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For our system, that would depend on what level of care the patient

required. e.g. a transport to the emergency department is always received

by rn or md/do. for services that transport to nursing homes, etc (private

services in this area, ems does not provide routine transport services) then

the receiving person may be of lower certification.

A. Rasmussen, Ph.D., REMTP

EMS Coordinator

Greenville County EMS

301 University Ridge, Suite 1100

Greenville, SC 29601

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It's my understanding that an EMT-I or Paramedic must release care to a RN or

higher or at least someone who can continue with patient care at your level or

higher. EMT-B must release to a LVN or higher....the exceptions I have found

to this rule is:

1. Your medical director gives permission to release care to

someone of

lower certification/licensure.

2. The receiving facility's medical director, in writing and shown

to you, has

authorized personnel certified/licensed at a lower level than

you or even

uncertified/unlicensed personnel to accept the patient and

obligations of

continuing care in the physicians name.

that's what I know....anyone know anything else?

Jim N.

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My understanding is that you must release the patient to someone who can

provide the appropriate level of care. I believe that in some cases this

could be someone without any medical certification/license. An example

would be when a non-emergency service takes a bed-ridden patient home from

the hospital. In this situation, they may be turning the patient over to a

family member. In tiered response systems, it is fairly common for an ALS

unit to turn a patient over to a BLS unit. In short, I believe that who you

can turn a patient over to has less to do with your level of certification

than it does with the patient's needs.

Hope this helps!

Trey Wood

Release of care

I was recently approached with a question I didn't have a fact-based answer

for:

Who can a paramedic release care of a patient to? An LVN is the particular

case in question.

Thanx,

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I don't know what the law says but what Trey says makes a lot of sense. I

know that is what his system did for years as a tiered system. It is also

what my system does when doing non emergency transfered back to private

residences or to assisted living centers with no medical care on site.

Stay safe,

Wiseman

Release of care

>

>

> I was recently approached with a question I didn't have a fact-based

answer

> for:

>

> Who can a paramedic release care of a patient to? An LVN is the

particular

> case in question.

>

> Thanx,

>

>

>

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This was taken directly from the Texas Board of Vocational Nurse Examiner's

website

Stay safe

Easley

The Texas Board of Vocational Nurse Examiners' General Statement on the

Scope of Vocational Nurse Practice

Texas does not have a practice act for vocational nurses. The law which

governs vocational nursing in Texas (Occupational Code, Chapter 302) is a

title act; therefore, specific nursing interventions and clinical skills

relative to licensed vocational nurses (LVNs) are not delineated.

The patient care responsibilities of vocational nurses should be within the

parameters of their educational preparation and their demonstrated

abilities. The clinically intensive vocational nursing program prepares

entry-level bedside nurses to provide direct nursing care to acutely and

chronically ill patients, with predictable health outcomes, in structured

health care settings. LVNs may expand their practice through continuing

education.

LVNs and health care employers have a joint responsibility to assure that

LVNs practice within the scope of their educational bases and demonstrated

abilities. If employers assign LVNs patient care responsibilities that are

beyond the basic nursing preparation, the employers should: 1) validate and

appropriately document that LVNs are competent to perform the assigned

patient care responsibilities, and 2) include the expanded practices in the

LVN job description.

LVNs shall accept patient care assignments with due regard for the safety of

the patients and sound health care practices.

Re: Release of care

It's my understanding that an EMT-I or Paramedic must release care to a RN

or

higher or at least someone who can continue with patient care at your level

or

higher. EMT-B must release to a LVN or higher....the exceptions I have

found

to this rule is:

1. Your medical director gives permission to release care to

someone of

lower certification/licensure.

2. The receiving facility's medical director, in writing and

shown

to you, has

authorized personnel certified/licensed at a lower level

than

you or even

uncertified/unlicensed personnel to accept the patient and

obligations of

continuing care in the physicians name.

that's what I know....anyone know anything else?

Jim N.

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Thanks to everyone who replied. I agree with all of ya...was hoping to find

some legal reference.

Re: Release of care

> For our system, that would depend on what level of care the patient

> required. e.g. a transport to the emergency department is always

received

> by rn or md/do. for services that transport to nursing homes, etc

(private

> services in this area, ems does not provide routine transport services)

then

> the receiving person may be of lower certification.

>

> A. Rasmussen, Ph.D., REMTP

> EMS Coordinator

> Greenville County EMS

> 301 University Ridge, Suite 1100

> Greenville, SC 29601

>

> _____________________________________________

> NetZero - Defenders of the Free World

> Click here for FREE Internet Access and Email

> http://www.netzero.net/download/index.html

>

> ------------------------------------------------------------------------

> Over 1,000 solutions for allergies & asthma-gazoontite.com! Shop now!

> http://click./1/5490/7/_/4981/_/961501321/

> ------------------------------------------------------------------------

>

>

>

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Thanks . Should be just what I needed to give a good answer.

Re: Release of care

>

> It's my understanding that an EMT-I or Paramedic must release care to a RN

> or

> higher or at least someone who can continue with patient care at your

level

> or

> higher. EMT-B must release to a LVN or higher....the exceptions I have

> found

> to this rule is:

>

> 1. Your medical director gives permission to release care to

> someone of

> lower certification/licensure.

>

> 2. The receiving facility's medical director, in writing and

> shown

> to you, has

> authorized personnel certified/licensed at a lower level

> than

> you or even

> uncertified/unlicensed personnel to accept the patient

and

> obligations of

> continuing care in the physicians name.

>

> that's what I know....anyone know anything else?

>

> Jim N.

>

>

> ------------------------------------------------------------------------

> Free Conference Calling with Firetalk!

> Click Here!

> http://click./1/5480/7/_/4981/_/961502320/

> ------------------------------------------------------------------------

>

>

>

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>

>

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Most of the time you are going to release care to an RN if you go to an ER.

There are some LVN's that work in the ER also, and to my knowledge you can

release care to them as they are of a higher level of care. If you are

talking about smaller rural hospitals, you may only have an LVN working the

ER with one RN over the floor and ER.

To my knowledge you can release pt care to LVN, RN, MD or DO. In some

places that use paramedics in the ER, they will allow them to sign your run

sheets since they are the same training level.

If you go to a nursing home, most of the time you are only going to have an

LVN, with an RN somewhere in the building if you are lucky. CNA would be

the only one that could not take your pt or sign the runsheet.

I would have no problem turning a pt over to an LVN.

But here is another question for you. What if you are taking your patient

for pre-admit testing, who do you release your patient to? X-ray tech, lab

tech, etc???

Doug

>

>Reply-To: egroups

>To: <egroups>

>Subject: Release of care

>Date: Wed, 21 Jun 2000 00:13:32 -0500

>

>I was recently approached with a question I didn't have a fact-based answer

>for:

>

>Who can a paramedic release care of a patient to? An LVN is the particular

>case in question.

>

>Thanx,

>

>

>

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Guest guest

Wouldn't the realize of care have more to do with what care and treatment has

been provided? Of course you would not release a intubated patient with a

dopamine drip running to an LVN or CNA, but what about those patients that no

treatment has been rendered? What about those patient transfers back to a

nursing home? Patients transported home after hospitalization? Patients

taken to outpatient diagnostic facilities? How does a physician release a

patient to be transferred to a higher level of care to a paramedic?

It seems to me that the real issue is not to turn a patient with treatment in

progress (or a patient in need of treatment) over to someone who is unable to

continue the care and treatment needed.

Just my opinion

, N.A. (non attorney)

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good question doc....me personally most of the hospitals I take patients to have

an RN or LVN working in that department as well for pre-admission

testing....that is usually one of their responsibilities according to their

policies...other cases...the medical director of the department usually gives

authority to his techs to accept patient care in his/her name...most of the time

I play it by ear and take the most appropriate action like waiting with the

patient because the call is a " wait and return "

Jim N. EMT-I

" Doug , DO, NREMT-P " wrote:

> Most of the time you are going to release care to an RN if you go to an ER.

> There are some LVN's that work in the ER also, and to my knowledge you can

> release care to them as they are of a higher level of care. If you are

> talking about smaller rural hospitals, you may only have an LVN working the

> ER with one RN over the floor and ER.

>

> To my knowledge you can release pt care to LVN, RN, MD or DO. In some

> places that use paramedics in the ER, they will allow them to sign your run

> sheets since they are the same training level.

>

> If you go to a nursing home, most of the time you are only going to have an

> LVN, with an RN somewhere in the building if you are lucky. CNA would be

> the only one that could not take your pt or sign the runsheet.

> I would have no problem turning a pt over to an LVN.

>

> But here is another question for you. What if you are taking your patient

> for pre-admit testing, who do you release your patient to? X-ray tech, lab

> tech, etc???

>

> Doug

>

> >

> >Reply-To: egroups

> >To: <egroups>

> >Subject: Release of care

> >Date: Wed, 21 Jun 2000 00:13:32 -0500

> >

> >I was recently approached with a question I didn't have a fact-based answer

> >for:

> >

> >Who can a paramedic release care of a patient to? An LVN is the particular

> >case in question.

> >

> >Thanx,

> >

> >

> >

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In a message dated 06/22/2000 5:46:06 PM Central Daylight Time,

TX1@... writes:

<< It seems to me that the real issue is not to turn a patient with treatment

in

progress (or a patient in need of treatment) over to someone who is unable

to

continue the care and treatment needed. >>

That is EXACTLY the issue. There is some case law on this problem, though

not much, and what there is doesn't hit the question head-on...sort of a

glancing blow.

I had the (mis)fortune of having to deal with this question fairly directly

in my last job, where our medics were assuming and/or releasing care to a

variety of providers, both in a clinical setting and in the field.

My interpretation of the case law and opinions that are out there is:

1. You are required to ensure that whoever assumes patient care from you

can provide the care that you can reasonably expect the patient to need in

the near future. You are not required to forsee unusual occurences or have a

crystal ball of some sort...if it would be obvious to other people with your

training, then you are expected to see it. For example, leaving a patient

who has a chest injury and dyspnea with someone who cannot do cx

decompression (but you can) would be a bad move.

2. At hospitals or other health-care facilities, that facility generally

has the responsibility of determining who can accept the patient/report from

you. Some facilities allow LVN's or even techs to accept a patient from EMS,

some restrict that process to RN's. In any case, one should find out what

that hospital wants and, generally, stick to that. You will still be

expected to " over-ride " if it's obviously wrong for a given case; for

example, if the hospital allows techs to accept patients but this patient

might need cardioversion at any minute, you should probably insist that a

nurse take the patient from you.

Last, there is the issue of " equivalent level of care " . It is important to

note that it would probably be impossible to establish a relative level of

care between providers who have fundamentally different medical practices.

Nurses simply do NOT do the stuff that paramedics do, and vice-versa. For

example, with rare exceptions, most nurses (including RN's) cannot intubate

or perform chest decompression or " clear " a c-spine, while most paramedics

can. On the other hand, most paramedics cannot administer many of the

medications that RN's (and in some facilities LVN's) administer.

Certainly, I believe that Dr. ' comment that LVN's are a higher level

of care is erronious. In virtually every setting, LVN's have a much more

limited scope of practice than paramedics. I think that most of us who have

spent some time researching this issue would say that if there *was* an

equivalency, then the only one we could draw would be that RN's and

paramedics are " equivalent " (although very different). I don't think one

could draw " level of care " comparisons for any other EMS certification or

allied health care license levels.

I hope that sheds some light. Like , I am certainly not an attorney but

I have had to look at this issue in some depth.

City of Beaumont EMS

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Well ,

If LVNs are not approperate health care providers why do we even use them in

a hospital? Should they only be floor nurses and not ER nurses?

To me an LVN is just important in the health care ranks as an RN. Granted

an RN is considered a " professional " nurse, or at least some of them are.

As with anything you have the good ones and the bad ones, just like there

are good and bad medics.

An LVN goes to school for about a yr same as a medic. A medic can do most

of the skills that an LVN and RN can do. It all ready depends on the nurse

as a person. You will find that most LVNs are care providers on the floor,

with very few in the ER. Granted as I said, there are some places that use

an LVN to treat pts in the ER, such as those in your rural settings. Most

larger ERs will be staffed by RNs. As you know LVNs are not allowed to

triage pts when they first come into the ER, that is an RNs rsponsibility

and usually hospital policy.

If you are calling medics and RNs equal, when are medics paid so little?

Why are medics not allowed to challange the RN exam if you are calling them

equal? Why are LPs not allowed to test out RN?

As far as you saying that nurses and medics are allowed to clear a c-spine,

I have never seen that. From reading other posts from Beaumont EMS people,

I realize that you all or most of you think that you are doctors with a red

patch, but unless you have an x-ray machine in your ambulance, you CANNOT

CLEAR A C-SPINE. I've never seen a nurse clear on either. Most physicians

don't clear them without x-rays first. Granted there are some that you can,

but I have always had x-rays done before ever clearing a c-spine. If you

were under my license and cleared a c-spine when you are not allowed to, you

would be unemployed, and without a certification.

Did you happen to read the post by Jim Easly I think it was as to what he

has done as an LVN? Have you ever done that as a medic?

Since when have you seen an RN do chest decompression in the ER or in the

hospital? That is usually something that the attending physician does and

it's usually done with a chest tube.

Let me ask you this, would you turn care over to a PA [physician

assistant]what training level would you consider them?

Folks, if you want to flame go right ahead. But not many physicians will

defend LVNs in the ER, but I will. I have known some good LVNs that have

worked in ERs, and most I don't have a problem with them providing care in

the ER. I may have sounded harsh toward , but since he posted the

reply to the group I will too. As you know his service is the one that says

they are better than ANY private provider in Texas.

Thanks,

Dr. , DO/NREMTP

>From: DPEMS500@...

>To: egroups

>CC: traumadoc2@..., hemoroyd@...

>Subject: Re: Release of care

>Date: Thu, 22 Jun 2000 23:37:23 EDT

>

>

>That is EXACTLY the issue. There is some case law on this problem, though

>not much, and what there is doesn't hit the question head-on...sort of a

>glancing blow.

>

>I had the (mis)fortune of having to deal with this question fairly directly

>in my last job, where our medics were assuming and/or releasing care to a

>variety of providers, both in a clinical setting and in the field.

>

>My interpretation of the case law and opinions that are out there is:

> 1. You are required to ensure that whoever assumes patient care from

>you

>can provide the care that you can reasonably expect the patient to need in

>the near future. You are not required to forsee unusual occurences or have

>a

>crystal ball of some sort...if it would be obvious to other people with

>your

>training, then you are expected to see it. For example, leaving a patient

>who has a chest injury and dyspnea with someone who cannot do cx

>decompression (but you can) would be a bad move.

> 2. At hospitals or other health-care facilities, that facility

>generally

>has the responsibility of determining who can accept the patient/report

>from

>you. Some facilities allow LVN's or even techs to accept a patient from

>EMS,

>some restrict that process to RN's. In any case, one should find out what

>that hospital wants and, generally, stick to that. You will still be

>expected to " over-ride " if it's obviously wrong for a given case; for

>example, if the hospital allows techs to accept patients but this patient

>might need cardioversion at any minute, you should probably insist that a

>nurse take the patient from you.

>

>Last, there is the issue of " equivalent level of care " . It is important to

>note that it would probably be impossible to establish a relative level of

>care between providers who have fundamentally different medical practices.

>Nurses simply do NOT do the stuff that paramedics do, and vice-versa. For

>example, with rare exceptions, most nurses (including RN's) cannot intubate

>or perform chest decompression or " clear " a c-spine, while most paramedics

>can. On the other hand, most paramedics cannot administer many of the

>medications that RN's (and in some facilities LVN's) administer.

>

>Certainly, I believe that Dr. ' comment that LVN's are a higher

>level

>of care is erronious. In virtually every setting, LVN's have a much more

>limited scope of practice than paramedics. I think that most of us who

>have

>spent some time researching this issue would say that if there *was* an

>equivalency, then the only one we could draw would be that RN's and

>paramedics are " equivalent " (although very different). I don't think one

>could draw " level of care " comparisons for any other EMS certification or

>allied health care license levels.

>

>I hope that sheds some light. Like , I am certainly not an attorney

>but

>I have had to look at this issue in some depth.

>

>

>City of Beaumont EMS

________________________________________________________________________

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I just took care of a patient yesterday in an ICU where the pt. was on a

ventilator, had a ventriculostomy with ICP readings and tx, had 3

vasopressor meds infusing, a swan-ganz catheter w/ cardiac outputs q1 hr as

well as wedge pressures and required continuous monitoring and changing of

drip rates to maintain some semblance of a cardiac output and a decent CPP.

I have also done international flights with critically ill patients, and

been the coordinator of an ICU and ER, as well as being a major trauma

preceptor in a level II Emergency Department, all while being an LVN. Just

food for thought.

Easley LVN

President UHCS, Inc.

Re: Release of care

Wouldn't the realize of care have more to do with what care and treatment

has

been provided? Of course you would not release a intubated patient with a

dopamine drip running to an LVN or CNA, but what about those patients that

no

treatment has been rendered? What about those patient transfers back to a

nursing home? Patients transported home after hospitalization? Patients

taken to outpatient diagnostic facilities? How does a physician release a

patient to be transferred to a higher level of care to a paramedic?

It seems to me that the real issue is not to turn a patient with treatment

in

progress (or a patient in need of treatment) over to someone who is unable

to

continue the care and treatment needed.

Just my opinion

, N.A. (non attorney)

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price. New FREE service!

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Reply in your response

Re: Release of care

>In a message dated 06/22/2000 5:46:06 PM Central Daylight Time,

>TX1@... writes:

>

><< It seems to me that the real issue is not to turn a patient with treatment

>in

> progress (or a patient in need of treatment) over to someone who is unable

>to

> continue the care and treatment needed. >>

>

>That is EXACTLY the issue. There is some case law on this problem, though

>not much, and what there is doesn't hit the question head-on...sort of a

>glancing blow.

>

>I had the (mis)fortune of having to deal with this question fairly directly

>in my last job, where our medics were assuming and/or releasing care to a

>variety of providers, both in a clinical setting and in the field.

>

>My interpretation of the case law and opinions that are out there is:

> 1. You are required to ensure that whoever assumes patient care from you

>can provide the care that you can reasonably expect the patient to need in

>the near future. You are not required to forsee unusual occurences or have a

>crystal ball of some sort...if it would be obvious to other people with your

>training, then you are expected to see it. For example, leaving a patient

>who has a chest injury and dyspnea with someone who cannot do cx

>decompression (but you can) would be a bad move.

> 2. At hospitals or other health-care facilities, that facility generally

>has the responsibility of determining who can accept the patient/report from

>you. Some facilities allow LVN's or even techs to accept a patient from EMS,

>some restrict that process to RN's. In any case, one should find out what

>that hospital wants and, generally, stick to that. You will still be

>expected to " over-ride " if it's obviously wrong for a given case; for

>example, if the hospital allows techs to accept patients but this patient

>might need cardioversion at any minute, you should probably insist that a

>nurse take the patient from you.

>

>Last, there is the issue of " equivalent level of care " . It is important to

>note that it would probably be impossible to establish a relative level of

>care between providers who have fundamentally different medical practices.

>Nurses simply do NOT do the stuff that paramedics do, and vice-versa. For

>example, with rare exceptions, most nurses (including RN's) cannot intubate

>or perform chest decompression or " clear " a c-spine, while most paramedics

>can. Since when has a paramedic been allowed or able to " CLEAR " as c-spine.

Unless you are a doctor or have x-ray vision, I don't know of ANY medic that

would clear a C-Spine. Do any of you fellow medic " CLEAR " C-Spines in the field

or ER. But I forgot, Beaumont EMS medics are wonder medics also. On the other

hand, most paramedics cannot administer many of the

>medications that RN's (and in some facilities LVN's) administer.

>

>Certainly, I believe that Dr. ' comment that LVN's are a higher level

>of care is erronious.Let me guess, you must be an RN also. In virtually

every setting, LVN's have a much more

>limited scope of practice than paramedics.I know an LVN that works in a level

II trauma center that I would not have ANY problems turning over a pt to her.

Granted LVNs are not allowed to triage ER patients when they first come in, as

an RN has to or is required to in most places. Yes, there are some things that

an LVN can't do but for the most part are capable of doing the job required of

them. I think that most of us who have

>spent some time researching this issue would say that if there *was* an

>equivalency, then the only one we could draw would be that RN's and

>paramedics are " equivalent " (although very different). If we are " equivalent "

then why can't we challange the RN exam? Why don't we make the money that RNs

do if we are considered " equivalent " I don't think one

>could draw " level of care " comparisons for any other EMS certification or

>allied health care license levels.

>

>I hope that sheds some light. Like , I am certainly not an attorney but

>I have had to look at this issue in some depth.

>

>

>City of Beaumont EMS

>

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>http://click./1/5492/9/_/4981/_/961731451/

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In a message dated 06/23/2000 1:19:06 AM Central Daylight Time,

traumadoc2@... writes:

<< Well ,

If LVNs are not approperate health care providers why do we even use them in

a hospital? Should they only be floor nurses and not ER nurses?

To me an LVN is just important in the health care ranks as an RN. Granted

an RN is considered a " professional " nurse, or at least some of them are.

As with anything you have the good ones and the bad ones, just like there

are good and bad medics.>>

Um.......that has *nothing* to do with what I said. I said that an LVN is

not a *higher* level of care than a paramedic, which is what I thought you

had said. In fact, I saved your post and I am *sure* that's what you

said....LVN's are a higher level of care (than EMS), and I interpret " EMS " as

including paramedics. I also did *not* say that they were a lower level,

neccessarily, either. I worked in hospitals for a long time. LVN's are

quite capable and important practitioners, without a doubt. I have worked

with LVN's in the ICU who were far more competent and capable than some of

the RN's working in that same unit, and were a damn sight better at it than

me.

<<An LVN goes to school for about a yr same as a medic. A medic can do most

of the skills that an LVN and RN can do.>>

But not all. I agree.

And a nurse can do *most* of the things a medic can do, but *not all*.

<<It all ready depends on the nurse as a person. You will find that most

LVNs are care providers on the floor,

with very few in the ER. Granted as I said, there are some places that use

an LVN to treat pts in the ER, such as those in your rural settings. Most

larger ERs will be staffed by RNs. As you know LVNs are not allowed to

triage pts when they first come into the ER, that is an RNs rsponsibility

and usually hospital policy.>>

Not in all places. In many hospitals, including medium to large facilities

in suburban and even urban settings, LVN's can do initial triage or anything

else that an RN can do. At at least one of the two hospitals here in

Beaumont, LVN's can and do accept patients initially from EMS without an RN's

" signoff " , and do triage as well. Each facility determines its own policy.

<<If you are calling medics and RNs equal, when are medics paid so little?>>

I'm not, neccessarily. I actually said that we cannot make comparisons

between medics and nurses because it is apples and oranges...fundamentally

different medicine. If I did *have* to make a comparison, I would say that

the only one I could make is that paramedics and RN's are roughly equivalent,

because of general scopes of practice.

Medics are paid poorly, compared to RN's, for a lot of reasons. That is a

very large and important topic. It does *not* have to do with clinical

capabilities, *which was the point of my statements*, although you obviously

missed that. It does have a lot to do with formal education, which RN's are

required to have but medics are not (although many do).

<<Why are medics not allowed to challange the RN exam if you are calling them

equal? Why are LPs not allowed to test out RN?>>

Apples and oranges. Different medicine, different knowledge bases and

skills. One is not " higher " than the other, just different. That's actually

what I said originally.

<<As far as you saying that nurses and medics are allowed to clear a c-spine,

I have never seen that.>>

Well, if you haven't seen it, it certainly must not exist! Actually, I have

not heard of nurses being allowed to use clinical spinal clearance protocols,

which is what I said. My point was that this is one of things medics can do

(in many systems) but nurses generally cannot.

Spinal clearance via clinical criteria by paramedics is a widely accepted and

practiced procedure. It has been published for at least five (5) years, with

multiple studies demonstrating both safety and efficacy. I am surprised that

this is news to you.

<<From reading other posts from Beaumont EMS people, I realize that you all

or most of you think that you are doctors with a red patch,>>

Well, well. What did we do to pee in your Post-Toasties? No, we do not

think we are physicians. I am dissapointed that you feel so threatened by

some confident and educated medics that you would feel the need to attack

like that. That is an unfortunate position in which you have placed youself.

We do think we practice pretty good out-of-hospital medicine, but we also

think there are other EMS systems which do even better and we hope that we

will continue to improve and maybe someday be in the leagues of other great

paramedic systems.

<<but unless you have an x-ray machine in your ambulance, you CANNOT

CLEAR A C-SPINE. I've never seen a nurse clear on either. Most physicians

don't clear them without x-rays first. Granted there are some that you can,

but I have always had x-rays done before ever clearing a c-spine. If you

were under my license and cleared a c-spine when you are not allowed to, you

would be unemployed, and without a certification.>>

I'll keep that in mind. Thanks for the threat. I'm pretty sure I won't be

working for you in this lifetime, anyway.

Meanwhile, there are extensive, well done studies that demonstrate that there

is a protocol (the " Main (as in state of) protocol " , or a slight variation

thereof, is the one usually used) that does allow safe spinal clearance by

paramedics in the field. Again, I am shocked that this is news to you.

<<Did you happen to read the post by Jim Easly I think it was as to what he

has done as an LVN? Have you ever done that as a medic?>>

Gosh, I hope not! I have worked with other LVN's when I worked in ICU/CCU

that did the same thing everyday, and did it well. As I said earlier, those

are **different** clinical practices, not " bigger " . Does Jim Easly intubate

or perform a surgical airway or independantly provide chemical (paralytic) -

induced intubation? Probably not. That doesn't make *us* " bigger " either,

just different.

<<Since when have you seen an RN do chest decompression in the ER or in the

hospital? That is usually something that the attending physician does and

it's usually done with a chest tube.>>

I guess my post was either very confusing or you didn't read it. That was

exactly what I was saying...nurses, be it LVN or RN, generally do not do

chest decompression. On the other hand, medics do not give many of the

medicines that nurses give.

<<Let me ask you this, would you turn care over to a PA [physician

assistant]what training level would you consider them?>>

My point was that medics generally have an obligation to turn the patient

over to someone that can provide the care that we can reasonably predict the

patient will need in the immediate future, if the *medic* could provide that

care. In other words, you can't release a patient that might need to be

cardioverted very shortly, assuming that *you* can perform cardioversion, to

someone that couldn't cardiovert the patient. You would have to stay with

the patient.

PA's would certainly be able to provide the needed care in virtually every

case.

<<Folks, if you want to flame go right ahead. But not many physicians will

defend LVNs in the ER, but I will. I have known some good LVNs that have

worked in ERs, and most I don't have a problem with them providing care in

the ER. I may have sounded harsh toward , but since he posted the

reply to the group I will too. As you know his service is the one that says

they are better than ANY private provider in Texas. >>

You'll have to remind me when we said we were better than " ANY private

provider in Texas " . Don't recall that one. We certainly have said, and

continue to say to this very moment, that we provide a higher level of care

from a clinical capabilities standpoint than the private providers who

operate here in our city. By the way, the main reason for that is economics,

not some sort of demonic plan on the part of the private providers. The

stuff we do is *very* expensive and if we had to pay our bills based soley on

our revenues (which is what private services must do), we couldn't do what we

do now either....we couldn't afford to. Insurance reimbursement is simply

not adequate for the costs that EMS' now confront.

Is that what you're so upset about? Your response here seemed, at least to

me, to miss the mark of what I said in my post. My post must have been very

unclear.

In any case, I hope this reply clears it up.

, BS, EMT-P

EMS Manager

City of Beaumont

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