"ICU Level Care on the Street" Salt Lake City Program going to put Doctors on ambulances

johnrsemt

Forum Deputy Chief
1,464
202
63
A new program was just announced in Salt Lake City to have doctors responding with the FD for cardiac arrests and Mass Casualty events.

PIO from the fire department " This is exciting for us because it enhances the care that we can give in the streets. It enhances the opportunities for our physicians to directly be on the scenes with the patients and see the types of incidents that we have, and that greatly gives them the opportunity to alter or enhance the program and the way we deliver that care"
In some cases, the physicians will be dispatched directly to a scene based on certain criteria passed along by dispatchers, but the PIO said they'll have the opportunity to go on any calls they choose, including minor calls.

Should be interesting. Until they get bored LOL
 

CCCSD

Forum Deputy Chief
1,124
693
113
Why? What can they possibly do that a good plan can’t?
MASCAL? Use the Israeli methods. Stop all this BS triage and holding onto people with minimal injuries. You don’t need names or counts.
 

E tank

Caution: Paralyzing Agent
1,283
1,068
113
Not in this insurance model...not for long anyway. Kind of surprised they're doing this knowing full well it will likely be a short lived novelty.

When the physician resource utilization on a single call (as opposed to in the ER where that resource is maximized) is reduced to what amounts to a volunteer mission money wise, they'll be all 'meh'...


From an article:
"The idea of physicians going on the scenes of emergency calls isn't new — it's how protocols for emergency medical teams were originally developed. But Youngquist said to his knowledge, no agencies in the region have done a program like this."

...and it's not because no one has ever thought of it before...
 

EpiEMS

Forum Deputy Chief
3,588
1,010
113
Cardiac arrests? What are the physicians doing differently (that couldn’t be done by EMS)?
 

akflightmedic

Forum Deputy Chief
3,720
2,348
113
In my humble opinion, I think this is backwards. We do not need a higher level of care at cardiac arrests or MASCAS events.

What we need (if we are going to place providers on a booboo box) is a program where those providers obtain sign off after sign off and reduce the number of unnecessary transports and ER overcrowding. Pt the doc on an ambo with an EMT and attend call after call, refusal after refusal....

You know, start low, at the root of the problem, versus trying to jump in at the top with all the fun stuff. No one ever wants to do the hard work while not glamorous or often seen, yet would have tremendous impact over time.
 

Tigger

Dodges Pucks
Community Leader
7,469
2,422
113
Not in this insurance model...not for long anyway. Kind of surprised they're doing this knowing full well it will likely be a short lived novelty.

When the physician resource utilization on a single call (as opposed to in the ER where that resource is maximized) is reduced to what amounts to a volunteer mission money wise, they'll be all 'meh'...
I think as many large cities continue to employ medical directors as city employees that this will become less of an issue. The hospitals are not willing to “loan” physicians to EMS for reasons that you state, but if the city is just paying the medical director a hefty salary and eliminating the hospital altogether, there is less incentive if any for the physician to bother with billing.
 

DrParasite

The fire extinguisher is not just for show
5,683
1,694
113
"The idea of physicians going on the scenes of emergency calls isn't new — it's how protocols for emergency medical teams were originally developed. But Youngquist said to his knowledge, no agencies in the region have done a program like this."

...and it's not because no one has ever thought of it before...
and yet, it's been very successful elsewhere...




sending them to cardiac arrests and MCIs only is likely a waste... If you have young and eager MDs who go on interesting dispatches, and who are willing to give guidance to EMS when needed, I don't see this being any less successful than when it was been done elsewhere.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,322
3,011
113
and yet, it's been very successful elsewhere...




sending them to cardiac arrests and MCIs only is likely a waste... If you have young and eager MDs who go on interesting dispatches, and who are willing to give guidance to EMS when needed, I don't see this being any less successful than when it was been done elsewhere.
Define “very successful”.
 

E tank

Caution: Paralyzing Agent
1,283
1,068
113
and yet, it's been very successful elsewhere...




sending them to cardiac arrests and MCIs only is likely a waste... If you have young and eager MDs who go on interesting dispatches, and who are willing to give guidance to EMS when needed, I don't see this being any less successful than when it was been done elsewhere.
Like I said in my post, this will be reduced to a "volunteer mission". From your link:

What is the cost of using MD1?​

MD1 will respond anywhere at any time for serious emergencies at NO CHARGE TO PATIENTS.
  • As a charitable medical organization, all expertise and care is rendered without a patient ever receiving a bill.
  • This is only possible with the generous donations and continued support of MD1 partners
Some doc wants to put on a uniform and start taking calls? Great. I'm all for it, don't get me wrong. But it's a novelty and not getting paid doing the same work that your colleagues get paid well for, all the while having some pretty substantial bills to pay, will get old quickly. Doing this just takes time from a real paid position.

Tigger said:
I think as many large cities continue to employ medical directors as city employees that this will become less of an issue. The hospitals are not willing to “loan” physicians to EMS for reasons that you state, but if the city is just paying the medical director a hefty salary and eliminating the hospital altogether, there is less incentive if any for the physician to bother with billing.
I really don't know how individual cities and counties work the medical director angle or if the actual salary is substantial or not. I suspect a lot or most of these medical directors have regular day jobs too. Even if counties wanted more bang for their buck, they might have more trouble recruiting medical directors if it meant answering ambulance calls. Besides, what can one guy do? It couldn't be a 24/7 deal and if a doc doesn't start a gig with 10 weeks of vacation, he/she's getting hosed...that leaves a lot of uncovered time and if this were to really be a thing, there shouldn't be any coverage gaps at all.

akflightmedic said:
In my humble opinion, I think this is backwards. We do not need a higher level of care at cardiac arrests or MASCAS events.

What we need (if we are going to place providers on a booboo box) is a program where those providers obtain sign off after sign off and reduce the number of unnecessary transports and ER overcrowding. Pt the doc on an ambo with an EMT and attend call after call, refusal after refusal....
But ER overcrowding has more to do with walk in traffic. If getting refusal forms signed would help, they'd be able to grab a clip board and walk out into the lobby and start showing folks the door. Besides, if it can't be done via phone or radio, doubtful in person on the scene would be any more effective.

But what you said about root cause is spot on. Until ambulance crews can flat out deny transport, when indicated and demonstrable, that contribution to unwarranted consumption of emergency resources will never end.
 
Last edited:

FiremanMike

EMS Coordinator
812
411
63
Someone already mentioned this, but I prefer the idea of using these docs for community health. Look at what LA is doing with nurse practitioners, seeing their homeless population to provide primary care and hopefully cut down on ER usage..
 

BobBarker

Forum Lieutenant
150
29
28
Someone already mentioned this, but I prefer the idea of using these docs for community health. Look at what LA is doing with nurse practitioners, seeing their homeless population to provide primary care and hopefully cut down on ER usage..
Doesn't help when the homeless population is increasing and LAFD only has 2-3 advanced practioners on the road during business hours. This Dr. program sounds like what the UK has been doing for years
 

FiremanMike

EMS Coordinator
812
411
63
Doesn't help when the homeless population is increasing and LAFD only has 2-3 advanced practioners on the road during business hours. This Dr. program sounds like what the UK has been doing for years
Something I learned at Eagles (last time there was actually an Eagle conference). The UK is dramatically different in EMS delivery because there isn't a fully equipped/staffed hospital every 3 blocks like there is here in America. This is why they're doing field ECMO and doctors are taking runs, because it actually drastically decreases the time to get these services to the patient..
 

FiremanMike

EMS Coordinator
812
411
63
I’m just glad there are so many extra Physicians laying around that they can do these programs.
According to the interwebs, Emergency Medicine has shot itself in the foot by both creating too many residency spots and giving in to managed healthcare groups, which are bottom line driven and thus very interested in using as few physicians and as many advanced practice providers as possible.

So it sounds like there's going to be out of work ER docs begging for change.. Or I guess riding the medic for slightly more change..
 

Bullets

Forum Knucklehead
1,572
211
63
Like I said in my post, this will be reduced to a "volunteer mission". From your link:

What is the cost of using MD1?​

MD1 will respond anywhere at any time for serious emergencies at NO CHARGE TO PATIENTS.
  • As a charitable medical organization, all expertise and care is rendered without a patient ever receiving a bill.
  • This is only possible with the generous donations and continued support of MD1 partners
Some doc wants to put on a uniform and start taking calls? Great. I'm all for it, don't get me wrong. But it's a novelty and not getting paid doing the same work that your colleagues get paid well for, all the while having some pretty substantial bills to pay, will get old quickly. Doing this just takes time from a real paid position.


I really don't know how individual cities and counties work the medical director angle or if the actual salary is substantial or not. I suspect a lot or most of these medical directors have regular day jobs too. Even if counties wanted more bang for their buck, they might have more trouble recruiting medical directors if it meant answering ambulance calls. Besides, what can one guy do? It couldn't be a 24/7 deal and if a doc doesn't start a gig with 10 weeks of vacation, he/she's getting hosed...that leaves a lot of uncovered time and if this were to really be a thing, there shouldn't be any coverage gaps at all.


But ER overcrowding has more to do with walk in traffic. If getting refusal forms signed would help, they'd be able to grab a clip board and walk out into the lobby and start showing folks the door. Besides, if it can't be done via phone or radio, doubtful in person on the scene would be any more effective.

But what you said about root cause is spot on. Until ambulance crews can flat out deny transport, when indicated and demonstrable, that contribution to unwarranted consumption of emergency resources will never end.
MD1 is a bad example because they arent affiliated with an ALS project or hospital anymore.

An example of such a project that is is this one

These doctors are working in the ERs for the hospitals and are available to ride out in a fly car and meet ALS, who also work for and recieve daily medical direction from these same Fellows.
 

ffemt8978

Forum Vice-Principal
Community Leader
10,356
1,080
113
Given what's happening to the doc involved in the Wichita debacle, I wonder how many doctors are willing to volunteer to go to the scene.
 

E tank

Caution: Paralyzing Agent
1,283
1,068
113
Given what's happening to the doc involved in the Wichita debacle, I wonder how many doctors are willing to volunteer to go to the scene.
Assassins around every corner wherever there are patients, families and staff...no where is safe...the best defense is a good defense...no one ever hears about the calls where clarification, information and rational coherent explanation made everything go away. Could be an out of court settlement, could be an out right judicial dismissal...not really exciting to talk about.....but they happen every day.

What's exciting are gory details taken out of context and splashy, clueless allegations and insinuations...
 

Top