Prehospital command hierarchy, fitting it in with the regular medical community

Linuss said:
If a doctor doesn't know how walk around something, I'd be slightly concerned as to their ability. :P
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I would much rather have an RN start a line on me than a MD.... god knows they are out of pratice.... and we have specialized RNs to start Central and PICC lines at my hospital- don't know if thats a common pratice though.

Regarding RNs having to get MD orders for everything that is simply not true- thought i almost did die of laughter when i was told that RNs have to notified the MD if they increase O2 beyond 4lpm...but that is to update the doc not to get permission to do so...

-When a patient is admitted they have blanket orders/Holding orders till they are seeing by their Hospitalist/Internist MD- and each floor has their own protocals... ICU protocals covers pretty much everything without an MD present- I work in the ICU and have only seen ER MDs up here at night- and only when they missed something... ICU RNs does everything around here- Each type of Admission also has signed protocal by the MD... like Sepsis or CHF- not unlike our protocals in the field... so yes if something is out of the ordinary- they call the doc- same as us.
 
AchilliesOmega3 said:
I would much rather have an RN start a line on me than a MD.... god knows they are out of pratice.... and we have specialized RNs to start Central and PICC lines at my hospital- don't know if thats a common pratice though.

Regarding RNs having to get MD orders for everything that is simply not true- thought i almost did die of laughter when i was told that RNs have to notified the MD if they increase O2 beyond 4lpm...but that is to update the doc not to get permission to do so...

-When a patient is admitted they have blanket orders/Holding orders till they are seeing by their Hospitalist/Internist MD- and each floor has their own protocals... ICU protocals covers pretty much everything without an MD present- I work in the ICU and have only seen ER MDs up here at night- and only when they missed something... ICU RNs does everything around here- Each type of Admission also has signed protocal by the MD... like Sepsis or CHF- not unlike our protocals in the field... so yes if something is out of the ordinary- they call the doc- same as us.
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Making generalizations that an RN is better than an MD at starting a line isnt good. Anesthesiologists would be pissed off...In fact tell that to them when you go in for surgery.

Also blanket orders? what type of orders?
I know most units have emergency standing order meds (larger list for ICU/ED), but unless all hell is breaking loose giving blanket orders to all admitted patients seems like crap medicine (though a hospital that has EM MDs in the ICUs at night sounds a bit iffy too).
 
silver said:
Making generalizations that an RN is better than an MD at starting a line isnt good. Anesthesiologists would be pissed off...In fact tell that to them when you go in for surgery.

Also blanket orders? what type of orders?
I know most units have emergency standing order meds (larger list for ICU/ED), but unless all hell is breaking loose giving blanket orders to all admitted patients seems like crap medicine (though a hospital that has EM MDs in the ICUs at night sounds a bit iffy too).
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Blanket Orders like Cardiac maintence meds, Fluids, Diet, Activity level, Labs, Cultures, types of Antibiotics, antienemics, pain management meds- and I stand by what I say about starting lines- not including Anesthesiologists- how many lines do MDs start- VS numbers of lines RNs start in ONE shift. EM MDs write cover orders for Attendings that admit the patients- they are call HOLDING orders till the Attendings/hospitalists gets in to see the patients- sometimes they follow-up on the patients in the ICU. The RNs and RRTs pretty much manage the patients by themselves at night in the ICU- OB/GYN have MD and NPs throughout the night for obvious reasons. Med/Surg and AOU have less Blanket orders but their patients are also more stable and have less parameters to work with- so if anything is out of the ordinary- MD has to be informed inorder to change/modify Tx- which can be obtained over the phone. When something goes south- Rapid response or if really bad- Code blue is called- guess who responds? Charge Nurse from the ICU, Charge Nurse from Telemetry, Most Senior Respiratory Therapist, RN Supervisor (usually a NP)- and sometimes the ER MD... in the hospital-Nurses run the show.
 
silver said:
Making generalizations that an RN is better than an MD at starting a line isnt good. Anesthesiologists would be pissed off...In fact tell that to them when you go in for surgery.
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Two words- Nurse Anesthesiologists.
 
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AchilliesOmega3 said:
in the hospital-Nurses run the show.
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In small community ICUs with low acuity nurses MAY run the show. Your not going to find all that many tertiary centers that don't have hospitalist or residents available 24/7.

A whole host of folks can start peripheral IVs...big fricking deal....
 
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I have a quick question for someone on here who has EMT training in the US. I read one of the posts on this thread saying that in parts of the US you can get your cert in a 120-150 hour course or something like three weeks? If so what is the EMT licenced to do there? just trying to compare to what my training was here in Canada.
 
EMTPassion said:
I have a quick question for someone on here who has EMT training in the US. I read one of the posts on this thread saying that in parts of the US you can get your cert in a 120-150 hour course or something like three weeks? If so what is the EMT licenced to do there? just trying to compare to what my training was here in Canada.
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In general, medical interventions include oxygen, OPAs, NPAs, PPV via BVM, AEDs, CPR, basic child birth, rigid catheter suctioning, oral glucose, and, in places that still carry it, activated charcoal. "Assisting" patients with their own nitro and epi-pens. Some places will include epi-pens, aspirin for suspected ACS (read "chest pain"), and inhaled beta agonist with varying levels of training. Trauma interventions are basic first aid, splinting, and spinal immobilization. Assessment is a basic head to toe along with a stethoscope (lung sounds, BPs) and blood pressure cuff. Some systems will include blood glucose testing, pulse oximetry, and/or 12 lead acquisition (not interpretation). Interfacility transports includes the ability to monitor basic IV fluids at TKO such as normal saline, D5W, lactate ringer, and TPN.
 
Thanks for the reply, sounds like there isn't a lot of differences. The only two things I've found are here we can give Our own Nitro and Epi (with permission from doc of course).
 
EMTPassion said:
Thanks for the reply, sounds like there isn't a lot of differences. The only two things I've found are here we can give Our own Nitro and Epi (with permission from doc of course).
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Yeah it really just depends. Some places have more 'rigid' protocols for EMT's and some are lax. Here we don't carry Epi pens usually because almost all the rigs(except for way out in the sticks) are ALS so the Paramedic can push Epi if needed. Usually EMT's can also give Nitro up to 3 doses either via tablet or spray on standing orders.
 
JPINFV said:
For your reading from this very forum:
'The patient had 1 beer, is A/Ox4, and has capacity, but we need to call medical control just in case' http://emtlife.com/showthread.php?t=25667

Contact medical control to prevent liability: http://emtlife.com/showpost.php?p=49156&postcount=2

Hey, this is completely out of my scope, but maybe medical control will say I can and I won't have any liability over it. http://emtlife.com/showpost.php?p=195714&postcount=46

"There is one advantage to always having to be under a doc. the liability insurance that each medic has is significantly less, as much of the burden can be pushed off on the doc " http://www.emtlife.com/showpost.php?p=201752&postcount=10

I could probably fine many more.

My personal favorite from outside of EMTLife is this gem from a Facebook discussion:

Terry: Oh, let's contact medical control to determine if a patient can film their own treatment because I can't make a decision on this non-medical decision! http://www.facebook.com/jemsfans/posts/234345126617406



Again, stick around and it's going to come up sooner or later with someone honestly suggesting it.


It's not that I have a low opinion on what paramedics can be and should be. It's that I think EMS's biggest problem right now is that EMS tends to shoot itself in the foot more often than it actually advances towards the goal of being a paramedic. Until EMS decides that 1000 hours of post secondary training isn't enough and stops saying such stupid things like "EMS doesn't diagnosis" or "just call medical control," then it will continue shooting itself in the foot.
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Looks like someone is trying to get their Moderator certification next ;)

(Just messin' with you)
 
Cute :)
 
Hell, Michigan freezes over every winter... not that big of a deal to people who've actually been there. :cool:
 
I was in Orlando back in the late 90's and we had almost 3 inches of snow that scared the bejeezes out of the taxi drivers and put the airport into a serious delay. It only happens only every 7 years or so and it was my lucky year trying to take 2 weeks to go back and forth from Orlando Intl. to Newark Intl. I guess snow in Florida and the joy that it brings is sorta like hell freezing over :)
 
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