Just another regular dialysis patient....so it was supposed to be.

[VentMedic]

But on the scene of a MVA or a Medical call outside of a hospital or clinic a RN, LVN, or CNA will not be allowed to assist according to my local protocols.

There will be exceptions to that also when it comes to home healthcare. The patient with special technology such as VADs, ventilators, access ports, specific meds and/or gases and special needs may have a family member and/or any of the 3 health care workers mentioned at their side who have been specially trained for that patient, their technology and equipment. DO NOT dismiss them because they are not "EMS" and listen to whatever valuable information they have to assist in the care of the patient. That may prevent you from doing harm or killing the patient as you rush in with your book of protocols.

 

[Ridryder911]

Vent make some important statements but they are not blanket in every state. Flight nurses in many states has no more authority than another state and truthfully RN's are not always deemed higher in control or more authority. As the typical RN does not have the highest level of education in emergency or even critical care. Just alike prehospital they are under direct or written orders of a physician.

When a flight crew arrives, they are just a means of transportation to me. No more important or less. They have no more authority in care than I do as ground or as my Paramedics do in fact in prehospital maybe even less. For SCT on IFT I would be sure if nurses are going to be utilized that they check the insurance clause or carry malpractice on themselves as many carriers coverage is only good on hospital territory and not within another medical agency.

R/r 911

 

[JPINFV]

Train of thought writing works for people who know how to do it well.

As for the other story, without knowing the specifics, I'd have to guess that the crew did put their certificates in jeopardy for what they did. If that patient had an adverse outcome, that would have required ALS intervention en-route, I would imagine that the end result might easily have been different for both the Paramedic and the EMT crew. There's a lot more that I could probably go into, but without knowing more, including OC EMS protocols, I'm going to hold off. Personally, I think they were probably very lucky that they retained their certs.

As someone who's worked in OC and had to deal with this exact situation (question to the OP: Anaheim fire, female medic?), the fire department is supposed to transport with the company that called them. Period. Now my view on this is that if fire wants to transfer, then fine, what ever. I personally don't care which ambulance the patient goes with and I'm not there to impress the medics. Which company should transport is above my pay grade and I'm not going to get into a fight on scene. It simply isn't worth my time. There was a letter sent out by the old county medical director stating that this shouldn't happen.

 

[JPINFV]

Hmm...maybe the paramedics knew they type of shenanigans your company has pulled(like BLS'ing obviously ALS patients, or arguing about transports on scene, in front of patients)

You obviously don't know OCEMS that well. There are no paramedics with private companies and the current plan in place basically dilutes them down to an EMT with a monitor and an IV. It's essentially BLS or call 911.

 

[JPINFV]

I'll absolutely argee; this BLS crew was over zealous, under trained and pretty darned disrespectful of their patient's welfare as a whole. There is no doubt a person will worsen when he's constantly asked "ya sure ya don't feel sick", by what is perceived as a medical professional. Don't need 1000 words to say...wow, get a little more skill under yer belts there kiddo.

Welcome to Orange County, California.

 

[JPINFV]

To the OP:
Protip for calling for paramedics in Orange County. When you're on the line with 911 (and, yes, since paramedics were only fire based, every time I requested paramedics I did so through the 911 system) make sure you identify that you are Pacific/Lynch/Shoreline/etc ambulance company and need a paramedic response. Make sure you identify that you have an ambulance and will meet the paramedics in your ambulance (and plan on being at the ambulance when they arrive). If you do so (and do it professionally and with tact), the contracted 911 ambulance company won't always be dispatched.


To the 'OMG, a NURSE can't tell me anything' crowd:

Fun fact: It's better to work with other health care providers than against them. Just because you're 'in control' doesn't mean that they don't know more about 'your' patient than you do.

 

[VentMedic]

When a flight crew arrives, they are just a means of transportation to me. No more important or less. They have no more authority in care than I do as ground or as my Paramedics do in fact in prehospital maybe even less.

That being said, the flight crew does have the final say in what is best for the patient when it comes to flying. There should be no arguing about care when it comes to the safety of the patient and THE CREW. If that patient is too heavy and we can not safely drop a crew member or conditions do not allow us to fly to scene or a certain hospital that the ground crew believes best but we have a safer alternative, there should not be a peeing contest that jeopardizes that air crew. If that patient is combative with a TBI, we will sedate and intubate with or without the ground crew's blessing when that patient is in our care and before we take off. We also don't transport dead patients as one that is coding at scene will probably not even be a good organ procurement candidate. Tissue and whatever can be taken later at the ME's. We didn't just fly to the scene because we were bored and just thought it sounded like a good call on the scanner to go to. Time can also be a concern as we may be looking at weather conditions to return safely. I've flown to ground scenes where the crew has been on scene for 30 minutes and have yet to establish as IV or even make an effort to package because they didn't think the patient needed anything but yet called for a helicopter. Communication and coordination should be about what is best or safest for the patient and not whose ego might get a little bruised or for the convenience of the EMS provider.

For SCT on IFT I would be sure if nurses are going to be utilized that they check the insurance clause or carry malpractice on themselves as many carriers coverage is only good on hospital territory and not within another medical agency.

R/r 911

Yes this has been an issue for years until hospitals started establishing their own transport personnel that can just take the patient in their own ambulance (or contract truck) or will be covered when they have to get into a truck to provide care. At the also may not release a patient to a "CCT" if they appear to be clueless when they come for the patient unless one of our transport staff accompanies or another team can be arranged. For Peds, most hospital will now go with a dedicated team and/or with the guidelines from the AAP. For neonates, Florida has specific guidelines as to who can transport and now which facility/Medical Director is in charge of making crew arrangement for transport.

This is the proposed rewrite of the neonatal transport section in the EMS statutes. It eliminates the "ALS and BLS" terminology which is not appropriate for neonates or critical care medicine and it defines the training and control of the medical directors.

https://www.florida-air-medical.org...oposed RuleNeonatalInterfacilityTransfers.pdf

 

[Akulahawk]

Vent make some important statements but they are not blanket in every state. Flight nurses in many states has no more authority than another state and truthfully RN's are not always deemed higher in control or more authority. As the typical RN does not have the highest level of education in emergency or even critical care. Just alike prehospital they are under direct or written orders of a physician.

When a flight crew arrives, they are just a means of transportation to me. No more important or less. They have no more authority in care than I do as ground or as my Paramedics do in fact in prehospital maybe even less. For SCT on IFT I would be sure if nurses are going to be utilized that they check the insurance clause or carry malpractice on themselves as many carriers coverage is only good on hospital territory and not within another medical agency.

R/r 911

This makes an excellent point... Field Providers: if you're going to have any interaction with flight crews, make sure you know the policies in effect for these instances. Flights that are IFTs do not normally fall into the prehospital arena, so they're an entirely different animal.

As to the insurance issue, hospital staff that go on transports should carry malpractice insurance anyway. If you, the field provider, have any substantial assets... it should be an excellent idea as well for you to have this insurance.

 

[Akulahawk]

That being said, the flight crew does have the final say in what is best for the patient when it comes to flying. There should be no arguing about care when it comes to the safety of the patient and THE CREW. If that patient is too heavy and we can not safely drop a crew member or conditions do not allow us to fly to scene or a certain hospital that the ground crew believes best but we have a safer alternative, there should not be a peeing contest that jeopardizes that air crew. If that patient is combative with a TBI, we will sedate and intubate with or without the ground crew's blessing when that patient is in our care and before we take off. We also don't transport dead patients as one that is coding at scene will probably not even be a good organ procurement candidate. Tissue and whatever can be taken later at the ME's. We didn't just fly to the scene because we were bored and just thought it sounded like a good call on the scanner to go to. Time can also be a concern as we may be looking at weather conditions to return safely. I've flown to ground scenes where the crew has been on scene for 30 minutes and have yet to establish as IV or even make an effort to package because they didn't think the patient needed anything but yet called for a helicopter. Communication and coordination should be about what is best or safest for the patient and not whose ego might get a little bruised or for the convenience of the EMS provider.



Yes this has been an issue for years until hospitals started establishing their own transport personnel that can just take the patient in their own ambulance (or contract truck) or will be covered when they have to get into a truck to provide care. At the also may not release a patient to a "CCT" if they appear to be clueless when they come for the patient unless one of our transport staff accompanies or another team can be arranged. For Peds, most hospital will now go with a dedicated team and/or with the guidelines from the AAP. For neonates, Florida has specific guidelines as to who can transport and now which facility/Medical Director is in charge of making crew arrangement for transport.

This is the proposed rewrite of the neonatal transport section in the EMS statutes. It eliminates the "ALS and BLS" terminology which is not appropriate for neonates or critical care medicine and it defines the training and control of the medical directors.

https://www.florida-air-medical.org...oposed RuleNeonatalInterfacilityTransfers.pdf

I'm glad Florida is getting going on the neonate stuff. Clarity is always a better alternative to confusion...

As to the flight crew... I'm of the opinion that if it's unsafe to fly the patient but the patient still needs that level of care after the flight crew arrives... guess what? The flight crew is more than welcome to use my truck for transport instead of the egg-beater. I will be happy to assist them as I know where everything is... in my truck, but they're in charge. Also, if the patient is going to be flown... I'm going to do my best to ensure that the patient is ready for the flight team to transfer to their litter and can be packaged for flight easily.

 

[Shishkabob]

I know a few people on flight crews, and they all say essentially the same thing:

On an IFT, the nurse is in charge. On a field 911 call, the medic is in charge. Each has their own specialty in medicine, and they work off of eachother to get the job done.

 

[VentMedic]

This makes an excellent point... Field Providers: if you're going to have any interaction with flight crews, make sure you know the policies in effect for these instances. Flights that are IFTs do not normally fall into the prehospital arena, so they're an entirely different animal.

Do you remember a statement concerning a Sacramento Paramedic made a couple years ago by CA's EMSA director?

Jennifer Hardcastle, a nurse and spokeswoman for the air ambulance company, said there have been no complaints or concerns about patient care involving Parker. Aristeiguieta (EMSA Director Dr. Cesar Aristeiguieta) agreed, adding that flight paramedics typically work as a team with a flight nurse and "the nurse really runs the show."

http://www.sacbee.com/paramedics/story/117393.html

 

[Akulahawk]

The statement I made was a general one... but I believe I've met Nurse Hardcastle. In any event, with REACH, while the RN/EMT-P team works as a team, there's never been any question that the RN runs the show... and I've been familiar with them since about 2000-2001, and had the opportunity to run at least one call with them. I'm much more familiar with other programs... that run RN/RN and I've run probably 50-100 calls with that type of prehospital team. No question they're in charge. But flight crews are a different animal.

 

[medic_texas]

Do you remember a statement concerning a Sacramento Paramedic made a couple years ago by CA's EMSA director?




Jennifer Hardcastle, a nurse and spokeswoman for the air ambulance company, said there have been no complaints or concerns about patient care involving Parker. Aristeiguieta (EMSA Director Dr. Cesar Aristeiguieta) agreed, adding that flight paramedics typically work as a team with a flight nurse and "the nurse really runs the show."

Oh man, I remember that! That comment pissed a lot of people off, lol.

I think we all know what should happen on a 911 call if a nurse is on scene. My point was generally speaking about the scenario posted by OP; an IFT and 2 people jumping around and getting everyone all excited and wanting to turn a IFT into a "code 3 to the hospital".

 

[Sasha]

I know a few people on flight crews, and they all say essentially the same thing:

On an IFT, the nurse is in charge. On a field 911 call, the medic is in charge. Each has their own specialty in medicine, and they work off of eachother to get the job done.

Really? When I have the opprotunity to talk to flight crews at my hospital, the trauma center, and the boondock hospital, they all tel me the same thing. They work as a team, regardless of which call it is.

 

[VentMedic]

Oh man, I remember that! That comment pissed a lot of people off, lol.

I think we all know what should happen on a 911 call if a nurse is on scene. My point was generally speaking about the scenario posted by OP; an IFT and 2 people jumping around and getting everyone all excited and wanting to turn a IFT into a "code 3 to the hospital".

My point was also about the other medic scenario and the fact this is in California. That in itself gives things a weird twist. The county thing, the state scope, Paramedic utilization and the reasons Flight RNs and MICNs are utilized just makes this state a little different .

 

[VentMedic]

Really? When I have the opprotunity to talk to flight crews at my hospital, the trauma center, and the boondock hospital, they all tel me the same thing. They work as a team, regardless of which call it is.

A team may still have someone who is of a higher medical level. If a physician flies he/she is part of the team but now has the ultimate responsibility with the exception being for the resident in training who may be there to observe for the first few flights.

Each brings to the team a different set of expertise but it also depends on how the statutes and the agency policy are worded for various situations. If you read the job description on the flight help wanted boards you will notice that for the RN it will state "to supervise the Paramedic". This can shy away some applicants who may not want the responsibility so it is often made clear up front.

 

[medic_texas]

Lots of good points being made here. The comment about California is really true (and I may take a travel gig in the Sacramento area this spring).

I'm on my phone, at work, waiting on people. Don't ya just love that?

 

[VentMedic]

Lots of good points being made here. The comment about California is really true (and I may take a travel gig in the Sacramento area this spring).

I do travel assignments primarily in the Bay area. It has been a big step back in time both in the hospitals and viewing their EMS situations. I would say 10 - 15 years backward for the hospitals and about 25 - 30 for EMS.

 

[medic_texas]

I do travel assignments primarily in the Bay area. It has been a big step back in time both in the hospitals and viewing their EMS situations. I would say 10 - 15 years backward for the hospitals and about 25 - 30 for EMS.

Oh crap, that doesn't sound too good. No wonder they pay so well

 

[KillTank]

There will be exceptions to that also when it comes to home healthcare. The patient with special technology such as VADs, ventilators, access ports, specific meds and/or gases and special needs may have a family member and/or any of the 3 health care workers mentioned at their side who have been specially trained for that patient, their technology and equipment. DO NOT dismiss them because they are not "EMS" and listen to whatever valuable information they have to assist in the care of the patient. That may prevent you from doing harm or killing the patient as you rush in with your book of protocols.

Didn't I mention outside of the clincal and hospital a couple times already? Go back and re-read my thread. I think I remember mentioning that "I RATHER LET A RN ASSIST ME BECAUSE THEY KNOW MORE ABOUT THE PATIENT THAN I DO."
I will do what ever I want with my book-o-protocols thank you very much.