Tactical Med

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tegs15

tegs15

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Normally just a lurker but really interested in EM w/ added emphasis in tactical medicine. Can anyone give me some specifics as far as duties, weekly time commitment and/or any other tasks performed by the "tactical" physician. I'm assuming its a part-time gig on top of regular ED shifts. And I have found several residencies that list it as an elective to varing degrees but any more specific information from someone currently practicing would be great.:D

Additionally any suggestions on the best way to pursue this avenue of medicine would be appreciated.

(...Yes I did use the search fxn, but found little more than the topic being mentioned in passing)
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I'm not especially interested in the field but I would sure like to know what exactly Tactical Medicine is. With all due respect it seems like a bit of non-existent field to me.

I've seen a few presentations on it, they were pretty long on pictures of guys in body armor and in helicopters and pretty short on discussions of what you actually do...
 
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thanks Rockford. There is some interesting facts about TEMS at ACEP. Still looking for anybody active on SDN that is willing to share their personal knowledge of the subject.
 
Sort of like all the bioterrorism and homeland security training - Lots of training, body armor and shooting very cool weapons but where are the real patients?

Has any doc cared for a GSW at the scene and was it something that a good medic couldnt do a quarter mile away from the hot zone? Again, Ive attended several TM lectures but it was all about the training, no patient care issues.
 
All about the training? EM physicians training 1st responders on GSWs and other high velocity injuries?

Cincinnati's residency website mentions that residents train w/ SS and/or FBI, do you think they are actually w/ the teams on entry or just on site?
 
AmoryBlaine said:
I'm not especially interested in the field but I would sure like to know what exactly Tactical Medicine is. With all due respect it seems like a bit of non-existent field to me.

I've seen a few presentations on it, they were pretty long on pictures of guys in body armor and in helicopters and pretty short on discussions of what you actually do...
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It's like "flight medicine." I just don't get it and nobody has ever explained to me why flying in a helicoptor is good training for an Emergency Physician.

The market is saturated with "tactical medicine." In the Marines we call them "corpsmen." The Army calls them "medics." The SEALs have PA-level hospital corpsmen. Why having a residency-trained physician kicking down a door or rendering care in the capacity of an over-trained medic is a good use of resources is unfathomable. It's not as if civilian SWAT teams operate in the remote mountains of Afghanistan.
 
Why having a residency-trained physician kicking down a door or rendering care in the capacity of an over-trained medic is a good use of resources is unfathomable. It's not as if civilian SWAT teams operate in the remote mountains of Afghanistan.[/QUOTE]

My guess is municipalities could believe that having a DR on-site will decrease lawsuits from victims(criminals) of SWAT teams. Maybe physicians are just providing another deep pocket in case of a poor outcome?:confused:
 
I currently am a Medic who works with a Swat team. The DOC's I have met through training all over the county seem to range greatly in what they do.Some Doc's like to go through the full swat training and carry a weapon and wear the full gear as the rest of the team. And there are some docs such as the one I work under who trains the medics, and serves as our medical director which I think is a better role for a Doc. I have been through all the training and in addition to my Medic skills I am a full member of the Swat stack , but I don't think a Doc that is going to come out once a month that is the right place for them to be. Sometimes on long stand off or high profile things my Doc may come out and sit at the command post or in the APC, but 99% of the time I never see him unless I am training or meeting with him for something. We do have a direct line to him if we ever need anything above what standing orders cover. Tactical Medicine is one of those Fad things, when I move on to medical school I will miss it but there is so much better things for a doc to do with there time, leave the field work the to field providers, and serve in an advisory role and training which is where you can shine. To go in on entries takes lots of training and trust between you and your team. This is not something I want a part time person covering my back or not practicing good muzzle control and shooting someone on the team on accident. But the field is here and it is def a needed field, but the role of the Doc needs to be better defined. Now before a Doc that works with a team yells at me, I have met some very high speed Docs who I would trust to go through the door with me, but thats not the norm, most I have come in contact with like to come out and play with toys.... I think the command and control, training and oversight, are better uses of their skill set, without Docs there would be no tactical medicine...But just don't go into it thinking you will be kicking doors and making arrests...
 
I participated in Tactical medicine, and it actually not what you guys seem to think. We trained with the State Police/SWAT team to learn their protocols and procedures. This included PT, weapons training, non-lethal devices, and emergency extrication.

The role of the EP is actually very diverse, and does not involve kicking down doors or actually playing an active role in busts - this is the job for the police. There are trained medics in this arena who participate with the team in this capacity.

As the EP, we serve as consultants and caregivers outside of the hot zone. We contribute to the safety/health component of the planning of the raid (i.e. how to prepare the team and surrounding units for a potential ammonia explosion from a crystal meth lab, what the liklihood of catching Antrax is from a bust on a suspected terrorist den) We also stand by during the raid to make critical medical decisions in the middle of the bust - decisions that can impact the safety of everyone involved in the bust, and that may scrub the raid all together.

Examples of these would be if a team member were shot in the chest and the bullet did not penetrate the kevlar suit. Is there a chance that that member has a pneumothorax or other injury and, if so, can they extricate themself safely or require other team members to help them (which would jeopardize the raid). Do we need to call the van into the hot zone to evac a patient or can they safely take cover and hold tight?

Tactical physicians also command their own field unit in the case of mass casualty or multiple victim situations. For example, if several members of the team are exposed to noxious gases, or suffer heat stroke from environmental conditions, or if a crowd of protestors gets struck with tear gas, etc..

Each law enforcement jurisdiction has their own policies and procedures for the role of a tactical physician, but if you are expecting to go into TEMS to carry a weapon and bust down a few doors, you will invariably be dissapointed. We are physicians, and they are Police/Special Operations. We do what we do so that they can continue to do what they do.
 
i think hopkins may have some sort of TM fellowship....???
 
tegs15 said:
All about the training? EM physicians training 1st responders on GSWs and other high velocity injuries?

Cincinnati's residency website mentions that residents train w/ SS and/or FBI, do you think they are actually w/ the teams on entry or just on site?
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I haven't talked to anyone about the SS or FBI thing, but if it's like the Cinci PD SWAT, you are trained to be part of the entry team but it's up to you if you enter with the entry team or hang back and wait for a possible injury that requires treatment. You carry a weapon, etc., so you can enter with the team if you want. One of the senior residents that posts here occasionally is doing SWAT so hopefully he chimes in.

And in response to one of the posts, it certainly is an existent field. There are fellowships out there in Tactical Medicine.
 
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I guess its not so much a question of who does it ( Doc vs EMT vs PA) as how often they do it ( ie treating a critical patient). I know of one attending who loves this stuff, he has been the SWAT team Doc for a suburb county of Chicago for 5 years. He carries his equipment in his trunk and a pager 24/7 .Spends a lot of time training with these guys. He puts on a great lecture on TM - but when I asked him point blank how many truly life threatening injuries he has cared for in the field during his 5 year career in TM? His answer - "ONE"
 
To answer your question of how often the medic/Doc actually treats a pt I would say that it is rare. But a medic as with any armed service police/military is a force multiplier, they also add a sense of reassurance to the team, they know if they go down someone will be right there for them. I can tell you one nightmare situation that a doc/medic would shine would be a college/school shooting, getting medical aid to a pt now vs and hour from now could make all the difference in the world. The medic/doc also is there for all trainings for those minor injuries and other things that may prevent an officer from functioning that training day. I will agree that the number of actual pts in low, but the risk is there. The military doesn't go anywhere without a medic so why should we ask our police to do the same Urban combat without one. And for those who have never been on a raid this is combat. Drug dealers and meth labs we run into some of the worst types. No matter who does it I say it is a needed role to be filled. And once I move on the the next step as a DOC I hope to be able to support the guys anyway I can whether is be a admin role or in the field.
 
MedicFL said:
I can tell you one nightmare situation that a doc/medic would shine would be a college/school shooting, getting medical aid to a pt now vs and hour from now could make all the difference in the world. QUOTE]

Saw a few examples of that last spring. A couple of the patients may not have made it had there not been two medics with the police on entry.

However, we're still talking very basic life support skills in the form of tourniquets, bandages, NPA/OPA, and IVs (later not all that important immediately). You don't need a doctor for that, as even an Intermediate (I-85) can do those skills. The biggest thing in such situations is to stop the bleeding, and get the patient OUT, so proper care can be initiated by crews outside the hotzone.
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Flopotomist said:
http://www.dallasnews.com/sharedcon...copshot_18met.ART.North.Edition1.420be44.html

There is your answer. (swat doc saves cop shot in neck who needed a surgical airway)
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I would say that one life saved does not justify having residency trained EPs on scene with all SWAT teams etc......this is crazy. A ridiculous waste of resources. Just a bunch of MDs trying to prove something. "Hey look at me, I'm tough too".......you're fooling yourself if you think this aspect of TM is going to allow you to use your education properly. Now training, education, protocol revision etc etc is probably useful. Completely uninteresting to me, but probably useful none the less. Also keep in mind, for those of us who work in a county hospital serving the underserved, you may run into some of your patients in the field. How's that for an ethical dilemma? "Freeze you mothe%$#$%#@......oh, hey Mr. Johnson, how's your heart?" MDs essentially functioning as an additional member of the SWAT team (busting down doors, carrying a gun etc...) potentially undermines our relationships with these patients and should be highly discouraged.
 
Interestingly enough, Alex Eastman is a general surgery resident who was a year ahead of me at Parkland. Instead of taking time off for research like a lot of their residents do, he opted to take part in the GEMS fellowship. Alex is a good guy....hated the ER, though....but a good guy, nonetheless.
 
bobdobaleena said:
I would say that one life saved does not justify having residency trained EPs on scene with all SWAT teams etc......this is crazy. A ridiculous waste of resources.
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All I can say is wow......... Tell that to the officers family I agree with you that it in no way needs to be a doc it could be an medic or even an EMT-I, but to make a comment like that just wow. If it doesn't interest you don't do it stay in the office, where its nice and safe, the fact is there are lots of Docs out there who are willing to help and if they choose to do so more power to them... I am very for medics and medical personal in these situations, having worked in the military as a medic it is very unheard to not have one around....
 
A few random thoughts:

1. I agree that it is unlikely that there an officer (or suspect) will sustain a life-threatening injury that can be treated exclusively by a physician. That being said, the CHANCE still exists, and if departments are willing to pay for the service, why not.

2. Officers will feel more supported by their departments, and more likely to volunteer for high-risk assignments if the department can advertise that there will be an actual physician on the team.

3. Usually, the swat doc may be trained in "knocking down the door" but usually will be the last to enter the building (so he can pull out the wounded in front of him) or will remain outside in a secure area.
 
MedicFL said:
All I can say is wow......... Tell that to the officers family I agree with you that it in no way needs to be a doc it could be an medic or even an EMT-I, but to make a comment like that just wow. If it doesn't interest you don't do it stay in the office, where its nice and safe, the fact is there are lots of Docs out there who are willing to help and if they choose to do so more power to them... I am very for medics and medical personal in these situations, having worked in the military as a medic it is very unheard to not have one around....
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So you agree with bobdobaleena? He is right, you know. That's one of the reason the Navy, for example, doesn't put their surgeons at the Forward Line of Operations or with the guys kicking down the doors. It's a poor use of assets for a surgeon to do what a corpsman can do.

As far as deriding him for wanting to be safe, I rise in defense of bobdobaleena. For the value you can add to a SWAT team, most of which operate within minutes of a hospital, it is not worth the risk. No need to insult the guy for wanting to be safe. I have no particular interest in getting shot or even to find myself in situations where I could be otherwise injured. I've got a lot invested in my education with no payoff as of yet and a bullet in the head would not be a good career move at this point.
 
Panda Bear said:
So you agree with bobdobaleena? He is right, you know. That's one of the reason the Navy, for example, doesn't put their surgeons at the Forward Line of Operations or with the guys kicking down the doors. It's a poor use of assets for a surgeon to do what a corpsman can do.
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That's a different situation. Nobody is forcing docs to be on these teams (i.e. the military). It would be a bad utilization of resources to require physicians to be part of entry teams but it is an entirely different situation if they are civilians and want to be members.

Also, to the previous comment, a physician CAN provide a lot of potential benefits in this environment over an EMT or Paramedic. Anybody can plug up a bleeding wound, but a physician (and I should clarify, MOST physicians doing TEMS work) obviously has an advantage in terms of medical planning, general medical physical assessment of team members, toxicology, NBC weapon effects and planning, and even during the out-of-hospital trauma management. If you were shot in the chest in an austere environment who would you want putting in the chest tube a paramedic that has read about it and maybe trained on a cadaver or an EP that has put in over a hundred? Same for the cric.

Please don't take this the wrong way. I have lots of respect for EMS and absolutely think they should be involved in TEMS. I probably have as much or more EMS experience than anyone else on this board (including TEMS) but I definitely think that physician can have a very beneficial role in the tactical environment.
 
RockfordWF said:
Paramedics can do surgical airways. I'm not sure how a physician "saved the day" in this situation.
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Not in many places. I think a realistic compromise would be to have the physician on the scene, but not actually breaching the building. That way you get immediate access to a physician should you need one, without putting such a valuable resource at risk.
 
Flopotomist said:
Not in many places. I think a realistic compromise would be to have the physician on the scene, but not actually breaching the building. That way you get immediate access to a physician should you need one, without putting such a valuable resource at risk.
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It's alot easier to train a medic to do a cric than to staff a physician solely for that purpose.
 
I always thought Tactical Physicians primarilly were invovled in a training/medical director role as well as serving as a technical consultant for medical issues; that as a general rule, they were generally more part of the on-scene HQ staff than a member of the shooters.

It was my understanding that they recieved SWAT Training more for perspective and to help integrate them as team members than with any goal of actualy having them go in with the team and that those who actually did some of the door kicking did so because of thier own personal desire (and who is going to, or has the right to, tell an MD volunteering his services in this manner that he can't use his MD in a manner he is qualified to because it's not effecient?).

Is this not a correct take on the situation?
 
polygonal said:
Also, to the previous comment, a physician CAN provide a lot of potential benefits in this environment over an EMT or Paramedic. Anybody can plug up a bleeding wound, but a physician (and I should clarify, MOST physicians doing TEMS work) obviously has an advantage in terms of medical planning, general medical physical assessment of team members, toxicology, NBC weapon effects and planning, and even during the out-of-hospital trauma management.
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Indeed, they can bring all of this to the table...but what does that have to do with them being part of the entry team? All of that is pre-planning or warm-zone care, not care under fire. In the hot-zone, those physician skills are not as immediately necessary as good BLS care.

polygonal said:
If you were shot in the chest in an austere environment who would you want putting in the chest tube a paramedic that has read about it and maybe trained on a cadaver or an EP that has put in over a hundred? Same for the cric.
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If I was shot in an austere environment (how did we change from tactical to austere?), I wouldn't care who slapped the chest seal on the wound, and subsequently darted my chest. The data I have seen currently does not support chest tube insertion in the tactical realm (if you have conflicting data, let me know, as I'm always looking for new studies to bring back to my instructors). The team medic should be able to control bleeding, needle decompress, then drag my sorry butt out of there so the doc can take care of me. Wounds in a tactical setting tend to be a volume problem; so bleeding needs to be controlled, THEN worry about the rest of ABCs (when safer).
 
Panda Bear said:
It's like "flight medicine." I just don't get it and nobody has ever explained to me why flying in a helicoptor is good training for an Emergency Physician.

The market is saturated with "tactical medicine." In the Marines we call them "corpsmen." The Army calls them "medics." The SEALs have PA-level hospital corpsmen. Why having a residency-trained physician kicking down a door or rendering care in the capacity of an over-trained medic is a good use of resources is unfathomable. It's not as if civilian SWAT teams operate in the remote mountains of Afghanistan.
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Glad I have the back-up of Panda. I guess my biggest question would be to ask how many people are injured each year in "tactical" situations and if that # supports EVER having an MD at the scene of operations.

I mean I suppose that if we really wanted to deploy physicians on "forward" operations having them patrol busy urban interstates at rush-hour would be a better use of resources.

I would also wonder if data would back up improved outcomes in having MDs "on the scene." If someone is in that bad of shape, seems like the less delay in getting them packaged up and shipped to the nearest Level I the better. In this context it seems like alot of "Tactical Medicine" would be to say, "get this guy on the rig right now."
 
Flopotomist said:
Not in many places. I think a realistic compromise would be to have the physician on the scene, but not actually breaching the building. That way you get immediate access to a physician should you need one, without putting such a valuable resource at risk.
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Its very common for paramedics to be able to do crics.......But right I do think docs have better places to be that on the entry team...
 
AmoryBlaine said:
Glad I have the back-up of Panda. I guess my biggest question would be to ask how many people are injured each year in "tactical" situations and if that # supports EVER having an MD at the scene of operations.
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Again, I think that if you look only at the numbers, you will miss the bigger point, and that is the physicians role as a benefit that the departments can use to demonstrate to its officers how much support they are given. Imagine a recruiting campaign for the SWAT team within a deparment that can proudly advertise "We take such good care of our team, if you are injured during a raid, a board certified physician will be on scene to care for you"

I think that if there are physicians out there that want to do it, departments out there that want to pay for it... what is the problem?
 
bobdobaleena said:
Also keep in mind, for those of us who work in a county hospital serving the underserved, you may run into some of your patients in the field. How's that for an ethical dilemma? "Freeze you mothe%$#$%#@......oh, hey Mr. Johnson, how's your heart?" MDs essentially functioning as an additional member of the SWAT team (busting down doors, carrying a gun etc...) potentially undermines our relationships with these patients and should be highly discouraged.
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Please tell them this was a feeble attempt at sarcasm? I can understand not wanting to place a physician in harm's way (In the above story, the docs weren't "busting down doors," they were there as medical support), but being worried about my personal relationship with a felon when I might happen to take care them wouldn't be keeping me up at night, nor would it affect the quality of care they may get.
 
AmoryBlaine said:
Glad I have the back-up of Panda. I guess my biggest question would be to ask how many people are injured each year in "tactical" situations and if that # supports EVER having an MD at the scene of operations.

I mean I suppose that if we really wanted to deploy physicians on "forward" operations having them patrol busy urban interstates at rush-hour would be a better use of resources.

I would also wonder if data would back up improved outcomes in having MDs "on the scene." If someone is in that bad of shape, seems like the less delay in getting them packaged up and shipped to the nearest Level I the better. In this context it seems like alot of "Tactical Medicine" would be to say, "get this guy on the rig right now."
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You see, I understand the value of a physician to give lectures to the SWAT teams on medical subjects but hell, I can do that right now with no police experience whatsoever. And I have been out with EMS as a PGY-3 (EM-2) and you know what I did? I kept my mouth shut and let them do their thing because they knew what they were doing and I had nothing to add but witty conversation. I don't see why they need an Emergency Physician in the rig. It might add something but the marginal value is not worth the expense. My program is actually moving away from having us do "ride time" to having us give lectures and classes to the firemen and paramedics to satisfy our EMS requirements.

Now, if you want to volunteer just admit its because kicking down doors and shooting guns is pretty cool. Same with flying in helicopters, something I refuse to do ever again. It's cool, I guess, if you've never been in one but the educational value? Putting in an IV in a confined space? Watching vitals? Why do the job of a flight nurse?
 
A little off topic but things like critical care, toxicology, and wilderness medicine are more useful specialized skills for Emergency Physicians. A lot more useful and explainable than "Tactical Emergency Medicine."
 
Were I on a SWAT team, I'd be very nervous about the idea of having a physician on the trigger behind me.

In the rear with the gear? Great. But behind me with a gun? Not so much. No more than I'd want a full-time career cop to occassionally man a wing of my ED after a crash course in doctoring.
 
Going back to the waste of resources, I know a lot of ED docs work something like 32-36hrs/wk. If they want to spend their free time training and deploying with SWAT, it's not like that resource is "wasted," ie would have been more useful doing something else. Lots of medical directors, SAR team members, etc do it part time or on a volunteer basis. If anything I'd say it's more useful than playing golf.
 
I was gonna start my own post, but decided to just piggy back on this one.
I am a 3rd year medical student currently trying to decide between EM and GS residency and Trauma fellowship. One of the things it is coming down to is having access as a trauma surgeon to Wilderness Medicine/Tactical Medicine/EMS. I was an EMT for five years before starting med school, and I still work over breaks.
Do you think in the future as EM becomes a more mature specialty the above "extracurricular" interests will become solely the domain of the EP, or will people with the appropriate training (trauma surgeons, for example) still be able to get involved with EMS (helicopters, for example) and tactical medicine?
Thanks for all of your thought/advice.
 
2008 EM Reviews said:
I was gonna start my own post, but decided to just piggy back on this one.
I am a 3rd year medical student currently trying to decide between EM and GS residency and Trauma fellowship. One of the things it is coming down to is having access as a trauma surgeon to Wilderness Medicine/Tactical Medicine/EMS. I was an EMT for five years before starting med school, and I still work over breaks.
Do you think in the future as EM becomes a more mature specialty the above "extracurricular" interests will become solely the domain of the EP, or will people with the appropriate training (trauma surgeons, for example) still be able to get involved with EMS (helicopters, for example) and tactical medicine?
Thanks for all of your thought/advice.
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The only think I can add (as an MS1 in the same position) is that I know Metro Life Flight in Cleveland flies with either an EM doc or a Trauma Surgeon on board. Again, this doesn't speak to the evolution of EM and Tactical Medicine or EMS becoming EM specific interests...
I'd also like to hear what other people think
 
2008 EM Reviews said:
I was gonna start my own post, but decided to just piggy back on this one.
I am a 3rd year medical student currently trying to decide between EM and GS residency and Trauma fellowship. One of the things it is coming down to is having access as a trauma surgeon to Wilderness Medicine/Tactical Medicine/EMS. I was an EMT for five years before starting med school, and I still work over breaks.
Do you think in the future as EM becomes a more mature specialty the above "extracurricular" interests will become solely the domain of the EP, or will people with the appropriate training (trauma surgeons, for example) still be able to get involved with EMS (helicopters, for example) and tactical medicine?
Thanks for all of your thought/advice.
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Not sure what you mean by "appropriate training." What are your goals? Some of our faculty do training/education for SEALs down in Norfolk and Secret Service here in DC.
 
dlung said:
Not sure what you mean by "appropriate training." What are your goals? Some of our faculty do training/education for SEALs down in Norfolk and Secret Service here in DC.
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I can't speak for the person you are quoting, but I'm in the same boat do I'll answer the question...
My concern is that by the time I finish the surgeon pipeline (11+ years) the field will have changed such that one won't be able to work in EMS or do tactical medicine without being EM residency trained. Seeing as my interests are either EM or Trauma Surgery it would disappointed me if I (as a trauma surgeon) was prohibited from working with a SWAT team or on a helicopter. Obviously, I would have to go through department specific training, but I'm concerned about something broader.
The root of my concern (and probably the OPs) comes down to the fact that as EM becomes a more mature specialty and graduates more and more residency trained physicians with broader and broader interests (EMS and Tactical Medicine certainly fall into this category) will non-EPs be pushed out of things they're interested in simply because they're not EPs (think back to the question about the FM trained physician working in an ED).
Hope that makes sense...
 
IMO, I don't think that non EP trained doc's will be pushed out of the SWAT EMS world. We have one of each working with my team, an EP and a trauma surgeon. In the field there isn't much more done than a medic does to be honest. I work with pretty liberal standing orders. The docs that work with me almost never come on scene and even me who is cross certified and organic to the team you don't run around kicking in doors. If you get hit what good are you to the team none. Air programs; I know of four locally and none ever have a doc on board, they do have medical directors that sets protocols.
 
2008 EM Reviews said:
I was gonna start my own post, but decided to just piggy back on this one.
I am a 3rd year medical student currently trying to decide between EM and GS residency and Trauma fellowship. One of the things it is coming down to is having access as a trauma surgeon to Wilderness Medicine/Tactical Medicine/EMS. I was an EMT for five years before starting med school, and I still work over breaks.
Do you think in the future as EM becomes a more mature specialty the above "extracurricular" interests will become solely the domain of the EP, or will people with the appropriate training (trauma surgeons, for example) still be able to get involved with EMS (helicopters, for example) and tactical medicine?
Thanks for all of your thought/advice.
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Most of the physicians I've met that do TEMS work and training are trauma surgeons. I've actually only ever met two EPs that do anything related with Tactical Medicine.

Wildnerness Medicine is another broad area, that I don't see becoming closed to non-EM-trained docs in anything remotely resembling the near future. For there to be a move for something to be exclusive to one profession, there usually has to be some money involved (if not, then why try to fight over it, saying "this is mine, and nobody else's!"?). I've met FMs, EPs, trauma surgeons, anesthesiologists, and even a neurologist that were interested and did some Wilderness Medicine training (and not just in those lovely ski towns in which the conferences always seem to be).

Finally, to EMS. This is something that is dominated by EPs, and will likely continue to be. EMS has more interaction with the docs in the ED than in any other part of the hospital, and what is done in the field more closely mimics the ED than any other hospital service. That having been said, I'm sure that a non-EP can become a Medical Director for an EMS agency, if they want it enough. In VA, its easiest for EPs to become OMDs, but any physician with an interest in EM, holding active ACLS, PALS (and ATLS?), who receives the blessing of some other group of OMDs, can become one. One of our local (and recently former state) OMDs is a trauma surgeon.
 
Panda Bear said:
You see, I understand the value of a physician to give lectures to the SWAT teams on medical subjects but hell, I can do that right now with no police experience whatsoever. And I have been out with EMS as a PGY-3 (EM-2) and you know what I did? I kept my mouth shut and let them do their thing because they knew what they were doing and I had nothing to add but witty conversation. I don't see why they need an Emergency Physician in the rig. It might add something but the marginal value is not worth the expense. My program is actually moving away from having us do "ride time" to having us give lectures and classes to the firemen and paramedics to satisfy our EMS requirements.

Now, if you want to volunteer just admit its because kicking down doors and shooting guns is pretty cool. Same with flying in helicopters, something I refuse to do ever again. It's cool, I guess, if you've never been in one but the educational value? Putting in an IV in a confined space? Watching vitals? Why do the job of a flight nurse?
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Hey Panda! Good to hear you are still kicking.

Couple of the folks at my program (attendings) put in a chest tube in a dude that took a round in the chest. I've never been a paramedic, but to my knowledge that is not something that paramedics do in the field.

As everyone else has posted, it is not common for the EP to do alot in field situations, but then again, it is not common for too many missions to go awry (although it is higher than the regular street beat).


Wook
 
Most paramedics do not do chest tubes, but I do know of a couple flight programs in FL that allows medics too. We are allowed to put in chest tubes if I call for orders first on it. But I don't think I will ever see the need in the field it is so fast to get them to the ER where conditions are much better and someone better trained than me can do it...
 
MedicFL said:
Most paramedics do not do chest tubes, but I do know of a couple flight programs in FL that allows medics too. We are allowed to put in chest tubes if I call for orders first on it. But I don't think I will ever see the need in the field it is so fast to get them to the ER where conditions are much better and someone better trained than me can do it...
Click to expand...

Which is the logic of having a doc (who is willing to go through SWAT specific training) in the field to do it. If the doc is willing to put himself/herself in harm's way, and the members of the SWAT team trust the doc enough to give him/her a gun, what is the problem?
 
Dr. Dukes said:
Which is the logic of having a doc (who is willing to go through SWAT specific training) in the field to do it. If the doc is willing to put himself/herself in harm's way, and the members of the SWAT team trust the doc enough to give him/her a gun, what is the problem?
Click to expand...

I agree 110%........
 
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