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

[Akulahawk]

They were separate incidences, the one I spoke of touched off a change in our state which allowed a paramedic to perform any procedure the local medical director authorized to much more rigid statewide scope of practice. The latest state protocols are extremely conservative and now universal to all state services. It was definitely a step backward in my opinion.



Something I am all too familiar with However I was thinking more along the lines of emergent procedures like the crash c section. Usually when doing that, there is already significant fetal distress which is not responsive to treating the mother. (if she is even still alive)

Personally, I'd prefer a blend of the what your state had then and has now. There should be a single set of protocols that are common to ALL services. Why? So that any Paramedic can move around within the State and not have to learn the basics. Call it a Basic Scope of Practice, if you will. Then authorize each Local EMS Medical Director to authorize an expanded scope of practice and each Paramedic would "simply" have to be accredited for that procedure. Move out of that region and you leave your accreditations behind, but you still perform as a Basic Paramedic.

It is quite unfortunate that your state does NOT authorize a Paramedic to perform certain heroic measures AFTER making base contact. As I see it, if the mother is deceased and the fetus hasn't expired already, a crash c-section performed by someone authorized to do so, provides the best chance at life a fetus has instead of none. Those certain specific heroic measures should be documented though, in a heroic measures type of protocol. No base contact, no go for any of those.

I don't like the fact that mine doesn't authorize those either...

 

[Shishkabob]

Texas does it right with it's form of delegated practice

 

[emt seeking first job]

anyone have a link for a new york state version of those cards ?

thank you

 

[MSDeltaFlt]

I'm not sure if I understood the question completely, but I assume you are asking how would I be aware that my medical director has given permission for the physician to take over.

Our medical director keeps us updated with his cell # in case we cannot reach him via radio. I would pick up my phone call him, explain the situation and would say something like, "Dr. Smith, I have so and so patient here in critical condition, we are x minutes away from the medical center, and I have a bystander physician with me wishing to take over, he is an interventional cardiologist with X medical center and I felt it appropriate for him to speak with you before I allow him to take over any treatments" I would then hand the phone to the bystander physician so he could explain to Dr. Smith, why he wants to take over, why he feels physician accompanied transport is warranted, and can ask permission to take control. He would then hand me back the phone and Dr. Smith would either advise me to use him as an extra pair of hands, let him take over and have him ride with us to the medical center, or to not allow him to take over.

This is one of the situations where Dr. Smith does not have any problem whatsoever with us contacting him on his personal cell.

Hence why I said you'd be trumped. Because if a physician showed up on scene you'd put that physician on the phone with your physician and let them hash it out. That is what I meant.

 

[medicRob]

Hence why I said you'd be trumped. Because if a physician showed up on scene you'd put that physician on the phone with your physician and let them hash it out. That is what I meant.

Of course I would, and I agree. He went to medical school, I did not. If given the circumstances my medical director sees fit for the physician on scene to take over, by all means I will allow him to take over. This takes the liability off me in case something goes wrong, and it assures me that my medical director will not end up chewing me a new one when I get to the ER.

Now, that being said.. It is my choice completely as to whether or not I would even pick up the phone and contact my medical director, I have the authority to tell the bystander physician to get off my scene if I wish, although it would be quite ignorant of me to turn away a cardiologist on an MI patient, etc and I probably would not.

 

[MrBrown]

Our Officers can deliver an alternate dose of a drug or fluid or vary treatment from the Clinical Guidelines provided they can justify it.

This does not extend however to "winging it" and performing things that are not in any Offcers scope of practice such as performing a thoracotomy but rather gives us flexibility in deliving care rather than following a cookbook recipe.

A Doctor may request an Ambulance Officer perform a procedure that is not in thier scope of practice however they may only do so in good faith and may be declined.

 

[Seaglass]

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.

It's pretty weird, but not impossible. I was once in a system where I never even spoke to the official county medical director. I knew some medics who'd never met him either, though most of them had dealt with him somehow at one point or another. No way we'd have recognized him if he'd shown up on scene.

 

[Bloom-IUEMT]

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.

You just became my personal hero with this post!
This may be off topic (too bad mods!) but did you find medic school or MS I/MS II harder? Just curious...

 

[Too Old To Work]

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.

I don't find it hard to believe at all. Although I know and am on a first name basis with my medical director, in a lot of other services, the medical director is just a name on a form. In a system the size of NYC, it's quite possible not to recognize the medical director or even one of the assistants.

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

This is true. Doctors have more knowledge, but not much of a comfort level in emergencies unless they work in EM.

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

This is not true. I've had any number of doctors show up at emergencies over the years. With only one or two exceptions, they were out of their depth because they don't treat emergency patients on a regular basis. Someone who is a Primary Care Physician is not going to be better at intubating than a paramedic who does 15 or more tubes a year. Nor is a dermatologist going to know the ACLS protocols better than I do. When was the last time a psychiatrist started an IV or interpreted a 12 lead.

Paramedics have a very narrow body of knowledge in relation to the rest of the world. However, what we know, we generally know very well. A late friend of mine, who was a great doctor and early proponent of EMS was well known for saying that in his ideal world, he'd want to paramedics and two ER nurses on his code team and no one else.

 

[MrBrown]

Someone who is a Primary Care Physician is not going to be better at intubating than a paramedic who does 15 or more tubes a year. Nor is a dermatologist going to know the ACLS protocols better than I do. When was the last time a psychiatrist started an IV or interpreted a 12 lead.

Paramedics have a very narrow body of knowledge in relation to the rest of the world. However, what we know, we generally know very well. A late friend of mine, who was a great doctor and early proponent of EMS was well known for saying that in his ideal world, he'd want to paramedics and two ER nurses on his code team and no one else.

You may be better at a few psychomotor skills than a physician simply because you have more exposure to them but that is really a false positive and like comparing apples to oranges.

 

[Too Old To Work]

You may be better at a few psychomotor skills than a physician simply because you have more exposure to them but that is really a false positive and like comparing apples to oranges.

Not at all. I'll be better at assessing a patient because I do a lot of it. Non emergency physicians don't spend a lot of time dealing with emergent situations, but paramedics do. I can't assess someone to determine if they have cancer, which a physician can do. OTOH, I can assess someone with dyspnea and figure out if it's CHF or COPD. Physicians who don't do that on a regular basis probably can't.

The most important skill a paramedic possesses is assessment of patients in emergency conditions.

 

[CAOX3]

Not at all. I'll be better at assessing a patient because I do a lot of it. Non emergency physicians don't spend a lot of time dealing with emergent situations, but paramedics do. I can't assess someone to determine if they have cancer, which a physician can do. OTOH, I can assess someone with dyspnea and figure out if it's CHF or COPD. Physicians who don't do that on a regular basis probably can't.

The most important skill a paramedic possesses is assessment of patients in emergency conditions.

This is funny...

 

[rwik123]

Not at all. I'll be better at assessing a patient because I do a lot of it. Non emergency physicians don't spend a lot of time dealing with emergent situations, but paramedics do. I can't assess someone to determine if they have cancer, which a physician can do. OTOH, I can assess someone with dyspnea and figure out if it's CHF or COPD. Physicians who don't do that on a regular basis probably can't.

The most important skill a paramedic possesses is assessment of patients in emergency conditions.

i think you are underestimating something called medical school and residency. I'm pretty sure any doctor could identify CHF or COPD.. but you do have a point about the practical skiils.. id rather have a medic intubate me vs my primary care physician

 

[Too Old To Work]

i think you are underestimating something called medical school and residency. I'm pretty sure any doctor could identify CHF or COPD.. but you do have a point about the practical skiils.. id rather have a medic intubate me vs my primary care physician

No, not at all. I work in an area that has three medical schools. I see a lot of residents, in a lot of specialties. You'd be surprised how many of them can't differentiate CHF from Asthma. I also do a lot of ACLS teaching and have both residents and attendings in my classes. The ones that aren't EM physicians aren't that proficient at reading EKGs than the paramedics and RNs in the class. The ones that aren't anesthesiologists aren't any better at intubating than the medics in the class. A lot of doctors don't see acute patients in their daily practice and thus aren't very good at assessing them. Not all residency programs cover the same material. Pretty early on physicians have to start specializing because there is so much information in any given specialty or even sub specialty.

In the same vein, I'm not very good at reading Xrays or CT Scans since I don't do it very often.

 

[Veneficus]

You just became my personal hero with this post!
This may be off topic (too bad mods!) but did you find medic school or MS I/MS II harder? Just curious...

Actually, the hardest part I found was relearning things I thought I already knew.

What is taught in US paramedic class is a highly oversimplified version of a very few disease processes.

MSI and MSII isn't really harder, mostly because there is already a foundation of basic science that most US paramedics don't have, but it is more volumous. I don't think it is fair to say the first 2 years are "harder" but I would compare paramedic class as a sprint, and medical school as a marathon.

 

[Veneficus]

No, not at all. I work in an area that has three medical schools. I see a lot of residents, in a lot of specialties. You'd be surprised how many of them can't differentiate CHF from Asthma. I also do a lot of ACLS teaching and have both residents and attendings in my classes. The ones that aren't EM physicians aren't that proficient at reading EKGs than the paramedics and RNs in the class. The ones that aren't anesthesiologists aren't any better at intubating than the medics in the class. A lot of doctors don't see acute patients in their daily practice and thus aren't very good at assessing them. Not all residency programs cover the same material. Pretty early on physicians have to start specializing because there is so much information in any given specialty or even sub specialty.

In the same vein, I'm not very good at reading Xrays or CT Scans since I don't do it very often.

I think this is only accurate for US medical schools. (which I am rapidly finding are not nearly as good as schools in other parts of the world despite their propaganda) Myself and most of my classmates that spend the summer in the US are finding we put the 4th year students to shame.

 

[JPINFV]

id rather have a medic intubate me vs my primary care physician

Of course the difference between a physician and a paramedic is a non-anesthesia or EM physician knows their boundaries and most likely look for another method whereas a paramedic would attempt even if a proper analysis would dictate more prudent measures. There's a reason that paramedics get hammered in intubation studies and primary care physicians don't, despite intubation being in the legal scope of practice of both.

 

[MrBrown]

I think this is only accurate for US medical schools. (which I am rapidly finding are not nearly as good as schools in other parts of the world despite their propaganda) Myself and most of my classmates that spend the summer in the US are finding we put the 4th year students to shame.

Brown, MBChB, FANZCA, FJFICM has more letters than Brown, MD, FABA

... so by default it's better!

 

[mcdonl]

This is what we have in Maine...

It is right in our protocol books.

NON-EMS SYSTEM
MEDICAL INTERVENERS

Thank you for your offer of assistance.

Please be advised that these Emergency Medical Technicians are operating
under the authority of the State of Maine and under protocols approved by the State of Maine. These EMS providers are also operating under the authority of a Medical Control physician and standing medical orders.

If you are currently providing patient care, you will be relinquishing care to these EMS personnel and their Medical Control physician.

No individual should intervene in the care of this patient unless the individual
is:

1. requested by the attending EMT, and
2. authorized by the Medical Control physician, and
3. is capable of assisting, or delivering more extensive emergency
medical care at the scene.

If you are the patient’s own physician, PA, or nurse practitioner, the EMTs will work with you to the extent that their protocols and scope of practice allow.

If you are not the patient’s own physician, PA, or nurse practitioner,
you must be a Maine licensed physician who will assume patient management
and accept responsibility. These EMT’s will assist you to the extent that their protocols and scope of practice allow. They will not assist you in specific deviations from their protocols without Medical Control approval. This requires that you accompany the patient to the hospital, and that their Medical Control physician is contacted and concurs.

 

[Too Old To Work]

I think this is only accurate for US medical schools. (which I am rapidly finding are not nearly as good as schools in other parts of the world despite their propaganda) Myself and most of my classmates that spend the summer in the US are finding we put the 4th year students to shame.

This is funny...