Here ya go, Rif Raf!

["Mac Fianna" <macfianna@hotmail.com>]

Dear Jeff,

You welcomed this so here it is!

You stated:
>a physician-nurse team DOES provide definitive care. A physician on
>scene or in interhospital transfers provides immediate diagnosis and
>evaluation with appropriate treatment for the critically ill or >injured 
>patient.

Dear colleague,

Let's NOT suggest that by having an M.D. on board your aircraft you
are capable of immediately diagnosing or definitively treating anything! 
M.D.'s are simply humans as are medics, nurses or other flight crewmembers. 
We are ALL capable of misdiagnosing injury and illness, so unless you fly a 
CT scanner with a radiologist, (and numerous other diagnostic tools) around 
in your helo, you may want to retract that statement. I know from my own 
personal experience as I also crew with docs on 80% of my call volume.

Bottom line is that in the field, we all work under the same assessment 
pathways and algorithms of differential diagnosis to decide on a working 
diagnosis. In my 17 years in this business, I have seen many a doc "drop the 
ball" on patient diagnosis in house and in the field, and have seen 
inappropriate care delivered as well. I agree the PROPER docs may excel in 
certain skills and some may have more experience with certain areas of 
expertise than others, but I will take a well-seasoned Paramedic or Nurse 
with good assessment and procedure skills and sound judgement over any 
Miracle Doer, (M.D.) sitting on a scene burning up the golden hour 
"providing definitive care" driven not by necessity, but rather by their own 
  egomania.

Not once have I EVER wished for a doc when I didn't have one, but I have 
CERTAINLY wished NOT to have one on board when I did. The only sad but 
comforting thing is, is that they are ultimately responsible for their own 
screw ups.

Also regarding the Australia study: I would expect that many of the errors 
at the hands of the M.D.'s went unreported, or "swept under the rug" as I so 
often see in my own program and many others. No, I am not saying I condone 
innacountability as I am probably the strictest person you will ever find on 
that issue, but it DOES happen in every hospital. Period.

These are just my two cents. I would love to know what skill or treatment 
that your docs are capable of performing in the field that myself or my 
stellar nurses cannot perform.

I anxiously await Paul Jr's response to your post as well. =)

Peace and happy flying, brother!

P.R. Adams



>From: MLFFN1@aol.com
>Reply-To: flightmed@flightweb.com
>To: flightmed@flightweb.com
>Subject: Re: (no subject)
>Date: Fri, 22 Jun 2001 11:05:04 EDT
>
>WOW!
>where do I start?
>First of all kyfltgal, If you post an article such as the one you did, you
>need to properly context it. The "officials of eastern suburbs" , "Chief
>William Shaw" and "Solon Mayor Kevin Patton" where being quoted in response
>to having a helicopter service that served their community, as well as the
>surrounding communities, faithfully for many years, removed without much
>notice and without counsel from their respective communities and services.
>This aircraft, Metro Life Flight, was stationed at the Solon base 24 hours 
>a
>day, 7 days a week, 365 days a year and if you notice, in the article it is
>quoted as saying that Metro Life Flight would be replaced with a helicopter
>service that would "be there only three days a week". Their  concerns were
>only being aired in a public forum.
>Second
>Brian, I am sorry you and your fellow flight medics had to read this 
>without
>explanation or in its correct context. Frankly the article speaks the truth
>in that a physician-nurse team DOES provide definitive care. A physician on
>scene or in interhospital transfers provides immediate diagnosis and
>evaluation with appropriate treatment for the critically ill or injured
>patient. Their skills have been well defined through their practice in 
>either
>emergency medicine, orthopedics, anesthesia etc..
>Our physicians are highly trained in advanced trauma life support and many 
>of
>our physicians have flown with us for many years and have more field
>experience than some of the flight nurses. Now, with all of that said, it
>does not mean that services that fly nurse-medic provide substandard care. 
>In
>fact Brian, almost 90% of all flight programs fly nurse-medic. The quote 
>from
>Mayor Kevin Patton was once again an emotional response. The communities 
>are
>well aware of the study that was done in Australia comparing 
>physician-nurse
>and nurse medic flight teams. It showed a definite difference in the care
>patients received. It did not however show that care given by the 
>nurse-medic
>team was substandard at any level.
>Now, I am sure that I am going to be bombarded with critical responses from
>this email, and, frankly I welcome them. I would be happy to clear up any
>misconceptions that the posting of the plain dealer article has had.
>
>Sincerely,
>
>Jeff Martin CEN, RN, EMT-B
>
>Jeff Martin...aka rifraf4

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