MD to paramedic

[d3653je]

best thing to do then is call your state EMS office and ask them what the procedure is.

So you all are okay with a Medical School Resident, who specializes in Family Medicine, to be a Paramedic without taking the class! How absurd is that! Knowledge wise yes, can hack it but what about skills, basic skills like spinal immobilization, splinting... to say nothing about ALS Skills. You all throw me under the bus without an after thought and now you are willing to give this guy the keys to the bus.

Brown you are right, EMS in America is messed up!

 

[Veneficus]

So you all are okay with a Medical School Resident, who specializes in Family Medicine, to be a Paramedic without taking the class! How absurd is that! Knowledge wise yes, can hack it but what about skills, basic skills like spinal immobilization, splinting... to say nothing about ALS Skills. You all throw me under the bus without an after thought and now you are willing to give this guy the keys to the bus.

Brown you are right, EMS in America is messed up!

The doctor, who graduated medical school, and is expected to take and pass his final licensing exam for an unlimited license to practice medicine, is more capable than any certified EMS provider who is also not a physician.

Incidentally many of the senior Emergency docs are actually internal medicne and family practice docs because they went through residency before emergency medicine even existed as a medical specialty.

When EMS starts edcating itself beyond a vocational education course, I will go back to advocating for them, but I am tired of their inaction and embaressment I have been subject to for advocating for EMS with physicians.

 

[94H]

Do you have full competency in using a Sager/Hare traction splint, a KED, spinal immobilization (from standing, suping, sitting), running a code with only possibly only one EMTB at your side, etc etc? Are you comfortable running (physically, not just academically) ACLS and PALS procedures on a regular basis?


Good luck!

Do most of the people in the field know how to use the Hare traction splint?

At my in-service we went through 3 groups before we realized we were using it all wrong. And our training officer was running that station.....

 

[Veneficus]

Do most of the people in the field know how to use the Hare traction splint?

At my in-service we went through 3 groups before we realized we were using it all wrong. And our training officer was running that station.....

I have x rays of improperly applied traction splints, no harm done. But no help either. One medic even told me he couldn't extend the length because then the door of the rig wouldn't close.

It is a shame people try to make up for knowledge with devices. You can actually apply and maintain traction to a femur quite effectively with some kling and a seat belt. No contraptions, no space constraints, easy to switch from the cot on the rig to the hospital bed, easy to take off and doesn't interfere with xrays.

a little knowledge goes a long way.

 

[jjesusfreak01]

I'd be ok with a medical resident, with all the required PALS, ACLS, etc courses, who also had an EMT-B cert indicating competency with the basic ambulance equipment, working as a paramedic in the field. In fact, i'd be ok with an EM resident in the ambulance if they were with an EMT-B. They know the drugs, the treatments, etc, and may only need a little help with the physical operation of some of the equipment.

 

[Veneficus]

I'd be ok with a medical resident, with all the required PALS, ACLS, etc courses, who also had an EMT-B cert indicating competency with the basic ambulance equipment, working as a paramedic in the field. In fact, i'd be ok with an EM resident in the ambulance if they were with an EMT-B. They know the drugs, the treatments, etc, and may only need a little help with the physical operation of some of the equipment.

Do you guys realize that the ATLS course covers all of those gadgets like hare splints, etc?

 

[reaper]

Covers very little on them. Usually not even hands on. I help teach ATLS. They do not get a lot from the classes, as far as skills. They are shown how to use them. The knowledge is what is the greatest benefit from the course.

 

[AnthonyM83]

Interesting how everyonr SEEMS to be.one upping everyone and personalizing the discussion as if it is an us versus them, and with a clear cut answer that applies to every scenario. Personal frustrations, biases, and missions just flooding out of each post. Wow.

I'll probably do similar...here are my thoughts.

- Any graduating med student would not fare better than any non physician EMS provider. Not even as a generalization. There's way too much variation in skills competency of emergency procedures at different medical programs...and different lengths of time since they were last practiced.

The other poster can vouch for variety of competency in ATLS skills. I'll vouch for variety in BLS and ACLS skills. Having seen some great physicians on ride alongs I can also vouch for variety in scene management skills. That can be broken down into sub categories, some more critical than others.

-Yes, even if you don't keep yourself fresh with skills practice you should have a general idea of how to use it. Thigh strap, ankle strap, traction, then the extra straps.

- Yes I think a physician can go in the field without medic school, though not without some sort of modified internship. Fact is that there's a learning curve once your doing the hands on part of any job even if you know the steps in your head. The education teaches you the rules to respond to variabilities but doesn't give you experience in handling them. You want to have a preceptor ay your side during that learning period...most times it'll work out even if you wing it but sometimes you need the help. Most docs wouldn't know if the seatbelt trick either...much less would a new med grad know the basic tricks..

 

[d3653je]

I have x rays of improperly applied traction splints, no harm done. But no help either. One medic even told me he couldn't extend the length because then the door of the rig wouldn't close.

It is a shame people try to make up for knowledge with devices. You can actually apply and maintain traction to a femur quite effectively with some kling and a seat belt. No contraptions, no space constraints, easy to switch from the cot on the rig to the hospital bed, easy to take off and doesn't interfere with xrays.

a little knowledge goes a long way.

You know one call I had this guy whose was a belted driver vs a tree and he had an open femur fracture. Squad had to push the dash and pop the door. Mind u I was only BLS... he was not doing to bad all things considered. It was a pain to get a hare on him but I did and he felt a lot better... till the flight medic took it off because it would not fit in Trooper 8. What a bitttttttch.

In hind sight... no external out of control hemorrhage, good distal PMS, Vitals WNL... I suppose a blanket and carvats could have done the job for a 8 minute flight to the trauma center.

Off topic but seemed okay.

 

[MrBrown]

So you all are okay with a Medical School Resident, who specializes in Family Medicine, to be a Paramedic without taking the class! How absurd is that! Knowledge wise yes, can hack it but what about skills, basic skills like spinal immobilization, splinting... to say nothing about ALS Skills. You all throw me under the bus without an after thought and now you are willing to give this guy the keys to the bus.

Brown you are right, EMS in America is messed up!

Of course Brown is right, it's messed up because of opinions such as this.

A Paramedic may be more adept at the simple behaviourist psychomotor requirementss of the job description yet that is incomparable to the broad cognitive foundation that a Physician will bring.

Which is more important and which is most easily taught Brown asks you?

 

[rhan101277]

You know one call I had this guy whose was a belted driver vs a tree and he had an open femur fracture. Squad had to push the dash and pop the door. Mind u I was only BLS... he was not doing to bad all things considered. It was a pain to get a hare on him but I did and he felt a lot better... till the flight medic took it off because it would not fit in Trooper 8. What a bitttttttch.

In hind sight... no external out of control hemorrhage, good distal PMS, Vitals WNL... I suppose a blanket and carvats could have done the job for a 8 minute flight to the trauma center.

Off topic but seemed okay.

I thought traction splints were contraindicated with open femur fractures

 

[zmedic]

I've had some orthopods tell me that pulling traction on a open (ie exposed) femur fracture isn't that bad, since it'll get washed out in the OR anyway and they'll get lots of antibiotics. But they said not to pull on a severely angulated open fracture with lots of bone ends sticking out, mainly because if the bone ends are out in the air they aren't lacerating blood vessels and are in a fairly safe position. But I don't think it's been studied much. Hard study to do given the low rate of open femur fractures.

 

[zmedic]

Of course Brown is right, it's messed up because of opinions such as this.

A Paramedic may be more adept at the simple behaviourist psychomotor requirementss of the job description yet that is incomparable to the broad cognitive foundation that a Physician will bring.

Which is more important and which is most easily taught Brown asks you?

The question isn't if you can fairly easily train a physician to work as a medic, I'd agree you can. The question is if most physicians are ready to be certified and running calls based on the training they have gotten in medial school and residency. I'd argue they are not. I'm sure that in a month or two you could get most docs ready to take the test for medic, but there is a difference between having that course and just saying "take the test and you are good to go."

 

[Veneficus]

I thought traction splints were contraindicated with open femur fractures

Most open fractures do not appear as a bone sticking out, they appear as a slight wound to the skin because the accessory muscles pull the end back in as part of the body's natural splinting abilty.

Traction on those wounds would be no less indicated than on a closed fracture.

As for the rest, zmedic said it very well already.

 

[Phlipper]

I have to totally disagree with this. You're ignoring the fact that a doctor - any doctor - has years of full time medical education, including an ER rotation. ACLS doesn't change no matter where you do it, save that there are some more advanced interventions that can't be done outside a hospital. And ironically, I think being a relatively new MD helps the OP here. He hasn't spent 40 years practicing podiatrics or OB/GYN.

I think you overstate paramedics and denigrate doctors. Refreshing a few protocol-driven psychomotor skills shouldn't be a problem for someone who's has MD and PGY1 training.

+1

Sometimes I think we, in our little insular world of non-degreed meat wagon drivers, think a little too highly of ourselves. My wife is an RN working towards her MSN/NP and we discussed this just the other night. For my paramedic cert I had to take a measly 60-hour class whereas she had two full semesters. Same with pharmacology. And just about everything else. And that was just for an ADN.

Some of us really need to get over ourselves. I love what I do and I'm proud of what I do. But as far as education and general medical knowledge we're suck'n hind tit compared to MDs, PAs, NPs. If we don't like that fact, and it is a fact, then we need to get behind increased education requirements for basics (AAS minimum) and for medics (BS minimum), create a single professional organization to further our interests, and start acting like the professionals we like to think we are.