Your choice of PAW Primary care provider?

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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What level of training would you want as your PAW 'Doc'

MD Specialist level (Surgeon, cardiologist, oncologist, etc.)
7
17%
MD Family practitioner
8
20%
Nurse Practitioner / Physician's Asst.
1
2%
RN/LPN
0
No votes
Paramedic/combat medic/EMT
14
34%
Veterinarian (large/small animal)
9
22%
Other provider (DO/Chiropracter/midwife/etc.)
2
5%
 
Total votes: 41

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Your choice of PAW Primary care provider?

Post by DannusMaximus » Wed Oct 26, 2011 10:38 am

As a bit of a change from the normal discussion of FAK's and specific techniques, here's a question for the first aid groupies to ponder...

The zombies have risen, civilization has fallen. The lights flicked off a few months ago and, unless you've manged to find a fuel supply for your generators or a solar/wind/water power source, they won't be coming back on for months or years. Your group has survived and has the enviable position of hand-picking from a selection of medically trained people who will be added to your group to provide primary medical care. What level of training do you think would be best to provide medical care for a small group of people living in PAW conditions? Focus on the training, we'll assume that any person you pick is an experienced practitioner in the field and will fit in harmoniously with your group and won't be a burden in any way. Also, we'll assume that due to radical population reduction and the non-destructive nature of this PAW there are ample 'modern' supplies lying around hospitals and clinics waiting to be procured (I know, I know, no scavenging or stealing. The U.S. Govt., right before they stopped transmitting, said it was alright for survivors to procure supplies with no obvious owner as long as you were going to use them for personal survival :wink: ).

I've tried to lump individuals with roughly similar training together (Parmedic/combat medic/EMT, for example), even though I know there are levels of ability within those groupings. Feel free to debate my groupings as well, and if you can make a compelling argument that a group should be broken up or a certain skill level should be it's own stand alone choice I'll certainly consider it.

My choice? Large animal veterinarian. This level of training means they can help with pretty much any surviveable medical condition or trauma that a human would find themselves faced with, but they also have specialized knowledge to help keep your livestock healthy and fit. Surgical techniques used on animals are similar enough to those used on humans that a vet would have a very good shot at performing minor surgeries on either species, and the drugs used are also very similar in many cases. In the absence of a full, modern support infrastructure, if a vet can't address a human's medical problem, it's probably not a surviveable problem.

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Re: Your choice of PAW Primary care provider?

Post by IANMCDEVITT » Wed Oct 26, 2011 12:02 pm

DAM.............surgeon hands down. Hands frackin' down.

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Re: Your choice of PAW Primary care provider?

Post by nathat » Wed Oct 26, 2011 12:21 pm

I'm not crazy confident about my vote, but I went with EMT/Combat/etc. level. The main purpose for this is they are not used to having all the equipment of the hospital on hand, and most things they use can be improvised from other items. On top of that, they are used to trauma, being first on scene, and improvising according to the situation. I feel they have enough knowledge to pick up quickly other skills they would need with on hand training (hate it for the first group that they try to treat). anything a top level doctor knows that an EMT wouldn't be able to do (with some exceptions) I feel wouldn't matter without the care you would get from a hospital and the modern equipment... I'm probably missing some important aspects, but this is my first thought. My main concern with EMT would be their knowledge of drugs and other things for treatement. Not sure how available they will be to begin with however.

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Re: Your choice of PAW Primary care provider?

Post by phalanx » Wed Oct 26, 2011 1:30 pm

I went with EMT/medic.

My best friend is a Firefighter/EMT, and I've seen/heard his level of training and knowledge base. EMT's are used to facing situations where they have to make quick decisions and act under pressure, but since we're limiting the discussion to medical training, I would still pick the EMT. I would feel comfortable with the level of training since most of the issues realistically faced wouldn't really be long-term care situations but rather trauma and general illness. I understand the OP's pick, since it makes a lot of sense, but I wouldn't because animal illnesses are not as comparable to human ones. Surgeon? No chance. Those guys (from what I know, which isn't much) are hyper-specialized and it may have been 15-20 years since they took out an appendix or set a splint.
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Re: Your choice of PAW Primary care provider?

Post by Ech0Sierra » Wed Oct 26, 2011 1:34 pm

Personally I'd go with a missionary with medical training or someone from a humanitarian relief agency. They should know how to make do for long periods of time without hospital care and how to use less-than-ideal supplies for maximum benefit.

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Re: Your choice of PAW Primary care provider?

Post by phalanx » Wed Oct 26, 2011 1:42 pm

The more I think about it, the more I think a vet/EMT combo would be absolutely killer....
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Re: Your choice of PAW Primary care provider?

Post by CiggsWar » Wed Oct 26, 2011 1:44 pm

I went with the combat medic as a PAW enviroment is more likely a war zone, there view is essential in maintaining health on the spot. and looking for places to treat wounded, The conviences will be miniumal for a surgeon to perform. and travel may be nessary need moving wounded around with makeshift equiptment. The right training and preping allowing people to live and survive.
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Re: Your choice of PAW Primary care provider?

Post by duodecima » Wed Oct 26, 2011 2:37 pm

I'm stuck with the primary care doc since that's who lives in my house :lol:

In the perfect world I'd go with my ol buddy the rural general surgeon who spent 5 years in Africa (some surgeons are incredibly specialized. The general surgeons, however, are usually pretty, well, general.)

In all cases, the person who does the best at thinking/learning outside their usual prePAW box is going to do the best for you - a medic who's creative and flexible about working thru post-emergency care, rehab, and long term management is going to do better than an office based MD who can't adapt to thinking in a pre-hospital/emergency mindset when that's needed (or vice-versa). I know that's a copout on the OP's question but imo it's also true...

And phalanx's point about a cross trained DVM/(any human medical training of EMT or higher) is well taken.
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Re: Your choice of PAW Primary care provider?

Post by KMAC179 » Wed Oct 26, 2011 2:54 pm

Medic.

We are used to treating in the worst possible conditions, improvising tools and procedures, and simply getting it done. A cardiac surgeon trying to start an IV in anything less than a well lit surgical suit would probably lead to disaster.
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Re: Your choice of PAW Primary care provider?

Post by Bubba Enfield » Wed Oct 26, 2011 4:30 pm

KMAC179 wrote:Medic.

We are used to treating in the worst possible conditions, improvising tools and procedures, and simply getting it done. A cardiac surgeon trying to start an IV in anything less than a well lit surgical suit would probably lead to disaster.
I'm a paramedic, and I would want a veterinarian. Medics only get people to higher levels of care, which I'm assuming don't exist in this scenario.
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Re: Your choice of PAW Primary care provider?

Post by DannusMaximus » Wed Oct 26, 2011 5:15 pm

Bubba Enfield wrote:
KMAC179 wrote:Medic.

We are used to treating in the worst possible conditions, improvising tools and procedures, and simply getting it done. A cardiac surgeon trying to start an IV in anything less than a well lit surgical suit would probably lead to disaster.
I'm a paramedic, and I would want a veterinarian. Medics only get people to higher levels of care, which I'm assuming don't exist in this scenario.
My thoughts exactly, Bubba. Paras, EMT's, and combat medics really shine when temporarily treating acute medical or traumatic problems (i.e., keep them breathing or from bleeding to death until they can get to definitive care). In my scenario your group's PAW doc IS the higher level of care!

I'm actually surprised at the focus on trauma when people are thinking about PAW care. Trauma's important, of course, but it's also fairly straightforward, at least the stuff that you could possibly survive minus our modern surgical infrastructure (I'm thinking fractures, shallow to moderately deep lacerations, etc.). When I made my decision, I was actually thinking more along the lines of what MEDICAL issues would a small group run into. Mundane things like ear infections, asthma attacks, management of chronic illnesses, giving birth, cavities, getting stung by an insect or bitten by a snake, etc. The only profession I could think of that deals with any or all of these items on a daily basis is a veterinarian. On any given day, a vet might:

- Set and cast a dog's broken leg
- Diagnose and provide pharmaceutical treatment of organ problems (like my dog's liver problems... :( )
- Help a cow give birth
- Pull a cat's bad tooth
- Tell a farmer how to treat an animal's respiratory problem
- Determine what Fido ate that has him so damn sick, and treat it
- Stitch up a laceration that a horse got from a barbed wire fence and provide preventative infection treatment

Vet's must deal with a very large range of medical and physical problems, including trauma, and especially in smaller towns, they ARE higher treatment for any and all major medical or traumatic problems that animals must deal with. If a vet knows how to properly pull a cow's rotten tooth or set a badly broken leg on a dog, they can surely do the same for me!
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Re: Your choice of PAW Primary care provider?

Post by shrapnel » Wed Oct 26, 2011 7:50 pm

Veterinarian, or an MD who practices third world or austere medicine and who is thus used to getting by with not much in the way of fancy scanners and the like.
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Re: Your choice of PAW Primary care provider?

Post by nathat » Thu Oct 27, 2011 7:41 am

My choice comes from practical experience in my line of work. I work alongside engineers all the time, and get very frustrated with some of them because they have more knowledge than they know what to do with, but when it comes time to apply it they lack common sense and practical application. I fear doctors would fall into this catagory as well (depends on the doctor I know). I feel it would be easier for a EMT type to apply their knowledge in a "long term care" setting much easier than it would be for a surgeon to improvise. It's just a different type of personality, and improvisation is going to be very important in PAW. With that said, a family practice doctor may be a good mix other than they have no experience really with emergency type situations, and this would be a steep learning curve. I'm going to stick with EMT and understand that they will have to adapt and learn, but that is what they're good at.

Ideally I'd love to have an older doctor who is around 70 now, who is used to some older tech and things.

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Re: Your choice of PAW Primary care provider?

Post by Gingerbread Man » Thu Oct 27, 2011 7:52 am

I don't see the point in a surgeon. They need about 10 other people to help them and to top it off they need a full studio to work. Maybe with a larger population but small group, I don't see that they're going to be that effective just from lack of tools.

I'm going with a MD, PA or an EMT. MD or PA because they can diagnoise acute problems and may have the ability for uncomplicated surgury such an appendectomy, set bones or tooth extraction. I think in PAW if you get something serious, your done. The drugs necessary are only able to be made with a massive economy. An EMT to save your ass on the spot.

I'm of the mind that once the big society goes away you must expect the life expectancy to be cut in half. It's just the way it will be. The only saving grace is that we know about sanitation and how important it is.
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Re: Your choice of PAW Primary care provider?

Post by johndoe » Thu Oct 27, 2011 11:01 am

I'm an EMT and I damn sure wouldn't pick one if I had a choice. It's basically nothing but advanced first aid. Paramedics are more advanced but most of their training only addresses dealing with acute situations for the 5-30 minutes it takes to get someone to the hospital and not long term care of illness or injuries.

I suppose I'd go with an MD, since they have the most training, though I would argue that PAs and NPs should be grouped with them since they do, essentially, the exact same job.

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Re: Your choice of PAW Primary care provider?

Post by crypto » Thu Oct 27, 2011 11:44 am

Going with Veterinarian.

Vet's are more knowledgeable about fixing broken living things than 99% of doctors I know.

They do surgery, anesthesiology, infectious diseases, as well as chronic problems.

They are used to working in spartan surroundings outside a well-stocked hospital environment.


I would absolutely want a vet working on me.
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Re: Your choice of PAW Primary care provider?

Post by Gingerbread Man » Thu Oct 27, 2011 12:14 pm

crypto wrote:Going with Veterinarian.

Vet's are more knowledgeable about fixing broken living things than 99% of doctors I know.

They do surgery, anesthesiology, infectious diseases, as well as chronic problems.

They are used to working in spartan surroundings outside a well-stocked hospital environment.


I would absolutely want a vet working on me.
You know, I believe you're correct. I hadn't thought about it but a vet may be working in a barn, can deliver a multiude of animal births, and is used to combating infection.

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Re: Your choice of PAW Primary care provider?

Post by PotatoMuncher » Thu Oct 27, 2011 2:13 pm

I voted EMT/Combat Medic simply because that's what I am/was, and Im incredibly biased.
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Re: Your choice of PAW Primary care provider?

Post by Medic Mentor » Thu Oct 27, 2011 6:21 pm

8-)
PotatoMuncher wrote:I voted EMT/Combat Medic simply because that's what I am/was, and Im incredibly biased.

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Re: Your choice of PAW Primary care provider?

Post by shulatt » Fri Oct 28, 2011 1:59 am

Reminds me of an old joke that does have a little bearing here....
"What do you call someone who failed veterinary school?...Doctor."
A vet actually has a tougher time in school because of the multitude of species which they have to learn the anatomy and physiology and such. A Doctor of human medicine typically only has to worry about humans.

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Re: Your choice of PAW Primary care provider?

Post by LowKey » Fri Oct 28, 2011 3:17 am

Vet, hands down.

Aside from my being a "large animal" and therefore falling under their scope*, they are (as has been noted) used to working in austere conditions,ect.
What they are also very, very, used to is triage.\
Farmer Brown isn't going to spend oodles of cash (resources) on a cow that won't perform.

What that means in terms of human treatment is the vet will likely be more likely to look at you and say, "I can fix this/save you.......but it wont be worth it to you of the group. You're going to be fucking useless for any physical work for years/ever, and you're going to suck up scarce medical supplies like they are going out of style. I can and will do it if you want me to, or I can help you die. Your call."
Not saying the vet won't be tapping into the "medicinal ethanol" after days like that, just that they're used to having to weigh the expenditures versus the gains. Modern medical practice seems to lean more towards an "at any cost" philosophy as their default setting.

Not that I'm suggesting the primary care practitioner give up on a patient**. IMHO the patient and practitioner should fight death tooth and nail till the very end, but they need to take into account and discuss the cost of doing so in comparison to both the best and the most likely beneficial outcome.













*If someone uses "scope of practice" in their determination of who or what could or should be treated in a PAW I'd be likely to use my scope on them. :evil:
** Medical practitioners would be wise to respect the patients expressed/known wishes. If I tell you to NOT amputate under any circumstances you are seriously rolling the dice if you do so after I pass out. I may decide to thank you for it. On the other hand I may use the remaining limb to harm you when I'm otherwise recovered. Respect the patient and try to remember you are a highly trained and well respected biological mechanic, not "father knows best".
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Re: Your choice of PAW Primary care provider?

Post by LowKey » Fri Oct 28, 2011 3:22 am

shulatt wrote:Reminds me of an old joke that does have a little bearing here....
"What do you call someone who failed veterinary school?...Doctor."
A vet actually has a tougher time in school because of the multitude of species which they have to learn the anatomy and physiology and such. A Doctor of human medicine typically only has to worry about humans.

The other joke goes-

Q:"What do you call the guy who graduated last in in his class from medical school?"
A:"Doctor"
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Re: Your choice of PAW Primary care provider?

Post by squinty » Fri Oct 28, 2011 3:22 am

LowKey wrote: Respect the patient and try to remember you are a highly trained and well respected biological mechanic, not "father knows best".
Well said.
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Re: Your choice of PAW Primary care provider?

Post by squinty » Fri Oct 28, 2011 3:26 am

Someone with a knowledge of "traditional" medicines or herbalism etc. might be usefull when the machinery and supply routes necessary for allopathic medicine no longer exist. Someone smart enough to see through the hocum but knowledgeable enought to recognize what's valuable in folk renedies and low tech/field expedient treatments. Yeah, an MD with lot's of time in third world countries, a "doctors without borders" guy would be a good choice.

'Course in the PAW we won't get to choose. We'll be our own first responders and primary caregivers, and we'll take whatever assistance we can get.
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