SWAT Doctor

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I'm confused as to the dichotomy of him being there to treat people, but needing a rifle to defend himself? Is the idea that he's trying to help people during an active situation? I don't necessarily get how effective that would be.

It seems like he would essentially be acting as a SWAT team member (with rifle drawn) until the situation was handled, in which case regular paramedics could then come in and act as they normally would.
 
"Neeki said much of what doctors know today about treating assault rifle wounds has come from the wars in Iraq and Afghanistan. And because wounds like these shorten survival time for victims, it also means physicians need to be on the scene immediately, just like medics in foreign combat zones."

"I don't want to get hurt," said Neeki. "If someone has the intention like yesterday of coming in and just indiscriminately shooting and I'm the first there, I want to be able to defend myself and those civilians. A good guy should be able to defend himself and also help everybody else."

There's a split in the thought process behind this. Or at least in the way it's described.
 
tymont12 said:
I'm confused as to the dichotomy of him being there to treat people, but needing a rifle to defend himself? Is the idea that he's trying to help people during an active situation? I don't necessarily get how effective that would be.

It seems like he would essentially be acting as a SWAT team member (with rifle drawn) until the situation was handled, in which case regular paramedics could then come in and act as they normally would.
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http://www.naemt.org/Education/IGb Care Under Fire with Notes 2-17-09.pdf

A brief set of powerpoints with notes if you're interested on the way you handle care under fire situations.
 
tymont12 said:
I'm confused as to the dichotomy of him being there to treat people, but needing a rifle to defend himself? Is the idea that he's trying to help people during an active situation? I don't necessarily get how effective that would be.

It seems like he would essentially be acting as a SWAT team member (with rifle drawn) until the situation was handled, in which case regular paramedics could then come in and act as they normally would.
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you realize there's a difference in what a physician can do and a paramedic can do in emergency situations, right?
 
Tired said:
It's effective. It's the whole principle of care under fire. If you're bored, read the military handbook on TCCC.
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Would this approach be similarly effective in the cases of urban combat we've seen recently, though, with their significant differences from the battlefield? (I don't know - I'm actually asking.)
 
Tired said:
Not sure. Had never heard of this phenomenon in the civilian world prior to this article. Frankly, feels a little gimmicky to me, but whatever. I would imagine "SWAT doctors" find very infrequent use, as opposed to our military doctors/medics/corpsmen.
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I agree. That isn't to say I take any credit away from this guy. But the situations are different. The area under fire tends to be more concentrated and the shooter tends to fire at much closer range in these situations. The cases of penetrating trauma are less likely to be shots to the leg. I have a hard time picturing anyone being successful in treating someone "in the field" during these sorts of active shooter situations. But this is all from a complete outsider perspective.
 
PL198 said:
you realize there's a difference in what a physician can do and a paramedic can do in emergency situations, right?
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I get that physicians can legally do more but is 'on the scene' care going to be much different between a physician and a paramedic? Especially in a situation where they are worried about potentially being shot?
 
I think the discussion of whether this is the best use of a doctor's education is sort of silly. Honestly, a lot of preventive and routine primary care isn't exactly going to heavily utilize a physician's expertise in comparison to that of other providers.

This is America. Part of the beauty of a country like this in comparison to some communist society is that people aren't directly constrained by a requirement to utilize their skills toward social needs in the most efficient way. People get to utilize their skills as they enjoy and see fit. A doctor can certainly provide this type of care, and if they want to that's their choice. Who cares if it's an efficient use of the education?
 
tymont12 said:
I get that physicians can legally do more but is 'on the scene' care going to be much different between a physician and a paramedic? Especially in a situation where they are worried about potentially being shot?
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There's very little difference between a paramedic and a physician in the field. I'm no expert, but just think logically about it: what can doctors do that paramedics can't? Complicated medical treatment (as in actual medicines). Certain procedures. Not sure whether paramedics can do thoracostomies. Most of those things require either additional equipment or are ideally done in a more stable/clean environment.

However, the ability to competently establish hemostasis for certain wounds may be an important differentiating factor in this sort of event.

I know another "SWAT Doctor" but I don't think he carries a rifle. (Asked him about it a long time ago and it sounds like a purely noncombat role.)
 
PL198 said:
you realize there's a difference in what a physician can do and a paramedic can do in emergency situations, right?
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In the field, there isn't a whole lot of practical difference between what a doctor and paramedic can do.

The point isn't necessarily to get a physician to the pt's side - it is a sign that there is a mature system in place to train and maintain medical providers that are also operational, starting with a physician down to individual level basic first aid training. The physicians and medics train with the team to develop espirit de corp and to provide someone for the team members who both "gets" them and can also train them. This also the reason why the tactical medics and doctors (in some jurisdictions) train with weapons and are deputized (this also may limit liability from a law enforcement perspective, again, depending on the jurisdiction). One last point about arming the medical members: the best way to win a gunfight is to bring the most guns.

rilte4 said:
I agree. That isn't to say I take any credit away from this guy. But the situations are different. The area under fire tends to be more concentrated and the shooter tends to fire at much closer range in these situations. The cases of penetrating trauma are less likely to be shots to the leg. I have a hard time picturing anyone being successful in treating someone "in the field" during these sorts of active shooter situations. But this is all from a complete outsider perspective.
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You'd be surprised how bad of a shot people are, even at close range. And you are right, as the Aurora, CO shootings helped to show, oftentimes the best care is to get people out as quickly as possible, rather than turning the scene into a mini-hospital. The goal of getting medics (and less often, docs) in at the outset is to help lighten the workload on the fulltime police officers without becoming a liability, hence the training, guns, etc. That way, the cops can go after the bad guys. In the same way, having a medical element in the "hot zone" also provides immediate medical support to the officers.
 
tymont12 said:
I'm confused as to the dichotomy of him being there to treat people, but needing a rifle to defend himself? Is the idea that he's trying to help people during an active situation? I don't necessarily get how effective that would be.

It seems like he would essentially be acting as a SWAT team member (with rifle drawn) until the situation was handled, in which case regular paramedics could then come in and act as they normally would.
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Its essentially the same as being a military medic.

Your job is to evacuate casualties from the hot zone and then provide treatment.

We carried M4 carbines with us on missions. The rifle was for self defense and we only engaged the enemy if they fired upon us first.
 
I know physicians who are members of a SWAT team, and I witnessed some of the training sessions. In this SWAT team the physicians comprised a separate unit, but trained along with the police officers, although I believe that the physicians carried only pistols and not the automatic weapons the regular SWAT members carried ( MP-5's). They do the same physical training, and practice in simulated rooms, houses, etc along with the rest of the team. In real combat they would probably wait outside.

They had to train first as reserve police officers and go through the local police academy training and pass a background test, as would a police officer.The rationale was that the physicians would be available to provide maximum care to victims who were pinned down and could not be evacuated. I agree that there are likely to be few situations in which a physician skills would be able to provide better care than an EMT, especially since "scoop and run" is the best treatment for most trauma patients, but the police like having physicians available in the event that they are needed, and it's certainly true that there could be some cases in which a physician on scene could provide better care than an EMT.

The physicians liked it because they were able to obtain gun concealed carry permits in a county where it's almost impossible to get one otherwise, and of course, the training is interesting and fun. The doctors are on call most of the time for emergencies. From what I was told, after a couple of years, my friend was called up for duty a couple of times a month, but never saw an injury. Of course, as we see from the news, we'll probably see more need for SWAT activity and perhaps more need for physicians on the scene in the future.
 
In an active shooter situation law enforcement will forgo treating ANY wounded people on scene until the threat has been eliminated. I could be wrong, but I would guess that SWAT doctors might be able to respond and treat the non-ambulatory, critically wounded prior to the threat being eliminated. That would allow them to treat victims before other first responders like EMTs, paramedics, fire, who would typically be waiting for an all clear before moving in.
 
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I understand the utility of having a medical person on the SWAT team, but I still really don't understand why a doctor would be necessary or even requested for that role. What can they do beyond a paramedic with the equipment they have available? Seems like an ego stroke to me.

When I was deployed, one of the PA's got it in his head that he wanted to go on convoys with the unit regularly. The commanders allowed it because it was relatively quiet at the time and it was a boost for them to say they had a provider on their convoys. The reality is, he couldn't do much more than a medic with equipment available and he was gone 90% of the time off the base so that was additional work for the other doctors at the base hospital who were actually doing their jobs.
 
In terms of the extra capabilities of a physician, it all depends on the equipment available.

To name a few:

-thoracotomy
-thoracostomy
-limb amputation
-fracture reduction
-conscious sedation
-advanced airway management
-REBOA


*most EMS physicians also carry more medications (i.e. the majority of paramedics carry only a select few medications)
*most EMS physicians are also more experienced and skilled at paramedic level procedures (i.e. the majority of paramedics only intubate 3-4 times a year if not less)

But, yes, you'd never perform any complicated procedures or treatments in the middle of an active firefight. Most of those would only be an option after the patient was evacuated to a safer location. If you've been following the terrorist attack in London, the stabbing victims were cared for on the scene by a HEMS physician with the London's Air Ambulance. They function as a mobile emergency department and are able to perform advanced procedures for dying patients on the scene.

https://en.wikipedia.org/wiki/London's_Air_Ambulance
 
PL198 said:
you realize there's a difference in what a physician can do and a paramedic can do in emergency situations, right?
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Is there? Without having the additional resources of a hospital available, what I can do and what my medics can do out of an aid bag are essentially the same. Maybe I can do it better due to my clinical experience, that's about it. Otherwise we're following the same protocols. So it begs the question: "do the risks of losing the fund of knowledge possessed by a physician in a situation that could just as well be handled by a medic outweigh the benefits?" There's no point in having a physician/door kicker. The potential benefit of a physician comes about during "tactical evacuation care," which occurs after the patient is already well extracted front the fire fight.
 
sonofva said:
Is there? Without having the additional resources of a hospital available, what I can do and what my medics can do out of an aid bag are essentially the same. Maybe I can do it better due to my clinical experience, that's about it. Otherwise we're following the same protocols. So it begs the question: "do the risks of losing the fund of knowledge possessed by a physician in a situation that could just as well be handled by a medic outweigh the benefits?" There's no point in having a physician/door kicker. The potential benefit of a physician comes about during "tactical evacuation care," which occurs after the patient is already well extracted front the fire fight.
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you realize this is going to be planned right, so that the physician isn't just going to have the exact same aid bag a medic would.

the entire point is that a medic can't handle the situation, or they would. that seems pretty obvious.

2 posts above mine is an example of some of the things I'm talking about
 
PL198 said:
you realize this is going to be planned right, so that the physician isn't just going to have the exact same aid bag a medic would.

the entire point is that a medic can't handle the situation, or they would. that seems pretty obvious.

2 posts above mine is an example of some of the things I'm talking about
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In care under fire phase, fire superiority is the goal. The only medical intervention you are going to do is a high hasty tourniquet over the clothes.

In tactical field care phase your goal is to firstly control massive hemorrhage, with more tourniquets. Then to focus on airway compromise. This is accomplished with bagging, Lma/King LT, other airway adjuncts, or surgical cric. Then you focus on respiratory compromise, managed with needle decompression. Then you focus on circulation - IV/io access. Then hypothermia.

In these first two phases you aren't doing anything fancy. You don't do anything more fancy because studies have shown that they don't improve mortality outcomes. For example, there's a reason TCCC Guidelines don't endorse femoral cutdown anymore. It hasn't been shown to improve mortality on the battlefield.

Anything more than these basic procedures should be reserved for tactical evacuation care. This can occur on the helicopter flying away from the scene. I hope this helps you understand why a physician "door-kicker" isn't useful.
 
sonofva said:
In care under fire phase, fire superiority is the goal. The only medical intervention you are going to do is a high hasty tourniquet over the clothes.

In tactical field care phase your goal is to firstly control massive hemorrhage, with more tourniquets. Then to focus on airway compromise. This is accomplished with bagging, Lma/King LT, other airway adjuncts, or surgical cric. Then you focus on respiratory compromise, managed with needle decompression. Then you focus on circulation - IV/io access. Then hypothermia.

In these first two phases you aren't doing anything fancy. You don't do anything more fancy because studies have shown that they don't improve mortality outcomes. For example, there's a reason TCCC Guidelines don't endorse femoral cutdown anymore. It hasn't been shown to improve mortality on the battlefield.

Anything more than these basic procedures should be reserved for tactical evacuation care. This can occur on the helicopter flying away from the scene. I hope this helps you understand why a physician "door-kicker" isn't useful.
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A doctor isn't useful? Hm.
 
Psai said:
A doctor isn't useful? Hm.
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did you just selectively read the last sentence of my post and ignore the rest? lol. i never said a doctor isn't useful. i said a doctor isn't more useful than a well trained medic as a front line, gun-wielding, tactical operator. in fact, a physician is better utilized elsewhere.

a physician level tactical medicine expert definitely serves a purpose, but that purpose is acting as a force multiplier by providing high quality training to paramedics, and by analyzing tactical medical threats and providing guidance to commanders/police chiefs on how to mitigate those threats. secondary to this is by serving on the air ambulance/evac when appropriate. Tactical evacuation care (re: on the medevac) is when a physician may have the tools available to provide advanced interventions that give them a leg up on paramedics.

if you want to be a door kicker, that's fine. go join the swat team or the green berets or whatever. no shame in that. we need people to do that. but why would you misuse all that money and energy you've poured into your education/training when someone with 1/10th of the value/training as you can do an equally good job, and you could be better utilized elsewhere? frankly, unless your some prior service type, you'll likely just end up in the way of the trigger pullers who train full time to do that job.
 
Maybe he likes kicking down doors. Maybe this whole working at the top of your training thing is bull****. Maybe lesser trained people just aren't as good as physicians. Maybe he doesn't need you telling them where he is best utilized as if he was just another replaceable cog in a machine.
 
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Psai said:
Maybe they like kicking down doors. Maybe this whole working at the top of your training thing is bull****. Maybe lesser trained people just aren't as good as physicians. Maybe people don't need you telling them where they are best utilized as if they were just another replaceable cog in a machine.
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This foot-stamping response to a well-reasoned breakdown of an informed opinion makes you look pretty obnoxious and obscures whatever point you're trying to make.

On behalf of the entire forums- we get it. Making it clear that physicians are better and other healthcare workers know their place is very important to you.
 
Psai said:
Maybe they like kicking down doors. Maybe this whole working at the top of your training thing is bull****. Maybe lesser trained people just aren't as good as physicians. Maybe people don't need you telling them where they are best utilized as if they were just another replaceable cog in a machine.
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Maybe people don't need you defending them.

It's a discussion...not a frontal assault on someone's freedom.
 
So, an argument no one supprisingly made would be - while there may or may not be a large difference in physician vs medic skills in an active shooter situation simply due to lack of access to supplies, I would argue that a physician on scene will be a much better judge of pt injury severity and hence has a better ability triage pts. Furthermore, if I have a mass casualty situation, I would want the paramedics transporting folks, not managing them in the field.
 
I'm a police officer and SWAT paramedic - there probably isn't a whole lot more a physician can do in the field than a paramedic. Most places SWAT paramedics have expanded scopes and are trained in chest tubes, surgical airways, RSI, use of hextend, etc. The objective is to start treatment asap and arrange appropriate transport. So with minimal scene time, the true value and understanding that a physician brings to the table may not be utilized as effectively in that situation. I'm in no way saying a paramedic would be better than a physician in that situation as well.

For the true SWAT medics and physicians you're a cop first, doctor second. As a cop and paramedic, we clear the house and I'm in the stack with everyone else. With a gun drawn, not an IV bag and tourniquet. After the building has been cleared and bullets stop flying, then you change hats and start treatment. Or at least that's how it is in the regions I've been in.

A physician may not be needed, but a lot of the times they volunteer to be a SWAT physician and police departments take advantage of the opportunity.
 
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alpinism said:
In terms of the extra capabilities of a physician, it all depends on the equipment available.

To name a few:

-thoracotomy
-thoracostomy
-limb amputation
-fracture reduction
-conscious sedation
-advanced airway management
-REBOA
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I thought paramedics could do needle decompression and crics? They can do tourniquets. No need for fracture reduction in this sort of situation.

That being said, whatever floats the doctor's boat. I really don't see the added benefit of a physician being there, unless he's bringing the OR with him. Mobile ORs?
 
NontradCA said:
I thought paramedics could do needle decompression and crics? They can do tourniquets. No need for fracture reduction in this sort of situation.

That being said, whatever floats the doctor's boat. I really don't see the added benefit of a physician being there, unless he's bringing the OR with him. Mobile ORs?
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They can but there’s a ton of problems w/ needle decompression: high failure rate (studies show anywhere from 42-65%), easily obstructs after insertion, doesn’t drain a hemopneumothorax, etc… Chest tubes are far superior should be used instead if available.

Advanced airway management includes everything from RSI to DSI to NIV to surgical airways to doing nothing. Paramedics can do crics if needed but in most situations its a last resort after multiple failed intubation attempts so that patient is close to dying if not already there. With more and more advanced management techniques available crics are very rarely done nowadays by experienced EM docs.

Also, while you won’t see many fractures with pure mass shootings, with bombings or the use of explosive devices you can have multiple patients with fractures leading to severe hemorrhage or limb ischemia if not rapidly reduced as soon as possible.
 
alpinism said:
They can but there’s a ton of problems w/ needle decompression: high failure rate (studies show anywhere from 42-65%), easily obstructs after insertion, doesn’t drain a hemopneumothorax, etc… Chest tubes are far superior should be used instead if available.

Advanced airway management includes everything from RSI to DSI to NIV to surgical airways to doing nothing. Paramedics can do crics if needed but in most situations its a last resort after multiple failed intubation attempts so that patient is close to dying if not already there. With more and more advanced management techniques available crics are very rarely done nowadays by experienced EM docs.

Also, while you won’t see many fractures with pure mass shootings, with bombings or the use of explosive devices you can have multiple patients with fractures leading to severe hemorrhage or limb ischemia if not rapidly reduced as soon as possible.
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I understand what you're saying, and thank you for the education, as my trauma knowledge is amateur at best. I suppose I was thinking of these things as being time sensitive and what can be managed in the field and what can not. Trying to do more than crics, tourniquets, needles in a combat zone would seem to me to be minimally superior at best and catastrophic at worse. Bleeding, ABC. K.I.S.S.
 
rilte4 said:
"Neeki said much of what doctors know today about treating assault rifle wounds has come from the wars in Iraq and Afghanistan. And because wounds like these shorten survival time for victims, it also means physicians need to be on the scene immediately, just like medics in foreign combat zones."
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What the hell is an assault rifle wound? Is it different than a bolt action .223 wound?
 
alpinism said:
In terms of the extra capabilities of a physician, it all depends on the equipment available.

To name a few:

-thoracotomy
-thoracostomy
-limb amputation
-fracture reduction
-conscious sedation
-advanced airway management
-REBOA


*most EMS physicians also carry more medications (i.e. the majority of paramedics carry only a select few medications)
*most EMS physicians are also more experienced and skilled at paramedic level procedures (i.e. the majority of paramedics only intubate 3-4 times a year if not less)

But, yes, you'd never perform any complicated procedures or treatments in the middle of an active firefight. Most of those would only be an option after the patient was evacuated to a safer location. If you've been following the terrorist attack in London, the stabbing victims were cared for on the scene by a HEMS physician with the London's Air Ambulance. They function as a mobile emergency department and are able to perform advanced procedures for dying patients on the scene.

Click to expand...


It depends on the protocols in the region. In the US, there are places where paramedics can do finger thoracostomies, RSI/DSI/surgical airways, conscious sedation, fracture reduction, and limb amputation (usually reserved for SAR situations). The only things in that list we can't do is thoracotomy and REBOA. We also don't carry blood (thats more of a cost/benefit issue), cannot place chest tubes, pericardiocentesis, and get blood gas/invasive bp. I'm sure I'm also missing a bunch of other life saving procedures a physician can do that a paramedic can't, but in the field the benefit of most of that is marginal relative to timely stabilization and transport to definitive care.

Regardless, huge respect for Dr. Neeki for stepping up and risking his life in San Bernardino. Whether or not going into the hot zone is an "efficient" use of his medical education is irrelevant. Efficient or not, I would bet he does tactical medicine for a lot of the same reasons he became a physician in the first place.
 
NO_EMS(4u) said:
It depends on the protocols in the region. In the US, there are places where paramedics can do finger thoracostomies, RSI/DSI/surgical airways, conscious sedation, fracture reduction, and limb amputation (usually reserved for SAR situations). The only things in that list we can't do is thoracotomy and REBOA. We also don't carry blood (thats more of a cost/benefit issue), cannot place chest tubes, pericardiocentesis, and get blood gas/invasive bp. I'm sure I'm also missing a bunch of other life saving procedures a physician can do that a paramedic can't, but in the field the benefit of most of that is marginal relative to timely stabilization and transport to definitive care.

Regardless, huge respect for Dr. Neeki for stepping up and risking his life in San Bernardino. Whether or not going into the hot zone is an "efficient" use of his medical education is irrelevant. Efficient or not, I would bet he does tactical medicine for a lot of the same reasons he became a physician in the first place.
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The point of having a EM physician in the field is to bring definitive treatment to the patient.

Advanced airway management, surgical procedures, medications, blood, etc.. (including all the things listed above)

Those are essentially the same things we're going to do in the ED anyway (only after the patient has already died en route).

Medics are great (I used to be one) and can absolutely handle most emergency patients. But, we're talking about dying patients who don't have time to wait for an ambulance or helicopter ride to the hospital. Its these select few critical patients who can benefit from the extra knowledge/training/procedures/medications that an experienced EM physician brings to the table. For better or for worse, technology has rapidly improved over the past 10 years to the point that many things we do in the ED can now be done in the field (hence the term "mobile ED"). In the coming years we'll even see mobile ECMO for select patients (they're already doing trials in France).
 
This is something I'd definitely be interested in. Always said if I didn't do medicine, I would want to do FBI. Best of both worlds here
 
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alpinism said:
The point of having a EM physician in the field is to bring definitive treatment to the patient.

Advanced airway management, surgical procedures, medications, blood, etc.. (including all the things listed above)

Those are essentially the same things we're going to do in the ED anyway (only after the patient has already died en route).

Medics are great (I used to be one) and can absolutely handle most emergency patients. But, we're talking about dying patients who don't have time to wait for an ambulance or helicopter ride to the hospital. Its these select few critical patients who can benefit from the extra knowledge/training/procedures/medications that an experienced EM physician brings to the table. For better or for worse, technology has rapidly improved over the past 10 years to the point that many things we do in the ED can now be done in the field (hence the term "mobile ED"). In the coming years we'll even see mobile ECMO for select patients (they're already doing trials in France).
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An EM physician in the field is NOT definitive care, especially for profound trauma. That doesn't even cover ATS Level V requirements. Or are you saying the EM physician is going to bring general surgeons, orthopedic surgeons, CT surgeons, vascular surgeons, neurosurgeons, anesthesiologists and CNRAs, the radiology department, plastic surgeons, oral and maxillofacial, pediatricians, and critical care physicians into the field with him in his little jump bag?
 
NO_EMS(4u) said:
An EM physician in the field is NOT definitive care, especially for profound trauma. That doesn't even cover ATS Level V requirements. Or are you saying the EM physician is going to bring general surgeons, orthopedic surgeons, CT surgeons, vascular surgeons, neurosurgeons, anesthesiologists and CNRAs, the radiology department, plastic surgeons, oral and maxillofacial, pediatricians, and critical care physicians into the field with him in his little jump bag?
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Before the patient sees any of those specialists they're going to the emergency department first to be resuscitated.

Correcting life threatening blood loss and airway compromise is as definitive as it gets.

You can't operate on someone who's already dead.

Again, I'm talking about dying trauma patients who don't have time to wait for transport to the hospital. What do you expect all those specialists to do for a trauma patient who already bled out 30min ago on the scene?

Nice job including CRNAs in your list too (while leaving out NPs and PAs). Its nice to see you hold emergency medicine and anesthesiology physicians in equally low regard when it comes to trauma care.
 
alpinism said:
Before the patient sees any of those specialists they're going to the emergency department first to be resuscitated.

Correcting life threatening blood loss and airway compromise is as definitive as it gets.

You can't operate on someone who's already dead.

Again, I'm talking about dying trauma patients who don't have time to wait for transport to the hospital. What do you expect all those specialists to do for a trauma patient who already bled out 30min ago on the scene?

Nice job including CRNAs in your list too (while leaving out NPs and PAs). Its nice to see you hold emergency medicine and anesthesiology physicians in equally low regard when it comes to trauma care.
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My point is airway compromise and bleeding control is well within the paramedic skill set. The exception is bleeding control on a patient who is already dead (thorocotomy and reboa). With RSI/DSI/surgical airways/finger thorocostomy allowed by protocol, there is no difference in airway management between a PM and an EM physician. CRNAs were included because they are used ubiquitously to support anesthesiologists. But yes, midlevels are also useful in trauma care. As are RNs, respiratory therapists, clinical lab staff, and tons of other key players in the trauma care infrastructure that also don't fit in your tactical cowboy EM physician wannabe soldier jump bag. In that vein, sure, midlevels are probably more efficient to use in the field than EM physicians though I would still say the benefit is marginal.

BTW normal driving time between the San Bernardino shooting and the Level 1 was 8 minutes. Code 3 driving, maybe 5 or 6 min. So if you were Dr. Neeki, your patients would be dying on scene in your care while you "definitively" correct their unstable perfusion status to a very stable, albeit asystolic, one. This rather than receiving timely life-saving definitive care at an appropriate facility.

Idk how it is where you are, but in my system a prehospital trauma activation means the trauma team is waiting in the trauma bay when we get there. EM physicians are part of the trauma team, not the trauma team.
 
NO_EMS(4u) said:
My point is airway compromise and bleeding control is well within the paramedic skill set. The exception is bleeding control on a patient who is already dead (thorocotomy and reboa). With RSI/DSI/surgical airways/finger thorocostomy allowed by protocol, there is no difference in airway management between a PM and an EM physician. CRNAs were included because they are used ubiquitously to support anesthesiologists. But yes, midlevels are also useful in trauma care. As are RNs, respiratory therapists, clinical lab staff, and tons of other key players in the trauma care infrastructure that also don't fit in your tactical cowboy EM physician wannabe soldier jump bag. In that vein, sure, midlevels are probably more efficient to use in the field than EM physicians though I would still say the benefit is marginal.

BTW normal driving time between the San Bernardino shooting and the Level 1 was 8 minutes. Code 3 driving, maybe 5 or 6 min. So if you were Dr. Neeki, your patients would be dying on scene in your care while you "definitively" correct their unstable perfusion status to a very stable, albeit asystolic, one. This rather than receiving timely life-saving definitive care at an appropriate facility.
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Providing advanced airway management is as much about having additional knowledge and experience as it is about having extra equipment and procedures. Regardless of what most paragods think there is a vast difference between your average paramedic and EM physician (similar to your average CRNA and anesthesiologist). Your average EM physician has 100x more airway training and 10x as many intubations (you'd be surprised what you don't learn in paramedic school).

As for EMS physicians, calling them cowboys couldn't be further from the truth. In most developed countries outside the US its standard practice to have EM physicians respond to mass shootings and terrorist attacks. If anything the US has a more underdeveloped EMS system with worse outcomes. Not surprisingly, the most current research shows that having a physician in the field is associated with increased survival for patients.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657098/



NO_EMS(4u) said:
Idk how it is where you are, but in my system a prehospital trauma activation means the trauma team is waiting in the trauma bay when we get there. EM physicians are part of the trauma team, not the trauma team.
Click to expand...

At most hospitals with strong EM departments the EM physicians are the trauma team and run every trauma
(for example: USC, Denver, Hennepin, Jacobi, and Kings).
 
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