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Prehospital Care

Steve Urszenyi medic.steve at rogers.com
Fri Apr 7 20:57:14 BST 2006

Excellent post! As an Advanced Care Paramedic, I couldn't agree with you more. In the very few instances that I am aware of, medics doing double-duty in the ED are utilized as orderlies at best; certainly not as physician extenders. It would be an ideal situation for medics to shadow ED docs around between calls, as this would enable them to hone their assessment skills, as well as their medical "intuition." And, of course, the ability to be more involved in advanced patient care in the ED would allow them to be more effective in the field, having been exposed to the troubleshooting and problem-solving skills of the physician/mentor in the ED.
  Higher pay (while not such an issue in my area, as I feel we are quite well paid here) would likely help attract more of those individuals that we would like to see in this profession. Certainly, the day of the minimum wage medic, or the medic who takes a back seat in pay to a police officer, firefighter or nurse, should be behind us by now. But, sadly, it is not and medics all across the continent are forced to put up with terrible pay and a glass ceiling in dual operation (fire-ems) agencies.
  Steve Urszenyi, ACP, A-EMCA
  Toronto, CANADA

bensonblues at comcast.net wrote:
  My theory is that the problems faced by prehopital providers manifest largely from the fact that most (at least in the US) are either municipal-based or private companys. Local and regional oversight is provided from a distance by medical control at either the receiving hospital, or a governmant administrated board. Thus, there is a lack of real-time feedback and ongoing (daily) training and education. The highly motivated medic will often stick around after delivering their patient to the ED and ask questions ("how could I have done better?", etc), but in my neck of the woods, often they don't. 

I've long believed that the best prehospital care would be a hospital-based system, where the medics are stationed in the ED and assist in providing care under the supervision of the physician until being dispatched. In this situation, opportunities for ongoing education and procedural experience (airway management, ad nauseum) are ubiquitous and the medic would receive real-time performance feedback. In many schools in the Detroit area (and I suspect elsewhere), clinical experience is supervised by nursing personnel. Frankly, there is often animosity between the two camps, as most nurses are not trained in airway management and do not work autonomously. Medics are physician-extenders, and their training should be supervised and provided by physicians who are dedicated to the education and quality advancement of the prehospital system. No one doubts (at least, I don't) that the best prehospital care would be provided by a trained emergency physician. But, since this is
tical and/or exceptionally expensive, it should be provided by medics trained and supervised by emergency physicians. Further, they need to be well-compensated for their services, as this ultimately elevates their professional status (again, in my neck of the woods they are underpaid for their work). Enuff said. DB
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