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Prehospital Care

Mike MacKinnon mmackinnon at cox.net
Sat Apr 8 00:30:46 BST 2006

Another change which has been sweeping ems is centralized medical director
as opposed to base hospitals. What a bad idea. These docs are hired by the
county to have a phone and take calls. They have direct reimbursement for
service and often no interaction with the service the act as medical control
for. Its horrible. Essentially, you end up with a Dial-A-Doc who has no
vested interest as a stake holder in the EMS service. At least base
hospitals see whats coming in and can identify learning objectives and CQI,
this doesn't happen with independent and centralized med control. I see A
LOT swept under the table. Its frustrating as a paramedic and its
frustrating as an RN on the receiving side in hospital or on the aircraft.
Mike MacKinnon CEN CFRN BSN RN
"If we really are what we eat, then I'm easy, fast and cheap!"
mmackinnon at cox.net
-------Original Message-------
From: Bob Waddell II
Date: 4/7/2006 4:08:27 PM
To: 'Trauma &, Critical Care mailing list'
Subject: RE: Prehospital Care
Great Post!!!!  I was raised in an environment where 8 of every 24 hrs on
shift was spent in the ED at your level of training - EMT-B or Paramedic.
We worked hand-in-hand with the Nurses and ALL the Doctors.  They knew us
and we knew them.  They learned from us and WE learned from them.
Interesting and remedial cases alike where cared for as a Team with
feedback, education, and knowledge sharing being part of the daily routine.
This contributed to our service being the first (1986) I am aware of in the
country with open or near open protocols (only one or two procedures had to
be approved by Med Control, rarely had to call in for permission to do a
procedure AND were trained to provide many procedures now only available to
flight teams and CCEMT-P's).
Thanks for articulating your views so well.
Take care,
Robert K. Waddell II
Vice President -
Emergency Preparedness and Response
"The Sacco Triage Methodology"
ThinkSharp, Inc
Wyoming Office:
1302 East 5th Avenue
Cheyenne, Wyoming 82001
(307) 433 - 9789
(307) 920 - 2020 cell
bwaddell at sharpthinkers.com
or bobwaddell at bresnan.net
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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