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Hi to All, Forgive me for enter this foray concerning physicians, nurses and paramedics. I know that this debate will not end with this posting and many of my esteem colleagues have addressed some of the points I‘ll also attempt to make but there are some I wish to amplify. This discussion I believe began with some local officials making or allegedly making comments about one flight service capabilities (physician / nurse team) and the new comer (nurse / paramedic team). I would like to think that inter-program competition has nothing to do with it. But most would agree I would very naïve to believe that. Whether it was overtly or covertly implanted in the minds of the local officials, I’m not to say. I want the reader to understand that this may not be the case in this instance, but the list has seen flight programs bashed in the past. I do accept that the possibility, the local officials did make an emotional response as we all from time to time do. Besides if these officials are in anyway responsible for EMS they would think it absurd to staff street rigs with (physician / nurse teams) (besides the federal government would have to rethink that there is an excess of physicians and heaven forbid the nursing shortage). I also had a department chief once state that 3% of all ground EMS calls were ALS in nature and the remainder was BLS. I don’t believe that experience bears this out. There no research or practice (that I’m aware of) but my gut belief is that there is a unrecognized greater need for advanced level providers (CCEMT-P, CCRN and MD) on ground EMS rigs and critical care transport trucks with >30 minute transport times. Most often this occurs in a rural setting so there not much to draw these providers there to provide this level of care. Therefore, it becomes an issue of money which in turn leads to increased cost that now puts either the service provider at an operating loss or increased cost passed on to the consumer, Medicare / Medicaid or other third parties. With 85 – 90% of US programs flying nurse / paramedic teams this model has shown to be a more cost effective approach. But bear in mind the remainder provide care with Physician/Nurse, Nurse/Nurse, Nurse/RRT, Paramedic / Paramedic, Paramedic/EMT-B, lone Nurse or lone Paramedic. Also bear in mind that in some instances these nurses are not RNs but LPNs. Bottom line is I believe that the models are settling out to what works for a service area and the service to be provided. Paul Wright’s response (6/23/01) covers cost of operation very well. I believe that IF the per operating hour cost of a single pilot S-76 (less Medical Crew) was approximately the same as the single pilot BK-117 / Bell 222UT / A-STARs and A 109s we all would be in the S-76. ( A big space is always better than a small one) It seem to me that we are looking at apples and oranges again. I would also like to add that the post of Brian Wall, P.R. Adams, Mike Smith, Brian Jefferson, Rick Cosmar and Dr. Thomson reflect what I have learned to be the norm with the nine flight programs I am familiar with (two of whom I have been or are in their employ). (Nothing new here, the numbers bears this out). I beg to differ on the statement of who makes a diagnosis. Traditionally and legally speaking, only a physician can make a medical diagnosis and nurses make nursing diagnosis. What does the emergency care provider do, a guess, a SWAG*** or a working diagnosis. I think that this is borne of the same genre as MD is a MD, a Nurse is a Nurse. Medicine is evolving constantly but it would seem that some have to be pulled kicking and screaming with it. A foley cath was most likely a invasive procedure that only physicians could do when nurses scrubbed floors, offer their chairs to and fetched coffee for the same MDs. I offer that there is no emergency care provider who doesn’t create a working diagnosis, an evolving diagnosis that guides them in their treatment protocols and algorithms. At what point does water become jello? To address the occurrence of the medical diagnosis that not being treated properly. There are methods to get the attending physician to consider your points. I believe that most MD respect what advanced providers have to say. Most concede the possibility that they may have missed something. Without going into details we all have been given orders that are inappropriate for a given patient. If said physician is adamant in giving a treatment to a patient that just wrong and the care provider continues it, the patient’s lawyer will be much happier (more people to name in the successful suit). For example: MSO4 gtts with the patient with a magnesium level of 10 and no DTRs, Cardiac patient BP 50/0 and Nitro gtts of 100 ug/min. etc. It has not been my intent to further the controversy in question but to offer points for all to consider. If anyone would like to add, to rebuff, or would like to tell me I’m full of bull excrement and doesn’t want post it to the list my e-mail is jim.kendrick@worldnet.att.net. In closing I would also like to point out that the programs in question are excellent, one has offered much research and a body of knowledge to our profession. The other is also a well respected provider with members there also offering much to us. Fly Safe
Jim Kendrick, CC-NREMT-P, CFP and RN 2B in ‘01 *** SWAG Scientific Wild Ass Guess |