Eydawn Posted February 13, 2008 Posted February 13, 2008 Zippy? What exactly do you *mean* by "a physician cannot prescribe to a person he's never met"??? That's what happens all the time when a paramedic calls in for a drug that is within their scope of practice but requires physician authorization prior to administration! My brains itch... I will agree with you that the mere presence of another individual does not automatically discharge your responsibilities towards your patient, but if that arriving individual is legally or by protocol higher up on the food chain in terms of field authority, you *must* defer to them or face ejection from the scene for interfering with *their* responsibility to that patient. I've got to agree with what I've learned about St. John's... yes, y'all do emergent transports... but no, as a nurse with them, you do not operate at a higher level... that's what I've gleaned from *my own research* and what I've seen here. Can someone over there in Limey-Land (no offense, just got out of writing class and alliteration was the topic of the day) pull me some county laws regarding the status of off duty medical professionals? Here in the US you operate at the level of a bystander or BLS life support skills if you stop off duty. You better have a *damn good* reason to operate at a higher level, or your license/cert *will* be going away once you face the judge.... Good Sam only goes so far in protecting you. Wendy CO EMT-B
Kaisu Posted February 13, 2008 Posted February 13, 2008 Its one thing to Its another to kick the farts out of it.....
scott33 Posted February 13, 2008 Posted February 13, 2008 Zippy? What exactly do you *mean* by "a physician cannot prescribe to a person he's never met"??? That's what happens all the time when a paramedic calls in for a drug that is within their scope of practice but requires physician authorization prior to administration! My brains itch... He is probably referring to the UK model of "professional" EMS (the one he does not belong to) which DOES NOT have a medical control-based system. NHS Paramedics have their own license and can assess and manage (which includes what they have in their drug bag) as they deem fit. Doctors are not involved. They do not operate under a physician's license like they do here. Doesn't detract from the fact that almost everything he posts here is made up, grossly exaggerated, or just plain fantasizing. Glad you have done your own research into SJA. Unfortunately, they just don't have a system in place to train volly EMS like they do here (whether good, bad, or indifferent :roll: ). Look online all you want, you will be hard pushed to find any county-specific training guidelines, expected competencies, and (most importantly), expected time frame for training their new recruits, from fresh newby to seasoned event provider. This is why it will take years (6 in Zippy's case) to be trained to ambulance "attendant" level, (that's still less than an EMT-B, as far as what you can bring to the party). Other members have commented on the disillusionment they face, due to this and other factors (elitism among the HCPs), on the UK forum. Zippy will always say otherwise, but he obviously doesn't realize the damage he is causing his own organization, by painting such a one-sided picture of it by denying much of what SJA represents (VAS does not stand for "voluntary ambulance service" BTW). But as has already been proven, not only have no other RNs backed his claims, no other SJA members have either.
zippyRN Posted February 13, 2008 Posted February 13, 2008 Zippy? What exactly do you *mean* by "a physician cannot prescribe to a person he's never met"??? That's what happens all the time when a paramedic calls in for a drug that is within their scope of practice but requires physician authorization prior to administration! My brains itch... in UK law thart isn't allowed, which is why paramedic drugs are either under the statutory exemption fro mthe medicines act that allows Paramedics registered with the HPC to carry and adminster certain prescription only medicines or by a patient group direction which is a legal mechanism to allow ahealth professional who isn't a prescriber to supply and or adminster a Prescription only medicine I will agree with you that the mere presence of another individual does not automatically discharge your responsibilities towards your patient, but if that arriving individual is legally or by protocol higher up on the food chain in terms of field authority, you *must* defer to them or face ejection from the scene for interfering with *their* responsibility to that patient. please read the following statement carefully , it is from The NMC code of professional conduct: standards for conduct, performance and ethics "1.3 You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional." this document is the core professional standard for Registered Nurses ... "regardless of advice or directions from another professional" means that even if you were told by another registered practitioner ( of what ever profession) to do something or not do something which is in the best interests of the patient you may still be held liable as a Professional. http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=201 I've got to agree with what I've learned about St. John's... yes, y'all do emergent transports... but no, as a nurse with them, you do not operate at a higher level... that's what I've gleaned from *my own research* and what I've seen here. your information is incorrect, given there are systems in place to record and recognsie professional registration and post basic development and expansion of roles , and hand in hand with this comes the authorisation (or at least lack of prohibition_ from undertaking interventions, making assessments and adhering to professional standards of practice not lay person standards ... why then are Nurses and other HCPs within SJA required to be present at certain duties or taskings to provide their professional input and make triage, interventions, hospital admission, and discharge decisions... Can someone over there in Limey-Land (no offense, just got out of writing class and alliteration was the topic of the day) pull me some county laws regarding the status of off duty medical professionals? Here in the US you operate at the level of a bystander or BLS life support skills if you stop off duty. You better have a *damn good* reason to operate at a higher level, or your license/cert *will* be going away once you face the judge.... Good Sam only goes so far in protecting you. from the previously cited document "As a registered nurse, midwife or specialist community public health nurse, you must: protect and support the health of individual patients and clients protect and support the health of the wider community act in such a way that justifies the trust and confidence the public have in you uphold and enhance the good reputation of the professions." "8.5 In an emergency, in or outside the work setting, you have a professional duty to provide care. The care provided would be judged against what could reasonably be expected from someone with your knowledge, skills and abilities when placed in those particular circumstances." http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1571 makes interesting reading
zippyRN Posted February 13, 2008 Posted February 13, 2008 [<snip> Glad you have done your own research into SJA. Unfortunately, they just don't have a system in place to train volly EMS like they do here (whether good, bad, or indifferent :roll: ). Look online all you want, you will be hard pushed to find any county-specific training guidelines, expected competencies, and (most importantly), expected time frame for training their new recruits, from fresh newby to seasoned event provider. competencies are defined by St John Ambulance HQC14/07 , however the syllabi are 'restricted - commercially sensitive' documents time frames are explicitly stated for the contact time delivering the teaching associated with each set of outcomes. This is why it will take years (6 in Zippy's case) to be trained to ambulance "attendant" level, it will take several years but at each stage First aider, advanced first aider, Patient transport attendant , Emergency transport attendant you are required to consolidate your experience and to some extent 'repay' the investment that has been made in training you so far. traning to 'first aider' level takes at least 4 full days, topping that up to advanced first aider takes a minimum of 2 more days the PTA course is at least another 4 full days ( and often more depending on the learning needs of the group - the course that ran last year in the county i volunteer with included a couple of extra days for consolidation and scenario based training and this was by no means a 'remedial' group - including At least one Nurse, one 3rd year medical student one (non health or life science )PhD student, and several other graduates ...) the ETA course is a further six full days minimum on top of that ... the PTAand ETA courses are required to have a Paramedic as course leader although specific subject trainers within that and within the continuation training include other health professionals, ambulance technicians and layperson trainers. (that's still less than an EMT-B, as far as what you can bring to the party). exactly what interventions compared to core EMT-B would those be that are missing ( charcoal BTW is a none starter as it's not a JRCALC drug ...)
VentMedic Posted February 13, 2008 Posted February 13, 2008 The NHS Paramedics' autonomy doesn't sound that much different from the U.S. http://news.bbc.co.uk/1/hi/health/256382.stm Health Paramedics could solve NHS staff crisis "They are ideally suited to take on some of the roles of our nurses," a hospital spokesman said. Paramedics would take temperatures, blood pressure and even blood samples under plans that will be discussed with staff representatives this week, he said. Only one or two will work in the casualty department on any one shift, and they will be under the supervision of a nurse. Interesting blog: http://nhsblogdoc.blogspot.com/2005/12/read-this-or-die.html This is an interesting study: http://emj.bmj.com/cgi/content/abstract/20/5/473 Emerg Med J 2003; 20:473-475 Paramedic accuracy in using a decision support algorithm when recognising adult death: a prospective cohort study Conclusion: Paramedics can accurately apply a decision support algorithm when recognising adult death. It could be argued that the attendance of a medical practitioner to confirm death is therefore an inappropriate use of such personnel and may result in unnecessarily protracted on-scene times for ambulance crews. Further research is required to confirm this, and to determine the proportion of patients suitable for recognition of adult death who are actually identified as such by paramedics. So the Paramedics don't have to work with a physician but haven't bene fully cleared to declare death without one? I am referring to a quote from scott33's post: He is probably referring to the UK model of "professional" EMS (the one he does not belong to) which DOES NOT have a medical control-based system. NHS Paramedics have their own license and can assess and manage (which includes what they have in their drug bag) as they deem fit. Doctors are not involved. They do not operate under a physician's license like they do here. This is interesting with potential: http://www.jephc.com/uploads/Woollard990156.pdf Journal of Emergency Primary Health Care (JEPHC), Vol.4, Issue 1, 2006 The Role of the Paramedic Practitioner in the UK
zippyRN Posted February 13, 2008 Posted February 13, 2008 The NHS Paramedics' autonomy doesn't sound that much different from the U.S. http://news.bbc.co.uk/1/hi/health/256382.stm check the date on that article (1999) Interesting blog: http://nhsblogdoc.blogspot.com/2005/12/read-this-or-die.html crippen really is the worst kind of reactionary ... he is an old scholl doctor who thinsk that nurses shoudl stick to wiping arses and ambulance drivers should stick tp driving and polishing their ambulances ... This is an interesting study: http://emj.bmj.com/cgi/content/abstract/20/5/473 Emerg Med J 2003; 20:473-475 Paramedic accuracy in using a decision support algorithm when recognising adult death: a prospective cohort study So the Paramedics don't have to work with a physician but haven't bene fully cleared to declare death without one? a five year old document - so how many year old Data ? paramedics i nthe UK have beend doing ROLE for several years without the requirement ofr a physician to attend scene - certification of the cause of death still remains in the hands of Doctors and the Coroner.
ccmedoc Posted February 13, 2008 Posted February 13, 2008 11 pages already. WOW!!! For nothing more than to humor the egotistical rantings of a health professional with an inferiority complex...Or something like that... :naka:
Eydawn Posted February 13, 2008 Posted February 13, 2008 But this is fun! Besides, tenderized horse steak tastes *much* better. (and I'm being sarcastic!) Wendy CO EMT-B
Recommended Posts