The ems systems with strong physician involment are:

Seattle,
Boston,
metro Dallas (BioTel)
Chicago
and a half-dozen others. These four are the ones I am most familiar with in relation to large ufban ems systems.

they feature more than one physician,
24/7 physician access,
physician response to major incidents
continuing medical education based on agencies experiences and needs

LA City has one physician to oversee almost 600 paramedics (double eek!)

The second point remains troubling, because we are talking about fire-based ALS/BLS performance in many of the DC jurisdictions, from the richest to the poorest. I am not allowed to describe specifics, but the medical directors shared their informal survey results with each other. More similar than disimilar. (eek!)

I agree that the sterotyping is part of the problem, ETOH apparently leads to a consistently incomplete patient assessment.

What “fizes” this is a closer follow-up on the patients that get under-treated. The clinically excellent ems systems have a much higher level of physician oversight and involvement. Before entering academia I thought that this could be handled by ems supervisors, you need the physician clout to effect lasting change.

I appreciate your response.

Mike

So you are telling me that EMS crews in the DC area under-report closed head injuries. Please tell me that this is a training problem because I know you are an EMS training guru and could fix this problem. If it is not a training problem, then it is that “other” problem which leads me to believe that some EMS providers sterotype a patient because they can smell ETOH on the breath. After that they are’nt taking the time to shine that little penlight in patients eyes, or ascertain LOC, and they are not performing what I was taught so many years ago, what was that called, oh yeah, a thorough “PATIENT ASSESSMENT”.

A survey by three different fire-based ems agencies in the DC area after this incident showed an uncomfortable level of ALS and BLS crews under-reporting closed head injuries. To the order of 20 some patients in a three month period.

Mike