EMS - Wow!!!!

[Hard24Get]

I was just checking out a residency program, and it appears that the EMS rotation includes not only riding around in an ambulance, but flying in a helicopter, experience in fire fighting, and WEAPONS training with a SWAT team!

Why isn't everyone going into THIS fellowship? (And do I really get to shoot people - and then resuscitate them? )

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[southerndoc]

There are two tactical medicine fellowships. One at Hopkins (affiliation with Dept of Homeland Security's Immigration and Customs Enforcement as well as the Secret Service), and the other in Government EMS Security Systems at UT-Southwestern (affiliations with DHS, FBI). MCG also has an active program, but is limited on the federal level by training providers only (as far as I know no active involvement in a federal team).

Many EM residencies will allow you to participate in SWAT training and deployments.

 

[Croooz]

GW is working on one.

 

[DropkickMurphy]

but flying in a helicopter

That's the ONE thing I don't want to do. Everything else I am game for. I don't feel like risking my neck for no benefit to the patients.

 

[MD Dreams]

That's the ONE thing I don't want to do. Everything else I am game for. I don't feel like risking my neck for no benefit to the patients.

Forget the patient. Taking a helicopter ride is pure pleasure for me

 

[DropkickMurphy]

Then go take a rental flight over the Grand Canyon or something. Lets hope you don't wind up on one of the numerous medical helicopters that crashes every year due to shoddy repair and preventive work, bad weather, pilot error, collisions with various objects including terrain.

 

[turtle md]

In Delaware, we fly w/ the trooper-medics. So when not on a patient transport mssion, we may be able to observe a high-speed car chase, or provide reconnaissance for various ground operations. We also have life-flight, but who would want to fly w/ them when you can fly w/ medics w/ guns...

 

[Croooz]

Then go take a rental flight over the Grand Canyon or something. Lets hope you don't wind up on one of the numerous medical helicopters that crashes every year due to shoddy repair and preventive work, bad weather, pilot error, collisions with various objects including terrain.

I was about to call you paranoid but then went on google. I see your point. I've riden military copters but now that I'm civilized I won't be doing that. Good head's up. Would suck to go thru all this schooling & training to fall out of the sky. I'll still ride my motorcycle....I think.

 

[aliraja]

Then go take a rental flight over the Grand Canyon or something. Lets hope you don't wind up on one of the numerous medical helicopters that crashes every year due to shoddy repair and preventive work, bad weather, pilot error, collisions with various objects including terrain.

Or, instead, you could just avoid the "we'll fly in any conditions, we'll hire anyone with even minimal experience, and we're just out to make a buck" transport services out there. The vast majority of accidents happen with these folks, not the extremely well-trained pilots, nurses, and ground crews of the programs affiliated with most residencies.

And Hard24Get - we try not to shoot people and then resuscite them. It just looks bad on the report. Of note, there are a BUNCH of great places that are doing good work in the world of tactical medicine even without having fellowships. Just look around...

 

[DropkickMurphy]

I was about to call you paranoid but then went on google. I see your point. I've riden military copters but now that I'm civilized I won't be doing that. Good head's up.

I spent more time in military helicopters than I care to admit to....

you could just avoid the "we'll fly in any conditions, we'll hire anyone with even minimal experience, and we're just out to make a buck" transport services out there.

*cough* AirEvac *cough*

The vast majority of accidents happen with these folks, not the extremely well-trained pilots, nurses, and ground crews of the programs affiliated with most residencies.

Agreed, but the lack of patient benefit still stands, so even a small risk involved with well managed programs is effectively for naught. I would recommend talking with Dr. Bryan Bledsoe if you don't agree with me about the benefits of aeromedical transport.

 

[Jeff698]

I would recommend talking with Dr. Bryan Bledsoe if you don't agree with me about the benefits of aeromedical transport.

While I like Bryan, I'd recommend taking a look at the literature for yourself and drawing your own conclusions.

Take care,
Jeff

 

[DropkickMurphy]

I like Bryan too....LOL I meant that he is a pretty well known critic of aeromedical transport in most settings. But a literature search is optimal.....

 

[8744]

Forget the patient. Taking a helicopter ride is pure pleasure for me

I was once riding in a CH-46 on the way to our landing zone at the United States Embassy in Monrovia, Liberia. To avoid ground fire, the pilots came in low over the ocean and below the cliff on which the embassy sits. At the last second they stood the ship on its tail, or so it seemed to me, and blooped over the edge for the landing. If you looked out the back ramp all you could see was water and rocks.

No point. Just that I'll eschew the helicopter rides if at all possible.

 

[DropkickMurphy]

After flying 300+ medical evacuation missions in helicopters, get hoisted out of the water during water rescue training (that was fun ), etc., I can't really say that flying around in a helo holds any special joy for me. The only thing I thankfully avoided was getting shot at. A helicopter is just another way of getting around. Keep in mind that after the first few times, it loses it's "cool" factor.

 

[Croooz]

Keep in mind that after the first few times, it loses it's "cool" factor.

Yep...then all the cool parts about it begin to nauseate ya.

 

[Krazed_Medic]

*cough* AirEvac *cough*

ROTFLMAO bwahahahahah! so true, so very true....

 

[DropkickMurphy]

Yeah, there is a flight nurse from the same city as me who has the same name as me. He almost died in an ScareEvac crash and my parents received phone calls from EVERYWHERE wanting to know if it was me. I sent out an e-mail (and those of you on the TraumaList might remember this) stating: "I apologize for cutting short the celebrations in emergency departments, ICU's, fire departments, ambulance services and combat support hospitals worldwide, but the reports of my near death in helicopter crash were incorrect. It was another person with the same name as me"

 

[Hard24Get]

out of half-joking curiosity, can EPs go through the whole tactical training but not actually have to join the SWAT team or the army? or better yet, join specific SWAT operations at will?

Dunno about specific operations, but you can do the weapon's training without joining. One of the faculty members at the place I'm interested in is in medical support for the FBI SWAT team as one of his many professional activities

 

[Croooz]

out of half-joking curiosity, can EPs go through the whole tactical training but not actually have to join the SWAT team or the army? or better yet, join specific SWAT operations at will?

There are courses you can attend that put you thru the tactical medical. H&K had a course. There are quite a number of courses out there. Some good, some.....not worth their weight in spit.

The SWAT teams are beginning to place more & more physicians. Dallas SWAT seems to have started it. At least the TV show claims this. You basically become the SWAT teams FP. The funny thing is the physicians I know who are looking to do this now can't wait to carry a pager around and get paged......so now, all of a sudden, these EP's WANT to take call.

You can check out http://swatdoc.com

 

[aliraja]

out of half-joking curiosity, can EPs go through the whole tactical training but not actually have to join the SWAT team or the army? or better yet, join specific SWAT operations at will?

The H&K Course is great - one of our guys took it a couple of months ago and I'm going to be taking it in November. Definitely worth doing and you can take it without doing SWAT... but if you're part of a team you can get Homeland Security $$ to fund it for you!

As for training, it's basically a tradeoff. As part of the SWAT team I get to do weapons training and "get" to do PT and, in exchange, I provide tactical medical coverage. They're spending a lot of money on ammo and courses for me and it's only right that we give something back. Carrying the pagers IS a lot of fun but it can be time consuming - Cincinnati SWAT did almost 250 callouts last year and there was a MD at >90% of them (there is a medic that goes when we can't). In addition, we go out on the occasional FBI HRT callout (they're not super busy in Cincinnati ) and work with the secret service when the President rolls through town a few times a year. There's only 6 of us on the team so that's a lot of days where you finish your shift or your day in the unit and go home only to suit up and head back out for 3 hours or more. That might be normal for other residents but for EM residents it takes a little getting used to. Don't get me wrong - it's fun taking care of the good guys... but it also severely limits the other academic and medical persuits we can take advantage of. Just something to think about...

 

[Croooz]

aliraja,
If I may, how did you get on the team? Did they have a call-out for physicians? Is there any pay involved when you are on call? Not asking about any exact figures just curious as to how they work it with you. The doc I spoke to was a volunteer but said there are paid positions. His team at the time didn't have the funds so he did it for the experience.

 

[aliraja]

aliraja,
If I may, how did you get on the team? Did they have a call-out for physicians? Is there any pay involved when you are on call? Not asking about any exact figures just curious as to how they work it with you. The doc I spoke to was a volunteer but said there are paid positions. His team at the time didn't have the funds so he did it for the experience.

The program here started 4 years ago when one of our new attendings was an intern. The Cinci SWAT folks approached our Specials Operations Division (EMS, USAR, Bioterrorism, etc..) and said that they'd like to work together. Since then we've added 2 residents a year (PGY2-4) after having them take and pass some basic tactical medicine and firearm courses.

All of us (even the attending) are volunteers - I'm not sure whether or not the team has money to pay us but it's probably better spent on our training anyway. Plus, this way it's purely voluntary... we turn out because we want to and not because we have to and so if there's mandatory residency stuff that needs doing it always comes first.

 

[Rebelheart]

I was just checking out a residency program, and it appears that the EMS rotation includes not only riding around in an ambulance, but flying in a helicopter, experience in fire fighting, and WEAPONS training with a SWAT team!

Why isn't everyone going into THIS fellowship? (And do I really get to shoot people - and then resuscitate them? )

----------------------------------------------------------------
You have no idea what it is like going INTO a burning building.
The adrenaline rush is unbelievable. Your heart will be racing
and your mouth is dry. For some reason, you will love the
experience. Life is "too safe" and the experience will make you
feel more alive than you will have likely felt in a while.

I guess it isn't for everyone. A lot will depend on the
Fire Department you work with. A side note; if you observe
carefully, you will see team work executed on a level you
will never see again, in or out of medicine.

 

[monkeyarms]

----------------------------------------------------------------
You have no idea what it is like going INTO a burning building.
The adrenaline rush is unbelievable. Your heart will be racing
and your mouth is dry. For some reason, you will love the
experience. Life is "too safe" and the experience will make you
feel more alive than you will have likely felt in a while.

I guess it isn't for everyone. A lot will depend on the
Fire Department you work with. A side note; if you observe
carefully, you will see team work executed on a level you
will never see again, in or out of medicine.

i'll second that, having just been through a day of activities at our city fire department. running tip on a search and rescue in a burning building is possibly the most fun i've ever had in my life! i think i'm too firmly entrenched for a career change at this point, though

 

[MedSearchRescue]

----------------------------------------------------------------

I guess it isn't for everyone. A lot will depend on the
Fire Department you work with. A side note; if you observe
carefully, you will see team work executed on a level you
will never see again, in or out of medicine.

I'll third that. I would recommend talking to your local fire department and asking if you can ride along for a day. That will give you a feel for what they do. Although, I had no idea that FD's were letting EM residents work shifts, much less fires, with them. When I did it before entering med school, we wouldn't let anyone near an SCBA without at least 6 months training. This thread has been great, but does anyone have links to these programs that allow the more fun extracurricular activities?

 

[Hard24Get]

I'll third that. I would recommend talking to your local fire department and asking if you can ride along for a day. That will give you a feel for what they do. Although, I had no idea that FD's were letting EM residents work shifts, much less fires, with them. When I did it before entering med school, we wouldn't let anyone near an SCBA without at least 6 months training. This thread has been great, but does anyone have links to these programs that allow the more fun extracurricular activities?

Here is the EMS rotation description for Penn's EM residency program, which is what got me started. BTW, how cool is the new website?

I'm sure any of these programs only allow for training, such as in controlled fires, not actually working shifts (not sure if I'd want to, anyway!)

 

[MedSearchRescue]

Thanks for the link. It sounds like they let you tag along in the FD trainings - it's a lot of fun. It definitely is a different thing to experience. Are there any EM programs that let you run shifts or are "understanding" and let you moonlight in the EMS field?

 

[Doctor~Detroit]

i understand that pitt's residency involves driving around in an ems jeep, responding to calls.

 

[roja]

GW is working on one.

I believe they are starting it this year, with one of my close friends. She got the fellowship under thier International but I believe they are planning to slot her into the first disaster spot this year, as that is her 'area'- having worked extensively in disaster med here in nyc. She was also a paramedic for years and works with our EMS guys closely.

Personally, I would never want to do that stuff (and think she is bonkers) but it does read like it would be cool.

 

[McPoyle]

I was wondering if anyone could point me towards any of the good studies regarding helicopter transports. I'm an undergrad working as a paramedic, I personally never use helicopters as I just don't see their place (I'm never more than 15-25min from any of three trauma centers) however some of the newer medics here seem to be in love with them, calling for a chopper when they are <15 miles from a trauma center and I would like to break them of this habit.
Please pm with links or suggestions.

Thanks.