PAs intubating and doing central lines

[Fox800]

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The only skill a paramedic needs is to be able to hit the gas pedal.

I'm a physician and a paramedic, and that's the dumbest thing I've read on here in a long time.

 

[Psai]

Cool story bro

 

[Apollyon]

I'm a physician and a paramedic, and that's the dumbest thing I've read on here in a long time.

I am, also, and I agree, also.

But I think that that guy is just a rabble rouser.

 

[Fox800]

I am, also, and I agree, also.

But I think that that guy is just a rabble rouser.

Agreed. Likes to stir the pot without posting anything of substance. Lots of one liners.

 

[Psai]

Sorry for being busy due to working more than 12 hour shifts

 

[Apollyon]

Sorry for being busy due to working more than 12 hour shifts

I worked 24 yesterday, and am still up. Your attempt to indicate that you are better than EM people that work 12 hour shifts, as usual, is dim-witted, poorly thought out, and vapid. How busy are you, really, anyways?

 

[Psai]

You should work on that comma use.

 

[Doctor Bob]

Calm it down. This back and forth isn't adding anything to the body of medical knowledge and isn't proving either of your points. If you want to snipe at each other, do it through private messages.

 

[Apollyon]

You're not a mod, for one. Secondly, this zero has nothing to contribute. There is no value in PM. He seems impressed with his own self, and seems to think he is witty.

And, to whomever this person is, if you are referring to me, and comma use, I am correct. Break out a Strunk and White and look it up, but I am correct.

And, if THAT is all you have left, then, maybe, you see that it is time to move on.

 

[Psai]

Once a paragod...

 

[deleted497653]

this thread has really deteriorated.

Paramedics deserve more respect than they get

 

[Boatswain2PA]

this thread has really deteriorated.

Paramedics deserve more respect than they get

It's easy to bash on paramedics from the ED where you are working in a heated/air-conditioned, well lighted environment. Paramedics, on the other hand, ply their trade on the side of the road in 110 degree heat with cars buzzing by, or in the dark of night during a snowstorm, and in the rankest, smelliest, NASTIEST houses you can imagine.

 

[Doctor Bob]

You're not a mod, for one. Secondly, this zero has nothing to contribute. There is no value in PM. He seems impressed with his own self, and seems to think he is witty.

So, only moderators can point out when people are arguing like children?

 

[Doctor Bob]

It's easy to bash on paramedics from the ED where you are working in a heated/air-conditioned, well lighted environment. Paramedics, on the other hand, ply their trade on the side of the road in 110 degree heat with cars buzzing by, or in the dark of night during a snowstorm, and in the rankest, smelliest, NASTIEST houses you can imagine.

And as a former medic I recognize that, and try to cut them slack when they bring people in under less than ideal conditions.
But I also try to correct them when there's a cognitive error, usually one along the lines of "I can do best for this person by staying on scene for 20 additional minutes"

 

[deleted497653]

nvmd...carry on

 

[Siggy]

this thread has really deteriorated.

Paramedics deserve more respect than they get

The problem with EMS is that they're trained like technicians but are expected to act like clinicians. Want to see EMS improve? Get them off the fence and force them to either be clinicians (with the requisite education, not 1000 hours of non-college technical school training), or restrict the scope and thought process to protocol driven monkey... I meant technician work. Clinician expectations with technician training leads to "system dependent" arguments that makes any sort of EMS research useless.

 

[cbrons]

So about PAs doing central lines and whatnot... I am trying to feel out how much the mid-levels do procedures at various programs and avoiding those programs, because I feel like I would fall into some major kind of depression if I wasn't getting procedures as a resident because a PA or NP decided they wanted to do it.

 

[PlutoBoy]

You're not a mod, for one. Secondly, this zero has nothing to contribute. There is no value in PM. He seems impressed with his own self, and seems to think he is witty.

And, to whomever this person is, if you are referring to me, and comma use, I am correct. Break out a Strunk and White and look it up, but I am correct.

And, if THAT is all you have left, then, maybe, you see that it is time to move on.

That's a lot of commas 😛

 

[Radz123]

For what it's worth, your IR Department is almost certainly using PA's/NP's to do all the procedures you've listed and more. Personally its the only way our Department can handle the volume. Midlevels have been doing these procedures for decades.

If you're concerned about procedural training/volume, email your local IR Program Director and tell him/her you need more lines/LP's/drainages. They'll likely name a hallway after you if you're willing to help with the procedure load.

 

[FroggerMD]

When I was a resident, the PAs in the SICU put in central lines all the time and were excellent at it. A community hospital that i'm familiar with in the Adirondacks has a strong team of PAs that pretty much run the place (with a few MDs overseeing things, providing medical direction, etc) and they do pretty much everything: intubations, chest tubes, etc. The ability to do procedures is not MD-specific, it's just about having reasonable dexterity and practicing. It's the judgement as to when to do them that, in my opinion, takes years to hone.

 

[d2305]

At least you don't have to worry about PAs doing throacotomies. I remember when EMS was run by funeral homes. They would get you to the ER fast to see a general practice physician.

 

[illegallysmooth]

In my program the PAs generally fall into 4 categories.
1) they do as little as possible, love picking up hand injuries so they don't need to see the patient and they just page ortho
2) they are workhorses and and bang out charts for mostly fast track type stuff
3) they are young, curious, engaged, want to learn more, would be interested in learning to tube or line
4) they are older, seasoned EM midlevels

Category 4 is by far the most rare, 3 is close behind. So, it doesn't come up often, but I helped a type 3 PA through her first intubation attempt (there were no interns around), and last night a PA intubated a patient (should that attending have grabbed the intern in the other section of the ED?).

In our ICU, however, there are very sharp, young/middle aged nurse practitioners who have done TONS of lines and in fact coached me through my first few during my intern year. And you betcha they know what to do with complications.

I don't think it's a question of just education/degree-- there are too many factors - experience, personality, presence of year 1 and 2 ER residents who need training, the setting, the acuity, etc etc.