What is the pinnacle of field medicine?

wildmed

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In your experience/research/knowledge/opinion what or where is the highest level of true field medicine? ( Lets define field medical professional as someone who performs a minimum 75% of their job OUTSIDE of a fully functioning hospital, the more austere the conditions and sicker the patients, the better.) Is it somewhere/someone within the military? a remote village in AK? a certain agency or place within our country or another country? Is it a nurse, medic, PA, doc? Who is the best of the best? lets think out of the box here.

Extra credit: With this person/position/place/thing in mind, what SHOULD be the highest common point? how should it be implemented? How could this highest point be used to further field medicine as a whole? How could it be used to further healthcare as a whole? I have my own thoughts but I want to hear other peoples ideas on this topic.

This is a highly theoretical thread, everyone has their own opinions so please play nice.
 

94H

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Doctors working in Antarctica during their winter? They are stuck there for several months during the winter at which time no aircraft can come and land there to evacuate people/deliver supplies.

First Aid on the ISS?

Medics with hiking teams that climb Everest and K2?
 

hippocratical

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First Aid on the ISS?

I raise you - this guy:

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EpiEMS

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The pinnacle of field medicine? Whoo, that's a tough one.

My first instinct is to go with USAF Pararescue and the US Army 18D medics, who are at least EMT-Is, and usually P's (so I've read). After all, they operate with massive amounts of clinical autonomy and probably see more patients in field settings than anybody short of medical personnel with MSF. Granted, I can't personally vouch for how much the military folks do of medical as opposed to trauma, but I certainly wouldn't want anybody else taking care of me if I were shot outside of a reasonable distance from a high-tech trauma center.

My thought, based on this, is to try and bring lots of autonomy to "lower level" providers who have demonstrated aptitude and knowledge.

I've spoken with a lot of expedition medics at the EMT-I and -P levels, and they have many skills and lots of autonomy, so as far as civilian field medicine, you'd be hard pressed to beat them.

Much as in the civilian prehospital setting, short of those with specialized training or prior EMS and/or military medic-type experience, physicians and PAs are probably of limited use – after all, we don't generally carry ultrasounds on the rig, nor would you want to crack a chest in an ambulance.
 
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Handsome Robb

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My first instinct is to go with USAF Pararescue and the US Army 18D medics, who are at least EMT-Is, and usually P's (so I've read). After all, they operate with massive amounts of clinical autonomy and probably see more patients in field settings than anybody short of medical personnel with MSF. Granted, I can't personally vouch for how much the military folks do of medical as opposed to trauma, but I certainly wouldn't want anybody else taking care of me if I were shot outside of a reasonable distance from a high-tech trauma center.

Special Forces medics are all NREMT-P certified. Your standard 68W minimum standards are NREMT-B. :)

Personally I wouldn't call them the "pinnacle of field medicine". DUSTOFF units are 9 times out of 10 a radio call away but that's my personal opinion. Special Forces are in a different situation all together though, I will agree with that.

That's about all I'll add to this thread.
 

Veneficus

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Is he question specific to EMS or field medicine in general, the Red Cross along with several other government and private organizations have fielded doctors to austere environments for decades.

There are even books written about some of them and their exploits.

I have even met a Nigerian doctor who was explaining to me how to sterilize used IO needels in order to reuse them because the money didn't exist to replace them.
 

epipusher

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As far as EMS? My opinion is special forces medics. I was lucky enough to meet a couple via my brother who is in the military.
 

DavidM

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I don't know if this is what you are looking for but the guys at Doctors without Borders operate vitually unsupported and are forced to deal with all kinds of crazy scenarios.

I watched the documentary Living with Emergency recently. At one point a doctor is in a mud hut pushing a knotted portion of a woman's intestine the size of a grapefruit back through her belly button saying that this is the only thing he can do to possibly save her.
 

hippocratical

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I don't know if this is what you are looking for but the guys at Doctors without Borders operate vitually unsupported and are forced to deal with all kinds of crazy scenarios.

I'll second this. I've met these MSF cats in a variety of remote places (Zambia and Laos to name two) and they are the most intelligent, calm, professional bad-***-mothers I've met.

Nothing fazed them, and they were the personification of the "Wait - I got this" aura. Kinda like the special forces types I've met, but I guess in the opposite line of work.

Very cool.
 
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wildmed

wildmed

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Just to clarify im looking for everything, from EMS to DWOB and everything in between. Just an examination of how BA and advanced field medicine (anyone in field medicine) can actually get. Some of the examples I know of; Physicians with the HRA( Himalayan Rescue Association) that staff everest base camp, Docs/medics on medic 1 in london ( on site thoracotomy, field amputations!), some army PAs.
What about some examples state side?
 

Veneficus

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Just to clarify im looking for everything, from EMS to DWOB and everything in between. Just an examination of how BA and advanced field medicine (anyone in field medicine) can actually get. Some of the examples I know of; Physicians with the HRA( Himalayan Rescue Association) that staff everest base camp, Docs/medics on medic 1 in london ( on site thoracotomy, field amputations!), some army PAs.
What about some examples state side?

I don't think you are going to find a lot stateside.

Most of the really wld stuff happens in under or undeveloped areas.

While there are some extremely poor and extremely remote areas in the US, there will be very few patients and very few opportunities for the more hard-core field medicine.

There is a big difference in what is needed to stabilize somebody prior to evacuation than providing medical care where there will never be evacuation/rescue or even the possibility of going to a modern hospital or even clinic.

I can also tell you, in those environments, what you know is what counts the most, and that extends to diversity of knowledge, not just medical care.
 

abckidsmom

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I'll second this. I've met these MSF cats in a variety of remote places (Zambia and Laos to name two) and they are the most intelligent, calm, professional bad-***-mothers I've met.

Nothing fazed them, and they were the personification of the "Wait - I got this" aura. Kinda like the special forces types I've met, but I guess in the opposite line of work.

Very cool.

One day, I want to hook up with a group like this and work somewhere deep in Tanzania, digging wells and feeding starving children.
 

hippocratical

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One day, I want to hook up with a group like this and work somewhere deep in Tanzania, digging wells and feeding starving children.

MSF usually go to war zones though, or seriously damaged places that are like war zones (Haiti for example).

The ones I met in Zambia were there on vacation! This is not 5-star hotels you understand - it was a shanty town in literally in the middle of nowhere. I just happened to be working in a village nearby and you develop an amazing ability to spot another foreigner from a distance.
 

abckidsmom

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MSF usually go to war zones though, or seriously damaged places that are like war zones (Haiti for example).

The ones I met in Zambia were there on vacation! This is not 5-star hotels you understand - it was a shanty town in literally in the middle of nowhere. I just happened to be working in a village nearby and you develop an amazing ability to spot another foreigner from a distance.

They were there the last time I checked, a couple of years ago. They might not be the organization I am looking for, but I am fascinated by the medicine of refeeding starving people. I would love to do it in my retirement. My last kid will graduate when I am 48. That is still plenty young to live in a hut somewhere.
 
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