TP>If advanced prehospital care doesn't have to have such advanced
TP>training to do
TP>any bit of good, why in the world have haospitals spent so much $$$
TP>getting  helicoptors with nurses, Dr.s, etc, to respond to calls ?
TP>An entire system  of individuals are available to render care ASAP
TP>and to the extent of the  level of their training.
Because it looks good? 
TP>    Jumpin' Jehosaphat!  The VeitNam war demonstrated that more
TP>training in the field resulted in fewer casualties, less morbidity,
TP>from potentially life- threatening wounds.
Actually, what the experience of Viet Nam showed, was that getting the 
patient's too surgery faster resulted in higher survival rates. As a 
matter of fact, between 1968 and now there is not much difference in 
what is done in the field for combat injuries. The emphasis is still on 
rapid evacuation. However, that is trauma, which we all know is 
different than medical emergencies. Or is it?
TP> Call me a cynic, but my feeling is that, as more and more HMO's
TP> start putting accountability for $$$ spent on Dr.'s, nurses, and
TP> hospitals, they will typically point to ways to cut the costs of
TP> medical care.  Noticing that the prehospital care givers are the
TP> first to have the fingers pointed at them isn't surprising, but is
TP> aggrevating.  Gary, ever notice in an institutional setting that, as 
cuts start being talked about, everyone starts showing how they are 
indispensible, and how others are not as essential?   I  think that the 
good Dr. is reflecting on ways for his (and his colleagues)  economic 
survival, and not necessarily on better patient care.
As managed care becomes more prevalent, we are all going to have to 
prove our worth. However, Emergency Medicine, as a specialty seems to 
have more of burden than some of the other specialties. Remember, the 
concept of an HMO is to make Emergencies a rarity, if not extinct. 
Emergency care, by it's nature, is expensive, so HMOs and other managed 
health care organizations are going to be very critical in their look at 
that specialty. By extension, pre hospital EMS is going to be examined 
as well. It may turn out that it is cheaper to do things in the pre 
hospital setting, with no adverse result on the patient, or it may turn 
out that a lot of what we do will be judged as unneccesary. At this 
point, I don't think anyone knows. 
Gary
þ CMPQwk 1.42 129 þApathists of the world...ahh, forget it.
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