The White Coats Are Coming

Working occasional ambulance shifts can give physicians a taste of what it’s like to deliver care in the field. A second-year program at the University of South Carolina’s School of Medicine in Greenville gives them two full years of the whole buffet.

The school’s incoming med students are required to obtain their NREMT certification and maintain it for that duration, including riding shifts each month with Greenville County EMS.

The idea has quite a few benefits. One, it starts getting these students hands-on clinical experience earlier than traditional programs. They perform 12-hour monthly shifts as a third crew member who’s a working care provider, not an observer. They take histories and vital signs and conduct exams, and each semester for those two years, they have to write up a patient case from first call to conclusion. That means tracing 9-1-1 activation, EMS response, differential diagnosis and field care, ED and hospital courses, tests and procedures, OR and ICU activities and rehabilitation, as necessary.

Two, it exposes the young docs-to-be to interprofessional care and the wide range of providers and connections that comprise our evolving emergency care system.

“It used to be the physicians were always in charge, and our word was the last word,” says Tom Blackwell, MD, director of the school’s EMT training program and a clinical professor of emergency medicine. “It’s just not like that anymore. Today we have healthcare teams—nurses, physical therapists, nutritionists and dietitians, and collaboration all across the healthcare spectrum. So this is their first introduction to interprofessional health. EMTs and paramedics are the entry point to the healthcare system for many of these patients, and what they do in those first few minutes really matters.”

Naturally, field work gives these students a greater familiarity with the kind of work EMS providers do and, hopefully, more empathy for the challenging and aggravating aspects: the system abuse, the unpredictable players and uncontrolled environments, the limitations of capabilities and protocols, and the occasional handover difficulties and prickly condescension from colleagues at the ED. As students write their required reflections on their EMS experience, that occasional mistreatment is one of the recurring negatives. Empathy, it is hoped, may help them avoid dishing more out to some young EMT in the future.

Finally there’s empathy with patients, too, particularly the underserved and vulnerable ones. We know them well, but others have been a bit more sheltered.

“It lets them see the other side of that railroad track,” says Blackwell. “If our students can actually see where their patients come from, they may be less inclined to criticize when someone doesn’t follow their instructions exactly, or doesn’t get their medications filled promptly because they’re a single parent trying to feed five kids. They’re seeing abuse, which many of them have never seen before—child abuse, elder abuse, spousal abuse. They’re seeing that other side of the community, the disenfranchised parts of our population.”

Final ‘Exam’

At the end of the course, before they start seeing patients, students take part in a concluding multidisciplinary mass-casualty simulation event that also includes EMS, fire, law enforcement and other local responders, along with moulaged role-playing victims. This gives everyone the chance to walk through, and work together on, an MCI like they might face for real one day. Ultimately the med school’s EMT program will provide the school and local EMS system with a bunch of savvy hands if disaster ever really strikes