Physicians Responding to MCIs?

[firedude 985]

Thoughts?

MONOC Program Brings Physicians to EMS Calls

Richard Huff, NREMT-B | | Monday, March 12, 2012

First responders in New Jersey facing major mass casualty incidents and extensive entrapments will now be able to call on an extra set of hands—from a physician.

Full JEMS Article

N.J.-Based MONOC Adds EMS Physician MD-1 Program

Wall, NJ – January 19, 2012 – In a continuing effort to better serve their patients throughout New Jersey, MONOC Mobile Health Services recently added a program called MD-1.

Full EMS Worlds Article

Photo of a Physician Response Vehicle:

Photo Courtesy of EMS World

Edited March 14, 2012 by firedude

[INIT915 1,119]

Thoughts?

That's not really a new concept. There are a number of these programs in existence, and some have been around for years.

[x129K 1,393]

Wasnt there an MD who responded to bad wrecks up in the Peekskill area in the 90's and early 2000's, hell, maybe still does?

[INIT915 1,119]

Wasnt there an MD who responded to bad wrecks up in the Peekskill area in the 90's and early 2000's, hell, maybe still does?

Dr. John A. McGurty, Jr. He had a City of Peekskill issued response vehicle. He now devotes most of his time to his military commitments, however, he still does a few shifts at Hudson Valley ER. A true supporter of EMS, Police, and Fire.

[x129K 1,393]

Thats it! I remember seeing pics in the Journal News back in the day with him in a car with his MD turnouts on...very cool.

[comical115 32]

The PAPD Sgt. from 9-11 who survived in the rubble of the trade center has a Physician and a NYPD ESU Medic to thank. Every now and then I see the 5Mary car in the city responding on calls. They are a great resource and it helps to build a relationship between the personel in the field and the doctors on the phone and in the ED.

[OoO 24]

From what I've read, bringing physicians into the field actually results in longer on scene times and poorer patient outcomes. Though at an MCI, I suppose on scene times will already be extended. I would be interested to see how this works out.

Edited March 14, 2012 by OoO

[FDNY 10-75 640]

In the Albany area we have close to a dozen of physicians that respond to both EMS Calls and MCIs. They are a great resource.

Sidebar - We had a witnessed cardiac arrest recently at a home improvement store, one of the MDs was in the area and used 2 defibs to deliver a shock to a patient in refractory vfib. This corrected the rythm but not the patients blocked LAD. Not something anyone expected to see in the field (or when they rolled into the er) but it worked.

[FDNY 10-75 640]

[ny10570 745]

FDNY EMS uses physicians in a variety of roles. Primarily they respond to MCIs where they can provide a much more efficient system of evaluating and releasing patients than the traditional RMA or transport for everyone involved. Then there is the benefit of on scene medical control. Running an arrest with the doctor standing next to you is much easier than the hassle of calling telemetry and sitting on hold. For confined space and building collapse rescues we have USAR physicians that provide on scene medical control for their specific protocols and even offer additional interventions outside the paramedic scope of practice.

[M' Ave 1,466]

I've seen the EMS M.D. out a few times for very serious injuries as well. Jumper down on pavement who's still alive....ect.

[v85 212]

What can the EMS M.D. do intervention wise? Pain Management, Field Amputation, Surgical Procedures (chest tube, cricothorotomy)?

[mvfire8989 22]

I would imagine that there are not many limitations. Scope of practice limitations do not really apply to an MD.

What can the EMS M.D. do intervention wise? Pain Management, Field Amputation, Surgical Procedures (chest tube, cricothorotomy)?

[SageVigiles 1,194]

New Haven County in CT has the SHARP (Sponsor Hospital Area ResPonse) Team which can operate at major emergency incidents. If you listen to CMED New Haven they are the "Romeo" units that you'll occasionally hear on the radio.

According to their website they are usually called to:

MCIs

Complex or Difficult Extrications/Rescues

HAZMATs

Multi-Alarm Fires

I've seen them show up to a call in West Haven for a man trapped. Didn't get to see them operate though, the patient was DOA but they made it on scene about the same time we did. They do get around outside the New Haven area as well for some strange calls, usually up the shoreline. Izzy might know more about them.

http://www.sponsorhospital.org/aspxpages/SharpTeam.aspx

[IzzyEng4 427]

Alex hit the mark petty much on the SHARPS team that is utilized in Metro New Haven. The team is made up of doctors and physicians assistants from Yale-New Haven and St. Raphael's Hospitals, both comprise the New Haven Sponsor Hospital program.

Since their implementation, they have been involved with a lot of different incidents. They primarily will respond throughout the area covered by both New Haven hospitals and their affiliated clinics. They can also be special called into another area within the South Central Region if need be in the case of a MCI or massive trauma where a field amputation may be needed. Vary rarely have they been called outside of Metro-New Haven and the Shorline area.

When I was still actively dispatching at C-MED New Haven, every week there was a different on-call doctor from the SHARP team. Usually the on-call was the first contacted unless it was a major incident where additional doctors and PAs were needed.

If I remember correctly the first time we utilized the team was a major bus crash in the Long Wharf area of New Haven on I-95. Needless to say the team proved their place within the response system.

[Guest alsfirefighter]

Dr. John A. McGurty, Jr. He had a City of Peekskill issued response vehicle. He now devotes most of his time to his military commitments, however, he still does a few shifts at Hudson Valley ER. A true supporter of EMS, Police, and Fire.

John did this prior to the advent of ALS in the area. He is also Cortlandt/Peekskill Paramedics and Peekskill FD Medical Director. He is forward thinking and pushes for advancements in field skills and treatments for all ALS providers. His military service keeps him forward looking and on the edge of cutting trends.

I think it would have its place depending on the MCI. In the field...a Dr. basically becomes a Paramedic for all intensive purposes. Unless they are brining the pharmacy with them..they will have what is in the bag. The situations where more medical knowledge is needed with trauma is rare statistically.

[x635 4,066]

In Austin, the Medical Director has a vehicle to respond to the scene. There is a variety of reasons why he may need to respond to the scene.

The interesting part, is that the Medical Director for Austin-Travis County EMS started out his career as an EMT at Empress EMS.

[NWFDMedic 58]

John did this prior to the advent of ALS in the area. He is also Cortlandt/Peekskill Paramedics and Peekskill FD Medical Director. He is forward thinking and pushes for advancements in field skills and treatments for all ALS providers. His military service keeps him forward looking and on the edge of cutting trends.

I think it would have its place depending on the MCI. In the field...a Dr. basically becomes a Paramedic for all intensive purposes. Unless they are brining the pharmacy with them..they will have what is in the bag. The situations where more medical knowledge is needed with trauma is rare statistically.

We often think of MCI's as trauma because they usually are. One place where I think a physician would be particularly helpful is the "medical MCI". Specifically, HAZMAT incidents, potential chem/bio attacks, etc. You're right that a physician would essentially be a paramedic, however, if a plan was developed with a hospital response unit delivering other needed meds or equipment, the physician could be extremely helpful. Heck, something as simple as a bunch of kids in a dorm falling ill after potential food poisoning would benefit from having a doc in the field. That's something that may not happen every day, but it does happen often enough.

[SRS131EMTFF 471]

How much leeway does any MD have to deviate from our protocols. Obviously Med Control can set and create protocols at will, but how about a random MD? To what extent do you have to follow their treatments, I would think that you would have to follow the state, district and service protocols to the letter with no derivation regardless of the input of some "other" M.D.

[Guest alsfirefighter]

We often think of MCI's as trauma because they usually are. One place where I think a physician would be particularly helpful is the "medical MCI". Specifically, HAZMAT incidents, potential chem/bio attacks, etc. You're right that a physician would essentially be a paramedic, however, if a plan was developed with a hospital response unit delivering other needed meds or equipment, the physician could be extremely helpful. Heck, something as simple as a bunch of kids in a dorm falling ill after potential food poisoning would benefit from having a doc in the field. That's something that may not happen every day, but it does happen often enough.

Excellent point...but I would view it much differently then the food poisoning...again...they're not going to do much more then we are and if anything can be over deliberate. Perhaps if you have a unique haz mat situation where if knowledgable in AHLS you might want or need the support...but again..even in the medical part...we carry emergent medicines for a reason.

As far as a chem/bio attack....again...in what regard...other then to have support and get a yes/no from someone there.....atropine...is atropine....2pam is 2 pam.

I know we're talking about MCI's....but if I remember right...wasn't Princess Diana in the care of a physician?

[Bnechis 3,961]

I know we're talking about MCI's....but if I remember right...wasn't Princess Diana in the care of a physician?

Yes. At the time the City of Paris had 2 different ambulance services: The Paris Fire Brigade which was trained to about the EMT-I level and was normally dispatched to general medical and trauma calls. And SAMU which is hospital based and runs with a physician. They are primary response to Medical calls: Cardiac, Resp. etc. They do more workup than ALS here.

Both responded to Diana, and SAMU got there 1st. She was in the bus, when PFB arrived and was on scene being stabilized for over 40 minutes (if memory serves). She needed an OR not a medical ICU.

[Guest alsfirefighter]

Yes. At the time the City of Paris had 2 different ambulance services: The Paris Fire Brigade which was trained to about the EMT-I level and was normally dispatched to general medical and trauma calls. And SAMU which is hospital based and runs with a physician. They are primary response to Medical calls: Cardiac, Resp. etc. They do more workup than ALS here.

Both responded to Diana, and SAMU got there 1st. She was in the bus, when PFB arrived and was on scene being stabilized for over 40 minutes (if memory serves). She needed an OR not a medical ICU.

That was my point...but I was doing it in a more round about way in my tongue in cheek way. More then likely in any American urban setting they have said she would have survived

[PEMO3 523]

Back in the 80's NYC EMS would routinely have their MERVs respond to the ED and pick up an attending and 2 RNs when responding to certain MCIs e.g. aircraft emergencies, building collapses, etc. So having an MD respond to an MCI is not a new concept but certainly one that would need to be planned for an not allowed to run without protocols or guidelines. Even MDs in an ED have established protocols that they operate within. While an MD does have more discretionary leeway than a medic they do have limits.

[ny10570 745]

What can the EMS M.D. do intervention wise? Pain Management, Field Amputation, Surgical Procedures (chest tube, cricothorotomy)?

I don't know the details of the protocols, but any medications not in the State EMS formulary and any interventions outside our scope of practice can be performed by the doc.

We often think of MCI's as trauma because they usually are. One place where I think a physician would be particularly helpful is the "medical MCI". Specifically, HAZMAT incidents, potential chem/bio attacks, etc. You're right that a physician would essentially be a paramedic, however, if a plan was developed with a hospital response unit delivering other needed meds or equipment, the physician could be extremely helpful. Heck, something as simple as a bunch of kids in a dorm falling ill after potential food poisoning would benefit from having a doc in the field. That's something that may not happen every day, but it does happen often enough.

In our system, the docs greatest benefit is preventing unnecessary transports. Not much a doc can do on scene for a medical emergency other than streamlining the medical control process.

How much leeway does any MD have to deviate from our protocols. Obviously Med Control can set and create protocols at will, but how about a random MD? To what extent do you have to follow their treatments, I would think that you would have to follow the state, district and service protocols to the letter with no derivation regardless of the input of some "other" M.D.

Doc can do whatever they want. We are only allowed to operate within our scope of practice. Doesn't matter what the doc says or does, but I cannot place a chest tube or amputate a limb. As far as unsolicited medical advice in NYC we cannot deviate from our established protocols. If the doc would like, they can talk to our medical control physician and get approval to authorize our medical control options. An on scene non-OMA doc is useless unless they want to carry equipment or take a turn at compressions.

[87D124 37]

Several years ago while at the JEMS Conference in Baltimore, I attended a lecture on crush injuries. Our instructor, who was an ER Doc in a system just outside of Philly. He had a County issued emergency vehicle and often responded to major trauma jobs.

He responded to a call at a mill where a worker, who didnt have the proper guards in place on a large several ton press had both of his arms sucked into the press. It was determined that they could not disengage the press to reverse it because it would have completed another forward cycle before going in reverse. Since this press took a month to assemble & was made of hardened steel, there was no way to cut it or take it apart.

The Doc knew the only chance for removal of the patient was a double arm amputation to be performed at the scene. He called the hospital & got a team of OR nurses to bring him everything he needed to do a surgical amputation in the field.

The patient was removed from the press after being trapped for about 12 hours. Although he lost both arms, he was thankful that he was still alive.

If not for this Doc doing what he did, the outcome wouldnt have been the same. This is just one of the many times that a life was saved by a field Doc.

[mvfire8989 22]

That was my point...but I was doing it in a more round about way in my tongue in cheek way. More then likely in any American urban setting they have said she would have survived

I don't think that having a physician on scene contributed to her death, it was the failure to arrive in an OR in a timely fashion. If the ER docs tried to medically manage in the hospital the outcome would be the same.

The additional expertise that the physician brings is only valuable if there is a reason for an extended on scene time, and they have additional tools/meds at their disposal.

Edited March 15, 2012 by mvfire8989

[Guest alsfirefighter]

I don't think that having a physician on scene contributed to her death, it was the failure to arrive in an OR in a timely fashion. If the ER docs tried to medically manage in the hospital the outcome would be the same.

The additional expertise that the physician brings is only valuable if there is a reason for an extended on scene time, and they have additional tools/meds at their disposal.

I will have to see if I can find it online again but there was a medical article that clearly put some of the auspice on the doctor who sat on scene too long. It also discussed that standard U.S. trauma protocol that if in a metropolitan area similar to where she was between EMS and trauma center she more then likely would have survived. At least she would have had a higher statistical chance of survival depending on where there bleed was.

Your second sentence surmised exactly what I was trying to frame with mine. Well put!

87D...your instance is the exception rather then the rule. No one is discounting that there are times it is not a bad idea to have it...but its not always needed. I'm not sure what the other "many" times your referring too..but anything searched over time can find "many." Those unique situations are where that interaction is the most critical.

[mvfire8989 22]

I will have to see if I can find it online again but there was a medical article that clearly put some of the auspice on the doctor who sat on scene too long. It also discussed that standard U.S. trauma protocol that if in a metropolitan area similar to where she was between EMS and trauma center she more then likely would have survived. At least she would have had a higher statistical chance of survival depending on where there bleed was.

I agree that they stayed on scene too long, I'm just saying that the outcome wouldn't have been different if if was an paramedic on scene or a doctor. No one should be "staying and playing." Her survival rested on access to definitive care in an OR.

[Bnechis 3,961]

I agree that they stayed on scene too long, I'm just saying that the outcome wouldn't have been different if if was an paramedic on scene or a doctor. No one should be "staying and playing." Her survival rested on access to definitive care in an OR.

Agreed. My info was the PFB had protocol and a Hx of only a few minutes onscene with trauma and SAMU roll was medical not trauma and they wanted everyone "stable" 1st and we know thats not whats needed.