Don't get this at all

[overthehorizen]

Anti-PA seems a little harsh. Thats a lot of work and money to put up to go through accreditation to serve the sole purpose of destroying a profession.

Your statement would imply that "a lot of work and money are therefore for the purpose of advancing the profession." This is patently false. The programs that are being accredited merely need to fill out forms and create the appearance of having credibility. Their raw motive is money for the institution. College and University Presidents are business people and they see the PA program as an opportunity to get nearly $4M (four million dollars) added to the coffers with nearly zero investment and no accountability. Does Bryant University have a medical school? No! Does Bryant University have a hospital attached to its school where students train? No. What is Bryant University? Another community college on steroids. Check out the academics. The institution has no PhD granting program. Not a science faculty. Heck, not even a PhD in education. The sagging enrollment has created a desperate need to boost sales. Who is being duped into going there? PA students. 

[UGoLong]

I have read about this topic with interest and I think that the opponents of FPAR are missing a key point:

If you've ever worked in a non-healthcare job, you might remember that what your boss wanted you takes precedence over anything but the law. The same would be true if you are a physician or a PA with FPAR.

You will always be supervised unless you work for yourself. Where we have gotten into a logjam is when some outside authority demands that your supervisor has to manage you in a special way.

Clearly people new to a profession need a different level of supervision. Across most walks of life, that historically has been left to the supervisor.

Sent from my XT1254 using Tapatalk

[Boatswain2PA]

If you've ever worked in a non-healthcare job, you might remember that what your boss wanted you takes precedence over anything but the law. The same would be true if you are a physician or a PA with FPAR.

 

You will always be supervised unless you work for yourself. Where we have gotten in is when some outside authority demands that your supervisor has to manage you in a special way.

 

Clearly people new to a profession need a different level of supervision. Across most walks of life, that historically has been left to the supervisor.

 

Agreed.  I completely support removing bureaucratical restrictions (or, additions) to supervisory practice.  Too many states have too many regulations (no more than 2 PAs per doc, chart signature, % of on-site time, etc).  

 

But where do we draw the line?  The board certified physician is the pinnacle of the health care profession. I believe they should have SOME role in the care of every patient.  That role may simply be knowing that the particular PA/NP needs no supervision.

 

But I don't agree with PA/NPs being able to legally practice without any supervision.

[overthehorizen]

But I don't agree with PA/NPs being able to legally practice without any supervision.

If you continue to advance this thinking, your $220k per year income will erode to nothing over the next decade as the Nurse Practitioners eat your lunch. You can disagree all you like while the NPs keep marching forward and eliminating the PA from the equation. Unless and until the PA wins independent practice, the profession will inexorably decline into nonexistence in ten years. We must cease reboarding and cease to align ourselves in subservient fashion to a group that cannot work in a collaborative fashion. 

[Boatswain2PA]

We all hear you screaming, like Chicken Little screaming "THE SKY IS FALLING".

 

I just don't see it.

[ventana]

Vent - nobody should be forced to precept. If you or OTH want to decline precepting because of their desire to retain the status-quo, then that's your call. Or you could take students and expose them to your thoughts on the profession. But to suggest purposefully giving them a poor educational experience is uselessly damaging.

 

 

 

However I wouldn't want my wife, kids or grand kids to see an inexperienced PA (or especially NP) who didn't have some kind of medical oversight by a physician.

 

Please do not put words in my mouth.  I NEVER stated accept a student and purposefully give them a bad education - that is just wrong!

I did state that we live in a free society and if you don't want to take a student from a certain school - just decline that school.  I for one am busy enough in life that I have no desire to set up conflict where there was none.  I would teach a PA-S to be a fully responsible health care provider - not dependent on anyone.  The school would likely not like that..... hence they can find someone else to mentor their students.

 

 

 

 

 

 

 

 

 

 

Agreed.  I completely support removing bureaucratical restrictions (or, additions) to supervisory practice.  Too many states have too many regulations (no more than 2 PAs per doc, chart signature, % of on-site time, etc).  

 

But where do we draw the line?  The board certified physician is the pinnacle of the health care profession. I believe they should have SOME role in the care of every patient.  That role may simply be knowing that the particular PA/NP needs no supervision.

 

But I don't agree with PA/NPs being able to legally practice without any supervision.

 

 

Do you work in primary care?

I can tell you I can and do run circles around many of the doc's locally, whom have an MD after their name, panels full of patients addicted to benzo's and simply are finishing up their careers - or just trying to maximize revenue.......

 

A PHYSICIAN DOES NOT NEED TO BE INVOLVED IN PROVIDING CARE.

 

There was a great article about a transplant PA who outperformed most the residents and was made head of the harvest team.  No attendings went on the harvest - a proven winner!  Would you rather have this PA working on your case or some resident whom had never done the procedure before?

 

I do agree with you that new grads should be mentored for a year after grad (or have completed a residency) to protect the public.  I do NOT believe this is a roll that should be filled by a doc.  We need to train and escort our new PA's into the profession the same way as SLP's do with solid mentoring.  

 

I also think that there is a realization that comes with time and seeing different specialties that shows the "long in the tooth" PA what the real world is.  There are times when you want the MOST EXPERIENCED provider working on you - not the highest credentialed.  

 

As well the medical society has changed greatly since when PA and NP came about.  Back when PA was started doc's had practices, and would hire a PA as their own.  There was ownership, and training.  Now the hospitals and corporations have bought out most the doc practices and the doc's are now just employees themselves.  So the choice of hiring an NP without any supervision requirements - versus a PA with supervision requirements - which one would you hire?  

 

Additionally, as I pointed out previously - if the doc's just decided to not supervise PA's any more - where does that leave us?  yeah, broke, out of a job.  For what reason???? Because another profession saw us as a threat and "eliminated" the threat.  The only defense we currently have is we are cheaper than doc's to employ. 

 

As for you comments on PA managing pressors in the ICU - go out there and read about the hospitals that have closed residencies, and or made the switch to PA/NP staffed units and how their stays get shorter, their complications go down, and things flow smoother.   Think about it - if you are in the ICU would you want your family doc (who has a fully booked schedule that day and whom got 3 calls overnight last night and is on his 3 cup of coffee) managing your care over the phone to nurses, or a highly experienced intensivist PA?  I take the PA!!!

 

 

I just see zero reason why we should have our professional careers 100% dependent upon another profession - it makes no sense. 

 

 

Maybe in the medical specialties there is confusion on practice independence versus practicing as a doc or PA.  I am not a doc, and don't want to be one.  But I want to be able to practice what I know, and not have needless restrictions.  I would also state that we ALL ARE PART OF A TEAM - and knowing how and where you fit in that team is critical.   What value added is there for me notify my doc of a Sch II script with in 96 hours AFTER the script was written, or have to do 10 case reviews every quarter, or have their DEA number on my controlled sub license??  and so many more oversight issues...... It is all a zero value added situation and outdated.......

 

 

Again, I agree with you on the new grad issue and I think this is something that should be incorporated into new regulations, but for you to come out so far against FPR as a speciality PA who admits they dislike Primary care (and 30-50% of PAs work in a PCP field) seems strange.   It might not be the prefect thing in your specific speciality, but as a whole for PA profession it is an idea whose time has come.  

[Boatswain2PA]

You didnt, but OTH suggested that.

 

No, I hate primary care/IM. While YOU may run circles around a lot of PC MDs, I certainly wouldnt. Yet with independence I would be able to move into PC tomorrow without supervision. You certainly wouldn't want me managing your dad's parkinsons (or any of those other millions of PC things).

 

I agree they don't need to be involved in providing care. But still disagree with full independence of PA, or especially NPs.

[Boatswain2PA]

I would be pleased if the PAs who are asked to take the Bryant students on rotation simply refuse outright. If they are forced to take them, make sure they get a substandard training so future applicants are dissuaded from applying to the program.

This is what I was referring to.

[overthehorizen]

People want to take issue with this statement. "If they are forced to take them, make sure they get a substandard training so future applicants are dissuaded from applying to the program."

 

Not sure why that is an issue. No PA should be forced to take a student. If management comes to me and says that my wishes are irrelevant and a Bryant University PA student will rotate while I precept, my response to the boss is "Yes sir!" I then undermine every effort of the student to learn and progress.  I believe "Boatswain" is an alternate term for Petty Officer of the ship. So, perhaps Boatswain appreciates why we don't conscript men into military service. If you draft them, you'll end up with thinkers like me who smile all the way through boot camp until deployed. Then, the smiling private frags his CO while he sleeps. It is far better to have an all volunteer military. 

[ventana]

You didnt, but OTH suggested that.

 

No, I hate primary care/IM. While YOU may run circles around a lot of PC MDs, I certainly wouldnt. Yet with independence I would be able to move into PC tomorrow without supervision. You certainly wouldn't want me managing your dad's parkinsons (or any of those other millions of PC things).

 

I agree they don't need to be involved in providing care. But still disagree with full independence of PA, or especially NPs.

 

 

 

 

 

 

 

Long post (4) above edited with more info

 

 

 

 

 

But the fact of the matter is the PA in primary care is restricted by needless, senseless, zero value added regulations.  

 

 

As for making the jump to PCP from other specialities - - Doc's do this with some regularity.  I have worked with 3 surgeons who got tired and stopped surgery, and just became PCP's....  you read, you ask questions, you read and study (also know as being a PA :-))   and guess what - you figure it out!  

 

I assume you are a smart person, that cares, and tries to do a good job - with this and effort you become a great PCP over the years.  None of use are independent - we have teams of people to help, we refer, we treat, we ask co-workers, and even call specialists.  Heck last week I spoke to an ortho PA on the phone on fracture management that I just wanted a second (specialist) opinion on.  I didn't fly alone, the patient got the care they needed and there was no downgrading of quality of care because it was 2 PA's on the phone....

[Boatswain2PA]

Vent - I undersrand nobody operates in a vacuum, alone and cold.

 

I am perfectly fine with a PA having virtually no supervision....as long as it is agreed up by a SP. Again, many of us are fully capable of working independently.

 

But many of us are not. How do you draw that line, and protect our patients, if we remove the legal requirements of supervision?

 

I like a broad regulation saying PAS must be supervised by a MD/DO, with the level and type of supervision being determined by them.

 

That way your SP doesn't have to even read your charts....but allows newbie PA to grow.

[PeteK777]

I also oppose FPAR. It's short-sighted, and I, too wouldn't call myself hysterical or anti-PA. Too many PA programs churning out bambi new grads with little experience. And you want them to have less supervision...? Or you want us to move toward post-grad fellowship model? 

 

Currently I work in ED/ICU, rural and solo night coverage. Call my attending for major questions (i.e. almost never). Manage shock, airway, vent, CRRT, stroke, code team hospital wide etc. etc.

 

If you think FPAR is going to somehow increase your scope of practice, you're sorely mistaken. Find a new job if you don't like the way things are going for you; stop crying about NPs stealing your job (hint: they aren't) and pretending a new acronym is going to fix that for you (hint: it wouldn't).

[overthehorizen]

I am surprised at how quickly the PA is willing grant a seal of authority on the physician merely by a pair of letters, MD. As many have pointed out already, being a physician does not presuppose superior competence or intellectual power. A PA will find inferior physicians surrounding him or her regularly in practice. Yet, so many anoint the physician as emperor. A quick look at the history of how physicians developed the "wizard of oz" like aura is illustrated in the article below.

 

http://www.huffingtonpost.com/dana-ullman/how-the-ama-got-rich-powe_b_6103720.html

 

You can also read  Norm Gevitz' "The D.O's. The history of osteopathic medicine in America." You will learn of fraudulent and illegal behavior by the MD cadre in desperate measures to defend their financial interest. Their rallying cry has always been the fictional claim of "Patient safety." However, the two references above illustrate clearly that the physician class has no magnanimous motives but rather works from a Leviathan impulse. That is, the nature of the physician is solitary, poor, nasty, brutish and short. 

 

The pungent response by Bryant University (think Trump University) attempting to discredit the FPAR efforts should illustrate that the work poses a serious threat to the physician control and harm of the PA. We should expect many more and even more aggressive responses from the physician. Theirs is a tenuous existence that is secured only by the power of law; not by the power of reason. As technology changes, the ability of States to collaborate in a fraudulent exchange with physicians to protect their markets will be curtailed. The physician class must be well aware of this and their aim is squarely upon the FPAR. 

[True Anomaly]

Not sure why that is an issue. No PA should be forced to take a student. If management comes to me and says that my wishes are irrelevant and a Bryant University PA student will rotate while I precept, my response to the boss is "Yes sir!" I then undermine every effort of the student to learn and progress.  

 

Gee, I can't imagine why anyone would have a problem with someone who would deliberately undemine the education of a future colleague. That idea, just because you disagree with their opinion about FPAR is just wrong. No one here would have any issue with not accepting a student on rotation from that program, but to deliberately sabotage their learning is evil

[Guest JMPA]

Vent - I undersrand nobody operates in a vacuum, alone and cold.

 

I am perfectly fine with a PA having virtually no supervision....as long as it is agreed up by a SP. Again, many of us are fully capable of working independently.

 

But many of us are not. How do you draw that line, and protect our patients, if we remove the legal requirements of supervision?

 

I like a broad regulation saying PAS must be supervised by a MD/DO, with the level and type of supervision being determined by them.

 

That way your SP doesn't have to even read your charts....but allows newbie PA to grow.

what do you call a medical student whom graduated at the bottom of his class? --------, why do i need the permission of two letters (md) to say i am qualified to use my mind independently? are you aware that there are many mds practicing whom are not board certified? are you aware that there are many mds practicing who shouldn't be? now i'm sure that we all agree that a pa fresh out of school should have supervision, that is not the issue. just as mds have residencies pas should also have several years out of school practice to hone their skills. but if a pa seasoned pa wishes to become independent, then they should not need the ok of a md, especially when nurses can practice with absolutely no oversight. if you wish to remain independent throughout your career i'm sure it is quite easy for you to find an md that would exploit you for his own financial gain. obviously you have not been in practice long. if you were to ask any resident if he would go through his training just to remain as a dependent to be exploited by greedy doctors and hospitals, what do you think the response would be?

[Boatswain2PA]

J - I understand the arguments, and agree with many of them.

 

Med school prepares the new Doc for residency. Residency is 3-5 years of increasing knowledge and commiserate increase in autonomy, resulting in residency trained BC Doc; the pinnacle of the profession.

 

PA school prepares the new grad to practice immediately (no residency required), but with supervision.

 

Yes, there will certainly be some PAS in some specialties (FP, EM, and some others) who through hard work and experience can compare (and sometimes exceed) the docs within their specialty, this is NOT the norm.

 

I certainly understand the professional concern of being dependent, and I've heard the stories of the Doc dieing, moving, suspended (etc) leaving a PA stranded. But those things can happen in virtually any profession (sudden closing of business).

 

It is up to me to protect myself from exploitation. But rather than looking at it as "exploitation", I look at it as mutually beneficial arrangement as I always try to get paid the most that I can get.

 

I also understand your concern for the NP push for independence, and how it could incentivize the C-suites to hire them over us. And I'm sure that's happening some places. However I personally see more places that won't hire NPs because of a consistently lower quality of provider.

Saying we should push for independence just because they did it is wrong. NP independence is a TERRIBLE idea, I don't think we should follow that.

[roger777]

This is the same mentality of the juvenile snowflakes who trash neighborhoods and college campuses when they don't get their way, or to shut down the speech of someone they disagree with. It is idiotic has led to our current level of political intolerance.

Regardless of what 150 anarchists did in Berkeley, CA it comes from both sides. 2 of my 3 rotations I have been tormented by a strident, Brietbart/Infowars reading asshole MD who thought my training environment was the perfect setting to harass me (and previous students) with his self-righteous ideas and talking points. That's not free speech it's coercion bc. I've obviously got one hand tied behind my back with this person who has my rotation in his hands. A snowflake to me is someone who is self-important and thin-skinned and there are plenty on both sides.

[8404PA]

Clarification:

petty officer is a non-commissioned officer, it's a "rank"

Boatswain is a job in the navy, just like a corpsman or firefighter. Also known as a "rate"

 

 

So rank and rate are different.

 

 

Sent from my iPad using Tapatalk

[mmiller3]

J - I understand the arguments, and agree with many of them.

 

Med school prepares the new Doc for residency. Residency is 3-5 years of increasing knowledge and commiserate increase in autonomy, resulting in residency trained BC Doc; the pinnacle of the profession.

 

PA school prepares the new grad to practice immediately (no residency required), but with supervision.

 

Yes, there will certainly be some PAS in some specialties (FP, EM, and some others) who through hard work and experience can compare (and sometimes exceed) the docs within their specialty, this is NOT the norm.

 

I certainly understand the professional concern of being dependent, and I've heard the stories of the Doc dieing, moving, suspended (etc) leaving a PA stranded. But those things can happen in virtually any profession (sudden closing of business).

 

It is up to me to protect myself from exploitation. But rather than looking at it as "exploitation", I look at it as mutually beneficial arrangement as I always try to get paid the most that I can get.

 

I also understand your concern for the NP push for independence, and how it could incentivize the C-suites to hire them over us. And I'm sure that's happening some places. However I personally see more places that won't hire NPs because of a consistently lower quality of provider.

Saying we should push for independence just because they did it is wrong. NP independence is a TERRIBLE idea, I don't think we should follow that.

 

 

Where do you see these places? I have been in the primary care game for 10 years, and have never seen a job that would not take NPs. I have seen several that would not accept PAs. I would be interested in where this preference for PAs is seen.

 

Also, you seem to be basing your opposition to the FPAR on the physician residency. Since these 3 extra years mean so much to you in terms of experience and the ability to practice independently in primary care, would you agree to PAs gaining independence after they had practiced for 3 years?

[ventana]

In reading over all these comments. (And I thank everyone for thoughtful deliberation and keeping it professional) I think one common thread is coming thorugh

 

New Grad PAs need supervision for X number of years to protect society

 

Old crusty, established PAs might and probably should be independent

 

I would point out that FPR does not eliminate or advance any of this - and in fact might well help the case for direct supervision or residency competition as corporate employers will realize that new grad PAs are not the same as 10+ year PA (or even 2+ year PA's)

 

 

 

So where do we go from here?

 

I totally encourage folks to think more about this topic and let the PAFT and AAPA know your thoughts and feelings in a professional way. They are representing all of us, and although I strongly support FPR I think it is of upmost importance to have a discourse on it, and let our agencies know of feelings. As a part of this is also realizing that we are in a democracy and the majority rules - and we can all still get along and respect each other.

 

 

 

 

 

I do think the idea of having formalized supervision, or mandatory one year residency a key issue for societal safety.

[BruceBanner]

I for one went to a very rigorous academic program and smoked my boards along with many others. But I was nowhere near ready to practice unsupervised right out of the gates. Grades are just grades. 2 years is not enough time to gather the necessary experience to make decisions on the fly, when 3 other patients are waiting and you don't get do-overs.

 

I think common sense will dictate that a PA should have 3-5 years of experience before being cut loose.

 

I never resent appropriate criticism. If I'm wrong I'm wrong. I DO resent having my charts nitpicked because of subjective style issues, and being dumped on by physician "colleagues" who still see us as midlevels serving the sole purpose of making their existence easier.

[Kaepora]

So how about the bill(s) being introduced in Pennsylvania?  The legislation includes a compromise brokered in 2016 that would require nurse practitioners to practice for three years and 3,600 hours under the existing collaborative agreement mandate (a signed collaborative agreement with 2 physicians) before attaining full practice authority.  Keep in mind that three years and 3,600 hours would represent the strictest transition to practice period of any state in the country - well, of the 21 states and DoC that allow independent practice.  But it seems that this would be the ideal situation for some posting on this thread.  

 

I can't say I completely disagree.  It would be our "residency" period of supervised practice.

[8404PA]

does the potential exist that with a mandate of 3 years and 3,600 hrs (for example) for PA FPR, that hospitals or private practices turn the name of a "training salary" to "resident salary"? I know we are to reject any offer with a training salary attached and even though they're semantics, does this open the door for that? And in the end does it even matter? 

 

I don't know enough to have an opinion, just curious. 

[Boatswain2PA]

Regardless of what 150 anarchists did in Berkeley, CA it comes from both sides. 2 of my 3 rotations I have been tormented by a strident, Brietbart/Infowars reading asshole MD who thought my training environment was the perfect setting to harass me (and previous students) with his self-righteous ideas and talking points. That's not free speech it's coercion bc. I've obviously got one hand tied behind my back with this person who has my rotation in his hands. A snowflake to me is someone who is self-important and thin-skinned and there are plenty on both sides.

 

There are asshats in every profession, and from both political parties.  To me, the "snowflake" is the "Not My President" type who either cries themselves to sleep, has to take the day off from classes because of the traumatic results off the elections, spends all day in mommy's basement online spewing leftist bullshit, demands the silencing of opposing speakers on campus, demands a "safe space" from any speech that may upset their fragile little ego's, or in any way agrees with burning down a neighborhood because "the man" did something they disagree with. 

 

A "liberal" does not equal "snowflake".  I am more liberal (in the classical sense of the word) than most snowflakes.

 

Clarification:

petty officer is a non-commissioned officer, it's a "rank"

Boatswain is a job in the navy, just like a corpsman or firefighter. Also known as a "rate"

 

 

So rank and rate are different.

 

Correct.  But remember your military history 8404.  The Navy invented sex, but it was the Coast Guard that introduced it to WOMEN!  :-)

 

In all seriousness, I spent 20 years mostly doing SAR in the USCG, including command of 2 rescue stations.

 

Oh, and FMF corpsmen are the shit.  Huge thanks for what you did.

 

If any civilian PA reading this doesn't know what an FMF is...Spend the rest of the week correcting that significant deficiency in yourself.

Where do you see these places? I have been in the primary care game for 10 years, and have never seen a job that would not take NPs. I have seen several that would not accept PAs. I would be interested in where this preference for PAs is seen.

 

Also, you seem to be basing your opposition to the FPAR on the physician residency. Since these 3 extra years mean so much to you in terms of experience and the ability to practice independently in primary care, would you agree to PAs gaining independence after they had practiced for 3 years?

Middle America, where the docs still mostly run the show and put their patients first (instead of C-suite types who put money first).  

 

Surprisingly I just got a critical need email, from the ONE corporate company I work PRN for, with a job need in San Jose, CA.  I was shocked to see that they also ONLY wanted PAs (specifically excluded NPs). 

 

But, I almost exclusive do ED (occasionally do hospitalist as well, or walk-in clinic which sucks the soul out of my body).  

 

You are correct in that I put primacy on a full physician residency.  But 3 years of PA practice (or even MD practice) does not equal 3 years of MD residency. 

 

Speaking just of ED, which I am the most knowledgeable about: 

3 years of PA practice may very likely mean 3 years of working fast track in a busy ED.  The two hospital systems in my city use PA/NPs in the ED, but they limit them to level 3-5 patients. Both systems even prefer that the EP (Board Certified Emergency Physicain) see the level 3's, but realize they may not be able to.  So, a PA working there for 3 years may never run a code by themselves, handle a septic patient by themselves, intubate, insert a central line, touch an ultrasound machine, or even interpret an ABG.

 

Furthermore, while a new PA would CERTAINLY learn a lot in their first 3 years of practice, these three years are not in an environment designed STRICTLY for learning.  Instead, the PA is just seeing patients and moving the meat, and learning while they go.

 

Compare this with a EP residency where they not only LEARN  to move the meat, but they also rotate through various sub-specialties with specific LEARNING goals. They intubate hundreds of time in these 3 years.   They spend time LEARNING (not just working) in the ICU, managing vents, managing pressors.  They spend time LEARNING in the PICU, intubating the kids and watching their electrolyte imbalances.  They spend time LEARNING with Cardiology/Anesthesia/Surgery...and after each of these rotations they come back to the ED with a somewhat greater level of autonomy, yet still watched. 

 

And then there are the specialty boards that follow each residency, and are required before practicing medicine unsupervised.

 

If a PA thinks they are good enough to practice unsupervised, then maybe they should be able to challenge those boards.  More on that later (evolving idea in my head).

 

 

 

So how about the bill(s) being introduced in Pennsylvania?  The legislation includes a compromise brokered in 2016 that would require nurse practitioners to practice for three years and 3,600 hours under the existing collaborative agreement mandate (a signed collaborative agreement with 2 physicians) before attaining full practice authority.  Keep in mind that three years and 3,600 hours would represent the strictest transition to practice period of any state in the country - well, of the 21 states and DoC that allow independent practice.  But it seems that this would be the ideal situation for some posting on this thread.  

 

I can't say I completely disagree.  It would be our "residency" period of supervised practice.

See above.  3 years of practice does not equal 3 years of residency, in ANY field.  Add that to the overwhelming issue of non-standardization of NP education and, in my opinion, there should NOT be ANY mechanism where NPs practice unsupervised.

 

Just a few days ago I had a very "experienced" NP walk a patient over to my ED (where NPs are not allowed to staff) asking if I could clear him and send him for psych.  He had eaten 60-100 hydralazine tablets over the past 12 hours.  You could see the cholinergic toxidrome from across the room!

[8404PA]

In all seriousness, I spent 20 years mostly doing SAR in the USCG, including command of 2 rescue stations.

Oh, and FMF corpsmen are the shit.  Huge thanks for what you did.

 

If any civilian PA reading this doesn't know what an FMF is...Spend the rest of the week correcting that significant deficiency in yourself.

 

 

 

Oooo Rah!