Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 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, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 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, > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 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. ------------------------------------------------------------------------ Free Conference Calling with Firetalk! Click Here! http://click./1/5480/7/_/4981/_/961502320/ ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2000 Report Share Posted June 21, 2000 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/ > ------------------------------------------------------------------------ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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/ > ------------------------------------------------------------------------ > > > > ------------------------------------------------------------------------ > Never lose a file again. Protect yourself from accidental deletes, > overwrites, and viruses with @Backup. > Try @Backup it's easy, it's safe, and it's FREE! > Click here to receive 300 MyPoints just for trying @Backup. > http://click./1/5669/7/_/4981/_/961556897/ > ------------------------------------------------------------------------ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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, > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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, > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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 ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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) ------------------------------------------------------------------------ STEALS AND DEALS! Cheapest prices on airfare, new cars, insurance, maids, contractors, collectibles, more. Get exactly what you want at the lowest price. New FREE service! http://click./1/5746/9/_/4981/_/961713762/ ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2000 Report Share Posted June 22, 2000 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 > >------------------------------------------------------------------------ >Air purifiers, bedding, household cleaning & more! gazoontite.com! >http://click./1/5492/9/_/4981/_/961731451/ >------------------------------------------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2000 Report Share Posted June 23, 2000 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 Quote Link to comment Share on other sites More sharing options...
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