Protocol Changes

usalsfyre

You have my stapler
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Very honestly on chest tubes and escharotomy? Not often to never.

The issue I'm having is this. Things such as escharotomy are going to be extremely rare. That said, if marketed how we're aiming at we're looking at hour plus ground transports on "weather" days for HEMS in this area. So it puts our providers in a difficult spot. Take a patient you know is going to crash 25 minutes in or refuse the transport? Those two procedures in particular are intended for that environment. The concern of course is keeping a level of competency, with a small group I think that can be accomplished.

The most common procedure on that list I expect to see used? Art lines. We've run into a rash of patients on heavy duty pressors coming out of small EDs and rehab facilities with no pressure monitoring.
 
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Veneficus

Forum Chief
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Very honestly on chest tubes and escharotomy? Not often to never.

The issue I'm having is this. Things such as escharotomy are going to be extremely rare. That said, if marketed how we're aiming at we're looking at hour plus ground transports on "weather" days for HEMS in this area. So it puts our providers in a difficult spot. Take a patient you know is going to crash 25 minutes in or refuse the transport? Those two procedures in particular are intended for that environment. The concern of course is keeping a level of competency, with a small group I think that can be accomplished.

honestly, if you arrive at an ED or hospital, they should have a physician or surgeon who can provide those procedures. If they can't, then they should probably not call themselves an ED.
 

usalsfyre

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honestly, if you arrive at an ED or hospital, they should have a physician or surgeon who can provide those procedures. If they can't, then they should probably not call themselves an ED.

Would I hope? Yeah. Do I know of at least three rural EDs that routinely transfer patients to large hospitals in our area that run single coverage NP or PA at night and on weekends in the ED many of whom won't perform this procedures? Also yeah...

There's some scary, scary small facilities around here. It's not unusual for the crew showing up for transport to have the most experience with critical patients of anyone there.
 
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EMSLaw

Legal Beagle
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honestly, if you arrive at an ED or hospital, they should have a physician or surgeon who can provide those procedures. If they can't, then they should probably not call themselves an ED.

Can you call yourself an ED without any doctors present? I'd think that if someone rolled into a hospital, at any time of the day or night, they'd expect to find an MD in the place somewhere.

I'm now curious.
 

Veneficus

Forum Chief
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Would I hope? Yeah. Do I know of at least three rural EDs that routinely transfer patients to large hospitals in our area that run single coverage NP or PA at night and on weekends in the ED many of whom won't perform this procedures?

The solution there is not to pay those people.
 

the_negro_puppy

Forum Asst. Chief
897
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0
Getting:

Fentanyl IN
Zofran (no wafers though)
Atrovent (for imminent arrest only <_< )
capnography
chest needle decompression on consult
Vitamin B12 for cyanide poisoning :rofl::rofl: wtf lol?
Magnesium sulfate for envenomation only

hydrocortisone (for pt's with specific management plans i.e adrenal insufficiency
 

R99

Forum Lieutenant
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I'd think that if someone rolled into a hospital, at any time of the day or night, they'd expect to find an MD in the place .

The doctor might very well be a first year house officer who has just graduated and has less experience with sick people than the ambulance crew
 

JPINFV

Gadfly
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The doctor might very well be a first year house officer who has just graduated and has less experience with sick people than the ambulance crew

Not in this day and age as interns don't have an unrestricted license to practice medicine yet. 1st year residents are neither going to be moonlighting or working single coverage in an ED.
 

usalsfyre

You have my stapler
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Not in this day and age as interns don't have an unrestricted license to practice medicine yet. 1st year residents are neither going to be moonlighting or working single coverage in an ED.

Nope, but in this state an FNP who got their degree online can :eek:.
 

EMSLaw

Legal Beagle
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Nope, but in this state an FNP who got their degree online can :eek:.

Though theoretically that NP or PA is under the supervision of an MD with an unrestricted license. I say 'theoretically' because depending on the state, that can just mean that the MD reviews the charts every so often, and/or is available by telephone.

Not in this day and age as interns don't have an unrestricted license to practice medicine yet. 1st year residents are neither going to be moonlighting or working single coverage in an ED.

Moreover, even a PGY1 has two years of clinical time in medical school.

I still think, though, that if there isn't an MD present - be it house doc ('hospitalist' now days, I guess), attending, or resident - your ED is now an urgent care clinic that really isn't capable of providing acute care.
 

Veneficus

Forum Chief
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Not in this day and age as interns don't have an unrestricted license to practice medicine yet. 1st year residents are neither going to be moonlighting or working single coverage in an ED.

no offense, but a doctor who cannot function in their first year out of school, but a PA or NP can, sounds like a terrible failure of education and administration.
 

JPINFV

Gadfly
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Just a quick pedantic note. A "house officer" (archaic term for a resident) is not the same as a hospitalist (a fully licensed physician generally specialized in internal medicine).

PA and NP run EDs are the EMS volunteers of emergency medicine. Is it appropriate? Generally no. Are there places where they're the best we can do? Unfortunately yes. Can they handle the vast majority of cases? Yes, but generally not the ones that really count.
 

JPINFV

Gadfly
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no offense, but a doctor who cannot function in their first year out of school, but a PA or NP can, sounds like a terrible failure of education and administration.

That's how it's set up. I'm offering no judgement at this point at whether it's appropriate or not and just saying that most physicians aren't fully licensed until their second year of residency based on how most state laws are set up and because Step 3 isn't taken until sometime during PGY-1.
 

Veneficus

Forum Chief
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PA and NP run EDs are the EMS volunteers of emergency medicine. Is it appropriate? Generally no. Are there places where they're the best we can do? Unfortunately yes. Can they handle the vast majority of cases? Yes, but generally not the ones that really count.

I like you.
 

JPINFV

Gadfly
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I like you.
2130928000_6ec81b3b53_o.jpg
 

Veneficus

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R99

Forum Lieutenant
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Just a quick pedantic note. A "house officer" (archaic term for a resident) is not the same as a hospitalist (a fully licensed physician generally specialized in internal medicine).

PA and NP run EDs are the EMS volunteers of emergency medicine. Is it appropriate? Generally no. Are there places where they're the best we can do? Unfortunately yes. Can tthey handle the vast majority of cases? Yes, but generally not the ones that really count.

A house officer/ house surgeon is not the same as your resident (registrar) they are a first year graduate with no formal training beyond medical school, unfortunately they sometimes get left sole charge in some small EDs overnight with the surgical registrar on call as their backup.

My mates daughter is in her HO year at one of the hospitals up northland, poor thing, they have a bunch of missed meningococcocemia complaints against them, at least they can do something right!

ED here must, absolutely must have a doctor, even if its a first year house surgeon
 
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JPINFV

Gadfly
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I believe we're dealing with different medical education systems and different meanings of the same term used to describe different levels. "Registrar physician" and "consultant physician" are not terms used to describe resident vs attending in the US. Similarly, a house officer/house staff in the US and used elsewhere (specifically the UK, and by connection I imagine most commonwealth countries) may have different meanings.

Similarly, a "first year graduate with no formal training beyond medical school" is generally referred to as a first year resident in the US (post graduate year-1), along with the term "intern."
 
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STXmedic

Forum Burnout
Premium Member
5,018
1,355
113
Getting:

Fentanyl IN
Zofran (no wafers though)
Atrovent (for imminent arrest only <_< )
capnography
chest needle decompression on consult
Vitamin B12 for cyanide poisoning :rofl::rofl: wtf lol?
Magnesium sulfate for envenomation only

hydrocortisone (for pt's with specific management plans i.e adrenal insufficiency

We use hydroxocobalamin here for cyanide poisonings (people pulled out of fires) and have already had two saves. In essence, it's "super B12"
 
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