The lessons that I have learned throughout my career as a paramedic and physician assistant have reinforced the value of team-based practice.
Prior to becoming a physician assistant, I worked as a mobile intensive care paramedic. Having been at the scene of countless motor vehicle accidents, where mere seconds can be the difference between life and death, I learned early on the value and advantage of teamwork in emergency medicine.
When a critically injured person is trapped in the crumpled steel of a vehicle, it takes an entire team of rescue personnel to save that person’s life. As a paramedic, I was responsible for resuscitating the patient and protecting the patient's airway while firefighters on the scene were responsible for fire suppression and heavy rescue, which often involved cutting away the metal to free the occupant. All the while, police officers were on hand to ensure our safety by redirecting traffic. The public safety personnel, in the form of police officers, made sure that we were safe in the middle of the road.
On more than one occasion, I was inside of the vehicle, maintaining c-spine alignment and airway of a pinned-in patient while in a sea of gasoline. I was never more thankful than at that time for the firefighters who were on the scene to protect my safety and the patientunder my care.
The burn operating room is another good example of teamwork. The larger the burn, the more critical it is to have a fully prepared, expertly trained team working together. Large burns can be very complicated, extending the operative time and increasing exposure to anesthesia and significant blood loss. In our medical group, we commonly have two surgeons and a PA working together to debride and graft a large burn injury.
I can attest from personal experience that having an efficient team approach has significantly reduced morbidity and mortality, especially during burn surgery.
No matter how big or small, every community must be prepared to deal with critical injury and mass casualty situations. This requires careful planning and an accurate cataloging of resources to help ensure medical personnel can swiftly shift gears from “routine” traffic to a sudden influx of critical injuries.
Large city hospital emergency departments are well versed in triage, having to consistently sort through a significant number of patients seeking care, some of whom have life-threatening illnesses and injuries. A recent example in the United States was the Boston Marathon bombing. Hundreds of innocent people were wounded from the explosions, and many received treatment for injuries typically seen only in a war zone.
At this year’s American Academy of Physician Assistants (AAPA) annual conference, we are fortunate to have a panel discussion on disaster readiness featuring several PAs who staffed the Brigham and Women’s Hospital ED on that fateful day in April last year. I look forward to hearing about their experiences and appreciate that they are willing to share their insights with the conference attendees, many of whom work in emergency departments.
PAs, like physicians and other clinicians, are at the ready to practice medicine when it’s needed, like times of crisis. While they won’t be on the upcoming panel, the efforts of PAs to step in and immediately act during the Marathon bombing were recently covered in Runner’s World magazine.
Responding to an incident of mass casualties is an emotionally and physically challenging duty. The lessons that I’ve learned throughout my career have only reinforced the value of team-based practice in all aspects of medicine. During such incredibly traumatic circumstances, it takes a well-coordinated team of physicians, PAs, nurses, and other health and safety personnel to save as many lives as possible.
This blog was provided in partnership with the American Academy of Physician Assistants.