# Hangover Clinics and Paramedics



## Vegas Medical (Jan 31, 2015)

I have seen some hangover clinics here in Las Vegas that are using paramedics to give IV treatments for hangovers.  My understanding is that medics can only give IV meds when working for an EMS unit.  Does anybody else know the rules on this?


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## DesertMedic66 (Jan 31, 2015)

Doesn't have to be an EMS unit. As long as they have a medical director It's normally fine. Even in EMS units paramedics and EMT still have to have a medical director to operate.


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## Vegas Medical (Jan 31, 2015)

That is what some people have said, but the term "Medical Director" only applies to EMS units under the SNHD regulations.  A medical clinic is not an EMS unit, so there is no "Medical Director" like there is for an EMS unit.   The whole thing is a bit confusing, but even in hospitals, I have seen medics being able to start IV's, but they cannot push IV drugs.


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## Chewy20 (Jan 31, 2015)

Vegas Medical said:


> I have seen some hangover clinics here in Las Vegas that are using paramedics to give IV treatments for hangovers.  My understanding is that medics can only give IV meds when working for an EMS unit.  Does anybody else know the rules on this?


 
Are they actually giving meds or are they just pushing fluid? Wouldn't see any benefit besides normal saline. If they are, then its possible they are working under a doc who may own the company.

I had a medic talking to me about how he was going to start his own business doing this here in Texas. Don't know why people would waste their money. Saw a story on the news that people were paying this doc $400 per visit for IV therapy for hangovers.


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## cprted (Feb 1, 2015)

Chewy20 said:


> Saw a story on the news that people were paying this doc $400 per visit for IV therapy for hangovers.


There's a sucker born every minute.


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## teedubbyaw (Feb 1, 2015)

There was a bus in austin that did it. Not sure if it's still around.


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## chaz90 (Feb 1, 2015)

I don't know. I imagine if they're offering some electrolyte therapy and anti-emetics it could make people feel a bit better. I don't begrudge these guys the opportunity to make some cash. If hungover adults want to spend $400 bucks a pop for an IV, couple liters of saline, and 4 mg of Ondansetron, more power to the guys earning money. That's capitalism man.


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## Vegas Medical (Feb 2, 2015)

I talked to the folks at the Southern Nevada Health Division, which oversees EMS operations here in Southern Nevada.  They told me that EMTs and Paramedics are only licensed to touch patients when they are "clocked in" at a licensed EMS unit, such as AMR, Medicwest, or one of the County Fire Departments, or similar EMS unit.  A medical clinic is not an EMS unit.  

The people working for the hangover clinics are basically practicing medicine without a license, which is against the law.

I figured this was the case.   They also confirmed that the term "Medical Director" only applies to EMS units.  If the EMT/Paramedic is not "clocked in" at their EMS unit, then a medical director is not relevant.  A medical director only covers their activities when they are working on a rig or special event for their EMS unit.  

Things may be different in states other than Nevada, but a paramedic cannot push IV drugs, or even hook up a bag of a saline for a hangover clinic or hydration clinic.  Any patient who wants prescription medications has to be physically seen by an MD, PA, or nurse practitioner.  A bag of saline is a prescription medication.

The phone number for SNHD EMS is 702-759-1050 if people want to get it straight from the source.


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## DesertMedic66 (Feb 2, 2015)

call the company and ask. We have some places here who hire paramedics to work in post op centers for them to start IVs and use their ACLS cert if needed. They normally just work under the direction of the MD and their official title is not paramedic.


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## Tigger (Feb 2, 2015)

It is possible that they are not working as paramedics. If they are working directly under a doctor and that doctor is willing to take liability for their actions (and their insurance is ok with this), it may be fine. I used to work under a doctor when I did sports medicine in college. While I was an EMT I could do whatever I was comfortable with and trained in by my ATC boss.


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## Vegas Medical (Feb 2, 2015)

That is a good point you bring up.  Per the Nevada Medical Board, a "medical Assistant" can do just about whatever the physician trains them to do, so long as the physician is in the building.  I can find the Nevada Statute regarding that, but the doc has to be in the building.  The problem is these medics are taking Rx meds off to hotel rooms without a physician present.  They are "Han Solo" which is not copacetic with the law.


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## Tigger (Feb 2, 2015)

I guess I really don't see the issue here...what is your concern?


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## SandpitMedic (Feb 3, 2015)

Haha. Han Solo? That's funny.

Soooo... Are you looking to sue someone orrr are you looking for a job? Writing a thesis? An entrepreneur? 

If a doctor gives you orders... You're covered; they work under him and are not titled 'paramedics'. 

Yes, rich people pay big bucks for specialized services to come to their hotel room and give them fluids, banana bags, zofran, etc...

It's Vegas... Business finds the loopholes to make it legal. They have billboards and adverts. It is widely known. If it was illegal then they would shut it down. 

The guys make good tips for the customer service they provide. 

Is that completely on the level? I'm not a lawyer. But club hosts, dealers, valets, etc dealing or being the middle man for drugs and prostituion sound like a bigger deal than a trained medical professional providing actual relief from ones after-party symptoms.

Wouldn't you say?


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## Handsome Robb (Feb 3, 2015)

I'm confused as to the point of this thread...

I guess what I'm saying is who cares?? They're acting as an extension of the physician and treating patients...

Are you a nurse who's feeling like these Paramedics are impeding on your territory?


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## Carlos Danger (Feb 3, 2015)

Vegas Medical said:


> *The people working for the hangover clinics are basically practicing medicine without a license*, which is against the law.



No, not necessarily.

I don't know the first thing about Nevada, but many states allow what is called "delegated medical practice", the specifics of which vary by state of course, but which basically means that a physician can train and authorize just about anyone to perform just about any act, as long as the physician supervises and accepts complete responsibility for the individual's training and actions.

Based on my 0.76 second Google search, it looks like Nevada is one of these states. If that is the case, then paramedics doing this may not be practicing under authority of the state EMS agency or an EMS medical director, and still be perfectly legal. In essence, they aren't working as paramedics as all; they are just laypeople that the doctor running the drunk tank hired, trained to administer whatever they're administering, and supervises.

This was the very first result I got when I searched "Nevada delegated medical practice":

"After several abortive attempts by the Board to promulgate medical assisting regulations, the Nevada Legislature took matters into its own hands and passed Senate Bill 294 on the final day of the 2011 session. The bill confirms the authority of medical assistants to possess and administer “dangerous drugs” (i.e., any medication requiring a prescription, other than controlled substances) “at the direction of the prescribing physician and under the supervision of a physician or physician assistant.”5 SB 294 authorized the Board of Medical Examiners and the State Board of Osteopathic Medicine to develop regulations further addressing the delegation of administration of dangerous drugs to MAs (as of this writing, neither board had initiated such rulemaking proceedings). The bill also cre- ates a statutory definition of “Medical assistant”: an unli- censed person who performs clinical tasks under the supervision of a physician, an osteopathic physician, or a physician assistant; and does not include a person who performs only administrative, clerical, executive or other nonclinical tasks."​


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## SandpitMedic (Feb 4, 2015)

@Vegas Medical 

Where are you? We are awaiting your reply.


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## Chimpie (Feb 4, 2015)

I saw a news story about this a couple months back about a place in Tampa that's doing this. I believe they said the fee was $150.

Edit: $140 + extras

http://www.tampabay.com/news/busine...o-customers-to-cure-fatigue-hangovers/2190146



> The HangIVer Bar offers five kinds of IV treatments, or cocktails, which cost about $139 each. Extra doses of Vitamin C, Toradol (a pain killer) and Glutathione (an antioxidant) cost an additional $25 to $30.





> Treatments last about 30 minutes and are administered by paramedics from local fire departments who work at the spa part time. The needles are slightly bigger than ones used to draw blood at doctors' offices but smaller than ones for donating blood.


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## NomadicMedic (Feb 4, 2015)

They're hiring here in Georgia. I haven't applied, but may. I could use the extra cash.


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## Ewok Jerky (Feb 8, 2015)

Depending on state regs this is no different than a phlebotomist starting a line.  Or Joe Schmoe from of the street hired to be an ER tech or MA after some OTJ training.  A lot of these everyday tasks of "practicing medicine" are NEVER performed by docs. In my ED codes are run with the doc standing in the corner with his arms folded directing the team, not physically doing anything.  Then the doc sits at the computer and "practices medicine" by clicking on order sets with the mouse. The point is I guarantee there is an MD being paid to supervise and anybody's  toes are being stepped on its the nurse's union. But it really doesn't sound like anything shady going on here to me.


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## Vegas Medical (Feb 15, 2015)

If a EMT/paramedic is working outside of a licensed EMS unit, they are a medical assistant.  Per Nevada law, a MA can do quite few things if the physician is physically present in the building directly supervising them.  This is how medics, etc can place IVs in the ER.  An IV catheter is a prescription item by the way, just as is a bag of saline.  The problem with what is going on here in Las Vegas is that medics are being sent out to hotel rooms to treat clients for hangovers and the patient is not being physically seen/supervised by a Physician Assistant or Doctor.  This is governed by NRS 453.3643 that states that a patient must be physically seen by a midlevel or higher every six months to be directly given a prescription medication or a written prescription.   NAC 630.820 states that a MA cannot be remotely supervised. 

One person above asked what the point of this thread was and it is to get information together regarding these issues.  The result is that if an MA is going out giving prescription medications to a patient who has not been physically seen by a midlevel or higher, they can be found guilty of a Class B felony.  3 years in prison and fines of up to $100,000. 

The rules governing this are complex, but the information above is factual straight off the Nevada Government website.   I have also contacted the Southern Nevada Health District and they confirmed that Medics are not licensed to do anything other than be a medical assistant outside of their employment at an EMS unit.

I talked to the EMS office in Georgia and the hydration business there has a physician assistant on-site supervising the Medics.  That is the key issue is that somebody who holds an actual license to prescribe medications has to physically see these patients.  If you want, PM me and I can email you the actual regulations.  I did attach them to this post.  Not sure how they will show up.


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## Tigger (Feb 15, 2015)

And what do you plan to do with this information?

It seems like you have the answer you want.


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## Ewok Jerky (Feb 15, 2015)

Tigger said:


> And what do you plan to do with this information?
> 
> It seems like you have the answer you want.


Its a crusade.  I would bet OP is either a competitor, disgruntled former employee, or a vengeful ex-spouse.  This is a lot of work to go through to present all this on this forum.  The regulations that were just posted are annotated.

On topic: I don't know about going into hotel rooms, but a hangover "clinic" could certainly be supervised just the same as an special event with regards to the law.  And what to say these "medics" going up to hotel rooms to hang a bag aren't working off established protocols from the medical director, and have a line of communication for med control if needed? Not much different from a private company responding to a private (non 911) call, treat on scene with a refusal by the patient for transport.


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## Vegas Medical (Feb 15, 2015)

I am peripherally involved with EMS in Nevada and have an interest in a concierge medical company here in town.  I was hoping to get more information from people on this forum, but nobody really had any good information.  I have spent the last month getting the information together.  

Yes, if a physician or PA is supervising the MA in person, it is all good.  

If the EMT or Paramedic is "clocked in" for a licensed EMS unit, they can do a wide variety of things per their licensing with the appropriate regulatory body.  

But, if they are not "clocked in" for a licensed EMS unit, they function as a medical assistant (MA.)  An MA can do quite a bit if a physician or PA is supervising them in person.  The Nevada regulations do not allow for prescribing or supervision of MAs remotely via phone or otherwise.   It must be in person.  So, a paramedic or EMT going to a hotel room to give somebody a bag of IV fluid is a Class B felony if a physician or PA does not go with them physically.  

People can interpret this thread however they want, but there is clearly quite a bit of confusion.  We thought about employing medics in a similar fashion as some of these other operations in town, but decided not to once we did our research.  EMS personnel should do their own homework before signing up for one of these other outfits.  

This whole "medical director" thing has caused an enormous amount of confusion.  A "medical director" is only valid for a licensed EMS unit such as AMR, Medicwest, or similar.  For a medical clinic, the term "medical director" means absolutely nothing.

This is a crusade of sorts....to keep people from going to jail.


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## chaz90 (Feb 15, 2015)

The very same law you posted (NAC 630.820) mentions that remote supervision of a medical assistant is authorized if the delegating practitioner is A. located a significant distance away from the patient or B. Available immediately by phone. 

I'm no lawyer, but to me this seems like having the doctor live out of town or carry a phone that he/she can answer anytime during working hours of his medical assistants will fulfill the requirement. 

If you don't have some kind of strange crusade against these businesses why are you trying to create problems in what appear to be wholly legitimate and legal services to people who request their services? Perhaps it's just me, but I still can't figure out the point of this thread. You seem to have the information you want separate from the opinions we've provided.

If you are starting a concierge medical business and don't want to hire paramedics, don't. Seriously, hire whoever you want at whatever level of training and pay they require and price your services accordingly. Best of luck with your business endeavors!


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## Vegas Medical (Feb 15, 2015)

Please read the regulation again.  It is odd, but it is there in black and white.  A medical assistant can be supervised remotely if they are in a "rural area".  It specifically states that Las Vegas is not a rural area. 

Yes, it is BS that people in rural areas get a different level of healthcare, but governments do not always make laws in a logical fashion.......


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## Vegas Medical (Feb 15, 2015)

And also, in the rural area, the patient has to have been physically seen by a prescribing provider (doctor or PA-C) before anything can happen.  The MA can only do things remotely in a rural area for followup visits.


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## Ewok Jerky (Feb 15, 2015)

I worked a for a private ambulance service, with a medical director.  We did not respond to 911 calls but to private calls from SNFs, offices, private citizens whatever.  We also did standbys for parties, concerts, events, fairs, sports, BP clinics, walks, runs whatever.  We would often treat on scene and release for all kinds of stuff. We used local protocols.  We would transport if needed, wouldn't if it wasn't, and would handle RASs and AMAs just like a 911 ambulance. My medic was well within his rights to start a line, give whatever was indicated, DC the line and release the patient accordingly.  I'm not saying this happened often, we weren't running a hangover clinic, but it was certainly legal from an EMS perspective.  

I don't see this situation as any different from a medic from a private service fielding a private call to a hypoglycemic crisis, administering d50 through a line, charging for their services and taking off.

Would I want the liability of owning such a business? No.  But I do think it is legal in hypothetical sense, not knowing what all the laws are in NV besides the annotated ones you presented here.


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## triemal04 (Feb 15, 2015)

Vegas Medical said:


> This is a crusade of sorts....to get rid of my competition.


I went ahead and fixed that for you.


chaz90 said:


> If you are starting a concierge medical business and don't want to hire paramedics, don't. Seriously, hire whoever you want at whatever level of training and pay they require and price your services accordingly. Best of luck with your business endeavors!


Most likely he is trying to start the exact same type of buisness and can't figure out a way to do it as cheaply and easily without using paramedics.  And since he can't do that, and is a late comer to a party that already has at least one established group doing it, is now looking for a way to drive them out of buisness/scare off any employees so that he can increase his market share.

Of course that just the most likely explanation...


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## Vegas Medical (Feb 15, 2015)

One of the key issues here is that none of these hydration/hangover clinics have an EMS license.  This thread has gotten a bit long and I think that fact got lost in all thread.  

Yes, ambulance companies can do all sorts of things with their medics.  But, they have an EMS license.  These other operations don't and the EMTs and paramedics are putting themselves at high legal risk working for them, as they are only medical clinics, not EMS units.


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## MonkeyArrow (Feb 15, 2015)

@Vegas Medical If you're so worried about the legality of such operations, why don't you give the regional health district having jurisdiction over this geographical area a call and see what they say about it? If it was illegal, I am 99.9999999% that it would have already been shut down, judging by the fact that these companies have been featured in the news and advertise. Ask said health officials what licenses they have/need to operate. Make sure to report back to us and let us know what they say.


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## SandpitMedic (Feb 15, 2015)

http://www.hangoverheaven.com/in-room-treatments-2/

That there is a link to one of the most popular providers of the service we are talking about. Specifically, a link to the "in room therapy."

@Vegas Medical, can you read the 2nd and 3rd lines of the first paragraph to the jury please?

In case you can't, here is the text:

"At Hangover Heaven, we can treat you in the comfort of your hotel room.  We will send our physician, physician assistant, or nurse practitioner to your hotel room, along with an assistant to make sure your treatment is as professional and efficient as possible."

Does this answer your question and/or clearly display the way these companies are doing this legally?

I am a paramedic in Las Vegas. I'd work there per diem, and I know folks that do. There are no issues, and the governing agencies that oversee this type of practice are hard at work ensuring that it is all done on the level.

Rest assured... The only way you'd be able to prove that there was not in fact, a mid level provider present, would be to secretly record the meeting in your room. HOWEVER, since you're such a lawyer you must know that in the great State of Nevada, it is a class D felony (http://www.leg.state.nv.us/NRS/NRS-200.html#NRS200Sec690) to do so without the consent of the parties being recorded in any way.

SO... Good luck in your shady crusade.... Know when to hold 'em and when to fold 'em though.

Quit trying to stir the pot. Just go with the flow. It's VEGASSSS, baby!

And if your intent is not shady, lay all your cards on the table.


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## SandpitMedic (Feb 15, 2015)

@MonkeyArrow 
He already has been bugging the Health District. They just aren't as interested in it as he is.


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## irishboxer384 (Feb 16, 2015)

This is all too complex and tedious, it'd be much easier to just lease out the services of some attractive females on the strip


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## triemal04 (Feb 16, 2015)

Jeebus...this is ridiculous. 

Let's be objective for a second.  You came here to ask a question...that you already had an answer to.  Each time someone pointed out exceptions to your answer you counter with dire threats about what will happen to anyone who does that, up to now including going to jail.  You have a financial stake in a buisness that either is, or probably would like to perform the same services as you mentioned in the beginning.

Hmmmm....gee I wonder what could be going on here...


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## Cdurham0510 (Apr 27, 2022)

Vegas Medical said:


> I have seen some hangover clinics here in Las Vegas that are using paramedics to give IV treatments for hangovers.  My understanding is that medics can only give IV meds when working for an EMS unit.  Does anybody else know the rules on this?


Where can I find a lot of information on this?


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## CCCSD (Apr 27, 2022)

Cdurham0510 said:


> Where can I find a lot of information on this?


Read the thread. Stop necroposting.

Mods. Please close this thread.


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## HardKnocks (Apr 27, 2022)

CCCSD said:


> Read the thread. Stop necroposting.
> 
> Mods. Please close this thread.


Take a Chill Pill......

Some States allow Scope of Practice for IV Therapy Nurses that do home calls.  

AZ. Mobile IV Therapy


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## CCCSD (Apr 27, 2022)

HardKnocks said:


> Take a Chill Pill......
> 
> Some States allow Scope of Practice for IV Therapy Nurses that do home calls.
> 
> AZ. Mobile IV Therapy


WTF?  No one cares about IV nurses, nor your view. This is a seven year old thread that had all the information needed.

You can go now.


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## HardKnocks (Apr 27, 2022)

CCCSD said:


> WTF?  No one cares about IV nurses, nor your view. This is a seven year old thread that had all the information needed.
> 
> You can go now.


Regardless; Your inaccurate data is still in play.

EMT's that have only practices in over-regulated jurisdictions are shocked when EMT-B can legally do in some States , what they cannot as EMT-P or higher.

Example;

Here's a list of Special Skills that a Medical Director can train and sign off an EMT-B in AZ.
AZ EMT Special Skills


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## Jim37F (Apr 28, 2022)

HardKnocks said:


> Regardless; Your inaccurate data is still in play.
> 
> EMT's that have only practices in over-regulated jurisdictions are shocked when EMT-B can legally do in some States , what they cannot as EMT-P or higher.
> 
> ...


CCCSD literally only said "read the 5 year old thread that already has all the answers to the question you (Cdurham) asked"

Why are you jumping down his throat like they said the concept doesn't exist? We're all quite well aware that different jurisdictions have different scopes of practice including ones that let EMTs start IVs and give some meds....

Which has nothing to do with Cdurham's question on Paramedics doing IV for hangovers...


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## Cdurham0510 (Apr 28, 2022)

Hey thanks for the info guys! 🙏🏻


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## ffemt8978 (Apr 28, 2022)




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