u/ViolenceIs4Assholes — reddlx

An r/EMS post regarding encountering an NP on scene.

While generally I think it was a productive discussion, it was obvious there was some kick back from at least one particularly petulant Doctor of Non Physianary.

I think the important takeaway is that when it comes to “will you sign that you’re taking over care for this pt?” Most people are going to back off. But every medic should be comfortable telling anyone a firm, “no.”

Personally I find the idea of turning pt care over to a midlevel in the field laughable. If you’re in ATC where they have midlevels in fly cars that are a part of your service, sure. Why not. A rando? Not a chance. A random person claiming to be an NP, even in a state with independent practice is not trained in emergency care in the field. Period. They don’t have protocols. They don’t have equipment, and they don’t even have a fuckin ambulance. You are not going to get me, on behalf of my physician, and the lady that owns the ambulance, to turn over their pt and equipment to a new chain of care that doesn’t have physician supervision. Is an NP a higher level of care than me? Maybe. Maybe not. Definitely not if they don’t have a Doc on standby for orders. I’d go so far as to say I probably wouldn’t let a physician take over care of a pt on scene depending on their specialty and experience. I’m not doing a chest tube on a pt on behalf of a random dr and I’m not letting a Psychiatrist do one. The pt entrusts me with their care and I don’t take that lightly. But no psychiatrist, no radiologist or dermatologist EVER tries to run an ambulance out in the wild. NPs absolutely will try. I know because so do RNs.

Funny aside; a friend of mine had a Quackroproctic “doctor” stop for a wreck. They had done acupuncture for the pts neck pain and were considering an “adjustment.” I’d have been livid.

Any thoughts from the group? I’m very pro physician lead healthcare and would love to hear any thoughts from anyone who knows what we do in the wild, wild field for EMS.

u/ViolenceIs4Assholes — 1 day ago

▲ 281 r/Medals

I was hoping someone could give me any information on what’s here, thank you.

He was a reserve officer that was deployed to Korea at some point.

u/ViolenceIs4Assholes — 1 month ago

▲ 146 r/ems+1 crossposts

The wiki for “Health Care Provider” is super loose. However it does cite the Department of Health and Human Services definition of "person or organization who furnishes, bills, or is paid for health care in the normal course of business." In practice in the current culture of medicine I’d venture to say we could keep it as simple as, “health care professional who diagnosis and treats patients.” The distinction of “diagnoses” being important.

If a midlevel is given independent reign to diagnose a patient within a specialized limited scope and determine the appropriate treatment path they’re elevated to a different standard than nurses, RTs, CNAs etc.

Here’s the thing, paramedics do the same thing. I’m incredibly pro physician led healthcare. But similar to the midlevel standard a paramedic is a specialized pre hospital provider that operates within a scope of practice designed by state laws, federal laws, and physician medical direction. They operate to the same capacity of independence or similar to NPs and PAs.

In the field I have to make a diagnosis based on patient presentation. E.g. is my dyspniac pt having trouble breathing due to asthma, COPD exacerbation, CHF, or anaphylaxis? I have to be able to determine the root medical cause so I can develop an individual treatment path with in the bounds of my medical direction and scope of practice. Different cardiac and airway threats, etc. have their own very different treatment paths for the patient and that has to be rapidly determined by an educated “provider” independently in the field.

A paramedic operates in a leadership role in the field. Directing and delegating patient care to subordinate EMTs and first responders. In a cardiac arrest the paramedic fills the role of the physician in the hospital. Interpreting EKGs and performing airway maneuvers such as intubation while directing fellow responders through the ACLS procedure. This specialization is no different than the specialization of other midlevels in their own practice. Psych NPs. Family Medicine PAs. The paramedic performs advanced procedures up to the level of surgical airways and thorocostomies in their specialized domain, the wild.

All that to say, how the fuck did midlevels get all the glory, (and more importantly the pay), all of a sudden when we’ve been doing it at triple digit speeds, in the rain, and the middle of the night ever since our patron saints Drs. Peter Safar and Nancy Caroline gave us the beautiful gift of education and the belief the common man could extend the care of the physician out into the world?

I don’t have any desire to take your job. I’m in love with mine. I just feel like we’ve got a little stiffed in all of this.

reddit.com

u/ViolenceIs4Assholes — 2 months ago