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Dear Kevin,
In reply to your question, I never said our Paramedics and Nurses aren't heavily made accountable for quality of service. We are. We are glad we are, as we are given much autonomy and advanced training to perform many procedures most programs do not. But this autonomy comes with a cost. A VERY stringent QA system. Believe me, when WE screw up, it is our butt in a MAJOR sling. But because our Physicians are not "fully dedicated" members of our team, (they take call despite other duties in house AND they typically bitch and moan about having to do it in the first place). Because our administration does not support hiring dedicated Flight Physicians, we utilize Critical Care Medicine Fellows for our transports. Because of this, our program medical director will not critique more than a simple "slap on the wrist" or the occasional embarassment at M&M meetings for fear of losing their willingness to serve "his" program. I KNOW this is not an ideal situation, but it sadly is our reality.
This lack of accountability is one of the very things that make ME "bitch and moan" when I am told a doc is coming with us. Now, if we had FULLY DEDICATED docs, maybe I would feel different, but I still contest they still are no better qualified to diagnose or treat anything than our other crewmembers.
Hope this clears the confusion.
P.R. Adams