EMT or Athletic Trainer

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Linuss

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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

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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..."
 

nwhitney

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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$$. Then again if you ask my wife she'll tell you I don't need to try, I'm a natural a$$.
 

EMT11KDL

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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
 

nwhitney

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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.
 

Linuss

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

EMT11KDL

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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
 

Tigger

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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.
 

Akulahawk

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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

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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.
 

Akulahawk

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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...
 

JPINFV

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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?
 

Akulahawk

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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...
 

Engine66

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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!!!
 

PotatoMedic

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

CANMAN

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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.
 

PotatoMedic

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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.
 

Akulahawk

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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.
 

hometownmedic5

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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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