EMS exposure

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thorg12

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Im and MS3 in NJ and plan on applying tnext year to programs in the NJ, NY, PA, DE, maybe Boston area. And have been reading about the "Jeep" experience at Pitt. Ive always been involved in EMS and think this is an interesting idea and just had a couple questions. Is the jeep thing really that cool or is it some selling point that attracts people and gets boring fast? Anyone that has done some "jeep" shifts i would love to hear about them.
Besides Pitt, what other programs in the nj, ny, pa, de, boston area offer a unique experience like this? thanks a lot

disclaimer:I tried searching but couldnt find the thread about this. I think I read one a couple years ago.
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Huh? Jeep what?

Don't pick a residency that offers to buy you a Jeep. They're lying!
 
In general, I believe that the only useful knowledge gained from EMS exposure is the feeling of what it is like to be an EMS provider.

I think you go easier on the medics when you've been in their shoes, and you appreciate the skill it takes to take a blood pressure in the back of a wailing, bumpy ambulance, and to put in an IV when the patient is moving, the ambulance is moving, and you often have no help. You understand that paramedics often try to get meaningful information from patient and family, however, because of stupidity on the part of the patient, and family, or because of patient's clinical status, they often don't get a whole lot.

I don't think you shouldn't make residency decisions based on EMS experience.
 
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Jarabacoa said:
In general, I believe that the only useful knowledge gained from EMS exposure is the feeling of what it is like to be an EMS provider.

I think you go easier on the medics when you've been in their shoes, and you appreciate the skill it takes to take a blood pressure in the back of a wailing, bumpy ambulance, and to put in an IV when the patient is moving, the ambulance is moving, and you often have no help. You understand that paramedics often try to get meaningful information from patient and family, however, because of stupidity on the part of the patient, and family, or because of patient's clinical status, they often don't get a whole lot.
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You also might have the misfortune of knowing what it's like to have a gun or knife drawn on you or otherwise being assaulted, of being in public safety but having none of the pay, recognition, or job security of other jobs in public safety, you might learn a lot about the place that you live and the people who live there that you really would rather not know. As a veteran BostonEMS paramedic told me when I was a brand-new EMT, "Only get into this job if you have an interest in social work as well as prehospital care because it's half medical and half social work."

All that for less pay than an assistant manager at McDonald's earns? What a deal!
 
Basically, for 12 h shifts you staff an EMS Ford Explorer and are consulted by EMS during runs. Sometimes the consults are simple, and require only your expertise and input via radio transmission. Other times they are more difficult and EMS will call you to the scene if something is required asap or they feel you need to see the patient. When you are called to a scene (or not and its just a radio consult) you're the doc there, and you are the one making medical decisions ...and any procedures that need to be done, i.e. if someone arrests, they call and you are expected to manage the pt. and start a line, run the code, or IO if needed. An attending on Jeep call receives all consults you get, and will intervene only if necessary. From personal experience, a lot of things can happen during a jeep shift. Ironically, usually at 7am when shift change is about to happen. Anyways...

This prepares you to think for yourself and build your leadership skills...you know, get a little more comfortable with that autonomy thing. It also offers a ton of opportunity for prehospital research, if you're into it. Its different than the usual ride-alongs or observer role you may play on EMS flight service for the above reasons. Do you need this much intense exposure to be a competent resident? No, which is why other programs are different.

Do the residents think its boring or unhelpful? No. Do they jump up and down with excitement every time they do a shift? No, cause they are used to it. I think thats the point of the Jeep though, to get you comfortable to make decisions and handle things on your own, not just to regurgitate ACLS algorithms.

I dont know if theres any other programs off the top of my head that specifically have a "jeep", but there are programs that offer the same opportunity. UMass's flight program is structured the same way....you just do shifts on a bird, and are the flight physician making decisions, etc. Penn state comes to mind but I cant remember all the details. Case's new program wants a jeep-like EMS experience, although not sure when or if that will happen. Just to name a few. I'm sure theres more.
It all depends on how important EMS is to you during residency. If you are considering an EMS fellowship then you would prob want a program with strong EMS ties. On the contrary, IMO you dont need a program with strong EMS involvement to get a feel and experience what an EMTs day is like... if that is all you're looking for. :luck:
 
thanks for all the info. the whole idea of doing the jeep shift has really got me interested bc im considering doing an ems fellowship. ive worked as emt all through hs and college and like being involved prehospitally. and i think the exposure at pitt can really affirm if thats something i want to do during my career.
buckeye did you do an away at pitt? im considering doing one there and was wondering which of the two sites you think would be better.
 
If these residents are staffing Explorers/Jeeps and have to respond to calls, are they trained in emergency driving skills, and are they permitted to drive with lights and sirens?
 
I'd guess that there's a Jeep driver? Or otherwise, it's not that difficult to do... every nut with an EMT license and a blue light speeds around on their way to calls (or at least that's the favorite pastime in NJ :p)
 
leviathan said:
If these residents are staffing Explorers/Jeeps and have to respond to calls, are they trained in emergency driving skills, and are they permitted to drive with lights and sirens?
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AVOC (the course EMTs take to get "certified" to drive an ambulance) is about the biggest waste of time course and doesn't teach you anything. Driving an ambulance might take some getting used to (heavier/wider), but driving an SUV is driving an SUV, regardless of whether you have lights and sirens.
 
Dr. Dukes said:
AVOC (the course EMTs take to get "certified" to drive an ambulance) is about the biggest waste of time course and doesn't teach you anything. Driving an ambulance might take some getting used to (heavier/wider), but driving an SUV is driving an SUV, regardless of whether you have lights and sirens.
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First of all, its EVOC, not AVOC. It stands for Emergency Vehicle Operator Course. As an EVOC instructor for well over a decade, I can assure you its not a waste of time.

Giving a resident keys to an emergency vehicle with lights and sirens, in a city they probably don't know well, with adrenaline pumping and absolutely no experience operating an emergency vehicle is scary. There should be some training. I'm not sure how Pitt does it. EVOC or some iteration is required by virtually every police, fire and EMS system in the country for good reason.
 
polygonal said:
First of all, its EVOC, not AVOC. It stands for Emergency Vehicle Operator Course. As an EVOC instructor for well over a decade, I can assure you its not a waste of time.

Giving a resident keys to an emergency vehicle with lights and sirens, in a city they probably don't know well, with adrenaline pumping and absolutely no experience operating an emergency vehicle is scary. There should be some training. I'm not sure how Pitt does it. EVOC or some iteration is required by virtually every police, fire and EMS system in the country for good reason.
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I agree it's not a waste of time, but it's also just the beginning. Most agencies require some FTO time, which is usually when you really learn to drive. I imagine you could probably get by with less field training if you had really good simulators, but otherwise I'd be surprised if Pitt just turned people loose after EVOC.

The other thing I've always wondered about the "jeep" experience: does the uniqueness undermine the value of the experience? I mean, I'm sure it's cool and educational, but since most medical directors don't go responding to calls in the field all day, how much can it teach you about physician involvement in EMS? For that matter, how do the paramedics feel about their resident colleagues/supervisors/procedure thieves?
 
Dr. Dukes said:
AVOC (the course EMTs take to get "certified" to drive an ambulance) is about the biggest waste of time course and doesn't teach you anything. Driving an ambulance might take some getting used to (heavier/wider), but driving an SUV is driving an SUV, regardless of whether you have lights and sirens.
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It doesn't really have anything to do with the actual act of driving the car. It has to do with knowing how to drive safely with lights+sirens on: where to position yourself in lanes, how to safely go through reds / oncoming lanes, how to safely respond to calls together with other cars...basically, how to drive defensively and avoid killing someone or yourself. It's not rocket science, but I can't imagine just giving a physician the keys to a vehicle and letting them go loose. It does take a little bit of time to learn the safest way to drive.
 
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Dr. Dukes said:
AVOC (the course EMTs take to get "certified" to drive an ambulance) is about the biggest waste of time course and doesn't teach you anything. Driving an ambulance might take some getting used to (heavier/wider), but driving an SUV is driving an SUV, regardless of whether you have lights and sirens.
Click to expand...

Nevermind that almost no private companies (at least in my region) even require or offer their EMTs or medics to take an Emergency Vehicle Operations Course or equivalent. I was driving lights-and-siren within a week of being hired despite the fact that I had only held a license for four months -- and this is in metro Boston of all places. Most just check to see if you have a driver's license and any DUI/OUI's. And even if you have one on your record it doesn't necessarily preclude the possibility of your employment.

As usual with EMS, too much variability, not enough oversight.
 
leviathan said:
If these residents are staffing Explorers/Jeeps and have to respond to calls, are they trained in emergency driving skills, and are they permitted to drive with lights and sirens?
Click to expand...
The residents are the drivers of the Jeeps. There is a 2 day driving course they do and have to pass in order to drive the Jeep. Also,they learn EMS "rules of the road", for example like when it's legal to flip the siren and when it's not.
 
pseudoknot said:
I agree it's not a waste of time, but it's also just the beginning. Most agencies require some FTO time, which is usually when you really learn to drive. I imagine you could probably get by with less field training if you had really good simulators, but otherwise I'd be surprised if Pitt just turned people loose after EVOC.

The other thing I've always wondered about the "jeep" experience: does the uniqueness undermine the value of the experience? I mean, I'm sure it's cool and educational, but since most medical directors don't go responding to calls in the field all day, how much can it teach you about physician involvement in EMS? For that matter, how do the paramedics feel about their resident colleagues/supervisors/procedure thieves?
Click to expand...
From my experience, the EMS teams have a very strong relationship with the Pitt residents. I didn't get any sense of bitterness about "procedure stealing" or any EMTs getting territorial. When they consult you to come to a scene, its because they really need the help and feel more comfortable if a physician was present.

For example, if someone was SOB and they anticipated that person needing an intubation, they would call you there before **** hits the fan and be like "This lady is SOB, SpO2 is 76% on room air, altered mental status, vomitting, etc..we need you to come to 123 main st. while we attempt to stabilize and anticipate intubation". It's not a consult service strictly for procedures, and the EMTs are capable of handling whatever comes to them, so I hope that's not what people are perceiving it to be or think that the EMS ppl aren't trained enough. If something needs to be done, they aren't going to wait for you to get there. Residents and attendings rely on EMS judgement, and when EMS is questioning their judgement they have an extended lifeline of the physician staffed Jeep to call on and to the scene if they want. If you've ever been on a run, you know that patients don't just get whisked away in an ambulance when EMTs arrive....they are lying in hallways, weigh 350lbs, etc. so it takes some time to get to them, or move and assess/stabilize them... definitely gives you time to get to the scene if needed.

For physician involvement, I think it's beneficial as a physician to see what happens out in the field during EMS runs to provide a more complete prehospital understanding, considering that EMS is an extension of us and we are all part of the same team. On the contrary, I just don't know the numbers or evidence you're inquiring about as to whether it's actually considered beneficial to EMS and/or pateints to have a physician on scene.... like it's better to have a witness initiate CPR immediately when someone arrests prehospital, I wonder if it's a better outcome for a patient (in other medical situations) if a physician was present prehospital. I'd be curious to know though...
 
GoBuckeyes913 said:
For example, if someone was SOB and they anticipated that person needing an intubation, they would call you there before **** hits the fan and be like "This lady is SOB, SpO2 is 76% on room air, altered mental status, vomitting, etc..we need you to come to 123 main st. while we attempt to stabilize and anticipate intubation".
Click to expand...

Don't they have paramedics for that?


In some european countries, doctors ride on ambulances... but their paramedic system is different than ours, and (i believe) it happens more in rural areas...
 
quideam said:
Don't they have paramedics for that?


In some european countries, doctors ride on ambulances... but their paramedic system is different than ours, and (i believe) it happens more in rural areas...
Click to expand...
Yeah there's paramedics.....maybe I'm not explaining it right. It's difficult to get the idea without experiencing it and I may not be doing a good job of filling everyone in. It's just an awesome system and an awesome experience.
 
GoBuckeyes913 said:
Yeah there's paramedics.....maybe I'm not explaining it right. It's difficult to get the idea without experiencing it and I may not be doing a good job of filling everyone in. It's just an awesome system and an awesome experience.
Click to expand...
I'm guessing physicians come out and provide assistance on difficult calls where the paramedics COULD scrape through the call on their own, but request to have a higher trained/more experienced provider around?
 
leviathan said:
I'm guessing physicians come out and provide assistance on difficult calls where the paramedics COULD scrape through the call on their own, but request to have a higher trained/more experienced provider around?
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yes ;)
 
The EMS Physician's role when responding to calls in the field isn't to provide direct patient care, although they may in some rare circumstances.

In general (Pitt may be different), their role is observation and field training, the EMS version of bedside teaching.

Here's a related board question:

Q: What's the best way for the medical director to assess quality of care?
A. Direct field observation.

Take care,
Jeff

PS, if anyone's interested in the NAEMSP's position statement on EMS medical direction, go here: http://naemsp.org/pdf/physicianmedical.pdf
 
thorg12 said:
Im and MS3 in NJ and plan on applying tnext year to programs in the NJ, NY, PA, DE, maybe Boston area. And have been reading about the "Jeep" experience at Pitt. Ive always been involved in EMS and think this is an interesting idea and just had a couple questions. Is the jeep thing really that cool or is it some selling point that attracts people and gets boring fast? Anyone that has done some "jeep" shifts i would love to hear about them.
Besides Pitt, what other programs in the nj, ny, pa, de, boston area offer a unique experience like this? thanks a lot

disclaimer:I tried searching but couldnt find the thread about this. I think I read one a couple years ago.
Click to expand...

I think you can get a good EMS experience at any program, you just have to be motivated and ask. The EMS providers I work with love it when I ride with them. You can get a good EMS experience, and see what they have to do in the field.

The places I rotated at as a student, offered the opportunity to get some EMS ride along experience if intersted. All the providers were gracious and glad to have someone interested in what they do/experience.



Wook
 
wook said:
I think you can get a good EMS experience at any program, you just have to be motivated and ask.
Click to expand...
I disagree. To answer the original poster's question, " Is the jeep thing really that cool or is it some selling point that attracts people and gets boring fast?" I'd say it completely depends on your personality. Personally, I'm an adrenaline junky, and I LOVE the EMS/Disaster/Tactical medicine scene. Which is also why I love Trauma, and why all my hobbies revolve around fast exciting things to do. For some ppl like me, it NEVER gets old. It makes you feel like a kid all over again, and you enjoy it each and every time. As such, I was very particular on where I applied to for EM, based on what kind of EMS experience they offered. Why? Because it varies GREATLY.

Most places' version of "EMS Experience" is merely a ride-along w/ the medics in the bus & helicopter. If that's all you're looking for, then wook is right; you can get that virtually anywhere.

BUT...if you're really gung-go, and looking for more, much more is available. Here are a few examples of the EMS/Disaster/Tactical Pre-hospital experiences I found offered at the various places I've interviewed and/or rotated at:

- A real, live, hands-on tactical research facility where you can face and train on life-like scenarios (plane crashes, underwater submersions, climbing/mountain/cliff associated accidents, etc)
- A Tactical Medicine Resident Interest Group
- A Prolonged Extracation Course (in conjunction w/ the Fire Dept, where you actually learn and are able to use the "Jaws of Life" to extracate a dummy from a mashed-up vehicle
- Ride-alongs w/ Physician Response Units (like the Jeep)
- Active participation in SWAT drills (from tactical scenario role-play/training to weapons training & firing)
- Active participation in Tactical Medicine drills w/ the local Armed Forces
- Moonlighting as an MD providing tactical medicine support to State Troopers/FBI/SWAT

The list goes on and on. And at each of these programs, I found not just one, but a few EMS (and or Associate EMS) Directors who were very well "older" (late 30s, 40s, etc) but still were obviously VERY excited by what they did, and loved every single second of it. They still had that "inner child" in 'em that I saw I still had in me. And THAT'S the type of program I wanna be at, so I can have a real in-depth longitudinal EMS & Tactical Medicine experience throughout my residency.

As for getting your feet wet, I'd HIGHLY suggest signing up for this EMS/Pre-Hospital Elective for 3rd & 4th year med students @ Robert Wood Johnson in New Brunswick, NJ: http://www2.umdnj.edu/emedpweb/EMS/training.htm.

I was the first student to participate in that elective, and I gotta tell you, I had the time of my LIFE. It's what opened up the world of EMS & Tactical Medicine to me, and really defined my short & long term goals for me. The link has details, but in short, it offers many of the aforementioned activities & opportunities. And yes, they have their own Physician Response Unit, and your JOB that month is to actively participate in pretty much everything. You can find out more about their Physician Response Unit (dubbed "MD-1") here:

- http://www.emsresponder.com/web/onl...l-Capabilities-for-Special-Situations/22$8474
- http://www.emsresponder.com/print/Emergency--Medical-Services/Docs-on-Demand/1$8232

Lastly, one of the EM Attendings here actually completed the EMS & Tactical Medicine Fellowship @ Johns Hopkins, and was the MD providing support for the Secret Service under Clinton. He's now heavily involved in providing local EMS support for SWAT & local police etc, while still maintaining his role as an Attending in the ED. So again, the opportunities are definitely there; it's up to you to find 'em and see how far you wanna go w/ 'em/what you want to make of 'em.

Hope that helps :)

PS: DO THE ROBERT WOOD JOHNSON/UMDNJ ELECTIVE!
 
FDNewbie said:
I disagree. To answer the original poster's question, " Is the jeep thing really that cool or is it some selling point that attracts people and gets boring fast?" I'd say it completely depends on your personality. Personally, I'm an adrenaline junky, and I LOVE the EMS/Disaster/Tactical medicine scene. Which is also why I love Trauma, and why all my hobbies revolve around fast exciting things to do. For some ppl like me, it NEVER gets old. It makes you feel like a kid all over again, and you enjoy it each and every time. As such, I was very particular on where I applied to for EM, based on what kind of EMS experience they offered. Why? Because it varies GREATLY.

Most places' version of "EMS Experience" is merely a ride-along w/ the medics in the bus & helicopter. If that's all you're looking for, then wook is right; you can get that virtually anywhere.

BUT...if you're really gung-go, and looking for more, much more is available. Here are a few examples of the EMS/Disaster/Tactical Pre-hospital experiences I found offered at the various places I've interviewed and/or rotated at:

- A real, live, hands-on tactical research facility where you can face and train on life-like scenarios (plane crashes, underwater submersions, climbing/mountain/cliff associated accidents, etc)
- A Tactical Medicine Resident Interest Group
- A Prolonged Extracation Course (in conjunction w/ the Fire Dept, where you actually learn and are able to use the "Jaws of Life" to extracate a dummy from a mashed-up vehicle
- Ride-alongs w/ Physician Response Units (like the Jeep)
- Active participation in SWAT drills (from tactical scenario role-play/training to weapons training & firing)
- Active participation in Tactical Medicine drills w/ the local Armed Forces
- Moonlighting as an MD providing tactical medicine support to State Troopers/FBI/SWAT

The list goes on and on. And at each of these programs, I found not just one, but a few EMS (and or Associate EMS) Directors who were very well "older" (late 30s, 40s, etc) but still were obviously VERY excited by what they did, and loved every single second of it. They still had that "inner child" in 'em that I saw I still had in me. And THAT'S the type of program I wanna be at, so I can have a real in-depth longitudinal EMS & Tactical Medicine experience throughout my residency.

As for getting your feet wet, I'd HIGHLY suggest signing up for this EMS/Pre-Hospital Elective for 3rd & 4th year med students @ Robert Wood Johnson in New Brunswick, NJ: http://www2.umdnj.edu/emedpweb/EMS/training.htm.

I was the first student to participate in that elective, and I gotta tell you, I had the time of my LIFE. It's what opened up the world of EMS & Tactical Medicine to me, and really defined my short & long term goals for me. The link has details, but in short, it offers many of the aforementioned activities & opportunities. And yes, they have their own Physician Response Unit, and your JOB that month is to actively participate in pretty much everything. You can find out more about their Physician Response Unit (dubbed "MD-1") here:

- http://www.emsresponder.com/web/onl...l-Capabilities-for-Special-Situations/22$8474
- http://www.emsresponder.com/print/Emergency--Medical-Services/Docs-on-Demand/1$8232

Lastly, one of the EM Attendings here actually completed the EMS & Tactical Medicine Fellowship @ Johns Hopkins, and was the MD providing support for the Secret Service under Clinton. He's now heavily involved in providing local EMS support for SWAT & local police etc, while still maintaining his role as an Attending in the ED. So again, the opportunities are definitely there; it's up to you to find 'em and see how far you wanna go w/ 'em/what you want to make of 'em.

Hope that helps :)

PS: DO THE ROBERT WOOD JOHNSON/UMDNJ ELECTIVE!
Click to expand...

I just looked at that link and it sounds great. Thanks for passing it along! My question, however, is whether it is geared towards students who have no exposure to EMS or anyone. Do you think its worthwhile for someone who worked as a paramedic before medical school but is interested in staying involved in the EMS world?
 
As one of the Pitt PGY-3s I wanted to comment on some of the postings on this page. First off, Buckeye has posted a pretty detailed and accurate summary of our role on the "Jeep." Our role in prehospital care as residents is pretty multifaceted, however, and includes the following:

The Jeep - A unique experience and I defer to Buckeye's post for his excellent description. We are very involved in hands-on care of the patient when we are called to responses (about 3/4 of our 12-hour shifts will have one). Our role is to provide experience and supervision with intubations, needle decompressions, ACLS, etc. We also have central lines, IO needles, and our own drug bag with medications the medics don't carry such as RSI drugs. Occasionally we also get refusals, crazy folks, and even delivering preemie twins on a highway! We also do consults as described in Buckeye's post. Overall, I feel its a great way to develop leadership skills early in residency (beginning of 2nd year) and helps you know the medics on a first name basis - most have grown up with us for over 28 years and have learned to work in conjunction with us in patient care. Plus, we get more intubations and rescussitations this way and become well trained in "working the radio" which even EMS-averse people may have to do in some community jobs. To address the actual driving aspect - we have a 2 day EVOC training course. When we are on our shift, we can only go lights and sirens when medic command gives us a "confirmed response" code. It's like driving and SUV as was mentioned before - we all know how to be careful when driving - it's not rocket science but the EVOC course does give us a refresher. Finally, as of 2 weeks ago we have a laptop in the Jeep with a GPS grid showing the location of all medic units and the dispatch information of all EMS calls so we have the capability (but not the requirement) to go to calls that sound concerning to assist the medics if they need us. If you are a real "whacker" this is a great addition! Oh, and we also review the EMS EKG's in real time and can activate the cath lab (in conjunction with our faculty backup attending) if we get a STEMI.

STAT Medevac - Our helicopter transport system. We do 24 hour shifts at a helicopter base and as 2nd and 3rd years, we act as flight physicans with one other provider (either RN or EMT-P), usually who is very experienced at running the radio and on protocols and such. We are an equal member of the flight crew and provide our procedural and intellectual expertise to patient care. And we get to fly. And we can moonlight with them for extra cash.

Also, like some other programs, there are opportunities for offline medical direction as a resident of neighboring EMS services as well as hands on teaching of medics. Tactical, SWAT, training, and EMS research are other possibilities

I hope this has been helpful. Please PM me if you have any further questions.
 
just going back to the earlier post...it can be either EVOC or AVOC, AVOC is ambulance specific...
 
EMmedic said:
I just looked at that link and it sounds great. Thanks for passing it along! My question, however, is whether it is geared towards students who have no exposure to EMS or anyone.
Click to expand...
I think it would be useful (and fun) for anyone. If you have EMS experience, you'll feel at home very quickly. If you don't, it eases you into it, since you do runs w/ the Medics for a while, and some dispatch work too, to see and understand how it works. Then you'll get to go on the copter rides + MD ridealongs, both of which are a bit more involved.

Do you think its worthwhile for someone who worked as a paramedic before medical school but is interested in staying involved in the EMS world?
Click to expand...
If you haven't seen the medical side, then yes. Few places have MD "go-teams," which is something I'd suggest you get exposure to, since usually these EM docs serve as the Medical Directors of their local Prehospital system.
 
Personally, the best ER doc i've seen in EMS used to be a medic, he broke down that "communication barrier" and it was the smoothest transition I've ever seen between EMS and hospital staff. I am going through school to become a Registerd Nurse (Paramedic RN) so I can work the whirly bird through med school. Hey, ya gotta start somewhere. I think its great to work at every level.
 
I just want to thank everyone for the kind words on EMS providers. I am an NREMT-Paramedic in a suburb of Pittsburgh and routinely make a trip to the city to drop off a patient at UPMC-Presby or Shadyside. Heck, a lot of docs on here at Pitt would recognize my service as one of the biggest providers in the area, if not the biggest.

I wish you all luck in your medical careers and look forward to the day I can retire from the truck and learn from you as a medical student/intern/resident, etc...

all the best,
dxu
 
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