Need For Definitive Care

[Sasha]

Who lied to you? Nurses can tube, etc.

And be careful, I think the T in RT is therapist not tech, you might offend some people on this board. And I've been to quite a few nursing homes who have had them on staff, and not just rehabs.

And so they use a vital machine? You have ONE patient when you come to the nursing home, the nurse may have a dozen all of which may be needing care at that point in time. Many EMTs wouldn't even do a manual BP if their truck came equipped with a vital machine.

 

[emtfarva]

CCT nurses also do not have any power in a pre-hospital setting. They receive their orders form a doctor prior to transport. CCRNs are great, don't get me wrong. They just have no power pre-hospital.

 

[JPINFV]

A nurse has to have orders to increase O2 on a Pt. I have standing orders to increase O2 if clinically indicated.

So, let me get this straight. You're saying that a nurse needs an order to increase oxygen. You're also saying that you need an order (need, by virtue of saying that you have such an order) to adjust O2. I don't think that saying you're a higher level is best exemplified by saying that both you and the RN need an order for oxygen.

 

[Sasha]

CCT nurses also do not have any power in a pre-hospital setting. They receive their orders form a doctor prior to transport. CCRNs are great, don't get me wrong. They just have no power pre-hospital.

Technically neither do you, as an EMT. So you can increase O2. Big deal. What can you REALLY do? CPR? A finger stick? Put on an AED?

Your orders come from a doctor too... You know.. the guy you call med control.

 

[emtfarva]

MOST Rn's can not tube (oops). I am saying that I can increase O2 without paging a Doctor and waiting for a call back. I already have an order and can increase IMO if needed. No, this an example that I could readily think of off the top of my head. If I sat down longer I could think of more reasons that we have more abilities than SNF nurse in a emergent situation.

 

[AJ Hidell]

CCT nurses also do not have any power in a pre-hospital setting. They receive their orders form a doctor prior to transport. CCRNs are great, don't get me wrong. They just have no power pre-hospital.

Speaking only for MA, I'm sure, because you are definitely very wrong in most states.

Regardless, Sasha is correct. You too are bound solidly by doctors orders.

 

[Aidey]

Sasha, your normal run of the mill everyday nurse can not intubate. Nurse Anesthetists can, flight nurses can and a few others can, but it's because they received special training in it after nursing school. One of my cousins just graduated from a 4 year nursing school and we were comparing what we had to do for our clinicals and she specifically told me they were not allowed to intubate.

The biggest difference between your run of the mill RN and an MICP is that MICPs are classified as medical providers, while RNs are not. We generally work under standing orders with some online direction, while most RNs only work under online direction.

However, this situation changes greatly when you are talking about Nurse Anesthetists, Flight nurses etc because they are working under standing orders, and their orders are often expanded compared to those of an MICP.

 

[emtfarva]

Right, I have Doctor's order's for emergencies. Hence the Emergency Medical Technician. And you are all right about CCRN's. I forgot about Medflight and such. I was thinking about our ground critical care team when they are needed for a 911 call. Sorry didn't mean to offended any CCRN's out there.

 

[emtfarva]

Who lied to you? Nurses can tube, etc.

And be careful, I think the T in RT is therapist not tech, you might offend some people on this board. And I've been to quite a few nursing homes who have had them on staff, and not just rehabs.

And so they use a vital machine? You have ONE patient when you come to the nursing home, the nurse may have a dozen all of which may be needing care at that point in time. Many EMTs wouldn't even do a manual BP if their truck came equipped with a vital machine.

My point is that the nurses themselves do not check VS, they send in the aids to do it. and no, I don't trust nurse-on-a-stick inside a moving ambulance. I will trust what i hear or feel, not just reading the numbers off the machine.

 

[AJ Hidell]

Medics send in EMTs to do their vitals. Nurse Aides have the same amount of training as an EMT. So what's the difference?

 

[emtfarva]

It doesn't even matter what I think about what we can do over a nursing home nurse. The Pt from the OP should have been transported without delay and should have been brought to the hosp without Als. The SNF called for the Pt to be transported to the ER. They transfered care to the EMS providers. Those providers were wrong and should not have waited.​

 

[AJ Hidell]

The Pt from the OP should have been transported without delay and should have been brought to the hosp without Als. The SNF called for the Pt to be transported to the ER. They transfered care to the EMS providers. Those providers were wrong and should not have waited.

Absolutely agreed on that point.

Unfortunately, there are systems where IFT units are prohibited from doing so, and required by law to call for EMS.

 

[ILemt]

Getting back to the original problem...
I would transport immediately, wouldn't even bother dispatch concerning ALS given time/distance.

The EMT's on that call should lose their cert permanently, for putting Pt outcome at risk like that. The NH staff should likewise be fired.

The dispatcher should be suspended for not insisting BLS transport.

If BLS is 5 or less from ER, run the call BLS at whatever priority the situation dictates.

 

[OzAmbo]

I would transport immediately, wouldn't even bother dispatch concerning ALS given time/distance.

The EMT's on that call should lose their cert permanently, for putting Pt outcome at risk like that. The NH staff should likewise be fired.

interesting

 

[ILemt]

Absolutely agreed on that point.

Unfortunately, there are systems where IFT units are prohibited from doing so, and required by law to call for EMS.

Any EMT IS EMS, regardless of whether or not you are working for a private company or municipality so long as your vehicle can transport.
That is FEDERAL Law.

A HUGE HUGE HUGE Liability suit if I was a lawyer.
I'd own the entire service by sunset.

(No I'm not sue happy, just anti-stupid )

 

[ILemt]

Oz... the highlights in your quote are off. An ER supplies ALS care. The key in what I said is "given the time/distance" [in the original problem, the ER was 1 minute away vs 60 for a MICU ]

It is NOT to say I advocate against calling for ALS.

 

[VentMedic]

CCT nurses also do not have any power in a pre-hospital setting. They receive their orders form a doctor prior to transport. CCRNs are great, don't get me wrong. They just have no power pre-hospital.

You are greatly misinformed.

Did you know that several states now have specific PreHospital certifications for RNs? There RNs can work in both scene response and CCT IFT if needs. As well, do you know how many RNs do 911 scene response on HEMS? They provide the same skills as a Paramedic with the knowledge of an ICU/CCU/ED RN. I could also tell all about what Specialty (Peds, Neo) RNs do to stablilze a very long distance transport like from the islands or another country.

CCT RNs receive a report before they leave a facility. For the RN working under another facility of higher care, will also work under another physicians protocols and standing orders. A doctor who may be a lower level provider may not be able to write the orders necessary to some transports even if they wanted to. That is why the called to get the patient to another facility. Often the CCT team, whether flight or ground, may spend much time stabilizing a patient for transport. This may include doing their own RSI for intubation.

You think doctors anticipate everything that goes wrong during a transport. You have a lot to learn about medicine and other professionals.

There are of course exceptions. Since Paramedics may not be able to administer or even monitor some medications, the RN will either accompany or the hospital will give the med before the team leaves. If the Paramedic can "watch the pump" but not do much more, The sending facility's physician will issue an order for that med, it will be set up and included in the med list.

Nurses in almost every work situation have protocols and standing orders. No they do NOT call the doctor for everything. Again, you don't understand how much there is to medicine besides just "O2". The basic first aid standing orders that EMTs have, almost any licensed professional in healthcare has.

 

[emtfarva]

You are greatly misinformed.

Did you know that several states now have specific PreHospital certifications for RNs? There RNs can work in both scene response and CCT IFT if needs. As well, do you know how many RNs do 911 scene response on HEMS? They provide the same skills as a Paramedic with the knowledge of an ICU/CCU/ED RN. I could also tell all about what Specialty (Peds, Neo) RNs do to stablilze a very long distance transport like from the islands or another country.

CCT RNs receive a report before they leave a facility. For the RN working under another facility of higher care, will also work under another physicians protocols and standing orders. A doctor who may be a lower level provider may not be able to write the orders necessary to some transports even if they wanted to. That is why the called to get the patient to another facility. Often the CCT team, whether flight or ground, may spend much time stabilizing a patient for transport. This may include doing their own RSI for intubation.

You think doctors anticipate everything that goes wrong during a transport. You have a lot to learn about medicine and other professionals.

There are of course exceptions. Since Paramedics may not be able to administer or even monitor some medications, the RN will either accompany or the hospital will give the med before the team leaves. If the Paramedic can "watch the pump" but not do much more, The sending facility's physician will issue an order for that med, it will be set up and included in the med list.

Nurses in almost every work situation have protocols and standing orders. No they do NOT call the doctor for everything. Again, you don't understand how much there is to medicine besides just "O2". The basic first aid standing orders that EMTs have, almost any licensed professional in healthcare has.

I restated my quote on CCRN's. Answer this though, Why on most of my calls at SNF for Diff Breathing, do I find a Pt on a NC at 3-5 lpm from a concentrator rather than some type of mask on a O2 bottle? What I was taught in EMT school is if you don't have airway, you don't have a Pt. I took that for not only a patent airway but for O2 admind also. Maybe I am wrong because I don't have the education like you. Please explain how I am wrong.

 

[CAOX3]

This post went to hell quickly.

This place is a riot. Medics continually bash EMTs in the head due to their lack of education, yet when the subject is broached about the relativity between nurse and paramedic everyone gets their panties in a bunch.

Their is no correlation between the two an RN is educated through traditional means most EMs providers are trained and thats a stretch.

As far as the original post, the thing that bothers me most is the fact that the crew REFUSED the call. I dont know, I work in a 911 system, is it common practise for an IFT ambulance to refuse calls because they dont feel comfortable with the situation? I dont think there is a difference in training/education is there.

Lets say A guy on the corner takes two in the chest, aint much me as a BLS provider, you as an ALs provider, hell the community hospital down the street are going to do for this pt. Do I have the right to say sorry bud your on your own here this is out of my realm of treatment? No. We treat and transport to the best of our ability.

There our a a million complaints that cant be handled by EMS providers. We still transport, we dont leave them there because we dont feel comfortable.

This is insane, transport the F'n pt., treat to the best of your ability. When done hand in your uniform because your an ______ ! (fill in the blank.)

 

[VentMedic]

I restated my quote on CCRN's. Answer this though, Why on most of my calls at SNF for Diff Breathing, do I find a Pt on a NC at 3-5 lpm from a concentrator rather than some type of mask on a O2 bottle? What I was taught in EMT school is if you don't have airway, you don't have a Pt. I took that for not only a patent airway but for O2 admind also. Maybe I am wrong because I don't have the education like you. Please explain how I am wrong.

Do you know what a concentrator is?

Do you know why patients in NHs and homecare patients are on concentrators?