SF medics at Duke

[Devildoc]

Nice article. I have chatted some of these guys up over the months/years they have been at Duke.

Green Beret medics train at Duke

 

[Kraut783]

This is very cool, props to Duke.

"In addition to the workshop, Duke helps train Special Forces medics by hosting them for one-month residencies.
Dr. Mark Shapiro, chief of acute care surgery at Duke, said up to four Green Berets are working in the hospital at any given time."


"Nearly 50 medics have trained at Duke since that partnership began in 2014, Shapiro said. That includes soldiers from the 1st, 3rd, 5th and 7th Special Forces Groups.
"It's really a big source of pride for Duke," Shapiro said."

 

[Gunz]

"When you want to get to know folks and earn their trust, one of the best ways is to do some tailgate medicine," Hines said. "You build that rapport and that trust by going out and helping folks."

Absolutely. Well done. Good on Duke.

 

[Red Flag 1]

i

 

[Devildoc]

FWIW, Duke was the first University to define the "Advanced Practice" programs. The Advanced Practice programs are the Physician's Assistant, and Nurse Practitioner rolls. Duke took a select number, I think it was five, of Naval Corpsmen, and ran them through the first PA program. Advanced practice for nurses began much earlier by training RNs to administer Anesthesia, a position that is now called Certified Registered Nurse Anesthetists (CRNA).

Yes...a source of pride the PA program started with 5 Corpsmen; and at Duke.

Regarding this program, Mark (Shapiro, whom I know well) is very pro-military and is a huge advocate of SF specifically and the military in general. He is good people.

Now if we could just get Duke to buy into trauma and emergency medicine as well. It isn't a cash cow like cancer or cardiology so it's not as sexy. If Duke could give up its trauma center status it would. But that's a whole 'nother thread.

 

[policemedic]

Yes...a source of pride the PA program started with 5 Corpsmen; and at Duke.

Regarding this program, Mark (Shapiro, whom I know well) is very pro-military and is a huge advocate of SF specifically and the military in general. He is good people.

Now if we could just get Duke to buy into trauma and emergency medicine as well. It isn't a cash cow like cancer or cardiology so it's not as sexy. If Duke could give up its trauma center status it would. But that's a whole 'nother thread.

Penn successfully transferred its Level 1 from one campus to another specifically to avoid the drama associated with the knife and gun club once they went whole hog on CA, proton therapy, and other high dollar stuff. It's amazing how that happens when money becomes the driving force instead of providing care to the community and training the next generation of physicians and nurses.

 

[Red Flag 1]

Penn successfully transferred its Level 1 from one campus to another specifically to avoid the drama associated with the knife and gun club once they went whole hog on CA, proton therapy, and other high dollar stuff. It's amazing how that happens when money becomes the driving force instead of providing care to the community and training the next generation of physicians andnurses.

 

[TLDR20]

BST and University of Maryland are separate hospitals, but across the street from each other. Keeps the guns out.

 

[Devildoc]

Penn successfully transferred its Level 1 from one campus to another specifically to avoid the drama associated with the knife and gun club once they went whole hog on CA, proton therapy, and other high dollar stuff. It's amazing how that happens when money becomes the driving force instead of providing care to the community and training the next generation of physicians and nurses.

Unfortunately for Duke it's the only show in town.

 

[Devildoc]

There are benefits in having a high end ER program. It brings cases in for the Residents of just about every specialty but Derm & Allergy. Unless a lot of Grant, and other funds come with it, it can become a black hole to support that kind of care, as @policemedic points out. It also becomes a burn out rotation for Nurses and Med Techs.

Duke's EM program is buried within the Dept of Surgery. I think it's the least funded of all the divisions in the department. Many in the Dept of Surgery still think, after 12ish years of of having EM residency, that the ED is in the purview of surgery and EM doesn't have a place at the table.

 

[policemedic]

Duke's EM program is buried within the Dept of Surgery. I think it's the least funded of all the divisions in the department. Many in the Dept of Surgery still think, after 12ish years of of having EM residency, that the ED is in the purview of surgery and EM doesn't have a place at the table.

Interesting. EM is near and dear to my heart, so it pains me to hear the EM residents and docs are treated that way at Duke.

 

[Devildoc]

Interesting. EM is near and dear to my heart, so it pains me to hear the EM residents and docs are treated that way at Duke.

The culture, it is a'changing. It is definitely much better than it used to be, but still far from where it needs to be. There are a lot of intra-organizational issues with EM here...(relative) low pay for docs, they can't admit so ED admit holds take forever to dispose, the docs sit at the kid's table with regard to major hospital committees. The nursing side isn't much better. Awesome director but he has a shit-load on his plate, good manager, very weak mid-management, enormous turnover.

I will say the ED is very EMS-friendly and has a good relationship with local EMS, which is very nice. When I was a medic there were some ED's who had horrible relationship with EMS and patient care really suffered. Duke is medical control with local EMS, and several docs are former paramedics.

 

[Red Flag 1]

Duke's EM program is buried within the Dept of Surgery. I think it's the least funded of all the divisions in the department. Many in the Dept of Surgery still think, after 12ish years of of having EM residency, that the ED is in the purview of surgery and EM doesn't have a place at the table.

 

[TLDR20]

Unfortunately for Duke it's the only show in town.

Except for that giant hospital less than 10 miles away, UNC.

 

[Devildoc]

Except for that giant hospital less than 10 miles away, UNC.

Yeah, true. I meant "town" literally. Durham's only other hospital is a community hospital. UNC does EM very, very well. The former chief is Judy Tininalli (she wrote THE EM textbook), molded EM into its own department (vice "division"), and created a well-run, well-respected department.

I was a paramedic when UNC started its EM residency, UNC was our medical control (same county). All of the EM residents (and all new ED nurses) had to do EMS rotations, and we did a lot of the ED-specific teaching for ACLS, PALS, etc.

 

[Muppet]

Yeah, true. I meant "town" literally. Durham's only other hospital is a community hospital. UNC does EM very, very well. The former chief is Judy Tininalli (she wrote THE EM textbook), molded EM into its own department (vice "division"), and created a well-run, well-respected department.

I was a paramedic when UNC started its EM residency, UNC was our medical control (same county). All of the EM residents (and all new ED nurses) had to do EMS rotations, and we did a lot of the ED-specific teaching for ACLS, PALS, etc.

In my opinion, we as paramedics had to do E.D., ICU, burn and so on, time. New nurses and residents should have to do EMS time to better understand EMS as a whole. I have been fortunate to have EMS residents and fellows doing EMS time for their EMS fellowship / medical directors course. I learned alot, they did also. Now, when we bring in a fucked up trauma not all packaged pretty but saved, they will know not to cry and bitch about how the line is taped, why they may not be intubated BUT were properly ventilated and that permissive hypotension SOP was preformed.

M.

 

[Devildoc]

In my opinion, we as paramedics had to do E.D., ICU, burn and so on, time. New nurses and residents should have to do EMS time to better understand EMS as a whole. I have been fortunate to have EMS residents and fellows doing EMS time for their EMS fellowship / medical directors course. I learned alot, they did also. Now, when we bring in a fucked up trauma not all packaged pretty but saved, they will know not to cry and bitch about how the line is taped, why they may not be intubated BUT were properly ventilated and that permissive hypotension SOP was preformed.

M.

I didn't know how good I had it. I went through a paramedic certification program taught and sponsored by UNC Hospitals. Every department in which we did clinicals pretty much welcomed us with open arms. We did far more clinical time than the minimum required by the state or DOT curriculum, and the resulting relationships between EMS and that hospital, particularly the ED, thrived because of it.

I now know, many (MANY) years later that not all EMS agencies and hospitals have such a warm relationship. So much the pity.

When I was in the ED at Duke I tried to get ED nurses to do ride-along time, but the hospital wouldn't allow it because of "liability." Even though the two other, local Level 1 trauma centers did it fine. I also tried to get local reserve and NG corpsmen and medics to come into the ED for clinical time or con ed; again, I could get MOAs with the military folks, but the hospital wouldn't hear of it.

I had a love-hate relationship with that department. We did (and it still does) provide excellent, excellent care in the face of many roadblocks. The department really wants to be better, but for whatever reasons, it just won't be allowed.

 

[policemedic]

As @Muppet said, we rotated through almost every department with a heavy emphasis on EM and critical-care areas. To this day I STILL say if I ever did nursing school it would only be to practice in an ED or ICU.

The only unit I didn't feel welcome in was L&D. The nurses really didn't like us being there; the physicians were great but the nurses killed the experience.

 

[Devildoc]

As @Muppet said, we rotated through almost every department with a heavy emphasis on EM and critical-care areas. To this day I STILL say if I ever did nursing school it would only be to practice in an ED or ICU.

The only unit I didn't feel welcome in was L&D. The nurses really didn't like us being there; the physicians were great but the nurses killed the experience.

I have spent the majority of my nurse time in the ED, after working in a surgery-trauma and neurosurg ICU. Last couple years in radiology for a mental and emotional break. I think the vast majority of former medics who go into nurses do ED or ICU.

Yeah, L&D nurses are cliquish. Even to other nurses. When I was in nursing school I had already delivered a handful of babies between EMS and the military, so I know my attitude did not endear myself to them.

 

[TLDR20]

In my opinion, we as paramedics had to do E.D., ICU, burn and so on, time. New nurses and residents should have to do EMS time to better understand EMS as a whole. I have been fortunate to have EMS residents and fellows doing EMS time for their EMS fellowship / medical directors course. I learned alot, they did also. Now, when we bring in a fucked up trauma not all packaged pretty but saved, they will know not to cry and bitch about how the line is taped, why they may not be intubated BUT were properly ventilated and that permissive hypotension SOP was preformed.

M.

I disagree. Maybe new ED nurses need that, but there is no reason for an ICU nurse to ride a rig.