In this podcast episode, we are joined by Dr. Bill Hinckley to discuss advanced practice models in HEMS. Bill is a rare breed that defines “passion” in HEMS, to say the least. His experience coupled with being an overwhelmingly nice guy led to a lengthy discussion. We did not want to cheat your experience, so we split the podcast episode into two separate parts.
This second part focuses on the big picture. We talk about the Airline Disregulation Act (ADA), HEMS bureaucracy, over-saturation, and billing practices. We touch on the need for advanced practice models in our current climate and the importance of generally doing the right thing.
Den Hartog Injury 2015 Survival benefit of physician-staffed HEMS assistance for trauma
Fukuda JAMA Surg 2018 Association of Prehospital ALS by physician with survival after blunt trauma OOHCA from MVC
Garner Emerg Med Australasia 2004 The role of physician staffing of HEMS in prehospital trauma response
Garner EMJ 2015 HIRT Head injury retrieval trial
I’m curious about the team dynamics in an advanced practice model. I work in a nurse/medic model which is very much a partnership. Do you have a similar dynamic with an NP and a nurse or does the NP call the shots more like in the hospital setting?
It will vary depending on the state, program, and individual clinician. Just like a nurse/medic model, level of education doesn’t necessarily determine level of autonomy. It’s more or less based on whatever rapport has been established. To a certain degree, the advanced practice provider will always have the final say from a legal standpoint. That being said, being a competent and motivated clinician will buy you more say no matter what setting you find yourself in.