I'd say that 90% of the patients could have walked to the hospital rather then call 911. 5% would be helpful to have a paramedic to perform some intervention (albuterol, D50), 5% need a doctor but could not make it to hospital without the ride due to health reasons.
Part of the reason I went to med school was because I wanted to make more of a difference in outcome ... and I hope being a physician will allow that to happen ... if I gave up these years learning all this BS for nothing, I'll be pissed.
I got a master's degree while I was in paramedic school. Medic school was just something I'd wanted to do for a long time, and I was a bit turned off by my post-graduate studies. So I came from a little different background than a lot of the other students in my classes. Being 30, I think a little more life experience helped me with the patient care aspects of being a paramedic. It's easier to see people as people and not as a problem to be solved.
Unfortunately, I run into the "What's really going on with this patient?" quite a bit. And the reality is that I just don't have the education to understand the bigger picture. There's many times when presented with a patient that I really want to do a lot more than the O2, IV, monitor, SAMPLE, OPQRST. But that's the extent of what I'm equipped to do with someone not presenting with an acute, going to crap out on my in the next 25 minutes unless I do something, condition.
The bulk of this thread has focused on the Who is Better at This and That. I never make any apologies for EMS. I work for a very famous, high volume urban system. I'm blessed to work side by side with some of the best paramedics in the world. But even in this group, there are a lot of horrible medics.
The thing is, prehospital care needs to undergo a paradigm shift. Most older, experienced medics have it figured out, if they don't burn out from the working conditions, the hours, or the stress. It's not about "saving lives." Never has been really. Unfortunately, that's the public perception. I ran 50 911 calls in the past 7 shifts. One was a full on code, and the outcome for that is almost always a foregone conclusion. 48 of them were people that could have taken a cab to the hospital for less money, but being homeless or indigent, didn't have the means. I'm a cab driver most days. In a nation with horrible access to health care for the poor, I am the revolving door, the doorman, and the bellhop for the beat down and the poor. And the one call was a refusal, but it was the most satisfying call of them all because it really felt like I gave someone hope.
What being a paramedic is about for me is making people comfortable. It's advocating for my patients when they go to triage instead of getting a room if I think they need it. It's about reporting elderly or child abuse when I see a home where the floor is literally crawling with a million roaches.
It's about waiting 20 minutes on scene with a elderly woman to gather up her purse, hair curlers, packing a suitcase, and making sure the cats have enough food before she goes to the hospital.
It's about spending a half an hour with a woman who has recurrent panic attacks but doesn't yet recognize the precipitating factors or the early signs, and giving her some advice on what to do next time.
It's about reassurance. It's about bringing a calm to an emergency. That's what I love about it. Every day, people have "emergencies" that pale in comparison to what is a Real emergency. But if I can arrive with a calm head, and suppress my own fears and insecurities (which are always palpable), I can help more people than any psychomotor skill ever will.
I love my job. Nurses have better job security, more pay, and safer work environments. Physicians have more respect and magnitudes greater autonomy, but right now, I'd not trade my job for anything.
Unfortunately, I like to fix things. I like to know what's going on. And as a medic, I just don't have the education or the tools to do that for many cases.
That leaves me two options: get upset that I have to call for orders for interventions that are clearly warranted, but for which I am still required to call, get disgusted and quit caring, and just do the O2, IV, Monitor, transport because that's all I'm equipped to do. OR, take advantage of the unique situation I'm in and do what doesn't cost me or them a penny: care and listen. Every shift, between 6 and 12 times per 12 hours, I am invited into the most intimate situations in people's lives. I see their homes, smell their food, see their depravity, and muddy their carpet with my boots and bags.
There's something wholesome and raw about seeing people in the very situations that caused them the insult and injury they're seeking care for. It's rarely pretty to open a car door on a trauma patient and have a crack pipe and .22 shell casing fall on your feet. But it sure tells one hell of a story.
That's what I'm in it for. The story. I get lied to by about 75% of the patients I transport. "No boss. I didn't do any PCP. I don't touch the stuff." "Dude! I was just walking along this street, minding my own business, when I got stabbed." But everyone has a story and I'm glad to be the one to hear it, fiction or not.
I might not save any lives, and I really don't care if I do. But if I can make someone with a broken hip pain free, if I can lessen the likelihood that a patient with an acute asthma attack will be admitted to the hospital, and especially if I can give someone a sense of hope that things will be better, I feel like I've done something important.
About a year ago, I was reading a journal article that was discussing the direction EMS should go, one of the more memorable lines was something like this, To think that 15 minutes of care in the prehospital environment will make a significant difference in patient outcomes is foolish.
That's a hard pill to swallow. But if I don't admit that it's true, I'll be stuck focusing on the minutia and forgetting the other fact about EMS: the prehospital provider spends, in minutes, more time with a patient than an emergency medicine physician. That's an opportunity. A hell of a time to talk about teachable moments, a hell of a time to just Listen. Which in the end, is what most people want anyway -- to be respected and heard.
On the subject of the actual subject, I worked with a few people who'd made the bridge from EMT-P to either MD or DO. All in emergency medicine. They all were very good medics, and it was always very interesting to hear them relate their experiences in the prehospital setting to their work in the ED.
One thing that goes unrecognized is that working in emergency medicine as a physician, you'll be dealing with a lot of EMTs and paramedics. They'll be calling you for orders, advice, suggestions, and help. If for no other reason, having that first hand experience will give you a chance to impart useful knowledge for those paramedics, and you'll understand the limitations of EMS better than many people. Hell, you might even have the opportunity to work as a medical director or improve prehospital protocols.
But as someone who works as a paramedic, I don't think I have any special knowledge or skills that would make me a better physician that someone who isn't. They're quite a bit different, and the year I spent in medic school would have been better spent doing pre-med work if my immediate goal was to work as a physician.
