List Archives

Mon Dec 17 14:46:35 GMT 2007

Isn't there an ACS requirement that a trauma surgeon be in house 24/7
for level II verification?

I have to qualify my remarks -- I didn't mean to agree that NPs and PAs
could cover traumas without a surgeon in the house at all, although many
of us would feel comfortable covering the ICU with the surgeon in the
OR.  

Jane

----------------------
Jane Harper, PhD(c), RN, ACNP, CCNS, CNRN, CCRN
Rockford, IL
m.jane.harper at osfhealthcare.org

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Monday, December 17, 2007 8:43 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Physician Extenders (was RE: trauma-list Digest, Vol 54,
Issue 16)

Hey, Lorick.  Well said.

As List veterans will attest, I'm wrong with astonishing frequency about
a breathtaking variety of stuff.  But if only for my own edification,
I'd be eager to hear from someone with connections to the ACS VRC before
abandoning my half-witted interpretation of reality.  

During our earliest consultations with the College in the 1990's, we
were strongly cautioned against having boarded medical intensivists
cross-covering our traumas, even over short terms, even with a surgeon
as backup.  Surely, then, there are surveyors who would frown on a PA
covering nights.  

And good luck meeting Leapfrog.

Sorry if I'm muddying things.  It's what I do.  I'm ready and grateful
for any enlightening smackdown that awaits.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Lorick Fox, PA-C
Sent: Monday, December 17, 2007 9:18 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Physician Extenders (was RE: trauma-list Digest, Vol 54,
Issue 16)

	I understand what Pret means, but for clarity:

	Always have to have the surgeon in place for trauma admissions. 
	However, I can assure you that many PA's manage SICU, MICU, CCU
patients routinely, with the physician in the OR, at home or otherwise
occupied. 
	They don't provide SOLE management, but they provide
initial/primary management, with the MD fine tuning (or making the "no
good answer" decisions), either in person or via phone. 
	St, Joseph's wasn't a trauma center (that was next door) but we
had at least 30 ICU beds that I was the primary call person for between
2000 and 0800 for the year and half I survived that.  The post CABG
patients were primarily managed by the surgeon from home, but he would
ask us to see them if there was question or they needed
cardioversion/new line/airway management/etc.  If there was a surgical
decision to be made, however, either the cardiac surgery PA or the
surgeon would come in (often without my involvement at all - they could
open chests, I couldn't).  "Manage ICU patients" was certainly in my
state approved job description in both Georgia and Virginia.

	Lorick

	At 03:54 PM 12/17/2007, you wrote:

		Our general/trauma extenders assist in the OR, round
with the attendings
		on all inpatients (inc ICU), do a variety of procedures
(chiefly wound
		care, tubes, and lines), and handle much of the day to
day
		documentation.  Our trauma surgeons also staff a busy
general surgery
		practice, so there's a wide variety of work to be done.

		The PA's (there are no NP's in trauma at the moment, but
our recruitment
		is non-discriminatory on that account) do not take call,
and are not
		assigned to the trauma response team as such; however,
when they're on
		site (weekdays mostly), at least one of them is usually
accompanying the
		trauma attending, and thus tags along and acts as an
extra set of hands,
		further freeing the surgeon to direct the resuscitation.

		I don't think you'll find a Level I or II center which
lists "management
		of ICU patients" in the PA/NP job description.
Functional realities
		notwithstanding, you've got to have a doctor (almost
certainly a
		surgeon, and further, a boarded intensivist) directly
responsible for
		ICU care.  It's part of the verification requirement.

		In my observation, our PA's get more OR and procedure
time than most.
		I'm aware of plenty of practices wherein the extenders
are used for
		clinical and clerical infrastructure (i.e., scut work).
But then, ours
		were selected in large part for their surgical
experience, and have
		enormous operative credibility.  We've been immensely
fortunate in our
		hiring, and have a team of surgeons that admires and
supports the unique
		surgical capacities of its assistants.  

		All of which is to say that in a great many programs,
and for any number
		of PA's and NP's, one person's scut work is another's
indispensable role
		in a comprehensive system of patient care.  I have no
doubt that the use
		of extenders in trauma centers will continue and
increase; but I can't
		see there ever being a standardized job description
across the
		profession.

		Pret Bjorn, RN
		EMMC Trauma Program (ACS Level II)
		Bangor, ME USA

		-----Original Message-----
		From: trauma-list-bounces at trauma.org
		[ mailto:trauma-list-bounces at trauma.org
<mailto:trauma-list-bounces at trauma.org> ] On Behalf Of
		czuehlke at frontiernet.net
		Sent: Friday, December 14, 2007 5:50 PM
		To: trauma-list at trauma.org;
trauma-list-request at trauma.org
		Subject: Re: trauma-list Digest, Vol 54, Issue 16

		Greetings list members,

		This is directed toward those that are in Level I and II
centers (or
		other
		high volume centers).

		How many of you use physician assistants on your
service?

		For those that have residents and fellows, what is the
role of the PA
		during
		pt care? Does the PA take call? Do the PAs manage
patients in the SICU?

		Do you see a change in demand for PAs in trauma care?

		Hi,
		In the one trauma centers I work in the PA sees just the
mildly ill  
		patients and places sutures and or staples in patients.
The PA is  
		never seen in the trauma rooms nor is he/she in a place
where there  
		are serious medical conditions. NP's are treated exactly
the same way.
		At the other hospital newly named trauma center level II
for 2010. It  
		does not use NP's or PA's at all.
		Carol Eisenbrandt

		Quoting trauma-list-request at trauma.org:

		> Send trauma-list mailing list submissions to
		>        trauma-list at trauma.org
		>
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visit
		>
http://list.mistral.net/mailman/listinfo/trauma-list
		> or, via email, send a message with subject or body
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		>
		> When replying, please edit your Subject line so it is
more specific
		> than "Re: Contents of trauma-list digest..."
		>
		>
		> Today's Topics:
		>
		>    1. Nearly Famous! (tuganddawn at talktalk.net)
		>    2. Physician Assistants in Trauma (Michael Krowka)
		>    3. Re: Physician Assistants in Trauma (Ronald
Gross)
		>    4. RE: Physician Assistants in Trauma (Brian E.
Fletcher)
		>    5. Re: Nearly Famous! (Krin135 at aol.com)
		>
		>
		>
----------------------------------------------------------------------
		>
		> Message: 1
		> Date: Thu, 13 Dec 2007 20:56:15 -0000
		> From: <tuganddawn at talktalk.net>
		> Subject: Nearly Famous!
		> To: <trauma-list at trauma.org>
		> Message-ID:
<000a01c83dca$9b0826f0$4752f259 at 049682920380>
		> Content-Type: text/plain;      charset="iso-8859-1"
		>
		> Hello to everyone.
		>
		>   Before I begin may I wish all of you wherever you
are and whatever  
		>  your beliefs a very Merry Christmas and a pleasant
and event free   
		> New Year.
		>      I am a Paramedic/Firefighter working in the UK
and have   
		> recently been asked to consider appearing in a
documentary series   
		> about the ambulance service speciffically dealing with
concerns   
		> about the increase in calls, abuse of the service and
out of hours   
		> GP service effects.
		>     A few months ago I would have been completely
against this idea   
		> but recent reforms, behaviour of management and
treatment by other   
		> health care professionals has made me consider the
potential   
		> benefits of exposing certain ignored aspects of my
service   
		> (including the appalling lack of professionalism,
training and   
		> negligence by many Paramedics).
		>   I wonder if the list might offer any insights they
have about the   
		> ethics and problems faced with this sort of media
exposure   
		> especially when one considers the uncontrolable
environment we work   
		> in. I would also appreciate any advice about how to
deal with these   
		> "cutthroat" sensationalist media types!
		>    In any event, thanks for your time and trouble and
I hope to hear  
		>  your responses.
		>
		>   Yours with kindest regards
		>
		>   Tug Crumpton
		>
		> ------------------------------
		>
		> Message: 2
		> Date: Thu, 13 Dec 2007 16:00:59 -0700
		> From: Michael Krowka <mkrowka at gmail.com>
		> Subject: Physician Assistants in Trauma
		> To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
		> Message-ID: <C38707BB.3C00%mkrowka at gmail.com>
		> Content-Type: text/plain;      charset="US-ASCII"
		>
		> Greetings list members,
		>
		> This is directed toward those that are in Level I and
II centers (or
		other
		> high volume centers).
		>
		> How many of you use physician assistants on your
service?
		>
		> For those that have residents and fellows, what is the
role of the PA
		during
		> pt care? Does the PA take call? Do the PAs manage
patients in the
		SICU?
		>
		> Do you see a change in demand for PAs in trauma care?
		>
		>
		>
		> Michael D. Krowka
		> EMT-P
		>
		>
		>
		>
		> ------------------------------
		>
		> Message: 3
		> Date: Thu, 13 Dec 2007 19:17:30 -0500
		> From: "Ronald Gross" <Rgross at harthosp.org>
		> Subject: Re: Physician Assistants in Trauma
		> To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
		> Message-ID: <47618535.7FF1.00B9.0 at harthosp.org>
		> Content-Type: text/plain; charset=US-ASCII
		>
		> Michael,
		>
		> We have 4 PAs and one APRN on service.  Contact me
off-line and I   
		> would be happy to discuss.......
		>
		> Ron
		>
		>>>> Michael Krowka <mkrowka at gmail.com> 12/13/2007 6:00
PM >>>
		> Greetings list members,
		>
		> This is directed toward those that are in Level I and
II centers (or
		other
		> high volume centers).
		>
		> How many of you use physician assistants on your
service?
		>
		> For those that have residents and fellows, what is the
role of the PA
		during
		> pt care? Does the PA take call? Do the PAs manage
patients in the
		SICU?
		>
		> Do you see a change in demand for PAs in trauma care?
		>
		>
		>
		> Michael D. Krowka
		> EMT-P
		>
		>
		> --
		> trauma-list : TRAUMA.ORG
		> To change your settings or unsubscribe visit:
		> http://www.trauma.org/index.php?/community/
		>
		>
		>
		> ------------------------------
		>
		> Message: 4
		> Date: Thu, 13 Dec 2007 19:44:10 -0500
		> From: "Brian E. Fletcher" <bfletcher at columbus.rr.com>
		> Subject: RE: Physician Assistants in Trauma
		> To: "'Trauma &amp; Critical Care mailing list'"
		>        <trauma-list at trauma.org>
		> Message-ID:
<20071214004410.BJDP22267.hrndva-omta06.mail.rr.com at BRIAN>
		> Content-Type: text/plain;      charset="us-ascii"
		>
		> We have 10 Nurse practitioners.  We manage the step
down ICU, floor
		> patients, and respond to traumas.  We essentially
function like a
		resident,
		> performing primary/secondary assessment, FAST, central
lines, Chest
		tubes, A
		> lines, suturing etc.  We also have an NP clinic and an
attending
		clinic. The
		> NP clinic sees lower acuity patients and we also
assist in the
		attending
		> clinic.  Hope this helps.
		>
		> Brian
		>
		> -----Original Message-----
		> From: trauma-list-bounces at trauma.org
		[ mailto:trauma-list-bounces at trauma.org
<mailto:trauma-list-bounces at trauma.org> ]
		> On Behalf Of Michael Krowka
		> Sent: Thursday, December 13, 2007 6:01 PM
		> To: Trauma &amp; Critical Care mailing list
		> Subject: Physician Assistants in Trauma
		>
		> Greetings list members,
		>
		> This is directed toward those that are in Level I and
II centers (or
		other
		> high volume centers).
		>
		> How many of you use physician assistants on your
service?
		>
		> For those that have residents and fellows, what is the
role of the PA
		during
		> pt care? Does the PA take call? Do the PAs manage
patients in the
		SICU?
		>
		> Do you see a change in demand for PAs in trauma care?
		>
		>
		>
		> Michael D. Krowka
		> EMT-P
		>
		>
		> --
		> trauma-list : TRAUMA.ORG
		> To change your settings or unsubscribe visit:
		> http://www.trauma.org/index.php?/community/
		>
		>
		>
		> ------------------------------
		>
		> Message: 5
		> Date: Thu, 13 Dec 2007 20:39:34 EST
		> From: Krin135 at aol.com
		> Subject: Re: Nearly Famous!
		> To: trauma-list at trauma.org
		> Message-ID: <c73.2076a517.349338d6 at aol.com>
		> Content-Type: text/plain; charset="US-ASCII"
		>
		>
		> In a message dated 13-Dec-07 14:57:36 Central Standard
Time,
		> tuganddawn at talktalk.net writes:
		>
		> I  wonder if the list might offer any insights they
have about the
		ethics and
		>  problems faced with this sort of media exposure
especially when one
		> considers  the uncontrolable environment we work in. I
would also   
		> appreciate any
		> advice  about how to deal with these "cutthroat"
sensationalist media
		types!
		> In any event, thanks for your time and trouble and I
hope to  hear
		your
		> responses.
		>
		>
		>
		> Tug:
		>
		> good luck with your project.
		>
		> You might have better luck posting to the EMS-L using
instructions
		found  at:
		>
		> List FAQ:      http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2007-December/_HTTP://EMS-L.ORG <http://ems-l.org/> _
(http://EMS-L.ORG <http://ems-l.org/> )
		> Unsubscribe:   _EMS-L-UNSUBSCRIBE at EMS-L.ORG_
		> ( mailto:EMS-L-UNSUBSCRIBE at EMS-L.ORG
<mailto:EMS-L-UNSUBSCRIBE at EMS-L.ORG> )
		> (subscribe should be _EMS-L-SUBSCRIBE at EMS-L.ORG_
		> ( mailto:EMS-L-SUBSCRIBE at EMS-L.ORG
<mailto:EMS-L-SUBSCRIBE at EMS-L.ORG> ) )
		> Manage:   _ HTTP://EMS-L.ORG/MAN-EMS-L.HTM
<http://ems-l.org/MAN-EMS-L.HTM> _
		( http://EMS-L.ORG/MAN-EMS-L.HTM
<http://ems-l.org/MAN-EMS-L.HTM> )
		> Post to list:  _EMS-L at EMS-L.ORG_ (
mailto:EMS-L at EMS-L.ORG <mailto:EMS-L at EMS-L.ORG> )
		> List Manager:  _LISTADMIN at EMS-L.ORG_ (
mailto:LISTADMIN at EMS-L.ORG <mailto:LISTADMIN at EMS-L.ORG> )
		> Moderator:   _MODERATOR at EMS-L.ORG_ (
mailto:MODERATOR at EMS-L.ORG <mailto:MODERATOR at EMS-L.ORG> )
		>
		> Or one of the various Yahoo Paramedic groups...
		>
		> ck
		> Charles S. Krin, DO FAAFP
		>
		>
		>
		> **************************************See AOL's top
rated recipes
		> (
http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004
<http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004> )
		>
		>
		> ------------------------------
		>
		> --
		> trauma-list : TRAUMA.ORG
		> To change your settings or unsubscribe visit:
		> http://www.trauma.org/index.php?/community/
		>
		> End of trauma-list Digest, Vol 54, Issue 16
		> *******************************************
		>

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		trauma-list : TRAUMA.ORG
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	LFFox, MPAS, PA-C
	Distinguished Fellow, AAPA
	CCA, American College of Cardiology
	Associate, Society for Critical Care Medicine
	Associate, Underwater and Hyperbaric Medical Society 

	Lorick Fox, MPAS, PA-C
	SEAVIN/Peace Vector IV
	Unit 64903, Box 1201
	APO, AE 09868-4903
	(cell) +20-18-230-4448
	(landline) +20-45-240-9450
	www.lorick.org
	<http://www.lorick.org/> 

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Physician Extenders (was RE: trauma-list Digest, Vol 54, Issue 16)