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AOA Warning on PA "Independence"

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1 minute ago, EMEDPA said:

Yup. Folks- remember the worst day you ever had in the ER with all the labs down, the CT scanner broken, 1/2 the nurses out sick. This is still a more controlled environment than 2 medics on scene with someone actively trying to die. For those of you who think being a medic is start an IV and drive, you need to go do some ride alongs...

Don't they start the IV while driving?

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1 minute ago, thinkertdm said:

Don't they start the IV while driving?

sometimes. I was a medic intern in Fresno, CA where all the train tracks in the state cross. starting a line in the back of the rig at speed hitting train tracks at random intervals was unpleasant. Most medical calls are worked on scene for a bit. Some traumas require extrication and have extended scene times. I have climbed into cars to start lines, etc while fire were tearing off the roof around me. 

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Just now, EMEDPA said:

sometimes. I was a medic intern in Fresno, CA where all the train tracks in the state cross. starting a line in the back of the rig at speed hitting train tracks at random intervals was unpleasant. Most medical calls are worked on scene for a bit. Some traumas require extrication and have extended scene times. I have climbed into cars to start lines, etc while fire were tearing off the roof around me. 

So as EmedPA points out, you are coming up with this "differential beast" on the fly, while the patient is dying.  By necessity, it is a working list, with items being added to it and taken away constantly.  You can't just go to "differentials.com" and put in chest pain, and run around with that list; it's useless. 

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1 hour ago, SHU-CH said:
Different strokes for different folks. Some of us have aspirations related adding value to people's lives beyond just moving meat. Did all of the mentors in your life get paid?

 


This isn’t a student being precepted. We’re talking about a paid individual who is there to perform a specific job duty. If it’s a student that I’ve been asked to precept then that’s a different matter.

To answer your last question, yes, all mentors were professionals who were being paid.  All mentors now are either retired or dead.

 

Edited by GetMeOuttaThisMess
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2 minutes ago, thinkertdm said:

So as EmedPA points out, you are coming up with this "differential beast" on the fly, while the patient is dying.  By necessity, it is a working list, with items being added to it and taken away constantly.  You can't just go to "differentials.com" and put in chest pain, and run around with that list; it's useless. 

yup, remember ordering tests even has consequences. Often I do NOT order a d-dimer because I will know that it will be positive AND it will be positive for a reason other than a PE, but if I order the damn test, I have to deal with the result.

"remember, the road to hell is paved with d-dimers and ultrasensitive troponins"- Mel Herbert, MD EM guru supreme

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Doing 1 man CPR in the back of a fast moving ambulance.... been there done that. Starting an IV while flying down a bumpy road...been there done that.

Ahh the halcion days of being 10 feet tall and bullet proof.

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2 hours ago, GetMeOuttaThisMess said:

This isn’t a student being precepted. We’re talking about a paid individual who is there to perform a specific job duty. If it’s a student that I’ve been asked to precept then that’s a different matter.

To answer your last question, yes, all mentors were professionals who were being paid.  All mentors now are either retired or dead.

 

I don't think anyone would say that it's your responsibility to teach an employee in that situation; it may just be an question of enjoying teaching or not. I worked for a time with a fantastic physician and an Army-trained PA who both took the time to teach and let me do more as a medical assistant than any of their full-time MAs, simply because they knew I'd soon be starting PA school. Of course when the practice was busy things sped up and we just had to get patients in and out, but they both very much enjoyed teaching and went out of their way to provide lessons for me wherever they could; my guess is that they saw it not only as investing in my future, but as investing in the education of a future colleague. 

 

2 hours ago, sas5814 said:

Doing 1 man CPR in the back of a fast moving ambulance.... been there done that. Starting an IV while flying down a bumpy road...been there done that.

Ahh the halcion days of being 10 feet tall and bullet proof.

I wasn't a paramedic, but I have had to start an IV on a dude with a displaced femoral shaft fracture in the back of a pickup truck driven by Afghan soldiers going 120km/hr (with a windchill of like 10 degrees at that speed), just hoping the route was clear of IEDs. I was having as much of an issue getting the stick due to shaking from the cold as I was from their terrible driving. 

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3 hours ago, EMEDPA said:

you don't understand the difference between 2 years of intensive emergency medical training done by folks who already have a prior 6 month course(emt-basic) and a minimum of 1 year of experience as basics and a 2 week course in EMR documentation done by bio majors?

Are the scribes at your facility really trained in just 2 weeks? Our process (classroom training, floor training, and written exams specifically on topics in emergency medicine) usually took 8-10 weeks from start to finish. 

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On 11/9/2018 at 6:09 PM, karebear12892 said:

Are the scribes at your facility really trained in just 2 weeks? Our process (classroom training, floor training, and written exams specifically on topics in emergency medicine) usually took 8-10 weeks from start to finish. 

I don't think they even got that. I think they have to pass a typing test and do the one day epic provider -level training course. At the facilities where I worked with scribes they were not allowed to put in any orders. They really were mobile transcriptionists who took dictation. I truly believe any scribe doing more than that with their very limited training is dangerous. 

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I was hesitant to derail this much further.. but it seems we are already there..

At the most recent ER physician meeting.  My group (I am told) would like to make our (PAs) role more like, and I quote "a superscribe".  I must admit I feel rather dangerous myself right now.

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15 minutes ago, eliotsbay44 said:

I was hesitant to derail this much further.. but it seems we are already there..

At the most recent ER physician meeting.  My group (I am told) would like to make our (PAs) role more like, and I quote "a superscribe".  I must admit I feel rather dangerous myself right now.

using PAs as scribes is a waste of a medical education. I would not tolerate this. As soon as that was announced I would resign effective immediately(and yes, I have done it before over moves to diminish PAs roles).

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4 hours ago, EMEDPA said:

I don't think they even got that. I think they have to pass a typing test and do the one day epic provider -level training course. At the facilities where I worked with scribes they were not allowed to put in any orders. They really were mobile transcriptionists who took dictation. I truly believe any scribe doing more than that with their very limited training is dangerous. 

We were not allowed to put in orders, either. One typing test and one day of EMR training is ridiculous. Just goes to show that there is a lot of variability in the role of a scribe. I've heard of scribes at other facilities taking vitals, obtaining EKG's, etc. in addition to documentation.  

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Just now, karebear12892 said:

We were not allowed to put in orders, either. One typing test and one day of EMR training is ridiculous. Just goes to show that there is a lot of variability in the role of a scribe. I've heard of scribes at other facilities taking vitals, obtaining EKG's, etc. in addition to documentation.  

most places require a minimum of emt-basic training to do this. When I was an ER tech in the 80s I had to have my emt-basic (then called EMT1-A) and a medical assistant certification (through a summer of supervised on the job training) to do this kind of stuff.

One facility that I currently work at requires er techs to be paramedics....

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On 11/11/2018 at 4:55 PM, EMEDPA said:

 

One facility that I currently work at requires er techs to be paramedics....

ouch

AAS and skills to make $14/hr in an ER..... yuck

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