Turn over of care from school nurse

[rogersam5]

Maine made it real simple for us... the last page in the protocol book is for Non-EMS system providers (bold print is exactly as written in the protocol):

Please be advised that these Emergency Medical Technicians are operating under the authority of the State of Maine and under protocols approved by the State of Maine. These EMS providers are also operating under the authority of a Medical Control physician and standing medical orders.

If you are currently providing patient care,
you will be relinquishing care
to these EMS personnel and their Medical Control physician.

 

[JPINFV]

Maine made it real simple for us... the last page in the protocol book is for Non-EMS system providers (bold print is exactly as written in the protocol):

Please be advised that these Emergency Medical Technicians are operating under the authority of the State of Maine and under protocols approved by the State of Maine. These EMS providers are also operating under the authority of a Medical Control physician and standing medical orders.

If you are currently providing patient care,
you will be relinquishing care
to these EMS personnel and their Medical Control physician.

Over my dead body if I've initiated care that needs to be continued, yet are out of the scope of practice of the responding ambulance.


Edit: And let's include the rest of that page too...

No individual should intervene in the care of this patient unless the individual is:
1. Requested by the attending EMT, and
2. Authorized by the Medical Control physician, and
3. Is capable of assisting, or delivering more extensive emergency medical care at the scene.

Which is, of course, irrelevant prior to the arrival of EMS, as the Maine Department of Public Safety does not regulate the practice of physicians anyways.

If you are the patient’s own physician, PA, or nurse practitioner, the EMTs will work with
you to the extent that their protocols and scope of practice allow.

If you are not the patient’s own physician, PA, or nurse practitioner, you must be a Maine
licensed physician who will assume patient management and accept responsibility. These
EMT’s will assist you to the extent that their protocols and scope of practice allow. They will
not assist you in specific deviations from their protocols without Medical Control approval.
This requires that you accompany the patient to the hospital and that their Medical Control
physician is contacted and concurs.

No emphasis added.


Apparently not as clear cut as you're leading us to believe.

 

[rogersam5]

Over my dead body if I've initiated care that needs to be continued, yet are out of the scope of practice of the responding ambulance.

If you really want to i guess.... here is the rest of the protocol:

No individual should intervene in the care of this patient unless the individual is:
1. RequestedbytheattendingEMT,and
2. AuthorizedbytheMedicalControlphysician,and
3. Is capable of assisting, or delivering more extensive emergency medical care at the scene.

If you are the patient’s own physician, PA, or nurse practitioner, the EMTs will work with you to the extent that their protocols and scope of practice allow.

If you are not the patient’s own physician, PA, or nurse practitioner, you must be a Maine licensed physician who will assume patient management and accept responsibility. These EMT’s will assist you to the extent that their protocols and scope of practice allow. They will not assist you in specific deviations from their protocols without Medical Control approval. This requires that you accompany the patient to the hospital and that their Medical Control physician is contacted and concurs.

..............
But another question... what are you going to be able to do that the ambulance can't on scene. I mean I don't know one physician that caries around nearly as much crap as our ambulance does let alone a hospital.

 

[usafmedic45]

But another question... what are you going to be able to do that the ambulance can't on scene. I mean I don't know one physician that caries around nearly as much crap as our ambulance does let alone a hospital.

Contrary to popular belief in EMS, what you pack around between your ears is often a lot more important than what's strapped to your belt, in your bags and on your truck.

 

[JPINFV]

But another question... what are you going to be able to do that the ambulance can't on scene. I mean I don't know one physician that caries around nearly as much crap as our ambulance does let alone a hospital.

Depends on the patient. Let's say it's an OB call. Are you prepared to handle something like a shoulder dystocia? Additionally, there's the question of how much the physician can do with all of the crap on the ambulance that you can't. Airway if the paramedic is having issues intubating depending on the physician's specialty.

 

[usafmedic45]

Depends on the patient. Let's say it's an OB call. Are you prepared to handle something like a shoulder dystocia?

I actually had the patient's doc on one of my deliveries show up on scene (he lived four houses down). I've never been so glad to see someone in my whole life because it was a breech delivery.

 

[rogersam5]

Depends on the patient. Let's say it's an OB call. Are you prepared to handle something like a shoulder dystocia? Additionally, there's the question of how much the physician can do with all of the crap on the ambulance that you can't. Airway if the paramedic is having issues intubating depending on the physician's specialty.

Thats a valid point and I was never trying to say the physician would be useless. I was just wondering if you started care and you didn't want to give up control of patient care what more can you do without the tools on the ambulance. Yes you may have better assessment skills or a wider range of procedures you can preform but how many of the procedures would you need some sort of tool or device to help you with?

If you actually know what you are doing and you can help the pt better then I or anyone else on the truck could, AND you wanted to go to the hospital with us, AND our medical control OKed it (I wouldn't imagine they wouldn't, they tend to let us have what we ask for) I have no problem just assisting you.... Heck I do it with medics all the time.

But in my experience every doctor that has sent a patient with us said "here you go, have fun" and the pt went with us alone and in many cases a physician could have helped them a lot more the the EMT necessarily could. I am guessing it has something to do with the 2 hour time commitment it is to accompany us to the hospital, not to mention the crap they would have to deal with at the hospital that we don't deal with.



Anyway enough of that... the moral is in our protocols it is fairly evident that the way Maine looks at it is that the provider is releasing to not just the EMT (maybe a "lower" license level) but their Medical Control Physicians (I can't think of someone higher then a Doctor in this food chain). I wasn't trying to say that You absolutely had to relinquish care, how it appears the state "works around" the typical stipulation of "Equal level or Higher"

 

[usafmedic45]

Thats a valid point and I was never trying to say the physician would be useless. I was just wondering if you started care and you didn't want to give up control of patient care what more can you do without the tools on the ambulance. Yes you may have better assessment skills or a wider range of procedures you can preform but how many of the procedures would you need some sort of tool or device to help you with?

It might not be doing something, as I tried to point out earlier, but rather it's easier to ride along and explain to the receiving physician in person than trying to play telephone through a much less well educated person. Once again the idea that if you're not physically doing something to the patient there is no benefit rears its ugly head.

 

[JPINFV]

Thats a valid point and I was never trying to say the physician would be useless. I was just wondering if you started care and you didn't want to give up control of patient care what more can you do without the tools on the ambulance. Yes you may have better assessment skills or a wider range of procedures you can preform but how many of the procedures would you need some sort of tool or device to help you with?

Again, depends on what's wrong with the patient and where you're picking the patient up from. What if you're picking the patient up from a clinic or doctor's office instead of a private residence or other place of business? Additionally, not every procedure needs tools, and not all tools are limited to just what EMS providers are trained on how to use them.

But in my experience every doctor that has sent a patient with us said "here you go, have fun" and the pt went with us alone and in many cases a physician could have helped them a lot more the the EMT necessarily could. I am guessing it has something to do with the 2 hour time commitment it is to accompany us to the hospital, not to mention the crap they would have to deal with at the hospital that we don't deal with.

Again, it depends on a lot of things. The biggest two questions are going to be, "Is the physician anything more than minimally competent, or are you dealing with Dr. Conrad Murray?" and "Is this patient in the physician's wheelhouse?" In general, the first question is a "yes" and the second question is often going to be a "no." However, the tone of "Don't do anything to the patient and you must hand the patient over to the ambulance crew" is something I disagree with.

 

[rogersam5]

Athe tone of "Don't do anything to the patient and you must hand the patient over to the ambulance crew" is something I disagree with.

You are right and that wasn't the tone I was attempting to put out. I was just attempting to address the "You can only transfer to someone with a higher license than you" statement/phylosophy. In Maine it appears they take that out of the question by saying the provider is transferring care to "And their medical control physicians" That is why I didn't bother copying the bottom half of the page because it didn't deal with the point I was trying to make.

 

[bigbaldguy]

You are right and that wasn't the tone I was attempting to put out. I was just attempting to address the "You can only transfer to someone with a higher license than you" statement/phylosophy. In Maine it appears they take that out of the question by saying the provider is transferring care to "And their medical control physicians" That is why I didn't bother copying the bottom half of the page because it didn't deal with the point I was trying to make.

I got it By adding the words "And their medical control physicians" it makes it much clearer that we are receiving a patient not so much as a EMT but as extensions of our medical control physician.

 

[BlakeFabian]

It's my understanding that (Based on my protocols) unless that RN is a part of the 911 system which she activated, then the abandonment issues don't pertain to her.

The RN there is providing care on behalf of that school. When you arrive, you'll initiate care on behalf of your EMS service. At that point the RN is supposed to provide a verbal report and a copy of all information she has received from the Pt thus far, then basically step back and let EMS do its thing.

You can also look at it a different way. Odds are the nurse at a school isn't going to initiate any kind of ALS care which would require continued ALS monitoring. She would, most likely, be providing BLS level care for that Pt which you could legally take over as a BLS provider.