# Turn over of care from school nurse



## bigbaldguy (Oct 10, 2011)

This is a question that would probably be better answered on a nursing forum but I'm too lazy to find one. 
I've been on several calls to schools where a minor is under the care of a school nurse but needs to be transported. In every case where transport was required the nurse has handed care over to us and we take the kid. My question is how does this work considering that a patient is only supposed to be released to a provider of equal or greater care level. In my case there was always a medic so it could be argued there is a parity of skill but what happens if a BLS truck answers the call?


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## Anjel (Oct 10, 2011)

I don't think the same rules apply.

For example..Nursing homes. 

They call 911. We come and take their pts to wherever they need to go. They are giving us the pts to take to the hospital and turning over care. 

I think it is just once EMS has care we have to turn it over to to someone with a higher cert. 

But the same rules don't apply when they call you to take their pts somewhere.


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## exodus (Oct 10, 2011)

bigbaldguy said:


> This is a question that would probably be better answered on a nursing forum but I'm too lazy to find one.
> I've been on several calls to schools where a minor is under the care of a school nurse but needs to be transported. In every case where transport was required the nurse has handed care over to us and we take the kid. My question is how does this work considering that a patient is only supposed to be released to a provider of equal or greater care level. In my case there was always a medic so it could be argued there is a parity of skill but what happens if a BLS truck answers the call?



The nurses SOP available to her may also be much smaller than what an EMT-B/Medic has. Knowledge, yes more, but I'm pretty sure school nurses carry any type of ACLS / Respiratory / etc drugs.


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## exodus (Oct 10, 2011)

Anjel1030 said:


> I don't think the same rules apply.
> 
> For example..Nursing homes.
> 
> ...



Nursing home are totally different as they are not truly 911 calls. Anything leaving a NH is an inter-facility transport where the patients doctor, or on call at the home must order the patient to be transferred.  The doctor specifics the level of care.


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## JPINFV (Oct 10, 2011)

bigbaldguy said:


> This is a question that would probably be better answered on a nursing forum but I'm too lazy to find one.
> I've been on several calls to schools where a minor is under the care of a school nurse but needs to be transported. In every case where transport was required the nurse has handed care over to us and we take the kid. My question is how does this work considering that a patient is only supposed to be released to a provider of equal or greater care level. In my case there was always a medic so it could be argued there is a parity of skill but what happens if a BLS truck answers the call?




So, in your area if a pediatric call doesn't need a paramedic, the paramedic can't hand over to an EMT? 

Also, ensuring continuation of care and requiring care always goes up are two different things completely.


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## bigbaldguy (Oct 10, 2011)

JPINFV said:


> So, in your area if a pediatric call doesn't need a paramedic, the paramedic can't hand over to an EMT?
> 
> Also, ensuring continuation of care and requiring care always goes up are two different things completely.



No Idea. We run ALS trucks so there is always a paramedic on the truck.


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## bigbaldguy (Oct 10, 2011)

Anjel1030 said:


> I don't think the same rules apply.
> 
> For example..Nursing homes.
> 
> ...



It didn't even occur to me that the same situation occurs when we pick up from a nursing home. You could well be right this may be strictly an EMS thing. I just assumed that the whole "you touch you own em" thing was universally applied.


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## Handsome Robb (Oct 10, 2011)

We run I/P trucks. Every call starts off as the I's call and the medic listens in for ALS keys. Once one is recognized the medic steps in and takes over. Once an ALS intervention has been performed care cannot be transferred back down to the I, if the medic deems the pt an BLS/ILS patient he can pass the patient back to the I.


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## WickedGood (Oct 10, 2011)

exodus said:


> Nursing home are totally different as they are not truly 911 calls. Anything leaving a NH is an inter-facility transport where the patients doctor, or on call at the home must order the patient to be transferred.  The doctor specifics the level of care.



No, nursing homes do call 9-11 sometimes for medical emergencies (and not so emergencies) it's not prearranged or ordered the pt has some emergent thing that needs to be addressed at the hospital.........


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## ArcticKat (Oct 10, 2011)

Not to mention interfacility transports.  We've done hundreds of emergency transports to trauma/cardiac/neuro...etc from outlying areas.  In that case we take over care from a doc.


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## mycrofft (Oct 10, 2011)

*It's an IFT.*

Also, arguably, the nurse's scope on station is much lower than the EMT or paramedic has and they are providing their knowledge in the form of a transfer form. 
Hopefully.
Now we need thirty more responses...:wacko:


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## Shishkabob (Oct 10, 2011)

It's not "equal level or higher" to the provider releasing care, it's "equal level or higher" to the care being provided / suspected of being needed / needed after transfer.

This is why EMTs can pick up BLS transfers from a hospital.  This is why a Paramedic can leave with a tech in the triage room at a hospital.



Plus, it's accepted that there may / may not be some drop off in capabilities during transport, so long as the patient is being transported to a facility that has better capabilities than the sending facility.


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## bigbaldguy (Oct 10, 2011)

Ok I think I'm getting it. I think perhaps I misinterpreted how the "release to equal or higher level provider" thing works.


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## exodus (Oct 10, 2011)

WickedGood said:


> No, nursing homes do call 9-11 sometimes for medical emergencies (and not so emergencies) it's not prearranged or ordered the pt has some emergent thing that needs to be addressed at the hospital.........



Of course they call 911, but they need some type of transfer order to release the patient to the care of the paramedics or EMT's. This is either written as a standing order that the charge RN has, or through a phone order the MD gives to the RN.


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## jjesusfreak01 (Oct 11, 2011)

exodus said:


> The nurses SOP available to her may also be much smaller than what an EMT-B/Medic has. Knowledge, yes more, but I'm pretty sure school nurses carry any type of ACLS / Respiratory / etc drugs.



A school nurse does primarily preventative/community health type work. Besides immunizations, I doubt they can do much more treatment wise than bandaids...

Nursing home staff are at an entirely different level. I recently realized that LPNs in nursing homes really aren't allowed to do much at all, and no staff member will really do anything for a patient without a written order, which is why we get called for every change in the patient's status.


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## exodus (Oct 11, 2011)

jjesusfreak01 said:


> A school nurse does primarily preventative/community health type work. Besides immunizations, I doubt they can do much more treatment wise than bandaids...
> 
> Nursing home staff are at an entirely different level. I recently realized that LPNs in nursing homes really aren't allowed to do much at all, and no staff member will really do anything for a patient without a written order, which is why we get called for every change in the patient's status.



Oops! I meant *DONT'* carry any of those drugs.... grawr.. Could a mod edit my post to say that? It totally throws the point of my post.


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## jjesusfreak01 (Oct 11, 2011)

exodus said:


> Oops! I meant *DONT'* carry any of those drugs.... grawr.. Could a mod edit my post to say that? It totally throws the point of my post.



Worry not, I noticed the mistake, and I wasn't responding directly to your post. Its fairly obvious what you meant to say.


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## BEorP (Oct 11, 2011)

Linuss said:


> It's not "equal level or higher" to the provider releasing care, it's "equal level or higher" to the care being provided / suspected of being needed / needed after transfer.
> 
> This is why EMTs can pick up BLS transfers from a hospital.  This is why a Paramedic can leave with a tech in the triage room at a hospital.



This is exactly it. And OP, I don't think you are the only one who is confused by this because I think it is often taught poorly in class.


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## truetiger (Oct 11, 2011)

Just because the school nurse is an RN, doesn't mean the care she is rendering is ALS. I can't think of any situations in which a school nurse would start ALS care. So if you show up and the nurse has only rendered BLS care, she can transfer her BLS care to your EMT.


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## Akulahawk (Oct 11, 2011)

jjesusfreak01 said:


> A school nurse does primarily preventative/community health type work. Besides immunizations, *I doubt they can do much more treatment wise than bandaids...*
> 
> Nursing home staff are at an entirely different level. I recently realized that LPNs in nursing homes really aren't allowed to do much at all, and no staff member will really do anything for a patient without a written order, which is why we get called for every change in the patient's status.


While an RN likely has the knowledge out of the gate to do some "ALS" interventions, they have a knowledge base that will allow them to learn those interventions later on. Over on a nursing forum, I've read some posts that some RN's haven't ever started an IV on a live patient until they got a job that required that skill...

School Nursing doesn't require that the RN know interventions beyond BLS. The school sites aren't set up for it. ALS interventions for those Nurses would be to call 911... I'd be very surprised if Local EMS systems _didn't_ consider calls to those locations to be a regular "scene" call. In those instances, EMS will often consider an RN on scene to be limited to BLS only anyway unless specifically authorized to provide advanced level care.


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## FFEMT427 (Oct 11, 2011)

In this instance I do think that it is like any other scene because the school is not a facility in the same way a hospital or NH is just because they have a nurse.
Its sad that "higher level of care " has to be defined by a piece of paper rather than knowledge and skills sets. I've had care handed to me from small outlieing hospital RN's that didn't even know what narcan is LOL


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## truetiger (Oct 12, 2011)

I wonder in which states is an RN license "higher" than a medic license? It's not the case here, we're on equal terms.


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## JPINFV (Oct 12, 2011)

I'm trying to figure out which state actually has a set list of the volume of each level's proverbial cup size. Are EMTs A while physicians DD? Additionally, do they rank sub-specialties?


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## Handsome Robb (Oct 12, 2011)

truetiger said:


> I wonder in which states is an RN license "higher" than a medic license? It's not the case here, we're on equal terms.



I don't have an EMT/Medic license. I have a certification and an Ambulance Attendant license relevant to my current level of practice.

I do know that our flight crews cannot turn over care to a ground unit whether it be a Medic or a CC-Medic, even if said Medic's main employment is flight and they are just filling a ground shift, but that's more protocol than anything.


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## JPINFV (Oct 12, 2011)

NVRob said:


> I don't have an EMT/Medic license. I have a certification and an Ambulance Attendant license relevant to my current level of practice.



Do you have a piece of paper from a government agency that grants you permission to engage in acts (such as providing medical care within a defined scope of practice) that are otherwise illegal to engage in?


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## Handsome Robb (Oct 12, 2011)

JPINFV said:


> Do you have a piece of paper from a government agency that grants you permission to engage in acts (such as providing medical care within a defined scope of practice) that are otherwise illegal to engage in?



My ambulance attendant's license allows me to do this under my protocols as defined by my Medical Director. My EMT/Medic cert doesn't allow any of the above.

edit: I should have worded my original post better. I don't have an EMT license. I have an EMT Certificate, however I do have an Ambulance Attendant's license for the level of EMT-I.

Certification = Demonstrated competence in a specific skill set.

License = privilege to practice within set guidelines.


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## AlphaButch (Oct 12, 2011)

Jems has a decent article on this.

JEMS article


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## Fish (Oct 12, 2011)

This always seem to be different in different areas of the States, in CA nurses were thought to be above Medics and Nurses gave Medics medical Direction. In Texas it is the opposite, Medics do not take direction from nurses and are on the same playing field. Infact most Doctors think of us as more closely related to them than to nurses. So what I am getting at is, if a nurse hands over care to a Medic it is thought to be a provider of equal care.


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## mycrofft (Oct 12, 2011)

*Sounds like airmen pulling rank based on hours in service.*

My experience in real world is each facility says their employees are superior to anyone else's except MD's and pharmacists.
Anyone who thinks RN's are better at emerge cy work due to their training is ignorant or disingenuous.
If a pt would benefit from a ride with an EMT, the best surgeon in the world will send him, if he care about pt outcome. No pre-determined absolute hierarchy like the military purportedly does.


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## HMartinho (Oct 13, 2011)

Enlighten me a question: Registered Nurses programs do not teach ACLS, BLS, pharmacology and emergency care?


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## JPINFV (Oct 13, 2011)

There's a huge difference between learning the basics in class and making it your specialty.


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## HMartinho (Oct 13, 2011)

And an E.R. nurse? or an ICU nurse, or critical care transport nurse/ flight nurse?

If you think so, a family doctor who works in an office, also has a lower "degree" of knowledge than an EMT-P, I guess...


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## JPINFV (Oct 13, 2011)

HMartinho said:


> And an E.R. nurse? or an ICU nurse, or critical care transport nurse/ flight nurse?
> 
> If you think so, a family doctor who works in an office, also has a lower "degree" of knowledge than an EMT-P, I guess...



When it comes to a medical emergency walking into a doctor's office, the first thing that primary care physician needs to do is pick up the phone and call 911. Yes, when it comes to handling a medical emergency, I'd rather have the average paramedic, than the average internal med physician. Otherwise you have people like Dr. Conrad Murry trying to revive a propofol induced respiratory arrest with chest compressions.

Also, are you suggesting that the average school nurse has a background in any of those fields?


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## HMartinho (Oct 13, 2011)

JPINFV said:


> When it comes to a medical emergency walking into a doctor's office, the first thing that primary care physician needs to do is pick up the phone and call 911. Yes, when it comes to handling a medical emergency, I'd rather have the average paramedic, than the average internal med physician. Otherwise you have people like Dr. Conrad Murry trying to revive a propofol induced respiratory arrest with chest compressions.
> 
> Also, are you suggesting that the average school nurse has a background in any of those fields?



And don't forget, he do CPR on a bed, instead putting him on the floor<_<h34r:

A school nurse is not an RN?

No, She/he not, but can provide first-aid  until the paramedics/emt's arrives.


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## JPINFV (Oct 13, 2011)

Not claiming they aren't. I'm claiming that they don't generally run emergencies, and thus in an emergency situation they should be expected to recognize an emergency exists, call 911, and begin care, and that care cannot, and should not, be compared to providers whose job is providing emergency care.


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## HMartinho (Oct 13, 2011)

JPINFV said:


> Not claiming they aren't. I'm claiming that they don't generally run emergencies, and thus in an emergency situation they should be expected to recognize an emergency exists, call 911, and begin care, and that care cannot, and should not, be compared to providers whose job is providing emergency care.



I see, and I  agree.

what I meant is that an ER nurse, or an ICU nurse learn pharmacology and ACLS too, but if a school nurse does not care for so many urgent patients as an paramedic or an ER nurse, this is also true.


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## Akulahawk (Oct 13, 2011)

HMartinho said:


> Enlighten me a question: Registered Nurses programs do not teach ACLS, BLS, pharmacology and emergency care?


In short, they're taught BLS, how to give meds by various routes (including IV), how to assess patients, and so on. They're not really going to be exposed or expected to learn to do rapid, emergent patient assessment and exercise a LOT of autonomy. It's not that they can't do it, it's that they just _don't_ do it enough to get really good at it. They do get a very good pharm education... but they don't likely commonly take a formal ACLS course. 

Thus, at times, having a Paramedic on hand is the better resource of the two... and the above is also why Nurses are usually restricted to BLS only care in the field.


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## Farmer2DO (Oct 13, 2011)

exodus said:


> Nursing home are totally different as they are not truly 911 calls. Anything leaving a NH is an inter-facility transport where the patients doctor, or on call at the home must order the patient to be transferred.  The doctor specifics the level of care.







exodus said:


> Of course they call 911, but they need some type of transfer order to release the patient to the care of the paramedics or EMT's. This is either written as a standing order that the charge RN has, or through a phone order the MD gives to the RN.




Keep in mind that different states do things in different ways.  In New York, a nursing home call is a 911 call, period.  It's billed to Medicare as a 911 call, and we take the patient to the ED, just like any other patient.  Sometimes the staff does call the doctor who orders them sent out, but often they just call 911 and call the doctor later to tell them they sent the patient out.  This avoids the mess that California seems to have regarding ambulances that can only do IFTs and can't do 911s.  All ambulances are in NY are NYS certified, meaning they can do all the jobs.  The only IFTs are coming out of hospitals and going to hospitals.  (Discharges to NHs or anywhere else aren't considered inter-facility.)


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## JPINFV (Oct 13, 2011)

Farmer2DO said:


> This avoids the mess that California seems to have regarding ambulances that can only do IFTs and can't do 911s.



...and where would that be in Califonria? There's a difference between a free for all, like NY City with the volunteer, voluntary, and FDNY (which I would consider a mess), and contracting out ambulance service to a specific company. Unless a contract dictates additional equipment, the equipment and staffing for EMT level ambulances in California is the same, regardless of if the company does 911, 911 and IFT, or just IFT.


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## Farmer2DO (Oct 13, 2011)

I'm going by what I've read on these posts about California.  If I mis-interpreted the way things are, that wasn't the intention.  

NYC is a free for all.  But I'm a 7 hour drive from there, and most of us consider it another world, and things are completely different Upstate.


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## rogersam5 (Oct 14, 2011)

Maine made it real simple for us... the last page in the protocol book is for Non-EMS system providers (bold print is exactly as written in the protocol):

Please be advised that these Emergency Medical Technicians are operating under the authority of the State of Maine and under protocols approved by the State of Maine. These EMS providers are also operating under the authority of a Medical Control physician and standing medical orders.

If you are currently providing patient care,
you will be relinquishing care
to these EMS personnel *and their Medical Control physician*.


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## JPINFV (Oct 14, 2011)

rogersam5 said:


> Maine made it real simple for us... the last page in the protocol book is for Non-EMS system providers (bold print is exactly as written in the protocol):
> 
> Please be advised that these Emergency Medical Technicians are operating under the authority of the State of Maine and under protocols approved by the State of Maine. These EMS providers are also operating under the authority of a Medical Control physician and standing medical orders.
> 
> ...



Over my dead body if I've initiated care that needs to be continued, yet are out of the scope of practice of the responding ambulance.


Edit: And let's include the rest of that page too...



> No individual should intervene in the care of this patient unless the individual is:
> 1. Requested by the attending EMT, *and*
> 2. Authorized by the Medical Control physician, *and*
> 3. Is capable of assisting, or delivering more extensive emergency medical care at the scene.



Which is, of course, irrelevant prior to the arrival of EMS, as the Maine Department of Public Safety does not regulate the practice of physicians anyways. 




> *If you are the patient’s own physician, PA, or nurse practitioner, the EMTs will work with
> you to the extent that their protocols and scope of practice allow.*
> 
> *If you are not the patient’s own physician, PA, or nurse practitioner,* you must be a Maine
> ...


No emphasis added. 


Apparently not as clear cut as you're leading us to believe.


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## rogersam5 (Oct 14, 2011)

JPINFV said:


> Over my dead body if I've initiated care that needs to be continued, yet are out of the scope of practice of the responding ambulance.



If you really want to i guess.... here is the rest of the protocol:

No individual should intervene in the care of this patient unless the individual is:
1. RequestedbytheattendingEMT,and
2. AuthorizedbytheMedicalControlphysician,and
3. Is capable of assisting, or delivering more extensive emergency medical care at the scene.

If you are the patient’s own physician, PA, or nurse practitioner, the EMTs will work with you to the extent that their protocols and scope of practice allow.

If you are not the patient’s own physician, PA, or nurse practitioner, you must be a Maine licensed physician who will assume patient management and accept responsibility. These EMT’s will assist you to the extent that their protocols and scope of practice allow. They will not assist you in specific deviations from their protocols without Medical Control approval. This requires that you accompany the patient to the hospital and that their Medical Control physician is contacted and concurs.

..............
But another question... what are you going to be able to do that the ambulance can't on scene. I mean I don't know one physician that caries around nearly as much crap as our ambulance does let alone a hospital.


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## usafmedic45 (Oct 14, 2011)

> But another question... what are you going to be able to do that the ambulance can't on scene. I mean I don't know one physician that caries around nearly as much crap as our ambulance does let alone a hospital.



Contrary to popular belief in EMS, what you pack around between your ears is often a lot more important than what's strapped to your belt, in your bags and on your truck.


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## JPINFV (Oct 14, 2011)

rogersam5 said:


> But another question... what are you going to be able to do that the ambulance can't on scene. I mean I don't know one physician that caries around nearly as much crap as our ambulance does let alone a hospital.



Depends on the patient. Let's say it's an OB call. Are you prepared to handle something like a shoulder dystocia? Additionally, there's the question of how much the physician can do with all of the crap on the ambulance that you can't. Airway if the paramedic is having issues intubating depending on the physician's specialty.


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## usafmedic45 (Oct 14, 2011)

> Depends on the patient. Let's say it's an OB call. Are you prepared to handle something like a shoulder dystocia?



I actually had the patient's doc on one of my deliveries show up on scene (he lived four houses down).  I've never been so glad to see someone in my whole life because it was a breech delivery.


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## rogersam5 (Oct 14, 2011)

JPINFV said:


> Depends on the patient. Let's say it's an OB call. Are you prepared to handle something like a shoulder dystocia? Additionally, there's the question of how much the physician can do with all of the crap on the ambulance that you can't. Airway if the paramedic is having issues intubating depending on the physician's specialty.



Thats a valid point and I was never trying to say the physician would be useless. I was just wondering if you started care and you didn't want to give up control of patient care what more can you do without the tools on the ambulance. Yes you may have better assessment skills or a wider range of procedures you can preform but how many of the procedures would you need some sort of tool or device to help you with?

If you actually know what you are doing and you can help the pt better then I or anyone else on the truck could, AND you wanted to go to the hospital with us, AND our medical control OKed it (I wouldn't imagine they wouldn't, they tend to let us have what we ask for) I have no problem just assisting you.... Heck I do it with medics all the time.

But in my experience every doctor that has sent a patient with us said "here you go, have fun" and the pt went with us alone and in many cases a physician could have helped them a lot more the the EMT necessarily could. I am guessing it has something to do with the 2 hour time commitment it is to accompany us to the hospital, not to mention the crap they would have to deal with at the hospital that we don't deal with.



Anyway enough of that... the moral is in our protocols it is fairly evident that the way Maine looks at it is that the provider is releasing to not just the EMT (maybe a "lower" license level) but their Medical Control Physicians (I can't think of someone higher then a Doctor in this food chain).  I wasn't trying to say that You absolutely had to relinquish care, how it appears the state "works around" the typical stipulation of "Equal level or Higher"


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## usafmedic45 (Oct 14, 2011)

> Thats a valid point and I was never trying to say the physician would be useless. I was just wondering if you started care and you didn't want to give up control of patient care what more can you do without the tools on the ambulance. Yes you may have better assessment skills or a wider range of procedures you can preform but how many of the procedures would you need some sort of tool or device to help you with?



It might not be doing something, as I tried to point out earlier, but rather it's easier to ride along and explain to the receiving physician in person than trying to play telephone through a much less well educated person.  Once again the idea that if you're not physically doing something to the patient there is no benefit rears its ugly head.


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## JPINFV (Oct 14, 2011)

rogersam5 said:


> Thats a valid point and I was never trying to say the physician would be useless. I was just wondering if you started care and you didn't want to give up control of patient care what more can you do without the tools on the ambulance. Yes you may have better assessment skills or a wider range of procedures you can preform but how many of the procedures would you need some sort of tool or device to help you with?



Again, depends on what's wrong with the patient and where you're picking the patient up from. What if you're picking the patient up from a clinic or doctor's office instead of a private residence or other place of business? Additionally, not every procedure needs tools, and not all tools are limited to just what EMS providers are trained on how to use them. 




> But in my experience every doctor that has sent a patient with us said "here you go, have fun" and the pt went with us alone and in many cases a physician could have helped them a lot more the the EMT necessarily could. I am guessing it has something to do with the 2 hour time commitment it is to accompany us to the hospital, not to mention the crap they would have to deal with at the hospital that we don't deal with.



Again, it depends on a lot of things. The biggest two questions are going to be, "Is the physician anything more than minimally competent, or are you dealing with Dr. Conrad Murray?" and "Is this patient in the physician's wheelhouse?" In general, the first question is a "yes" and the second question is often going to be a "no." However, the tone of "Don't do anything to the patient and you *must* hand the patient over to the ambulance crew" is something I disagree with.


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## rogersam5 (Oct 14, 2011)

JPINFV said:


> Athe tone of "Don't do anything to the patient and you *must* hand the patient over to the ambulance crew" is something I disagree with.



You are right and that wasn't the tone I was attempting to put out. I was just attempting to address the "You can only transfer to someone with a higher license than you" statement/phylosophy. In Maine it appears they take that out of the question by saying the provider is transferring care to "*And their medical control physicians*" That is why I didn't bother copying the bottom half of the page because it didn't deal with the point I was trying to make.


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## bigbaldguy (Oct 15, 2011)

rogersam5 said:


> You are right and that wasn't the tone I was attempting to put out. I was just attempting to address the "You can only transfer to someone with a higher license than you" statement/phylosophy. In Maine it appears they take that out of the question by saying the provider is transferring care to "*And their medical control physicians*" That is why I didn't bother copying the bottom half of the page because it didn't deal with the point I was trying to make.



I got it  By adding the words "And their medical control physicians" it makes it much clearer that we are receiving a patient not so much as a EMT but as extensions of our medical control physician.


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## BlakeFabian (Oct 16, 2011)

It's my understanding that (Based on my protocols) unless that RN is a part of the 911 system which she activated, then the abandonment issues don't pertain to her.

The RN there is providing care on behalf of that school. When you arrive, you'll initiate care on behalf of your EMS service. At that point the RN is supposed to provide a verbal report and a copy of all information she has received from the Pt thus far, then basically step back and let EMS do its thing.

You can also look at it a different way. Odds are the nurse at a school isn't going to initiate any kind of ALS care which would require continued ALS monitoring. She would, most likely, be providing BLS level care for that Pt which you could legally take over as a BLS provider.


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