Just so that I understand, where exactly is the ER physician while you are assessing, evaluating, intubating, thoracostomating, stabilizing, and making transfer arrangements for these trauma patients?
at my rural job the doc will be treating one of the other unstable pts from the multi casualty incident while I have my own pts....it's not uncommon at this particular er to have several critical trauma pts at one time and with just 2 of us there we each manage our fair share.
you may not be aware of this but there are rural level 4 ed's all over the country that don't staff physicians at all. the entire e.d. staff is pa's with an available on call doc available for phone consults.
this is very common in vermont, maine, texas, georgia, montana, minnesota, alaska, hawaii, and other similar rural states.
here is a recent ad for such a job:
SOUTHWEST GEORGIA RURAL ER!
Rural Southwest Georgia Hospital has IMMEDIATE opening for Physician Assistant in the emergency room. Join team of two other PAs in sharing coverage duties. Must have at least three years experience in an emergency room and be capable of independent practice with off site physician backup. acls/atls/pals required. Solo position requires comfort with a full range of medical and trauma patients.
Great quality of life in rural, agricultural based community with easy access to larger cities. Excellent hospital system with long history of physician assistant utilization. Salary $85-90K to start with bonus structure. exceptional cafeteria-style benefit package including paid CME, professional memberships, licensure, malpractice insurance, retirement and relocation!
and another( I have 3 friends who work here. no doc on site, ATLS required):
Experienced Emergency PA-C For Two Week On/ Two Week Off Rotation
Job #: 1075247
Beacon Occupational Health and Safety Services
Prudhoe Bay, Alaska
Beacon is currently recruiting experienced Emergency Care PA-C's who would like working a two week on two week off work rotation on the North Slope of Alaska. While on all expenses are all paid for.
Physician Assistant
Two Week On/ Two Week Off Work Rotation
Description: Physician Assistant North Slope, Alaska
This position will be located on the North Slope at a Beacon medical facility. The workforce consists of oil field contractor employees. The number of employees varies considerably due to construction stages, drilling operations, maintenance and operating.
Roles & Responsibilities:
Provides acute and occupational medical care to on-site employees. Responds to emergency situations (medical, fire and spills). Stabilizes seriously ill and injured patients and arranges emergency air evacuation to hospitals in Anchorage or Fairbanks.
Principal Accountabilities:
1. Responds primarily to emergency situations on the North Slope. Provides leadership and supervision to the EMTs of the Medical Emergency Response Team. Directs triage, patient transport, and medical supervision at mass casualty incidents. Interfaces with other response team sections. Maintains readiness of emergency vehicles and supplies.
2. Determines the need for emergency air evacuation of seriously ill or injured patients to appropriate medical centers in Anchorage and Fairbanks.
3. Diagnoses and treats illnesses and injuries of the workforce according to collaborative agreement with the supervising physicians.
4. Conducts laboratory, radiological and electro-cardiograph diagnostic procedures as required.
5. Refers patients to appropriate consulting physicians and dentists within Alaska when the scope of required medical care is beyond the capabilities of the medical facility.
6. Prescribes and dispenses appropriate pharmaceuticals including controlled substances as approved by the supervising physician, within the scope of the collaborative agreement and in accordance with DEA regulations.
7. Leads and participates in weekly training sessions of the MERT (Medical Emergency Response Team). Participates in MERT, ERT, and SRT drills.
Experience:
Graduate of an American Medical Association (AMA) accredited Physician Assistant training program. Maintains professional certification with the National Commission on Certification of Physician Assistants (NCCPA) and State of Alaska licensure (or eligible to apply of State of AK Lic). Maintains emergency medicine skills through specific training (Advanced Cardiac Life Support, Advanced Burn Life Support, Advanced Trauma Life Support). Have or obtain appropriate certifications in Occupational Medicine Testing, CAOHC and NIOSH, weather observation as required by the client. Preferred candidates will have a minimum of 5 years remote site/independent duty or ED experience.
Education:
Graduate of an American Medical Association (AMA) accredited Physician Assistant training program.
Certifications:
Graduate of an American Medical Association (AMA) accredited Physician Assistant training program. Maintains professional certification with the National Commission on Certification of Physician Assistants (NCCPA) and State of Alaska licensure. Maintains emergency medicine skills through specific training (Advanced Cardiac Life Support, Advanced Burn Life Support, Advanced Trauma Life Support).
Compensation ranges from 119,000 to 133,000, with the opportunity to earn much more. Beacon offers, Medical, Dental, Vision, Life, Long Term Disability, 401(k) with a company matching plus more.
look at the entire er staff of this mayo affiliated hospital(yup, I have a friend who works here too)
waseca medical ctr., minnesota. er staff is 6 pa's.
there are also many fine pa em and critical care residencies available now that train pa's in trauma and critical care.. see
www.appap.org for links
this one has a mission statement that it trains em pa's for solo practice:
http://www.healthcare.uiowa.edu/EmergencyMedicine/paResidency.html
my point from all of the above is that there are places(more than you would think) that the pa runs the traumas and therefore needs all the skills provided in an atls course.
as is the case with my buddy who works solo in the aleutians sometimes the nearest doc is 6 hrs away.....
