Re: PA or RN on Scene other legalities

[Guest guest]

i spoke at length with the BNE (board of nursing examiners) in austin about

nurses showing or or being present @ a scene and asking if they can perform

skills on a patient.

what i was told is that they are not supposed to being doing that in an

out-of-hospital environment.

jim davis

paramedic

Subject: Re: PA or RN on Scene other legalities

To: texasems-l

Date: Tuesday, January 11, 2011, 11:30 PM

 

Jodi,

What a person can do on an ambulance varies from state to state. A physician

has a license that allows him to practice medicine anywhere in the state at any

time. However, he does not automatically have the right to take over care at a

scene when paramedics are present. Generally, if he wishes to assume care, he

must accompany the patient to the hospital and issue all orders. If he orders

you to do something against protocol, the way to handle it is to get him in

touch with med control physician and let them hash it out.

I do not believe that a PA or an RN has any power to assume care from you. PAs

and nurses practice under a physician's orders. Unless they are a part of the

system you're in, I don't think they have the right to practice in your

ambulance.

The easiest way to get a definitive answer is to call Robin Gil and ask her.

I'll bet she has the answer on the tip of her tongue.

Next, there is no legal liability for having a first aid kit in your car or in

not having one. When you are outside the state where you are certified, you are

on the level of a Boy Scout, meaning you can do first aid only. If you choose

to do it, you are bound to do it competently, but only to First Aid level. You

don't need medical control to do first aid. You do need medical control to do

anything invasive or give a drug.

I carry no advanced equipment since I would have no authority to use it. My

paramedic has no validity in a state where I am not certified. I COULD ask for

and receive medical control if a physician were willing to do it, but the

chances of that happening are nil. I would have no idea how to contact an

online physician on my cellphone.

The best legal reference is a book named Legal Medicine, published by Mosby. It

is not specific for EMS but general. However, it does cover lots of basic legal

stuff about medicine.

Happy reading.

GG

PA or RN on Scene other legalities

GG,

Here is an off the wall question for you: Presently we have Protocols in

place for Physician On Scene and the requirement that physician be willing

to escort a Patient to the hospital if he/she so desires to provide aid but

what if you run across a Physician Assistant or an RN with field

experience/training as in a Flight Nurse? Are they also legally responsible

for the Patient so long as they agree to escort to the hospital? Either one

is the next echelon higher in care. Would you consider patient care to be

more of a cooperative work in the later case based on scope of practice and

equipment expected to be available? Is there some literature or

state/federal statute that I can review that you can assist me with?

I am on a role here.. Here is the other can: It has been advised EMS

personnel remove First Aid Kits from their vehicles as it may also become a

legal liability. Here is the what if; what if I am traveling away from home

area and come upon a desolate scene where I am the only medically trained

person available. How does one request medical control or is it possible?

Regardless of whether or not it is a band aid or an ET tube. Where does

layperson give way to Paramedicine in a court of Law? Especially where no

foreseeable survivability exists without it. I am leaving common sense out

of this because my Cert is near and dear to my heart and my pocket book.

Long ago during class you had pointed out a legal reference for EMS. I don't

suppose you recall the reference?

J. Meere

CEP, Arizona Ambulance

U.S. Army, Retired

[Guest guest]

thanks, gene. i found the book. it's $$$$ new but i found a used one for $26.00

here is the isbn (the best way to find a cheap used book IMHO)

Legal Medicine (Legal Medicine (American College of Legal Medicine))

By: ACLM

ISBN: 0323037534 ISBN-13: 9780323037532

List Price: $199.00

jim davis

paramedic

Subject: Re: PA or RN on Scene other legalities

To: texasems-l

Date: Tuesday, January 11, 2011, 11:30 PM

 

Jodi,

What a person can do on an ambulance varies from state to state. A physician

has a license that allows him to practice medicine anywhere in the state at any

time. However, he does not automatically have the right to take over care at a

scene when paramedics are present. Generally, if he wishes to assume care, he

must accompany the patient to the hospital and issue all orders. If he orders

you to do something against protocol, the way to handle it is to get him in

touch with med control physician and let them hash it out.

I do not believe that a PA or an RN has any power to assume care from you. PAs

and nurses practice under a physician's orders. Unless they are a part of the

system you're in, I don't think they have the right to practice in your

ambulance.

The easiest way to get a definitive answer is to call Robin Gil and ask her.

I'll bet she has the answer on the tip of her tongue.

Next, there is no legal liability for having a first aid kit in your car or in

not having one. When you are outside the state where you are certified, you are

on the level of a Boy Scout, meaning you can do first aid only. If you choose

to do it, you are bound to do it competently, but only to First Aid level. You

don't need medical control to do first aid. You do need medical control to do

anything invasive or give a drug.

I carry no advanced equipment since I would have no authority to use it. My

paramedic has no validity in a state where I am not certified. I COULD ask for

and receive medical control if a physician were willing to do it, but the

chances of that happening are nil. I would have no idea how to contact an

online physician on my cellphone.

The best legal reference is a book named Legal Medicine, published by Mosby. It

is not specific for EMS but general. However, it does cover lots of basic legal

stuff about medicine.

Happy reading.

GG

PA or RN on Scene other legalities

GG,

Here is an off the wall question for you: Presently we have Protocols in

place for Physician On Scene and the requirement that physician be willing

to escort a Patient to the hospital if he/she so desires to provide aid but

what if you run across a Physician Assistant or an RN with field

experience/training as in a Flight Nurse? Are they also legally responsible

for the Patient so long as they agree to escort to the hospital? Either one

is the next echelon higher in care. Would you consider patient care to be

more of a cooperative work in the later case based on scope of practice and

equipment expected to be available? Is there some literature or

state/federal statute that I can review that you can assist me with?

I am on a role here.. Here is the other can: It has been advised EMS

personnel remove First Aid Kits from their vehicles as it may also become a

legal liability. Here is the what if; what if I am traveling away from home

area and come upon a desolate scene where I am the only medically trained

person available. How does one request medical control or is it possible?

Regardless of whether or not it is a band aid or an ET tube. Where does

layperson give way to Paramedicine in a court of Law? Especially where no

foreseeable survivability exists without it. I am leaving common sense out

of this because my Cert is near and dear to my heart and my pocket book.

Long ago during class you had pointed out a legal reference for EMS. I don't

suppose you recall the reference?

J. Meere

CEP, Arizona Ambulance

U.S. Army, Retired

[Guest guest]

A question - where do we draw the lines between First Aid and BLS and ALS?

It seems to constantly change, from in-hospital to out-of-hospital, and provider

to provider.

In the hospital, First Aid is a band-aid, and BLS includes IV therapy, and ALS

includes Central Lines.

Out of the Hospital, in one service, First Aid is a band-aid, BLS includes blood

pressures and pulse oximetry, and ALS includes IV therapy.

In another service, blood pressures and pulse oximetry is First Aid, BLS

includes d-sticks, and ALS includes cardiac interp.

Legally, where are the lines?

If someone goes down, and I have a BVM, and I pull it from my car, have I just

crossed the line into BLS? What about an OPA? NPA? Suctioning? Blood glucose

check? Blood pressure? Epi Pen or Albuterol admin assistance? What if I'm in

another state? Or are first aid and BLS really the same? Do we even practice ALS

in the field or is ALS only physician-level?

Or is it all just legal shades of gray?

Alyssa Woods, NREMT-B

CPR Instructor

> Jodi,

>

> What a person can do on an ambulance varies from state to state. A physician

has a license that allows him to practice medicine anywhere in the state at any

time. However, he does not automatically have the right to take over care at a

scene when paramedics are present. Generally, if he wishes to assume care, he

must accompany the patient to the hospital and issue all orders. If he orders

you to do something against protocol, the way to handle it is to get him in

touch with med control physician and let them hash it out.

>

> I do not believe that a PA or an RN has any power to assume care from you. PAs

and nurses practice under a physician's orders. Unless they are a part of the

system you're in, I don't think they have the right to practice in your

ambulance.

>

> The easiest way to get a definitive answer is to call Robin Gil and ask her.

I'll bet she has the answer on the tip of her tongue.

>

> Next, there is no legal liability for having a first aid kit in your car or in

not having one. When you are outside the state where you are certified, you are

on the level of a Boy Scout, meaning you can do first aid only. If you choose to

do it, you are bound to do it competently, but only to First Aid level. You

don't need medical control to do first aid. You do need medical control to do

anything invasive or give a drug.

>

> I carry no advanced equipment since I would have no authority to use it. My

paramedic has no validity in a state where I am not certified. I COULD ask for

and receive medical control if a physician were willing to do it, but the

chances of that happening are nil. I would have no idea how to contact an online

physician on my cellphone.

>

> The best legal reference is a book named Legal Medicine, published by Mosby.

It is not specific for EMS but general. However, it does cover lots of basic

legal stuff about medicine.

>

> Happy reading.

>

> GG

>

> PA or RN on Scene other legalities

>

> GG,

>

> Here is an off the wall question for you: Presently we have Protocols in

> place for Physician On Scene and the requirement that physician be willing

> to escort a Patient to the hospital if he/she so desires to provide aid but

> what if you run across a Physician Assistant or an RN with field

> experience/training as in a Flight Nurse? Are they also legally responsible

> for the Patient so long as they agree to escort to the hospital? Either one

> is the next echelon higher in care. Would you consider patient care to be

> more of a cooperative work in the later case based on scope of practice and

> equipment expected to be available? Is there some literature or

> state/federal statute that I can review that you can assist me with?

>

> I am on a role here.. Here is the other can: It has been advised EMS

> personnel remove First Aid Kits from their vehicles as it may also become a

> legal liability. Here is the what if; what if I am traveling away from home

> area and come upon a desolate scene where I am the only medically trained

> person available. How does one request medical control or is it possible?

> Regardless of whether or not it is a band aid or an ET tube. Where does

> layperson give way to Paramedicine in a court of Law? Especially where no

> foreseeable survivability exists without it. I am leaving common sense out

> of this because my Cert is near and dear to my heart and my pocket book.

>

> Long ago during class you had pointed out a legal reference for EMS. I don't

> suppose you recall the reference?

>

> J. Meere

>

> CEP, Arizona Ambulance

>

> U.S. Army, Retired

>

>

[Guest guest]

90% of those skills are taught as Scout/Red Cross First Aid...no license

needed....

Stop the Bleeding, Open the Airway, Stabilize the Fractures, Keep the

victim protected from the weather...

if your aid bag doesn't contain anything beyond dressings, splints, and

maybe simple airways and eye wash, I don't see how anyone can be charged with

practicing without a license...

ck

In a message dated 01/14/11 13:00:36 Central Standard Time, jmeere@...

writes:

I am talking about exercising

skills to stabilize road side until well equipped ambulance arrives to

assist or take over patient care. Anywhere, in any state

[Guest guest]

Hence my VERY LARGE GREIVANCE with the legal system as it pertains to EMS.

I find it to be a gross misuse of available resources when a Off Duty

Medical Professional is legally withheld from performing within his/her

scope of Practice. It needs to be defined and you should be legally

responsible to perform/give medical aid within your scope in an emergent

situation to prevent the loss of life or limb without having to contact a

base hospital and request mother-may-I save this person's life and not lose

my license permission in the process. I am not talking about starting Nitro

and dopamine drips on the side of the road, I am talking about exercising

skills to stabilize road side until well equipped ambulance arrives to

assist or take over patient care. Anywhere, in any state.

J. Meere

PA or RN on Scene other legalities

>

> GG,

>

> Here is an off the wall question for you: Presently we have Protocols in

> place for Physician On Scene and the requirement that physician be willing

> to escort a Patient to the hospital if he/she so desires to provide aid

but

> what if you run across a Physician Assistant or an RN with field

> experience/training as in a Flight Nurse? Are they also legally

responsible

> for the Patient so long as they agree to escort to the hospital? Either

one

> is the next echelon higher in care. Would you consider patient care to be

> more of a cooperative work in the later case based on scope of practice

and

> equipment expected to be available? Is there some literature or

> state/federal statute that I can review that you can assist me with?

>

> I am on a role here.. Here is the other can: It has been advised EMS

> personnel remove First Aid Kits from their vehicles as it may also become

a

> legal liability. Here is the what if; what if I am traveling away from

home

> area and come upon a desolate scene where I am the only medically trained

> person available. How does one request medical control or is it possible?

> Regardless of whether or not it is a band aid or an ET tube. Where does

> layperson give way to Paramedicine in a court of Law? Especially where no

> foreseeable survivability exists without it. I am leaving common sense out

> of this because my Cert is near and dear to my heart and my pocket book.

>

> Long ago during class you had pointed out a legal reference for EMS. I

don't

> suppose you recall the reference?

>

> J. Meere

>

> CEP, Arizona Ambulance

>

> U.S. Army, Retired

>

>

[Guest guest]

Hence my VERY LARGE GREIVANCE with the legal system as it pertains to EMS.

I find it to be a gross misuse of available resources when a Off Duty

Medical Professional is legally withheld from performing within his/her

scope of Practice. It needs to be defined and you should be legally

responsible to perform/give medical aid within your scope in an emergent

situation to prevent the loss of life or limb without having to contact a

base hospital and request mother-may-I save this person's life and not lose

my license permission in the process. I am not talking about starting Nitro

and dopamine drips on the side of the road, I am talking about exercising

skills to stabilize road side until well equipped ambulance arrives to

assist or take over patient care. Anywhere, in any state.

J. Meere

PA or RN on Scene other legalities

>

> GG,

>

> Here is an off the wall question for you: Presently we have Protocols in

> place for Physician On Scene and the requirement that physician be willing

> to escort a Patient to the hospital if he/she so desires to provide aid

but

> what if you run across a Physician Assistant or an RN with field

> experience/training as in a Flight Nurse? Are they also legally

responsible

> for the Patient so long as they agree to escort to the hospital? Either

one

> is the next echelon higher in care. Would you consider patient care to be

> more of a cooperative work in the later case based on scope of practice

and

> equipment expected to be available? Is there some literature or

> state/federal statute that I can review that you can assist me with?

>

> I am on a role here.. Here is the other can: It has been advised EMS

> personnel remove First Aid Kits from their vehicles as it may also become

a

> legal liability. Here is the what if; what if I am traveling away from

home

> area and come upon a desolate scene where I am the only medically trained

> person available. How does one request medical control or is it possible?

> Regardless of whether or not it is a band aid or an ET tube. Where does

> layperson give way to Paramedicine in a court of Law? Especially where no

> foreseeable survivability exists without it. I am leaving common sense out

> of this because my Cert is near and dear to my heart and my pocket book.

>

> Long ago during class you had pointed out a legal reference for EMS. I

don't

> suppose you recall the reference?

>

> J. Meere

>

> CEP, Arizona Ambulance

>

> U.S. Army, Retired

>

>