# Suspended for possible policy violation...



## AVALANCHE (Nov 4, 2013)

I work at a SoCal company as an EMT-B and while on an IFT call hospital to SNF, we were informed we'd need an RN along as well that will take charge of the call. They have a company car that they met us in the hospital with. When we gathered the patient (which did require ALS level of care), I loaded the patient in the rig (I was the driver, my partner the attendant) and the RN then asked my partner to follow behind us in the RN company vehicle to the SNF. My partner had no issue with this as it wasn't uncommon for RNs to ask and the patient is in a higher level of care.

Once we were finished with the call, the RN left in their company vehicle and dispatch asked us to drive the RN back to the hospital to which I informed them of what had happened. Dispatch said that they were aware of RNs doing this but it needed to be curbed. Later a supervisor found out and issued a suspension to both myself and my partner, with the RN having a separate supervisor that didn't give any sort of reprimand to the RN other than "don't do it anymore."

Were we fairly suspended? Is this situation technically a OC policy violation and if so where is it worded specifically? I can't find anything that fits from the OCEMS website.

Thanks for your input guys.


----------



## Christopher (Nov 4, 2013)

AVALANCHE said:


> I work at a SoCal company as an EMT-B and while on an IFT call hospital to SNF, we were informed we'd need an RN along as well that will take charge of the call. They have a company car that they met us in the hospital with. When we gathered the patient (which did require ALS level of care), I loaded the patient in the rig (I was the driver, my partner the attendant) and the RN then asked my partner to follow behind us in the RN company vehicle to the SNF. My partner had no issue with this as it wasn't uncommon for RNs to ask and the patient is in a higher level of care.
> 
> Once we were finished with the call, the RN left in their company vehicle and dispatch asked us to drive the RN back to the hospital to which I informed them of what had happened. Dispatch said that they were aware of RNs doing this but it needed to be curbed. Later a supervisor found out and issued a suspension to both myself and my partner, with the RN having a separate supervisor that didn't give any sort of reprimand to the RN other than "don't do it anymore."
> 
> ...



You likely need 2 EMS personnel in the Ambulance at all times you are "In Service".


----------



## AVALANCHE (Nov 4, 2013)

Christopher said:


> You likely need 2 EMS personnel in the Ambulance at all times you are "In Service".



Myself as the driver and the RN? Or is the RN not technically considered EMS?


----------



## epipusher (Nov 4, 2013)

Did the supervisor not offer a specific reason for the suspension? Maybe ask him/her to sit down and discuss the policy?


----------



## AVALANCHE (Nov 4, 2013)

epipusher said:


> Did the supervisor not offer a specific reason for the suspension? Maybe ask him/her to sit down and discuss the policy?



They are reviewing our incident reports and are "investigating". Though I've never heard of anyone in the company coming back from a suspension. I'm waiting for them to contact me and I will demand a detailed explanation. Forgot to mention in my original post that this type of thing isn't mentioned in the new 80 page company policy manual we just received. Also if it's a known issue they never sent an e-mail bulletin to employees about it, in no way shape or form has this "zero tolerance policy" been communicated to us. And they usually send a lot of e-mails. Like having a blind patient doesn't excuse them from giving a signature. Y'know, important things like that.

Still can't find a violation of OC policy on their site.


----------



## Tigger (Nov 4, 2013)

AVALANCHE said:


> Still can't find a violation of OC policy on their site.



Just because it's not against county (or whatever authority you work under) policies doesn't mean you can't get suspended for it.


----------



## AVALANCHE (Nov 4, 2013)

Tigger said:


> Just because it's not against county (or whatever authority you work under) policies doesn't mean you can't get suspended for it.



But that was the excuse they were trying to use, that a county policy was violated. How about a policy that isn't even written in a manual for the company?


----------



## Akulahawk (Nov 4, 2013)

Yes, for an ambulance to be in-service as an ambulance, even with a patient on board being attended to by physicians or nurses, there must be at least 2 EMT's on board as well. Here's where things get interesting. A nurse isn't considered an EMT for purposes of that requirement, so an EMT and a Nurse on an ambulance does not = in-service ambulance, nor does having a 2nd EMT following the ambulance make it so. If the RN is also certified/licensed as an EMT or higher, then an EMT driver and an RN/EMT combination does equal a legally in-service ambulance. Being that I'm going to keep my Paramedic License after I get my RN license, should I ever start doing CCT-RN transports, I will be able to be on the street with an EMT partner and be legally OK as there will be 2 EMT personnel on board, one of whom would also be an RN. 

Clear as mud? In short, it completely depends upon the EMT or EMT-P status of the RN you had with you as to whether or not a violation actually occurred.


----------



## Mufasa556 (Nov 4, 2013)

There's a company in OC that runs one EMT and one RN on a rig. I don't believe OCEMS has a policy against it. If your company has a policy that requires two EMTs to be in a rig for it to be inservice, then you violated company policy and get written up.

You'll have to find out if it's against company or county policy.

Just remember, the nurses provide a higher level of service (more $$$ for the company) and are more educated. EMT management doesn't have authority over the RNs and the RN managers laugh at the silly things EMT ops make issue of. 

We had a night CCT unit held over 2hrs for a scheduled pick up. The pick up wasn't for another 45mins and the crew only had a 20min drive time to the hospital. The crew stopped to get coffee as running the call wouldn't allow them to get off until 11am. Dispatch flipped, stated they were not authorized to stop and they were delaying the call. Supervisors got involved and suspended the crew. The RN was told that they had to ask permission to stop. Nothing more. That's just how it is in private EMS. EMTs are dime a dozen and companies exploit that.


----------



## ZombieEMT (Nov 4, 2013)

Mufasa556 said:


> Just remember, the nurses provide a higher level of service (more $$$ for the company) and are more educated. EMT management doesn't have authority over the RNs and the RN managers laugh at the silly things EMT ops make issue of.



Hmmm... I think it is possible that you have the wrong idea. A RN is a higher medical authority than an EMT and when it comes to patient care, a RN does make the final decision if they are the highest licensed profession. That does not mean that EMT Management does not have authority over the RN within the company. 

I work for a company in NJ that does BLS and SCT (or CCT) transports. A RN is not any further up the chain of command than an EMT, just in patient care of a SCT patient. When it comes to policy, it does not matter if you are an RN or EMT, you follow it or can be reprimanded. In fact, of the 4 supervisors, only one is an RN. No supervisor is higher than than the other, just different tour and shift. In the upper management, the only RN is the director of clinical care/sctu coordinator. The CEO/COO/Director of Operations, none are RNs.


----------



## ffemt8978 (Nov 4, 2013)

Just a guess, but your partner not technically "attending" the patient means they can not bill insurance and Medicare/Medicaid for the transport.  This "common practice" probably cost the company a few hundred dollars in revenue and may lead to investigations of insurance/Medicare fraud if it has been an ongoing practice.


----------



## mycrofft (Nov 4, 2013)

Tigger said:


> Just because it's not against county (or whatever authority you work under) policies doesn't mean you can't get suspended for it.



true dat


----------



## JPINFV (Nov 4, 2013)

HaleEMT said:


> I work for a company in NJ that does BLS and SCT (or CCT) transports. A RN is not any further up the chain of command than an EMT, just in patient care of a SCT patient. When it comes to policy, it does not matter if you are an RN or EMT, you follow it or can be reprimanded. In fact, of the 4 supervisors, only one is an RN. No supervisor is higher than than the other, just different tour and shift. In the upper management, the only RN is the director of clinical care/sctu coordinator. The CEO/COO/Director of Operations, none are RNs.




I'm sure there's an argument that, based on the nursing practice act, supervision of the practice of nursing care must be done by nurses. That doesn't mean that the CEO has to be a nurse since the CEO is more often directing the strategic direction of the company than providing direct QA. However the clinical chain of command supervising the company's nursing staff isn't going to have non-nurses involved.


----------



## firecoins (Nov 5, 2013)

Mufasa556 said:


> Just remember, the nurses provide a higher level of service (more $$$ for the company) and are more educated. EMT management doesn't have authority over the RNs and the RN managers laugh at the silly things EMT ops make issue of.



I make fun of the the silly things EMT/Medic ops make issue of.  That's not exclusive to RNs.


----------



## Uclabruin103 (Nov 5, 2013)

It's wrong of them to do that. When i worked for a private as an EMT if a nurse said jump, we'd always ask how high. They're the senior people of the company who should know more than us about everything.


----------



## ZombieEMT (Nov 5, 2013)

As stated (and quoted by you) there is a RN in the upper management. The Director of Clinical Care/SCT Coordinator is an RN, he is the person that oversees the clinical aspect of the nursing. However, there are still company supervisors and upper management that have authority over nursing staff when it comes to policy. This includes things like absentees, tardies, harrassments, driving incidents, scheduling conflicts, hiring, raises/promotions, etc.

 I did not say there are no RNs, but there are few. Our Chief/CEO is only and EMT/EMT Instuctore, the supervisors (except for one that happens to be an RN) are EMTs. The one RN that is a supervisor does not even meet the state standards for RN on SCT trucks, so can not even function in her nursing capacity while working.


----------



## ZombieEMT (Nov 5, 2013)

With all that said, again, the Director of Clinical Care/SCT Coordinator oversees the "practice of nursing" or clinical aspect of the RNs. However, he also oversees the EMTs, and provides the QA for all clinical aspects.


----------



## Mariemt (Nov 5, 2013)

Most of the time RNs don't work for the ambulance but for the hospital the transfer is coming from.  Our pokicy is 2 EMTs or paramedics must be in the ambulance


----------



## ZombieEMT (Nov 5, 2013)

That's not here. Our nurses are employees of company.


----------



## JPINFV (Nov 5, 2013)

Mariemt said:


> Most of the time RNs don't work for the ambulance but for the hospital the transfer is coming from.  Our pokicy is 2 EMTs or paramedics must be in the ambulance


Nope... the CCT RNs in So Cal are employed by the ambulance service.


----------



## AVALANCHE (Nov 5, 2013)

Thanks for all of the info and replies everyone!

I was able to contact OC EMS and they DO NOT require an EMT with an RN in the patient compartment. However in LA County they do.


----------



## medictinysc (Jan 4, 2014)

I have only one question why did u need an RN?  Can your medic not perform ALS skills interfacility?


----------



## Akulahawk (Jan 4, 2014)

medictinysc said:


> I have only one question why did u need an RN?  Can your medic not perform ALS skills interfacility?


I would hazard a guess that the particular county they were operating in does not allow ALS IFTs by Paramedics, so an RN would have to take those calls where the patient must be monitored by someone with > BLS level capability, in other words, someone authorized to provide > EMT level care in that county.


----------



## medictinysc (Jan 4, 2014)

Ok thanks


----------



## TheLocalMedic (Jan 5, 2014)

Here we occasionally have an RN or MD from a hospital accompany on high acuity transfers.  We have our own CCT unit, but because the RN works for/has been trained by the company they are allowed to accompany a patient without another EMT in the patient compartment.  However if personnel from outside the company are attending, then we always require an EMT or medic to be with them in the patient compartment at all times.  The reasoning is that WE know what's in the back of the ambulance and how to work it (even something as simple as the lights or AC) and others do not.


----------



## Akulahawk (Jan 5, 2014)

TheLocalMedic said:


> Here we occasionally have an RN or MD from a hospital accompany on high acuity transfers.  We have our own CCT unit, but because the RN works for/has been trained by the company they are allowed to accompany a patient without another EMT in the patient compartment.  However if personnel from outside the company are attending, then we always require an EMT or medic to be with them in the patient compartment at all times.  The reasoning is that WE know what's in the back of the ambulance and how to work it (even something as simple as the lights or AC) and others do not.


When I was in the field, our own in-house policies were similar, however we always required 2 "field" certified personnel to be on-board the ambulance anytime we were using it. Most of our RN personnel didn't have current EMT or Paramedic certs. Any time we had a patient in the back being attended to by non-company Nurses, RTs or MDs, we had to have a company EMT or Paramedic in the back.


----------

