Re: Physician-Staffed Helicopters

["MIKE SMITH" <msmith_01@email.msn.com>]

>there are medical diagnoses, nursing
>diagnoses, and paramedic assessments.  Although there are subtle
differences

One last thing, I as a medic on the street or on the Heli,  make a Field
Diagnoses (provisional Dx, Working Dx, or I make an informed judgment of
what's going on with the patient).  I then work through the signs and
symptoms to work out a differential diagnoses and hopefully arrive at the
cause.  If we didn't do this then all chest pain complaints would be treated
as chest pain in general.  Since I can and do make a field dx I can suspect
that the chest pain is an AMI, PE, Pneumo, condritis, pneumonia or CHF.  We
all would be remiss in our respective roles if we didn't use this type of
Critical thinking in our jobs.

I hope that this will help those of you whom feel that you must have a MD or
a DO after your name to make a Dx, realize that this is critical to helping
sick and injured persons.

As far as allowing someone to use the wrong modalities in a RvMI, how many
people really know how to diagnose one and the proper treatment?  I have
come across many Physicians, nurses and medics who do not know that there is
a difference.  Many protocols do not even consider RvMI.

Thanks,
Mike Smith
----- Original Message -----
From: <Helodoc@aol.com>
To: <flightmed@flightweb.com>
Sent: Tuesday, June 26, 2001 10:02 AM
Subject: Re: Physician-Staffed Helicopters


> 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
>
> _______________________________________________
> Flightmed mailing list
>


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