Module One

Patient Based Care

The first article that I chose to read was one about Paramedic Endotracheal Intubation. I was very interested in reading this article because I have heard plenty of horror stories from friends of mine in the medical field. I did not have much confidence in paramedic intubation prior to reading the article and I surely do not have any faith in it now. It is not my faith in the paramedic that is lacking; rather it is my faith in the training of the paramedic. From what I read, paramedics do not get the proper training in order to perform this type of lifesaving procedure. The article gave the amount of hours that a board certified anesthesiologist must earn in order to graduate and to proficiently perform endotracheal intubation. Medical students must be able to perform 35-50 endotracheal intubations in order to graduate. The number required for a paramedic is only 5. Also, a medical student will spend 160 hours under supervision of doctors and anesthesiologists learning to perform ETIs while a paramedic will normally only receive 16-32 hours of training under paramedic program directors. I can only say that I am astounded at the statistics. The article went on to say that when an ETI is performed incorrectly that the outcome is normally worse than if it had not been performed at all. Sometimes the endotracheal tube will be misplaced with the air going into the patient’s stomach versus going into the patient’s lungs. Of the cases that were misplaced the paramedics thought that 84 % of the placements that were done were “easy”. In conclusion, I tend to think that anyone doing these types of procedures needs to be properly trained in how to do them.

Wang, H. (July/August 2007) Paramedic Endotracheal Intubation. North Carolina Medical Journal, Volume 68, Number 4. Retrieved November 18, 2007, from http://www.ncmedicaljournal.com/jul-aug-07/Wang.pdf


The second article I chose to read was about the hiring challenges that affect rural communities and providers. According to the article, the rural hospitals and rural physicians infrastructure is a very delicate and fragile one. When a qualified or specialized physician decides to leave a rural community it leaves them very vulnerable. Also, patients are faced with having to travel out of their home area to receive qualified care. To hire a replacement for that physician is not always an easy task. There is not a line of physicians waiting to get into practice in a rural community. Often times, physicians and their families choose to live and work in urban locations. This is for numerous reasons. A lot of physicians choose to live and work in urban communities because those hospitals usually are more technologically advanced than their rural counterparts. Also, there are more amenities for the physician and their family in urban locations. Another reason is that the call schedule the physician must work is usually a lot less than that of a rural setting. There are however some incentives to employment in a rural setting. The federal government has allowed the rural areas to offer incentives such as income guarantees, loan repayment of medical school loans and a start-up bonus for employment.

Chewnig, L.& Spade, J. (May/June 2007). Rural Hospitals and Rural Physicians: Understanding the Physician Workforce Challenges that Affect Rural Communities and Providers. North Carolina Medical Journal,Volume 68, Number 3 . Retrieved November 18, 2007, from http://www.ncmedicaljournal.com/may-jun-07/Chewning.pdf