EMS working in small hospitals, long term care

[Chief1C]

The local hospital staffs two MICU's, during the day; and one at night. But there's always an extra medic on duty.. Often when they send a unit out to assist ambulances, rather than to actually transport, it's just a medic.. and someone from the ambo being assisted has to bring their unit back. The duty of that extra person is to register the ER patients; and assist with assessing, etc. of the ppl that walk into the ER. I guess I read this, as your system "maximizing it's resources". Can't use the slang for EMS, Earn Money Sleeping, anymore.

[rock_shoes]

What you say is true, but even in Canada, don't paramedics still need to operate under a physician's license?

Well HERBIE, the best answer I can give you is “kind of.” The higher standard education levels aspire to the less direct liability is placed on the overseeing physician. One of the best examples I can give you is what’s currently taking place in BC where we are actually issued a license by a branch of the provincial government versus a registration by an independent body (ie. Alberta College of Paramedics). We do have directors of medical programs, however primary liability is placed on the individual provider. Additionally we have moved away from set protocols into “Treatment Guidelines” which, though a clear demonstration of trust from the medical staff, even further shifts responsibility to the individual provider. It’s become more of a “here are your meds, dosages, and procedures, do what’s best for your patient within that.” For lack of a better analogy it has become “this is your sandbox to play in” versus the old “this is what you will do in our sandbox.”

[tniuqs]

Well HERBIE, the best answer I can give you is “kind of.” The higher standard education levels aspire to the less direct liability is placed on the overseeing physician. One of the best examples I can give you is what’s currently taking place in BC where we are actually issued a license by a branch of the provincial government versus a registration by an independent body (ie. Alberta College of Paramedics).

We do have directors of medical programs, however primary liability is placed on the individual provider. Additionally we have moved away from set protocols into “Treatment Guidelines” which, though a clear demonstration of trust from the medical staff, even further shifts responsibility to the individual provider. It’s become more of a “here are your meds, dosages, and procedures, do what’s best for your patient within that.” For lack of a better analogy it has become “this is your sandbox to play in” versus the old “this is what you will do in our sandbox.”

RS: Do you still believe in this analogy ?

end rambling rant.

[rock_shoes]

RS: Do you still believe in this analogy ?

I do. The problem is that we are continuing to let others set the boundaries of our "sandbox" without sufficient input from the providers expected to play within it. Moving to "Treatment Guidelines" was a huge leap forward in BC after many years of remaining stagnant. We're just starting to come full circle in BC. From the days we set some of the highest standards to the more recent days where we've fallen behind. Now we're finally moving back in a positive direction. I have hope for my dear far left province yet.

[tniuqs]

Oddly enough Alberta has come full circle back to the term "Protocol" my dear tree hugging friend, these new improved EBM studies and analysis of meta studies done in tim buck 2 and of which have very little bearing at all on OUR population, in fact dummied down hugely to be laughable so contact OLMC when you don't even have cell service to patch for Toradol ... WTF Over?

In a perfect world (and back to the OP) where in scope of EMT and (I must agree with annie)EMTs are not "personal care assistants in long term care" in fact are not trained in geriatric medicine or even how to give granny safe bath (for the most part) put EMT to work in the "emergency room" (that's the E Part isn't it ? ) With clear rules of engagement, not at the whim of a RN, but how do they expect an EMT to work and be in 2 places at the same time as this is true lunacy of it all.

I do believe that EMS can become more of an integral part of Health Care but NO one turf war group especially a union, should have any influence on ones scope of practice as the glass in a window or the door is not a legal dividing line any more ... what so ever. Just speaking for this province, allowing NPs and PAs ACP's EMT's to practice (full scope) in Hospital certainly would improve care and be far more cost effective overall, will that happen well not with this {PC government it will not)IMHO.

YES it is our sandbox so then why are we letting others dictate ?

Most Honestly this all falls back to what Dust had said so many, many times we in EMS would have arguments on how to organise a blow job in a whore house.

cheers

Edited December 29, 2010 by tniuqs

[mattmattmattmatt]

How is it that a paramedics scope of practice is larger than that of a registered nurse? Did i read that correctly somewhere?

(this is my first post, and i really just want to get inside the chatroom)

[tniuqs]

Welcome:

Stuttering can be cured you know !

Define "larger"

[Siffaliss]

Oh RumFiend, you know. I assume (yeah, I'm an ass) that he would be referring to our standing orders and capabilities. RN's cannot intubate, etc and need physician approval for pretty much everything. We can intubate, give narcs, suture, so on and so forth without having to see if Simon Says ...

[zippyRN]

Oh RumFiend, you know. I assume (yeah, I'm an ass) that he would be referring to our standing orders and capabilities. RN's cannot intubate, etc and need physician approval for pretty much everything. We can intubate, give narcs, suture, so on and so forth without having to see if Simon Says ...

oh dear oh dear oh dear ...

it'd would be funny if it wasn't showing the ignorance of individuals

from a UK perspective there is only one thing an 'ordinary' RN cannot DO that a paramedic can do and that is give IV morphine without an existing prescription. Every other Paramedic intervention requires either a small piece of administrative work ( e.g. Patient group directives for medications) or simply proof of competency - e.g. peripheral IV cannulation

Similarly for a Paramedic to do everything an RN does again requires proof of competency and various small pieces of administrative work, however there are a substantially larger list of things a paramedic would have to demonstrate to be able to do everything an RN can.

perhaps if those who are fond of saying 'Nurses can't do X, Y or Z' were to do a little bit of research they might find that aside from legislation surrounding medication , most of these prohibitions are nothing more than organisational policy or 'widely held truths' without a basis in regualtion or legislatiion.

[tniuqs]

zippy RN

Canada vs UK .. 2 completely different sets of rules of engagement .

cheers

Edited November 21, 2011 by tniuqs