Re: Physician-Staffed Helicopters

[Helodoc@aol.com]

Mr. Martin-

You are absolutely right in saying that if you walked in to an ED where the 
physician was not providing proper care that you would have to tread lightly. 
 So would I, though.  That is one of the biggest issues in air medical 
transport - dealing with the referring personnel, be they physicians, nurses, 
or paramedics.  If you run in shouting the Mighty Mouse theme (for you 
youngsters it goes: "Here I come to save the day!") you will probably not be 
asked back, regardless of you credentials.

As regards the diagnosis issue, there are medical diagnoses, nursing 
diagnoses, and paramedic assessments.  Although there are subtle differences, 
the basic idea behind them all is that we need to know where we want to end 
up before we choose the route. As a physician I can perform an elaborate 
history and physical exam, come up with an extensive differential diagnosis, 
and choose testing to narrow that differential based on the latest 
literature.  I can then treat based on that literature.  People who do that 
well are called "Internists."  I am an emergency physician, which means I get 
to perform a brief H&P, come up with a "most likely to die from" differential 
list, and order some tests to rule out "the really bad stuff." Some times I 
have to treat before I order those tests.  Why the compression?  Because time 
and space are limited in the emergency department.

The air medical environment is even more compressed, so most of what I can do 
as a physician is unavailable.  That is why nurses and medics are able to 
render such good care, and why physicians don't make a difference in this 
environment.

As to North American studies, there have been several, and none of them 
showed a true benefit to physician staffed helicopters.

Dave Thomson


David P. Thomson, MS, MD, FACEP
Associate Professor
Emergency Medicine
Upstate Medical University
Syracuse, NY 13210
315.464.6219 voice
315.464.6229 fax

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