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. 

“Mostly our kids are the offspring of baby boomers, and they’ve not seen the other sides of our communities where a lot of our patients come from,” says Tom Blackwell, MD, director of the school’s EMT training program and a clinical professor of emergency medicine. “Letting them see that has been a tremendous benefit. They come back and tell me, ‘Man, how some of these people live…I have never seen anything like it in my life.’ It really opens their eyes.” 

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 Blackwell. “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. 

In 2013 that two-part capstone event included a motor-vehicle collision and an active-shooter incident. The first part posed a two-car head-on with a fatality, an ejected infant and two additional patients. The second presented around 80 victims evacuated from a building with injuries ranging from cuts and sprains to gunshot wounds and smoke inhalation from a simultaneous fire. 

Preceptors, including adjunct faculty from Greenville Tech’s EMS program, worked with small student groups to help steer them through. Students aren’t graded on the exercise, but it wraps things up and preps them for the National Registry exam that follows. Fire and police also use it as a training opportunity. 

“This kind of thing never really happened around here before,” Blackwell says. “Greenville Technical College has a fine EMT and paramedic training program that’s been going on for years, with a long reputation of doing really great things, but they’d never put on an exercise like this. So we made it happen, but they were part of the team as well, and it’s been fun to get everyone spun up on it.” 

There’s good reason to be jazzed; 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. Class sizes, around 50-plus so far, will gradually ramp up to around 100, and when the school reaches full enrollment in another couple of years, that means 400 new certified EMTs within the Greenville community.