Stupid EMS Rules, Regulations, or Practices ................

[katbemeEMT-B]

I think it's stupid that we are certified to perform certain duties on the truck (IV, intubation, etc.), but we can't perform these duties in the ED because LPNs can't do them. What's even dumber, when one of the ED docs has to RSI and respiratory and anesthesia aren't available, who do they call? Yep, that's right, EMS!

[VentMedic]

I think it's stupid that we are certified to perform certain duties on the truck (IV, intubation, etc.), but we can't perform these duties in the ED because LPNs can't do them.

LVNs at least have a minimal education requirement of a 1 year certificate. However, that is a poor comparison because the LVN can do many things a Paramedic is not educated or trained for also.

The inconsistencies in Paramedic education starting with a 500 hour or 13 week medic mill wonder who might work for an agency that rarely intubates and has little medical oversight, it makes even calling the paramedics a scary thought in some areas. Some ALS services are not doing ETI either but rather they are carrying the King and the hospitals are doing the intubations.

The other reason is that EMS wrote their own statutes declaring their certicate or license as PREHOSPITAL only. So, the hospitals are not entirely the decision makers on that issue. EMS just wanted to be "different" and shot themselves in both feet in many ways.

What's even dumber, when one of the ED docs has to RSI and respiratory and anesthesia aren't available, who do they call? Yep, that's right, EMS!

It is tragic that your hospital can not maintain competent staff for intubation. It sounds like it may need further investisgation and a possible citation by the state and other accrediting agencies to get it to become compliant with what it needs to provide competent and safe emergency services. If you want to PM me I can give you a list of agencies to contact concerning this situation which should not be tolerated. I definitely have the number to address the lacking Respiratory services and issues with RSI information that have already been addressed in other hospitals that tried to bluff their way through the accreditation and creditialing. Of course, you will have to disclose incidents with accurate information but it can get them into the deep do-do they deserve.

[spenac]

It is tragic that your hospital can not maintain competent staff for intubation. It sounds like it may need further investisgation and a possible citation by the state and other accrediting agencies to get it to become compliant with what it needs to provide competent and safe emergency services. If you want to PM me I can give you a list of agencies to contact concerning this situation which should not be tolerated. I definitely have the number to address the lacking Respiratory services and issues with RSI information that have already been addressed in other hospitals that tried to bluff their way through the accreditation and creditialing. Of course, you will have to disclose incidents with accurate information but it can get them into the deep do-do they deserve.

Umm yup and get a medic fired or slowly pushed out. Small town politics are tough. If the EMS crews are doing a good job intubating the patient is not being harmed. So if you are ready to move report, if not be prepared for a job change. But even with your statement I have known of some darn good doctors and respiratory techs that would ask certain EMS people for help on difficult intubations because they had a rep of being able to get the hard one with less trauma to the patients, if they were handy. So even if our education sucks some actually do have the skills, those also though usually have gotten educated.

[VentMedic]

Umm yup and get a medic fired or slowly pushed out. Small town politics are tough. If the EMS crews are doing a good job intubating the patient is not being harmed. So if you are ready to move report, if not be prepared for a job change. But even with your statement I have known of some darn good doctors and respiratory techs that would ask certain EMS people for help on difficult intubations because they had a rep of being able to get the hard one with less trauma to the patients, if they were handy. So even if our education sucks some actually do have the skills, those also though usually have gotten educated.

We had a local little hospital that called for EMS to clean up their messes and eventually landed them into an expensive legal situation after the hospital filed the required sentinel event paperwork when things went very bad. The investigation went deep into what paperwork the Paramedics were doing since it became known that some would just pop over, tube and leave without filling out a report especially if they were near the ED. The big trouble came when the ED physician listed himself as the intubator and the Paramedics knew this because they didn't want to do a run report.

If this happens once a year, that might be acceptable if the proper paperwork is done with no fudging on who did the actual procedure. However, if a hospital continuously fails to meet minimumally accepted practice standards, they should face the consequences from the appropriate agencies.

[spenac]

We had a local little hospital that called for EMS to clean up their messes and eventually landed them into an expensive legal situation after the hospital filed the required sentinel event paperwork when things went very bad. The investigation went deep into what paperwork the Paramedics were doing since it became known that some would just pop over, tube and leave without filling out a report especially if they were near the ED. The big trouble came when the ED physician listed himself as the intubator and the Paramedics knew this because they didn't want to do a run report.

If this happens once a year, that might be acceptable if the proper paperwork is done with no fudging on who did the actual procedure. However, if a hospital continuously fails to meet minimumally accepted practice standards, they should face the consequences from the appropriate agencies.

That is stupidity to lie. They deserve it. When I have done an intubation even as a student the doctors and techs have documented my name. They deserve it for fraud. Most small towns in my area have one respiratory tech or higher. If they are not available or run into trouble they do ask us medics to attempt. In the paperwork I have seen it lists each person that made an attempt or that was successful. I hope no doctor, doctor of anesthesia, respiratory tech, medic, etc ever gets the attitude that they are the only one that can do the job. Sometimes it just needs another person to try. Not to brag I'm good. But I am also not stupid enough to think that I will never run into a patient I can not intubate yet someone else can.

[WolfmanHarris]

Heck I'm documented when I take vitals in hospital clinical and have to sign the ACR as 3rd crew when I rideout, even if I only observed.

[VentMedic]

That is stupidity to lie. They deserve it. When I have done an intubation even as a student the doctors and techs have documented my name.

But, what have you documented in case there is a question about the patient care later? You have just done an advanced invasive procedure. Are you going to rely on memory or the quality of another person's charting especially when it comes to airway assessment? You will be the one looking at the teeth and cords to know what abnormalities existed or trauma has already been inflicted.

Each believes the other is doing a courtesy and that includes the Paramedics for not wanting to do any extra documentation. Everything is great as long as everything goes well.

[spenac]

But, what have you documented in case there is a question about the patient care later? You have just done an advanced invasive procedure. Are you going to rely on memory or the quality of another person's charting especially when it comes to airway assessment? You will be the one looking at the teeth and cords to know what abnormalities existed or trauma has already been inflicted.

Each believes the other is doing a courtesy and that includes the Paramedics for not wanting to do any extra documentation. Everything is great as long as everything goes well.

We're required to do a run report.

[firedoc5]

We had a round-table talk one time (actually we were playing cards). And one of the main things we talked about was when someone made Medic or were in EMS for let's just say 5 yrs. or more, instead of having to recertify every year for CPR, but have a "Life Time" card or something, or just be exempt from having to recert. How many vets are out there that's been doing CPR in the field, which is rarely like what is done in the classroom, have to go through the time and very boring and redundant class?

[WolfmanHarris]

What we need is to make the CPR recert more health care specific (and I don't mean AHA's or CRC or anyone's CPR-HCP) course such that it makes good CME. So rather than spending hours on the how boring everyone to death, spend the recert on the latest from ILCOR and the why. That would be a recert worth the few hours. Though I just sign my friend's card and he signs mine each year, since we're both instructors.