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By John Newcomb, MD, FACEP
I am a fifty-five-year-old physician trained in family practice working as an emergency physician in a high-volume rural emergency department. This is my story.
Ever since I can remember, I have wanted to do something that would allow me to help people. My mother told me I should be a dentist. After being rejected by numerous first responder organizations, I resolved myself to enrolling in college. After one year of college, I received a call from one of the ambulance companies with an offer of employment. Despite a budding career in academia, with a stellar 2.0 GPA, I made the sacrifice and left college and took to the streets, literally. My credentials for being a medic were a standard Red Cross First Aid course, a CPR card, and a “willingness to learn.” At the tender age of eighteen I was assigned to patient care while my older, more experienced partner was assigned to the important job of driving the truck!
I served on the ambulance for three years. Little did I know I was living in the beginning of the end of the dark ages in EMS. I was an EMT but I was treated as a TGT (Throw and Go Technician). I had the privilege of taking the first AHA ACLS course ever. No mannequins for us. We practiced our intubation skills on anesthetized patients in the OR. I still feel badly about what happened to that man’s frontal incisors. I took some solace in the fact that lives would be saved and pre-hospital care advanced by the experience; too bad though, he once had a nice smile. It was a time of the esophageal airway tube, mast trousers, and calcium gluconate with its legendary mythical powers of bringing the dead back to life. I particularly miss the passing of the “pre-cordial thump.” Maybe it’s just nostalgia, but it saddens me when I think how emergency care professionals training today will never know the exhilaration one felt when you could literally beat the life into someone.
Today, I am the Medical Director and Chairman of a rural ED with an annual volume of nearly 50,000. I serve on most of the major committees of my hospital and committees that govern the hospital system. Recently, I served as Co-Chair for the Workforce Section of ACEP and as Section Councilor for two consecutive years. I am board certified in family medicine, but this July I celebrated 21 years as an emergency physician.
So much talk today revolves around who is qualified to practice emergency medicine. I recall a time when the idea of paramedics was first introduced. ED nurses saw it as a threat to their position. When mid-level providers were beginning practice, physicians felt threatened. Now I ask you, how would we care for our patients today if it weren’t for paramedics and mid-level providers? Throughout my life I have seen a lot of changes in EMS, but turf battles seem to remain the one constant.
Maybe it’s in my position as medical director, or maybe it’s just because of my experience, but most likely my perspective is the result of both. As emergency physicians, we have been given a tremendous opportunity, and I believe a great privilege, to care for the sick and injured among us. I stress teamwork in my ED. Every member of the department is responsible for the needs of every patient and every member is responsible for making every other member the best they can be. This attitude extends to the registrars and to the ambulance personnel. Despite my commitment to teamwork, from time to time, I still have to resist the urge to give somebody a good “thumping.”
There is a shortage of nurses and physicians to staff our nation’s EDs at a time when volume and acuity are increasing. The turnover of staff makes the task even more challenging. We frequently do not have inpatient beds, we do not always have the specialty care our patients need or the most appropriate diagnostic or therapeutic equipment available. We go to our jobs everyday under the threat of the next terror attack and knowing the next pandemic is inevitable. Because of the high pace, and lack of readily available resources, I lean on my experience more each day to help me to be as efficient as possible. Today there is no place for turf battles in America’s EDs. Our patients and our country can’t afford it. In addition to caring for our patients, everyone will be better served if we look for ways to take care of our own and lift each other up.
To summarize, I’ve learned a couple of things from my life’s journey in EMS. Change is inevitable and usually for the good. Teamwork is essential to providing the best patient outcomes. Experience should not be underestimated. Finally, always consider a mother’s advice.