, working as part of a team, developing patient-physician relation ships, etc. Anyhow, I could be wrong, it will be another 5 months before I'm doing my clerkships, so I'll be able to provide a far better insight a year from now.

That is my understanding of it. In 5 months I will be counting down the days on my fingers until I am done The end is near!!!

 

[RocketMedic]

People come to American ERs for follow ups all the time. Its generally pretity smooth.

 

[Veneficus]

People come to American ERs for follow ups all the time. Its generally pretity smooth.

For what and where?

I spent 4 years in an Urban ED in the US, in nearly 100K patients a year, I never saw somebody who came in for a follow up.

 

[RocketMedic]

Here in El Paso (granted, at an Army hospital), we see follow ups all the time.