Hospital settles for childs death, faults EMTParamedic

[VentMedic]

Now, let's talk about how the Paramedic fits into this.

A Paramedic's training is focused for PREHOSPITAL.

Since many of the Paramedic programs differ in how the minimum standards are taught and that many schools are not accredited, it is hard to maintain a standard of education for comparison at even the simplest level.

Paramedics have the choice of a career college, state or community college and online programs with outsourced clinicals. The instructor oversight varies greatly even within the same type of educational system.

The medical oversight for the initial and continuing education varies even more once the Paramedic enters the work situation. Some medical directors fail to adequately monitor the core skills of their staff to where even those have to be questioned. One could only guess how much effort is placed on their knowledge as well.

Not all Paramedics will have the same work experience. In Florida, you may be at a disadvantage for getting work in a 911 system if you are not a FF. It is not unually for many Paramedics to work an ALS (not CCT) transfer truck and not start an IV or intubate for years. They may also not put the same effort into their assessments as one might in a different job description.

Those that may want a change may find themselves placed in a situation to which they are not fully prepared for. Some may not even know how unprepared they are. The few that do realize the need to seek more education than their prehospital training prepared them for may excel at new opportunities. Unfortunately it will be difficult to assume all will be on the same page.

EMS is still adding more certifications even as I am typing this with new layers between EMT-B and EMT-I. Kentucky just added AEMT which is something like an EMT-I.

The professions mentioned in the previous posts must have their education from accredited schools, pass a NATIONAL certification for state licensure and only have 1 - 3 levels per profession even though their educational levels extend through Masters and Doctorate.

Other professions are also more critical when their peers that fail to maintain certain professional and educational standards. Nursing is no exception. Of course, not every hospital will have the same professional standards within their walls and may become very lax in maintaining their own inhouse mentoring and educating. Some barely meet the minimum required by JCAHO. If you go to JCAHO's website, you may even see the lower scores and recommendations for these hospitals.

[Doczilla]

Me condescending? You just insulted most of the "techs" in a hospital. You must not be aware of how much these professions have progressed or you think of them as insignificants that got the RNs' leftovers and have not taken the time to know what their education level is. I guess it is easy to see how much you think of the "techs" in the hospital in your hierachy of patient care.

I have not seen an IV tech around for about 20 years so I can not comment on that. RNs do most of the IVs as well as the PICCS.

EKG techs may also be Cardiopulmonary, Respiratory Therapist or CV Technologists, all of which require at least a two year degee. Just because you see someone doing a simple skill does not mean they are uneducated. Departments have had to cut out the majority of their unlicensed staff many years ago and the licensed staff must now do those "tech" skills. Hence, RNs are again doing their own EKGs and IVs.

I don't see anywhere in my post where I said that they were uneducated, ill-educated, or picking up the scraps left over from nurses. I also don't see where you get that I think so little of these specialized techs, this so called "crappy attitude I have toward radiology professionals." I also mentioned nothing regarding licensure.

But by all means, rant on.

'zilla

[streetsurgeon]

o.k. ., let's face it.. paramedics are geared towards triage.. right? maybe more so for mci's... but none the less.. triage is many times our bread and butter.. how many times have you transported and the hospital advices to take the pt. to er waiting triage.. humm i am sure at least once.. now the medic did triage the pedi. in the hospital.. many times that is what medics in the hospital setting are employed to do.. now let's say the family called ems to the house.. then would the story change? i think just a little . let's all hope that this does not start a trend of trying to find more ems to sue on mistriage..

[chbare]

o.k. ., let's face it.. paramedics are geared towards triage.. right? maybe more so for mci's... but none the less.. triage is many times our bread and butter.. how many times have you transported and the hospital advices to take the pt. to er waiting triage.. humm i am sure at least once.. now the medic did triage the pedi. in the hospital.. many times that is what medics in the hospital setting are employed to do.. now let's say the family called ems to the house.. then would the story change? i think just a little . let's all hope that this does not start a trend of trying to find more ems to sue on mistriage..

Well, yes and no. There is a difference between START triage in the field and what may occur at a hospital. Many hospital triage systems require a slightly different way of thinking. For example, you may use mental status to sort out some of the "less critical" patients at an MCI. However, depending on your triage system within the hospital, you may sort out people by resource utilization. You may find your self asking, how many resources is this patient going to require? Compare a deep laceration with controlled arterial bleeding to an abdominal pain patient. Who will need more resources? What specific findings suggest one patient may need more resources than the other? It is a different way of thinking than the field in many cases.

I agree with Ridryder911 that triage is a very important area and in many facilities with a dedicated triage position, it is considered a crap assignment.

I still do not see where Doczilla tried to offend other providers. I guess if you really want to spin it that way; however, he asks some good questions. Not saying I agree one way or the other; however, can other providers effectively perform triage in the ER?

We also need to remember, things you do in your backyard may not be the same things somebody else does in their back yard. For example, it was stated earlier that somebody had not seen an LPN in 15 years. However, where I live and work LPN's are common place. In fact, one of my part time jobs had me as the only RN in the facility. I had a LPN and a CNA on the floor and a LPN in the ER with me. This was the entire facility staff excluding our ER physician. LPN's are common place where I live; however, they may not be common in other areas of the country.

Take care,

chbare.

[medicv83]

Although my opinion is obviously not as well versed as those above, it still holds true, at least in my hospital, that the nurses do very little than the staff medics do. Things as simple as starting an EJ. Once again, I said it in a previous thread that many of you had opinions on, these nurses are not even allowed to put oxygen on a patient without the Doctors consent. Now once again, hardly an experienced or educated view, but a view none the less. Does this make them less educated, we all know that is absolutely not the case, but it does show that these nurses, even though better educated, are limited in a scope of practice that pushes the paramedics scope above the nurses. Unfortunately this leaves cracks for weak, and lazy paramedics to slide through.

Paramedics can, and should be able to triage a patient with any disease process. It ties in with the education recieved and the objective of a paramedics duties.

Everyone has their own scope with the education to back it. RT's, LPN's..you pick. But to say one is better than the other simply isnt a basis of education, but education with scope. The nurse, at least here, is held back. Limited if you will, in his/her duties, even though they have the education to back it. The ER actually would be better employing more medics than nurses, saving themselves a buck or two, and have an even more "hands on" approach to the sick/injured ER patient.

It just seems to me that the nurses (at least here, once again) are just robots, simply taking vital signs, and keeping a close eye on a patient. When the pt goes sour, the nurse simply informs the Doc, and the doc does the ordering. Again, not knocking the nursing profession, I understand that is not the case in most areas. Just saying though.

[VentMedic]

Although my opinion is obviously not as well versed as those above, it still holds true, at least in my hospital, that the nurses do very little than the staff medics do. Things as simple as starting an EJ. Once again, I said it in a previous thread that many of you had opinions on, these nurses are not even allowed to put oxygen on a patient without the Doctors consent. Now once again, hardly an experienced or educated view, but a view none the less. Does this make them less educated, we all know that is absolutely not the case, but it does show that these nurses, even though better educated, are limited in a scope of practice that pushes the paramedics scope above the nurses. Unfortunately this leaves cracks for weak, and lazy paramedics to slide through.

Paramedics can, and should be able to triage a patient with any disease process. It ties in with the education recieved and the objective of a paramedics duties.

Everyone has their own scope with the education to back it. RT's, LPN's..you pick. But to say one is better than the other simply isnt a basis of education, but education with scope. The nurse, at least here, is held back. Limited if you will, in his/her duties, even though they have the education to back it. The ER actually would be better employing more medics than nurses, saving themselves a buck or two, and have an even more "hands on" approach to the sick/injured ER patient.

It just seems to me that the nurses (at least here, once again) are just robots, simply taking vital signs, and keeping a close eye on a patient. When the pt goes sour, the nurse simply informs the Doc, and the doc does the ordering. Again, not knocking the nursing profession, I understand that is not the case in most areas. Just saying though.

You truly live in an area where nurses are limited by something and probably not their state protocols. Nurses can and do all the skills a paramedic can and much more in the majority of states. This has been the case for at least 3 decades for nurses on Flight and specialty teams. Nurses that work in progressive EDs and ICUs definitely are nothing like you described. It is too bad you have such a limited view of these very valuable professionals.

Being able to do a few skills is just a few of the things that go into patient care. It is the belief that these skills are the absolute end all solution to all problems and for that reason many paramedics have seen no need to get past that for more education. You can argue that a nurse can not do an EJ. But, do you really want to get into a peeing match with the things a nurse can do? I can guarantee you will lose that match very quickly. Even the LVN could list some impressive skills back in the day they were used.

Okay, the Paramedic may be able to triage under the supervision of an RN. That exception was made in Kentucky since triage is not a responsibilty that an RN is suppose to delegate under any circumstances. Unless your state also has that clause in the statutes, there will eventually be penalities to pay as in this case. Also, the paramedic would not be able to do equal share if an ICU patient is held over, so other accomondations would have to be made since the Paramedic is still not capable of doing everything in the ED in the majority of states. Most states still say their license/certification is good PREHOSPITAL and PREHOSPITAL only.

Work on the eduation and standardization issues so you can present some valid arguments instead of trying to boast your "skills".

[Ridryder 911]

Your right Doc there is a difference between MSE & triage. As well, most facilities do not allow an MSE to be performed until the patient is triaged. However; there is national standard programs of triage as recommended and endorsed by Emergency Nurses Association. Part of the triage(18 lesson) program is knowing what the initial diagnoses is then what standard of tests will be required to obtain a conclusive diagnosis. (http://www.ena.org/education/triage/default.asp )

For example, a possible sepsis patient that is hypothermic will need a complete work-up with C & S, multiple medications and time spent upon a diagnosis, where as a UTI will be more specific in nature with few lab and treatment modalities and would be triaged differently. Most triage criteria is not just based upon the initial assessment but as well as potential requirements and treatments that will be rendered to the patient. Sorry folks, medical triage is something that is NOT covered and taught in Paramedic curriculums. As well again, talk all you want but when the reviewers come in see where they will place the medics and whom they will ask if they triage and chart. Again a precedent has been determined and yes, we will see things change from now on unless your hospital likes writing checks out...

It is much cheaper to hire someone qualified and prevent litigation than save a few bucks ...Sorry, I am all for Paramedics but they are not qualified to perform triage in an ER and now the court system has stated such. Stick a fork in it... it's a done deal.

R/r 911

[VentMedic]

Let's find out what a review of the literature shows. This research was to see if Paramedics can adequately triage in the field to determine if transport is warranted.

http://www.naemsp.org/pdf/triageevidence.pdf

Accuracy of Prehospital Triage and Non Triage:

What Does The Evidence Show?

David C. Cone, MD

Chief, Division of EMS

Section of Emergency Medicine

Yale School of Medicine

[jsadin]

Hmmm...seems medics need more education to make these types of decisions. Shocker. Medic courses are measured in hours. A medical doctor's eduction requirements are measured in years...

[defib_wizard]

This has been a very interesting post. I have learned a lot about how many of you feel about the educational differences between medics and rns. I have to say ( at the risk of offending an ego or 2 ) WAKE UP!

As far as why they blamed the medic his name was on the triage form. We were not there and he may have been the best person or most experienced healthcare provider in the er that day. However because he is an"unlicensed provider" it must be his fault.

The last time I read the definition of standard of care it was; What someone with the same type of experience and training would do in a simular situation. I surely hope that any one of us in this type of situation would have figured it out sooner. but would you have been able to. We don't know what was going on in the er that day and it is sooooooo easy to monday morning quarterback!

I realize that having an rn do triage is the ideal, but there is a nursing shortage. Do we know that an RN would have picked up on this pt's situation in some of the opinions here nurses don't ever make mistakes. The medication error form is there just in case an error happens, even though it never has. LOL

As far as higher education for nurses yes they go to school longer and learn more disease processes, but the last time I took PALS, ACLS, NRP the er and icu nurses were taking the same course and the same test. Now some of the nurses I know are taking PEPP courses that are primarily for prehospital providers. Hmm same class, same card, god forbid we could have some of the same education.

The reason this child died is because she was ill. If an rn would have triaged this pt and placed her in the waiting room they would have still sued and they would have won . The only difference would be the nursing forums would be reviewing this like we are

Medics can be a useful addition to helping an ed's staffing situation. We can assess a patient and make a triage decision based on that assessment. Only the future will tell what happens with this. If there are no nurses to work the hospital admin will find a way to fill the void.

Well I am ready for the name calling and medic bashing to start on your replies to this.