He's Baaaaaack…

Glacier Doc should come out to Methodist Hospital here in Sacramento. He’d fit right in. Nobody would notice. Honest.

Ha ha ha! Sometimes you gotta work s l o w and make sure you are extra through to make sure that those damned hoofbeats ARE zebras and not those silly horses.Plus, I bet the patients like a personal doc better than the jerk who takes a glance, writes a bad script, and puts foot to patient ass. I know I prefer the personable approach when I look at the bill that insurance refused to pay!

Save your own head, and beat HIS head methodically against the wall.

Scott, I have no problem with the Doc taking a thorough history and physical. I <>like<> a Doc that takes a thorough history and physical.But when you spend forty-seven minutes talking and eight minutes sewing on a simple finger laceration, you chap my ass like cheese grater toilet paper.He’s not thorough. He’s just <>slow<>. And you do <>not<> want him working on you when you’re having a cardic event.I’m just thankful I reviewed the chart on the MI patient after the fact, and wasn’t directly involved.Otherwise he’d be complaining about the uppity paramedic who butted his clueless ass out of the way.Glacier Doc is a nice guy, he really is. He just has zero business doing emergency medicine.

I can’t believe it. I always double check the ER doc schedule before agreeing to work a ER shift. Most of the time, Unless I am the Charge (yes a paramedic can supervise a large ER) ((Holly fuck, paramedics are that smart?)) and if Dr. Raad, I shouldn’t use his real name, is working I will not sign up. The chart wrack fills up in milliseconds when he is at the helm. Can you say. CT scan for everyone. He has to have a kickback policy with the radiologist.

Tell me – were the stitches lined up picture perfectly and is the doc completely anal with a smidge of OCD? Tall sort of slender guy with either a bad rug or a ton of hairspray? I’m beginning to wonder if that doc from around here moved out your way.

I know him, or his doppleganger. Same doc I had when I fell and stuck my car keys through my hand. 4.5 hours later they slowly pull the keys out and give me a bandaid and some gauze….Heck, I could have done that myself.

I feel for you, AD!Don’t lose all your tooth enamel, now, even though clenching/grinding your teeth may be the only way to survive shifts with Glacier Doc.

Augggggggghh !

I’m confused. As an ambulance driver, how do you know anything like this? Our ambulance crews deposit the patient in the stretcher, give report, and leave ASAP. Some will hover around to see us stabilize the patient or what we think is wrong, etc. Most are gone within 20 minutes though.Dr. Bloody Gloves from my facility will do about the same thing, although the assessment part is 5 seconds and storytime is 45 minutes (about a patient he had with similar problems that turned out to have XYZ). It’s not like the assessment rules anything in or out in 5 seconds, so we must order all manners of diagnostic exams all day and night too. A simple back pain is lucky to be discharged in 128 minutes, a female abdominal pain will get a pelvic, ultrasound, and CT with PO contrast, one at a time, then, once the results are back, maybe 2 hours to discharge.

“I’m confused. As an ambulance driver, how do you know anything like this? Our ambulance crews deposit the patient in the stretcher, give report, and leave ASAP. Some will hover around to see us stabilize the patient or what we think is wrong, etc. Most are gone within 20 minutes though.”I don’t work on an EMS unit right now, although that will change in fairly soon. Currently I work full-time as a paramedic ER tech, practicing to my full scope of practice as a critical care paramedic.In other words, I be one of da Nursin Thugz, only wifout da Benjamins, fo shizzle.

Okay, gawtcha. I’ve been bewildered by that for ages. However, I assume a medic can’t really take an assignment and do everything for the patient as a nurse would, or am I crayzee? I know medics can give emergency meds with “medical direction”, but can you give the slightly, but not immediately urgent, 80 mg bolus of Lasix legally for CHF or hang the Heparin or push a metoprolol? I could delegate a whole lot of crap to you, in other words? What can’t you do? Patient teaching?Educate the poor nurse.

“I could delegate a whole lot of crap to you, in other words? What can’t you do? Patient teaching?Educate the poor nurse.”I can do everything the nurses do, with the exception of signing the front of the nursing assessment form. Only the nurse can begin the “nursing process.”Technically, that means the nurse reviews and signs off my triage assessment. In practice, the nurses I work with trust me to handle the patient without direction, and at most they sign the report before we put it in the completed chart rack.If I were subordinate to the nurse, we’d run into all sorts of delegation of practice issues. The way we get around that is to place the medic directly under the supervision of the ER doc, who is the one who delegates my practice.Our medics can do everything in the ER but conscious sedation and blood administration. As a critical care paramedic, I am allowed to perform both of those functions, as well as monitoring and troubleshooting of arterial lines, ICP monitoring, IABP, pulmonary artery catheters and all central lines, as well as troubleshooting of AICDs and pacemakers with the handly little magnet – which is to say I can turn the damned thing on or off, but that’s all.In our facility, I teach all the ACLS, PALS, BLS, basic and 12 Lead EKGs, plus most of the other critical care and emergency education.And my pay sucks for a nurse, but is really sweet for a medic.

Weird. I’d never heard of such a thing. I think our nurses would get territorial. I think I’d be weary about a non-nurse acting in the same manner as a nurse with an exception here or there that no one really heeds. In my state, since calling yourself a “nurse” is illegal unless you are a LPN or RN, you’d probably get real close daily to having people talk you into saying you’re a nurse, especially if they never see a nurse. If an old, confused patients asks if you’re his nurse, in my state, you must say “no”, otherwise, there is stiff penalties. If there is no RN s assigned to a patient explicitly, there are also practice issues.

Or, if someone asks to see his “nurse”, you have to get the patient a registered nurse or an LPN unless you explain that you’re not a nurse, but are assigned to his care as a critical care EMT, etc. You can’t just say “that’s me” or whatever to save the patient a detailed explanation.Maybe it’s not the same in Louisiana.

“Or, if someone asks to see his “nurse”, you have to get the patient a registered nurse or an LPN unless you explain that you’re not a nurse, but are assigned to his care as a critical care EMT, etc. You can’t just say “that’s me” or whatever to save the patient a detailed explanation.Maybe it’s not the same in Louisiana.”Nope, you’re right. I just tell them, “I’m not a nurse, I’m a medic. Is there something I can help you with?”If that something is within my scope of practice, I do it. It virtually always <>is<> within my scope of practice.My name tag clearly identifies me as a medic. Thus far, no one has yet to say, “Well, I want a <>nurse.<> Actually, I get mistaken for the doctor far more often, but that’s sexism for you. People assume since I’m a male, I must be the doctor.You gotta keep in mind – this is a very rural ER, and we have a very collegial relationship. No turf issues here.Our ER medic program is modeled after one used in an ER in a fairly large metropolitan medical center. The ER director, the one who designed the program, is (or at least was the last time I checked) the president of the state Emergency Nurses Association. The RNs I work with would rather have me than another LPN on their shift – larger skill set and more autonomy.Make no mistake – I don’t equate myself with a BSN when it comes to education – at least not *formal* education. But my non-formal and continuing education is rather, well, <>extensive<> to put it mildly. My formal education is more analogous to ADN than BSN.I work as a physician extender, just as I would in the field, under a legislatively defined scope of practice.Unlike nursing, EMS practice and education varies widely from state to state. Louisiana is about the middle of the pack when it comes to EMS practice – a few states are far more liberal, a great many others are far more restrictive.You may be surprised at how extensive the scope of practice is for medics in some areas of the country.I know a medic that actually works in your neck of the woods, Nurse K. As a matter of fact, he may be a mutual acquaintance.From what I gather from conversations with my friend, the hospital-based EMS system in your area is top notch.

<>From what I gather from conversations with my friend, the hospital-based EMS system in your area is top notch.<>I wouldn’t know. I get the sense that our health care in general around here is much better than the national norm. I only speak for myself, but if I had a highly-trained EMT taking care of me in lieu of an averagely-trained nurse in an ER, I’d be slightly suspicious that the subtle assessment/prioritization skills might not be there. I think protocol-driven codes are relatively easy; it’s those weird medical problems that may or may not be something where you really have to decide how much you care.

“I only speak for myself, but if I had a highly-trained EMT taking care of me in lieu of an averagely-trained nurse in an ER, I’d be slightly suspicious that the subtle assessment/prioritization skills might not be there.”You’re right on that one, and I agree. I wouldn’t want many paramedics I know to be working on me, in <>any<> setting.But I think you’re letting your personal experience color your assumptions a bit.Not all medics are protocol monkeys,and in some states may have far more extensive education than you appreciate. Indeed, in some parts of the country, Basic EMTs leave EMS and go into nursing because the time investment and educational requirements are virtually the same as becoming a medic, but with substantially higher pay and better hours. Some of us are proficient historians in our own right. The education level of medics in some systems would surprise you, Nurse K.I understand the clinical significance of the basic lab values as well as any of our nurses, to name but one example. I’m no radiologist, but I know my way around a chest film. I taught ABG interpretation and 12-lead EKG interpretation (not just the simple “how to localize an MI” stuff) to a couple of our nurses prior to their CEN exams.Much of that knowledge I have gleaned from nurses over the years, but a great deal of it was taught to me in medic school. That particular paramedic curriculum was only 2/3 as long as the one I teach today.