Pre-Hospital/Medevac Physician in Military?

[Mike97]

I’m a senior year premed student and I'm looking into the HPSP scholarship. I’m currently an EMT and on my local fire department. I really like the prehospital medicine and strongly thought about doing flight medic.

Are there any prehospital / in the field roles for physicians in the military? Would there be any chance of an MD doing medevac?

Thank you!

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[armytrainingsir]

The closest 'In the field roles' for MDs that I imagine you are envisioning would be Army Forward Surgical Teams

Army upgrades frontline surgical teams

The 745th Forward Surgical Team, a detachment of the 31st Combat Support Hospital, became the Army's first unit to upgrade into a Forward Resuscitation and Surgical Team at Fort Bliss, Texas, Feb. 6. The unit converted as part of a coordinated medica...

www.army.mil

The only MD evac role I can think of would be AF CCATT

AFMS Capability: Critical Care Air Transport Team

 

[DrMetal]

I’m a senior year premed student and I'm looking into the HPSP scholarship. I’m currently an EMT and on my local fire department. I really like the prehospital medicine and strongly thought about doing flight medic.

Are there any prehospital / in the field roles for physicians in the military? Would there be any chance of an MD doing medevac?

Thank you!

Not really. It certainly could happen (not me personally, but I've had friends act as physician escorts for medevacs.....quite honestly it can and should be done by a corpsman or medic). If you use a physician as an escort, you leave a gap in that field hospital or triage center that's very difficult to fill. Not a good utilization of resources. Same is true in the civilian world.

 

[Gastrapathy]

The problem with the prehospital world is that the care provided doesn’t require a physician’s training. Once you’ve completed a residency, it generally loses its appeal.

 

[armytrainingsir]

The German EMS system has ( or at least had) physicians as first responders.

Take the doc to the patient instead of the US system of take the patient to the doc.

And France has physicians manning the dispatch phone lines, triaging and advising.

I'm curious if one model has better outcomes, but a very brief search didn't come up with anything.

 

[DrMetal]

The German EMS system has ( or at least had) physicians as first responders.

Take the doc to the patient instead of the US system of take the patient to the doc.

Silly and unnecessary, makes no sense. Is a general surgeon gonna do a splenectomy in the middle of the street? Those silly Germans, always trying to reinvent themselves and take over the world.

And France has physicians manning the dispatch phone lines, triaging and advising.

This makes a little more sense and is done in some parts of the U.S., especially during the current pandemic. If talking to a doctor over the phone makes the patient feel better and prevents him/her from coming in for something silly, it's well worth it.

 

[pgg]

I’m a senior year premed student and I'm looking into the HPSP scholarship. I’m currently an EMT and on my local fire department. I really like the prehospital medicine and strongly thought about doing flight medic.

Are there any prehospital / in the field roles for physicians in the military? Would there be any chance of an MD doing medevac?

Thank you!

There are some circumstances where physicians are involved in point-of-injury casualty care and evac. But not often. I wouldn't get your heart set on that kind of work.

It happens, but outside of some special operations commands where they do their own thing, my opinion is that in most cases where it does happen, there's a poorly informed commander misusing a physician, or a physician who wants to play adventure summer camp who talked the commander into misusing him, or inadequate resources available where a physician fills in to do a job that should be done by a medic (again, arguably a failure of leadership).

The truth is that there is very little that a physician can do for trauma on-scene that a well-trained medic can't do. There are a handful of causes of preventable battlefield death and none of them are really so much better served by a physician at the point of injury that it's rational to risk a physician getting injured or killed.

 

[pgg]

The German EMS system has ( or at least had) physicians as first responders.

Take the doc to the patient instead of the US system of take the patient to the doc.

And France has physicians manning the dispatch phone lines, triaging and advising.

I'm curious if one model has better outcomes, but a very brief search didn't come up with anything.

The vast majority of civilian EMS calls are medical in nature, not trauma. Maybe (maybe) there's a benefit in having a physician at the scene when the issue is something vague like altered mental status, chest pain, etc. Where some triage is needed or if there's a question whether transport to a hospital is even necessary. When the problem is "bleeding" the gap in POI care between a medic and a doctor is narrower.

 

[armytrainingsir]

The vast majority of civilian EMS calls are medical in nature, not trauma. Maybe (maybe) there's a benefit in having a physician at the scene when the issue is something vague like altered mental status, chest pain, etc. Where some triage is needed or if there's a question whether transport to a hospital is even necessary. When the problem is "bleeding" the gap in POI care between a medic and a doctor is narrower.

I agree. But you know the Germans. If you need to know if they do something the right way, just ask them.🙂

 

[usma05]

There are some circumstances where physicians are involved in point-of-injury casualty care and evac. But not often. I wouldn't get your heart set on that kind of work.

It happens, but outside of some special operations commands where they do their own thing, my opinion is that in most cases where it does happen, there's a poorly informed commander misusing a physician, or a physician who wants to play adventure summer camp who talked the commander into misusing him, or inadequate resources available where a physician fills in to do a job that should be done by a medic (again, arguably a failure of leadership).

The truth is that there is very little that a physician can do for trauma on-scene that a well-trained medic can't do. There are a handful of causes of preventable battlefield death and none of them are really so much better served by a physician at the point of injury that it's rational to risk a physician getting injured or killed.

100% agree with this sentiment. I did MEDEVAC in Afghanistan in 2011 on a rotation with fellow providers per instruction from my Brigade Flight Surgeon. It was certainly interesting, but it led to situations where medics felt uncomfortable if they didnt defer to the Doc/PA in the UH-60 with them because of 'expertise,' when really they had the experience necessary to accomplish the mission. In the back of helicopter isnt much of a place to render advanced level care, neither is POI. In 2015, they pushed me out with a FST to maintain the 'Golden Hours which was slightly better because I could bring supplies, but they have unrealistic expectations of what came be accomplished surgically when you set up something short term. An example would be a mission in which the plan was to perform DCR in the back of a C130 during a hasty extraction from an airfield if things went south.

I think most physicians have an appreciation for how resource intensive what we do is. There are prehospital fellowships available, particularly in ER, but my impression is they are mostly to help those docs transition into an admin role running a facile prehospital program, developing medic/EMT protocols, and mascal planning. I know some cowboys out there exist and push for doc prehospital care, but at least most people I talk to are hesitant and view this as individuals seeking an unnecessary adrenaline rush without dramatic patient benefit. There should be some thought about the cost associated with training a physician and if it results much better outcomes....which i haven't seen outside of a hosptial.