Chain of Command in Medical Field

shadowstewie

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Im not completely sure if this has been said or not on this forum (though I've check everywhere.) I was trying to figure out who has higher authority. An EMT or CNA, then an EMT and LVN, then a Paramedic and RN. From what I remember, it goes CNA, EMT, LVN, Paramedic, RN, etc. Let me know and thanks in advance!
 

TransportJockey

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Heh, LVN is still a higher level of care than an EMT. There is no way they are the same level. RN is higher than a medic in all ways.
EDIT: I misread the original post. Ignore my snarkiness please.
 
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akflightmedic

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From what I recall, you are all wrong.

Seeing as how you are listing a chain of command yet merging/comparing only two from the actual dozens upon dozens of titles in the medical field, your info is inaccurate.

Nursing is CNA, LPN, RN with several more higher titles of those RNs.

EMS is EMT and Medic.

To merge the two and say this one is higher than that one is dishonest and has no relevance to the topic of chain of command.

Because on an EMS scene, a nurse does not trump me. In a hospital, I do not trump the nurse. We all work together as it is about the patient.

Who has more authority than the other is all location/job dependent. There is no one size fits all here.
 
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CAOX3

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Im not completely sure if this has been said or not on this forum (though I've check everywhere.) I was trying to figure out who has higher authority. An EMT or CNA, then an EMT and LVN, then a Paramedic and RN. From what I remember, it goes CNA, EMT, LVN, Paramedic, RN, etc. Let me know and thanks in advance!

We all answer to the doctor.
 

46Young

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From what I recall, you are all wrong.

Seeing as how you are listing a chain of command yet merging/comparing only two from the actual dozens upon dozens of titles in the medical field, your info is inaccurate.

Nursing is CNA, LPN, RN with several more higher titles of those RNs.

EMS is EMT and Medic.

To merge the two and say this one is higher than that one is dishonest and has no relevance to the topic of chain of command.

Because on an EMS scene, a nurse does not trump me. In a hospital, I do not trump the nurse. We all work together as it is about the patient.

Who has more authority than the other is all location/job dependent. There is no one size fits all here.

+1. It's really an apples to oranges comparison. The CNA is trained differently than the EMT. The RN is trained differently than the paramedic, although the RN can be trained to fufill both ground and air emergent/IFT due to their level of education. With the paramedic, their education is focused to emergency medicine, and it's hit or miss whether they have even an Assosciate's. The vast majority only have 6-12 month tech school certifications. Their level of education, even with an EMS AAS or even a BA in EMS doesn't enable them to be trained to fufill certain roles in nursing. Like I said, apples and oranges.
 

usalsfyre

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We all answer to the doctor.

Yes and no. I answer to my medical direction. Which infuriates the local "doc in the box" hospital's physicians when we transport there. They would much rather we just scoop and run rather than actually intervene on behalf of the patient.
 

usalsfyre

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+1. It's really an apples to oranges comparison. The CNA is trained differently than the EMT. The RN is trained differently than the paramedic, although the RN can be trained to fufill both ground and air emergent/IFT due to their level of education. With the paramedic, their education is focused to emergency medicine, and it's hit or miss whether they have even an Assosciate's. The vast majority only have 6-12 month tech school certifications. Their level of education, even with an EMS AAS or even a BA in EMS doesn't enable them to be trained to fufill certain roles in nursing. Like I said, apples and oranges.

Being unable to fufil certain nursing roles has FAR more to do with nurse practice acts and JACHO requirements than nurses being exceptionally better. I've seen many nurses flounder in the transport environment just as I've seen many medics flounder in the high-acuity IFT environment. It takes an exceptional individual to be able to do critical care transport. What license/cert they have becomes immaterial after a while.
 

adamjh3

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The person in charge on-scene is the most level-headed one.
 

Akulahawk

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Being unable to fufil certain nursing roles has FAR more to do with nurse practice acts and JACHO requirements than nurses being exceptionally better. I've seen many nurses flounder in the transport environment just as I've seen many medics flounder in the high-acuity IFT environment. It takes an exceptional individual to be able to do critical care transport. What license/cert they have becomes immaterial after a while.
Ultimately, given good education, This.
 

Akulahawk

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Yes and no. I answer to my medical direction. Which infuriates the local "doc in the box" hospital's physicians when we transport there. They would much rather we just scoop and run rather than actually intervene on behalf of the patient.
I've seen that too. I had a physician tell me: "Don't do ANYTHING." This was an IFT transport from his office to the hospital. I asked him: Are you going to ride in with me? His answer: No.

I had to tell him that while his patient appears stable enough for transport now, I must follow the orders of the County EMS director if your patient deteriorates unless he rode in with me. He declined to ride in...
 

akflightmedic

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The person in charge on-scene is the most level-headed one.

Or they are the least knowledgeable or informed...it is easy to be calm when you don't know what you don't know. :)
 

Linuss

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Like akf said, no, an RN being an RN doesn't instantly trump me as a medic.

If the RN is part of my agency, and they are a CCRN, then yes, they are in charge of the patint.

If its not a nurse from my agency, but say an RN at a nursing home that we were called to, sorry toots, I'm top dog.

Heck, I work with several RNs at standbys, and there's just an understanding that neither is "in charge", we work off each others skills and knowledge. Cardiac or trauma? The medic tends to lead. Complex medical? The nurse tends to lead. But key word is "tends" as medicine, especially field medicine, is fluid.


Really, cert level is irrelevent after a point. Do you really think people like vene are less capable than a newer nurse just because he's a "lowly medic"? Base education is different, sure, as were a speciality whilst RNs are educated as generalist, but anyone who doesn't continue to learn after school shouldn't be in medicine anyway.


Heck, having an MD after your name still doesn't give you ultimate authority over me. The one and only doctor I'm required to listen to is the one that signs my protocol book. Any and every other doctor I encounter, I can utilize for the benefit of the patient, but don't have to follow.
 

MrBrown

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The senior officer is always incharge, ie highest clinical skill level or most senior in the case of equal skill level

A Technician is under the direction of a Paramedic, a Paramedic under an Intensive Care Paramedic etc ....

That said nobody presumes to be more important than anybody else however in a proper MCI then the Incident Commander is in charge operationally

It is the Officer treating the patient who decides how time critical they are, not the Officer driving.

The HEMS Doctor if he or she is on scene takes an overall medical leadership position however never discounts what everybody else has to say or suggest.

The Fire Service is guided by what the Ambulance staff want since they are mainly there in a technical role to cut people out of cars, get them out from squished places etc and its no good ripping doors off when the patient needs to be tended too first.
 

CAOX3

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Funny only one person mentioned the team attitude.

More of a team effort then a chain of command, we all have a job to do, if at any level one of those team members fails then the patient suffers.
 

emtchick171

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I am a CNA and an EMT.

EMT in every way is much higher cert. than a CNA. basically all CNAs can do is take vitals and tell a nurse what they see.
**this is in North Carolina, may vary from state to state.

In a hospital setting...technically an RN/BSN has more "power" than a medic.
However, a medic can do much more medically than an RN. A medic in a hospital setting does not have to have a doctor's orders to treat/medicate a patient. RN/BSN must have a doctors orders prior to doing anything to a pt...even starting an IV.
 

Linuss

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Do you mean a medic in a hospital or out of?

Either way, both certs must have orders from a doctor... and many nurses have standing orders much like we do in the field.

Granted there's a bit more leeway for field providers (nurses included) due to the very nature that we can't always have a doctor there... but make no mistake, nurses can have standing orders too.
 

firetender

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The more pertinent question might be "How would you determine who to release your patient to at the scene of an emergency? Would you adhere to a hierarchy?"
 

Akulahawk

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As Linuss has stated, both Paramedics and RN's can function under standing orders. Out of the gate, a Paramedic may have more leeway than an RN does, but the Paramedic is a niche provider of field emergency medicine. They're supposed to be trained to be "safe" out of the gate. They still suck. Give them a year or two and they're a better medic than when they started. RN's are generalists. They learn about the various parts of the medical system and a bit about how to function in each. Then when the RN gets hired, out of the gate, they suck. They get weeks and weeks of pre-service and in-service training to get them ready for their role in that area of medicine and THEN they're watched and mentored for about a year. In other words, they begin to specialize and have improved greatly from their beginning stages.

After a few years of seasoning, ideally, both providers (say a Paramedic and an ED RN) will end up being very competent in their jobs. It's at that point that I don't care who takes care of me... Get the job done, and competently so.
 
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