<html>
<body>
<font size=3>Pret,<br><br>
This actually is a potentially "interesting" question. In
most states (as far as I know), the acts of a PA are generally considered
to be legally the acts of their supervising physician and that physician
is responsible for appropriate delegation and monitoring of the PA's
functions. Some states define the PA scope of practice as that of
their supervising physician, subject to that physician's judgement.
Many require a job description, or something along that line, at the time
of approval of the license, but some do not. Often, it is the
hospital credentialing process that is most restrictive. <br><br>
For a period in Maryland, prior to prescribing privileges being
explicitly granted, there was a time (1979) that we ended up with an
Attorney General opinion that said that as the PA was acting as an agent
for the physician, a hospital nurse was authorized AND required to accept
PA written orders exactly as they would if the MD wrote them (i.e. if
there was something they would question from the MD, they could call the
MD to verify, otherwise, they were required to accept the order as that
of the MD). This was before PA's were even credentialed - they were
simply considered surrogates. <br><br>
Cardiac surgery PA's often are credentialed to open chests in
emergencies. I suspect in many states, a PA licensed to a
trauma surgeon would be legally considered the same as the physician for
in-house patients. However, since no institution has ever
credentialed a PA to take a patient to the OR solo (although there at
least used to be states where that would theoretically be legal if a doc
was so dumb as try to delegate same), I think that the in-house presence
of the surgeon for a Trauma Center is assured. <br><br>
The AAPA (rightfully) makes a big deal of PA/MD or DO
"partnership". Every such partnership is to some extent
unique because every physician and every PA have their own strengths and
weaknesses. For example: I don't have fancy level suturing skills -
when I was covering an ER in 1981, my supervising physician refused to
come in for cardiac arrests because "you know more about it that I
do", but asked (directed) me to refer significant facial lacerations
either the PCP or surgeon. (I admit, that was a bit weird, and was
based in part on the fact that the first cardiac arrest I managed there
was "pronounced" by two very senior physicians who came to the
ER to watch me; I declined to accept that judgment and the patient walked
out of the hospital a week later.)<br><br>
Every State has it's own PA law, and it has been a LOT of years since I
was the Chairman of the Judicial Affairs for the American Academy of
PA's, but I suspect this represents the legal position in most
cases.<br><br>
Lorick<br><br>
At 04:43 PM 12/17/2007, you wrote:<br>
<blockquote type=cite class=cite cite="">Hey, Lorick. Well
said.<br>
<br>
As List veterans will attest, I'm wrong with astonishing frequency
about<br>
a breathtaking variety of stuff. But if only for my own
edification,<br>
I'd be eager to hear from someone with connections to the ACS VRC
before<br>
abandoning my half-witted interpretation of reality. <br>
<br>
During our earliest consultations with the College in the 1990's, we<br>
were strongly cautioned against having boarded medical intensivists<br>
cross-covering our traumas, even over short terms, even with a
surgeon<br>
as backup. Surely, then, there are surveyors who would frown on a
PA<br>
covering nights. <br>
<br>
And good luck meeting Leapfrog.<br>
<br>
Sorry if I'm muddying things. It's what I do. I'm ready and
grateful<br>
for any enlightening smackdown that awaits.<br>
<br>
Pret<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 Lorick Fox,
PA-C<br>
Sent: Monday, December 17, 2007 9:18 AM<br>
To: Trauma &amp; Critical Care mailing list<br>
Subject: Re: Physician Extenders (was RE: trauma-list Digest, Vol
54,<br>
Issue 16)<br><br>
<br><br>
<x-tab> </x-tab>I
understand what Pret means, but for clarity:<br>
<x-tab> </x-tab><br>
<x-tab> </x-tab>Always
have to have the surgeon in place for trauma admissions. <br>
<x-tab> </x-tab>However, I
can assure you that many PA's manage SICU, MICU, CCU<br>
patients routinely, with the physician in the OR, at home or
otherwise<br>
occupied. <br>
<x-tab> </x-tab>They don't
provide SOLE management, but they provide<br>
initial/primary management, with the MD fine tuning (or making the
"no<br>
good answer" decisions), either in person or via phone. <br>
<x-tab> </x-tab>St,
Joseph's wasn't a trauma center (that was next door) but we<br>
had at least 30 ICU beds that I was the primary call person for
between<br>
2000 and 0800 for the year and half I survived that. The post
CABG<br>
patients were primarily managed by the surgeon from home, but he
would<br>
ask us to see them if there was question or they needed<br>
cardioversion/new line/airway management/etc. If there was a
surgical<br>
decision to be made, however, either the cardiac surgery PA or the<br>
surgeon would come in (often without my involvement at all - they
could<br>
open chests, I couldn't). "Manage ICU patients" was
certainly in my<br>
state approved job description in both Georgia and Virginia.<br>
<x-tab> </x-tab><br>
<x-tab> </x-tab>Lorick<br>
<x-tab> </x-tab><br>
<x-tab> </x-tab><br>
<x-tab> </x-tab>At 03:54
PM 12/17/2007, you wrote:<br>
<x-tab> </x-tab><br><br>
<x-tab> </x-tab><x-tab>
</x-tab>Our
general/trauma extenders assist in the OR, round<br>
with the attendings<br>
<x-tab> </x-tab><x-tab>
</x-tab>on all inpatients
(inc ICU), do a variety of procedures<br>
(chiefly wound<br>
<x-tab> </x-tab><x-tab>
</x-tab>care, tubes, and
lines), and handle much of the day to<br>
day<br>
<x-tab> </x-tab><x-tab>
</x-tab>
documentation. Our trauma surgeons also staff a busy<br>
general surgery<br>
<x-tab> </x-tab><x-tab>
</x-tab>practice, so
there's a wide variety of work to be done.<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>The PA's (there
are no NP's in trauma at the moment, but<br>
our recruitment<br>
<x-tab> </x-tab><x-tab>
</x-tab>is
non-discriminatory on that account) do not take call,<br>
and are not<br>
<x-tab> </x-tab><x-tab>
</x-tab>assigned to the
trauma response team as such; however,<br>
when they're on<br>
<x-tab> </x-tab><x-tab>
</x-tab>site (weekdays
mostly), at least one of them is usually<br>
accompanying the<br>
<x-tab> </x-tab><x-tab>
</x-tab>trauma attending,
and thus tags along and acts as an<br>
extra set of hands,<br>
<x-tab> </x-tab><x-tab>
</x-tab>further freeing
the surgeon to direct the resuscitation.<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>I don't think
you'll find a Level I or II center which<br>
lists "management<br>
<x-tab> </x-tab><x-tab>
</x-tab>of ICU
patients" in the PA/NP job description.<br>
Functional realities<br>
<x-tab> </x-tab><x-tab>
</x-tab>notwithstanding,
you've got to have a doctor (almost<br>
certainly a<br>
<x-tab> </x-tab><x-tab>
</x-tab>surgeon, and
further, a boarded intensivist) directly<br>
responsible for<br>
<x-tab> </x-tab><x-tab>
</x-tab>ICU care.
It's part of the verification requirement.<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>In my
observation, our PA's get more OR and procedure<br>
time than most.<br>
<x-tab> </x-tab><x-tab>
</x-tab>I'm aware of
plenty of practices wherein the extenders<br>
are used for<br>
<x-tab> </x-tab><x-tab>
</x-tab>clinical and
clerical infrastructure (i.e., scut work).<br>
But then, ours<br>
<x-tab> </x-tab><x-tab>
</x-tab>were selected in
large part for their surgical<br>
experience, and have<br>
<x-tab> </x-tab><x-tab>
</x-tab>enormous
operative credibility. We've been immensely<br>
fortunate in our<br>
<x-tab> </x-tab><x-tab>
</x-tab>hiring, and have
a team of surgeons that admires and<br>
supports the unique<br>
<x-tab> </x-tab><x-tab>
</x-tab>surgical
capacities of its assistants. <br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>All of which is
to say that in a great many programs,<br>
and for any number<br>
<x-tab> </x-tab><x-tab>
</x-tab>of PA's and NP's,
one person's scut work is another's<br>
indispensable role<br>
<x-tab> </x-tab><x-tab>
</x-tab>in a
comprehensive system of patient care. I have no<br>
doubt that the use<br>
<x-tab> </x-tab><x-tab>
</x-tab>of extenders in
trauma centers will continue and<br>
increase; but I can't<br>
<x-tab> </x-tab><x-tab>
</x-tab>see there ever
being a standardized job description<br>
across the<br>
<x-tab> </x-tab><x-tab>
</x-tab>profession.<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>Pret Bjorn,
RN<br>
<x-tab> </x-tab><x-tab>
</x-tab>EMMC Trauma
Program (ACS Level II)<br>
<x-tab> </x-tab><x-tab>
</x-tab>Bangor, ME
USA<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>-----Original
Message-----<br>
<x-tab> </x-tab><x-tab>
</x-tab>From:
trauma-list-bounces@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>[
<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a><br>
<<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a>> ] On Behalf Of<br>
<x-tab> </x-tab><x-tab>
</x-tab>
czuehlke@frontiernet.net<br>
<x-tab> </x-tab><x-tab>
</x-tab>Sent: Friday,
December 14, 2007 5:50 PM<br>
<x-tab> </x-tab><x-tab>
</x-tab>To:
trauma-list@trauma.org;<br>
trauma-list-request@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>Subject: Re:
trauma-list Digest, Vol 54, Issue 16<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>Greetings list
members,<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>This is directed
toward those that are in Level I and II<br>
centers (or<br>
<x-tab> </x-tab><x-tab>
</x-tab>other<br>
<x-tab> </x-tab><x-tab>
</x-tab>high volume
centers).<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>How many of you
use physician assistants on your<br>
service?<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>For those that
have residents and fellows, what is the<br>
role of the PA<br>
<x-tab> </x-tab><x-tab>
</x-tab>during<br>
<x-tab> </x-tab><x-tab>
</x-tab>pt care? Does the
PA take call? Do the PAs manage<br>
patients in the SICU?<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>Do you see a
change in demand for PAs in trauma care?<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>Hi,<br>
<x-tab> </x-tab><x-tab>
</x-tab>In the one trauma
centers I work in the PA sees just the<br>
mildly ill <br>
<x-tab> </x-tab><x-tab>
</x-tab>patients and
places sutures and or staples in patients.<br>
The PA is <br>
<x-tab> </x-tab><x-tab>
</x-tab>never seen in the
trauma rooms nor is he/she in a place<br>
where there <br>
<x-tab> </x-tab><x-tab>
</x-tab>are serious
medical conditions. NP's are treated exactly<br>
the same way.<br>
<x-tab> </x-tab><x-tab>
</x-tab>At the other
hospital newly named trauma center level II<br>
for 2010. It <br>
<x-tab> </x-tab><x-tab>
</x-tab>does not use NP's
or PA's at all.<br>
<x-tab> </x-tab><x-tab>
</x-tab>Carol
Eisenbrandt<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>Quoting
trauma-list-request@trauma.org:<br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Send
trauma-list mailing list submissions to<br>
<x-tab> </x-tab><x-tab>
</x-tab>
>
trauma-list@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> To subscribe
or unsubscribe via the World Wide Web,<br>
visit<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<a href="http://list.mistral.net/mailman/listinfo/trauma-list" eudora="autourl">
http://list.mistral.net/mailman/listinfo/trauma-list</a><br>
<x-tab> </x-tab><x-tab>
</x-tab>> or, via
email, send a message with subject or body<br>
'help' to<br>
<x-tab> </x-tab><x-tab>
</x-tab>
>
trauma-list-request@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> You can
reach the person managing the list at<br>
<x-tab> </x-tab><x-tab>
</x-tab>
>
trauma-list-owner@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> When
replying, please edit your Subject line so it is<br>
more specific<br>
<x-tab> </x-tab><x-tab>
</x-tab>> than
"Re: Contents of trauma-list digest..."<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Today's
Topics:<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>
> 1. Nearly Famous! (tuganddawn@talktalk.net)<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> 2. Physician Assistants in Trauma (Michael
Krowka)<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> 3. Re: Physician Assistants in Trauma (Ronald<br>
Gross)<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> 4. RE: Physician Assistants in Trauma (Brian
E.<br>
Fletcher)<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> 5. Re: Nearly Famous! (Krin135@aol.com)<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
----------------------------------------------------------------------<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message:
1<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Date: Thu,
13 Dec 2007 20:56:15 -0000<br>
<x-tab> </x-tab><x-tab>
</x-tab>> From:
<tuganddawn@talktalk.net><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Subject:
Nearly Famous!<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To:
<trauma-list@trauma.org><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Message-ID:<br>
<000a01c83dca$9b0826f0$4752f259@049682920380><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Content-Type: text/plain;
charset="iso-8859-1"<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Hello to
everyone.<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Before I begin may I wish all of you wherever you<br>
are and whatever <br>
<x-tab> </x-tab><x-tab>
</x-tab>> your
beliefs a very Merry Christmas and a pleasant<br>
and event free <br>
<x-tab> </x-tab><x-tab>
</x-tab>> New
Year.<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> I am a Paramedic/Firefighter working
in the UK<br>
and have <br>
<x-tab> </x-tab><x-tab>
</x-tab>> recently
been asked to consider appearing in a<br>
documentary series <br>
<x-tab> </x-tab><x-tab>
</x-tab>> about the
ambulance service speciffically dealing with<br>
concerns <br>
<x-tab> </x-tab><x-tab>
</x-tab>> about the
increase in calls, abuse of the service and<br>
out of hours <br>
<x-tab> </x-tab><x-tab>
</x-tab>> GP service
effects.<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> A few months ago I would have been
completely<br>
against this idea <br>
<x-tab> </x-tab><x-tab>
</x-tab>> but recent
reforms, behaviour of management and<br>
treatment by other <br>
<x-tab> </x-tab><x-tab>
</x-tab>> health care
professionals has made me consider the<br>
potential <br>
<x-tab> </x-tab><x-tab>
</x-tab>> benefits of
exposing certain ignored aspects of my<br>
service <br>
<x-tab> </x-tab><x-tab>
</x-tab>> (including
the appalling lack of professionalism,<br>
training and <br>
<x-tab> </x-tab><x-tab>
</x-tab>> negligence
by many Paramedics).<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
I wonder if the list might offer any insights they<br>
have about the <br>
<x-tab> </x-tab><x-tab>
</x-tab>> ethics and
problems faced with this sort of media<br>
exposure <br>
<x-tab> </x-tab><x-tab>
</x-tab>> especially
when one considers the uncontrolable<br>
environment we work <br>
<x-tab> </x-tab><x-tab>
</x-tab>> in. I would
also appreciate any advice about how to<br>
deal with these <br>
<x-tab> </x-tab><x-tab>
</x-tab>>
"cutthroat" sensationalist media types!<br>
<x-tab> </x-tab><x-tab>
</x-tab>
> In any event, thanks for your time and trouble
and<br>
I hope to hear <br>
<x-tab> </x-tab><x-tab>
</x-tab>> your
responses.<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Yours with kindest regards<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Tug Crumpton<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
------------------------------<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message:
2<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Date: Thu,
13 Dec 2007 16:00:59 -0700<br>
<x-tab> </x-tab><x-tab>
</x-tab>> From:
Michael Krowka <mkrowka@gmail.com><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Subject:
Physician Assistants in Trauma<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To:
"Trauma &amp; Critical Care mailing list"<br>
<trauma-list@trauma.org><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message-ID:
<C38707BB.3C00%mkrowka@gmail.com><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Content-Type: text/plain;
charset="US-ASCII"<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Greetings
list members,<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> This is
directed toward those that are in Level I and<br>
II centers (or<br>
<x-tab> </x-tab><x-tab>
</x-tab>other<br>
<x-tab> </x-tab><x-tab>
</x-tab>> high volume
centers).<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> How many of
you use physician assistants on your<br>
service?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> For those
that have residents and fellows, what is the<br>
role of the PA<br>
<x-tab> </x-tab><x-tab>
</x-tab>during<br>
<x-tab> </x-tab><x-tab>
</x-tab>> pt care?
Does the PA take call? Do the PAs manage<br>
patients in the<br>
<x-tab> </x-tab><x-tab>
</x-tab>SICU?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Do you see a
change in demand for PAs in trauma care?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Michael D.
Krowka<br>
<x-tab> </x-tab><x-tab>
</x-tab>> EMT-P<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
------------------------------<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message:
3<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Date: Thu,
13 Dec 2007 19:17:30 -0500<br>
<x-tab> </x-tab><x-tab>
</x-tab>> From:
"Ronald Gross" <Rgross@harthosp.org><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Subject: Re:
Physician Assistants in Trauma<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To:
"Trauma &amp; Critical Care mailing list"<br>
<trauma-list@trauma.org><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message-ID:
<47618535.7FF1.00B9.0@harthosp.org><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Content-Type: text/plain; charset=US-ASCII<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Michael,<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> We have 4
PAs and one APRN on service. Contact me<br>
off-line and I <br>
<x-tab> </x-tab><x-tab>
</x-tab>> would be
happy to discuss.......<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Ron<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>>>>
Michael Krowka <mkrowka@gmail.com> 12/13/2007 6:00<br>
PM >>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Greetings
list members,<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> This is
directed toward those that are in Level I and<br>
II centers (or<br>
<x-tab> </x-tab><x-tab>
</x-tab>other<br>
<x-tab> </x-tab><x-tab>
</x-tab>> high volume
centers).<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> How many of
you use physician assistants on your<br>
service?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> For those
that have residents and fellows, what is the<br>
role of the PA<br>
<x-tab> </x-tab><x-tab>
</x-tab>during<br>
<x-tab> </x-tab><x-tab>
</x-tab>> pt care?
Does the PA take call? Do the PAs manage<br>
patients in the<br>
<x-tab> </x-tab><x-tab>
</x-tab>SICU?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Do you see a
change in demand for PAs in trauma care?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Michael D.
Krowka<br>
<x-tab> </x-tab><x-tab>
</x-tab>> EMT-P<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> --<br>
<x-tab> </x-tab><x-tab>
</x-tab>> trauma-list
: TRAUMA.ORG<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To change
your settings or unsubscribe visit:<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
------------------------------<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message:
4<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Date: Thu,
13 Dec 2007 19:44:10 -0500<br>
<x-tab> </x-tab><x-tab>
</x-tab>> From:
"Brian E. Fletcher" <bfletcher@columbus.rr.com><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Subject: RE:
Physician Assistants in Trauma<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To:
"'Trauma &amp; Critical Care mailing list'"<br>
<x-tab> </x-tab><x-tab>
</x-tab>
>
<trauma-list@trauma.org><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Message-ID:<br>
<20071214004410.BJDP22267.hrndva-omta06.mail.rr.com@BRIAN><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Content-Type: text/plain;
charset="us-ascii"<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> We have 10
Nurse practitioners. We manage the step<br>
down ICU, floor<br>
<x-tab> </x-tab><x-tab>
</x-tab>> patients,
and respond to traumas. We essentially<br>
function like a<br>
<x-tab> </x-tab><x-tab>
</x-tab>resident,<br>
<x-tab> </x-tab><x-tab>
</x-tab>> performing
primary/secondary assessment, FAST, central<br>
lines, Chest<br>
<x-tab> </x-tab><x-tab>
</x-tab>tubes, A<br>
<x-tab> </x-tab><x-tab>
</x-tab>> lines,
suturing etc. We also have an NP clinic and an<br>
attending<br>
<x-tab> </x-tab><x-tab>
</x-tab>clinic. The<br>
<x-tab> </x-tab><x-tab>
</x-tab>> NP clinic
sees lower acuity patients and we also<br>
assist in the<br>
<x-tab> </x-tab><x-tab>
</x-tab>attending<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
clinic. Hope this helps.<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Brian<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
-----Original Message-----<br>
<x-tab> </x-tab><x-tab>
</x-tab>> From:
trauma-list-bounces@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>[
<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a><br>
<<a href="mailto:trauma-list-bounces@trauma.org" eudora="autourl">
mailto:trauma-list-bounces@trauma.org</a>> ]<br>
<x-tab> </x-tab><x-tab>
</x-tab>> On Behalf Of
Michael Krowka<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Sent:
Thursday, December 13, 2007 6:01 PM<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To: Trauma
&amp; Critical Care mailing list<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Subject:
Physician Assistants in Trauma<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Greetings
list members,<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> This is
directed toward those that are in Level I and<br>
II centers (or<br>
<x-tab> </x-tab><x-tab>
</x-tab>other<br>
<x-tab> </x-tab><x-tab>
</x-tab>> high volume
centers).<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> How many of
you use physician assistants on your<br>
service?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> For those
that have residents and fellows, what is the<br>
role of the PA<br>
<x-tab> </x-tab><x-tab>
</x-tab>during<br>
<x-tab> </x-tab><x-tab>
</x-tab>> pt care?
Does the PA take call? Do the PAs manage<br>
patients in the<br>
<x-tab> </x-tab><x-tab>
</x-tab>SICU?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Do you see a
change in demand for PAs in trauma care?<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Michael D.
Krowka<br>
<x-tab> </x-tab><x-tab>
</x-tab>> EMT-P<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> --<br>
<x-tab> </x-tab><x-tab>
</x-tab>> trauma-list
: TRAUMA.ORG<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To change
your settings or unsubscribe visit:<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
------------------------------<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message:
5<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Date: Thu,
13 Dec 2007 20:39:34 EST<br>
<x-tab> </x-tab><x-tab>
</x-tab>> From:
Krin135@aol.com<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Subject: Re:
Nearly Famous!<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To:
trauma-list@trauma.org<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Message-ID:
<c73.2076a517.349338d6@aol.com><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Content-Type: text/plain; charset="US-ASCII"<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> In a message
dated 13-Dec-07 14:57:36 Central Standard<br>
Time,<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
tuganddawn@talktalk.net writes:<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> I
wonder if the list might offer any insights they<br>
have about the<br>
<x-tab> </x-tab><x-tab>
</x-tab>ethics and<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
problems faced with this sort of media exposure<br>
especially when one<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
considers the uncontrolable environment we work in. I<br>
would also <br>
<x-tab> </x-tab><x-tab>
</x-tab>> appreciate
any<br>
<x-tab> </x-tab><x-tab>
</x-tab>> advice
about how to deal with these "cutthroat"<br>
sensationalist media<br>
<x-tab> </x-tab><x-tab>
</x-tab>types!<br>
<x-tab> </x-tab><x-tab>
</x-tab>> In any
event, thanks for your time and trouble and I<br>
hope to hear<br>
<x-tab> </x-tab><x-tab>
</x-tab>your<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
responses.<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Tug:<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> good luck
with your project.<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> You might
have better luck posting to the EMS-L using<br>
instructions<br>
<x-tab> </x-tab><x-tab>
</x-tab>found
at:<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> 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>
(<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>
<x-tab> </x-tab><x-tab>
</x-tab>>
Unsubscribe: _EMS-L-UNSUBSCRIBE@EMS-L.ORG_<br>
<x-tab> </x-tab><x-tab>
</x-tab>> (
<a href="mailto:EMS-L-UNSUBSCRIBE@EMS-L.ORG" eudora="autourl">
mailto:EMS-L-UNSUBSCRIBE@EMS-L.ORG</a><br>
<<a href="mailto:EMS-L-UNSUBSCRIBE@EMS-L.ORG" eudora="autourl">
mailto:EMS-L-UNSUBSCRIBE@EMS-L.ORG</a>> )<br>
<x-tab> </x-tab><x-tab>
</x-tab>> (subscribe
should be _EMS-L-SUBSCRIBE@EMS-L.ORG_<br>
<x-tab> </x-tab><x-tab>
</x-tab>> (
<a href="mailto:EMS-L-SUBSCRIBE@EMS-L.ORG" eudora="autourl">
mailto:EMS-L-SUBSCRIBE@EMS-L.ORG</a><br>
<<a href="mailto:EMS-L-SUBSCRIBE@EMS-L.ORG" eudora="autourl">
mailto:EMS-L-SUBSCRIBE@EMS-L.ORG</a>> ) )<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
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>
<x-tab> </x-tab><x-tab>
</x-tab>(
<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>
<x-tab> </x-tab><x-tab>
</x-tab>> Post to
list: _EMS-L@EMS-L.ORG_ (<br>
<a href="mailto:EMS-L@EMS-L.ORG" eudora="autourl">
mailto:EMS-L@EMS-L.ORG</a>
<<a href="mailto:EMS-L@EMS-L.ORG" eudora="autourl">
mailto:EMS-L@EMS-L.ORG</a>> )<br>
<x-tab> </x-tab><x-tab>
</x-tab>> List
Manager: _LISTADMIN@EMS-L.ORG_ (<br>
<a href="mailto:LISTADMIN@EMS-L.ORG" eudora="autourl">
mailto:LISTADMIN@EMS-L.ORG</a>
<<a href="mailto:LISTADMIN@EMS-L.ORG" eudora="autourl">
mailto:LISTADMIN@EMS-L.ORG</a>> )<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
Moderator: _MODERATOR@EMS-L.ORG_ (<br>
<a href="mailto:MODERATOR@EMS-L.ORG" eudora="autourl">
mailto:MODERATOR@EMS-L.ORG</a>
<<a href="mailto:MODERATOR@EMS-L.ORG" eudora="autourl">
mailto:MODERATOR@EMS-L.ORG</a>> )<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> Or one of
the various Yahoo Paramedic groups...<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> ck<br>
<x-tab> </x-tab><x-tab>
</x-tab>> Charles S.
Krin, DO FAAFP<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
**************************************See AOL's top<br>
rated recipes<br>
<x-tab> </x-tab><x-tab>
</x-tab>> (<br>
<a href="http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004" eudora="autourl">
http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004</a><br>
<<a href="http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004" eudora="autourl">
http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004</a>>
)<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>>
------------------------------<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> --<br>
<x-tab> </x-tab><x-tab>
</x-tab>> trauma-list
: TRAUMA.ORG<br>
<x-tab> </x-tab><x-tab>
</x-tab>> To change
your settings or unsubscribe visit:<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab>> End of
trauma-list Digest, Vol 54, Issue 16<br>
<x-tab> </x-tab><x-tab>
</x-tab>>
*******************************************<br>
<x-tab> </x-tab><x-tab>
</x-tab>><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>--<br>
<x-tab> </x-tab><x-tab>
</x-tab>trauma-list :
TRAUMA.ORG<br>
<x-tab> </x-tab><x-tab>
</x-tab>To change your
settings or unsubscribe visit:<br>
<x-tab> </x-tab><x-tab>
</x-tab>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab><br>
<x-tab> </x-tab><x-tab>
</x-tab>--<br>
<x-tab> </x-tab><x-tab>
</x-tab>trauma-list :
TRAUMA.ORG<br>
<x-tab> </x-tab><x-tab>
</x-tab>To change your
settings or unsubscribe visit:<br>
<x-tab> </x-tab><x-tab>
</x-tab>
<a href="http://www.trauma.org/index.php?/community/" eudora="autourl">
http://www.trauma.org/index.php?/community/</a><br><br>
<x-tab> </x-tab><br>
<x-tab> </x-tab>LFFox,
MPAS, PA-C<br>
<x-tab> </x-tab>
Distinguished Fellow, AAPA<br>
<x-tab> </x-tab>CCA,
American College of Cardiology<br>
<x-tab> </x-tab>Associate,
Society for Critical Care Medicine<br>
<x-tab> </x-tab>Associate,
Underwater and Hyperbaric Medical Society <br>
<x-tab> </x-tab><br>
<x-tab> </x-tab><br>
<x-tab> </x-tab>Lorick
Fox, MPAS, PA-C<br>
<x-tab> </x-tab>
SEAVIN/Peace Vector IV<br>
<x-tab> </x-tab>Unit
64903, Box 1201<br>
<x-tab> </x-tab>APO, AE
09868-4903<br>
<x-tab> </x-tab>(cell)
+20-18-230-4448<br>
<x-tab> </x-tab>(landline)
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