Agree with Ninja. Physicians in a major city responding to all serious patients are a complete waste of resources.
Where'd you make the jump from having an on-call service available as needed (and/or when it's the EMS Physician's day to ride around prehospital) to responding to ALL serious complaints. Having A system in place doesn't necessitate using it ALL the time. Like any good power/privileged, the most important element lies in how & when you use it.
Thoracotomies in the field? Assinine...worse, delusional.
Hmm...ok, lets study that "argument." To perform a proven life-saving procedure at the time when it is MOST useful, and proven to be of benefit, vs. waiting while they've had 20+ minutes of CPR while en-route via that super bumpy ambulance you mentioned. We're talking about the sole procedure that has any chance of saving their life, and you're ok with postponing it 20 minutes...or abandoning it altogether? There's a comforting thought.
And if you're gonna argue thoracotomies are useless because of their extremely low survival rate, then we shouldn't bother coding people either, now should we? Cuz if you look at the statistics, requiring CPR has a dismal prognosis too...
Amputations in the field? Just call a general surgeon or orthopod for the one in a million transports where that is going to be needed.
That typically ends up requiring two ppl; the surgeon & the anesthesiologist. And if you're talking about cost-effectiveness, these are best suited & most familiar with in-patient, in OR conditions. An EMS Physician can fulfill both roles, AND is familiar with prehospital care.
You sound like someone who should be in the military, deployed to Iraq, where you can see lots of maimed people and get your jollies. You desire an occupation that doesn't exist, and that shouldn't exist, and will never exist here in the USA.
It's not about jollies. It's about seeing an opportunity to do good, and having good hard evidence to showing that it improves survival AND neurologic outcome.
And I hate to burst your bubble, but the occupation I'm talking about DOES exist, and is alive, well, and thriving in SEVERAL large urban centers in the US. I know; I've been talking to a bunch of them. And I worked with one of 'em for a bit as well. Granted, it's not something you do 24/7 as your sole profession, but it's definitely something that you do in addition to your clinical shifts & other EMS duties as a Medical (Co/Assoc.) Director. Just cuz you don't know about it doesn't mean it doesn't exist.
I would be interested in a discussion about a critical piece of information that I lack regarding the above studies. How are EMT's and their training different in the UK, Australia, etc. compared to ours. Is it competitive to become an EMS provider in those countries compared to here? Our EMT's are usually top-notch here due to the fact that it is a well-compensated job with minimal training (making close to $50,000 a year a few months out of high-school, with ludicrously generous pensions thanks to their unions). Would studies done in the UK be comparable to our system?
That's a very good question I don't know the answer to.
We have thousands of ERs in this country that are staffed by foreign medical graduates, family practice docs who are inadequately trained, and even PAs and NPs because the volume at those ERs are so small. You want to take hundreds more ER physicians away from those rural settings where they could make a huge difference in the care recieved and make them into literal ambulance chasers. Do you know how spread out our cities are?
No one is gonna "take" anyone away from anywhere. This is something ppl sign up for and train to do out of their own interest and passion. Why else do you think a fresh EM grad would squander the opportunity of making $200K-$300K to make less than $100K during a fellowship if it wasn't a passion of theirs? If it's not something you wanna do, so be it. No reason to get all uptight if someone else does lol. Relax man.
Who is going to pay for that physician who is going to want at least $100 an hour to be sitting at home watching ER re-runs? Is that worth the 3 calls they try to respond to per day (the 1 call that they can actually participate in care of patient on)? What if they make a difference in 1 out of 15 patients that they see (we'll say they average 30 patients a month), how often is that improved care going to be the difference between life and death?
It's part & parcel of EMS direction, training, and quality control. So whether you're making the oh-so-critical difference you belittle (despite evidence based medicine stating that's the case), or you're just twiddling your thumbs, you're still there serving a purpose.
There are very few medical interventions can you make without an IV, which generally takes about half the ambulance ride to get. I can't imagine trying to get a central line in the back of a bumpy ambulance going lights and sirens, screaming down the highway while trying to keep sterile.
You obviously haven't read any of the articles I referenced, because the evidence they were providing wasn't supporting having a doc jump on board and do stuff instead of the medic while en-route; it was bringing physician-level care TO THE FIELD, and stabilizing the patient IN THE FIELD prior to proceeding with transport to the ED.
Sure, you'll say oh we've already proven scoop 'n run is the better way to go - we have, with medics. But not when physician-level care can be provided in the field; we have VERY little data on that in the US. Try reading the articles first.
Crich? Those are so far and few between that I haven't seen one in 6 years of being a physician.
I dunno where you practice, but we see a few every MONTH, and no it's not simply because of extremely difficult intubations that even Anesthesia can't get; a lot of it is secondary to patients with contraindications to orotracheal intubation (severe oral/facial trauma, etc). I've DONE a few myself...
You could cite another dozen of biased, flawed studies performed, written, and spun by fellow "trauma junkies" and I would still think your idea is stupid.
Hmmm...wow, you don't sound biased at all yourself. Makes your argument a heck of a lot stronger...
If you want to hang out with your paramedic homies that you are the medical director for, responding to calls when you can so you can understand their world better, I think that is cool.
That's a big part of it, but just watching when you can be helping is only 50% of the game.
If you want to specialize in helicopter medicine to transfer critical patients in suburban and rural areas and hospitals, I think I would buy the physician argument (which would in part, help solve the crappy medical care that currently exists in rural areas).
I'll buy that.
But to push for a standard of care where you are simply acting as an over-paid paramedic, riding around in a cool truck that will impress people is simply ******ed.
Where you got "standard of care" from, I don't know. And where you got so personally offended from me simply presenting literature and my perspective, to the point that you throw insults and insinuate this is because I wanna "impress" people...THAT'S ******ed. And as an Attending - who I'm assuming means you're older than me, and should be more mature - you should be ashamed. There should be NO problem with us exchanging perspectives, opinions, and looking at evidence objectively with a difference of opinion.
More importantly, just because YOU don't like something doesn't mean you should put it down as unimportant and trivial. You should respect your fellow EM colleagues, no matter how crazy (to you)their ideas are. And more importantly, as a professional physician, you should know better than to take a cheap shot at an article by simply calling it "biased" and "flawed." The more intelligent would either actually read the article, argue its merits and flaws on an intellectual & factual level (hence have a *meaningful* discussion), or opt to simply remain quiet. You chose neither. And that's shameful.
