RE: Re: Scope of Practice Questions

[Guest guest]

And remember.

" You can have anything you want, at Alice's Restaurant (except for Alice). "

Barry E. McClung, FF/EMT-P

_____

From: LaChance

Sent: Monday, 06 December, 2004 13:44

To:

Subject: Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a Thanksgiving

dinner that couldn't be beat. . . ?

[Guest guest]

Remember that the PA still needs a Physician under who's direction he will

practice.

" Alfonso R. Ochoa " wrote:

Knowing what to do is one thing, knowing why is a totally different

story. Why do we need doctors when PA's can do the majority of their

work?

-aro

> > Why go to a 4 year degree whebn I can take a S.L.A.M. (steet level

> airway maintenance) course and get the same knowledge and skill. <<

>

>

>

>

>

[Guest guest]

In my almost thirty years on ambulancce work, I have only done one, but to see

that teenager being ventilated was well worth alla the training and practice we

put in.

" Alfonso R. Ochoa " wrote:

I agree with you. At the company I work for, we're cleared to do

surgical crics and chest decompressions. But in a year's time I have

done exactly 0 of both.

-aro

> I keep seeing arguments for RSI and/or surgical trachs - I have to

> wonder just how many of these are done by an individual medic in a

> year's time. . .

> Also, I would much rather have someone who has formal training in

an

> advanced procedure performing that procedure on me, as opposed to

> someone who merely has his medical director's permission.

>

>

> Rick LaChance

[Guest guest]

Donn,

Rmeind me of the date's and time for EMStock. In my aged condition my memory is

a little rusty. I'll print it off this time.

" D.E. (Donn) " wrote:

But first you have to pick up the garbage.

Regards,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

~~ Mellita, domi adsum ~~

Don't Miss EMStock 2005

www.EMStock.com

May 20 - 22 2005

________________________________

From: LaChance

Sent: Monday, December 06, 2004 1:44 PM

To:

Subject: Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

I Plan to be there this time barring unforseen misfortune.

wrote:

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

I Plan to be there this time barring unforseen misfortune.

wrote:

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

I Plan to be there this time barring unforseen misfortune.

wrote:

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

Did someone ask about EMStock?

It's May 20 - 22, 2005

Regards,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

" Bury me on my face ... because in a little while everything will be

turned upside down. "

~~ Laertius Diogenes (c. 320 BC) ~~

Don't Miss EMStock 2005

www.EMStock.com

May 20 - 22, 2005

_____

From:

Sent: Monday, December 06, 2004 4:54 PM

To:

Subject: RE: Re: Scope of Practice Questions

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

Did someone ask about EMStock?

It's May 20 - 22, 2005

Regards,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

" Bury me on my face ... because in a little while everything will be

turned upside down. "

~~ Laertius Diogenes (c. 320 BC) ~~

Don't Miss EMStock 2005

www.EMStock.com

May 20 - 22, 2005

_____

From:

Sent: Monday, December 06, 2004 4:54 PM

To:

Subject: RE: Re: Scope of Practice Questions

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

Did someone ask about EMStock?

It's May 20 - 22, 2005

Regards,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

" Bury me on my face ... because in a little while everything will be

turned upside down. "

~~ Laertius Diogenes (c. 320 BC) ~~

Don't Miss EMStock 2005

www.EMStock.com

May 20 - 22, 2005

_____

From:

Sent: Monday, December 06, 2004 4:54 PM

To:

Subject: RE: Re: Scope of Practice Questions

Here ya go go to the website. Take care my friend.

www.EMStock.com

May 20 - 22 2005

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

Gene,

I mailed a CD with some pictures of the Conference Booth and Give aways today,

snail mail.

wegandy1938@... wrote:

Go sit on the Group W Bench, Kenny.

GG

In a message dated 12/6/04 13:40:08, kenneth.navarro@...

writes:

>

>

> And then there were three...

>

> " And if three people do it, three, can you imagine, three people

> walking in singin a bar of Alice's Restaurant and walking out. They

> may think it's an organization. And can you imagine fifty people a

> day,I said fifty people a day walking in singin a bar of Alice's

> Restaurant and walking out. And friends they may think it's a

> movement. " - Arlo Guthrie

>

> Kenny Navarro

>

>

> >>

> Also, I would much rather have someone who has formal training in an

> advanced procedure performing that procedure on me, as opposed to

> someone who merely has his medical director's permission. <<

>

>

>

>

>

>

>

>

[Guest guest]

Gene,

I mailed a CD with some pictures of the Conference Booth and Give aways today,

snail mail.

wegandy1938@... wrote:

Go sit on the Group W Bench, Kenny.

GG

In a message dated 12/6/04 13:40:08, kenneth.navarro@...

writes:

>

>

> And then there were three...

>

> " And if three people do it, three, can you imagine, three people

> walking in singin a bar of Alice's Restaurant and walking out. They

> may think it's an organization. And can you imagine fifty people a

> day,I said fifty people a day walking in singin a bar of Alice's

> Restaurant and walking out. And friends they may think it's a

> movement. " - Arlo Guthrie

>

> Kenny Navarro

>

>

> >>

> Also, I would much rather have someone who has formal training in an

> advanced procedure performing that procedure on me, as opposed to

> someone who merely has his medical director's permission. <<

>

>

>

>

>

>

>

>

[Guest guest]

Gene,

I mailed a CD with some pictures of the Conference Booth and Give aways today,

snail mail.

wegandy1938@... wrote:

Go sit on the Group W Bench, Kenny.

GG

In a message dated 12/6/04 13:40:08, kenneth.navarro@...

writes:

>

>

> And then there were three...

>

> " And if three people do it, three, can you imagine, three people

> walking in singin a bar of Alice's Restaurant and walking out. They

> may think it's an organization. And can you imagine fifty people a

> day,I said fifty people a day walking in singin a bar of Alice's

> Restaurant and walking out. And friends they may think it's a

> movement. " - Arlo Guthrie

>

> Kenny Navarro

>

>

> >>

> Also, I would much rather have someone who has formal training in an

> advanced procedure performing that procedure on me, as opposed to

> someone who merely has his medical director's permission. <<

>

>

>

>

>

>

>

>

[Guest guest]

Gene -

I really wasn't implying that anyone would or could do a procedure

without formal training. I was merely stating that if the patient was

me, I'd rather the procedure be done by someone with formal training in

the procedure.

There are reasons physicians have to meet a minimum standard and

receive training in specific areas in order to practice medicine. There

are more than a few physicians that I've seen and worked with that we

not board certified in emergency medicine. Some were able to handle the

job, some were not. And this is true in paramedicine and indeed any

profession. But who would you rather have working on you, the board

certified physician? Or the guy who has some experience and training?

RSI and chrichs can save a patient's life, I agree. But it has to

be done right. So it must taught well, practiced often, and quality

controlled or it won't help anyone. These type of procedures would end

up injuring someone even worse than if they'd never had the procedure

attempted on them. In my 10 years of E.R. time, I have seen prime

examples of both.

I see the NSoP as a tool to establish minimum standards that would

apply no matter where in the U.S. you might be. This is a good thing for

us and more importantly, for the patient.

Rick LaChance

[Guest guest]

Gene -

I really wasn't implying that anyone would or could do a procedure

without formal training. I was merely stating that if the patient was

me, I'd rather the procedure be done by someone with formal training in

the procedure.

There are reasons physicians have to meet a minimum standard and

receive training in specific areas in order to practice medicine. There

are more than a few physicians that I've seen and worked with that we

not board certified in emergency medicine. Some were able to handle the

job, some were not. And this is true in paramedicine and indeed any

profession. But who would you rather have working on you, the board

certified physician? Or the guy who has some experience and training?

RSI and chrichs can save a patient's life, I agree. But it has to

be done right. So it must taught well, practiced often, and quality

controlled or it won't help anyone. These type of procedures would end

up injuring someone even worse than if they'd never had the procedure

attempted on them. In my 10 years of E.R. time, I have seen prime

examples of both.

I see the NSoP as a tool to establish minimum standards that would

apply no matter where in the U.S. you might be. This is a good thing for

us and more importantly, for the patient.

Rick LaChance

[Guest guest]

Gene -

I really wasn't implying that anyone would or could do a procedure

without formal training. I was merely stating that if the patient was

me, I'd rather the procedure be done by someone with formal training in

the procedure.

There are reasons physicians have to meet a minimum standard and

receive training in specific areas in order to practice medicine. There

are more than a few physicians that I've seen and worked with that we

not board certified in emergency medicine. Some were able to handle the

job, some were not. And this is true in paramedicine and indeed any

profession. But who would you rather have working on you, the board

certified physician? Or the guy who has some experience and training?

RSI and chrichs can save a patient's life, I agree. But it has to

be done right. So it must taught well, practiced often, and quality

controlled or it won't help anyone. These type of procedures would end

up injuring someone even worse than if they'd never had the procedure

attempted on them. In my 10 years of E.R. time, I have seen prime

examples of both.

I see the NSoP as a tool to establish minimum standards that would

apply no matter where in the U.S. you might be. This is a good thing for

us and more importantly, for the patient.

Rick LaChance

[Guest guest]

I hope to see ya there.

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

I hope to see ya there.

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

I hope to see ya there.

FF/LP

Vernon College

FIRE/EMS Training Program

4105 Maplewood

Wichita Falls, Texas 76308

Office ext 3233

Fax

Re: Scope of Practice Questions

Is it too late to want to go back to the church and have a

Thanksgiving

dinner that couldn't be beat. . . ?

>>> kenneth.navarro@... 12/6/2004 1:35:59 PM >>>

And then there were three...

" And if three people do it, three, can you imagine, three people

walking in singin a bar of Alice's Restaurant and walking out. They

may think it's an organization. And can you imagine fifty people a

day,I said fifty people a day walking in singin a bar of Alice's

Restaurant and walking out. And friends they may think it's a

movement. " - Arlo Guthrie

Kenny Navarro

>>

Also, I would much rather have someone who has formal training in an

advanced procedure performing that procedure on me, as opposed to

someone who merely has his medical director's permission. <<

[Guest guest]

Find me a study that says 12-leads affect pt. outcome demonstrably in

pre-hospital medicine.

magnetass sends

Re: Re: Scope of Practice Questions

You got it, my friend. 12-lead is standard of care. It is well within

the

means of most services to provide it. So some lawyer, somewhere, will

attempt to hold a service liable for not providing " standard of care. "

Remember, SOC is a question of fact. Try to find an expert in emergency

cardiac care who will testify that 12-lead is not standard of care? Then

the

question becomes whether or not it is reasonable to deviate from SOC. Some

may

argue that they deviate because they simply do not have the funds to acquire

the equipment necessary. To win that argument, it had better be

demonstrably

true.

Here's an example of deviation from SOC justified by economic concerns:

Your community hospital doesn't have a CT or an MRI because it cannot afford

it.

But a reconditioned 12-lead monitor isn't the same as a CT or MRI, and there

are grants available. See what I mean?

Standard of Care is always going to be determined by a jury based upon the

testimony presented by experts. I'm only trying to explain what the

experts

are going to say.

Even if you cannot afford a 12-lead, everybody can use Marriot's or Modified

Chest leads to approximate a 12 lead and learn enough to identify a possible

right sided MI. Failure to do even that is, in my judgment, indefensible.

GG

>

>

> So you're saying, if I'm interpreting this correctly, is if I work for

> a service that only has 3-lead EKG capabilities and the prevailing

> standard of care is 12-lead EKG capability, the company,

> administration, and medical director can be held liable?

>

> -aro

>

>

>

> > Writes Alphonso:

> >

> > " tis why when the time comes, I can point out it's beyond my Scope of

> > Practice so I didn't do it for risk of being arrested. :-) "

> >

> > That's an interesting argument and one that would surely be set forth;

> > however, since scope or practice and standard of care are two

> different things, a

> > service that chooses to limit scope of practice may in fact be

> guilty of failing

> > to provide the prevailing standard of care. The persons who will

> be liable

> > for that failure will be the administrators, owners, managers, and

> medical

> > directors.

> >

> > Further, the SoP is sure to be attacked as an impermissible

> restriction on a

> > physician's medical practice, as interfering with the patient's 5th

> and 14th

> > Amendment rights, and so forth. The service that is chosen to be the

> > defendant in one of these cases will lose even if it wins.

> >

> > GG

> > GG

> > In a message dated 12/6/04 16:44:08, asclapius@a... writes:

> >

> >

> > >

> > >

> > >

> > > >

> > > > And believe me, RSI and surgical crichs are well enough

> > > established as

> > > > being within the expertise of paramedics to perform, that if your

> > > patient could

> > > > have been saved through such a procedure and you didn't do it,

> > > you'll be taking

> > > > a long journey through the legal system.

> > > >

> > >

> > > '

> > >

> > > -aro

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Find me a study that says 12-leads affect pt. outcome demonstrably in

pre-hospital medicine.

magnetass sends

Re: Re: Scope of Practice Questions

You got it, my friend. 12-lead is standard of care. It is well within

the

means of most services to provide it. So some lawyer, somewhere, will

attempt to hold a service liable for not providing " standard of care. "

Remember, SOC is a question of fact. Try to find an expert in emergency

cardiac care who will testify that 12-lead is not standard of care? Then

the

question becomes whether or not it is reasonable to deviate from SOC. Some

may

argue that they deviate because they simply do not have the funds to acquire

the equipment necessary. To win that argument, it had better be

demonstrably

true.

Here's an example of deviation from SOC justified by economic concerns:

Your community hospital doesn't have a CT or an MRI because it cannot afford

it.

But a reconditioned 12-lead monitor isn't the same as a CT or MRI, and there

are grants available. See what I mean?

Standard of Care is always going to be determined by a jury based upon the

testimony presented by experts. I'm only trying to explain what the

experts

are going to say.

Even if you cannot afford a 12-lead, everybody can use Marriot's or Modified

Chest leads to approximate a 12 lead and learn enough to identify a possible

right sided MI. Failure to do even that is, in my judgment, indefensible.

GG

>

>

> So you're saying, if I'm interpreting this correctly, is if I work for

> a service that only has 3-lead EKG capabilities and the prevailing

> standard of care is 12-lead EKG capability, the company,

> administration, and medical director can be held liable?

>

> -aro

>

>

>

> > Writes Alphonso:

> >

> > " tis why when the time comes, I can point out it's beyond my Scope of

> > Practice so I didn't do it for risk of being arrested. :-) "

> >

> > That's an interesting argument and one that would surely be set forth;

> > however, since scope or practice and standard of care are two

> different things, a

> > service that chooses to limit scope of practice may in fact be

> guilty of failing

> > to provide the prevailing standard of care. The persons who will

> be liable

> > for that failure will be the administrators, owners, managers, and

> medical

> > directors.

> >

> > Further, the SoP is sure to be attacked as an impermissible

> restriction on a

> > physician's medical practice, as interfering with the patient's 5th

> and 14th

> > Amendment rights, and so forth. The service that is chosen to be the

> > defendant in one of these cases will lose even if it wins.

> >

> > GG

> > GG

> > In a message dated 12/6/04 16:44:08, asclapius@a... writes:

> >

> >

> > >

> > >

> > >

> > > >

> > > > And believe me, RSI and surgical crichs are well enough

> > > established as

> > > > being within the expertise of paramedics to perform, that if your

> > > patient could

> > > > have been saved through such a procedure and you didn't do it,

> > > you'll be taking

> > > > a long journey through the legal system.

> > > >

> > >

> > > '

> > >

> > > -aro

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Find me a study that says 12-leads affect pt. outcome demonstrably in

pre-hospital medicine.

magnetass sends

Re: Re: Scope of Practice Questions

You got it, my friend. 12-lead is standard of care. It is well within

the

means of most services to provide it. So some lawyer, somewhere, will

attempt to hold a service liable for not providing " standard of care. "

Remember, SOC is a question of fact. Try to find an expert in emergency

cardiac care who will testify that 12-lead is not standard of care? Then

the

question becomes whether or not it is reasonable to deviate from SOC. Some

may

argue that they deviate because they simply do not have the funds to acquire

the equipment necessary. To win that argument, it had better be

demonstrably

true.

Here's an example of deviation from SOC justified by economic concerns:

Your community hospital doesn't have a CT or an MRI because it cannot afford

it.

But a reconditioned 12-lead monitor isn't the same as a CT or MRI, and there

are grants available. See what I mean?

Standard of Care is always going to be determined by a jury based upon the

testimony presented by experts. I'm only trying to explain what the

experts

are going to say.

Even if you cannot afford a 12-lead, everybody can use Marriot's or Modified

Chest leads to approximate a 12 lead and learn enough to identify a possible

right sided MI. Failure to do even that is, in my judgment, indefensible.

GG

>

>

> So you're saying, if I'm interpreting this correctly, is if I work for

> a service that only has 3-lead EKG capabilities and the prevailing

> standard of care is 12-lead EKG capability, the company,

> administration, and medical director can be held liable?

>

> -aro

>

>

>

> > Writes Alphonso:

> >

> > " tis why when the time comes, I can point out it's beyond my Scope of

> > Practice so I didn't do it for risk of being arrested. :-) "

> >

> > That's an interesting argument and one that would surely be set forth;

> > however, since scope or practice and standard of care are two

> different things, a

> > service that chooses to limit scope of practice may in fact be

> guilty of failing

> > to provide the prevailing standard of care. The persons who will

> be liable

> > for that failure will be the administrators, owners, managers, and

> medical

> > directors.

> >

> > Further, the SoP is sure to be attacked as an impermissible

> restriction on a

> > physician's medical practice, as interfering with the patient's 5th

> and 14th

> > Amendment rights, and so forth. The service that is chosen to be the

> > defendant in one of these cases will lose even if it wins.

> >

> > GG

> > GG

> > In a message dated 12/6/04 16:44:08, asclapius@a... writes:

> >

> >

> > >

> > >

> > >

> > > >

> > > > And believe me, RSI and surgical crichs are well enough

> > > established as

> > > > being within the expertise of paramedics to perform, that if your

> > > patient could

> > > > have been saved through such a procedure and you didn't do it,

> > > you'll be taking

> > > > a long journey through the legal system.

> > > >

> > >

> > > '

> > >

> > > -aro

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

The Phoenix FD did the first study on this in the 80's, it proved several

things; you can save the patient (and his myocardial muscle) about 50 mins

of door-to-drug time. Secondly, if you are adequately trained it will make

a difference in your pre-hospital treatments in STEMI patients (RVI vs.

Anterior). If you doubt that 12 leads are not standard of care why don't

you produce a study that validates your point? If you are so inclined to

educate yourself on the issue then pick up an ACLS text and look at the

referenced scientific studies cited that were used to substantiate their

standards on pre-hospital 12 lead.

Lee

_____

From: Brown

Sent: Monday, December 06, 2004 7:38 PM

To:

Subject: Re: Re: Scope of Practice Questions

Find me a study that says 12-leads affect pt. outcome demonstrably in

pre-hospital medicine.

magnetass sends

Re: Re: Scope of Practice Questions

You got it, my friend. 12-lead is standard of care. It is well within

the

means of most services to provide it. So some lawyer, somewhere, will

attempt to hold a service liable for not providing " standard of care. "

Remember, SOC is a question of fact. Try to find an expert in emergency

cardiac care who will testify that 12-lead is not standard of care? Then

the

question becomes whether or not it is reasonable to deviate from SOC. Some

may

argue that they deviate because they simply do not have the funds to acquire

the equipment necessary. To win that argument, it had better be

demonstrably

true.

Here's an example of deviation from SOC justified by economic concerns:

Your community hospital doesn't have a CT or an MRI because it cannot afford

it.

But a reconditioned 12-lead monitor isn't the same as a CT or MRI, and there

are grants available. See what I mean?

Standard of Care is always going to be determined by a jury based upon the

testimony presented by experts. I'm only trying to explain what the

experts

are going to say.

Even if you cannot afford a 12-lead, everybody can use Marriot's or Modified

Chest leads to approximate a 12 lead and learn enough to identify a possible

right sided MI. Failure to do even that is, in my judgment, indefensible.

GG

>

>

> So you're saying, if I'm interpreting this correctly, is if I work for

> a service that only has 3-lead EKG capabilities and the prevailing

> standard of care is 12-lead EKG capability, the company,

> administration, and medical director can be held liable?

>

> -aro

>

>

>

> > Writes Alphonso:

> >

> > " tis why when the time comes, I can point out it's beyond my Scope of

> > Practice so I didn't do it for risk of being arrested. :-) "

> >

> > That's an interesting argument and one that would surely be set forth;

> > however, since scope or practice and standard of care are two

> different things, a

> > service that chooses to limit scope of practice may in fact be

> guilty of failing

> > to provide the prevailing standard of care. The persons who will

> be liable

> > for that failure will be the administrators, owners, managers, and

> medical

> > directors.

> >

> > Further, the SoP is sure to be attacked as an impermissible

> restriction on a

> > physician's medical practice, as interfering with the patient's 5th

> and 14th

> > Amendment rights, and so forth. The service that is chosen to be the

> > defendant in one of these cases will lose even if it wins.

> >

> > GG

> > GG

> > In a message dated 12/6/04 16:44:08, asclapius@a... writes:

> >

> >

> > >

> > >

> > >

> > > >

> > > > And believe me, RSI and surgical crichs are well enough

> > > established as

> > > > being within the expertise of paramedics to perform, that if your

> > > patient could

> > > > have been saved through such a procedure and you didn't do it,

> > > you'll be taking

> > > > a long journey through the legal system.

> > > >

> > >

> > > '

> > >

> > > -aro

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

The Phoenix FD did the first study on this in the 80's, it proved several

things; you can save the patient (and his myocardial muscle) about 50 mins

of door-to-drug time. Secondly, if you are adequately trained it will make

a difference in your pre-hospital treatments in STEMI patients (RVI vs.

Anterior). If you doubt that 12 leads are not standard of care why don't

you produce a study that validates your point? If you are so inclined to

educate yourself on the issue then pick up an ACLS text and look at the

referenced scientific studies cited that were used to substantiate their

standards on pre-hospital 12 lead.

Lee

_____

From: Brown

Sent: Monday, December 06, 2004 7:38 PM

To:

Subject: Re: Re: Scope of Practice Questions

Find me a study that says 12-leads affect pt. outcome demonstrably in

pre-hospital medicine.

magnetass sends

Re: Re: Scope of Practice Questions

You got it, my friend. 12-lead is standard of care. It is well within

the

means of most services to provide it. So some lawyer, somewhere, will

attempt to hold a service liable for not providing " standard of care. "

Remember, SOC is a question of fact. Try to find an expert in emergency

cardiac care who will testify that 12-lead is not standard of care? Then

the

question becomes whether or not it is reasonable to deviate from SOC. Some

may

argue that they deviate because they simply do not have the funds to acquire

the equipment necessary. To win that argument, it had better be

demonstrably

true.

Here's an example of deviation from SOC justified by economic concerns:

Your community hospital doesn't have a CT or an MRI because it cannot afford

it.

But a reconditioned 12-lead monitor isn't the same as a CT or MRI, and there

are grants available. See what I mean?

Standard of Care is always going to be determined by a jury based upon the

testimony presented by experts. I'm only trying to explain what the

experts

are going to say.

Even if you cannot afford a 12-lead, everybody can use Marriot's or Modified

Chest leads to approximate a 12 lead and learn enough to identify a possible

right sided MI. Failure to do even that is, in my judgment, indefensible.

GG

>

>

> So you're saying, if I'm interpreting this correctly, is if I work for

> a service that only has 3-lead EKG capabilities and the prevailing

> standard of care is 12-lead EKG capability, the company,

> administration, and medical director can be held liable?

>

> -aro

>

>

>

> > Writes Alphonso:

> >

> > " tis why when the time comes, I can point out it's beyond my Scope of

> > Practice so I didn't do it for risk of being arrested. :-) "

> >

> > That's an interesting argument and one that would surely be set forth;

> > however, since scope or practice and standard of care are two

> different things, a

> > service that chooses to limit scope of practice may in fact be

> guilty of failing

> > to provide the prevailing standard of care. The persons who will

> be liable

> > for that failure will be the administrators, owners, managers, and

> medical

> > directors.

> >

> > Further, the SoP is sure to be attacked as an impermissible

> restriction on a

> > physician's medical practice, as interfering with the patient's 5th

> and 14th

> > Amendment rights, and so forth. The service that is chosen to be the

> > defendant in one of these cases will lose even if it wins.

> >

> > GG

> > GG

> > In a message dated 12/6/04 16:44:08, asclapius@a... writes:

> >

> >

> > >

> > >

> > >

> > > >

> > > > And believe me, RSI and surgical crichs are well enough

> > > established as

> > > > being within the expertise of paramedics to perform, that if your

> > > patient could

> > > > have been saved through such a procedure and you didn't do it,

> > > you'll be taking

> > > > a long journey through the legal system.

> > > >

> > >

> > > '

> > >

> > > -aro

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >