clinical at hosp telling me NOT to use BSI. NEED HELP NOW

[JPINFV]

Nah.....California may be administratively screwed up and massively oversaturated with EMTs, but it's a long way from the most messed up state for EMS. Maryland from an operational standpoint has everyone beat hands down.

California isn't all that backwards, to be honest. It's just the low standards that very few providers seem willing to surpass, as well as the regionalization to a fault.

 

[usafmedic45]

California isn't all that backwards, to be honest. It's just the low standards that very few providers seem willing to surpass, as well as the regionalization to a fault.

That was my point.

 

[bstone]

I strongly encourage the OP to follow her protocols. Nurses are great and wonderful but they aren't her protocols.

 

[Veneficus]

EMS protocols do not cover in hospital activities.

The hospital will have its own SOPs for PPE as well as what students may or may not participate in doing.

 

[Remeber343]

Do what you want. If you feel better with gloves wear gloves.

 

[bstone]

Veneficus, she isn't working in the ER. She is an EMT-in-training and is required to follow all protocols. BSI is non-negotiable.

 

[Veneficus]

I'm currently doing clinical rotations at the hospital's Pre Op department for AEMT. The nurses want me to make pt contact without gloves and use gloves only for IV sticks.

Hospital policy supercedes EMS protocols. If her EMS protocols say she can intubate and admin medication and the hospital does not extend that to students (and some don't) then she is not permitted in that facility.

If the facility has decided what level of PPE is required in any given department, then the student, who is a guest of the facility, is obliged to that policy as well.

If they decided all students will wear facemasks with eye protection, disposable gowns, gloves, and shoe covers for all patient contact, the student will.

If they decide on lesser PPE, that has no less obligation.

 

[bstone]

I think you're missing the part where it says she is an EMT student. She thus has to follow each and every single rule of her EMT program. If the hospital says she can do open heart surgery but her program say she can't then she cannot.

 

[Veneficus]

I think you're missing the part where it says she is an EMT student. She thus has to follow each and every single rule of her EMT program. If the hospital says she can do open heart surgery but her program say she can't then she cannot.

I think you are getting a little carried away.

Nobody is permitted to exceed the scope of thier training in their respective field.

That is a different matter from standing order protocol approved by a physician for the offline medical treatment of patients.

 

[JPINFV]

How many states actually define "appropriate PPE" or "standard precautions" to mean "always wear gloves"?

 

[bstone]

I am unaware of any EMS protocol that allows any EMT or student to disregard BSI. Students are especially required to follow BSI. The insurance policies that cover students would be unhappy to learn that students would not follow BSI as it significantly increases the risk to the student.

If I am mistaken about the protocol then please cite your source for a protocol that allows a student to disregard BSI.

 

[usafmedic45]

I think you're missing the part where it says she is an EMT student. She thus has to follow each and every single rule of her EMT program.

I've never seen an EMS program where they say you can override the policies of the agency or entity with which you are doing their internships. A lot of them have a caveat that says if you refuse to follow reasonable ("lawful" to use the military term) orders from a person supervising you, you can be removed from the program for unprofessional conduct. An unreasonable and misguided belief instilled by lack of real education on BSI is no more a defense than taking the Nuremberg defense.

If the hospital says she can do open heart surgery but her program say she can't then she cannot.

C'mon Baruch.....you're smarter than to resort to a strawman argument.

 

[Veneficus]

How many states actually define "appropriate PPE" or "standard precautions" to mean "always wear gloves"?

I wouldn't doubt an EMS program may actually write that or follow that interpretation, but it doesn't matter if they write the student will wear a pink and fuzzy thong with matching corsette, once you step into a facility, you are governed by the rules of that facility.

If a physician in a hospital asked you not to wear gloves when seeing her patients and to wash your hands instead, and you told her you were following your protocols from school, you'd likely be sitting in the break room studying, or standing in the parking lot.

Not following the reasonable requests of any staff member when you are a student is a sure fire way to get tossed from a clinical site, and the bad blood can carry over to having the whole program lose their partnership.

 

[bstone]

I've never seen an EMS program where they say you can override the policies of the agency or entity with which you are doing their internships. A lot of them have a caveat that says if you refuse to follow reasonable ("lawful" to use the military term) orders from a person supervising you, you can be removed from the program for unprofessional conduct. An unreasonable and misguided belief instilled by lack of real education on BSI is no more a defense than taking the Nuremberg defense.



C'mon Baruch.....you're smarter than to resort to a strawman argument.

In this case it's the nurses who are giving an unlawful order. No EMT or EMT student may disregard BSI and still be acting within protocols.

 

[usafmedic45]

but it doesn't matter if they write the student will wear a pink and fuzzy thong with matching corsette

I suggest we start a petition to get one of the female members of the forum to model this for us.

 

[Veneficus]

In this case it's the nurses who are giving an unlawful order. No EMT or EMT student may disregard BSI and still be acting within protocols.

Cite your source for an EMS protocol that supercedes hospital policy (edit: in that facility) please.

 

[JPINFV]

I am unaware of any EMS protocol that allows any EMT or student to disregard BSI. Students are especially required to follow BSI. The insurance policies that cover students would be unhappy to learn that students would not follow BSI as it significantly increases the risk to the student.

If I am mistaken about the protocol then please cite your source for a protocol that allows a student to disregard BSI.

No one is saying to disregard BSI. What is being said is that "BSI" is not defined as "Always wear gloves." Furthermore, implying that not using gloves 100% of the time "significantly increases the risk to the student" is the absolute height of hyperbole.

Please cite a source that says that BSI means gloves 100% of the time. If EMS providers, including students nearing the end of their initial education are too ignorant or inept to decide on their own when gloves are appropriate or not without a cookbook, then I weep for the state of EMS.


Edit:

Also, the only place "PPE" or "glove" shows up in the Alabama State Wide protocol is when dealing with influenza. So, apparently, outside of that Alabama thinks that their providers are intelligent enough to decide what components of PPE are actually necessary given the specifics of each individual case.

http://www.adph.org/ems/assets/6thEditionProtocolsFinal.pdf

 

[bstone]

This is a good resource: http://www.jstor.org/pss/30148309

 

[usafmedic45]

In this case it's the nurses who are giving an unlawful order. No EMT or EMT student may disregard BSI and still be acting within protocols.

http://www.adph.org/ems/assets/6thEditionProtocolsFinal.pdf
Here's what the protocols actually have to say about BSI so that everyone will just STFU:

Use appropriate standard infectious precautions.
 Appropriate PPE for suspected cases of influenza includes disposable N-95 mask, eye protection, and disposable non-sterile gloves. Disposable non-sterile gown is optional depending on the situation (follow guidance of service medical director).

That's it. There's no mention of what "appropriate" precautions are and there is no mention of a requirement to wear gloves during all patient contacts. It appears that the OP simply does not know her protocols very well and has been badly misinformed.

 

[JPINFV]

...and there's a source or specific quote that won't cost me $19?