Turn over of care from school nurse

[bigbaldguy]

This is a question that would probably be better answered on a nursing forum but I'm too lazy to find one.
I've been on several calls to schools where a minor is under the care of a school nurse but needs to be transported. In every case where transport was required the nurse has handed care over to us and we take the kid. My question is how does this work considering that a patient is only supposed to be released to a provider of equal or greater care level. In my case there was always a medic so it could be argued there is a parity of skill but what happens if a BLS truck answers the call?

 

[Anjel]

I don't think the same rules apply.

For example..Nursing homes.

They call 911. We come and take their pts to wherever they need to go. They are giving us the pts to take to the hospital and turning over care.

I think it is just once EMS has care we have to turn it over to to someone with a higher cert.

But the same rules don't apply when they call you to take their pts somewhere.

 

[exodus]

This is a question that would probably be better answered on a nursing forum but I'm too lazy to find one.
I've been on several calls to schools where a minor is under the care of a school nurse but needs to be transported. In every case where transport was required the nurse has handed care over to us and we take the kid. My question is how does this work considering that a patient is only supposed to be released to a provider of equal or greater care level. In my case there was always a medic so it could be argued there is a parity of skill but what happens if a BLS truck answers the call?

The nurses SOP available to her may also be much smaller than what an EMT-B/Medic has. Knowledge, yes more, but I'm pretty sure school nurses carry any type of ACLS / Respiratory / etc drugs.

 

[exodus]

I don't think the same rules apply.

For example..Nursing homes.

They call 911. We come and take their pts to wherever they need to go. They are giving us the pts to take to the hospital and turning over care.

I think it is just once EMS has care we have to turn it over to to someone with a higher cert.

But the same rules don't apply when they call you to take their pts somewhere.

Nursing home are totally different as they are not truly 911 calls. Anything leaving a NH is an inter-facility transport where the patients doctor, or on call at the home must order the patient to be transferred. The doctor specifics the level of care.

 

[JPINFV]

This is a question that would probably be better answered on a nursing forum but I'm too lazy to find one.
I've been on several calls to schools where a minor is under the care of a school nurse but needs to be transported. In every case where transport was required the nurse has handed care over to us and we take the kid. My question is how does this work considering that a patient is only supposed to be released to a provider of equal or greater care level. In my case there was always a medic so it could be argued there is a parity of skill but what happens if a BLS truck answers the call?

So, in your area if a pediatric call doesn't need a paramedic, the paramedic can't hand over to an EMT?

Also, ensuring continuation of care and requiring care always goes up are two different things completely.

 

[bigbaldguy]

So, in your area if a pediatric call doesn't need a paramedic, the paramedic can't hand over to an EMT?

Also, ensuring continuation of care and requiring care always goes up are two different things completely.

No Idea. We run ALS trucks so there is always a paramedic on the truck.

 

[bigbaldguy]

I don't think the same rules apply.

For example..Nursing homes.

They call 911. We come and take their pts to wherever they need to go. They are giving us the pts to take to the hospital and turning over care.

I think it is just once EMS has care we have to turn it over to to someone with a higher cert.

But the same rules don't apply when they call you to take their pts somewhere.

It didn't even occur to me that the same situation occurs when we pick up from a nursing home. You could well be right this may be strictly an EMS thing. I just assumed that the whole "you touch you own em" thing was universally applied.

 

[Handsome Robb]

We run I/P trucks. Every call starts off as the I's call and the medic listens in for ALS keys. Once one is recognized the medic steps in and takes over. Once an ALS intervention has been performed care cannot be transferred back down to the I, if the medic deems the pt an BLS/ILS patient he can pass the patient back to the I.

 

[WickedGood]

Nursing home are totally different as they are not truly 911 calls. Anything leaving a NH is an inter-facility transport where the patients doctor, or on call at the home must order the patient to be transferred. The doctor specifics the level of care.

No, nursing homes do call 9-11 sometimes for medical emergencies (and not so emergencies) it's not prearranged or ordered the pt has some emergent thing that needs to be addressed at the hospital.........

 

[ArcticKat]

Not to mention interfacility transports. We've done hundreds of emergency transports to trauma/cardiac/neuro...etc from outlying areas. In that case we take over care from a doc.

 

[mycrofft]

It's an IFT.

Also, arguably, the nurse's scope on station is much lower than the EMT or paramedic has and they are providing their knowledge in the form of a transfer form.
Hopefully.
Now we need thirty more responses...:wacko:

 

[Shishkabob]

It's not "equal level or higher" to the provider releasing care, it's "equal level or higher" to the care being provided / suspected of being needed / needed after transfer.

This is why EMTs can pick up BLS transfers from a hospital. This is why a Paramedic can leave with a tech in the triage room at a hospital.



Plus, it's accepted that there may / may not be some drop off in capabilities during transport, so long as the patient is being transported to a facility that has better capabilities than the sending facility.

 

[bigbaldguy]

Ok I think I'm getting it. I think perhaps I misinterpreted how the "release to equal or higher level provider" thing works.

 

[exodus]

No, nursing homes do call 9-11 sometimes for medical emergencies (and not so emergencies) it's not prearranged or ordered the pt has some emergent thing that needs to be addressed at the hospital.........

Of course they call 911, but they need some type of transfer order to release the patient to the care of the paramedics or EMT's. This is either written as a standing order that the charge RN has, or through a phone order the MD gives to the RN.

 

[jjesusfreak01]

The nurses SOP available to her may also be much smaller than what an EMT-B/Medic has. Knowledge, yes more, but I'm pretty sure school nurses carry any type of ACLS / Respiratory / etc drugs.

A school nurse does primarily preventative/community health type work. Besides immunizations, I doubt they can do much more treatment wise than bandaids...

Nursing home staff are at an entirely different level. I recently realized that LPNs in nursing homes really aren't allowed to do much at all, and no staff member will really do anything for a patient without a written order, which is why we get called for every change in the patient's status.

 

[exodus]

A school nurse does primarily preventative/community health type work. Besides immunizations, I doubt they can do much more treatment wise than bandaids...

Nursing home staff are at an entirely different level. I recently realized that LPNs in nursing homes really aren't allowed to do much at all, and no staff member will really do anything for a patient without a written order, which is why we get called for every change in the patient's status.

Oops! I meant DONT' carry any of those drugs.... grawr.. Could a mod edit my post to say that? It totally throws the point of my post.

 

[jjesusfreak01]

Oops! I meant DONT' carry any of those drugs.... grawr.. Could a mod edit my post to say that? It totally throws the point of my post.

Worry not, I noticed the mistake, and I wasn't responding directly to your post. Its fairly obvious what you meant to say.

 

[BEorP]

It's not "equal level or higher" to the provider releasing care, it's "equal level or higher" to the care being provided / suspected of being needed / needed after transfer.

This is why EMTs can pick up BLS transfers from a hospital. This is why a Paramedic can leave with a tech in the triage room at a hospital.

This is exactly it. And OP, I don't think you are the only one who is confused by this because I think it is often taught poorly in class.

 

[truetiger]

Just because the school nurse is an RN, doesn't mean the care she is rendering is ALS. I can't think of any situations in which a school nurse would start ALS care. So if you show up and the nurse has only rendered BLS care, she can transfer her BLS care to your EMT.

 

[Akulahawk]

A school nurse does primarily preventative/community health type work. Besides immunizations, I doubt they can do much more treatment wise than bandaids...

Nursing home staff are at an entirely different level. I recently realized that LPNs in nursing homes really aren't allowed to do much at all, and no staff member will really do anything for a patient without a written order, which is why we get called for every change in the patient's status.

While an RN likely has the knowledge out of the gate to do some "ALS" interventions, they have a knowledge base that will allow them to learn those interventions later on. Over on a nursing forum, I've read some posts that some RN's haven't ever started an IV on a live patient until they got a job that required that skill...

School Nursing doesn't require that the RN know interventions beyond BLS. The school sites aren't set up for it. ALS interventions for those Nurses would be to call 911... I'd be very surprised if Local EMS systems didn't consider calls to those locations to be a regular "scene" call. In those instances, EMS will often consider an RN on scene to be limited to BLS only anyway unless specifically authorized to provide advanced level care.