What is the most appropriate age to be directly involved in patient care?

Pre-Med & Medical School Careers in Medicine
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<p>Fellow Medics,</p>

<p>Just wondering for Premeds what is the most appropriate age to begin to get directly involved in patient care?</p>

<p>If one gets EMT license by 17, is this too early to be involved in direct patient contact? In our town, due to dearth of EMT personnel, there is a push to get even a 17 year old directly involved as soon as he or she gets the EMT certification. However, these teenage EMT personnel are liable for medical lawsuits.</p>

<p>Is it better to wait till you are more mature, say around 19-20 to get more direclty involved in patient contact?</p>

<p>For those of you who have experience, please post your experiences.</p>

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<p>If you have the training and have completed all necessary and required licensing exams, there is no reason why you shouldn't be allowed to use your skills. I mean, the job of EMTs is to stabilize a patient so that those with more knowledge and training can do their job, which is getting to fix the problem. Even the Advanced Cardiac Life Support protocols are straight forward and in a properly trained and tested individual should have a high degree of effectiveness. </p>

<p>Do I think a 17 year old should be put out on their own to handle a case? No. Obviously, they should be paired with other more experienced individuals, who are capable of teaching key points while in the field.</p>

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<p>I would like some other opinions please.</p>

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<p>
[quote]
Even the Advanced Cardiac Life Support protocols are straight forward and in a properly trained and tested individual should have a high degree of effectiveness.

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<p>ACLS is straightforward and easily tested. ACLS is, however, only somewhat effective for out of hospital patients. ACLS is even less effective for in-hospital arrests due to greater prevalence of comorbid conditions.</p>

<p>This review article quotes optimistic survival rates: <a href="http://pdm.medicine.wisc.edu/bissell.htm%5B/url%5D"&gt;http://pdm.medicine.wisc.edu/bissell.htm&lt;/a>. This abstract reports survival rates for out of hospital cardiac arrest of 1.4%: <a href="http://jama.ama-assn.org/cgi/content/abstract/271/9/678%5B/url%5D"&gt;http://jama.ama-assn.org/cgi/content/abstract/271/9/678&lt;/a>. Note that ACLS protocols cover a variety of clinical scenarios.</p>

<p>The science of ACLS protocols has been questioned. For many years, no outcomes data existed to support any ACLS intervention other than doing BLS and giving a vasoconstrictor. Pharmaceutical interventions were, at best, based on animal models, and, at worst, conjecture. A review of the pharmaceutical protocol history is educational.</p>

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<p>Both of your articles are from 1994. I'd prefer, if you're going to cite data on something that changes every five years that you at least use the most recent testable protocol (2000). I expect better of you, double penny.</p>

<p>A January 2006 JAMA article by Nadkarni et al. on in-hospital astysole and pulseless electrical activity (both associated with far worse outcomes than ventricular tachycardia or ventricular fibrillation) had survival rates for adults at 18% and children (who are more likely to present with asystole or PEA) at 27%. </p>

<p>You could have also used an August 2004 NEJM article by Stiel et al for your out of hospital survival to discharge, which puts the rate at about 5% for most cities.</p>

<p>The issue with poor survival rates though is that a sudden cardiac arrest is a serious medical condition, one that has severe complications even in those who are lucky enough to have everything fall their way from early CPR and EMT intervention to rapid defibrillation and all the other variables that are associated with improved outcomes. While the research has lagged, that really has little to do with the question posed by the original poster. If the 17 year old has been properly trained and certified, there should be little reason why they can't perform at the same level as other, older EMTs (especially since there is plenty of data out there that no one performs compressions to the basic standards).</p>

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<p>I apologize for using old citations and wandering off topic.</p>

<p>ACLS has little to do with the original poster's question. In the context of EMT tasks, age alone should not preclude clinical involvement. Most EMT interventions, performed by a well-trained EMT, are effective.</p>

<p>Among all medical tasks though, ACLS remains a largely ineffective (70-95%) and poorly founded intervention. ACLS outcomes data have not changed much in 20 years. </p>

<p>See the 1997 Circulation article.

[quote]
Nevertheless, the true effectiveness of many aspects of resuscitation remains unknown despite the huge investment of scientific and healthcare resources.2-9 For example, we do not know the value of antiarrhythmic or adrenergic agents given for cardiac arrest,9-11 nor do we know the true effectiveness of training programs in emergency cardiac care.3,12 How well do people learn, and can they remember what they learn?5 Will they perform these skills in a true emergency?4,13,14 Although several investigators have observed that the quality of resuscitation attempts in terms of objective process criteria improve after formal CPR training,6-8 significant differences in the critical outcome of survival rates have not been recorded. Finally, it is not firmly established that the correct use of resuscitation protocols, even by formally trained emergency personnel, influences patient outcome.2

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<p><a href="http://www.americanheart.org/presenter.jhtml?identifier=1856%5B/url%5D"&gt;http://www.americanheart.org/presenter.jhtml?identifier=1856&lt;/a&gt;&lt;/p>

<p>Note also that ACLS certification only states that the certificate bearer took the course and passed the test</p>