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Prehospital Care

Michael Ferker xg2k2 at yahoo.com
Sat Apr 8 07:55:41 BST 2006

>From what I know, which granted isn't much, the EMS seems to focus most on keeping a patient stable on their way to the hospital. In Chicago, there are many municipal parademics that are part of the fire department, and also many other private EMS services. Chicago also has the benefit of having multiple trauma centers, both Level 1 and 2, within a 15-20 minute drive of one another. Therefore, not every ambulance may always bring patients to the same hospital, and from there, the EMTs may have slightly varying experiences as to their experiences in handing over pts to the trauma bay. I believe that at this point, the primary focus of urban and high population and concentration EMS is to be able to provide life support to as many different types of traumas as possible. This would necessitate ensuring that as many EMTs as possible were familiar with as many multi-applicable techniques as possible, while at the same time knowing when they're doing what they should, and when they may be
 doing too much and hence possibly sacrificing precious time in getting the pt to the trauma center ASAP.
  I feel that we shouldn't forget that the majority of calls EMTs respond to don't usually require many advanced field operations such as difficult intubations or thorocotomies. It'd definitely be extremely important for there to be many paramedics that could handle difficult cases, but I believe overall, the primary focus should be equipping paramedics to be able to provide necessary pre-hospital life support so that when the pt finally makes it to the ER, they can be treated with minimal morbidity. Just my 2 cents. :-)
  -Mike F

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 imprac
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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