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Mon Aug 28 20:29:51 BST 2006

Anthony, 

Medicine is replete with examples of treatments and procedures that
some said would never work or would never happen.  The way these
treatments came to pass and came to be accepted is that, for the most
part, they were tested in the non-clinical arena first, and our patients
were not our experimental animals.  Having said that, we test new
procedures every day -  in the form of randomized, controlled,
prospective trials, based on good facts and science, NOT on feelings or
emotions.  We then accept the results of those trials as the determining
factors in how we practice, and what we practice.

Ours is a calling, not a job.  The thing that we all have in common -
we that have chosen to go into medicine - is that we all take great joy
in leaving someone better than we found them, and that we have harmed no
one in the process.   I have no doubt that you are competent - and that
you consult medical control when you need to deviate on a protocol - but
you stay within your level of competence and your scope of practice!! 
As I said in an earlier post to Dave, in this profession our egos keep
us honest, and keep us on the cutting edge.  Our egos keep us wanting to
do better and better every day we come to work.  Unfortunately, there
are some whose egos misdirect them - and as I said before, this is not
just restricted to the street medic.  Remember that there are bad apples
in every single basket in life.  Our job is to weed those bad apples
out, not turn a blind eye and excuse their existence.
Ron

>>> "Anthony Caruso" <Medic541 at hotmail.com> 8/28/2006 2:59 PM >>>
Ron, above and beyond the scope of practice is called the human side. 
We
are not "cook book" professionals.  I have no need to stoke my ego. 
In
fact, the only thing that matters to me is seeing that patient is in a
better condition than when we 1st meet them.  As for stoking ego's? I
don't
need to do that in my profession.  I have the great joy of going into
work
everyday and doing something that I love for the greater good.  My
medical
control physicians know that I am competent, and when I have to deviate
with
in reason of my practice then I consult them. There is no cowboy'n
preformed.  Although some paramedics call nasally intubating a patient
a
cowboy procedure.  Remember, they said that putting Succinylcholine in
an
ambulance will, shouldn't and wont happen.  As of today I know of 4
services
in Massachusetts that currently use it as part of there protocols for
a
securing an airway! Although emergent c-sections pre hospital will
never
happen in this life time, what harm dose it do when you are able to
look
into a subject for further investigation?  Should this ever be
warranted,
should this ever be considered in the 1st place?

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Ronald Gross
Sent: Monday, August 28, 2006 2:03 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: pre-hospital C-section

Anthony,

Your/our job is to treat the patient, NOT our egos by doing something
that is (1) of no merit, and (2) assured to fail.   In short, we are
to
alleviate pain and suffering and DO NO FURTHER HARM!

What worries me is your statement:  "So when it comes to staying within
the
scope of practice I'm all for it.  I have gone above and beyond what my
job
calls for to do the right thing for my patients, at times." 
Exactly how do you want it?   Scope of practice is scope of practice,
and that predetermined scope of practice is not for you or me or anyone
else
to change on a whim or because our ego or emotion tells us that we want
to
do something else to make us feel better.

In-field C-section?  Give me a break.  Please refer back to Dr.
Mattox's
comments for some reality testing.

Ron

>>> "Anthony Caruso" <Medic541 at hotmail.com> 8/28/2006 1:35 PM >>>
Ouch!  Well Dave, I totally agree with you.  Yes they have a less then
one
percent of chance in living and yes were here to help them. The line
has to
be drawn somewhere though.  I like to think of myself as a medic that
would
do that cardioversion that some medic's "feels uncomfortable".  So when
it
comes to staying within the scope of practice I'm all for it.  I have
gone
above and beyond what my job calls for to do the right thing for my
patients, at times.  I could understand if we did attend rounds with
the L&D
physicians and had further training and testing. (like an R.S.I
project,
retavaise waiver)  Then I'm all for it.  To give that little life a
chance
of survival. (by the way I'm expecting my 1st baby in November)  So
having
said this and wanting the best care possible for my patients I would
rather
walk away from a situation saying to myself the injuries were just to
severe
for her to survive.   Than not having a job in the end!  Oh, and by
the
way
will till "docrickfry" hears about this one.  Lets just say he's been
a
staunch opponent of some of my ideas with other subjects.  Sincerely, 
Anthony M. Caruso NREMT-P 
Town Of Natick Fire Department, 
Natick, Massachusetts. 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 

On Behalf Of Parrish, Richard
Sent: Monday, August 28, 2006 1:06 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: pre-hospital C-section

A Jersey City NJ Medic did this a few years ago.  Medical control gave
the
go ahead and talked the medic through the process.  The MD was censured
and
the Medic lost his certificate.

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