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<font size=3>I understand what Pret means, but for clarity:<br><br>
Always have to have the surgeon in place for trauma admissions. <br>
However, I can assure you that many PA's manage SICU, MICU, CCU patients
routinely, with the physician in the OR, at home or otherwise occupied.
<br>
They don't provide SOLE management, but they provide initial/primary
management, with the MD fine tuning (or making the "no good
answer" decisions), either in person or via phone. <br>
St, Joseph's wasn't a trauma center (that was next door) but we had at
least 30 ICU beds that I was the primary call person for between 2000 and
0800 for the year and half I survived that. The post CABG patients
were primarily managed by the surgeon from home, but he would ask us to
see them if there was question or they needed cardioversion/new
line/airway management/etc. If there was a surgical decision to be
made, however, either the cardiac surgery PA or the surgeon would come in
(often without my involvement at all - they could open chests, I
couldn't). "Manage ICU patients" was certainly in my
state approved job description in both Georgia and Virginia.<br><br>
Lorick<br><br>
<br>
At 03:54 PM 12/17/2007, you wrote:<br>
<blockquote type=cite class=cite cite="">Our general/trauma extenders
assist in the OR, round with the attendings<br>
on all inpatients (inc ICU), do a variety of procedures (chiefly
wound<br>
care, tubes, and lines), and handle much of the day to day<br>
documentation. Our trauma surgeons also staff a busy general
surgery<br>
practice, so there's a wide variety of work to be done.<br><br>
The PA's (there are no NP's in trauma at the moment, but our
recruitment<br>
is non-discriminatory on that account) do not take call, and are not<br>
assigned to the trauma response team as such; however, when they're
on<br>
site (weekdays mostly), at least one of them is usually accompanying
the<br>
trauma attending, and thus tags along and acts as an extra set of
hands,<br>
further freeing the surgeon to direct the resuscitation.<br><br>
I don't think you'll find a Level I or II center which lists
"management<br>
of ICU patients" in the PA/NP job description. Functional
realities<br>
notwithstanding, you've got to have a doctor (almost certainly a<br>
surgeon, and further, a boarded intensivist) directly responsible
for<br>
ICU care. It's part of the verification requirement.<br><br>
In my observation, our PA's get more OR and procedure time than
most.<br>
I'm aware of plenty of practices wherein the extenders are used for<br>
clinical and clerical infrastructure (i.e., scut work). But then,
ours<br>
were selected in large part for their surgical experience, and have<br>
enormous operative credibility. We've been immensely fortunate in
our<br>
hiring, and have a team of surgeons that admires and supports the
unique<br>
surgical capacities of its assistants. <br><br>
All of which is to say that in a great many programs, and for any
number<br>
of PA's and NP's, one person's scut work is another's indispensable
role<br>
in a comprehensive system of patient care. I have no doubt that the
use<br>
of extenders in trauma centers will continue and increase; but I
can't<br>
see there ever being a standardized job description across the<br>
profession.<br><br>
Pret Bjorn, RN<br>
EMMC Trauma Program (ACS Level II)<br>
Bangor, ME USA<br><br>
<br><br>
-----Original Message-----<br>
From: trauma-list-bounces@trauma.org<br>
[<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a>] On Behalf Of<br>
czuehlke@frontiernet.net<br>
Sent: Friday, December 14, 2007 5:50 PM<br>
To: trauma-list@trauma.org; trauma-list-request@trauma.org<br>
Subject: Re: trauma-list Digest, Vol 54, Issue 16<br><br>
<br>
Greetings list members,<br><br>
This is directed toward those that are in Level I and II centers (or<br>
other<br>
high volume centers).<br><br>
How many of you use physician assistants on your service?<br><br>
For those that have residents and fellows, what is the role of the
PA<br>
during<br>
pt care? Does the PA take call? Do the PAs manage patients in the
SICU?<br><br>
Do you see a change in demand for PAs in trauma care?<br><br>
Hi,<br>
In the one trauma centers I work in the PA sees just the mildly ill
<br>
patients and places sutures and or staples in patients. The PA is
<br>
never seen in the trauma rooms nor is he/she in a place where there
<br>
are serious medical conditions. NP's are treated exactly the same
way.<br>
At the other hospital newly named trauma center level II for 2010.
It <br>
does not use NP's or PA's at all.<br>
Carol Eisenbrandt<br><br>
<br>
Quoting trauma-list-request@trauma.org:<br><br>
> Send trauma-list mailing list submissions to<br>
>
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><br>
> To subscribe or unsubscribe via the World Wide Web, visit<br>
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> or, via email, send a message with subject or body 'help' to<br>
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><br>
> When replying, please edit your Subject line so it is more
specific<br>
> than "Re: Contents of trauma-list digest..."<br>
><br>
><br>
> Today's Topics:<br>
><br>
> 1. Nearly Famous! (tuganddawn@talktalk.net)<br>
> 2. Physician Assistants in Trauma (Michael
Krowka)<br>
> 3. Re: Physician Assistants in Trauma (Ronald
Gross)<br>
> 4. RE: Physician Assistants in Trauma (Brian E.
Fletcher)<br>
> 5. Re: Nearly Famous! (Krin135@aol.com)<br>
><br>
><br>
>
----------------------------------------------------------------------<br>
><br>
> Message: 1<br>
> Date: Thu, 13 Dec 2007 20:56:15 -0000<br>
> From: <tuganddawn@talktalk.net><br>
> Subject: Nearly Famous!<br>
> To: <trauma-list@trauma.org><br>
> Message-ID: <000a01c83dca$9b0826f0$4752f259@049682920380><br>
> Content-Type:
text/plain;<x-tab> </x-tab>
charset="iso-8859-1"<br>
><br>
> Hello to everyone.<br>
><br>
> Before I begin may I wish all of you wherever you are
and whatever <br>
> your beliefs a very Merry Christmas and a pleasant and event
free <br>
> New Year.<br>
> I am a Paramedic/Firefighter working
in the UK and have <br>
> recently been asked to consider appearing in a documentary
series <br>
> about the ambulance service speciffically dealing with
concerns <br>
> about the increase in calls, abuse of the service and out of
hours <br>
> GP service effects.<br>
> A few months ago I would have been
completely against this idea <br>
> but recent reforms, behaviour of management and treatment by
other <br>
> health care professionals has made me consider the
potential <br>
> benefits of exposing certain ignored aspects of my
service <br>
> (including the appalling lack of professionalism, training
and <br>
> negligence by many Paramedics).<br>
> I wonder if the list might offer any insights they have
about the <br>
> ethics and problems faced with this sort of media
exposure <br>
> especially when one considers the uncontrolable environment we
work <br>
> in. I would also appreciate any advice about how to deal with
these <br>
> "cutthroat" sensationalist media types!<br>
> In any event, thanks for your time and trouble and
I hope to hear <br>
> your responses.<br>
><br>
> Yours with kindest regards<br>
><br>
> Tug Crumpton<br>
><br>
> ------------------------------<br>
><br>
> Message: 2<br>
> Date: Thu, 13 Dec 2007 16:00:59 -0700<br>
> From: Michael Krowka <mkrowka@gmail.com><br>
> Subject: Physician Assistants in Trauma<br>
> To: "Trauma &amp; Critical Care mailing list"
<trauma-list@trauma.org><br>
> Message-ID: <C38707BB.3C00%mkrowka@gmail.com><br>
> Content-Type:
text/plain;<x-tab> </x-tab>
charset="US-ASCII"<br>
><br>
> Greetings list members,<br>
><br>
> This is directed toward those that are in Level I and II centers
(or<br>
other<br>
> high volume centers).<br>
><br>
> How many of you use physician assistants on your service?<br>
><br>
> For those that have residents and fellows, what is the role of the
PA<br>
during<br>
> pt care? Does the PA take call? Do the PAs manage patients in
the<br>
SICU?<br>
><br>
> Do you see a change in demand for PAs in trauma care?<br>
><br>
><br>
><br>
> Michael D. Krowka<br>
> EMT-P<br>
><br>
><br>
><br>
><br>
> ------------------------------<br>
><br>
> Message: 3<br>
> Date: Thu, 13 Dec 2007 19:17:30 -0500<br>
> From: "Ronald Gross" <Rgross@harthosp.org><br>
> Subject: Re: Physician Assistants in Trauma<br>
> To: "Trauma &amp; Critical Care mailing list"
<trauma-list@trauma.org><br>
> Message-ID: <47618535.7FF1.00B9.0@harthosp.org><br>
> Content-Type: text/plain; charset=US-ASCII<br>
><br>
> Michael,<br>
><br>
> We have 4 PAs and one APRN on service. Contact me off-line and
I <br>
> would be happy to discuss.......<br>
><br>
> Ron<br>
><br>
>>>> Michael Krowka <mkrowka@gmail.com> 12/13/2007 6:00
PM >>><br>
> Greetings list members,<br>
><br>
> This is directed toward those that are in Level I and II centers
(or<br>
other<br>
> high volume centers).<br>
><br>
> How many of you use physician assistants on your service?<br>
><br>
> For those that have residents and fellows, what is the role of the
PA<br>
during<br>
> pt care? Does the PA take call? Do the PAs manage patients in
the<br>
SICU?<br>
><br>
> Do you see a change in demand for PAs in trauma care?<br>
><br>
><br>
><br>
> Michael D. Krowka<br>
> EMT-P<br>
><br>
><br>
> --<br>
> trauma-list : TRAUMA.ORG<br>
> To change your settings or unsubscribe visit:<br>
>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br>
><br>
><br>
><br>
> ------------------------------<br>
><br>
> Message: 4<br>
> Date: Thu, 13 Dec 2007 19:44:10 -0500<br>
> From: "Brian E. Fletcher"
<bfletcher@columbus.rr.com><br>
> Subject: RE: Physician Assistants in Trauma<br>
> To: "'Trauma &amp; Critical Care mailing list'"<br>
>
<x-tab> </x-tab>
<trauma-list@trauma.org><br>
> Message-ID:
<20071214004410.BJDP22267.hrndva-omta06.mail.rr.com@BRIAN><br>
> Content-Type:
text/plain;<x-tab> </x-tab>
charset="us-ascii"<br>
><br>
> We have 10 Nurse practitioners. We manage the step down ICU,
floor<br>
> patients, and respond to traumas. We essentially function like
a<br>
resident,<br>
> performing primary/secondary assessment, FAST, central lines,
Chest<br>
tubes, A<br>
> lines, suturing etc. We also have an NP clinic and an
attending<br>
clinic. The<br>
> NP clinic sees lower acuity patients and we also assist in the<br>
attending<br>
> clinic. Hope this helps.<br>
><br>
> Brian<br>
><br>
> -----Original Message-----<br>
> From: trauma-list-bounces@trauma.org<br>
[<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a>]<br>
> On Behalf Of Michael Krowka<br>
> Sent: Thursday, December 13, 2007 6:01 PM<br>
> To: Trauma &amp; Critical Care mailing list<br>
> Subject: Physician Assistants in Trauma<br>
><br>
> Greetings list members,<br>
><br>
> This is directed toward those that are in Level I and II centers
(or<br>
other<br>
> high volume centers).<br>
><br>
> How many of you use physician assistants on your service?<br>
><br>
> For those that have residents and fellows, what is the role of the
PA<br>
during<br>
> pt care? Does the PA take call? Do the PAs manage patients in
the<br>
SICU?<br>
><br>
> Do you see a change in demand for PAs in trauma care?<br>
><br>
><br>
><br>
> Michael D. Krowka<br>
> EMT-P<br>
><br>
><br>
> --<br>
> trauma-list : TRAUMA.ORG<br>
> To change your settings or unsubscribe visit:<br>
>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br>
><br>
><br>
><br>
> ------------------------------<br>
><br>
> Message: 5<br>
> Date: Thu, 13 Dec 2007 20:39:34 EST<br>
> From: Krin135@aol.com<br>
> Subject: Re: Nearly Famous!<br>
> To: trauma-list@trauma.org<br>
> Message-ID: <c73.2076a517.349338d6@aol.com><br>
> Content-Type: text/plain; charset="US-ASCII"<br>
><br>
><br>
> In a message dated 13-Dec-07 14:57:36 Central Standard Time,<br>
> tuganddawn@talktalk.net writes:<br>
><br>
> I wonder if the list might offer any insights they have about
the<br>
ethics and<br>
> problems faced with this sort of media exposure especially
when one<br>
> considers the uncontrolable environment we work in. I would
also <br>
> appreciate any<br>
> advice about how to deal with these "cutthroat"
sensationalist media<br>
types!<br>
> In any event, thanks for your time and trouble and I hope to
hear<br>
your<br>
> responses.<br>
><br>
><br>
><br>
> Tug:<br>
><br>
> good luck with your project.<br>
><br>
> You might have better luck posting to the EMS-L using
instructions<br>
found at:<br>
><br>
> List FAQ:
_<a href="http://ems-l.org/" eudora="autourl">HTTP://EMS-L.ORG</a>_
(<a href="http://ems-l.org/" eudora="autourl">http://EMS-L.ORG</a>)<br>
> Unsubscribe: _EMS-L-UNSUBSCRIBE@EMS-L.ORG_<br>
>
(<a href="mailto:EMS-L-UNSUBSCRIBE@EMS-L.ORG" eudora="autourl">
mailto:EMS-L-UNSUBSCRIBE@EMS-L.ORG</a>)<br>
> (subscribe should be _EMS-L-SUBSCRIBE@EMS-L.ORG_<br>
>
(<a href="mailto:EMS-L-SUBSCRIBE@EMS-L.ORG" eudora="autourl">
mailto:EMS-L-SUBSCRIBE@EMS-L.ORG</a>) )<br>
> Manage:
_<a href="http://ems-l.org/MAN-EMS-L.HTM" eudora="autourl">
HTTP://EMS-L.ORG/MAN-EMS-L.HTM</a>_<br>
(<a href="http://ems-l.org/MAN-EMS-L.HTM" eudora="autourl">
http://EMS-L.ORG/MAN-EMS-L.HTM</a>)<br>
> Post to list: _EMS-L@EMS-L.ORG_
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> Moderator: _MODERATOR@EMS-L.ORG_
(<a href="mailto:MODERATOR@EMS-L.ORG" eudora="autourl">
mailto:MODERATOR@EMS-L.ORG</a>)<br>
><br>
> Or one of the various Yahoo Paramedic groups...<br>
><br>
> ck<br>
> Charles S. Krin, DO FAAFP<br>
><br>
><br>
><br>
> **************************************See AOL's top rated
recipes<br>
>
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><br>
> ------------------------------<br>
><br>
> --<br>
> trauma-list : TRAUMA.ORG<br>
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><br>
> End of trauma-list Digest, Vol 54, Issue 16<br>
> *******************************************<br>
><br><br>
<br><br>
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To change your settings or unsubscribe visit:<br>
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<x-sigsep><p></x-sigsep>
<br>
</font><font face="Lucida Handwriting" size=3><b><i>LFFox, MPAS,
PA-C<br>
</i></font><font size=2>Distinguished Fellow, AAPA<br>
CCA, American College of Cardiology<br>
Associate, Society for Critical Care Medicine<br>
Associate, Underwater and Hyperbaric Medical Society <br><br>
</b></font><div align="center"><font size=1>Lorick Fox, MPAS, PA-C<br>
SEAVIN/Peace Vector IV<br>
Unit 64903, Box 1201<br>
APO, AE 09868-4903<br>
(cell) +20-18-230-4448<br>
(landline) +20-45-240-9450<br>
<a href="http://www.lorick.org/" eudora="autourl">www.lorick.org<br>
</a></font></div>
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