Southern did you do any sort of a fellowship related to EMS or tactical EMS? This is something of great interest to me over several months, but as you said it is a small community and we don't have any TEMS providers at all, just basics on the team
I can't speak for Southern, but I can tell ya that having spoken to well over a dozen Tactical Physicians, it appears that the vast majority do NOT have any formal fellowship training, be it in a Tactical-specific fellowship (GEMSS or JHU), or in an EMS Fellowship with tactical opportunities.
Interestingly enough, ABEM's decision this year to recognize EMS as a boarded specialty prompts the question about how they will tackle the requirement for TEMS experience in an EMS Fellowship (since it is part & parcel of EMS Medicine). My guess is with a scarce nature of active TEMS throughout the country, the requirement will be more based on Medical Direction rather than a primary provider.
Jolly sums it up pretty well. As an RN, RRT, PA, etc, you are trained to work in a much more controlled clinical environment. Where I live, there are no programs allowing for allied healthcare providers to go through the paramedic program any faster than someone who went straight through EMS.
The state license as an RN or RRT does not include in your scope of practice the skill set required to work EMS, so you won't find one providing solo care on an ambo.
Maybe I misunderstood this post, but to me it seems like you're saying as a doc, you'd need to go to EMT school (several months) to be able to become a Tactical and/or Prehospital Provider. Not quite so.
1) On a liability perspective, I'd say you need SOME type of formal pre-hospital training, because the second you make a mistake, the question asked will be, are you practicing within or beyond your scope of practice? And technically speaking, being that docs don't get any prehospital training (intrinsic to med school or residency), playing prehospital/tactical doc IS beyond your scope, and opens you up for liability. Which is why I've chosen to pursue a formal fellowship in EMS. Get the formal training, under supervision. And shortly (as mentioned above) you'll have a board certification behind your name to prove it.
2) On a practical level, as a physician, you possess a terminal degree, so you're automatically past the qualification of an EMT, Paramedic, RN, etc. So what many TEMS programs simply prefer (and some require) is that you enroll & complete the CONTOMS course, which earns you your EMT-T (EMT-Tactical) certification, recognized by the Dept. of Homeland Security as well as various other federal and national security/law enforcement/medical organizations. So you DON'T need months of EMT/Paramedic school to go through this.
3) Having said that, the same typa scenario (#s 1 & 2) applies to if you wanna carry a weapon/be a member of the entry team. Liability and realistically, you'd wanna be a law enforcement officer (go through the academy). And while few docs actually wanna be on the entry team, those that do, many of them are merely deputized officers (ie have not gone through the entire police academy); they've simply gone through SWAT school, go to the range with the team to maintain firearm competency, and complete X numbers/hours of SWAT/special ops training sessions with your local team/month or year. Having said that, there are a few who are sworn law enforcement officers as well.
My good friend is a police officer. They have some physicians that like to come hang out with them for SWAT team training. In his opinion, (take it for what it's worth), the physicians don't perform as well as the paramedics. Physicians are so worried about history, treatment and advanced diagnostic measures that they forget about the basics (clog the holes, and get them the heck out of there).
Couldn't agree with you more. We often lose sight of the big picture (stabilize and move) because we often work at the final stop in patient care (the hospital).
I think physicians are allowed to participate for the additional insight they might occasionally provide in training sessions.
And that some teams simply feel warm & fuzzy inside knowing there's an actual doc there. Plus, you are your own medical command, so there's no need to call in for Rxs, or when you reach a prompt @ a certain point in an EMS Protocol, etc. And there are a few procedures here & there that if you're a solid, proficient EM doc, you're gonna be the best at - and they're typically the most critical & life-saving procedures. That's not a knock on the medics, cuz they can certainly hold their own.
Could tactical medicine be a silly past-time/hobby for a practicing ER physician, who has found the ER a little less exciting than they wish, and wishes to renew the feeling of being worshipped at cocktail parties?
If you have found you hate the ER and are trying to find a way to supplement your income as a way to have to spend less time there, this isn't a good way.
If you get a kick out of it and have no expectations of personal reimbursement, it might rarely be an option.
For some of us, it provides a nice temporary departure from the hum & drum of daily ED life, with the perks of one heck of an exciting experience, while providing the opportunity to really make a difference in the most critical of stages. And you're right; it's def. not for extra cash haha.
My $0.02
